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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
SSRIs therapeutic uses
many indications! Depression, anxiety, OCD, bulimia nervosa, PMDD
26
SSRIs ADRs
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
27
SSRIs contraindications and interactions
MAOIs St johns wort Ibuprofen May decrease glucose control in clients w/ DM
28
SSRIs RN interactions and client education
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
29
SNRIs prototype and other drug names
Vanlafaxine (Effexor XR) Duloxetine (Cymbalta)
30
SNRIs EPA
block neuronal reuptake of serotonin AND norepinephrine - inc amount of serotonin/norepinephrine available
31
SNRIs administration
PO. Start with low dose and gradually titrate up
32
SNRIs therapeutic use
major depression, social anxiety disorder, generalized anxiety disorder (GAD)
33
SNRIs ADRS
very similar to SSRI. sexual dysfunction less common than w/ SSRI and can cause HTN
34
SNRIs contraindications and interactions
MAOIs First gen antipsychotics/typicals ibuprofen
35
SNRIs RN intervention and client education
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
MAOI Prototype and other drug names
phenelzine (Nardil) Isocarboxazid (Marplan)
37
MAOIs EPA
blocks monoamine oxidase-A and monoamine oxidase-B
38
MAOIs administration
PO. start with low dose possible
39
MAOIs therapeutic uses
depression that hasn’t responded to other meds, depression in bipolar
40
MAOIs ADRs
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
MAOIs Contraindications and interactions
Renal failure Liver disease Cardiac disease Clients >60 SSRIs glaucoma
42
MAOIs RN intervention and client education
Monitor VS and BP Provide client a list of foods to avoid Instruct client to report severe anxiety, insomnia, and agitation to provider
43
Atypical Antidepressants prototype
bupropion (Wellbutrin)
44
atypical antidepressants EPA
inhibits dopamine reuptake thereby inc dopamine availability
45
atypical antidepressants administration
PO
46
Atypical antidepressants therapeutic uses
depression, seasonal affective disorder, adjunctive to smoking cessation
47
Atypical antidepressants ADRs
N/V, weight loss, appetite suppression, inc risk for seizure. CNS stimulation: insomnia, agitation, tremor, headache. Inc risk for psychosis/hallucination, SI
48
Atypical antidepressants contraindications and interactions
Hx of an eating disorder Seizure disorder MAOI Head trauma or tumor in CNS Interacts with many meds
49
atypical antidepressants RN intervention and client education
Give w/ food Give in the morning Weekly weights Assess for ADRs Assess for inc depression of SI
50
Mood stabilizer prototype
lithium carbonate (Lithobid)
51
mood stabilizer EPA
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
mood stabilizer administration
PO. Give with milk or food to reduce GI upset
53
mood stabilizer therapeutic uses
controls acute mania and acute manic episodes assoc with bipolar disorder. Used prophylactically to prevent recurrence of mania or depression
54
mood stabilizer ADRs
therapeutic levels: GI distress, fatigue, confusion, muscle weakness, memory impairment. Polyuria, dec secretion of thyroid hormone - goiter or hypothyroidism. Fine hand tremors
55
mood stabilizers contraindications and interactions
pregnancy/lactation Moderate-severe cardiac disorders Dehydration Hyponatremia Renal insufficiency Many drug interactions Avoid NSAIDS
56
mood stabilizers RN intervention and client education
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
First generation antipsychotics (FGA) prototype and other drug names
Chlorpromazine Other: Haloperidol (Haldol)
58
FGA EPA
Block several receptors: norepinepherine, acetylcholine, dopamine, hsitamine
59
FGA administration
PO, IV, IM, Rectal
60
FGA therapeutic uses
suppresses symptoms of schizophrenia. Acute manic phase of bipolar disorder
61
FGA ADRs
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
FGA contraindications and interactions
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
FGA RN intervention and client education
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
Second Generation Antipsychotics (SGA) prototype and other drug names
risperidone (Risperdal) Others: olanzapine (Zyprexa), quetiapine (Seroquel), apriprazole (Ability), clozapine (Clozaril)
65
SGA EPA
block receptors for dopamine and serotonin. Dopamine blockade is less than conventional antipsychotics thus fewer EPS occur
66
SGA administration
PO - instructions vary by drug
67
SGA therapeutic uses
treat symptoms of schizophrenia and bipolar disorder
68
SGA ADRs
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
SGA contraindications and interations
Prolonged QT Severe CNS depression Psychosis related to dementia in order adults pregnancy/lactation Drugs to treat parkinsons disease Many drug interactions
70
SGA RN interventions and client education
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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