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pharm > Neuro System - Drugs to treat mental health disorders > Flashcards

Neuro System - Drugs to treat mental health disorders Flashcards

1
Q

benzodiazepines prototype and other drug names

A

Diazepam (Valium) and Alprazolam (Xanax)
Others: lorazepam, clonazepam (Klonopin), midazolam (Versed)

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2
Q

Benzos EPA

A

enhance inhibitory effects of gamma-aminobutyric acid (GABA)

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3
Q

benzos administration

A

Alprazolam oral only, diazepam PO/IV: admin IV slowly/monitor IV site

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4
Q

benzos therapeutic uses

A

generalized anxiety disorder (GAD) and panic disorder

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5
Q

benzos ADRs

A

CNS depression, hypotension, tachycardia, respiratory depression, tolerance and physical dependence (especially with alprazolam)
- Overdose/toxicity: possibility life-threatening sedation, hypotension, respiratory depression, cardiac arrest

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6
Q

benzos contraindications and interactions

A

Pregnancy - teratogenic
Glaucoma
Respiratory and/or CNS depression
Concurrent use of CNS depressants

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7
Q

benzos RN intervention and client education

A

Monitor for withdrawal symptoms: insomnia, anxiety, tremors, diaphoresis, hypertension, seizures
Monitor for phlebitis
assess/monitor for falls
Regular vital signs
Do not stop abruptly
Assess CNS and resp depression
Antidote: Flumazenil (Anexate, Romaxicon)

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8
Q

Non-benzodiazepines/mics. Anxiolytic prototype

A

buspirone (BuSpar)

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9
Q

Non-benzos EPA

A

binds to serotonin and dopamine receptors, agonistic action on dopamine

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10
Q

Non-benzos admindstration

A

PO, give 2-4 weeks before tapering Benzodiazepines. Can take 2-4 weeks to take effect

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11
Q

non-benzos therapeutic use

A

short term treatment of GAD

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12
Q

non-benzos ADRs

A

paradoxical effects: insomnia, anxiety, restlessness, headache, dizziness, GENERALLY well tolerated

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13
Q

non-benzos contraindications and interactions

A

MAO inhibitors - HTN
Grapefruit juice, ketoconazole, erythromycin - inc. blood levels

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14
Q

non-benzos RN intervention and client education

A

Monitor for paradoxical effects
assess/monitor falls
Avoid contraindicated meds/grapefruit juice
*Does not cause sedation so no risk for abuse/dependence

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15
Q

Tricyclic Antidepressants (TCA) prototype and other drug names

A

Amitriptyline (Elavil)
Other: Imapramine (Torfranil), Nortriptyline (Aventyl)

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16
Q

TCA EPA

A

Block norepinephrine reuptake pump and serotonin reuptake pump in synaptic space - boosts the availability of serotonin, norepinephrine, acetylcholine, dopamine

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17
Q

TCA administration

A

admin PO at bedtime due to sedative effects. Takes several weeks to take effect

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18
Q

TCA therapeutic use

A

treatment of major depression. 2nd line drug

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19
Q

TCA ADRs

A

MANY. Anticholinergic effects; sedation, inc risk for suicide (child/adolescent); abrupt discontinuation can cause withdrawal (anxiety, headache, muscle pain, nausea); high risk for overdose (life-threatening dysrhythmias, confusion, seizure

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20
Q

TCA contraindications and interactions

A

Avoid use of MAOIs
Avoid anticholinergics
Avoid CNS depressants
Cardiac dysrhthmias
Seizure d/o
Recent MI

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21
Q

TCA RN intervention and client education

A

Give at bedtime
Monitor orthostatic VS
Monitor for increases in depression and suicidal ideation
Initiate suicide precautions when appropriate
Taper the drug over 2 weeks to prevent or minimize withdrawl
Assure that clients have no more than a 1 week supply of the drug

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22
Q

SSRIs Prototype and other drugs

A

Fluoxetine (Prozac)
others: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)

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23
Q

SSRIs EPA

A

block reuptake of serotonin - strengthened transmission of serotonin at serotonergic synapses

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24
Q

SSRIs administration

A

admin PO in morning due to CNS excitation. Takes 4-6 weeks to take effect

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25
Q

SSRIs therapeutic uses

A

many indications! Depression, anxiety, OCD, bulimia nervosa, PMDD

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26
Q

SSRIs ADRs

A

insomnia, nervousness, sexual dysfunction, weight gain, inc risk for GI bleeding, hyponatremia (older adults and those taking diuretics), increased fisk for suicidal ideation (children and young adults), serotonin syndrome
*Serotonin syndrome: HTN crisis, hyperpyrexia, agitation - coma, muscle rigidity, seizure

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27
Q

SSRIs contraindications and interactions

A

MAOIs
St johns wort
Ibuprofen
May decrease glucose control in clients w/ DM

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28
Q

SSRIs RN interactions and client education

A

Monitor for insomnia, anxiety, HA
Monitor for decreased libido and/or impotence
Monitor weight gain
Monitor periodic sodium levels
Monitor for inc depression or suicidal ideation
Monitor for s/sx serotonin syndrome
Do not stop abruptly
Notify the provider if you develop persistent HA

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29
Q

SNRIs prototype and other drug names

A

Vanlafaxine (Effexor XR)
Duloxetine (Cymbalta)

30
Q

SNRIs EPA

A

block neuronal reuptake of serotonin AND norepinephrine - inc amount of serotonin/norepinephrine available

31
Q

SNRIs administration

A

PO. Start with low dose and gradually titrate up

32
Q

SNRIs therapeutic use

A

major depression, social anxiety disorder, generalized anxiety disorder (GAD)

33
Q

SNRIs ADRS

A

very similar to SSRI. sexual dysfunction less common than w/ SSRI and can cause HTN

34
Q

SNRIs contraindications and interactions

A

MAOIs
First gen antipsychotics/typicals
ibuprofen

35
Q

SNRIs RN intervention and client education

A

Take in the morning with food
Monitor for insomnia
Monitor for dec libido and/or impotence
Monitor weight gain
Monitor periodic sodium levels
Monitor for inc depression or suicidal ideation
Monitor for s/sx serotonin syndrome
Do not stop abruptly
Monitor BP periodically

36
Q

MAOI Prototype and other drug names

A

phenelzine (Nardil)
Isocarboxazid (Marplan)

37
Q

MAOIs EPA

A

blocks monoamine oxidase-A and monoamine oxidase-B

38
Q

MAOIs administration

A

PO. start with low dose possible

39
Q

MAOIs therapeutic uses

A

depression that hasn’t responded to other meds, depression in bipolar

40
Q

MAOIs ADRs

A

CNS stimulation, constipation, dry mouth, nausea, weight gain, sexual dysfunction, orthostatic hypotension, HTN crisis when eating foods with tyramine (aged cheese, meats, yeast, chocolate, alcohol)

41
Q

MAOIs Contraindications and interactions

A

Renal failure
Liver disease
Cardiac disease
Clients >60
SSRIs
glaucoma

42
Q

MAOIs RN intervention and client education

A

Monitor VS and BP
Provide client a list of foods to avoid
Instruct client to report severe anxiety, insomnia, and agitation to provider

43
Q

Atypical Antidepressants prototype

A

bupropion (Wellbutrin)

44
Q

atypical antidepressants EPA

A

inhibits dopamine reuptake thereby inc dopamine availability

45
Q

atypical antidepressants administration

A

PO

46
Q

Atypical antidepressants therapeutic uses

A

depression, seasonal affective disorder, adjunctive to smoking cessation

47
Q

Atypical antidepressants ADRs

A

N/V, weight loss, appetite suppression, inc risk for seizure. CNS stimulation: insomnia, agitation, tremor, headache. Inc risk for psychosis/hallucination, SI

48
Q

Atypical antidepressants contraindications and interactions

A

Hx of an eating disorder
Seizure disorder
MAOI
Head trauma or tumor in CNS
Interacts with many meds

49
Q

atypical antidepressants RN intervention and client education

A

Give w/ food
Give in the morning
Weekly weights
Assess for ADRs
Assess for inc depression of SI

50
Q

Mood stabilizer prototype

A

lithium carbonate (Lithobid)

51
Q

mood stabilizer EPA

A

not well understood. Changes to transport of sodium ions in nerve cells and alters metabolism of catecholamines (fight or flight) in response to stress. This is thought to dec mania assoc with bipolar

52
Q

mood stabilizer administration

A

PO. Give with milk or food to reduce GI upset

53
Q

mood stabilizer therapeutic uses

A

controls acute mania and acute manic episodes assoc with bipolar disorder. Used prophylactically to prevent recurrence of mania or depression

54
Q

mood stabilizer ADRs

A

therapeutic levels: GI distress, fatigue, confusion, muscle weakness, memory impairment. Polyuria, dec secretion of thyroid hormone - goiter or hypothyroidism. Fine hand tremors

55
Q

mood stabilizers contraindications and interactions

A

pregnancy/lactation
Moderate-severe cardiac disorders
Dehydration
Hyponatremia
Renal insufficiency
Many drug interactions
Avoid NSAIDS

56
Q

mood stabilizers RN intervention and client education

A

Narrow therapeutic range
Monitor lithium levels. Desired serum plasma levels = 0.6-0.8 mEq/L
Regular bloodwork
- Electrolytes (sodium) and CBC
- Thyroid function - hypothyroidism
- Renal function
Monitor for s/sx of toxicity and other ADRs
Drink 2-3 L of fluid per day
Avoid caffeine and stressors
Consume foods with sodium

57
Q

First generation antipsychotics (FGA) prototype and other drug names

A

Chlorpromazine
Other: Haloperidol (Haldol)

58
Q

FGA EPA

A

Block several receptors: norepinepherine, acetylcholine, dopamine, hsitamine

59
Q

FGA administration

A

PO, IV, IM, Rectal

60
Q

FGA therapeutic uses

A

suppresses symptoms of schizophrenia. Acute manic phase of bipolar disorder

61
Q

FGA ADRs

A

Extrapyramidal symptoms (EPS): abnormal muscle contraction/posturing and acute dystonia
Neuroleptic malignant syndrome: fever, stiffness of muscles, altered mental status, change in BP rep. failure
Akathisia (inability to sit still)
Anticholinergic symptoms (dry mouth, dizziness, urinary retention, etc)
Parkinsonism
Orthostatic hypotension
Cardiac arrhythmias - prolonged QT interval
Liver failure

62
Q

FGA contraindications and interactions

A

Alcohol and other CNS depressants
Caution with meds that activate dopamine receptors (levodopa)
SSRIs - increase levels of serotonin - serotonin syndrome
Hyponatremia
Antihypertensives
pregnancy/lactation
Parkinsons disease, bone marrow depression

63
Q

FGA RN intervention and client education

A

Monitor for ADRs
Wear gloves when handling
Have client report:
- Muscle rigidity, tremors, and sluggish movements, drooling, and shuffling gait
- Severe spasms of the neck and body
- Involuntary movements of tongue, face, limbs, trunk
- Palpitations, fainting spells, other cardiac symptoms
- Avoid sun exposure, use sunscreen, wear protective clothing, wear sunglasses
- Sudden fever immediately to provider

64
Q

Second Generation Antipsychotics (SGA) prototype and other drug names

A

risperidone (Risperdal)
Others: olanzapine (Zyprexa), quetiapine (Seroquel), apriprazole (Ability), clozapine (Clozaril)

65
Q

SGA EPA

A

block receptors for dopamine and serotonin. Dopamine blockade is less than conventional antipsychotics thus fewer EPS occur

66
Q

SGA administration

A

PO - instructions vary by drug

67
Q

SGA therapeutic uses

A

treat symptoms of schizophrenia and bipolar disorder

68
Q

SGA ADRs

A

dizziness, sedation, hypotension (blockade of alpha adrenergic receptors), metabolic syndrome: wt gain, diabetes, dyslipidemia: arrhythmias, agranulocytosis (Clozapine), liver and kidney dysfunction; severe constipation. Extrapyramidal symptoms when given high doses

69
Q

SGA contraindications and interations

A

Prolonged QT
Severe CNS depression
Psychosis related to dementia in order adults
pregnancy/lactation
Drugs to treat parkinsons disease
Many drug interactions

70
Q

SGA RN interventions and client education

A

Very similar to FGAs/typocals
Weekly blood tests (CBC)
Periodic blood glucose monitoring
Report lethargy/flu like symptoms
Notify provider if you become pregnant
Notify provider if you have increased HR
BLACK BOX WARNING - don’t give to elderly clients with dementia

pharm (13 decks)

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