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Mental Health 2024 - JF > Chapter 4: Psychopharmacology > Flashcards

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

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2
Q

Phenothiazine is a type of anti________

A

antipsychotic

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3
Q

In early 20th century France, _________ had been use as a preoperative medication.

A

phenothiazine

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4
Q

Historically, reaction and treatment of individuals with mental illness ranged from benign to __________________

A

fear, inhumane, demonic, loathsome, mistreatment.

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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

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6
Q

Before 1950, __________ and _____________ were the only significant psychotropic medications available

A

amphetamines, sedatives

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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.

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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

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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.

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10
Q

Why is a thorough initial assessment important before a patient begins psychopharmacological therapy.

A

Set patient’s baseline.

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11
Q

Why is an ethnocultural assessment necessary?

A

Genetic variations in select populations may influence response to some medications

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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.

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13
Q

What is continuously monitored after administering a psychotropic medication?

A

side effects, adverse events, therapeutic effectiveness

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14
Q

Why must a nurse be familiar with psychotropic medications?

A

to anticipate potential problems and outcomes associated with medication

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15
Q

What is the nurse responsible for while teaching to the patient?

A
  1. Why the med has been prescribed
  2. When it should be taken
  3. What possible side effects and adverse reactions could occur
  4. Whom to contact with questions/concerns
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16
Q

in 2015, the FDA required that drug labeling includes more specific information on _________

A

pregnancy-associated risks

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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.

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18
Q

What is a receptor?

A

Molecules situated on the cell membrane that are binding sites for neurotransmitters

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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

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20
Q

Researchers hypothesize that most antidepressants work by __________________

A

blocking the reuptake of neurotransmitters, specifically SEROTOTONIN AND NOREPINEPHRINE.

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21
Q

Researchers hypothesize that most antidepressants work by blocking the reuptake of neurotransmitters, specifically ________ & ______

A

serotonin and norepinephrine

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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.

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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

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24
Q

SSRIs action on neurotransmitter and/or receptor

A

inhibit reuptake of serotonin (5-HT)

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25
Q

SSRIs physiological effects

A

reduce depression
control anxiety
control obsessions

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26
Q

SSRI side effects

A

nausea
agitation
headache
sexual dysfunction

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27
Q

SSRI examples

A

citalopram (Cipramil)
dapoxetine (Priligy)
escitalopram (Cipralex)
fluoxetine (Prozac or Oxactin)
fluvoxamine (Faverin)
paroxetine (Seroxat)
sertraline (Lustral)
vortioxetine (Brintellix)

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28
Q

Tricyclic antidepressants action on neurotransmitter and/or receptor

A

inhibit reuptake of serotonin
inhibit reuptake of norepinephrine

Block norepinephrine receptor
Block ACh receptor
Block histamine receptor

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29
Q

tricyclic antidepressants physiological effects

A

reduce depression
relief of severe pain
prevent panic attacks

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30
Q

tricyclic antidepressants side effects

A

sexual dysfunction
sedation
weight gain
dry mouth
constipation
blurred vision
urinary retention
postural hypotension and tachycardia

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31
Q

MAO inhibitors action on neurotransmitter and/or receptor

A

Increase norepinephrine and serotonin by inhibiting the enzyme that degrades them (MAO-A)

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32
Q

MAO inhibitors physiological effects

A

reduce depression
control anxiety

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33
Q

MAO inhibitors side effects

A

sedation
dizziness
sexual dysfunction
hypertensive crisis (interaction with tyramine)

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34
Q

Trazodone and nefazodone action on neurotransmitter and/or receptor

A

5-HT reuptake block 5-HT2 receptor antagonism
adrenergic receptor blockage

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35
Q

Trazodone and nefazodone physiological effects

A

reduce depression
reduce anxiety

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36
Q

Trazodone and nefazodone side effects

A

nausea
sedation
orthostasis
priapism

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37
Q

SNRI: venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran action on neurotransmitter and/or receptor

A

potent inhibitors of serotonin and norepinephrine and reuptake
weak inhibitors of dopamine reuptake

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38
Q

SNRI physiological effects

A

reduce depression
relieve pain of neuropathy (duloxetine)
relieve anxiety (venlafaxine)

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39
Q

SNRI side effects

A

nausea
increased sweating
insomnia
tremors
sexual dysfunction

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40
Q

Bupropion action on neurotransmitters and/or receptor

A

inhibits reuptake of norepinephrine and dopamine

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41
Q

Bupropion physiological effects

A

reduces depression
aids in smoking cessation
decreases symtoms of ADHD

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42
Q

Antipsychotics: phenothiazines and haloperidol physiological effects

A

relief of psychosis
relief of anxiety
(some) provide relief from nausea and vomiting and intractable hiccoughs

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43
Q

antipsychotics: phenothiazine and haloperidol side effects

A

blurred vision, dry mouth, decreased sweating, constipation, urinary retention, tachycardia, sedation, weight gain, ejaculatory difficulty

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44
Q

Antipsychotics (SECOND generation, ATYPICAL):
aripoprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone action on neurotransmitter

A

receptor antagonism of serotonin and dopamine

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45
Q

Second generation antipsychotics, atypical physiological effects

A

relief of psychosis
relief of anxiety
relief of acute mania

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46
Q

Second generation antipsychotics, atypical side effects

A

sedation, weight gain, diabetes, orthostasis, dizziness, blurred vision, dry mouth,

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47
Q

antianxiety: benzodiazepines action on neurotransmitter and/or receptor sites

A

Bind to BZ receptor sites on the GABA receptor complex; increase receptor affinity for GABA

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48
Q

antianxiety: benzodiazepines physiological effects

A

relief of anxiety
sedationa

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49
Q

antianxiety: benzodiazepines side effects

A

dependence
confusion
memory impairment
motor incoordination

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50
Q

antianxiety: busprione action on neurotransmitter

A

serotonin agonist
dopamine agonist
dopamine antagonist

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51
Q

antianxiety: busprione physiological effects

A

relief of anxietya

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52
Q

antianxiety: busprione side effects

A

nausea
headache
dizziness
restlessness

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53
Q

Although each psychotropic medication affects neurotransmission, the specific drugs within each class have varying neuronal effects. Their exact ____________ are unknown

A

mechanisms of action

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54
Q

anxiety meds are also called

A

anxiolytics

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55
Q

what is an anxiolytic

A

another name for antianxiety medicaion

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56
Q

Anxiolytics can treat

A

anxiety, acute alcohol withdrawl, skeletal muscle spasms, convulsive disorders, preoperative sedation

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57
Q

True or false: anxiolytics are used for long term treatment of anxiety

A

False
They are most appropriate for acute anxiety states rather than long-term
For longer term management a patient may be prescribed antidepressants

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58
Q

Antianxiety meds depress subcortical levels of the ____________

A

Central nervous system, particularly the limbic system and reticular formation

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59
Q

The most commonly prescribed antianxiety agents are

A

benzodiazepines:
- clonazepam (Klonopin)
- diazepam (valium)
- alprazolam (xanax)

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60
Q

Benzodiazepines are much like ________ in their effects on GABA receptors

A

alcohol

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61
Q

How is buspirone (BuSpar) to treat anxiety different than benzodiazepines?

A
  • 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
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62
Q

what are some nursing diagnoses we can apply for patients receiving antianxiety agents?

A

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

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63
Q

What are some criteria that may be used to evaluate effectiveness of therapy with antidepressant medications?

A
  • 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
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64
Q

What was the “first” antidepressant drug and what was it originally used to treat?

A

monoamine oxidase inhibitor (MAOI) isoniazid

tuberculosis

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65
Q

MAOIs are associated with potentially deadly side effects in those who ate foods high in ______

A

tyramine; aged cheeses, red wine, raisins, salami

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66
Q

Indications for SSRI therapy includes

A

depression, bulimia, borderline personality disorder, obesity, smoking cessation

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67
Q

Despite the mechanisms of action antidepressants use is theoretical, what we do know is __________

A

these drugs ultimately work to increase the concentration of norepinephrine, serotonin, and/or dopamine

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68
Q

How are (TCA, tetracyclics, SSRIs, and SSRIs) antidepressants able to increase the concentration of neurotransmitters: norepinephrine, serotonin, dopamine?

A

these drugs BLOCK the reuptake of these neurotransmitters by neurons

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69
Q

How are MAO antidepressants able to increase the concentration of norepinephrine, serotonin, and dopamine?

A

when the enzyme monoamine oxidase (which is known to inactivate NE, S, D) is INHIBITED at various sites in the nervous system

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70
Q

What are some more nursing diagnoses for patients receiving therapy with antidepressants

A
  • 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

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71
Q

Some individuals taking SSRI or SNRIs complain of __________ dysfunction
Men may report ________ ejaculation or __________
and women may report loss of __________.

Why is this alarming?

A

sexual; abnormal; impotence; orgasm

patients may stops medications ABRUPTLY

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72
Q

what is priapism

A

Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation.

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73
Q

what is a hypertensive crisis?

A

a sudden, severe INCREASE in blood pressure

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74
Q

for many years, the drug of choice for bipolar mania was _____ ________

A

lithium carbonate

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75
Q

In recent years, several other medications have demonstrated effectiveness either alone or in combination with lithium most notably _______________

A

some anticonvulsant meds

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76
Q

what is neuroleptic malignant syndrome

A

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.

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77
Q

Bipolar dis is characterized by ______ of depression and ________ episodes

A

cycles; manic

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78
Q

How do manic episodes manifest?

A

grandiose thinking, rapid thoughts. hyperactivity, impulsive agitation

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79
Q

Many may describe living with bipolar as _________________

A

“riding a rollercoaster”
cycles of ups and downs

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80
Q

Lithium is a _____ present in mineral springs and added to relaxing spa baths

A

salt

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81
Q

Lithium is therapeutically classified as a

A

mood stabilizer

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82
Q

Although lithium is not a cure for _________ ________ it is often described as “like insulin for a diabetic”

A

bipolar disorder

**not everyone responds this way, lithium can be fatal

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83
Q

What is the therapeutic range for lithium

A

0.6-1.2mEq/L

MEMORIZE FOR EVER AND EVER

84
Q

What is lithium’s mechanisim of action?

A

unknown; believed to have impact on neurotransmitters NE, gluamate, GABA, dopamine

85
Q

In 1995, the FDA approved __________ as a mood stabilizer; since then there has been a shift towards ___________ and __________ instead of lithium

A

valproate (Depakote)
anticonvulsant
moodstabilizers

86
Q

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?

A

sodium

MAINTAIN their usual dietary sodium and fluid intake

87
Q

some clients complain that they miss the _____feeling of being in a ______ or hypomanic state once they begin mood stabilizers

why is this concerning?

A

high; manic

they may be at risk for self adjusting meds or stopping all together

88
Q

Another undesirable side affect of LIthium

A

weight gain

89
Q

antipsychotic medications are also called

A

neuroleptics

90
Q

what is a neurolepic?

A

an antipsychotic

91
Q

what are extrapyramidal side effects?

A

involuntary, uncontrollable movements

92
Q

antipsychotics can cause _____________ side effects characterized by involuntary, uncontrollable movements

A

extrapyramidal

93
Q

what is tardive dyskinesias

A

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
Q

what condition is characterized by later-onset involuntary movements primarily in the lips, tongue, and jaw?

A

tardive dyskinesias

95
Q

Second generation antipsychotic meds have since been developed that have less potential for _____________

A

EPS extrapyramidal side effects

96
Q

which group of drugs is used to alleviate the positive symptoms of schizophrenia

A

second generation antipsychotics

97
Q

what are considered the positive symptoms of schizophrenia?

(from the book, why does the book call these positive symptoms?)

A

hallucinations, delusions, agitation

98
Q

Which atypical antipsychotic has been described as a third generation antipsychotic?

A

aripiprazole (Abilify)

99
Q

How is aripiprazole (Abilify) unique?

A

has a unique functional profile with dopamine receptors, and minimal risk for EPS!

100
Q

Name a typical antipsychotic

A

phenothiazines (the ogs)
haloperidol
thiothizene
etc

101
Q

name a atypical antipsychotic

A

aripiprazole
clozapine
quetiapine
risperidone

102
Q

How do typical anitpsychotics work

A

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
Q

how do atypical antipsychotics work?

A

atypical antipsychotics are weaker dopamine receptor antagonists, but they are more potent antagonists of serotonin type 2A receptors

104
Q

antipsychotics are NOT approved for treatment of __________________ patients

A

elderly patients with neurocognitive disorder related psychosis

105
Q

What is agranulocytosis

A

potentially fatal blood disorder in which the patients absolute neutrophil count drop to extremely low levels, this condition is called neuropenia.

106
Q

Which drug poses a rick for agranulocytosis

A

clozapine (Clozaril) an atypical antipsychotic

107
Q

How is clozapine monitored?

A

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
Q

what is pseudoparkinsonism

A

EPS antipsychotics

tremor, shuffling gait, drooling, rigidity;

109
Q

what is akinesia

A

EPS antipsychotics

absence or impairment of voluntary movement

110
Q

what is akathisia

A

EPS antipsychotics

continuous restlessness or fidgeting

111
Q

what is dystonia

A

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
Q

what is oculogyric crisis

A

EPS antipsychotics

uncontrolled rolling back of the eyes

Emergency situation

113
Q

what is tardive dyskinesia

A

EPS antipsychotics

later-onset characterized by bizarre facial and tongue movements, stiff neck, difficulty swallowing
more common in first gen antipsychotics

114
Q

what is the AIMS test?

A

The Abnormal Involuntary Movement Scale; aids in early detection of movement disorders and provides a means for ongoing surveillance

115
Q

what is retrograde ejaculation?

A

the discharge of seminal fluid into the bladder rather than through the urethra

116
Q

what is gynecomastia

A

overdevelopment of breast tissue in male

117
Q

what is amenorrhea galactorrhea

A

rare, abnormal production of breast milk, absense of regular period

118
Q

What are some things we can teach the patient when using medication for ADHD

A

use caution when driving
do not stop taking meds abruptly
avoid taking meds late in day
avoid caffeine

119
Q

what is the most commonly used group of drugs to treat anxiety

A

benzodiazepines

120
Q

Abrupt cessation of benzos can cause _________

A

withdrawal

121
Q

Benzos are antianxiety agents, their most common side effects include

A

drowsiness, confusion, lethargy

122
Q

Antidepressants elevate mood, these drugs work to increase the concentration of __________ and ____________ in the body

A

serotonin, norepinephrine (NE)

123
Q

Another group of antidepressants inhibits _______ and enzyme that is known to inactivate norepinephrine and serotonin. they are called ____

A

MAO; MAOI (MAO inhibitors)

124
Q

This category of antidepressants blocks the neuronal reuptake of serotonin and has minimal/no effect on reuptake of NE or D

A

SSRI (selectvie serotonin reuptake inhibitors)

125
Q

SSRIs blocks the neuronal reuptake of

A

serotonin

126
Q

Antidepressants can take ___________ to produce full therapeutic effects

A

4 weeks

127
Q

What are the most common side effects of antidepressants

A

anticholinergic effects such as orthostatic hypotension and sedation, they can also reduce seizure threshold

128
Q

Lithium carbonate is widely used as a

A

mood stabilizing agent

129
Q

several other meds are used as mood stabilizers, two groups include

A

anticonvulsants and verapamil( a calcium channel blocker)

130
Q

why are neurotransmiters important

A

essential in human emotion and developmentwh

131
Q

which neurotransmitters are implicated in psychiatry

A

cholinergics
monoamines
amino acids
neuropeptides

132
Q

what is adrenaline?

A

“fight or flight”
neurotransmitter
produced in stressful situations, increases heart rate and blood flow, leading to physical boost and heightened awareness

133
Q

what is GABA

A

“calming”
neurotransmitter
calms firing nerves in CNS, high levels improve focus, low levels cause anxiety, also contributes to motor control and vision

134
Q

what is acetylcholine

A

“learning”
neruotransmitter
involved in thought, learning nad memory, activates muscle action, attention, awakening

135
Q

what is dopamine

A

“pleasure”
neuro transmitter
feelings of pleasure, addiction, movement, movtivaiton
people repeat behaviors that lead to dopamine release

136
Q

what is serotonin

A

“mood”
neurotransmitter
contributes to well-being happiness, helps sleep cycle, digestion, affected by light exposure and exercise

137
Q

what are endorphins

A

“euphoria”
neurotransmitter
released during exercise, sex, excitement, reduces pain

138
Q

what is noradrenaline

A

“conocentration”
neurotransmitter
affects attention and responding actions in the brain, contracts blood vessels, increasing blood flow

139
Q

what are some anticholinergic side effects?

A

dry mouth
constipation
urinary hesitancy/retention
blurred vision
photophobia
nasal congestion
sedation

140
Q

what are two FDA-approved drugs used to treat tardive dyskinesia

A

austedo (deutrabenazine)

ingrezza
(valbenazine)

141
Q

what is serotonin syndrome

A

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
Q

what is the expected action of typical antipsychotics

A

blockage of dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery

143
Q

typical antipsychotic drug adverse effects

A

-EPS
-orthostatic hypotension
-sedation
-neuroendocrine effects (gynecomastia, galactorrhea, menstral irregularities)
-sexual dysfunction
-agranulocytosis
-neuroleptic malignant syndrome
-anticholinergic effects
-photosensitivity, contact dermititis

144
Q

what is neuroleptic malignant syndrome

A

adverse effect of antipsychotic: sudden high fever, bp fluctuations,dysrhythmias, muscle rigidity, changes in LOC, coma

145
Q

what are some advantages of atypical antipsychotics?

A
  • 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
Q

atypical antipsychotic drug adverse effects

A
  • new onset diabetes or loss of glucose control
  • weight gain
  • hypercholesterolemia
  • orthostatic hypotension
  • anticholinergic effects
  • mild EPS effects
  • agranulocytosis
147
Q

which drug has the lowest therapeutic index of all psychiatric drugs

A

lithium
0.6-1.2 mEq/L

148
Q

Mood Stabilizers, specifically anticonvulsants expected action is

A

potentiating the inhibitory effects of GABA

149
Q

What is the expected action of tricyclic antidepressants?

A

block the reuptake of NE and serotonin in the synaptic space

150
Q

Bupropion, an atypical antidepressant inhibits which neurotransmitter

A

dopamine

151
Q

what is the expected action of stimulants?

A

raise levels of norepinephrine, serotonin, and dopamine into the CNS

152
Q

Mnemonic “Lithiums”: side effects

A

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
Q
A
154
Q

Kaplan loves to test on _________

A

psychopharmachology

155
Q

what does psychotropic mean?

A

adjective; relating to drugs that affect a person’s mental state

156
Q

what is the most common compliance issue for patients and their meds

A

they start feeling better and think they can stop taking medication!!!!

157
Q

True or false: it’s important to start elderly or very young patients “low and slow” on psych meds

why or why not?

A

true;

versus “average” patient - metabolism is less effective/renal/hepatic functioning may be less efficient/ etc

158
Q

most psychotropic meds have their effects at the _________ synapse, producing changes in ____________ release and the receptors to which they bind

A

neuronal; neurotransmitter

159
Q
A
160
Q

what is acetylcholine? what does are its functions?

A

a neurotransmitter;
plays a role in memory, learning, attention, arousal, involuntary muscle movement

161
Q

antipsychotic meds block _______ receptors

A

dopamine

162
Q

atypical/2nd generation antipsychotics focus primarily on blocking specific _______receptors

A

serotonin

163
Q

Benzodiazepines facilitate the transmission of the inhibitory effects of _______

A

GABA

164
Q

Psychostimulants work by increasing ____,______,_______ release

A

norepinephrine, serotonin, dopamine

165
Q

True of false: the exact mechanisim of actions for psychotropic medications is known

A

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
Q

true or false; long term use of antianxiety meds is recommended

A

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
Q

antianxiety meds depress subcortical levels of the ________system, particularly the _______ and ________formation

A

central nervous
limbic
reticular

168
Q

the most commonly prescribed anti anxiety agents are

A

benzodiazepins

169
Q

benzodiazepines are much like ________ in their effects on GABA receptors, which explains why they are used for management of ______withdrawal

A

alcohol;alcohol

170
Q

The antianxiety agent buspirone (Buspar) is unique in that it does NOT depress the ___________system

A

central nervous

171
Q

The “first” antidepressant drug was the _______ which was initially used to treat tuburculosis

A

MAOI, monoamine oxidase inhibtior

172
Q

MAOI are great and all, but they are associated with potentially deadly side effects in patients who ate foods high in _________

A

tyramine

173
Q

Because MAOIs have dangerous side effects and need food restrictions, scientists developed _______

A

tricyclics

174
Q

However tricyclics kinda suck and only work in 70% of patient, they also have anti_________ effects, which limits prescription to the elderly

A

anticholinergic

175
Q

what the hell is an “anticholinergic effect”?

A

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
Q

in the late 1980s, ____________, an antianxiety hormone and neurotransmitter was identified as a potentional target for treatment of depression

A

serotonin

177
Q

Second generation antidepressents _______ and _______ are the preferred first line treatment for depression

A

SSRI AND SNRI

178
Q

true or false; levels of neurotransmitters in the brain can be directly measured

A

false; that is why our understanding of exact mechanisms of action are theoretical

179
Q

antidepressants ultimately work to increase the concentraion of ________, ______, and _______

A

norepinephrine serotonin, and dopamine

180
Q

MAOIs inhibited the action of the monoamine oxidase ________, which is known to inactivate norepinephrine, serotonin, and dopamine

A

enzyme

181
Q

ALL antidepressants carry an FDA black box warning for increased risk of _____________ in children and adolescents

A

suicidality

182
Q

as antidepressants begin to take effect, the individual may have increased energy with which to implement a _________plan

A

suicide

183
Q

For many years the drug treatment of choice for bipolar mania was _________

A

lithium carbonate

184
Q

however in recent years several other medications have demonstrated effectiveness in treating bp, such as __________ and ___________

A

anticonvulsants and atypical antipsychotics

185
Q

Because lithium has a lag period of 7 to 10 days, first generation __________ such as haloperidol may be helpful for immediate relief

A

antipsychotics

186
Q

monitoring lithium levels is crucial for patient safety, serum lithium levels should be checked ___________

A

once or twice weekly after initial treatment until dosage and serum levels are stable, then monthly during maintanence therapy

187
Q

another generally undesirable side effect of lithium is _________

A

weight gain

188
Q

first generation antipsychotics are associated with __________ side effects

A

extrapyramidal

189
Q

what are extrapyramidal side effects

A

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
Q

what is acute dystonia

A

muscle spasms, contractions

191
Q

what is dyskinesia

A

uncontrolled shakes, tics, tremors

192
Q

what is tardive dyskinesias

A

bizzare tongue movements, twitching of jaw, mouth, lips

193
Q

Second generation antipsychotics were developed to have less potential for _____________ side effects

A

extrapyramidal

194
Q

second generation antipsychotics are used to alleviate _________symptoms of schizophrenia and treat some __________symptoms as well

A

positive;negative

195
Q

what is a positive symptoms of schizophrenia

A

hallucinations, delusions, hyperactivity

196
Q

what is a negative symptom of schizophrenia

A

withdrawal, apathy, lethargy

197
Q

_______ has been described as a 3rd generation antipsychotic because of its unique funtional profile with dopamine and minimal risk for EPS

A

abilify

198
Q

typical (1st generation) antipsychotics work by blocking _______receptors

A

dopamine

199
Q

atypical (2nd generation) antipsychotics are weaker __________ receptor antagonists than the 1st generation/typical psychotics

A

dopamine

200
Q

true or false: alcohol is a great idea to drink while on antipsychotics

A

false; alcohol and antipsychotics potentiate each others effects

201
Q

Some antipsychotics, because of risks associated with their use are required to be monitored EXTREMELY closely, __________ is one such drug

A

Clozapine (Clozaril)

202
Q

Clozapine (Clozaril) has a risk of the patient developing ____________

A

agranulocytosis

203
Q

agranulocyosis is _________

A

a potentially fatal blood disorder in which teh patient’s absolute neutrophil count drops to extremely low levels - this condition is called neutropenia.

204
Q

Initially only __________ of medication is dispensed at a time

A

1 week

205
Q

initially, ANC (absolute neutrophil count) must be assessed ________ for the first 6 months of treatment, then monthly thereafter

A

biweekly

206
Q
A

Mental Health 2024 - JF (11 decks)

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