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Nurs 2800 > Mental Health Pharm Exam 2 > Flashcards

Mental Health Pharm Exam 2 Flashcards

1
Q

Instead of saying “committed suicide” one should say

A

Killed themselves, took their own life died as a result of blah blah

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2
Q

Depression is characterized by

A

sad or despondent mood out of proportion to actual life events

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3
Q

Depression increases risk of

A

suicide

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4
Q

Bigogenic Amine Theory

A

Deficiency of biogenic amines in key areas of the brain
Depression is associated with abnormally low levels of norepinephrine, serotonin, and dopamine

pretty solid theory since the meds work

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5
Q

suicide is the ____ leading cause of death in the US as of 2020

A

11th

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6
Q

All antidepressants come with a black box warning stating … and why

A

increased in suicide ideations or behavior.

Gives them more energy to do it

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7
Q

The nurse should educate a patient when starting antidepressants about what in the first few weeks?

A

May give them only a weeks worth of medications educate that this is a side effect

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8
Q

Standard reason meds are primary standard treatment of depression

A

enhance, elevate, or stabilize moods

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9
Q

What are the 4 antidepressant groups for depression

A

Selective serotonin reuptake inhibitors (SSRIs)
Atypical antidepressants
Tricyclic antidepressants (TCA)
Monoamine oxidate inhibitors (MAOIs)

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10
Q

when starting antidepressants the nurse should educate

A

1 it takes several weeks to work
2 therapy usually begins at SSRI with a low dose
3 If little to no improvement in 4 weeks second med is added
4 If you want to get off a minimum of 6 months after depression have resolved to prevent withdrawl and rebound depression

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11
Q

Selective serotonin reuptake inhibitors med to memorize

A

fluoxetine (prozac)

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12
Q

How does SSRI work

A

stops serotonin from being destroyed with increases it in the brain

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13
Q

Adverse effects of SSRI

A
  • N/V in the beginning but usually get over it
    Dry mouth and diarrhea
  • CNS stimulation: headache, dizzy, insomnia (really BAD)
  • Sexual dysfunction (70%) decrease libito and inability to orgasm
  • weight gain >20 lbs
    Bruxism (TEETH GRINDING ugggggghhhhhhhh)
    -increase in suicide and seritonin syndrom
    -withdraw syndrome
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14
Q

Therapeutic Use for SSRI

A

OCD, bulimia, ptsd, bipolar, social phobias, panic disorders

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15
Q

Contraindications to SSRI

A

MAOI or TCA and hypersensitivity

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16
Q

Food and Drug interactions with SSRI

A

MAOI and TCA risk of serotonin syndrome
Elevate lithium
nyquil
St. Johns wart (serotonin syndrome)
Grapefruit juice

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17
Q

SSRI makes you sleepy when should you take it?

A

at night… duh

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18
Q

Serotonin syndrome (SES)

A

Too much serotonin in body

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19
Q

When does SES usually happen

A

2-72 hours after starting treatment

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20
Q

Symptoms of Serotonin syndrome

A

confusion, ams, agitation, halluciantions, seizures, tachycardia, sweating, ataxia, tremors, fever, hyperreflexia, coma, death

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21
Q

treatment for SES

A

stop taking the fucking meds

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22
Q

ATYPICAL ANTIDEPRESSANTS:
SNRI- Serotonin Norepinephrine reuptake inhibitors do what

A

Blocks seritonin and norepinephrine from being taken away and keeps it in the brain

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23
Q

Venlafaxine is started at what dose

A

a very low dose (not even therapeutic)

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24
Q

Adverse effects

A

N/V obviously
CNS stimulation: like amphetamines’
Tachycardia
Sexual disfunction
Recital vaginal or uterine hemorrhage
Suicide and serotonin syndrome
Mild to moderate withdrawl dyndrome so taper over 2-4 weeks

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25
Q

Depressed and ADHD can you take SNRI?

A
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26
Q

what is withdrawal syndrome

A

Headache, nausea, visual disturbances, anxiety, dizziness, tremors

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27
Q

Drug/Food interactions for atypical antidepressant: venlafaxine

A

SSRI, MAOIs, TCA (serotonin syndrome)
CNS depressant/ alcohol

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28
Q

Atypical antidepressants: bupropion (Wellbutrin)

A

Primarily a dopamine reuptake inhibitor
??may also block reuptake of norepi they think

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29
Q

Bupropion aka Welbutrin benefits

A

Supressess appetite
Does not cause weight gain (don’t give to eating disorders)
increases sexual desire and pleasure

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30
Q

Bupropion aka Welbutrin use

A

depression
SAD
Smoking cessation

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31
Q

bupropion aka welbutrin

A

Agitation, insomnia, tremor, seizure, psychosis, tachycaardia, N/V weight loss

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32
Q

Welbutrin or bupropion Contraindications

A

allergy, seizure or hx of anorexia

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33
Q

Drug interactions with welbutrin

A

MAOI

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34
Q

Tricyclic Antidepressant is a ___ line medication

A

second line medicaations for when 1st line and atypical medications are not working

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35
Q

Therapeutic indications for TCA

A

Depressive stage of bipolar, depression, insomnia, ADHD, Neuropathic pain and fibromialgia, panic, OCD, Nocturnal Enuresis (bed wetting)

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36
Q

Tricyclic antidepressants MOA

A

Reduce neuronal reuptake of serotonin of norepi and keep it in the brain

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37
Q

Prototype of TCA

A

Imipramine

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38
Q

Adverse effects of TCA

A

Anticholinergic effect (Dry mouth, constipation, anorexia, decreased salivation, urinary retention, blurred vision)
Yawngasm hahahhahahhahahhaha
loss of libido, high risk of overdose withdrawl syndrome

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39
Q

Contraindications

A

Seizure, kids <12, allergies

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40
Q

Food and drug interactions with TCA

A

St. Johns wort Serotonin syndrome
CNS depressants alcohol ( sedation
MAOI (hypertensive crisss)
Cimetidine, fluoxetine, and ranitidine (increase in TCA levels)

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41
Q

Monoamine oxidase inhibitor (MAOIs) MOA

A

MOA(a) and MOA(b)
1 inactctivates norepi and seritonin
2 dopamine

Irreversibly inhibits the actions of monoamine oxidase a and b (enzymes that inactivate monoamines)

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42
Q

MAOI is given

A

atypical depresssion, depression associated bipolar disoreder migraine if other meds didnt work

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43
Q

MAOI prototype

A

Phenelzine (FIDDLEZINE)

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44
Q

Contraindications for MAOI

A

schezophrenia, CV disease, hepatic or renal impairment

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45
Q

Monoamine oxidase inhibitor adverse effect

A

Hypertensive crisis (from eating tyramine breakdown)
liver toxicity
incontinence and urinary retention

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46
Q

tyramine is

A

regulates blood pressure

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47
Q

What food contains tyramine

A

have a lot: aged cheese, red wine, smoked or pickled meats sausage and soy sauce
have a little: meat extracts (bouillon), light beer avocados
Basically dairy, alcohol, lunch meat, avacados and soy sauce

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48
Q

Nursing education with MAOIs

A

list of food to not drink (tyramine
St. John’s wort (serotonin syndrome)
Need to check with prescriber before taking any other medications

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49
Q

Treatment for hypertensive crisis

A

Phentolamine or SL nifedipine

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50
Q

4 primary medications for anxiety

A

benzos (“short term”)
nonbenzodiazepines
barbiturate’s (watch for respiratory depression)
antidepressants

51
Q

Prototype of bezo for anxiety

A

lorazepam
alprazolam

52
Q

Benzodiazepines MOA

A

Intensifies the effect of GABA (GABA is the primary inhibitory neurotransmitter)

53
Q

Antidote for Benzo

A

flumazenil

54
Q

Pharmacologic effects of Benzodiazepines

A

CNS (reduce anxiety and promote slep
Weak resp depression
Death from od unlikely

55
Q

Benzo classification

A

antianxiety, sedative, hypnotic, antiseizure drug

56
Q

adverse effects of benzos

A

anterior grade amnesia (trouble recalling events while on it)
paradoxical CNS excitation
CNS DEPRESSION (sleep driving apparently)
IV give slow so not cardiac arrest,
tolerance and withdrawal syndrome

57
Q

Non Benzodiazepine anxiolytics

A

Valporic acid: treats anxiety in bipolar
beta blockers and clonidine: dont cure anxiety
antihistamines: drowsiness and may calm people down

58
Q

Non benzo anxiety medication prototype

A

BUSPIRONE or BUSPAR do not confuse with bupropion (the depression one)

59
Q

Buspirone

A

not CNS depressant
no abuse potential
no increased effects of central nervous systemp depressants
Anxiolytic defelop slow

60
Q

Buspirone MOA

A

they dont know

61
Q

Adverse effects of buspirone (non benzo anxiolytics

A

not back heaache

62
Q

drug and food interactions with buspirone

A
  • erythromycin and ketoconazole
  • grapefruit juice
  • no withdrawl from it
63
Q

Insomnia

A

a sleep disorder defined by the inability to fall asleep, frequent awakenings, or difficulty staying asleep

64
Q

Insomnia CAM treatment options

A

melatonin MAY improve sleep
Valerian and kava root have shown efficacy in promoting relaxation

65
Q

Hypnotic vs sedation

A

hypnotic: used to help people fall asleep by causing sedation vs sedation which is the loss of awareness and reaction to environmental stimuli

66
Q

Benzos for sleep disorders

A

Relieve insomnia decrease repeated awakenings through the night

67
Q

Benzo prototype

A

Temazepam

68
Q

Benzo doses for anxiety vs sleep

A

higher for insomnia so they can sleep. Use 30 minutes before bed and ensure 8 hours of sleepso they arent groggy

69
Q

nursing interventions for Benzos for sleep disorders

A
  • Monitor people while they sleep incase they get up —> fall risk
  • Paradoxical reaction (CNS excitation common in old and young populations)
  • tolerance
  • make sure they know no to use alcohol or other CNS depressants
70
Q

Non benzodiazepine: zolpidem

A

sedative-hypnotic
non benzo, anxiolytic with miscellaneous CNS depressant

71
Q

Therapeutic uses for for nonbenzodiazepine: zolpidem

A

short term for insomnia (7-10 days)
just prior to sleep because of rapid onset

72
Q

MOA of zolpidem

A

enhances the action of GABA

73
Q

Route of Zolpidem

A

PO and oral spray

74
Q

Adverse effects of zolpidem

A
  • females cannot have the max dose because of he hangover groggy feeling the next day
  • Amnesia daytime drowsiness, old = confusion, sleep activities
  • can be used and lead to dependency
75
Q

Contratindications of zolpidem (non benzo for insomnia

A

hypersensitivity

76
Q

Drug interactions with zolpidem (non benzo for insomnia)

A

take on an empty stomach
ssri = worseningdepression
alcohol and cns depresions

77
Q

Bipolar disorder

A

involves extremes of depresion alternating wth hyperactivity and excitement
3.7% people in the US have it

78
Q

Non pharmacologic for bipolar

A

Education of patient and family
psychotherapy - individual group and family
Electroconvulsive therapy: very effective at treating acute mania and depressive episodes

79
Q

conversion side effect

A

Memory loss

80
Q

Pharmacologic drugs for bipolar disorders

A

Mood stabilizers
antipsychotics
antidepressants: used in depression phase

81
Q

Mood stabilizers for bipolar work by

A

moderate extreme shifts in emotion and relieve symptoms of mania and depression during acute episodes
and prevent recurrence of manic and depressive episodes

82
Q

medications used as mood stabilizers

A

: lithium, valproic acid/divalproex, carbamazepine and lamotrigine

83
Q

Lithium as mood stabilizer in bipolar

A

need to take several times a day, need to have lab draws for thyroid (hypothyroidism) and lithium levels and takes a couple weeks to start working.

Sodium transport in muscles and inhibits release of norepi and dopamine but otherwise doctors don t know how it works

84
Q

Serum manic and maintenance level lithium level

A

Initial therapeutic level if having mania 1-1.5
maintenance level 0.6 - 1.2 mEq/L

85
Q

Dont reduce sodium in lithium t/f

A

true

86
Q

Lithium adverse effects

A

gi early on
goiter an dhypothyroidisms
most are associated are directly related to serum levels of drug

87
Q

drug food interaction

A

NSAID increase lithium up to 60%
diuretics
caffine

88
Q

nursing monitoring with lithium

A

Lithium toxicity
hydration
kidney function
hypothyroidsim
increasing tremor (they getting toxic)

89
Q

Schizophrenia

A

Most common psychotic disorder with peak incidence in men 15-24 and women 25-34 years
Characterized by abnormal though and thought process disordered communication, withdrawal from people and outside enviroment inability to preform adls, and high risk for suicide

90
Q

schizophrenias primary goal

A

function as independently as possible and accomplish ADLs with minimum assistance

91
Q

Initial treatment for schizophrenia

A
  • High initial dose for aggressive treatments
  • Usually given po but some can be IV )depo - long acting injections with meds)
  • Acute symptoms usually resolve in 3-7 days and they can be switched to maintenance therapy
92
Q

Maintenance treatment

A

cate up to 6-8 weeks for improvement
most commonly require lifelong treatment
abrupt cessation can cause withdrawal

93
Q

Promoting medication adherence for schizophrenia

A

promoting compliance and that meds are taken
encourage family members to oversee meds
therapeutic relationship
Assure patients that antipsychotic drug use does not lead to addiction

94
Q

Antipsychotic Drugs

A

All have a blackbox warning should not be used to treat dementia in older adults because it increases death … but they fucking do like seroquel to sleep

They are used for a diverse spectrum schizophrenia, turrets etc

95
Q

2 major groups of antipsychotic drugs

A

1 gen (typicals) started in 1950s block receptors for dopamine in CNS. Cause serious movement disorders (extrapyramidal symptoms)

96
Q

1 gen (typicals)

A

started in 1950s block receptors for dopamine in CNS. Cause serious movement disorders (extrapyramidal symptoms) work by blocking dopamine

97
Q

2nd gen atypical antipsychotics (SGA)

A

work by blocking serotonin

98
Q

What are EPS extrapyramidal symptoms

A

Movement disorders

99
Q

Posative symptoms in schizophrenia

A

heightened reality: hallucinations

100
Q

negative symptoms in schizophrenia

A

losing normal function: lack of motivation, inability to care for self, poverty of speech (not speaking)

101
Q

1st generation typical antipsychotics MOA

A

dopamine blocker

102
Q

Adverse effects of 1st gen

A

EPS
Neuroleptic malignant syndrome

103
Q

Types of EPS 4 and treatment

A

Acute dystonia - painful spasms of neck and body
* anticholinergic (Benadryl and benztropine)
parkinsonism- movement issues that mimic Parkinson’s
* anticholinergic and amantadine (Parkinson’s treatment)
Akathisia (ants in pants)- inability to relax could be rocking, crossing and uncrossing arms. It is the most common
* Benzos and beta blockers
Tardive dyskinesia - involuntary twisting, writhing movements of tongue and they have no idea
* no treatment available other than decreasing or discontinuing but it is sometimes permanent

104
Q

neuroleptic malignant syndrome

A

HIgh fever, rigidity, autonomic instability, confusion, (autonomic instability like dysrhythmias and fluctuations in BP) confusion seizures and coma.

Its likey hypermalignant syndrome but from the brain

105
Q

prior to starting 1st gen

A

they should have a baseline ECG

106
Q

1st generation med prototype

A

chlorpromazine

107
Q

Chlorpromazine

A

blocks postsynaptic dopamine receptors

108
Q

1st gen chlorpromazine drug interactions

A

CNS depressants/ alcohol
anticholinergic

109
Q

Atypical 2nd generation antipsychotics therapeutic effect

A

negative symptoms associated with schizophrenia
acute mania with bipolar
irritability in pediatric autism pts

110
Q

Prototype of 2nd gen antipsychotics atypical

A

risperidone

111
Q

narcolepsy and ADHD

A

Narcolepsy daytime sleepiness and sudden periods of loss of wakefullness with sleep attacks where they fall asleep at inappropriate times

ADD - various conditions charaterized by an inability to concentrate on one activity for longer than a few minutes and a state of hyperkinesis

112
Q

3 types of CNS stimulant drugs used

A

1 amphetamines
2. methylphenidate
3.

113
Q

amphetamines MOA

A

release Norepi and dopaamine in brain and peripheral nervous system
improves mood
increases focus and attention

114
Q

amphetamine prototype

A

Adderall

115
Q

nursing evaluation for children that are on amphetamine

A

make sure they are eating before meals and grazing and monitoring their height, encourage drug holidays to promote growth. Fun fact Vitamin c decreases effects

116
Q

Methylphenidate

A

same as ampetamines works faster then amphetamines’ but amphetamines work longer

117
Q

Non amphetamines for narcolepsy and ADHD therapeutic effects/use

A

promotes wakefulness in narcolepsy, shift-work sleepiness, and obstructive sleep apnea

118
Q

MOA of non amphetamines

A

no idea maybe related to the drug blocking reuptate of norepi

119
Q

prototype for non amphetamines

A

modafinil (daffodil)

120
Q

Drug interactions for modafinil

A

Oral contraceptives

121
Q

Cyclobenzaprine what is it? side effects? And how to discontinue

A
  • Used for muscle spasms
    Anticholinergic medication
    Side effects: Dry mouth, Urinary retention
  • taper off medication to prevent abstinence syndrome or rebound insomnia
122
Q

What’s the best finding for a pain medications effectiveness

A

Their description on the pain is the most accurate assessment of pain

123
Q

After administering Cefazolin, a patient is experiencing anxiety hypotension and dyspnea. What is happening and what do you do?

A

Epi for the anaphylaxis is first line
Benadryl is the second line medication
Albuterol and prednisone are next

124
Q

Oxybutynin is used for what and what are adverse effects?

A

Anticholinergic that inhibits parasympathetic used for overactive bladder

  • Side effects dry mouth
  • Dry eyes (eye pain, halos) pupil dilation
  • Blurred vision (increased intraoccular pressure)
  • Prolongation of QT interval palpitation, hypertension, and tachycardia

Nurs 2800 (16 decks)

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