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Mental Health > Midterm Meds > Flashcards

Midterm Meds Flashcards

1
Q

What are pharmacologic treatments for depression?

A

ketamine
antidepressants
- SSRIs
- SNRIs
- Trazodone
- TCAs
- MAOIs
- Bupropion

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2
Q

What is a priority when giving antidepressants?

A

safety!

black box warning
- increased risk of suicide in first few weeks, check on pt often

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3
Q

What are examples of SSRIs?

A

citalopram
escitalopram
fluoxetine
paroxetine
sertraline

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4
Q

What are SSRIs used for?

A

tx for:
- depression with anxiety
- panic disorder
- PTSD
- OCD
- bulimia

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5
Q

How long will it take to see the effects of SSRIs?

A

2-3 weeks

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6
Q

Is it possible to overdose on SSRIs?

A

no

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7
Q

Are SSRIs tolerable?

A

yes

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8
Q

What are the side effects of SSRIs and SNRIs?

A

sleep disturbance
sexual dysfunction (decreased libido)
tension headaches
reduced appetite
hyponatremia
rash/SJS

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9
Q

What are the symptoms of SSRIs?

A

increased bleeding
serotonin syndrome (SHIVERS A)
- Shivering
- hyperreflexia
- increased temp
- Vital sign instability
- encephalopathy (mental status changes)
- restlessness
- sweating
- abdominal pain

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10
Q

What are examples of SNRIs

A

venlafaxine
desvenlafaxine
duloxetine
levomilnacipran

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11
Q

What are SNRIs used for?

A

major depressive disorder
anxiety disorder

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12
Q

What are the side effects of SNRIs?

A

serotonin syndrome
hyponatremia

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13
Q

What is trazodone used for?

A

adjunct for depression
insomnia

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14
Q

What are the adverse effects of trazodone?

A

sedation
priapism (painful erect penis)

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15
Q

What are examples of TCAs (tricyclics)?

A

amitriptyline
doxepin
imipramine
nortriptyline

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16
Q

How long does it take for TCAs to take effect?

A

4-8 weeks for full effect

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17
Q

What are TCAs used for?

A

stimulating
- target lethargy and fatigue

sedating
- target agitation or restlessness

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18
Q

What are the side effects of TCAs?

A

orthostatic hypotension
anticholinergic
sedation
increased appetite
dysrhythmias
MI
heat block

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19
Q

Describe the anticholinergic side effects of TCAs

A
  • dry mouth
  • blurred vision
  • tachycardia
  • constipation
  • urinary retention
  • esophageal reflux
  • photophobia
  • sexual dysfunction
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20
Q

Which side effects of TCAs are considered a medical emergency?

A

constipation
urinary retention

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21
Q

What are safety precautions for TCAs?

A

it is cardiotoxic
pt can overdose

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22
Q

What are the contraindications of TCAs?

A

recent MI
narrow-angle glaucoma
benign prostatic
hypertrophy
seizures
pregnancy

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23
Q

What are examples of MAOIs?

A

phenelzine
tranylcypromine
isocarboxazid
selegiline

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24
Q

What can MAOIs cause?

A

hypertensive crisis (over 180/100)
- blurry vision
- chest pain
- tachycardia
- SOB
- diaphoresis
- anxiety
- mental status change
- confusion
- N/V

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25
Q

How long will a pt need to be off of SSRIs in order to take MAOIs?

A

for 5 weeks and then take MAOI

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26
Q

What should a pt avoid if taking MAOIs? Why?

A

tyramine foods

it will cause HTN crisis

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27
Q

What are examples of tyramine foods?

A

avocados
figs
deli meats
cheese
yeast extract
beer
protein supplements
shrimp paste
soy sauce
red wine

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28
Q

What are the contraindications for MAOIs?

A

cardiovascular disease
HTN, CHF
liver disease
headaches
surgery

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29
Q

What is bupropion used for?

A

depression
prevention of seasonal depression

mainly for:
- smoking cessation

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30
Q

What are the adverse effects of bupropion?

A

appetite suppression
seizures

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31
Q

Who should not be given bupropion? Why?

A

pt with eating disorder

it causes appetite suppression

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32
Q

What is ketamine used for?

A

anesthetic
targets suicidal ideation

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33
Q

What are the side effects of ketamine?

A

increased HR/BP
dissociation

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34
Q

How long does ketamine last for?

A

fades within 1-3 days

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35
Q

What are pharmacological therapies for anxiety?

A

antidepressant
antihistamine
anticonvulsant
antipsychotic
buspirone
benzodiazepine

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36
Q

What antidepressants are given for anxiety?

A

SSRIs
SNRIs

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37
Q

Will a patient suddenly stop antidepressants? Why?

A

No
b/c there is a high risk of suicide, the medication will have to be tapered down

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38
Q

Describe antidepressants for anxiety

A

start with low doses
long term tx

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39
Q

What are examples of benzodiazepines?

A

lorazepam
clonazepam

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40
Q

Describe benzodiazepines for anxiety

A

short term tx
tolerance develops
withdrawal symptoms
addiction

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41
Q

Should higher doses of benzodiazepines be given? Why?

A

no
b/c tolerance/addiction develops and it can lead to an overdose
(withdrawal symptoms develop)

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42
Q

What are examples of antihistamines?

A

diphenhydramine
hydroxyzine

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43
Q

What are antihistamines used for in regard to anxiety?

A

good for those w/ substance use disorder
sedating

44
Q

How long will a pt be on antihistamines for anxiety?

A

short term use only

45
Q

Describe buspirone

A

non-addictive
long-term tx
2-4 weeks to be effective
risk for serotonin syndrome

46
Q

Who should not be given buspirone? Why?

A

older adults

can develop delirium

47
Q

What are examples of anticonvulsants for anxiety?

A

valproic acid
gabapentin
pregabalin

48
Q

What are anticonvulsants used for in regard to anxiety?

A

generalized anxiety dis.
social anxiety
panic attacks

adjunct medication

49
Q

What are pharmacological therapies for bipolar disorders?

A

mood stabilizers
anticonvulsants
anxiolytics
second-generation antipsychotics
ECT

50
Q

What medication is a mood stabilizer?

A

lithium

51
Q

What is lithium effective in treatment for?

A

first line of tx

antisuicidal effects
acute mania
acute bipolar depression
prevention of manic/depressive episodes

52
Q

What are safety precautions with lithium?

A

cautious with diuretics
do not give with NSAIDs

53
Q

How long does lithium take for a full effect?

A

3-6 weeks

54
Q

What is a therapeutic level for lithium?

A

0.5-1.2 mEq/L

55
Q

What are expected side effects of lithium?

A

fine hand tremors
polyuria, mild thirst
nausea
weight gain
sedation
acne

56
Q

What are early signs of lithium toxicity? What is the range?

A

N/V/D
slurred speech
muscle weakness

early toxicity: 1.2-1.5 mEq/L

57
Q

What are advanced signs of lithium toxicity? What is the range?

A

coarse hand tremor
GI upset
mental confusion
muscle hyperirritability
EEG changes
incoordination

toxic: 1.5-2 mEq/L

58
Q

What are signs of severe lithium toxicity? What is the range?

A

HTN
ataxia
serious EEG changes
blurred vision
renal failure
clonic movements/seizures
stupor
coma
death

toxic: above 2 mEq/L

58
Q

What are the long term side effects of using lithium?

A

hypothyroidism goiter
kidney dysfunction

58
Q

What are examples of anticonvulsants?

A

valproic acid
depakote
divalproex
valproate

carbamazepine
lamotrigine

59
Q

What are anticonvulsants effective in treatment of?

A

bipolar mania
hypomania
mixed states
rapid cycling

60
Q
A
61
Q

If a patient is taking lithium and they are not responding well, what can they take?

A

anticonvulsants

62
Q

If a patient has kidney issues and bipolar disorders, what can they take?

A

anticonvulsants

63
Q

What are the expected side effects of anticonvulsants?

A

GI pain
tremors
sedation
hair loss
weight gain
blood dyscrasias
hepatotoxicity
pancreatitis

64
Q

What are the signs of toxicity with anticonvulsants? What is the therapeutic range?

A

ataxia
confusion
somnolence
coma

85-125 ug/mL

65
Q

What is carbamazepine effective in treatment for?

A

rapid cycling
mixed states
acute mania
prevents relapse of mania

66
Q

What should a nurse monitor for a patient taking carbamazepine?

A

monitor blood levels for the first 8 weeks of tx weekly

67
Q

What are the expected side effects of carbamazepine?

A

hepatic disease
blood dyscrasias
fluid overload
hyponatremia
SJS (rash)

67
Q

What are signs of toxicity with carbamazepine? What is the therapeutic range?

A

fatigue
nausea
diplopia
blurred vision
ataxia

4-12 mcg/mL

68
Q

What is lamotrigine effective in treatment of?

A

bipolar depression
acute and maintenance

69
Q

What are serious side effects of lamotrigine?

A

SJS
aseptic meningitis
can lower effectiveness of birth control

70
Q

What are examples of anxiolytics?

A

benzodiazepines
- clonazepam
- lorazepam

71
Q

What are anxiolytics used for?

A

adjunct medication
acute mania
psychomotor agitation

calms pt

72
Q

What are second generation antipsychotics effective in treatment of?

A

acute mania
bipolar depression
prevent relapse of mania and depression

73
Q

What is the pharmacological therapy for schizophrenia?

A

first generation antipsychotics

74
Q

Describe first generation antipsychotics

A

traditional dopamine antagonist
used less frequently
minimal impact on - symptoms
side effects experienced more

75
Q

What are examples of first generation antipsychotics?

A

chlorpromazine
loxapine
fluphenazine
haloperidol

76
Q

What side effects that are experienced with first generation antipsychotics?

A

extrapyramidal symptoms
- acute dystonia
- tardive dyskinesia
- akathisia
- pseudoparkinsonism

77
Q

What are the expected side effects of antipsychotics?

A

sedation
orthostatic hypotension
lowered seizure threshold
increased prolactin
- sexual dysfunction
- galactorrhea
- amenorrhea
- gynecomastia

78
Q

What are serious adverse effect of antipsychotics?

A

prolonged QT interval
anticholinergic toxicity
neuroleptic malignant syndrome
metabolic syndrome
- weight gain
- HTN
- diabetes
- dyslipidemia

79
Q

What are examples of second/third generation antipsychotics?

A

aripiprazole
clozapine
lurasidone
olanzipine
quetiapine
risperidone

80
Q

What are the side effects of second/third generation antipsychotics?

A

same as first generation, but not as bad

81
Q

Describe clozapine

A

last resort
side effects are severe/common
high risk of myocarditis and seizures

82
Q

What are examples of CNS depressants?

A

alcohol
benzodiazepines
barbiturates

83
Q

What are examples of medications for alcohol withdrawal?

A

benzodiazepines
barbiturates
anticonvulsants
vitamins

84
Q

What are examples of vitamins for alcohol withdrawal?

A

folic acid (folate)
thiamine (B1)
cyanocobalamin (B12)

85
Q

Why would barbiturates be used for alcohol withdrawal?

A

only if pt is not responding to benzodiazepines

86
Q

Why would anticonvulsants be used for alcohol withdrawal?

A

for seizures and to decrease anxiety

87
Q

What are examples of medications for alcohol sobriety?

A

disulfiram (antabuse)
naltrexone
acamprosate

88
Q

What should a patient know if they are taking medications for alcohol sobriety?

A

avoid any and all alcohol

89
Q

What are examples of opiates?

A

heroin
oxycodone
fentanyl

90
Q

What are examples of medications for opioid overdose?

A

naloxone
nalmefene

91
Q

What should be done with naloxone?

A

administer every few hours until all opioids are out of system

92
Q

What is important to know about nalmefene?

A

not used as often
withdrawals last longer with RX

93
Q

What are examples of medications for opioid withdrawal?

A

methadone
clonidine
buprenorphine

94
Q

Why is methadone used for opioid withdrawal?

A

replaces opioid bc it is a long-acting opioid (pt doesn’t feel high)
- pt can then taper off
or
- pt can be on it for life

95
Q

What is the benefit of using clonidine for opioid withdrawal?

A

used for pt with unstable VS

96
Q

What is the benefit of using buprenorphine for opioid withdrawal?

A

used for detox and to decrease cravings

97
Q

What are examples of CNS stimulants?

A

cocaine
methamphetamine

98
Q

What are the effects of CNS stimulants?

A

increase alertness
heighten sexual arousal
increase energy

99
Q

What are pts at right for when using CNS stimulants?

A

seizures
stroke
chest pain
overdose, which can lead to heart attack

100
Q

What are the effects of methamphetamine?

A

long lasting
psychosis
cracked teeth
skin infections (tactile hallucinations - picking at skin)

101
Q

What are pharmacological aids for nicotine?

A

nicotine based products
varenicline
bupropion

102
Q

Describe marijuana

A

mixed depressant and hallucinogenic

Mental Health (8 decks)

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