Chapter 4 - Psychotherapeutic Drugs Flashcards
Alteration in CNS function often results in an imbalance of neurotransmitters (too much, too little, not enough, too many receptors)
Medications are used to stimulate or depress NT effects
Medications can potentiate (increase activity of) or block NT activity
Dopamine, 5HT, NE, GABA (amino acid), Acetylcholine
Neurotransmitters
Lithium
Classification: Antimanic; mood stabilizer
Action: Alters sodium transport in nerve cells and muscle cells
Why Take It: Bipolar disorder; mania; migraines
Overexpression: Lithium toxicity, hyponatremia, SEIZURES, ATAXIA, DROWSINESS
Administration: PO; with food or milk after a meal; do not chew or crush; nurse needs to know that therapeutic window is very narrow 0.8-1.2
Follow Up: Experiencing mania still? (means not working),
Education: Maintain hydration and sodium; report diarrhea or fever; do not abruptly discontinue
Side Effects: drowsiness, nausea, headache, polyuria
Beta 1 Receptors
stimulated by E and NE
Inhibition:
“Selective Beta blocker” used to decrease HEART RATE and blood pressure
Medication example: Metoprolol to decrease heart rate and blood pressure
Stimulation:
Primarily stimulates heart with increased heart rate and contractility
Also causes kidneys to release renin
Medication example: Dobutamine to treat acute heart failure to increase cardiac output
Beta 2 Receptors
stimulated by E and NE
Inhibition: “Nonselective Beta Blockers” block Beta-1 and Beta-2 receptors so also cause bronchoconstriction
Medication example: Propranolol blocks Beta-1 and Beta-2 receptor so lowers blood pressure but inadvertently causes bronchoconstriction
Stimulation:
Primarily relax smooth muscle
Blood vessels: vasodilation
Lungs: bronchodilation
GI: decreased motility
Liver: glyconeogenesis
Uterus: relaxation
Medication example: Albuterol for bronchodilation
Alpha 1 Receptors
stimulated by E and NE
Stimulation:
Contract smooth muscle
CNS stimulation
Blood vessels: vasoconstriction to nonessential organs
GI: relax smooth muscle and decrease motility
Liver: glyconeogenesis
Bladder: contraction
Uterus: contraction
Pupils: dilation
Medication example: Pseudoephedrine to treat nasal congestion by vasoconstriction
Inhibition: Relax smooth muscle Vasodilation Bladder: Increase urine flow Medication example: Tamsulosin to improve urine flow
Alpha 2 Receptors
stimulated by E and NE
Stimulation:
Vasodilation
Medication Example: Clonidine to treat hypertension
Inhibition:
Not used clinically.
Associated with fight or flight response, increases metabolism, cognition,
Abnormal Levels:
- depression
- decreased alertness + interest
- palpitations -
- anxiety
- panic attacks
Norepinephrine
Associated with cognition and motor function/movement, pleasure/reward, mostly EXCITATORY
Abnormal Levels:
- ADHD
- paranoia
- schizophrenia
- increase= manic behaviour
Dopamine
Heavily involved in many bodily processes like mood, sleep, and digestion, and appetite
-increase = stabilize mood (we need it to settle and relax)
Abnormal Levels:
- disturbed sleep
- disturbed libido
- mood
- temperature regulation is off
Disorder Involvement:
- depression
- bipolar disorder
- anxiety
- body disorders
Serotonin (5HT)
GABA
Inhibitory neurotransmitter that assists with communication in the brain
- helps our mind when anxious by inhibiting
- increase in GABA meds = calm/inhibiting effect
Low/Abnormal Levels:
-anxiety, seizures, mania, impulse control
Glutamate
Excitatory neurotransmitter
Works with GABA to control other functions in the brain
Acetylcholine
cognition and muscle function
*should always be a balance of dopamine and Acetylcholine
Classification: antianxiety; benzodiazepine
Action: Potentiates (intensifies) GABA, an inhibitory neuron; sedates and relieves anxiety; reduces seizure activity
Why Take It: anxiety; sedation (anesthetic)
Overexpression: Respiratory depression, over sedation, drowsiness, sleep apnea
Administration: Oral, subcutaneous, IV, sublingual; short term use
Follow Up: How are you feeling, do you think it is helping, is it affecting daily life (sedation)
Education: Do not abruptly discontinue, short term use
*Flumazenil is antidote *Benzos are controlled substances
Lorazepam (Ativan)
Classification: Antidepressant; Selective Serotonin Reuptake Inhibitors (SSRIs)
Action: inhibits reuptake of serotonin so there is more in the synaptic cleft; decreases feelings of depression
Why take it: Depression, OCD, panic disorder, bulimia, PTSD
Overexpression: SUICIDALITY, hypersomnia, neuroleptic malignant syndrome (ie. fever, ataxia, muscle rigidity, Parkinsonian symptoms, resp. distress, dysarthria-slurred speech), SEROTONIN SYNDROME (ie. myoclonus, dystonia, diaphoresis, diarrhea, confusion, increased HR/BP, mydriasis)
Administration: PO; taper discontinuation, use caution with liver dysfunction, increased risk of suicidality
Follow Up: How are you feeling today? Do you think it is helping? Any suicidal thoughts?
Education: taper, may take 4-6 weeks to reach therapeutic affect, remind Pt of sx of serotonin syndrome, explain side effects like sexual dysfunction; take in morning, NOT at night (insomnia)
Fluoxetine (Prozac)
Classification: Antidepressant; Serotonin Norepinephrine Reuptake Inhibitors
Action: Inhibits the reuptake of norepinephrine and serotonin in the synapse; minor inhibition of dopamine reuptake; decreased feelings of depression
Why take it: Major Depressive Disorder
Overexpression: hypersomnia, SUICIDALITY, neuroleptic malignant syndrome, serotonin syndrome
Administration: PO, increased risk of suicidality, use cautiously with liver and renal dysfunction, taper dose, monitor BP (adverse effect= elevated BP)
Follow Up: How are you feeling today? Do you think it is helping? Any suicidal thoughts?
Education: taper, may take 4-6 weeks to reach therapeutic affect, remind Pt of sx of serotonin syndrome, explain side effects like sexual dysfunction, remind Pt and family to watch for signs of SI
Venlafaxine (Effexor)
