Mental Health Drugs Flashcards
what is the function of GABA?
inhibitory neurotransmitter “sleep hormone”
what is the role of serotonin and norepinephrine?
contributes to sleep, mood, appetite, attentiveness, and emotions
what is the role of dopamine?
modulates mood, behavior, and emotion
what is the purpose of anxiolytics?
decrese ANXIETY and suppress CNS
what is the purpose of hypnotics?
SLEEP - the goal is to initiate and extend sleep, improve REM sleep
what do sedatives help with?
help pt sleep, but not restorative sleep
what tends to come with anxiety?
insomnia
what is the action of benzodiazepines?
increase the actions of GABA (sleep hormone)
what is the use of benzodiazepines?
- 1st choice for anxiety
- short term treatment for sleep (not restorative sleep)
what is the common ending for benzodiazepines?
-lam or -pam
do benzodiazepines help with restorative sleep?
no - helps with sleep but not restorative sleep
what side effects are seen with benzodiazepines?
- daytime sedation (not getting enough restorative sleep)
- dizziness and ataxia (impaired coordination)
- anterograde amnesia (decreased memory after dose)
- rebound insomnia
- respiratory depression
- fatigue, muscle weakness, dry mouth, nausea, and vomiting
what benzodiazepine is used for alcohol withdrawal?
lorazepam (Ativan)
what are some examples of benzodiazepines?
- diazepam (Valium)
- chlordiazepoxide (Librium)
- flurazepam (Dalmane)
- alprazolam (Xanax)
- lorazepam (Ativan)
- temazepam (Restoril)
what route are benzodiazepines given?
all are PO
- ativan can be given IV but causes a risk of hypotension, cardiac arrest, and respiratory arrest, life-threatening reaction in 2% of patients
what is the antidote for benzodiazepines?
flumazenil (Romazicon)
what should never be used with benzodiazepines?
alcohol/ethanol because they are both respiratory depressants
what are the symptoms of benzodiazepines overdose?
- respiratory depression
- hypotension
- depression
- confusion
- lethargy
there is a high risk of what with benzodiazepines?
abuse
what is the treatment for benzodiazepines overdose?
- airway management
- gastric lavage
- flumazenil (Romazicon)
what is the action of benzodiazepine-like drugs?
bind to GABA receptor sites (sleep hormone)
what is the use for benzodiazepine-like drugs?
insomnia (not anxiety)
what are examples of benzodiazepine-like drugs?
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
what is the duration of zolpidem (Ambien)? what is the onset like?
- duration is 6-8 hours
- rapid onset
what is the purpose of zaleplon (Sonata)? what is duration like?
- helps fall asleep, but not stay asleep
- short-acting
what is the use like for eszopiclone (Lunesta)? what is the onset like? what is the downside?
- no limits on the length of use
- rapid onset
- bitter aftertaste
what is the use for melatonin agonist ramelteon (rozerem)?
chronic insomnia
what is the onset like for melatonin agonist ramelteon (rozerem)?
rapid onset
what is the action of melatonin agonist ramelteon (rozerem)?
a newer medication that activates the receptors for melatonin
what is the use for melatonin?
- insomnia
- jet lag
what is the component in melatonin
tryptophan (turkey)
what gland is melatonin associated with?
pineal gland
what does melatonin help with the release of?
sleep-wake cycle
- released while sleeping
what is the action of barbiturates?
- enhance actions of GABA
- directly mimic GABA receptors
(sleep hormone)
what is the negative of barbiturates?
cause tolerance/dependence
- high potential for abuse
what would barbiturates be used for?
- seizures (epilepsy)
- surgery (general anesthesia)
what is the common ending for barbiturates?
-tal
what are some examples of barbiturates?
- phenobarbital (luminal)
- secobarbital (seconal)
- thiopental (pentothal)
what are the side effects of barbiturates?
- CNS: drowsiness, lethargy
- powerful respiratory depressant
- CV: bradycardia, hypotension
what kind of patient should not be prescribed barbiturates?
a depressed patient because of increased risk of suicide with barbiturate overdose
what should nurses know about barbiturates?
- short term use (except in seizure patients)
- discontinue ASAP
- not for pain control
- infrequent use because it is dangerous
what are the symptoms of barbiturate overdose?
- respiratory depression
- coma
- pinpoint pupils
what is the antidote for barbiturates?
there is no antidote (makes overdose even worse)
what are the different types of antidepressants?
TCA’s, SSRI’s, MAOI’s, SNRIS
what is the action of tricyclic antidepressants (TCAs)?
block the uptake of norepinephrine and serotonin/5-HT (sleep, mood, appetite, attentiveness, and emotions)
what are tricyclic antidepressants (TCAs) used for?
- depression
- bipolar
- OCD
- insomnia
- ADHD
what are some examples of tricyclic antidepressants (TCAs)?
- amitriptyline
- imipramine
what are the side effects of tricyclic antidepressants (TCAs)?
- orthostatic hypotension
- anticholinergic
- sedation
- dysrhythmias
- seizures
- hypomania
what is a negative of tricyclic antidepressants (TCAs)?
overdose can lead to death
what is the action of selective serotonin reuptake inhibitors (SSRIs)?
inhibit the reuptake of serotonin (creates a higher concentration of serotonin)
what are selective serotonin reuptake inhibitors (SSRIs) used for?
- DEPRESSION
- anxiety
- OCD
- panic
- ptsd
- bulimia nervosa
- bipolar (adjunct therapy)
what are some examples of selective serotonin reuptake inhibitors (SSRIs)?
- Prozac
- Celexa
- Lexapro
- Luvox (OCD)
- Paxil
- Zoloft
what is the most commonly prescribed selective serotonin reuptake inhibitor (SSRI)? explain more about it…
Prozac
- takes 1-3 weeks to be effective
- half-life is 7-15 days so pt would need a washout period before starting a new drug
- washout period is 5 weeks for MAOIs
what are some side effects of selective serotonin reuptake inhibitors (SSRIs)?
- serotonin syndrome
- withdrawal syndrome
- neonatal effects when used late in pregnancy
- sexual dysfunction (70% decrease sex drive)
- weight gain, nausea, headache,
- increased suicide ideation
- hyponatremia
- GI issues (improves with food and time)
what is serotonin syndrome? how do you treat it? what are the signs and symptoms?
- too much serotonin
- treatment: stop drug
- agitation, confusion, hallucinations, hyperreflexia, tremor, and fever
what happens with selective serotonin reuptake inhibitors (SSRIs) use in late pregnancy?
the baby goes through withdrawal and will have extreme crying
what are the drug interactions for selective serotonin reuptake inhibitors (SSRIs)?
- monoamine oxidase inhibitors (MAOIs - would cause serotonin syndrome and would need a five-week wash out before)
- warfarin
- tricyclic antidepressants and lithium
what are the signs and symptoms of depression? what are the qualifications?
symptoms must be present most of the day, nearly every day for at least 2 weeks
- depressed mood
- loss of interest
- feeling worthless/sad
- weight loss/gain
why does the risk of suicide increase during early treatment with antidepressents? what should patients be observed for?
pts have a sudden burst of “energy” to potentially commit suicide
- watch for suicide ideation, worsening mood, changes in behavior such as mania
- patients and families should be educated on this
how do you address suicide with a patient?
clear and direct to receive a clear and direct response
how does a doctor choose selective serotonin reuptake inhibitors (SSRIs), select dosing, and know when to increase?
- doctor has a personal preference
- dosing is based on age and weight
- after a period of time the doctor will increase based on age and weight
what are monoamine oxidase inhibitors (MAOIs)? why would they be used?
2nd or 3rd choice antidepressants
- more dangerous and would only be used if a patient isn’t responding to another drug
what are the uses for monoamine oxidase inhibitors (MAOIs)?
- depression
- anxiety
- panic
- OCD
- bulimia nervosa
what is the action of monoamine oxidase inhibitors (MAOIs)?
prevent the breakdown of tyramine
- tyramine promotes the release of norepinephrine causing severe vasoconstriction
what do monoamine oxidase inhibitors (MAOIs) react badly with?
tyramine - foods that are high in tyramine:
- avocado
- soybean paste
- bean curd
- cheeses
- beer
- wine
- smoked meats and sausages
what is a potentially dangerous side effect of monoamine oxidase inhibitors (MAOIs)? how would you treat it?
hypertensive crisis from tyramine
- IV phentolamine
- IV labetalol
- SUBLINGUAL NIFEDIPINE
what are some side effects of monoamine oxidase inhibitors (MAOIs)?
- headache
- orthostatic hypotension
- tachycardia
- palpitations
- N/V
- confusion
- profuse sweating
what are some examples of monoamine oxidase inhibitors (MAOIs)?
- phenelzine (Nardil)
- selegine (emsam)
what is bupropion (Wellbutrin)?
an atypical antidepressant
what is the action of bupropion (Wellbutrin)?
blocks the uptake of dopamine and norepinephrine
- does not affect serotonin
what is bupropion (Wellbutrin) used for?
- smoking cessation
- ADHD
- depression
- seasonal affective disorder
how long does it take for bupropion (Wellbutrin) to work?
1-3 weeks
what are two benefits that bupropion (Wellbutrin) has, that many antidepressants don’t?
- increases sexual desire
- doesn’t cause weight gain (suppresses appetite)
what are some adverse effects of bupropion (Wellbutrin)?
- seizures (don’t take with history of seizures)
- increased agitation
- weight loss
- hand tremors
what is the action of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
block reuptake of 5-HT & NE
what are the uses for serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- major depression
- generalized anxiety disorder
- social anxiety disorders
what is one abnormal use of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
specifically, Cymbalta helps with fibromyalgia
what are 3 examples of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- venlafaxine (effexor)
- duloxetine (cymbalta)
- desvenlafaxine (Pristiq)
what are some side effects of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- nausea
- headache
- sexual dysfunction
what is mirtazapine (Remeron)?
an antidepressant without a category (effects serotonin)
what is the use of mirtazapine (Remeron)?
sleep issues and eating disorders (causes weight gain)
what is trazodone (Desyrel)?
an antidepressant without a category (effects serotonin)
what is trazodone (Desyrel) used for?
depression-related insomnia (adjunct therapy, sedative effect)
what is the action of conventional antipsychotics 1st generation?
- block a variety of receptors within and outside of the CNS
- decrease levels of dopamine to suppress undesirable behaviors
what are the uses of conventional antipsychotics 1st generation?
- schizophrenia
- bipolar disorder (manic depressive illness)
- Tourette’s syndrome
- prevention of emesis
what are the drug interactions of conventional antipsychotics 1st generation?
- anticholinergic drugs
- CNS depressants
- levodopa (antiparkinsons and direct dopamine receptor agonists)
what are the adverse effects of conventional antipsychotics 1st generation?
extrapyramidal symptoms (EPS)
- acute dystonia - onset within hours and if it is not treated it will turn into tardive dyskinesia
- parkinsonism onset - 5-30 days
- tardive dyskinesia - with long-term use, no treatment
how would you treat acute dystonia related to conventional antipsychotics 1st generation?
with diphenhydramine
what is a neuroleptic malignant syndrome?
rare but serious disease seen with conventional antipsychotics 1st generation
- risk of death without treatment
- sweating, rigidity, sudden high fever, automatic instability
what is an example of a low potency conventional antipsychotic 1st generation? what is used for? what are the side effects?
chlorpromazine (Thorazine)
- used for schizophrenia, manic phase of bipolar, hiccups
- side effects are sedation, hypotension, and anticholinergic
what is an example of a medium potency conventional antipsychotic 1st generation? what is used for?
loxapine (Loxitane)
- schizophrenia (acute agitation) and bipolar disorder
what is an example of a high potency conventional antipsychotic 1st generation? what is used for? what are the side effects?
haloperidol (Haldol)
- used for Tourette’s syndrome and agitation
- side effects are early EPS and prolonged QT intervals causing serious dysrhythmias
what does low and high potency related to conventional antipsychotic 1st generation mean?
low potency - means they would need a really high dose to be effective like 600mg
high potency - means a small dose would be effective like 4mg
what are examples of 2nd generation agents: atypical antipsychotic agents
- clozapine
- risperdal
- zyprexa
- abilify
- lithium carbonate
- depot preparation
what is a benefit of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?
- fewer EPS (extrapyramidal side effects, commonly referred to as drug-induced movement disorders)
what is a negative of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?
increased metabolic problems
- increased cholesterol
- increased blood sugar
- increased weight gain
what is the action of clozapine?
blocks receptors of dopamine and serotonin
what are the uses for clozapine?
- schizophrenia
- levodopa-induced psychosis ( a side effect of a treatment for Parkinson’s disease - can alleviate the symptoms of PD without making them worse)
what are the adverse effects of clozapine?
- agranulocytosis (drop in WBC)
- seizures
- diabetes (not often used in diabetics)
- weight gain
- myocarditis
- effects in elderly patients with dementia
what is risperidone (Risperdal) used for?
- schizophrenia (PO or IM for long term therapy)
- bipolar disorder
- autism
- Alzheimer’s disease
what is olanzapine (Zyprexa) used for?
- schizophrenia
- bipolar
- off label use: nausea and vomiting caused by chemo
what are the adverse effects of olanzapine (Zyprexa)?
- low risk of EPS
- high risk of metabolic issues
- weight gain
what is the action of aripiprazole (Abilify)?
blocks multiple receptors
what is the benefit of aripiprazole (Abilify)?
generally well tolerated
what is aripiprazole (Abilify) used for?
- major depressive disorder
- bipolar disorder
- schizophrenia
what is lithium carbonate (Lithobid) used for?
bipolar disorder (prevent manic episodes)
what is the dosing like with carbonate (Lithobid)?
- begin with low doses and increase slowly
- doses will vary with patients
- monitor serum level (lithium toxicity)
what are depot antipsychotic preparations?
long-acting injectables used for long term maintenance for schizophrenia
what are the side effects of depot antipsychotic preparations?
no long term risks
what is the benefit of depot antipsychotic preparations?
IM injection every 4 weeks
- good for patients who forget to take meds
what are the three depot antipsychotic preparations available?
- haloperidol decanoate (haldol decanoate)
- fluphenazine decanoate (prolixin decanoate)
- risperidone microspheres (risperdal consta)
