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NUR 317: Mental Health Lecture > Exam 2 drugs > Flashcards

Exam 2 drugs Flashcards

1
Q

What is Lithium used for?

A

Acute mania/manic episodes, prevent mania/depression related to bipolar, decrease suicide incidence

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2
Q

Lithium effect on neurotransmitters

A

reduce dopamine and glutamate, increase GABA, change sodium ion transport

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3
Q

Lithium adverse reactions

A 
L-levels-thyroid
I-increased urination
T-thirst/tremor
H-hair loss/hypothyroidism
I-impaired memory/interactions
U-upset stomach
M-muscle weakness
S-skin conditions-dry skin, psoriasis

N/V, GI upset, hand tremors, polyuria, mild thirst, weight gain, hypotension, electrolyte imbalance, renal toxicity, goiter, hypothyroidism

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4
Q

Lithium toxicity

A

narrow therapeutic range. 1.0-1.5 initial treatment. Maintenance 0.6-1.2

Early toxicity indications: 1.5-2.0 mEq/L confusion, sedation, poor coordination, coarse tremors, GI distress, N/V/D; hold med and inform provider

Advanced: 2.0-2.5 mEq/L extreme polyuria, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor leading to coma, possible death-respiratory complications; give emetic, gastric lavage, meds to increase excretion

Severe greater than 2.5 mEq/L manifestations rapidly progress coma and death. Need hemodialysis at this point.

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5
Q

Lithium contraindications/precautions

A

teratogenic, renal insufficiency, cardiac disorders, dehydration, low salt diets, diabetes, seizures disorders, SI

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6
Q

Lithium interactions

A

diuretics, NSAIDs, ACE inhibitors-CAN CAUSE LITHIUM TOXICITY
Remember “AND” (ACE, NSAIDs, Diuretics)
anticholinergics=abdominal pain

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7
Q

Patient education-Lithium

A

take with food/milk, s/s hypothyroidism and lithium toxicity, 2-3 L fluids daily, avoid low sodium diets, sweating, vomiting, diarrhea can increase lithium levels

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8
Q

What is carbamazepine used for?

A

seizures, mood stabilizer for bipolar

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9
Q

Carbamazepine mechanism of action?

A

inhibit influx of sodium through sodium channels=decreased discharge neurons around areas of increased activity

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10
Q

Carbamazepine therapeutic level?

A

4-12 mcg/mL

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11
Q

Carbamazepine adverse reactions?

A

visual disturbances, headache, ataxia, nystagmus, blurred vision, fluid retention, photosensitivity (usually subsides), SIADH, bone marrow suppression, leukopenia, anemia, thrombocytopenia, Stevens-Johnson syndrome

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12
Q

Carbamazepine interactions

A

OTC and prescription drugs may increase or decrease drug levels, contraceptives, warfarin

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13
Q

Carbamazepine patient education

A

take with food, no grapefruit, monitor for rashes, s/s HF due to fluid retention (decreased urine output, SOB, edema), sun protection, need alternate birth control, report all meds and supplements

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14
Q

Valproic acid use:

A

mania associated with bipolar

off brand use for agitation and behaviors r/t dementia

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15
Q

Valproic acid effect on neurotransmitters:

A

increase GABA, might inhibit glutamate (exact mechanism unknown), inhibits influx of sodium through sodium channels=decreased discharge neurons around areas of increased activity

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16
Q

Valproic acid therapeutic level

A

50-120 mcg/mL

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17
Q

Valproic acid adverse reactions

A

GI upset, weight gain, thrombocytopenia, bone marrow suppression (low RBC, platelets=increased bleeding, bruising, hematuria), hyperammonemia, liver toxicity, anorexia, jaundice, nausea, abdominal pain, pancreatitis, vomiting, confusion, decreased LOC, increased serum amylase

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18
Q

Valproic acid contraindications/precautions

A

teratogenic, liver dz, hyperammonemia, pancreatitis

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19
Q

Valproic acid interactions

A

phenytoin, phenobarbital, topiramate (other anticonvulsants)

20
Q

First Gen Antipsychotics and Use

A

Chlorpromazine and Haloperidol

Suppress positive symptoms of schizophrenia

21
Q

First Gen Antipsychotics effect on neurotransmitters

A

Suppresses the release of dopamine

Blocks receptors for: norepinephrine, acetylcholine, dopamine, and histamine

22
Q

First Gen Antipsychotics adverse reactions

A

Extrapyramidal effects (EPS)
Acute dystonia (hours to days)
Tardive dyskinesia (months to years)
Akathisia (days to weeks)
Pseudoparkinsonism-weeks to months, usually resolves
Anticholinergic, gynecomastia, galactorrhea, weight gain, sexual dysfunction, menstrual irregularities, liver impairment, cataracts
Agranulocytosis
Neuroleptic malignant syndrome (NMS) – medical emergency
Severe dysrhythmias, seizures, sedation

23
Q

First Gen Antipsychotics Contraindications/Precautions

A

ETOH withdrawal, bone marrow suppression, CNS depression, pregnancy or lactation
Glaucoma, diabetes, HTN
Cardiac, liver, thyroid disorders

24
Q

First Gen Antipsychotics Interactions

A

CNS depressants, antacids and antidiarrheals
Decreases levels of anticonvulsants– measure serum levels
Meds for bipolar disorders!
Especially valproic acid (Depakote)

25
Q

Second Gen Antipsychotics and Use

A

risperidone, olanzapine, quetiapine

Use: Treat schizophrenia, bipolar disorder, irritability d/t autism

26
Q

Second Gen Antipsychotics effect on neurotransmitters

A

Block dopamine and serotonin receptors

27
Q

Second Gen Antipsychotics adverse effects

A

Extrapyramidal effects (EPS) at high doses
Metabolic side effects: weight gain, dyslipidemia, impaired glucose regulation, diabetes
Anticholinergic effects, drowsiness, insomnia, dizziness, gynecomastia, galactorrhea

28
Q

Second Gen Antipsychotics Contraindications/precautions

A

CNS disorders, cardiac concerns, cerebrovascular accidents, hypotension, seizure disorders, kids and older adults

29
Q

Second Gen Antipsychotics Interactions

A

antihypertensives, anticonvulsants

30
Q

Benztropine use

A

Used for muscle spasms, bronchospasm

Treat side effects associated with antipsychotics
Pseudoparkinsonism, acute dystonia
does NOT treat tardive dyskinesia

Anticholinergic (antimuscarinic), blocks histamine receptors and antagonizes (blocks) acetylcholine

31
Q

Benztropine interactions

A

histamines and other anticholinergics

32
Q

Aripiprazole

A

3rd gen antipsychotic, lowest risk for side effects, extrapyramidals, metabolic, anticholinergic effects

33
Q

Clozapine

A

First developed second gen
highest risk of fatal agranulocytosis, more adverse effects than other second gen
high risk weight gain, diabetes, dyslipidemia
requires special license to prescribe

34
Q

Benzodiazepines and use

A

Diazepam and Lorazepam ‘lam or pam’ endings

Short term GAD and panic disorder

35
Q

Benzodiazepine effect on neurotransmitters

A

Increase effect of GABA, risk for addiction

36
Q

Benzodiazepine adverse reactions:

A

CNS depression, dizziness, drowsiness, lethargy, hypotension, tachycardia, respiratory depression

37
Q

Benzodiazepine contraindication/precaution

A

teratogenic, conditions/meds that increase CNS depressant effect, patients prone to addiction

38
Q

Benzodiazepine interactions

A

Respiratory depression when combined with other CNS depressants (alcohol, opioids other benzos), kava kava, chamomile, valerian, Cimetidine, smoking decreases effect of benzos

39
Q

Benzodiazepine Monitoring/Intervention

A

fall risk, sedation, paradoxical rxn older adults, tolerance/dependence, taper to avoid withdrawal, vital signs, memory assessment, if giving through IV give slowly
Keep IV Flumazenil nearby,

40
Q

Buspirone use

A

Short acting for anxiety, GAD

41
Q

Buspirone effect on neurotransmitters

A

agonist for serotonin and dopamine

42
Q

Buspirone adverse effects

A

insomnia, anxiety, restlessness, GI upset, nausea, headache, dizziness, lightheaded

43
Q

Buspirone contraindications

A

liver or kidney insufficiency

44
Q

Buspirone patient education

A

Must take daily-takes several weeks to reach therapeutic levels

45
Q

Buspirone interactions

A

MAOI’s within 2 weeks=HTN crisis, erythromycin, grapefruit juice, ketoconazole

NUR 317: Mental Health Lecture (6 decks)

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