Common NCLEX Psychiatric Medications Flashcards
1
Q
Alprazolam Drug Class
A
Benzodiazepine
2
Q
Alprazolam Labeled Uses
A
- Treatment of Generalized Anxiety Disorder (GAD)
- Panic Disorder (with or without agoraphobia)
- Management of anxiety associated with depression
3
Q
Alprazolam Therapeutic Action
A
Increases the effects of GABA
4
Q
Alprazolam Pregnancy Drug Category
A
Category D
5
Q
Alprazolam Contraindications
A
- Allergy/hypersensitivity
- Psychosis
- Shock/Coma
- Acute narrow-angle glaucoma
- Renal or hepatic dysfunction
- Alcohol intoxication
- Pregnancy and lactation
6
Q
Birth Defects that alprazolam can cause
A
- Cleft lip/palate
- Inguinal hernia
- Cardiac defects
- Microcephaly
- Pyloric stenosis
7
Q
Alprazolam Side Effects
A
- Sedation
- Blurred vision and dizziness
- Drowsiness and lethargy
- Dry mouth, N/V
- Amnesia and confusion
- Elevated liver enzymes
- Agranulocytosis
- Drug dependence with withdrawal syndrome
- Loss of libido and changes in sexual function
8
Q
Agranulocytosis
A
- An acute reaction to medications that causes the WBC count to drop to very low levels (WBC < 200 cells/mm) with concurrent neutropenia
- Usually diagnosed by sore throat, fever, and mouth ulcerations and sores, and low WBCs
9
Q
Alprazolam Patient Education
A
- Avoid drinking grapefruit juice during therapy.
- Avoid the use of alcohol or other CNS depressants
- Effects of alprazolam will increase if taken with cimetidine, oral contraception, or disulfiram.
- Effects of alprazolam will decrease if taken with: theophylline or ranitidine
- Advise patient to not share medication with anyone.
10
Q
Cultural Differences in Metabolism of Alprazolam: Asian Populations
A
- Concentration and ½ life of Xanax are 15-25% higher in Asian
- Metabolize drugs in the CYP450 system a lot slower than other ethnic groups.
- Prescribe lower dose (Ex: 0.25 mg PO TID)
11
Q
Cultural Differences in Metabolism of Alprazolam: African Americans
A
- 15-20% genetically predisposed to delayed metabolism of benzodiazepines
- Results in high serum levels of drug, increased sedation, and increase in adverse effects
12
Q
Cultural Differences in Metabolism of Alprazolam: Elderly
A
- Polypharmacy (drug interactions)
- Slow metabolism due to aging process
13
Q
Buspirone Drug Class
A
Antianxiety
14
Q
Buspirone FDA Approved for
A
Anxiety Disorders
15
Q
Buspirone Therapeutic Action
A
Unknown
16
Q
Buspirone Pregnancy Category
A
Category C
17
Q
Nursing Considerations for Buspirone
A
- No sedative or muscle relaxing properties
- Is not used for acute anxiety attacks
- Buspirone has a slow onset: It can take 2-3 weeks to reach max effectiveness.
- Not to be used PRN for anxiety
- Needs to be taken daily!!
18
Q
Fluoxetine Drug Class
A
SSRI (antidepressant)
19
Q
Fluoxetine FDA Approved for
A
- Major depressive disorder
- Bipolar (depression)
- OCD
- PMDD
- Bulimia
20
Q
Fluoxetine Therapeutic Action
A
Inhibits CNS uptake of serotonin
21
Q
Fluoxetine Pregnancy Class
A
Category C
22
Q
Fluoxetine Unlabeled Uses
A
- Alcoholism
- Borderline personality disorder
- Fibromyalgia
- Nocturnal enuresis (bedwetting)
- PTSD
- Migraine prevention
23
Q
Fluoxetine Contraindications
A
- Hypersensitivity/allergy
- MAOI usage
- Pregnancy or lactation
- Impaired hepatic or renal function
- Diabetes mellitus
- Seizures
- History of suicide attempts
24
Q
Fluoxetine Side Effects
A
- Seizures
- Anxiety
- Drowsiness
- HA
- Insomnia
- Impotence
- Weight loss
- Excessive sweating
- Hot flashes
- Pruritis
25
Fluoxetine Patient Education
1. Report thoughts of suicide!!
2. May take up to 4-6 weeks for drugs full effect.
3. Do Not stop taking abruptly (must be tapered)
4. Do Not use with St. John’s Wort!!
5. Inform HCP if pregnancy is planned or suspected
6. Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions
7. Inform patient that medication may cause decreased libido.
26
Imipramine Drug Class
Tricyclic (antidepressant)
27
Imipramine FDA Approved for
Depression and enuresis in children
28
Imipramine Therapeutic Action
Inhibits the presynaptic reuptake of norepinephrine and serotonin
29
Imipramine Pregnancy Class
Category C
30
Imipramine Contraindications
1. May increase risk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children or adolescents.
2. Seizure disorders (lowers the seizure threshold)
3. Schizophrenic or Paranoid patients may exhibit worsening psychosis
4. Aspirin or tartrazine allergy
31
Imipramine Side Effects
1. ARRHYTHMIAS, ECG changes
2. Sedation, drowsiness and fatigue
3. Blurred vision, dry eyes
4. Hypotension
5. Anticholinergic effects: constipation, dry mouth
32
Anticholinergic Side Effects
1. Hot as a hare (hyperthermia)
2. Blind as a bat (dilated pupils)
3. Dry as a bone (dry skin)
4. Red as a beet (vasodilation)
5. Mad as a hatter (hallucinations/agitation)
6. The bowel and bladder lose their tone and the heart goes on alone (ileus, urinary retention, tachycardia)
33
Imipramine Patient Education
1. Inform patient of need to monitor dietary intake, as possible increase in appetite may lead to undesired weight gain.
2. Instruct patient to notify health care professional if visual changes occur. Inform patient that periodic glaucoma testing may be needed during long-term therapy.
3. Dose increases should be made at bedtime because of sedation.
4. Administer PO medication with or immediately following a meal to minimize gastric irritation.
34
Paroxetine Drug Class
SSRI (antidepressant)
35
Paroxetine FDA Approved for
1. Major depressive disorder
2. OCD
3. Panic disorders
4. Social anxiety disorder
5. PTSD
6. Generalized anxiety disorder
36
Paroxetine Pregnancy Class
Category D
37
Paroxetine Contraindications
1. Concurrent MAOI medication
2. Increased serum levels/toxicity if taken with TCAs or warfarin
3. Severe renal or hepatic impairment
4. Risk of suicide
5. Do not take with TAMOXIFEN : Can cause increase risk in breast cancer recurrence.
38
Paroxetine Side Effects
1. Anxiety
2. Dizziness
3. Drowsiness/sedation
4. Headache
5. Insomnia
6. Agitation
7. Skin rash
8. Ejaculatory disturbance/Erectile dysfunction in men
9. Anorgasmia in women
39
Paroxetine Patient Education
1. Black box warning: Increase in suicidal behavior in children being treated with paroxetine
2. Watch for increased energy and suicidal ideations
3. Tablets should be swallowed whole. Do not crush, break, or chew.
4. Prevent pregnancy while taking paroxetine
5. Taper to avoid potential withdrawal reactions
Monitor appetite and nutritional intake. Weigh weekly.
40
Tranylcypromine Drug Class
MAOI (antidepressant)
41
Tranylcypromine FDA Approved for
Major depressive episodes
* Usually reserved for patients who do not tolerate or respond to other modes of therapy (e.g. tricyclic antidepressants, SSRIs, SSNRIs or electroconvulsive therapy)
42
Tranylcypromine Contraindications
1. Liver disease
2. Cerebrovascular disease
3. Cardiovascular disease
4. HTN
5. Pheochromocytoma
6. Concurrent use of foods containing high concentrations of tyramine
43
Tranylcypromine Drug Interactions
1. Serious, potentially fatal adverse reactions may occur with concurrent use of other antidepressants (SSRIs, SSNRIs, bupropion, tricyclics)
2. Hypertensive crisis may occur with amphetamines, methyldopa, levodopa, dopamine, epinephrine, norepinephrine, or vasoconstrictors
3. Hypertension or hypotension, coma, seizures, respiratory depression, and death may occur with meperidine (avoid using within 2–3 wk. of MAO inhibitor therapy)
44
Tranylcypromine Patient Education
1. Avoid tyramine
2. Instruct patient to notify health care professional immediately if symptoms of hypertensive
3. Report signs of suicide ideation
45
Bupropion Drug Class
Atypical antidepressant
*Smoking deterrent
46
Bupropion FDA Approved
1. Major depressive disorder
2. Smoking cessation treatment
3. Seasonal affective disorder (SAD)
47
Bupropion Therapeutic Action
Not really understood; weak blocker of uptake of serotonin and norepinephrine and inhibits reuptake of dopamine
48
Bupropion Pregnancy Class
Category C
49
Bupropion Contraindications
1. Hypersensitivity/allergy
2. History of seizure disorder
3. Bulimia or anorexia
4. Treatment with MAOIs
5. Renal disease or liver disease
6. Heart disease
7. Pregnancy
50
Bupropion Side Effects
1. Seizures
2. Weight loss
3. Tachycardia
4. Rash, dry skin
5. Dry mouth, constipation
6. Increased sex drive for women
51
Bupropion Nursing Considerations
1. Increased risk of seizures (lowers the seizure threshold)
2. Avoid or limit alcohol (seizures can occur if combined due to further lowering of seizure threshold)
3. Monitor for suicide
4. Serious mental health events, including changes in behavior, depression, and hostility
52
Chlorpromazine Drug Class
Typical antipsychotic, antimanic, antiemetic
53
Chlorpromazine FDA Approved for
1. Psychotic disorders
2. Manic-depressive
3. Schizophrenia
4. Hiccups
5. Hyperactivity and combativeness
6. Severe behavioral problems in children
7. N/V
8. Preoperative sedation
9. Treatment of acute porphyria
54
Chlorpromazine Therapeutic Action
Blocks postsynaptic dopamine receptors in the brain
55
Chlorpromazine Pregnancy Class
Category C
56
Chlorpromazine Contraindications
1. Hypersensitivity
2. Narrow-angle glaucoma.
3. Bone marrow depression.
4. Severe liver/cardiovascular disease.
5. Epilepsy
57
Chlorpromazine Side Effects
1. NEUROLEPTIC MALIGNANT SYNDROME
2. AGRANULOCYTOSIS
3. Sedation, drowsiness
4. Extrapyramidal reactions
5. Blurred vision & dry eyes; photosensitivity
6. Irreversible retinitis pigmentosus high doses
7. Hypotension & tachycardia.
8. Male impotence
9. Urine discolored (pink to red-brown)
58
Chlorpromazine Drug Interactions
1. Additive hypotension with antihypertensives
2. Additive CNS depression with alcohol, antidepressants, antihistamines, MAO inhibitors, opioid analgesics, sedative/hypnotics, or general anesthetics.
3. Concurrent use with lithium may produce disorientation, unconsciousness, or extrapyramidal symptoms. Concurrent use with propranolol increases blood levels of both drugs.
59
Chlorpromazine Patient Education
1. Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia and to report these symptoms
2. Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
3. False-positive pregnancy test in women
4. Keep pt. recumbent (lay flat) for 30 min after injection (avoid orthostatic hypotension)
5. Inform patient that this medication may turn urine a pink-to-reddish-brown color.
6. Report sore throat, fever, unusual bleeding, rash, tremors, yellowing of eyes/skin, and impaired vision
60
Fluphenazine Drug Class
Typical antipsychotic
61
Fluphenazine FDA Approved for
1. Acute and chronic psychotic disorders
| 2. Schizophrenia
62
Fluphenazine Therapeutic Action
Block postsynaptic dopamine receptors in the brain
63
Fluphenazine Pregnancy Class
Category C
64
Fluphenazine Side Effects
1. Neuroleptic malignant syndrome
2. Agranulocytosis
3. Extrapyramidal reactions
4. Drug-induced hepatitis
5. Photosensitivity
6. Galactorrhea
7. Infertility
8. Cardiac arrest, arrhythmias
65
Fluphenazine Contraindications
1. Hypersensitivity
2. Subcortical brain damage
3. Bone marrow depression
4. Liver disease
5. Products containing alcohol or tartrazine (yellow dye in foods)
6. Concurrent use of drugs that prolong the QT interval
66
Fluphenazine Patient Education
1. Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia
2. Caution patient to avoid driving or other activities requiring alertness
3. Advise patient to use sunscreen and protective clothing when exposed to the sun. Exposed surfaces may develop a blue-gray pigmentation, which may fade after discontinuation of the medication.
4. Extremes of temperature should also be avoided because this drug impairs body temperature regulation
5. Maintain fluid intake (temp regulation)
67
Thiothixene Drug Class
Typical antipsychotic
68
Thiothixene FDA Approved for
1. Schizophrenia
| 2. Psychotic disorders
69
Thiothixene Therapeutic Action
Blocks postsynaptic dopamine receptors
70
Thiothixene Pregnancy Class
Category C
71
Thiothixene Side Effects
1. NEUROLEPTIC MALIGNANT SYNDROME
2. Tardive dyskinesia
3. Extrapyramidal syndrome
4. Pseudoparkinsonism, dystonia, akathisia
5. Seizures
6. Fatal arrhythmias, cardiac arrest, & tachycardia
7. Aplastic anemia
8. Suppression of cough reflex, bronchospasms, dyspnea
9. Breast enlargement, galactorrhea
72
Thiothixene Patient Education
1. Lowers the seizure threshold
2. Risks of death increases if used to treat elderly patients with dementia-related psychosis.
3. Monitor serum creatinine, BUN and WBC
4. Can cause dehydration: Drink a lot of water each day
5. Taper medication
6. Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Caution patient to report these symptoms immediately to health care professional.
73
Clozapine Drug Class
Atypical antipsychotic
74
Clozapine FDA Approved for
1. Severe schizophrenia that does not respond to standard antipsychotics
2. Schizoaffective disorder
75
Clozapine Therapeutic Action
Block dopamine receptors in the brain
76
Clozapine Pregnancy Class
Category B
77
Clozapine Nursing Considerations
1. Black box warnings:
- Monitor WBC weekly during treatment and for 4 weeks after. Dosage adjusted based on WBC.
- Fatal agranulocytosis
- Medication only available through restricted program called the Clozaril National Registry
2. Risk for serious CV and respiratory effects (myocarditis)
3. Elderly patients with dementia-related psychosis increase risk for death.
4. Risks for seizures as dose increases
