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Maria > Mental Health Pharmacology > Flashcards

Mental Health Pharmacology Flashcards

1
Q

Which neurotransmitters do antidepressants work on?

A

Enhance the action of certain neurotransmitters in the brain

Norepinephrine
Serotonin
Dopamine

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2
Q

Role of serotonin and dopamine in mental health issues?

A

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.

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3
Q

4 most common antidepressant classifications?

A

1) Selective serotonin reuptake inhibitors (SSRIs)
2) Atypical antidepressants (SNRIs, NDRIs)
3) Tricyclic antidepressants (TCAs)
4) Monoamine oxidase inhibitors (MAOIs)

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4
Q

Most common side effects of SSRI?

A

most common; side effects of hypotension, nausea, weight changes (gain or loss), loss of libido.

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5
Q

Which antidepressants are the first gen drugs?
Second gen?
Key difference?

A

1st = TCA + MAOIs
2nd: Atypical + SSRI

1st = more side effects,

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6
Q

Important considerations for MAOIs
Who are these used in?
Interactions?

A

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.

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7
Q

SSRIs
- are they used often for depression?
- Most common S/E?
-

A 
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
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8
Q

What drug are we studying that’s an SSRI?

If you take too much, what side effect might you experience (added notes from class)

A

Sertraline (Zoloft)

If take too much of it, you can get a tremor that feels a bit like anxiety

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9
Q

MoA of atypical antidepressants?

Common S/E?

A

Inhibit the uptake of Norepinephrine, Norepinephrine & Dopamine, Norepinephrine & Serotonin

Potential drug/drug interactions

Common S/E
dry mouth, hypotension, nervousness

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10
Q

What atypical antidepressant are we responsible to know/.

A

Venlafaxine (Effexor)

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11
Q

How do tricyclic antidepressants work?

Are they used typically? S/E?

A

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

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12
Q

Tricyclic antidepressant we need to know?

A

Imipramine (Tofranil)

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13
Q

DO all antidepressants have suicide risk?
Why?
Which is particularly bad?

A

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.

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14
Q

MAOIs

  • Are there common interactions?
  • serious and unique interaction?
  • COmmon side effects?
A

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

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15
Q

WHAT MOAI DO WE NEED TO KNOW?

A

Phenelzine (Nardil)

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16
Q

What kinds of foods interact with MAOIs to cause htn crisis?

A

avocado, banana, raisins, beer, wine, chocolate.

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17
Q

What sort of teaching needs to be done around antidepressants?

A

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

18
Q

Key nursing interventions for pts on antidepressants?

A
  • 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
19
Q

What is the “main stay” drug for those with bipolar?

A

Lithium carbonate

20
Q

Lithium carbonate

  • Class?
  • MoA
  • How is therapeutic level monitored?
  • side effects?
A

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

21
Q

teaching points of lithium carb?

A

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.

22
Q

besides lithium, What is the other drug we need to know for bipolar disorder?

Class?
What measurement is key?

A

Divalproex sodium (Epival)

Anticonvulsant
Baseline liver function tests and CBC

23
Q

What kinds drugs other than mood stabilizers may be used with bipolar pt?

A

Antidepressants
Antipsychotics
Benzos

24
Q

What is an important risk to consider with taking antidepressants with bipolar?

A

Can trigger manic phase –> may also need to take antipsychotics to counter this risk

25
Q

WHo are antipsychotics sometimes used in for bipolar disease? (can’t tolerate…)

A

Can’t tolerate mood stabilizers

- Used for psychosis + mania, insomnia

26
Q

Benefit of benzos for pt with bipolar?

A

used short-term for agitation

27
Q

What sort of neurotransmitter issues are associated with schizo?

A

Excess of excitatory neurotransmitters
norepinephrine

Deficiency of inhibitory neurotransmitters
GABA

Excess dopamine at/with D2-receptors

28
Q

What are the two categories of antipsychotics used?

A

Conventional antipsychotics/neuroleptics (Phenothiazines and Non-phenothiazines)
Atypical antipsychotics

29
Q

Antipsychotics

  • Risk for side effects?
  • One drug of choice?
A

Adverse effects differ, are common, are severe
Selection of specific drug based on client need
No single drug of choice.

30
Q

Atypical antipsychotics
aka?
includes what 2?

A

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

31
Q

What two drugs are we responsible for knowing for schizo?

Which is a typical antipsychotic?

A

Loxapine (loxapac)
Quetiapine

Lox = typical antipschyotic

32
Q

Typical Antipsychotics

MoA

A

Blocks dopamine transmission

blocks D2 and other dopamine receptors of other neurotransmitters

Don’t just effect tracts of dopamine that you are targeting…
therefore&raquo_space;> frequent side effects

33
Q

Typical antipsychotics
How long to work?
How long should a trial last?

A

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

34
Q

A/E of antipsych drugs?

A 
Anticholinergic effects
Sedation
Hypotension
Sexual dysfunction
Extrapyramidal symptoms
Neuroleptic malignant syndrome
35
Q

Do Antipsychotic drugs cause dependence?

A

Antipsychotic drugs do not cause dependence; wide margin of safety.

36
Q

What are extrapyramidal symtptoms?

A
  • Acute dystonic reactions (torticollis, oculogyric crisis, tongue or jaw spasms, difficulty swallowing)
  • Akathisia
  • Pseudo-Parkinsonism (cogwheeling, bradykinesia/akinesia, resting tremor)
  • Tardive dyskinesia
37
Q

EPS Treatment:

A

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

38
Q

What is neuroleptic malignant syndrome?

Symptoms

A

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)

39
Q

Atypical Antipsychotics

A

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.

40
Q

Which atypical antispychotic are we supposed to know?

A

Quetiapine (Seroquel)

41
Q

Common S/E of atypical antipsychotics?

A 
Orthostatic hypotension
Hyperprolactinemia - presence of manifestations of prolactin such as breast development
Weight gain
Sedation
New-onset diabetes
Cardiac arrhythmias 
Agranulocytosis
42
Q

Atypical Antipsychotics: Teaching Points

A

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)

Maria (14 decks)

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