Medications Flashcards
Classes of medications used in psychiatry
ANTIPSYCHOTICS: TYPICAL 1ST GENERATION, ATYPICAL 2ND GENERATION , 3RD GENERATION; SSRI’S; SNRI’S; NDM’S; MOOD STABILIZERS; ANTIANXIETY AGENTS; ANTIPARKINSONIAN DRUGS
ANTIPSYCHOTICS TYPICAL (1ST GENERATION)
FLUPENTHIXOL DECANOATE (FLUANXOL), HALOPERIDOL DECANOATE (HALDOL LA), FLUPHENAZINE (MODECATE), ZUCLOPENTHIXOL (CLOPIXOL), ZUCLOPENTHIXOL ACETATE (CLOPIXOL ACCUPHASE)
ATYPICAL 2ND GENERATION ANTIPSYCHOTICS
CLOZAPINE (CLOZARIL), OLANZAPINE (ZYPREXA), QUETIAPINE (SEROQUEL), RISPERDAL (INCLUDE CONSTA INJECTABLE FORM), PALIPERIDONE (INVEGA SUSTENNA), ARIPIPRAZOLE (ABILIFY)
3RD GENERATION
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SSRIs
CITALOPRAM (CELEXA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC), FLUVOXAMINE (LUVOX), SERTRALINE (ZOLOFT)
SNRIs
VENLAFAXINE XR (EFFEXOR), ATOMOXETINE (STRATTERA)
NDMs
WELLBUTRIN (BRUPROPION)
Mood Stabilizers
LITHIUM, CARBAMAZEPINE (TEGRETOL), DEVALPROEX SODIUM (EPIVAL), VALPROIC ACID (DEPAKENE), GABAPENTIN (NEURONTIN), LAMOTRIGINE (LAMICTAL), CLONAZEPAM (RIVOTRIL)
Antianxiety agents
LORAZEPAM (ATIVAN), ALPRAZOLAM (XANAX), OXAZEPAM (SERAX), TEMAZEPAM (RESTORIL), ZOPLICONE (IMOVANE)
ANTIPARKINSONIAN DRUGS
BENZTROPINE (COGENTIN), PROCYCLIDENE (KEMADRIN), TRIHEXPHENIDYL (ARTANE)
Extra-pyramidal Symptoms (EPS)
Movement disorders that occur when there is a disruption of the brain’s extra-pyramidal system, can be caused by anti-psychotic agents (both 1st, and, to a lesser extent, by 2nd generation agents)
PARKINSONISM
tremor and muscle rigidity, also extreme slowness of movements
AKINESIA
also known as “bradykinesia” mean slowing down of movement, person may appear listless or lifeless or the face loose usual range of expression
ACUTE DYSTONIA
sudden muscular contractions, often produces neck or jaw spasms or causes eye to roll, severe EPS signs
ACUTE AKATHESIA
motor restlessness, inability to resist urge to move, pacing and inability to sit still common
TARDIVE DYSKINESIA
spasmodic involuntary movements, writhing like movements are common in face, mouth, tongue hands, assess using Abnormal Involuntary Movement Scale (AIMS), severe EPS signs
NEUROLEPTIC MALIGNANT SYNDROME (NMS)
Dopamine receptor blockade: Increased body temperature >38°C (>100.4°F), or Confused or altered consciousness, Diaphoresis “sweat shock”, Rigid musclesAutonomic imbalance
ABNORMAL INVOLUNTARY MO (AIMS) AND SIMPSON- ANGUS SCALE
designed to measure signs/symptoms of TD, monitoring the effects of long-term medication consumption; given every three to six months to monitor the patient for the development of TD; measure progression of TD; most patients, TD develops three months after the initiation of neuroleptic therapy
MENTAL HEALTH ACT
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PERSONAL SAFETY ISSUES
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Link the following signs and symptoms to the associated side-effect of antipsychotics
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Loss of energy
Akinesia: slowing of movements, person may appear listless or lifeless with a restricted range of emotion expressed in the face (phsyical aspecti)
Feeling unmotivated or numb
Akinesia: the person complains of “feeling like zombie” or “slowed down” (internal aspect of akinesia)
Daytime sedation or drowsiness
Sedation: Common side-effect
Sleeping too much
Sedation: Common side-effect
Muscles to tense or stiff
Muscle Rigidity (EPS): Anti-psychotics can make person muscles too firm or tense, can cause person to walk slowly with small steps
Muscles trembling or shaking
Tremor (EPS): repeated shaking movement of a person’s mucles
Feeling restless or jittery
Akathisia (EPS): inability to sit still, “feeling like they want to jump out of their skin (subjective feeling of akathisia)
Need to move around or pace
Cause pt to repeatedly get up and down from chair or have fidgety leg movements (phsyical restlessness of akathisia)
Blurry vision
Anticholinergic side-effect: associate with some antipsychotics and antidepressents
Dry mouth
Anticholinergic side-effect: associate with some antipsychotics and antidepressents
Drooling
Excessive salivation: often worse at night, associate with the antipsychotic clozapine
Memory and concentraion
Benzodiazepine side-effect: associate with medications used to address anxiety
Constipation
Anticholinergic side-effect: associate with some antipsychotics and antidepressents
Weight gain
Most antipsychotics cause some degree of weight gain
Change in sexual function
Sexual side effects are comon, males errection and ejaculation, females lubrication and orgasm
Menstral or breast problems
Amenorrhea: missed or irregular periods; galactorrhea: elevate hormone prolactin and cause breast milk leakage
What side effects are common with TCAs and MAOIs?
- anithistaminic side effects (sedation and weight gain)
- anticholinergic side effects (potentiating CNS drugs, blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia, and decreased memory
What are anticholinergic side effects?
potentiating CNS drugs, blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia, and decreased memory
What are signs of TCA toxicity?
dry mucous membranes warm, dry skin blurred vision decreased bowl motility urinary retention CNS depression (sedation to coma) or agitated delirium death results from cardiac arrythmia, hypotension, or uncontrollable seizures
treatment: emesis, gastric lavage, cardioresp. care
What are the common side effects of MAOIs?
headache, drowsy, dry mouth constipation blurred vision orthostatic hypotension
Describe the symptoms and cause of hypertensive crisis with MAOIs
if co-administered with food containing tyramine (e.g., aged cheese, bear, red wine)
sudden, severe pounding or explosive headache in back of head or temples, racing pulse, flushing, stiff neck, chest pain, nausea/vomiting, profuse sweating
What are the adverse effects of MAOIs?
headache, drowsiness, dry mouth and throat, insomnia, nausea, agitation dizziness constipation asthenia blurred vision, weight loss, postural hypotension priapism
What are the signs/symptoms of serotonin syndrome?
Result of build up of serotonin Can be life threatening Must be differentiated from NMS - develops within 3 to 9 days after intro of medication - altered mental status - autonomic dysfunction - neuromuscular abnormalities - must have at least three of the following: - mental status change - aggitation - myoclonus - hyperreflexia - fever - shivering - sweating - ataxia - diarrhea - in pt with PVD or aetherosclerosis can have severe vasospasm and hypertension
What interventions are appropriate for response to SE syndrome if suspected?
- hold offending drug
- notify physician
- provide supportive care (e.g., IV fluids, antipyretics and cooling blanket)
What are the common side effects of SSRIs and newer atypical antidepressants?
- insomnia and activation
- headaches
- GI symptoms
- weight gain
What side effects are common with sertraline?
It is an SSRI and can cause sexual side effects including diminished interest and performance
What side effects are common for the following medications:
- nefazodone
- trazodone
- buproprion
- venlafaxine
- nefazodone: raised hepatic enzyme levels leading to hepatic failure, no longer recommended for use in Canada
- trazodone: erectile dysfunction and priapism
- buproprion: seizures (especially in pts at risk for seizures), associated with developement of psychosis (not recommended for pt with schizophrenia)
- venlafaxine: increase in BP but is related to dosage level
What are the phases of pharmacotherapy for bipolar d/o?
Acute: symptom reduction and stabilization, 1st wks combine mood stabilizers + (antipsychotics OR benzodiazopenes) for pt with psychosis, agitation, or insomnia, once stablization is achieved serum levels monitored every 1 to 2 wks for 1st 2 months and every 3 to 6 months during long term maintenance
Continuation: prevention of relapse of current episode or cycling between opposite poles, lasts 2 to 9 months, continue mood stabilizer and monitor for relapse
Maintenance: sustain remission and prevent new episodes, maintain long-term prophylaxis to prevent reoccurrence of symptoms, LT or life-time prophylaxis is recommended after two manic episodes or one severe manic episode, or if there is family history of BP
Discontinuation
What three agents are significantly effective in mood stabilization?
Lithium
divalpreox sodium
carbemazepine
What medications are used to treat acute mania?
Lithium,
divalpreox sodium,
and an atypical antipsychotic, olanzapine
Describe the issues with use of lithium.
- 70% of pt will have at least partial improvement,
- is not suitable as monotherapy for acute phase (requires antipsychotic or a benzodiazopene)
- during depressive episodes a supplemental antidepressent is indicated
- lithium has significant side effects in 1/3 pts
- narrowest gap between therapeutic and toxic concentrations
What are predictors of poor response to lithium?
- history of poor response
- rapid cycling
- dysphoric symptoms
- mixed symptoms of depression and mania
- psychiatric comorbidity
- medical comorbidity
What are possible side effects or symptoms of toxicity with Lithium?
2.5 (severe toxicity): cardiac arrthymias, blackouts, nystagmus, coarse tremor, fasciculations, visual or tactile hallucinations, oliguria, renal failure, peripheral vascular collapse, confusion, seizures, coma and death
Describe how lithium interacts with saodium and fluid levels in the body.
- lithium is a salt
- inverse relationship between sodium and lithium levels in the body (increase salt, decreases lithium)
- if fluid volume decreases signficantly it can increase the levels of lithium in the body (hot climate, strenuous exercise, vomiting, diarrhea or decrease in fluid intake)
Describe the target symptoms of lithium treatment.
Mania including rapid speech, flight of ideas, irritability, grandiose thinking, impulsiveness and agitation
- used to treat mania and depressive episodes
- can be used to potentiate antidepressants
- can be used to treat cluster headaches
- stimulate leukocytosis (treat conditions that cause neutropenia)
- can inhibit replication of DNA viruses (e.g., herpes simplex)
Describe the MOA of lithium
- Lithium is actively transport across cell membranes
- Alters Na transport in nerve and muscle cells
- Replaces Na in the Na-K pump and is retained in cell for readily than Na
- Li influx into nerve cell results in increased storage of catecholamines in cell, reduce DO neurotransmission, increase NE reuptake, increase GABA activity and increased SE receptor sensitivity
- also alters the distribution of Ca and Mg ions and inhibits second messenger systems in neuron
Describe the pharmacokinetic properties of lithium
- readily absorbed in gastric system, can be taken with good
- not protein bound, distribution across the blood-brain barrier is slow
- onset of action = 5-7 days but up to 14 days
- excreted entirely by kidneys
- 80% is reabsorbed across proximal tubule (with Na and water)
- maintenance levels: .4 to 1, monitor blood levels 12hrs after lost dose
What are the MOST common side effects with Li?
excessive thirst and metallic taste in mouth
What are the signs of toxicity for valproate and carbamazepine?
- symptoms appear in 1 to 3 hrs,
- neuromuscular disturbances,
- dizzyness
- stupor
- disorientation
- nystagmus
- urinary retention
- nausea/vomiting
- tachycardia
- hyper/hypotension
- cardiovascular shock
- coma
- respiratory stress
When is ECT indicated for bipolar disorder?
- pts with severe mania who exhibit unremitting, frenzied physical activity
- acute mania unresponsive to antimanic agents and high suicide risk
- use of valproate or carbamazepine elevate the seizure threshhold
