Mental Health Pharmacology Flashcards
Which neurotransmitters do antidepressants work on?
Enhance the action of certain neurotransmitters in the brain
Norepinephrine
Serotonin
Dopamine
Role of serotonin and dopamine in mental health issues?
Serotonin – We think the body isn’t producing enough or the way the brain is taking it up isn’t sufficient. So the meds work to keep serotonin saturating the neurons in the brain/synapses, it seems to help with mood.
Dopamine – quite a large role in psychosis; too much dopamine can make us psychotic and too little, we can become depressed.
4 most common antidepressant classifications?
1) Selective serotonin reuptake inhibitors (SSRIs)
2) Atypical antidepressants (SNRIs, NDRIs)
3) Tricyclic antidepressants (TCAs)
4) Monoamine oxidase inhibitors (MAOIs)
Most common side effects of SSRI?
most common; side effects of hypotension, nausea, weight changes (gain or loss), loss of libido.
Which antidepressants are the first gen drugs?
Second gen?
Key difference?
1st = TCA + MAOIs
2nd: Atypical + SSRI
1st = more side effects,
Important considerations for MAOIs
Who are these used in?
Interactions?
there is an enzyme that attacks the brain, and this inhibits the enzyme/NT.
Only see this in patients who don’t tolerate the other drugs because there are SO many interactions with foods and other medications.
** Foods with like tyramine in it can set off a huge hypertensive crisis.
SSRIs
- are they used often for depression?
- Most common S/E?
-
1st Line therapy for depression Safer drug, fewer side effects Most common S/E 70% men/women report decreased libido, nervousness, insomnia Potential drug/drug interactions MAO inhibitors, Warfarin
What drug are we studying that’s an SSRI?
If you take too much, what side effect might you experience (added notes from class)
Sertraline (Zoloft)
If take too much of it, you can get a tremor that feels a bit like anxiety
MoA of atypical antidepressants?
Common S/E?
Inhibit the uptake of Norepinephrine, Norepinephrine & Dopamine, Norepinephrine & Serotonin
Potential drug/drug interactions
Common S/E
dry mouth, hypotension, nervousness
What atypical antidepressant are we responsible to know/.
Venlafaxine (Effexor)
How do tricyclic antidepressants work?
Are they used typically? S/E?
Developed in the1950s
Inhibit reuptake of norepinephrine, serotonin, and dopamine
Serious S/E –
sedation, orthostatic hypotension, cardiac dysrhythmias, anti-cholinergic effects, suicidal potential
Not 1st Line therapy
Tricyclic antidepressant we need to know?
Imipramine (Tofranil)
DO all antidepressants have suicide risk?
Why?
Which is particularly bad?
your depression doesn’t lift but your motivation does… so for the first 6-8 weeks, your suicide potential is high. For other drugs this is high…but for TCA it is even more common.
MAOIs
- Are there common interactions?
- serious and unique interaction?
- COmmon side effects?
1950s – first drugs used for depression
Numerous drug/drug and food/drug interactions, and hepatotoxicity
Common S/E
orthostatic hypotension, headache, insomnia, diarrhea
Hypertensive crisis when interacting with foods containing tyramine
WHAT MOAI DO WE NEED TO KNOW?
Phenelzine (Nardil)
What kinds of foods interact with MAOIs to cause htn crisis?
avocado, banana, raisins, beer, wine, chocolate.
What sort of teaching needs to be done around antidepressants?
Teaching hugely important.
To maximize therapeutic effects and minimize SE, should take them every day and preferable at the same time every day ideally (check if bed time or a.m. is better).
- take 2-6/8 weeks to kick in. Check in with your doctor if strong suicidal ideations.
- Should stay on the drugs for at least a year
If you think it’s situational depression, can possibly try come off of it within a year. Go to doc and discuss first!
- Under supervision, you can wean off the drug over 2-3 months. If you don’t its uncomfortable and bad for the brain.
Not really harmful if you’re on it for too long
Key nursing interventions for pts on antidepressants?
- Awareness of factors leading to depression
- Monitoring for side effects
- Teaching – therapeutic blood levels (2-6 weeks)
- Baseline liver, kidney function
- Weight
- Support systems – psychotherapy, family
What is the “main stay” drug for those with bipolar?
Lithium carbonate
Lithium carbonate
- Class?
- MoA
- How is therapeutic level monitored?
- side effects?
Mood stabilizer
Mechanism of action: unknown
Blood Levels: 0.6 – 1.2 mEq/L (monitored 1-3 days, then q 2-3 months)
Side effects: dizzy, fatigue, short-term memory loss, GI, dry mouth, weight gain; acute kidney injury
teaching points of lithium carb?
Change in salt intake can alter effect (maintain salt in diet)
Concern with weight gain
Monitor fluid and fluid intake
Lithium is dangerous during pregnancy. For women living with bipolar, they are at risk if they don’t find drugs that stabilize mood as well.
besides lithium, What is the other drug we need to know for bipolar disorder?
Class?
What measurement is key?
Divalproex sodium (Epival)
Anticonvulsant
Baseline liver function tests and CBC
What kinds drugs other than mood stabilizers may be used with bipolar pt?
Antidepressants
Antipsychotics
Benzos
What is an important risk to consider with taking antidepressants with bipolar?
Can trigger manic phase –> may also need to take antipsychotics to counter this risk
WHo are antipsychotics sometimes used in for bipolar disease? (can’t tolerate…)
Can’t tolerate mood stabilizers
- Used for psychosis + mania, insomnia
Benefit of benzos for pt with bipolar?
used short-term for agitation
What sort of neurotransmitter issues are associated with schizo?
Excess of excitatory neurotransmitters
norepinephrine
Deficiency of inhibitory neurotransmitters
GABA
Excess dopamine at/with D2-receptors
What are the two categories of antipsychotics used?
Conventional antipsychotics/neuroleptics (Phenothiazines and Non-phenothiazines)
Atypical antipsychotics
Antipsychotics
- Risk for side effects?
- One drug of choice?
Adverse effects differ, are common, are severe
Selection of specific drug based on client need
No single drug of choice.
Atypical antipsychotics
aka?
includes what 2?
Also referred to as neuroleptics
Typical antipsychotics include phenothiazines and non-phenothiazines
Help to block the positive symptoms of schizophrenia
Can be used as a scheduled antipsychotic but more commonly seen as a PRN
What two drugs are we responsible for knowing for schizo?
Which is a typical antipsychotic?
Loxapine (loxapac)
Quetiapine
Lox = typical antipschyotic
Typical Antipsychotics
MoA
Blocks dopamine transmission
blocks D2 and other dopamine receptors of other neurotransmitters
Don’t just effect tracts of dopamine that you are targeting…
therefore»_space;> frequent side effects
Typical antipsychotics
How long to work?
How long should a trial last?
Takes 1-2 weeks to work (some improvement immediately)
Adequate trial 6-12 weeks
Adherence to prescribed medication is best prevention of relapse
Discontinuation is rare
A/E of antipsych drugs?
Anticholinergic effects Sedation Hypotension Sexual dysfunction Extrapyramidal symptoms Neuroleptic malignant syndrome
Do Antipsychotic drugs cause dependence?
Antipsychotic drugs do not cause dependence; wide margin of safety.
What are extrapyramidal symtptoms?
- Acute dystonic reactions (torticollis, oculogyric crisis, tongue or jaw spasms, difficulty swallowing)
- Akathisia
- Pseudo-Parkinsonism (cogwheeling, bradykinesia/akinesia, resting tremor)
- Tardive dyskinesia
EPS Treatment:
Acute EPS reaction: Anticholinergic medication IM (Cogentin)
EPS can be permanent if not treated (tardive dyskinesia, pseudo-Parkinsonism)
Treatment includes withdrawal of medication and switching to an atypical antipsychotic
What is neuroleptic malignant syndrome?
Symptoms
Life-threatening neurological disorder most often caused by a toxic reaction to therapeutic doses of neuroleptics
Associated with elevated plasma creatine kinase (CK)
Symptoms include muscle rigidity, high fever, autonomic instability and cognitive changes (delirium)
Atypical Antipsychotics
Newer
More efficacious
Safer
- Help to control the positive and negative symptoms of schizophrenia
- Also commonly used in the treatment of bipolar disorder
- Less risk for EPS but higher risk for metabolic syndrome
Drugs of choice for treating psychosis, less EPS
Mechanism of action unknown
Associated with obesity and its risk factors
Risperidone etc. - decreased libido & impotence, etc.
May alter glucose metabolism
Precaution in clients with cardiovascular disorders, hypotension, alcohol use, renal and hepatic disorders, prostatic hypertrophy, etc.
Client Education: multifaceted.
Routine lab tests important.
Which atypical antispychotic are we supposed to know?
Quetiapine (Seroquel)
Common S/E of atypical antipsychotics?
Orthostatic hypotension Hyperprolactinemia - presence of manifestations of prolactin such as breast development Weight gain Sedation New-onset diabetes Cardiac arrhythmias Agranulocytosis
Atypical Antipsychotics: Teaching Points
Consistency in taking medications
Medication and symptom amelioration
Side effects and management
Interpersonal skills that help patient and family report medication effects.
Side effects often are observed long before therapeutic effects (drug frequently discontinued)
