Exam 2 Flashcards
1
Q
What is the
first atypical antipsychotic
Symptoms:
agranulocytosis:
fever,
sore throat,
mouth ulcers,
lower immune response
A
Clozapine (Clozaril)
2
Q
What drug is this?
Contraindicated with dementia
risk death r/t CVA or infection
*Highest risk for EPS among atypicals
*Avoid alcohol
*Sexual side effects
*Monitor glucose levels carefully
- Orthostatic Hypotension
A
Risperidone (Risperdal)
3
Q
What neutrotransmitter is involved in voluntary movement, learning, memory, and sleep
A
Acetylcholine
4
Q
What neurotransmitter is correlated with movement, attention, and learning ?
A
Dopamine
5
Q
What is neurotransmitter is associated with eating, alertness
A
Norepinephrine
6
Q
What neurotransmitter plays a role in mood, sleep, appetite, and impulsive and aggressive behavior ?
A
Serotonin
7
Q
What neurotransmitter inhibits excitation and anxiety?
A
GABA
8
Q
What is a major risk while taking ADHD meds?
A
weight loss; due to reduced appetite and growth suprression
9
Q
Is methylphenidate a stimulant or non-stimulant?
A
Stimulant
10
Q
What are interventions for methylphenidate?
A
Monitor height and weight at baseline
Administer either right before or right after meals
At Decatur West on the children & Adolescent units, snacks are provided in the evening because by then the appetite suppression has worn off and the kids can become HANGRY!!!
11
Q
Is atomoxetine a stimulant or non-stimulant?
A
non-stimulant
12
Q
What are interventions for atomoxetine?
A
Monitor height and weight at baseline
Administer right before or after meals
May also cause GI distress – take with food if GI distress occurs
13
Q
What are anxiolytics?
A
psychological and somatic symptoms of anxiety disorders.
14
Q
What are some examples of anxiolytics?
A
Diazepam (Valium)
Clonazepam (Klonopin)
Alprazolam (Xanax)
Lorazepam (Ativan)
the -pams
15
Q
What neurotransmitter do Benzo’s (anxiolytics) act on?
A
GABA
16
Q
Are benzo’s safe for long term use?
A
no; short term only, contraindicated with narcotics and alcohol abuse history
highly addictive
17
Q
What are side effects of benzos??
Hint: Slows you down with ironic effects
A
Sedation
Withdrawal
CNS depression
Parodoxical response
18
Q
WHat does buspirone do?
A
Reduces anxiety without the strong sedative-hypnotic properties
Non-addictive
Will not leave the patient sleepy or sluggish
Less danger of interaction with other CNS depressants such as alcohol
19
Q
What are side effects of buspirone?
A
- Dizziness,
- headache,
- nervousness,
- insomnia,
- light headedness,
- nausea,
- dry mouth,
- vomiting
- gastric distress & diarrhea
20
Q
What are contraindications for buspirone?
A
renal/liver impairment
lactating women
21
Q
What are examples of sedating antihistamines?
A
Diphenhydramine / hydroxyzine
22
Q
What is an example of a sedating antidepressants?
A
Trazadone
23
Q
What is important to monitor for with anti-depressants?
A
suicidal thoughts?
24
Q
How does TCA’s work?
A
blocks acetylcholine & histamine as well –
25
What are side effects of TCA's?
Sedation,
dry mouth,
blurred vision,
urinary retention,
dizziness & fainting
26
What are contraindications for TCA's?
seizure disorder
27
What can TCA's increase the risk of?
suicide risk
28
T or F, a 10 day supply of TCA's is safe
False; a 10 day supply can be fatal
29
What are examples of TCA's?
| the -lines
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
30
What are examples of first line SSRI's?
Fluoxetine (Prozac)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
31
What are side effects of SSRI's?
Most common side effects are nausea, vomiting, weight changes
Delayed or impaired orgasm, decreased libido, impotence (sexual side effects)
32
What should you avoid drinking with SSRI's?
Grapejuice
33
What are contraindications for SSRI's?
TCA or MAOI use
34
What are s/s of serotonin syndrome?
Mental confusion, difficulty concentrating
Abdominal pain
Diarrhea
Agitation
Fever
Anxiety
Hallucinations
Hyperreflexia, incoordination
Diaphoresis
Tremors
35
What serious complication can SSRI's cause?
Serotonin Syndrome
36
What are examples of MAOI's?
Phenelzine Sulfate (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
37
What are MAOI's used for?
Good for atypical depression and bulimia
38
What are risks with taking MAOI's?
CNS stimulation: agitation, mania
Orthostatic hypotension
Hypertensive crisis
39
What are contraindications for MAOI's?
MUST AVOID TYRAMINE FOODS!!!
MUST AVOID OTHER ANTIDEPRESSANTS!!
MUST AVOID OTC COLD MEDICATIONS!!
40
What are examples of tyramine foods?
Aged cheeses
Processed meats
Dried, processed or fermented fish
Beer/ Wine
Banana
Avocados
Pickled foods
Sauerkraut/Yeast
Figs & Raisins
Bananas
Chocolate
Livers
Soy sauce
Yogurt/Sour Cream
41
What is trazadone used for?
Given at night to help treat insomnia
42
What does trazadone have a risk for?
priapism
43
What is bupropion used for?
smoking cessation
44
What are venlafaxine/duloxetine used for?
| Related to a peripheral sensation
Neuropathic pain
45
What are examples of mood stabilizers?
Lithium
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Lamotrigine (Lamictal)
46
What is the therapeutic range for lithium?
0.5-1.5 mEq/L
47
What should you avoid while taking lithium?
caffeine
48
What is lithium contraindicated with?
thiazide diuretics and NSAIDS
49
What labs do you monitor for lithium?
blood level
kidney funcntion
may cause hypothyroidism
50
What accompanies early lithium toxicity?
below 1.5
lethargy
vomiting and diarrhea,
slurred speech,
muscle weakness, and hand tremor
51
What are s/s of late lithium toxicity?
Severe respiratory complications
coma
death
52
What is the therapeutic range for depakote?
Therapeutic level 50-100 mcg/ml
53
What is pharmacodynamics?
what the meds do in our body
54
What is pharmacokinetics?
how the meds travel in our body
55
What are neurotransmitters?
“neuromessengers” [crosses synapses – attaches to receptors] Does things
56
What is Valproic acid (depakote) used for?
Bipolar disorder, mania
57
What is carbamazepine (tegretol) used for?
aggression and hostile symptoms
58
What type of drug is carbamazepine?
Anticonvulsant
59
What are risks with carbamazepine?
Risk for other drug-drug interactions
●Also risk for Steven’s Johnson Syndrome
●FDA requires genetic testing before using this drug on people of Asian descent
60
What is lamotrigine (lamictal) used for?
Approved for bipolar depression
61
What type of drug is lamotrigine
Anticonvulsant
62
What are risks with lamotrigine?
* Risk for fatal rash
●Stevens-Johnsons syndrome
●If rash appears STOP medication and call MD
63
What are antipsychotics?
medications are used to treat severe thought disorders such as Schizophrenia.
64
What are examples of 1st gen antipsychotics?
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
65
What are risks of 1st gen antipsychotics?
| Complications
Agranulocytosis,
anticholinergic effects,
orthostatic hypotension,
sedation,
sexual dysfunction,
photosensitivity,
liver impairment,
seizures,
dysrhythmias
66
What do 1st gen antipsychotics work best on?
| What symptoms?
hallucinations, delusions, bizarre behavior
67
What are positive symptoms?
Think + (adding) things
*Hallucinations, delusions, bizarre behavior
68
What are negative symptoms?
Think – (subtracting) things
*Bland/blunted affect, zero motivation, Anhedonia, isolation, diminished speech
69
What are examples of 2nd gen antipsychotics?
lozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
70
What are risks of atypical (2nd gen) aantipsychotics?
but often includes orthostatic hypotension, anticholinergic effects, sexual dysfunction, mild EPS
71
What symptoms do atypical antipsychotics work on?
POSITIVE & NEGATIVE symptoms
72
What do you monitor with a patient on clozapine?
CBC
73
What is a risk with clozapine?
Cause agranulocytosis
74
What is risperidone contraindicated with?
dementia
75
What is a risk with olanzapine?
Neuroleptic Malignant Syndrome
76
What other condition can ziprasidone treat?
Depression
77
What else can quetiapine treat?
Depression and bipolar
78
What are EPS?
Extrapyramidal symptoms
79
What are the 4 main types of abnormal involuntary movements?
Psuedo-Parkinsonism
Acute Dystone
Akathisia
Tardive dyskinesia
80
What is torticollis?
Severe arching of the head, neck or spine?
81
What is an oculogyric crisis?
Eyes rolling back into the head
82
What is akathisia?
This is an INTENSE need/urge to move about.
●Client will appear anxious/restless
●VERY disturbing to the client
●May result in the client discontinuing the medication
●Can be treated by changing the medication or adding a beta blocker or benzo.
83
What is tardive dyskinesia?
May become PERMANENT and IRREVERSIBLE!!!
Most serious side effect of long-term use of antipsychotics
Involuntary movements affecting face, tongue, and perioral, buccal, and masticatory muscles
May also involve neck, torso, and extremities
Fine, wormlike movements of tongue may be first sign of TD
Discontinuation of medication may prevent full-blown syndrome
84
How do you treat dystonia, Parkinsonism, and akathisia?
Benztropine or Benadryl
85
What is neuroleptic malignant syndrome?
Muscle rigidity (LEAD PIPE RIGIDITY)
●Altered consciousness/ disorientation
●Dysphagia
●Elevated creatinine phosphokinase (Lab levels)
●Stupor/catatonia
●Hyperpyrexia (HIGH FEVER)
●Labile pulse and blood pressure
●Possible life-threatening
86
How do you treat neuroleptic malignant syndrome?
Treatment: Immediate cessation of drug and hospitalization to stabilize acute symptoms
87
What are examples of stimulant cognitive enhancers
Methylphenidate (Ritalin)
●Dextroamphetamine(Adderall)
88
What are examples of non-stimulant cognitive enhancers?
●Atomoxetine (Strattera)
89
What kind of meds is ADHD treated with?
Stimulants
90
What are common side effects for ADHD meds?
Insomnia is a common side effect
●Appetite suppression – weight loss
●Headache, abdominal pain, Somnolence (sleepiness!) and Insomnia?!?!? What?!!?
91
What are examples of cholinesterase inhibitor meds (memory and cognitive enhancers))?
●Donepezil HCL (Aricept)
●Galantamine (Razadyne/Reminyl)
●Rivastigmine (Exelon)
Other Meds
●Memantine (Namenda)
92
What are cholinesterase inhibitors used for?
sed to delay cognitive decline in people with Alzheimer’s Disease
There is NO CURE or reversing treatment…
93
What is disulfiram (Antabuse) used for?
Used for relapse prevention in alcoholism: Aversion behavioral therapy. Also encourage 12 step program or similar.
94
What can disulfiram cause?
acetaldehyde syndrome
95
What happens if you drink alcohol with disulfiram?
Intense nausea, vomiting, headache, sweating, weakness, sweating, palpitations
96
What are positive symptoms of schizophrenia?
Hallucinations, delusions, paranoia, disorganized or bizarre thoughts, behavior or speech
97
What are negative symptoms of schizophrenia?
anhedonia, social discomfort, lack of goal directed behavior (avolition)
98
What are cognitive symptoms of schizophrenia?
impairments in memory attention or thinking, disorganized or irrational thoughts, judgement or problem solving –
99
What are affective symptoms of schizophrenia?
ymptoms involving emotions or the expression of those emotions – Severe emotional distress (Dysphoria), suicidality, hopelessness- can also be bizarre, incongruent, blunted, labile
100
101
What are the different types of bipolar disorder?
Bipolar Mixed (Mania/Depression/Normal Moods)
*Bipolar Type 1 (Mostly Mania/Depression)
*Bipolar Type 2 (Mostly Depression/Hypomania)
102
What is hypomania?
Slightly less severe subcategory of mania
*No psychotic features
*Does not impair functioning to level of need for hospitalization
*Elevated, expansive, or irritable mood usually lasting about 4 days
*Not severe enough to cause marked social or occupational dysfunction
103
What is mania?
Abnormal and persistent elevated, expansive, or irritable mood
*Severe enough to cause marked impairment in occupational, social, relationship activities
*Often necessitates hospitalization to prevent harm to self or others, or if there are psychotic features
*Episode lasts at least one week
104
What is mania?
Elevated, expansive, or irritable moods – unpredictable mood swings
*Up at night, full of energy, restless & relentless activity – poor sleep
*Exaggerated self-esteem with delusions of grandeur – “10 ft tall and bullet proof” – can lead to risky behavior
*Poor nutrition during periods of nonstop activity - too busy to eat
*Excessive and inappropriate talking and laughing – exhausting to be around
105
What are examples of atypical thought processes?
flight of ideas & loose grandiose or persecutory circumstantial or tangential Cognitive function decline (correlating with number of manic episodes) pressured A manic client may not realize they are acting strangely & therefore resist illogical rhyming, punning, word associations, clanging
106
What are indications for lithium?
Elation, grandiosity, expansiveness
*Flight of ideas
*Irritability and manipulation
*Anxiety
107
What is valproic acid used for?
Useful in treating acute mania
*Rapid-cycling
*Dysphoric mania
*Helpful in preventing future mania
*Remember to monitor liver function and platelet count periodically!
108
What are s/s of hepatoxicity?
anorexia, nausea, vomiting, fatigue, abdominal pain and jaundice
109
What is carbamazepine used for?
Helps with rapid cycling
*Severely paranoid or angry patients
*Patients experiencing euphoric, hyperactive, overfriendly mania
110
What is lamotrigine used for?
First-line treatment option for bipolar depression
●Generally well-tolerated
Warn of potentially life-threatening rash (Steven Johnson Syndrome)
111
What is the therapeutic range for carbamazepine?
5-12mcg/mL
112
When is seclusion warranted?
Substantial risk of harm to others or self
●Patient unable to control their actions(chaotic/impulsive/psychotic)
●Problematic behavior has been sustained and other measures have failed (limit setting, verbal de-escalation, chemical restraints)
113
What is a staple for schizophrenia (one thing it always includes)?
One psychotic feature
( hallucinations, delusions, disorganized speech)
114
What are hallmark signs of neuroleptic malignant syndrome?
Reduced consciousness
●Increased muscle tone (lead-pipe rigidity)
●Autonomic dysfunctIon
115
What two meds are linked to steven's johns syndrome?
Carbemazepine
lamotrigine
