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mental health > Meds exam 2 > Flashcards

Meds exam 2 Flashcards

1
Q

Lithium

(Category, intended actions)

A

Drug Category: Mood stabilizers
What other frequently prescribed medications are in this category? Carbamazepine, risperidone
Intended Action (s): resolve symptoms of mania (hyperactivity, pressured speech, poor judgment), decreased incident of mood swings, etc.

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2
Q

Lithium

(SE & AE)

A

Common Side Effects: fatigue, HA, impaired memory, EKG changes, hypothyroidism, abdominal pain, N/V, leukocytosis, muscle weakness, tremors, polydypsia, polyuria
Adverse Side Effects: seizures, serotonin syndrome

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3
Q

Lithium

(nursing implications, teaching priorities)

A

Patient Teaching Priorities: changes in sodium will alter the elimination of lithium. Increased sodium intake will increase the renal excretion of lithium.
Nursing Implications: very narrow therapeutic range (0.6-1.2), monitor levels closely and teach patient they will need to get blood work periodically. Look for lithium toxicity (vomiting, diarrhea, slurred speech, lightheadedness, decreased coordination, drowsiness, muscle weakness, tremors, seizures). Stop drug administration if toxicity. Worried also about potassium levels with the salt intake. Not having enough sodium can lead to increased reuptake of lithium→ toxicity. Prelithium workup → cardiac and renal status. Adequate sodium and fluid intake. Teach pt to wear sunscreen

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4
Q

Depakote

(Category, intended actions)

A

Drug Category: Valproate, anticonvulsant
What other frequently prescribed medications are in this category: carbamazepine, Lamotrigine, Phenytoin
Intended Action(s): increase levels of GABA, → decrease manic episodes

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5
Q

Depakote

SE/AE

A

Common Side Effects: agitation, dizziness, HA, insomnia, sedation, abdominal pain, diarrhea, N/V, tremors, thrombocytopenia
Adverse Side Effects: suicidal thoughts, hepatotoxicity, pancreatitis, hypothermia, hyperammonemia, agranulocytosis, aplastic anemia

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6
Q

Depakote

nurse impl, pt ed

A

Patient Teaching Priorities: abrupt withdrawal of drug may lead to seizures
Nursing Implication: assess for suicidal tendencies, restrict amount of drug available to pt. Looks for s/s of DRESS (drug reaction with eosinophilia and systemic symptoms) (fever, rash, lymphadenopathy, myocarditis, etc.) monitor hepatic function and serum ammonia levels. Discontinue therapy if hyperammonemia occurs.

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7
Q

Valproic acid/tegratol

category, action

A

Drug Category: Anticonvulsant, mood stabilizer
What other frequently prescribed medications are in this category? (Gabapentin), Valproic acid, (Phenytoin)
Intended Action (s): prevention of seizures, relief of neuralgia pain, decreased mania and depressive symptoms.

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8
Q

Valproic acid/tegratol

SE/AE

A

Common Side Effects: Suicidal thoughts ataxia, drowsiness fatigue. Hepatotoxicity, pancreatitis. Agranulocytosis, anemia, thrombocytopenia.
Adverse Side Effects: blood cell abnormalities, could result in bone marrow depression

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9
Q

Valproic acid/tegratol

nurse imp, pt ed

A

Patient Teaching Priorities: take doses around the clock as directed and take missed doses ASAP but not right before the next dose. Discontinue gradually to prevent seizures. Avoid grapefruit and grapefruit juice during therapy. Report changes in skin, behavior, rash, sore throat, suicidal thoughts, etc.
Nursing Implications: for bipolar: assess mental status and cognitive abilities before and during therapy. Monitor labs for the first 2 months.

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10
Q

Lamotrigine (Lamictal)

class, use

A

Anticonvulsent, esp in peds, used in BPD and Mania

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11
Q

Lamotrigine/Lamictal

SE, AE, caution

A

Significant AE: Stevens Johnson syndrome, hold and call provider if rash
Common SE
weight changes
sedation
upset stomach
Caution in hepatic and renal impairment

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12
Q

SSRIs

drugs, uses

A

Example drug: Zoloft
generic and trade: Sertraline
What other frequently prescribed medications are in this category? Include 2-3 examples: Fluoxetine (Prozac), Citalopam (Celexa), Escitalopam (lexapro), Fluvoxamine (Luvox)

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13
Q

SSRIs

SE/AE

A

Common Side Effects: suicide ideation, nausea, insomnia, dry mouth, HA, sexual dysfunction
Adverse Side Effects: serotonin syndrome, Agitation, diaphoresis

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14
Q

SSRIs

nurse imp, pt ed

A

Patient Teaching Priorities: Take at same time every morning
Nursing Implication: Teach patient that effects may take 4-6 weeks to take effect, report SI

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15
Q

TCAs

meds, uses

A

Name (generic and trade): clomipramine (anafranil) (first med for OCD)
What other frequently prescribed medications are in this category? Include 2-3 examples: Amitriptyline (Elavil), Imipramine (Trofanil), Noritryptaline (pamelor), Doxepin (sinequan)
Intended Action(s): depression, OCD, migraines, smoking cessation

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16
Q

TCAs

SE/AE

A

Common Side Effects: drowsiness, dry mouth, sexual problems
Adverse Side Effects: anticholinergic effects, delirium

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17
Q

TCAs

nurse imp, pt ed

A

Patient Teaching Priorities: TCA’s are sedative so take before bed
Nursing Implications: monitor for suicide ideation and orthostatic hypotension, high suicide effectiveness, high cost

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18
Q

MAOIs

drugs, uses

A

Example drug: Selegiline
generic and trade: edepryl, emsam
What other frequently prescribed medications are in this category? Include 2-3 examples: phenelzine (nardil), tranylcypromine (parnate), isocarboxazid (Marplan), Moclobemide (Manerix, RIMA)
Intended Action(s): depression, panic, social anxiety

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19
Q

MAOIs

SE/AE

A

Common Side Effects: runny nose, itching, skin rash
Adverse Side Effects: hypertensive crisis

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20
Q

MAOIs

nurse imp, pt ed

A

Patient Teaching Priorities: warn patients about signs of hypertensive crisis (headache, shortness of breath, headache, changes in vision), avoid eating tyramine (aged cheese, avocados, chinese food)
Nursing Implication: Monitor blood pressure

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21
Q

Serotonin syndrome

s/s

A

Confusion, muscle rigidity, diaphoresis, increased HR, fluctuating BP

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22
Q

Serotonin syndrome

nursing imp

A

vitals, reorient, when was the last med? hold all meds, talk to provider about what you see

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23
Q

Hypertensive crisis

A

from MAOIs, especially when taken with other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (Buspar) or if the patient has tyramine

24
Q

Benzos

drugs, uses

A

What other frequently prescribed medications are in this category? Chlordiazepoxide (Librium), Diazepam (Valium), Clonazepam (Klonopin), Alprazolam (Xanax), Chlorazepate (Tranxene), Midazolam (Virsed)
Lorazepam (Ativan) – short half-life, intermediate onset
Diazepam (Valium) – long half-life, fast acting
Intended Action(s): Depress CNS by potentiating GABA, resulting in sedation, decreased anxiety, and decreased seizures (Used during ECT), short term in alc withdrawl

25
Q

Benzos

SE/AE

A

Common Side Effects: Dizziness, drowsiness, lethargy, forgetfulness, confusion, constipation, feelings of detachment, irritability, hostility,
Adverse Side Effects: Respiratory depression, cardiac arrest (rapid IV usage), tolerance, physical dependence, rebound anxiety.

26
Q

Benzos

nursing imp, pt ed

A

Patient Teaching Priorities: This is a medication for short term use, and the dosage must be decreased gradually to minimize withdrawal symptoms (tremors, nausea, vomiting, abdominal, agitation, tremors, seizures and muscle cramps)
Nursing Implications: Flumazenil (Romazicon) is antidote if overdose, evaluate for too much CNS depression or potential for abuse.

27
Q

Clonidine

use, category

A

Treats physical symptoms associated with anxiety like tremors/diaphoresis/hypertension, also used for ADHD, can be used in withdrawl to help with symptoms
Category: Non-benzo anxiolytics, alpha 2 receptor agonist

28
Q

Clonidine

SE, nursing imp

A

Side effects: palpations, tachycardia, bradycardia, constipation, dry mouth sedation, rebound syndrome (increase in anxiety)
Check BP, monitor for hypotension, falls precaution, watch for rebound hypertension

29
Q

Disulfiram (antabuse)

use, SE, pt ed, nuring imp

A

alc deterant
SE: Rash, acne, HA, taste changes impotence
Cannot drink with med, start with flushing, increased heart rate, headache, can progress to life threatening rxn, so they even need to check things like mouthwash for alcohol
monitor liver function

30
Q

Acomprosate (campral)

A

prevents reengaging with alc
SE: GI upset, myalgia, arthritis, HA, dry mouth
poor compliance
monitor kidney function

31
Q

Naltrexone

A

opioid antagonist, helps them stay away from substance, can be long acting/given monthly
SE: N, HA, Dysphoria, elevated liver enzymes
Monitor liver enzymes
injection site reactions

32
Q

Buprenorphine

A

opiod substitute
partial opioid agonist/antagonist
SE: N/V, constipation, dry mouth
can cause precipitated withdrawal
watch for sedation and respiratory depression

33
Q

Methadone

A

synthetic opioid agonist
SE: N/V/C, dry mouth, sexual dysfunction, menstrual irregularities, weight gain, prolonged QT
Watch for sedation, respiratory depression
* Drug interactions
* Get baseline EKG

34
Q

Naltrexone (Revia, Vivitrol)

A

opioid antagonist
SE: N, HA, dysphoria, elevated liver enzymes
monitor liver enzymes
injection site rxns

35
Q

Haloperidol/Haldol

A

d, traditional antipsychotic

36
Q

Fluphenazine/prolixin

A

d, traditional antipsychotic

37
Q

chlorpromazine/thorazine

A

antipsychotic

38
Q

decanote

A

long acting dosing version, d

39
Q

risperidone

A

d, atypical antipsychotics

40
Q

Clozapine

A

atypical antipsychotics (AE)

41
Q

olanzapine/zyprexa

A

d, atypical antipsychotics

42
Q

Ziprasidone/geodon

A

atypical antipsychotics

43
Q

aripiprazole/abilify

A

d, atypical antipsychotics

44
Q

Quetiapine/seroquel

A

atypical antipsychotics

45
Q
A
46
Q

Side effect of antipsychotics

A

EPS – tardive dykinesia, acute dystonia, akathesia (restlessness), pseudoparkinsonism, anticholinergic effects (especially hypotension)
blurred vision, dry mouth, sedation
weight gain
orthostatic hypotension
lowers seizure threshold
neuroleptic malignant syndrome → mental status change, rigidity, fever, diaphoresis, hypertension
agranulocytosis, more with atypicals → cold/flu-like symtoms
photosensitivity
cardiac arrhythmias

47
Q

Nursing things to be aware of with antipsychotics

A

be aware of fevers or increased HR
look at available PRNs like cogentin or benadryl for side effects
Valbenazine (Ingrezza) SE: balance problems, HA, anticholinergic effects / AE: QT prolongation, somnolence, Parkinson’s S&S
teach pt to wear sunscreen especially with traditional antipsychotics
for agranulocytosis or NMS discontinue med and treat symptoms
monitor glucose, lipids and cholesterol periodically
monitor for agranulocytosis
use abnormal involuntary movement scale
importance of adherence

48
Q

daytrana

A

patch, methylphenidate, psychostimulants

49
Q

adderall, vyvanse

A

amphetamine, psychostimulants

50
Q

psychostimulants

AE

A

tics/stereotypical movements
anxiety
insomnia
rebound headaches

51
Q

psychostimulants

nursing implications

A

assess weight/height, may need to take breaks
potential for abuse by others

52
Q

Traditional vs atypical antipsychotics

A

Tradionals are more rapid acting and sedating, but have more side effects. Atypicals are cheaper with less side effects

53
Q

Aricept/donepezil

A

for dementia
increases Ach for mild-moderate disease

54
Q

Rivastigmine/exelon

A

dementia, patch, concern of them taking it off,

55
Q

memantine/Namenda

A

dementia, moderate to severe, slow degeneration

55
Q
A
56
Q

Namzaric (donepezil + memantine)

A

dementia, ER

mental health (6 decks)

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