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Medication > Medications for Mental Health > Flashcards

Medications for Mental Health Flashcards

1
Q

What are psychotropic medications

A

medications that affect the mind, emotions, and behaviour (act on the CNS system)

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2
Q

Autonomic nervous system includes (2)

A
  1. Sympathetic Nervous System (SNS)
  2. Parasympathetic Nervous System (PNS)
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3
Q

SNS (2) and medication impacts (2)

A
  • receptors include alpha 1/2 & beta 1/2
  • stimulated by epi/norepinephrine
    *Meds that stimulate these receptors are adrenergic agonists because they mimic body’s natural SNS activation (stimulant)
    *Meds that depress these receptors are adrenergic antagonists because they block SNS (beta blocker)
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4
Q

PNS (2) and medication impacts (2)

A
  • receptors include nicotinic and muscarinic receptors
  • stimulated by acetylcholine
    *Meds that stimulate these receptors called cholinergics (nicotine)
    *Meds that depress receptors called anticholinergics (antipsychotics)
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5
Q

neurotransmitters

A

chemicals in nervous system that move impulses from neuron to neuron, or to muscles, or to other structures in body

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6
Q

what happens when glutamate (excitatory) has elevated levels

A

increased levels associated w/ psychotic symptoms

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7
Q

what happens when GABA (inhibitory) levels are low

A

associated with anxiety, mania, impulse control challenges

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8
Q

Dopamine essential in (3)

A
  • learning
  • emotion
  • executive function
  • ++ re-uptake associated w/ depression, because not enough dopamine in the brain
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9
Q

Serotonin (1)

A
  • role in mood
  • ++ re-uptake associated w/ depression
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10
Q

Epi/Norepi (1)

A
  • role in SNS
  • ++ re-uptake associated w/ depression
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11
Q

why does adherence matter? (1)

A
  • rebounding effects
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12
Q

Nursing role (5)

A
  1. setting expectations (when does med start working)
  2. taking experience seriously (acknowledge side effects)
  3. Setting up structures to support adherence (apps, alarms)
  4. Skill building (how does client go to pharmacy?)
  5. Insight (how & why meds work & relaying experience w/ med to healthcare team)
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13
Q

Types of medications (4)

A
  • antidepressants
  • antianxiety
  • mood stabilizers
  • antipsychotic meds
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14
Q

Antidepressants work by

A

increase neurotransmitters (serotonin, norepi, dopamine) in brain by blocking reuptake so that it exists in synapses for longer

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15
Q

antidepressant trial treatment

A

3 months (minimum tria)

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16
Q

Serotonin effects (3) and side effects (7)

A
  • mood regulation, sleep, digestion
  • agitation, insomnia, irritability, anxiety, N/V/D, sexual dysfunction, weight gain
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17
Q

Norepi effects (2) and side effects (2)

A
  • increases HR and cardiac workload
  • hypertension and tachycardia
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18
Q

1st line (selective) antidepressants (3)

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin and Norepi Reuptake Inhibitors (SNRIs)
  • Serotonin Antagonist and Reuptake Inhibitors
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19
Q

First-generation (less selective) antidepressants (2)

A
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Tricyclic Antidepressants (TCAs)
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20
Q

SSRIs suffix and examples

A

“-pram” & “-xetine”
- citalopram (Celexa)
- Escitalopram (Cipralex)
- Fluoxetine (prozac)
- Fluvaxoamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)

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21
Q

SSRI side effects

A

serotonin side effects: insomnia, NVD, weight gain, irritability, agitation, anxiety, sexual dysfunction

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22
Q

SSRI considerations (4)

A
  • monitor for manic episodes (uptake in BPD)
  • interact w/ MAOIs, risk for serotonin syndrome
  • monitor liver, kidney, WBC (hepatic & renal toxic)
  • Don’t stop abrupt
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23
Q

SNRIs suffix and examples

A

“-axine”
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Milnacipran (Ixel)
- Venlafaxine (Effexor)
- Levomilnacipran (Fetzima) (no serotonin syndrome risk)

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24
Q

SNRI side effects (2)

A
  • serotonin side effects (agitation, insomnia, sexual dysfunction, irritation, anxiety, weight gain, NVD
  • norepi (tachycardia & hypertension)
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25
Q

SNRI considerations (3)

A
  • monitor for manic episodes
  • interacts with MAOIs
  • risk for serotonin syndrome
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26
Q

TCAs suffixes and examples

A

“-ipyline” or “-ipramine”
- amitriptyline
- amoxapine
- clomipramine
- desipramine
- doxepin
- imipramine
- nortriptyline

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27
Q

TCAs works by

A
  • inhibiting reuptake of norepi (& some serotonin) increasing norepi/serotonin in synapse, also impacts acetylcholine
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28
Q

TCA side effects (8)

A
  • sero/norepi SEs
  • anticholinergic effects (ortho HTN, dry mouth, urinary retention, constipation, blurred vision)
  • sedation
  • arrythmias
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29
Q

TCAs nursing considerations

A
  • monitor for anticholinergic effects
  • monitor kidneys & liver
  • 1st generations, less selective and more side effects
30
Q

Anticholinergic effects (5) (blocking of acetylcholine)

A
  • dry mouth
  • urinary retention
  • dilated pupils/blurred vision
  • constipation
  • decrease gastric motility
31
Q

Key Points for TCAs (3)

A
  1. Orthostatic hypotension
    - Memory trick (MT): amitriptyline - Amy trips on things so need to change positions slowly
  2. Urinary retention
    - MT: Imipramine - inhibit my peeing
  3. NEVER take w/ MAOI
    - 2 week wash-out period
    - NO MAO + antidrepressants
32
Q

MAOI examples (4)

A
  • Moclobemide (manerix)
  • Pheneizine (Nardil)
  • Selegiline (Emsem)
  • Tranyclypromine (Partite)
33
Q

MAOIs action

A
  • monoamine oxidase breaks down sero/norepi, inhibits MAO, therefore reduce amount of sero/norepi broken down in brain and increases their concentration
34
Q

MAOIs SE (5)

A
  • sero/norepi
  • ortho hypo
  • weight gain
  • arrythmias
  • edema
35
Q

MAOIs consideration and caution

A

consider: monitor for serotonin syndrome & risk of hypertensive crisis
caution: drug-drug interactions and drug-food interactions

36
Q

what does MAO do in the GI system?

A

breaks down monoamines in food, so when MAO is inhibited its not being broken down which causes increased tyramine in the body

37
Q

what can tyramine lead to?

A

increase BP and hypertensive crisis so need to avoid tyramine rich foods when taking MAOIs

38
Q

Produce to avoid high in tyramine (FFFO 4)

A
  • overripe & dried fruits
  • fermented veggies (sauerkraut)
  • fermented soybean and tofu!!
  • fresh fruit should be consumed within 48 hours of purchase
39
Q

Produce to avoid high w/ tyramine (FFFO 4)

A
  • overripe & dried fruits
  • fermented veggies (sauerkraut)
  • fermented soybean and tofu!!
  • fresh fruit should be consumed within 48 hours of purchase
40
Q

Dairy to avoid w/ high tyramine

A

aged cheese

41
Q

Meats to avoid w/ high tyramine

A
  • aged, dried, fermented and pickled meets:
  • bacon, sausage, liverwurst, pepperoni, salami…
42
Q

Bread to avoid w/ high tyramine

A
  • homemade yeast bread
  • sourdough
  • no marmite
43
Q

Other food to avoid high w/ tyramine

A
  • soy sauce, fish sauce, beer from taps, some red and white wine
44
Q

serotonin syndrome (3)

A
  • altered mental status: agitation, anxiety, disorientation, restlessness, excitement
  • neuromuscular abnormalities: tremors, hyperreflexia, muscle rigidity, barbinski reflex
  • autonomic hyperactivity: hypertension, tachycardia, tachypnea, hyperthermia, diaphoresis, dry mucous membranes, flushed skin, V/D, hyperactive bowel sounds, arrhythmias
    PRESENTATION: SWEATY HOT FEVER
45
Q

when is serotonin syndrome developed and what interventions

A
  • developed within 24 hours of dose increase or med initiations (resolves 24 hrs with treatment)
    *discontinue med, O2, support vital signs, IV fluid infusion, cardiac monitoring, administer serotonin antagonists
46
Q

what does lithium do?

A

increase norepi reuptake and serotonin sensitivity

47
Q

Lithium side effects (5)

A
  • sedative
  • resp depression
  • tremors
  • agitation
  • hallucinations
48
Q

Lithium considerations (5)

A
  • monitoring narrow therapeutic range
  • routine blood work
  • hydration/salt intake teaching
  • S/S of diabetes insipidus (++thirst & urination)
  • increase risk for hypothyroid
49
Q

appropriate lithium level

A

0.6-1.2 mEq/L

50
Q

Lithium monitoring (4)

A
  1. serum lithium (dose increase monitor 12 hours post-dose; maintenance monitor q2-3 months)
  2. NA levels (impact lithium levels)
  3. renal function (can cause kidney disease so monitor for increasing creatinine, presence of proteinuria
  4. thyroid function (lithium inhibits thyroid hormone release from the thyroid gland)
51
Q

mild lithium toxicity

A

1.2-1.5
- metallic taste in mouth
- fine tremors, muscle weakness or fatigue
- polyuria, polydipsia
- D/V
- weight gain
- memory impair

52
Q

moderate lithium toxicity

A

1.5-2.5
- severe D/V/N
- dry mouth
- ataxia (abnormal movement)
- dizzy, sluggish, vertigo
- tinnitus
- slurred speech
- blurred vision

53
Q

severe lithium toxicity

A

over 2.5
- cardiac arrhythmias
- blackouts
- nystagmus
- tremor
- seizures, hallucinations, delirium
- renal failure
- confusion
- coma, death

54
Q

lithium health teaching (6)

A
  • take as prescribed
  • hydrate and monitor salts
  • avoid alcohol & drugs
  • avoid NSAIDs
  • avoid excessive caffeine
  • pregnancy prevention
55
Q

antianxiety medications

A
  • SSRIs
  • SNRIs
  • Benzodiazepines
  • Beta-blockers (short-acting impact on symptoms)
  • Pregabalin (anticonvulsant)
56
Q

Benzodiazepines suffix and examples

A

“-azepam”
- clonazepam (klonpin)
- diazepam (valium)
- lorazepam (Ativan)
- oxazepam (seraf)

57
Q

Benzo action

A

stimulates effects of GABA, decrease action of SNS

58
Q

Benzo SE

A
  • sedative
  • resp depression
  • tremors
  • agitation
  • hallucinations
59
Q

Benzo considerations

A
  • tolerance
  • misuse
  • dependence
  • consider safety of activities (driving)
  • alcohol use may exacerbate sedative effects
60
Q

2 types of antipsychotics

A
  1. typical antipsychotics (more side effects, 1st generation)
  2. atypical a (fewer SEs, newer)
    * couple days = reduce agitation/hallucinations
    *3-6 weeks = reduce delusions
61
Q

why SEs in antipsychotics?

A
  • dopamine receptor blockers
  • typical A = non-selective & block all dopamine receptors, dopamine can’t do normal job
  • AA = more selective, block selective dopamine receptors and allow more normal activities to continue of dopamine
62
Q

Typical A exampes

A
  • phenothiazines (chlorpromazine)
  • thioxanthenes
  • dibenzozaxepines (loxapine)
  • butrophenones
  • haloperidol (haldol)
  • dihydroidolones
63
Q

Typical A SEs

A
  • anticholinergic symptoms (urinary retention, dry mouth blurred vision, constipation)
  • drowsy, dizzy, restless
  • weight gain
  • N/D
  • low BP
  • increase prolactin (breast tissue leaking)
64
Q

Typical A cautions

A
  • risk for extrapyramidal symptoms/tardive dyskinesia
65
Q

Extrapyramidal SE (EPS)

A
  • akathisia (agitation, distress, restless)
  • rigidity
  • bradykinesia (slow movements)
  • tremor
  • dystonia (involuntary contractions of muscles of extremities, face, neck, abdo, pelvis, larynx) *most concerned about this cause could be a medical emergency cause of restrict airway
66
Q

how to treat EPS

A

anticholinergics (diphenhydramine, antihistamine)

67
Q

Atypical antipsychotics suffix and examples

A

“-apine”
- clozapine
- risperidone
- olanzapine (zyprexa)
- quetiapine (Seroquel)

68
Q

AA SEs

A
  • anticholinergic symptoms
  • sedative
  • hypotension
  • hypersalivation
  • cardiac (myocarditis, QT prolongation)
69
Q

AA cautions

A

risk for metabolic syndrome (less EPS risk)

70
Q

clozapine considerations

A
  • routine blood work to monitor for toxicity cause narrow therapeutic window
  • agranulocytosis – extreme low WBCs, monitor WBCs
71
Q

neuroleptic malignant syndrome

A
  • potentially fatal syndrome resulting from antipsychotics drugs
  • fever, altered mental status, muscle rigidity, autonomic dysfunction (instability in vitals)
  • developed over days to weeks, resolves within 7-9 days from treatment
  • can happen w/ both typical and atypical
72
Q

intervention for neuroleptic malignant syndrome

A
  • discontinue med
  • O2
  • support vital signs
  • IV fluid infusion
  • cardiac monitoring

Medication (4 decks)

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