Chapter 4: Psychopharmacology Flashcards
Neurotransmitter, Psychotropic Medication, Receptor
1
Q
In the mid-20th century, what pivotal drug class was introduced in the US for the treatment of individuals with mental illness?
A
phenothiazine
2
Q
Phenothiazine is a type of anti________
A
antipsychotic
3
Q
In early 20th century France, _________ had been use as a preoperative medication.
A
phenothiazine
4
Q
Historically, reaction and treatment of individuals with mental illness ranged from benign to __________________
A
fear, inhumane, demonic, loathsome, mistreatment.
5
Q
In the early 20th century, we saw the use of some somatic therapies in psychiatry including __________________________
A
insulin shock, wet sheet packs, ice baths, electroconvulsive therapy, psychosurgery
6
Q
Before 1950, __________ and _____________ were the only significant psychotropic medications available
A
amphetamines, sedatives
7
Q
True or False: Psychotropic medications cure mental illness.
A
False!
Meds are used to relieve some psychiatric and behavioral symptoms.
Typically meds are used as an adjunct to therapy.
8
Q
Patient’s have a right to refuse medications; however the exceptions are…..
A
if a patient will hurt them selves or others
Keep in mind…
many states have laws that allow courts to order outpatient treatment
9
Q
What is “Kendra’s Law”?
A
A young woman, Kendra Webdale was pushed in front of a NYC subway by a man who was not seeking treatment for his mental illness.
Again many states have the legal authority to court order mental health treatment for a dangerous individual.
10
Q
Why is a thorough initial assessment important before a patient begins psychopharmacological therapy.
A
Set patient’s baseline.
11
Q
Why is an ethnocultural assessment necessary?
A
Genetic variations in select populations may influence response to some medications
12
Q
Which enzyme is tested for individuals at risk for being poor metabolizers of certain medications?
A
CYP450 isoenzyme variations
This enzyme influences metabolism of some medications.
13
Q
What is continuously monitored after administering a psychotropic medication?
A
side effects, adverse events, therapeutic effectiveness
14
Q
Why must a nurse be familiar with psychotropic medications?
A
to anticipate potential problems and outcomes associated with medication
15
Q
What is the nurse responsible for while teaching to the patient?
A
- Why the med has been prescribed
- When it should be taken
- What possible side effects and adverse reactions could occur
- Whom to contact with questions/concerns
16
Q
in 2015, the FDA required that drug labeling includes more specific information on _________
A
pregnancy-associated risks
17
Q
What is a neurotransmitter?
A
A chemical that is stored in the axon terminals of the presynaptic neuron. An electrical impulse through the neuron stimulates the release of the neurotransmitter into the synaptic cleft, which in turn determines whether another electrical impulse is generated.
18
Q
What is a receptor?
A
Molecules situated on the cell membrane that are binding sites for neurotransmitters
19
Q
Most psychotropic meds have their effects at the _________ _________, producing changes in ___________ release and the _________ to which they bind.
A
neuronal synapse; neurotransmitter; receptors
20
Q
Researchers hypothesize that most antidepressants work by __________________
A
blocking the reuptake of neurotransmitters, specifically SEROTOTONIN AND NOREPINEPHRINE.
21
Q
Researchers hypothesize that most antidepressants work by blocking the reuptake of neurotransmitters, specifically ________ & ______
A
serotonin and norepinephrine
22
Q
Reuptake is the process of what?
A
the process of neurotransmitter inactivation by which the neurotransmitter is reabsorbed into the presynaptic neuron from which it had been released.
Blocking the reuptake process therefore allows more of the neurotransmitter to be available for neurotransmission.
23
Q
However, some antidepressants also block receptor sites that are UNRELATED to their mechanism of action these receptors include_________________
What is the consequence of this
A
a-adrenergic, histaminergic, and muscarinic cholinergic receptors
side effects
24
Q
SSRIs action on neurotransmitter and/or receptor
A
inhibit reuptake of serotonin (5-HT)
25
SSRIs physiological effects
reduce depression
control anxiety
control obsessions
26
SSRI side effects
nausea
agitation
headache
sexual dysfunction
27
SSRI examples
citalopram (Cipramil)
dapoxetine (Priligy)
escitalopram (Cipralex)
fluoxetine (Prozac or Oxactin)
fluvoxamine (Faverin)
paroxetine (Seroxat)
sertraline (Lustral)
vortioxetine (Brintellix)
28
Tricyclic antidepressants action on neurotransmitter and/or receptor
inhibit reuptake of serotonin
inhibit reuptake of norepinephrine
Block norepinephrine receptor
Block ACh receptor
Block histamine receptor
29
tricyclic antidepressants physiological effects
reduce depression
relief of severe pain
prevent panic attacks
30
tricyclic antidepressants side effects
sexual dysfunction
sedation
weight gain
dry mouth
constipation
blurred vision
urinary retention
postural hypotension and tachycardia
31
MAO inhibitors action on neurotransmitter and/or receptor
Increase norepinephrine and serotonin by inhibiting the enzyme that degrades them (MAO-A)
32
MAO inhibitors physiological effects
reduce depression
control anxiety
33
MAO inhibitors side effects
sedation
dizziness
sexual dysfunction
hypertensive crisis (interaction with tyramine)
34
Trazodone and nefazodone action on neurotransmitter and/or receptor
5-HT reuptake block 5-HT2 receptor antagonism
adrenergic receptor blockage
35
Trazodone and nefazodone physiological effects
reduce depression
reduce anxiety
36
Trazodone and nefazodone side effects
nausea
sedation
orthostasis
priapism
37
SNRI: venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran action on neurotransmitter and/or receptor
potent inhibitors of serotonin and norepinephrine and reuptake
weak inhibitors of dopamine reuptake
38
SNRI physiological effects
reduce depression
relieve pain of neuropathy (duloxetine)
relieve anxiety (venlafaxine)
39
SNRI side effects
nausea
increased sweating
insomnia
tremors
sexual dysfunction
40
Bupropion action on neurotransmitters and/or receptor
inhibits reuptake of norepinephrine and dopamine
41
Bupropion physiological effects
reduces depression
aids in smoking cessation
decreases symtoms of ADHD
42
Antipsychotics: phenothiazines and haloperidol physiological effects
relief of psychosis
relief of anxiety
(some) provide relief from nausea and vomiting and intractable hiccoughs
43
antipsychotics: phenothiazine and haloperidol side effects
blurred vision, dry mouth, decreased sweating, constipation, urinary retention, tachycardia, sedation, weight gain, ejaculatory difficulty
44
Antipsychotics (SECOND generation, ATYPICAL):
aripoprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone action on neurotransmitter
receptor antagonism of serotonin and dopamine
45
Second generation antipsychotics, atypical physiological effects
relief of psychosis
relief of anxiety
relief of acute mania
46
Second generation antipsychotics, atypical side effects
sedation, weight gain, diabetes, orthostasis, dizziness, blurred vision, dry mouth,
47
antianxiety: benzodiazepines action on neurotransmitter and/or receptor sites
Bind to BZ receptor sites on the GABA receptor complex; increase receptor affinity for GABA
48
antianxiety: benzodiazepines physiological effects
relief of anxiety
sedationa
49
antianxiety: benzodiazepines side effects
dependence
confusion
memory impairment
motor incoordination
50
antianxiety: busprione action on neurotransmitter
serotonin agonist
dopamine agonist
dopamine antagonist
51
antianxiety: busprione physiological effects
relief of anxietya
52
antianxiety: busprione side effects
nausea
headache
dizziness
restlessness
53
Although each psychotropic medication affects neurotransmission, the specific drugs within each class have varying neuronal effects. Their exact ____________ are unknown
mechanisms of action
54
anxiety meds are also called
anxiolytics
55
what is an anxiolytic
another name for antianxiety medicaion
56
Anxiolytics can treat
anxiety, acute alcohol withdrawl, skeletal muscle spasms, convulsive disorders, preoperative sedation
57
True or false: anxiolytics are used for long term treatment of anxiety
False
They are most appropriate for acute anxiety states rather than long-term
For longer term management a patient may be prescribed antidepressants
58
Antianxiety meds depress subcortical levels of the ____________
Central nervous system, particularly the limbic system and reticular formation
59
The most commonly prescribed antianxiety agents are
benzodiazepines:
- clonazepam (Klonopin)
- diazepam (valium)
- alprazolam (xanax)
60
Benzodiazepines are much like ________ in their effects on GABA receptors
alcohol
61
How is buspirone (BuSpar) to treat anxiety different than benzodiazepines?
- NOT a benzodiazepine
- Does not depress the CNS
- Aciton is unknown, believed to interact with neurotransmitter receptors
- lag period 7 to 10 days, full therapeutic effect 3-4 weeks
- DOES NOT HAVE ADDICTION POTENTIAL
62
what are some nursing diagnoses we can apply for patients receiving antianxiety agents?
risk for injury related to seizures; panic anxiety; acute agitation from alcohol withdrawal; abrupt withdrawal from meds after long term use; effects of medication intoxication or overdose
63
What are some criteria that may be used to evaluate effectiveness of therapy with antidepressant medications?
- demonstrates reduction in anxiety
- is able to tolerate usual activities without excessive sedation
-exhibits no evidence of confusion
- verbalizes possible consequences of abrupt withdrawal from medicaion
64
What was the "first" antidepressant drug and what was it originally used to treat?
monoamine oxidase inhibitor (MAOI) isoniazid
tuberculosis
65
MAOIs are associated with potentially deadly side effects in those who ate foods high in ______
tyramine; aged cheeses, red wine, raisins, salami
66
Indications for SSRI therapy includes
depression, bulimia, borderline personality disorder, obesity, smoking cessation
67
Despite the mechanisms of action antidepressants use is theoretical, what we do know is __________
these drugs ultimately work to increase the concentration of norepinephrine, serotonin, and/or dopamine
68
How are (TCA, tetracyclics, SSRIs, and SSRIs) antidepressants able to increase the concentration of neurotransmitters: norepinephrine, serotonin, dopamine?
these drugs BLOCK the reuptake of these neurotransmitters by neurons
69
How are MAO antidepressants able to increase the concentration of norepinephrine, serotonin, and dopamine?
when the enzyme monoamine oxidase (which is known to inactivate NE, S, D) is INHIBITED at various sites in the nervous system
70
What are some more nursing diagnoses for patients receiving therapy with antidepressants
- risk for suicide r/t depressed mood
- risk for injury r/t side effects of sedation
- social isolation r/t depressed mood
- risk for constipation
- insomnia r/t depressed mood and elevated anxiety
pg72
71
Some individuals taking SSRI or SNRIs complain of __________ dysfunction
Men may report ________ ejaculation or __________
and women may report loss of __________.
Why is this alarming?
sexual; abnormal; impotence; orgasm
patients may stops medications ABRUPTLY
72
what is priapism
Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation.
73
what is a hypertensive crisis?
a sudden, severe INCREASE in blood pressure
74
for many years, the drug of choice for bipolar mania was _____ ________
lithium carbonate
75
In recent years, several other medications have demonstrated effectiveness either alone or in combination with lithium most notably _______________
some anticonvulsant meds
76
what is neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.
77
Bipolar dis is characterized by ______ of depression and ________ episodes
cycles; manic
78
How do manic episodes manifest?
grandiose thinking, rapid thoughts. hyperactivity, impulsive agitation
79
Many may describe living with bipolar as _________________
"riding a rollercoaster"
cycles of ups and downs
80
Lithium is a _____ present in mineral springs and added to relaxing spa baths
salt
81
Lithium is therapeutically classified as a
mood stabilizer
82
Although lithium is not a cure for _________ ________ it is often described as "like insulin for a diabetic"
bipolar disorder
**not everyone responds this way, lithium can be fatal
83
What is the therapeutic range for lithium
0.6-1.2mEq/L
MEMORIZE FOR EVER AND EVER
84
What is lithium's mechanisim of action?
unknown; believed to have impact on neurotransmitters NE, gluamate, GABA, dopamine
85
In 1995, the FDA approved __________ as a mood stabilizer; since then there has been a shift towards ___________ and __________ instead of lithium
valproate (Depakote)
anticonvulsant
moodstabilizers
86
Lithium is an imperfect substitute for ________, anything that depletes ________ will make more receptor sites available to lithium and increase risk for lithium toxicity
What are patients told to do about their diet?
sodium
MAINTAIN their usual dietary sodium and fluid intake
87
some clients complain that they miss the _____feeling of being in a ______ or hypomanic state once they begin mood stabilizers
why is this concerning?
high; manic
they may be at risk for self adjusting meds or stopping all together
88
Another undesirable side affect of LIthium
weight gain
89
antipsychotic medications are also called
neuroleptics
90
what is a neurolepic?
an antipsychotic
91
what are extrapyramidal side effects?
involuntary, uncontrollable movements
92
antipsychotics can cause _____________ side effects characterized by involuntary, uncontrollable movements
extrapyramidal
93
what is tardive dyskinesias
A condition affecting the nervous system, often caused by long-term use of first generation antipsychotics
later on-set involuntary movements primarily in jaw, tongue, lips
Tardive dyskinesia is caused by long-term use of neuroleptic drugs, which are used to treat psychiatric conditions.
Tardive dyskinesia causes repetitive, involuntary movements, such as grimacing and eye blinking.
94
what condition is characterized by later-onset involuntary movements primarily in the lips, tongue, and jaw?
tardive dyskinesias
95
Second generation antipsychotic meds have since been developed that have less potential for _____________
EPS extrapyramidal side effects
96
which group of drugs is used to alleviate the positive symptoms of schizophrenia
second generation antipsychotics
97
what are considered the positive symptoms of schizophrenia?
(from the book, why does the book call these positive symptoms?)
hallucinations, delusions, agitation
98
Which atypical antipsychotic has been described as a third generation antipsychotic?
aripiprazole (Abilify)
99
How is aripiprazole (Abilify) unique?
has a unique functional profile with dopamine receptors, and minimal risk for EPS!
100
Name a typical antipsychotic
phenothiazines (the ogs)
haloperidol
thiothizene
etc
101
name a atypical antipsychotic
aripiprazole
clozapine
quetiapine
risperidone
102
How do typical anitpsychotics work
blocking postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla
they also demonstrate varying affinity for cholinergic, alpha adrenergic, and histamine receptos
103
how do atypical antipsychotics work?
atypical antipsychotics are weaker dopamine receptor antagonists, but they are more potent antagonists of serotonin type 2A receptors
104
antipsychotics are NOT approved for treatment of __________________ patients
elderly patients with neurocognitive disorder related psychosis
105
What is agranulocytosis
potentially fatal blood disorder in which the patients absolute neutrophil count drop to extremely low levels, this condition is called neuropenia.
106
Which drug poses a rick for agranulocytosis
clozapine (Clozaril) an atypical antipsychotic
107
How is clozapine monitored?
a patient's absolute neutrophil count ANC must be assessed prior to treatment, weekly for the first 6 months. Initially only 1 week of medication is dispensed at a time
blood counts may be further monitored biweekly for another 6 months, then monthly after
108
what is pseudoparkinsonism
EPS antipsychotics
tremor, shuffling gait, drooling, rigidity;
109
what is akinesia
EPS antipsychotics
absence or impairment of voluntary movement
110
what is akathisia
EPS antipsychotics
continuous restlessness or fidgeting
111
what is dystonia
EPS antpsychotics
involuntary muscle spasms in face, arms, legs, neck, occurs most often in men
if left untreated can progress to laryngospams and can be fatal
Emergency situation
112
what is oculogyric crisis
EPS antipsychotics
uncontrolled rolling back of the eyes
Emergency situation
113
what is tardive dyskinesia
EPS antipsychotics
later-onset characterized by bizarre facial and tongue movements, stiff neck, difficulty swallowing
more common in first gen antipsychotics
114
what is the AIMS test?
The Abnormal Involuntary Movement Scale; aids in early detection of movement disorders and provides a means for ongoing surveillance
115
what is retrograde ejaculation?
the discharge of seminal fluid into the bladder rather than through the urethra
116
what is gynecomastia
overdevelopment of breast tissue in male
117
what is amenorrhea galactorrhea
rare, abnormal production of breast milk, absense of regular period
118
What are some things we can teach the patient when using medication for ADHD
use caution when driving
do not stop taking meds abruptly
avoid taking meds late in day
avoid caffeine
119
what is the most commonly used group of drugs to treat anxiety
benzodiazepines
120
Abrupt cessation of benzos can cause _________
withdrawal
121
Benzos are antianxiety agents, their most common side effects include
drowsiness, confusion, lethargy
122
Antidepressants elevate mood, these drugs work to increase the concentration of __________ and ____________ in the body
serotonin, norepinephrine (NE)
123
Another group of antidepressants inhibits _______ and enzyme that is known to inactivate norepinephrine and serotonin. they are called ____
MAO; MAOI (MAO inhibitors)
124
This category of antidepressants blocks the neuronal reuptake of serotonin and has minimal/no effect on reuptake of NE or D
SSRI (selectvie serotonin reuptake inhibitors)
125
SSRIs blocks the neuronal reuptake of
serotonin
126
Antidepressants can take ___________ to produce full therapeutic effects
4 weeks
127
What are the most common side effects of antidepressants
anticholinergic effects such as orthostatic hypotension and sedation, they can also reduce seizure threshold
128
Lithium carbonate is widely used as a
mood stabilizing agent
129
several other meds are used as mood stabilizers, two groups include
anticonvulsants and verapamil( a calcium channel blocker)
130
why are neurotransmiters important
essential in human emotion and developmentwh
131
which neurotransmitters are implicated in psychiatry
cholinergics
monoamines
amino acids
neuropeptides
132
what is adrenaline?
"fight or flight"
neurotransmitter
produced in stressful situations, increases heart rate and blood flow, leading to physical boost and heightened awareness
133
what is GABA
"calming"
neurotransmitter
calms firing nerves in CNS, high levels improve focus, low levels cause anxiety, also contributes to motor control and vision
134
what is acetylcholine
"learning"
neruotransmitter
involved in thought, learning nad memory, activates muscle action, attention, awakening
135
what is dopamine
"pleasure"
neuro transmitter
feelings of pleasure, addiction, movement, movtivaiton
people repeat behaviors that lead to dopamine release
136
what is serotonin
"mood"
neurotransmitter
contributes to well-being happiness, helps sleep cycle, digestion, affected by light exposure and exercise
137
what are endorphins
"euphoria"
neurotransmitter
released during exercise, sex, excitement, reduces pain
138
what is noradrenaline
"conocentration"
neurotransmitter
affects attention and responding actions in the brain, contracts blood vessels, increasing blood flow
139
what are some anticholinergic side effects?
dry mouth
constipation
urinary hesitancy/retention
blurred vision
photophobia
nasal congestion
sedation
140
what are two FDA-approved drugs used to treat tardive dyskinesia
austedo (deutrabenazine)
ingrezza
(valbenazine)
141
what is serotonin syndrome
Serotonin syndrome, more aptly named serotonin toxicity, is a potentially fatal drug-induced condition caused by too much serotonin in synapses in the brain. Patients present with a combination of neuromuscular, autonomic, and mental status symptoms.
confusion, difficulty concentrating, agitation, fever
142
what is the expected action of typical antipsychotics
blockage of dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery
143
typical antipsychotic drug adverse effects
-EPS
-orthostatic hypotension
-sedation
-neuroendocrine effects (gynecomastia, galactorrhea, menstral irregularities)
-sexual dysfunction
-agranulocytosis
-neuroleptic malignant syndrome
-anticholinergic effects
-photosensitivity, contact dermititis
144
what is neuroleptic malignant syndrome
adverse effect of antipsychotic: sudden high fever, bp fluctuations,dysrhythmias, muscle rigidity, changes in LOC, coma
145
what are some advantages of atypical antipsychotics?
- relief of both pos and neg symptoms
- fewer EPS effects
- fewer anticholinergic effects
- decrease in affective symptoms (depression) and suicidal behavior
improvement in cognition
146
atypical antipsychotic drug adverse effects
- new onset diabetes or loss of glucose control
- weight gain
- hypercholesterolemia
- orthostatic hypotension
- anticholinergic effects
- mild EPS effects
- agranulocytosis
147
which drug has the lowest therapeutic index of all psychiatric drugs
lithium
0.6-1.2 mEq/L
148
Mood Stabilizers, specifically anticonvulsants expected action is
potentiating the inhibitory effects of GABA
149
What is the expected action of tricyclic antidepressants?
block the reuptake of NE and serotonin in the synaptic space
150
Bupropion, an atypical antidepressant inhibits which neurotransmitter
dopamine
151
what is the expected action of stimulants?
raise levels of norepinephrine, serotonin, and dopamine into the CNS
152
Mnemonic "Lithiums": side effects
L - levels - maintenance at 0.6-1.0 mEq/L
I - increased urination
T - thirsty tremors
H - hair thinning/hypothyroidism
I - interactions - some drugs can increase Li levels
U - upset stomach
M - muscle weakness
S - skin effects - acne/psoriasis
153
154
Kaplan loves to test on _________
psychopharmachology
155
what does psychotropic mean?
adjective; relating to drugs that affect a person's mental state
156
what is the most common compliance issue for patients and their meds
they start feeling better and think they can stop taking medication!!!!
157
True or false: it's important to start elderly or very young patients "low and slow" on psych meds
why or why not?
true;
versus "average" patient - metabolism is less effective/renal/hepatic functioning may be less efficient/ etc
158
most psychotropic meds have their effects at the _________ synapse, producing changes in ____________ release and the receptors to which they bind
neuronal; neurotransmitter
159
160
what is acetylcholine? what does are its functions?
a neurotransmitter;
plays a role in memory, learning, attention, arousal, involuntary muscle movement
161
antipsychotic meds block _______ receptors
dopamine
162
atypical/2nd generation antipsychotics focus primarily on blocking specific _______receptors
serotonin
163
Benzodiazepines facilitate the transmission of the inhibitory effects of _______
GABA
164
Psychostimulants work by increasing ____,______,_______ release
norepinephrine, serotonin, dopamine
165
True of false: the exact mechanisim of actions for psychotropic medications is known
false; unknown; acute alterations in neural function do not fully explain how these medications work
long-term neuropharmacological reactions to increased NE and S levels may better explain their MOA
166
true or false; long term use of antianxiety meds is recommended
mostly false/kinda true; most appropriate for treatment of acute anxiety rather than long term use;
for long term management antidepressants are typically used because they are not addicted
however there is an increased use of benzos in the older adult population despite known concerns
167
antianxiety meds depress subcortical levels of the ________system, particularly the _______ and ________formation
central nervous
limbic
reticular
168
the most commonly prescribed anti anxiety agents are
benzodiazepins
169
benzodiazepines are much like ________ in their effects on GABA receptors, which explains why they are used for management of ______withdrawal
alcohol;alcohol
170
The antianxiety agent buspirone (Buspar) is unique in that it does NOT depress the ___________system
central nervous
171
The "first" antidepressant drug was the _______ which was initially used to treat tuburculosis
MAOI, monoamine oxidase inhibtior
172
MAOI are great and all, but they are associated with potentially deadly side effects in patients who ate foods high in _________
tyramine
173
Because MAOIs have dangerous side effects and need food restrictions, scientists developed _______
tricyclics
174
However tricyclics kinda suck and only work in 70% of patient, they also have anti_________ effects, which limits prescription to the elderly
anticholinergic
175
what the hell is an "anticholinergic effect"?
anticholinergic medications (like some psychotropic meds) BLOCK and INHIBIT the neurotransmitter acetylcholine
acetylcholine plays a role in memory, learning, attention, arousal, involuntary muscle movement
therefore an anticholinergic effect manifest as dry mouth, constipation, blurred vision, etc
176
in the late 1980s, ____________, an antianxiety hormone and neurotransmitter was identified as a potentional target for treatment of depression
serotonin
177
Second generation antidepressents _______ and _______ are the preferred first line treatment for depression
SSRI AND SNRI
178
true or false; levels of neurotransmitters in the brain can be directly measured
false; that is why our understanding of exact mechanisms of action are theoretical
179
antidepressants ultimately work to increase the concentraion of ________, ______, and _______
norepinephrine serotonin, and dopamine
180
MAOIs inhibited the action of the monoamine oxidase ________, which is known to inactivate norepinephrine, serotonin, and dopamine
enzyme
181
ALL antidepressants carry an FDA black box warning for increased risk of _____________ in children and adolescents
suicidality
182
as antidepressants begin to take effect, the individual may have increased energy with which to implement a _________plan
suicide
183
For many years the drug treatment of choice for bipolar mania was _________
lithium carbonate
184
however in recent years several other medications have demonstrated effectiveness in treating bp, such as __________ and ___________
anticonvulsants and atypical antipsychotics
185
Because lithium has a lag period of 7 to 10 days, first generation __________ such as haloperidol may be helpful for immediate relief
antipsychotics
186
monitoring lithium levels is crucial for patient safety, serum lithium levels should be checked ___________
once or twice weekly after initial treatment until dosage and serum levels are stable, then monthly during maintanence therapy
187
another generally undesirable side effect of lithium is _________
weight gain
188
first generation antipsychotics are associated with __________ side effects
extrapyramidal
189
what are extrapyramidal side effects
first generation Antipsychotic medications may produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
190
what is acute dystonia
muscle spasms, contractions
191
what is dyskinesia
uncontrolled shakes, tics, tremors
192
what is tardive dyskinesias
bizzare tongue movements, twitching of jaw, mouth, lips
193
Second generation antipsychotics were developed to have less potential for _____________ side effects
extrapyramidal
194
second generation antipsychotics are used to alleviate _________symptoms of schizophrenia and treat some __________symptoms as well
positive;negative
195
what is a positive symptoms of schizophrenia
hallucinations, delusions, hyperactivity
196
what is a negative symptom of schizophrenia
withdrawal, apathy, lethargy
197
_______ has been described as a 3rd generation antipsychotic because of its unique funtional profile with dopamine and minimal risk for EPS
abilify
198
typical (1st generation) antipsychotics work by blocking _______receptors
dopamine
199
atypical (2nd generation) antipsychotics are weaker __________ receptor antagonists than the 1st generation/typical psychotics
dopamine
200
true or false: alcohol is a great idea to drink while on antipsychotics
false; alcohol and antipsychotics potentiate each others effects
201
Some antipsychotics, because of risks associated with their use are required to be monitored EXTREMELY closely, __________ is one such drug
Clozapine (Clozaril)
202
Clozapine (Clozaril) has a risk of the patient developing ____________
agranulocytosis
203
agranulocyosis is _________
a potentially fatal blood disorder in which teh patient's absolute neutrophil count drops to extremely low levels - this condition is called neutropenia.
204
Initially only __________ of medication is dispensed at a time
1 week
205
initially, ANC (absolute neutrophil count) must be assessed ________ for the first 6 months of treatment, then monthly thereafter
biweekly
206
