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Pharm Exam 3 > Mental Health Drugs > Flashcards

Mental Health Drugs Flashcards

1
Q

what is the function of GABA?

A

inhibitory neurotransmitter “sleep hormone”

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2
Q

what is the role of serotonin and norepinephrine?

A

contributes to sleep, mood, appetite, attentiveness, and emotions

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3
Q

what is the role of dopamine?

A

modulates mood, behavior, and emotion

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4
Q

what is the purpose of anxiolytics?

A

decrese ANXIETY and suppress CNS

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5
Q

what is the purpose of hypnotics?

A

SLEEP - the goal is to initiate and extend sleep, improve REM sleep

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6
Q

what do sedatives help with?

A

help pt sleep, but not restorative sleep

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7
Q

what tends to come with anxiety?

A

insomnia

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8
Q

what is the action of benzodiazepines?

A

increase the actions of GABA (sleep hormone)

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9
Q

what is the use of benzodiazepines?

A
  • 1st choice for anxiety

- short term treatment for sleep (not restorative sleep)

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10
Q

what is the common ending for benzodiazepines?

A

-lam or -pam

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11
Q

do benzodiazepines help with restorative sleep?

A

no - helps with sleep but not restorative sleep

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12
Q

what side effects are seen with benzodiazepines?

A
  • 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
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13
Q

what benzodiazepine is used for alcohol withdrawal?

A

lorazepam (Ativan)

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14
Q

what are some examples of benzodiazepines?

A
  • diazepam (Valium)
  • chlordiazepoxide (Librium)
  • flurazepam (Dalmane)
  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • temazepam (Restoril)
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15
Q

what route are benzodiazepines given?

A

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

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16
Q

what is the antidote for benzodiazepines?

A

flumazenil (Romazicon)

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17
Q

what should never be used with benzodiazepines?

A

alcohol/ethanol because they are both respiratory depressants

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18
Q

what are the symptoms of benzodiazepines overdose?

A
  • respiratory depression
  • hypotension
  • depression
  • confusion
  • lethargy
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19
Q

there is a high risk of what with benzodiazepines?

A

abuse

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20
Q

what is the treatment for benzodiazepines overdose?

A
  • airway management
  • gastric lavage
  • flumazenil (Romazicon)
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21
Q

what is the action of benzodiazepine-like drugs?

A

bind to GABA receptor sites (sleep hormone)

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22
Q

what is the use for benzodiazepine-like drugs?

A

insomnia (not anxiety)

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23
Q

what are examples of benzodiazepine-like drugs?

A
  • zolpidem (Ambien)
  • zaleplon (Sonata)
  • eszopiclone (Lunesta)
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24
Q

what is the duration of zolpidem (Ambien)? what is the onset like?

A
  • duration is 6-8 hours

- rapid onset

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25
Q

what is the purpose of zaleplon (Sonata)? what is duration like?

A
  • helps fall asleep, but not stay asleep

- short-acting

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26
Q

what is the use like for eszopiclone (Lunesta)? what is the onset like? what is the downside?

A
  • no limits on the length of use
  • rapid onset
  • bitter aftertaste
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27
Q

what is the use for melatonin agonist ramelteon (rozerem)?

A

chronic insomnia

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28
Q

what is the onset like for melatonin agonist ramelteon (rozerem)?

A

rapid onset

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29
Q

what is the action of melatonin agonist ramelteon (rozerem)?

A

a newer medication that activates the receptors for melatonin

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30
Q

what is the use for melatonin?

A
  • insomnia

- jet lag

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31
Q

what is the component in melatonin

A

tryptophan (turkey)

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32
Q

what gland is melatonin associated with?

A

pineal gland

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33
Q

what does melatonin help with the release of?

A

sleep-wake cycle

- released while sleeping

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34
Q

what is the action of barbiturates?

A
  • enhance actions of GABA
  • directly mimic GABA receptors
    (sleep hormone)
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35
Q

what is the negative of barbiturates?

A

cause tolerance/dependence

- high potential for abuse

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36
Q

what would barbiturates be used for?

A
  • seizures (epilepsy)

- surgery (general anesthesia)

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37
Q

what is the common ending for barbiturates?

A

-tal

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38
Q

what are some examples of barbiturates?

A
  • phenobarbital (luminal)
  • secobarbital (seconal)
  • thiopental (pentothal)
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39
Q

what are the side effects of barbiturates?

A
  • CNS: drowsiness, lethargy
  • powerful respiratory depressant
  • CV: bradycardia, hypotension
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40
Q

what kind of patient should not be prescribed barbiturates?

A

a depressed patient because of increased risk of suicide with barbiturate overdose

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41
Q

what should nurses know about barbiturates?

A
  • short term use (except in seizure patients)
  • discontinue ASAP
  • not for pain control
  • infrequent use because it is dangerous
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42
Q

what are the symptoms of barbiturate overdose?

A
  • respiratory depression
  • coma
  • pinpoint pupils
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43
Q

what is the antidote for barbiturates?

A

there is no antidote (makes overdose even worse)

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44
Q

what are the different types of antidepressants?

A

TCA’s, SSRI’s, MAOI’s, SNRIS

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45
Q

what is the action of tricyclic antidepressants (TCAs)?

A

block the uptake of norepinephrine and serotonin/5-HT (sleep, mood, appetite, attentiveness, and emotions)

46
Q

what are tricyclic antidepressants (TCAs) used for?

A
  • depression
  • bipolar
  • OCD
  • insomnia
  • ADHD
47
Q

what are some examples of tricyclic antidepressants (TCAs)?

A
  • amitriptyline

- imipramine

48
Q

what are the side effects of tricyclic antidepressants (TCAs)?

A
  • orthostatic hypotension
  • anticholinergic
  • sedation
  • dysrhythmias
  • seizures
  • hypomania
49
Q

what is a negative of tricyclic antidepressants (TCAs)?

A

overdose can lead to death

50
Q

what is the action of selective serotonin reuptake inhibitors (SSRIs)?

A

inhibit the reuptake of serotonin (creates a higher concentration of serotonin)

51
Q

what are selective serotonin reuptake inhibitors (SSRIs) used for?

A
  • DEPRESSION
  • anxiety
  • OCD
  • panic
  • ptsd
  • bulimia nervosa
  • bipolar (adjunct therapy)
52
Q

what are some examples of selective serotonin reuptake inhibitors (SSRIs)?

A
  • Prozac
  • Celexa
  • Lexapro
  • Luvox (OCD)
  • Paxil
  • Zoloft
53
Q

what is the most commonly prescribed selective serotonin reuptake inhibitor (SSRI)? explain more about it…

A

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
54
Q

what are some side effects of selective serotonin reuptake inhibitors (SSRIs)?

A
  • 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)
55
Q

what is serotonin syndrome? how do you treat it? what are the signs and symptoms?

A
  • too much serotonin
  • treatment: stop drug
  • agitation, confusion, hallucinations, hyperreflexia, tremor, and fever
56
Q

what happens with selective serotonin reuptake inhibitors (SSRIs) use in late pregnancy?

A

the baby goes through withdrawal and will have extreme crying

57
Q

what are the drug interactions for selective serotonin reuptake inhibitors (SSRIs)?

A
  • monoamine oxidase inhibitors (MAOIs - would cause serotonin syndrome and would need a five-week wash out before)
  • warfarin
  • tricyclic antidepressants and lithium
58
Q

what are the signs and symptoms of depression? what are the qualifications?

A

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
59
Q

why does the risk of suicide increase during early treatment with antidepressents? what should patients be observed for?

A

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
60
Q

how do you address suicide with a patient?

A

clear and direct to receive a clear and direct response

61
Q

how does a doctor choose selective serotonin reuptake inhibitors (SSRIs), select dosing, and know when to increase?

A
  • 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
62
Q

what are monoamine oxidase inhibitors (MAOIs)? why would they be used?

A

2nd or 3rd choice antidepressants

- more dangerous and would only be used if a patient isn’t responding to another drug

63
Q

what are the uses for monoamine oxidase inhibitors (MAOIs)?

A
  • depression
  • anxiety
  • panic
  • OCD
  • bulimia nervosa
64
Q

what is the action of monoamine oxidase inhibitors (MAOIs)?

A

prevent the breakdown of tyramine

- tyramine promotes the release of norepinephrine causing severe vasoconstriction

65
Q

what do monoamine oxidase inhibitors (MAOIs) react badly with?

A

tyramine - foods that are high in tyramine:

  • avocado
  • soybean paste
  • bean curd
  • cheeses
  • beer
  • wine
  • smoked meats and sausages
66
Q

what is a potentially dangerous side effect of monoamine oxidase inhibitors (MAOIs)? how would you treat it?

A

hypertensive crisis from tyramine

  • IV phentolamine
  • IV labetalol
  • SUBLINGUAL NIFEDIPINE
67
Q

what are some side effects of monoamine oxidase inhibitors (MAOIs)?

A
  • headache
  • orthostatic hypotension
  • tachycardia
  • palpitations
  • N/V
  • confusion
  • profuse sweating
68
Q

what are some examples of monoamine oxidase inhibitors (MAOIs)?

A
  • phenelzine (Nardil)

- selegine (emsam)

69
Q

what is bupropion (Wellbutrin)?

A

an atypical antidepressant

70
Q

what is the action of bupropion (Wellbutrin)?

A

blocks the uptake of dopamine and norepinephrine

- does not affect serotonin

71
Q

what is bupropion (Wellbutrin) used for?

A
  • smoking cessation
  • ADHD
  • depression
  • seasonal affective disorder
72
Q

how long does it take for bupropion (Wellbutrin) to work?

A

1-3 weeks

73
Q

what are two benefits that bupropion (Wellbutrin) has, that many antidepressants don’t?

A
  • increases sexual desire

- doesn’t cause weight gain (suppresses appetite)

74
Q

what are some adverse effects of bupropion (Wellbutrin)?

A
  • seizures (don’t take with history of seizures)
  • increased agitation
  • weight loss
  • hand tremors
75
Q

what is the action of serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A

block reuptake of 5-HT & NE

76
Q

what are the uses for serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A
  • major depression
  • generalized anxiety disorder
  • social anxiety disorders
77
Q

what is one abnormal use of serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A

specifically, Cymbalta helps with fibromyalgia

78
Q

what are 3 examples of serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A
  • venlafaxine (effexor)
  • duloxetine (cymbalta)
  • desvenlafaxine (Pristiq)
79
Q

what are some side effects of serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A
  • nausea
  • headache
  • sexual dysfunction
80
Q

what is mirtazapine (Remeron)?

A

an antidepressant without a category (effects serotonin)

81
Q

what is the use of mirtazapine (Remeron)?

A

sleep issues and eating disorders (causes weight gain)

82
Q

what is trazodone (Desyrel)?

A

an antidepressant without a category (effects serotonin)

83
Q

what is trazodone (Desyrel) used for?

A

depression-related insomnia (adjunct therapy, sedative effect)

84
Q

what is the action of conventional antipsychotics 1st generation?

A
  • block a variety of receptors within and outside of the CNS

- decrease levels of dopamine to suppress undesirable behaviors

85
Q

what are the uses of conventional antipsychotics 1st generation?

A
  • schizophrenia
  • bipolar disorder (manic depressive illness)
  • Tourette’s syndrome
  • prevention of emesis
86
Q

what are the drug interactions of conventional antipsychotics 1st generation?

A
  • anticholinergic drugs
  • CNS depressants
  • levodopa (antiparkinsons and direct dopamine receptor agonists)
87
Q

what are the adverse effects of conventional antipsychotics 1st generation?

A

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
88
Q

how would you treat acute dystonia related to conventional antipsychotics 1st generation?

A

with diphenhydramine

89
Q

what is a neuroleptic malignant syndrome?

A

rare but serious disease seen with conventional antipsychotics 1st generation

  • risk of death without treatment
  • sweating, rigidity, sudden high fever, automatic instability
90
Q

what is an example of a low potency conventional antipsychotic 1st generation? what is used for? what are the side effects?

A

chlorpromazine (Thorazine)

  • used for schizophrenia, manic phase of bipolar, hiccups
  • side effects are sedation, hypotension, and anticholinergic
91
Q

what is an example of a medium potency conventional antipsychotic 1st generation? what is used for?

A

loxapine (Loxitane)

- schizophrenia (acute agitation) and bipolar disorder

92
Q

what is an example of a high potency conventional antipsychotic 1st generation? what is used for? what are the side effects?

A

haloperidol (Haldol)

  • used for Tourette’s syndrome and agitation
  • side effects are early EPS and prolonged QT intervals causing serious dysrhythmias
93
Q

what does low and high potency related to conventional antipsychotic 1st generation mean?

A

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

94
Q

what are examples of 2nd generation agents: atypical antipsychotic agents

A
  • clozapine
  • risperdal
  • zyprexa
  • abilify
  • lithium carbonate
  • depot preparation
95
Q

what is a benefit of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?

A
  • fewer EPS (extrapyramidal side effects, commonly referred to as drug-induced movement disorders)
96
Q

what is a negative of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?

A

increased metabolic problems

  • increased cholesterol
  • increased blood sugar
  • increased weight gain
97
Q

what is the action of clozapine?

A

blocks receptors of dopamine and serotonin

98
Q

what are the uses for clozapine?

A
  • schizophrenia
  • levodopa-induced psychosis ( a side effect of a treatment for Parkinson’s disease - can alleviate the symptoms of PD without making them worse)
99
Q

what are the adverse effects of clozapine?

A
  • agranulocytosis (drop in WBC)
  • seizures
  • diabetes (not often used in diabetics)
  • weight gain
  • myocarditis
  • effects in elderly patients with dementia
100
Q

what is risperidone (Risperdal) used for?

A
  • schizophrenia (PO or IM for long term therapy)
  • bipolar disorder
  • autism
  • Alzheimer’s disease
101
Q

what is olanzapine (Zyprexa) used for?

A
  • schizophrenia
  • bipolar
  • off label use: nausea and vomiting caused by chemo
102
Q

what are the adverse effects of olanzapine (Zyprexa)?

A
  • low risk of EPS
  • high risk of metabolic issues
  • weight gain
103
Q

what is the action of aripiprazole (Abilify)?

A

blocks multiple receptors

104
Q

what is the benefit of aripiprazole (Abilify)?

A

generally well tolerated

105
Q

what is aripiprazole (Abilify) used for?

A
  • major depressive disorder
  • bipolar disorder
  • schizophrenia
106
Q

what is lithium carbonate (Lithobid) used for?

A

bipolar disorder (prevent manic episodes)

107
Q

what is the dosing like with carbonate (Lithobid)?

A
  • begin with low doses and increase slowly
  • doses will vary with patients
  • monitor serum level (lithium toxicity)
108
Q

what are depot antipsychotic preparations?

A

long-acting injectables used for long term maintenance for schizophrenia

109
Q

what are the side effects of depot antipsychotic preparations?

A

no long term risks

110
Q

what is the benefit of depot antipsychotic preparations?

A

IM injection every 4 weeks

- good for patients who forget to take meds

111
Q

what are the three depot antipsychotic preparations available?

A
  • haloperidol decanoate (haldol decanoate)
  • fluphenazine decanoate (prolixin decanoate)
  • risperidone microspheres (risperdal consta)

Pharm Exam 3 (5 decks)

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