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N310 Mental Health Nursing CLN > Medications > Flashcards

Medications Flashcards

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1
Q

Classes of medications used in psychiatry

A

ANTIPSYCHOTICS: TYPICAL 1ST GENERATION, ATYPICAL 2ND GENERATION , 3RD GENERATION; SSRI’S; SNRI’S; NDM’S; MOOD STABILIZERS; ANTIANXIETY AGENTS; ANTIPARKINSONIAN DRUGS

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2
Q

ANTIPSYCHOTICS TYPICAL (1ST GENERATION)

A

FLUPENTHIXOL DECANOATE (FLUANXOL), HALOPERIDOL DECANOATE (HALDOL LA), FLUPHENAZINE (MODECATE), ZUCLOPENTHIXOL (CLOPIXOL), ZUCLOPENTHIXOL ACETATE (CLOPIXOL ACCUPHASE)

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3
Q

ATYPICAL 2ND GENERATION ANTIPSYCHOTICS

A

CLOZAPINE (CLOZARIL), OLANZAPINE (ZYPREXA), QUETIAPINE (SEROQUEL), RISPERDAL (INCLUDE CONSTA INJECTABLE FORM), PALIPERIDONE (INVEGA SUSTENNA), ARIPIPRAZOLE (ABILIFY)

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4
Q

3RD GENERATION

A

.

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5
Q

SSRIs

A

CITALOPRAM (CELEXA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC), FLUVOXAMINE (LUVOX), SERTRALINE (ZOLOFT)

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6
Q

SNRIs

A

VENLAFAXINE XR (EFFEXOR), ATOMOXETINE (STRATTERA)

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7
Q

NDMs

A

WELLBUTRIN (BRUPROPION)

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8
Q

Mood Stabilizers

A

LITHIUM, CARBAMAZEPINE (TEGRETOL), DEVALPROEX SODIUM (EPIVAL), VALPROIC ACID (DEPAKENE), GABAPENTIN (NEURONTIN), LAMOTRIGINE (LAMICTAL), CLONAZEPAM (RIVOTRIL)

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9
Q

Antianxiety agents

A

LORAZEPAM (ATIVAN), ALPRAZOLAM (XANAX), OXAZEPAM (SERAX), TEMAZEPAM (RESTORIL), ZOPLICONE (IMOVANE)

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10
Q

ANTIPARKINSONIAN DRUGS

A

BENZTROPINE (COGENTIN), PROCYCLIDENE (KEMADRIN), TRIHEXPHENIDYL (ARTANE)

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11
Q

Extra-pyramidal Symptoms (EPS)

A

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)

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12
Q

PARKINSONISM

A

tremor and muscle rigidity, also extreme slowness of movements

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13
Q

AKINESIA

A

also known as “bradykinesia” mean slowing down of movement, person may appear listless or lifeless or the face loose usual range of expression

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14
Q

ACUTE DYSTONIA

A

sudden muscular contractions, often produces neck or jaw spasms or causes eye to roll, severe EPS signs

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15
Q

ACUTE AKATHESIA

A

motor restlessness, inability to resist urge to move, pacing and inability to sit still common

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16
Q

TARDIVE DYSKINESIA

A

spasmodic involuntary movements, writhing like movements are common in face, mouth, tongue hands, assess using Abnormal Involuntary Movement Scale (AIMS), severe EPS signs

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17
Q

NEUROLEPTIC MALIGNANT SYNDROME (NMS)

A

Dopamine receptor blockade: Increased body temperature >38°C (>100.4°F), or Confused or altered consciousness, Diaphoresis “sweat shock”, Rigid musclesAutonomic imbalance

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18
Q

ABNORMAL INVOLUNTARY MO (AIMS) AND SIMPSON- ANGUS SCALE

A

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

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19
Q

MENTAL HEALTH ACT

A

.

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20
Q

PERSONAL SAFETY ISSUES

A

.

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21
Q

Link the following signs and symptoms to the associated side-effect of antipsychotics

A

.

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22
Q

Loss of energy

A

Akinesia: slowing of movements, person may appear listless or lifeless with a restricted range of emotion expressed in the face (phsyical aspecti)

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23
Q

Feeling unmotivated or numb

A

Akinesia: the person complains of “feeling like zombie” or “slowed down” (internal aspect of akinesia)

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24
Q

Daytime sedation or drowsiness

A

Sedation: Common side-effect

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25
Q

Sleeping too much

A

Sedation: Common side-effect

26
Q

Muscles to tense or stiff

A

Muscle Rigidity (EPS): Anti-psychotics can make person muscles too firm or tense, can cause person to walk slowly with small steps

27
Q

Muscles trembling or shaking

A

Tremor (EPS): repeated shaking movement of a person’s mucles

28
Q

Feeling restless or jittery

A

Akathisia (EPS): inability to sit still, “feeling like they want to jump out of their skin (subjective feeling of akathisia)

29
Q

Need to move around or pace

A

Cause pt to repeatedly get up and down from chair or have fidgety leg movements (phsyical restlessness of akathisia)

30
Q

Blurry vision

A

Anticholinergic side-effect: associate with some antipsychotics and antidepressents

31
Q

Dry mouth

A

Anticholinergic side-effect: associate with some antipsychotics and antidepressents

32
Q

Drooling

A

Excessive salivation: often worse at night, associate with the antipsychotic clozapine

33
Q

Memory and concentraion

A

Benzodiazepine side-effect: associate with medications used to address anxiety

34
Q

Constipation

A

Anticholinergic side-effect: associate with some antipsychotics and antidepressents

35
Q

Weight gain

A

Most antipsychotics cause some degree of weight gain

36
Q

Change in sexual function

A

Sexual side effects are comon, males errection and ejaculation, females lubrication and orgasm

37
Q

Menstral or breast problems

A

Amenorrhea: missed or irregular periods; galactorrhea: elevate hormone prolactin and cause breast milk leakage

38
Q

What side effects are common with TCAs and MAOIs?

A
  • 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
39
Q

What are anticholinergic side effects?

A 
potentiating CNS drugs, 
blurred vision, 
dry mouth, 
constipation, 
urinary retention, 
sinus tachycardia, and 
decreased memory
40
Q

What are signs of TCA toxicity?

A 
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

41
Q

What are the common side effects of MAOIs?

A 
headache,
drowsy,
dry mouth
constipation
blurred vision
orthostatic hypotension
42
Q

Describe the symptoms and cause of hypertensive crisis with MAOIs

A

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
43
Q

What are the adverse effects of MAOIs?

A 
headache,
drowsiness,
dry mouth and throat,
insomnia, 
nausea,
agitation
dizziness
constipation
asthenia
blurred vision,
weight loss,
postural hypotension
priapism
44
Q

What are the signs/symptoms of serotonin syndrome?

A 
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
45
Q

What interventions are appropriate for response to SE syndrome if suspected?

A
  • hold offending drug
  • notify physician
  • provide supportive care (e.g., IV fluids, antipyretics and cooling blanket)
46
Q

What are the common side effects of SSRIs and newer atypical antidepressants?

A
  • insomnia and activation
  • headaches
  • GI symptoms
  • weight gain
47
Q

What side effects are common with sertraline?

A

It is an SSRI and can cause sexual side effects including diminished interest and performance

48
Q

What side effects are common for the following medications:

  • nefazodone
  • trazodone
  • buproprion
  • venlafaxine
A
  • 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
49
Q

What are the phases of pharmacotherapy for bipolar d/o?

A

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

50
Q

What three agents are significantly effective in mood stabilization?

A

Lithium
divalpreox sodium
carbemazepine

51
Q

What medications are used to treat acute mania?

A

Lithium,
divalpreox sodium,
and an atypical antipsychotic, olanzapine

52
Q

Describe the issues with use of lithium.

A
  • 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
53
Q

What are predictors of poor response to lithium?

A
  • history of poor response
  • rapid cycling
  • dysphoric symptoms
  • mixed symptoms of depression and mania
  • psychiatric comorbidity
  • medical comorbidity
54
Q

What are possible side effects or symptoms of toxicity with Lithium?

A

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

55
Q

Describe how lithium interacts with saodium and fluid levels in the body.

A
  • 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)
56
Q

Describe the target symptoms of lithium treatment.

A

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)
57
Q

Describe the MOA of lithium

A
  • 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
58
Q

Describe the pharmacokinetic properties of lithium

A
  • 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
59
Q

What are the MOST common side effects with Li?

A

excessive thirst and metallic taste in mouth

60
Q

What are the signs of toxicity for valproate and carbamazepine?

A
  • 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
61
Q

When is ECT indicated for bipolar disorder?

A
  • 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

N310 Mental Health Nursing CLN (3 decks)

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