PHARM WEEK 1 PSYCH AGENTS Flashcards
1
Q
What are the 4 types of psychiatric agents?
A
- Antipsychotics
- Anxiolytics
- Antidepressants
- Mood stabilizers
2
Q
Antipsychotics
A
psychotic disorders particularly schizophrenia
3
Q
Anxiolytics
A
anxiety disorders, insomnia, cause and vomiting in cancer therapy
4
Q
Antidepressants
A
depression-reactive, major and bipolar disorders
5
Q
Mood stabilizers
A
antidepressant – bipolar disorders
6
Q
Physiology:
Moods and emotions are communicated throughout the CNS by __ __ .
These psych meds target those __ that go from one nerve to the other nerve in order to communicate emotions and moods
A
chemical neurotransmitters
neurotransmitters
7
Q
Physiology:
Impuse travels through the __ __ across the __ __ and binds to a __ on the __ __ neuron
A
presynaptic neuron
synaptic cleft
receptor
post synaptic
8
Q
Dopamine
A
- cognition
- emotional responses
- motivation
- movement
- attention
9
Q
Serotonin
A
- role in mood
- sleep rhythm
- arousal
- wakefulness
10
Q
Norepinephrine
A
- control of arousal
- vigilance
- mood,
- anxiety
- fight-or-flight response (
SNS response when we are stimulated through fear) - wakefulness
11
Q
Gamma-aminobutyric acid (GABA) :
A
- regulation of anxiety
- inhibitory to nervousness
- work to inhibit, calm down the brain, decrease the firing of the brain
12
Q
Losing contact with reality, manifested in mental or psychiatric disorders =
A
psychosis
13
Q
psychosis is thought to be due to
A
an imbalance of neurotransmitter dopamine and serotonin in the brain
14
Q
psychosis usually has > 1 of these symptoms:
A
- difficulty in processing information
- difficulty coming to a conclusion
- delusions
- hallucinations
- incoherence
- catatonia
- aggressive/violent behavior
15
Q
psychiatric meds target __ and __ receptors
A
dopamine and serotonin
16
Q
a false BELIEF in which one’s own thoughts, feelings, or fears cannot be distinguished from reality (delusions of persecution, grandeur, or control)
A
delusion
17
Q
a false PERCEPTION having no relation to reality
may be visual, auditory, tactile, gustatory, or olfactory
A
hallucination
18
Q
Schizophrenia is a __ __ of psychosis and is __.
A
major category
chronic
19
Q
Schizophrenia’s positive symptoms
A
agitation, hallucinations
20
Q
Schizophrenia’s negative symptoms
A
poverty of speech content , social withdrawal
21
Q
Two types of antipsychotics:
1.
2.
A
- typical (traditional) (first generation)
2. atypical (second generation)
22
Q
Examples of Typical Antipsychotics (First Generation)
A
- phenothiazines
2. nonphenothiazines
23
Q
What are Atypical Antipsychotics (Second Generation) effective at treating ?
A
Schizophrenia, and other psychotic disorders unresponsive to typical antipsychotics
Also used if intolerant of typical antipsychotics
24
Q
All antipsychotics block __ __
A
D2 receptor
25
Typical (phenothiazines) antipsychotics have a __ _ for the __ receptors
This increases the incidence of __ __ ___
strong affinity
D2
Extra Pyramidal Symptoms
26
Atypical antipsychotics have a __ __ for the __ receptors
There is a decreased incidence of _ ___ __
weak affinity
D2
extra pyramidal symptoms
27
EPS:
| Pseudoparkinsonism
```
stooped posture
shuffling gait
rigidity
bradykinesia
tremors at rest
pill-rolling motion of the hand
```
28
EPS:
| Acute Dystonia
facial grimacing
involuntary upward eye movement
muscle spasms of the tongue, face, neck and back (back muscle spasms cause trunk to arch forward)
Laryngeal spasms
29
EPS:
| Akathisia
Restless
Trouble standing still
Paces the floor
Feet in constant motion, rolling back and forth
30
EPS:
| Tardive dyskinesia
Protrusion and rolling of the tongue
Sucking and smacking movements of the lips
Chewing motion
Facial dyskinesia
Involuntary movements o the body and extremities
31
Acute dystonia can occur within __ of taking drug.
You can treat this with:
days
anticholinergic or antiparkinsonism drugs like: Benztropine (Cogent)
32
Akathisia can occur __ in treatment
You can treat this with:
early
benzodiazepines, e.g. Lorazepam (Ativan) OR a
beta blocker like Propanolol (Inderal)
33
Tardive Dyskinesia can occur typically after __ __ . This is a serious __ __ and drug should be __!
Treatment may include:
1 year
adverse reaction
stopped!
Treatment: Other benzodiazepines like Ca++ channel blockers or Beta blockers
High doses of Vitamin E may be helpful
34
Neuroleptic Malignant Syndrome (NMS) is rare but potentially fatal and includes these symptoms:
1. Sudden high fever
2. Muscle rigidity
3. Altered mental status
4. BP fluctuations
5. Tachycardia
6. Dysrhythmia
7. Seizures
8. Rhabdomyolysis (skeletal muscle destruction)
9. Acute renal failure (byproduct of skeletal muscle destruction)
10. Respiratory failure
11. coma
35
Treatment for NMS:
1. Immediate W/D of antipsychotics
2. Adequate hydration
3. Hypothermic blankets
4. Antipyretics
5. Benzodiazepines
6. Muscle relaxants
36
Phenothiazines - name the three groups
1. Aliphatic: Chlorpromazine (Thorazine)
2. Piperazine: Fluphenazine (Prolixin)
3. Piperidine: Thioridazine (Mellaril)
37
Aliphatic: Chlorpromazine (Thorazine) side effects
1. decreased BP
| 2. moderate EPS
38
Piperazine: Fluphenazine (Prolixin) side effects :
1. low sedative effect
2. strong antiemetic effect
3. little effect on BP
4. > EPS than other phenothiazines
39
Piperidine: Thioridazine (Mellaril) side effects
1. few EPS
| 2. can cause life threatening dysrhythmia
40
__ meds are Nonphenothiazines.
| What is an example?
Many
Haloperidol (Haldol)
- frequently prescribed
- similar to phenothiazines
- potent antipsychotic
- smaller dosages used
- prolonged QTc = leads to arrhythmia
- helps treat delirium (the waxing and waning of mental status)
41
Advantages of atypical antipsychotics
1. effective in treating both positive and negative symptoms
2. less likely to cause EPS or tardive dyskinesia
42
Action of atypical antipsychotics
blocks serotonin and dopaminergic D4 receptors
43
Examples of atypical antipsychotics:
```
1. Quetiapine (Seroquel)
2 Risperidone (Risperdal)
3. Ziprasidone (Geodon)
4. Olanzipine (Zyprexa)
5. Aripiprazole (Abilify)
```
44
Risperidone
- Use
- Side effects/Adverse Rxns
Use
- Manage symptoms of psychosis, schizophrenia
Side effects/adverse reactions
1. Sedation, headaches, photosensitivity
2. EPS, seizures
3. Dry mouth, weight gain
4. Tachycardia, orthostatic hypertension
5. Urinary retention, sexual dysfunction
45
Antipsychotics: Assessment
1. Baseline V/S and weight
2. Drug hx
- may need to increase anticonvulsant (anti epileptic) dose
- allergies
3. mental status, cardiac, eye, and respiratory
46
Antipsychotics: Nursing diagnoses
1. Disturbed though processes related to delusions
2. Disturbed sensory-perceptural responses related to biochemical imbalances (hallucinations)
3. Noncompliance related to loss of motivation
47
Antipsychotics: planning
Client's psychotic behavior with improve with __ and __
drugs and psychotherapy
48
Antipsychotics: interventions
| 7
1. Check V/S
- orthostatic hypotension w/ typical
2. Monitor for adherence
3. Observe for EPS
4. Assess for NMS
5. Monitor WBCs
4. Warn patients that it may take 3-6 weeks to achieve effectiveness
5. Warn client not to combine drug with alcohol, narcotics, or other CNS depressants
6. Warn against sudden discontinuation of antipsychotics to avoid sudden recurrence of psychotic symptoms
49
Anxiolytics treat __ and __.
| They are not usually given for __ __.
anxiety ; insomnia
secondary anxiety
50
What are the two types of anxiety?
Primary anxiety: not caused by medical condition or drug use
Secondary anxiety: related to drug use, medical/psych disorders
51
What are cautions for anxiolytics? (3)
1. long term use discouraged
2. tolerance in weeks or months
3. nonpharmacologic measures should be used first
52
What are the 4 uses of benzodiazepines?
What are 2 examples of benzodiazepines?
1. Anticonvulsants (dose increased)
2. Sedative - hypnotics
3. Pre-op drugs
4. Anxiolytics (smaller dose)
Examples:
1. Lorazepam (Ativan)
2. Diazepam (Valium)
53
Lorazepam (Ativan): Actions (5)
1. Enhances GABA effects
2. Binds to specific benzodiazepine receptors
3. Postsynaptic receptor becomes more sensitive to GABA
4. Results in inhibition of rapid neurotransmissions
5. Decreases signs and symptoms of anxiety
54
Lorazepam (Ativan): Pharmacokinetics:
1. Rapid GI absorption
2. High PB (protein-bound) 91%
3. T 1/2: 12-14 hours
4. Excreted in urine
55
Lorazepam (Ativan): Side effects
1. Drowsiness (enhance the work of the GABA neurotransmitter), dizziness
2. Weakness, confusion, blurred vision
3. N/V, anorexia
4. Sleep disturbance
5. Restlessness
6. Hallucinations
b/c these drugs are affecting the CNS, mostly brain-related side effects
Used for cancer patients who experience n/v
56
Lorazepam (Ativan) : Adverse reactions
1. Hypertension
2. Hypotension
3. Do not D/C benzodiazepines abruptly
- Withdrawal symptoms :
agitation, muscle tremors, cramps, nausea, sweating
(drug should be tapered over time)
57
Depression is a mood disorder that involves: (4)
1. Depressed mood, despair, insomnia
2. loss of interest in normal activities
3. fatigue, decreased ability to think
4. suicidal thoughts
58
Pathophysiology of depression
insufficient amount of monamine neurotransmitters (norepinephrine, serotonin, dopamine)
59
Depression can have a __ predisposition and can be caused by __ and __ factors
genetic
social; environmental
60
What are the three types of depression?
1. reactive
2. major
3. bipolar affective disorder
61
Reactive depression
sudden onset after a precipitating event; may last for months
62
Major depression
loss of interest in life;
inability to complete tasks
deep depression
63
Bipolar affective disorder
mood swings between manic (euphoric) and depressive (dysphoria)
64
Herbal supplements for depression : (2)
1. St. John's Wort
| 2. Gingko Biloba
65
St. John's Wort
can decrease repute of the neurotransmitters serotonin, norepinephrine, and dopamine
66
Gingko Biloba
the use of these and many herbal products should be discontinued 1-2 weeks before surgery
The patient should check with the health care provider regarding herbal treatments
67
What are the 4 types of antidepressants?
1. tricyclics (TCA)
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Atypical antidepressants
4. Monoamine oxidase inhibitors (MAOIs)
68
Tricyclics (TCAs)
1. used to treat major depression
- Example: amitriptyline (Elavil)
2. Blocks uptake/reuptake (removal of) norepinephrine & serotonin
3. Effective &
69
Amitriptyline (Elavil)
(tricyclic antidepressants)
-Interactions
Interactions
1. also blocks histamine and anticholinergic receptors
2. increased CNS effects with alcohol and other CNS depressants
3. increased sedation and anticholinergic effects with phenothiazines, haloperidol
70
Amitriptyline (Elavil)
| -Side effects/ adverse reactions
1. Sedation
2. dizziness
3. blurred vision
4. dry mouth and eyes
5. urinary retention
6. constipation
7. weight gain
8. GI distress
9. sexual dysfunction
10. orthostatic hypotension
11. dysrhythmia
12. EPS
13. blood dyscrasias
71
Selective Serotonin Reuptake Inhibitors (SSRIs)
What does it block?
What does it not block?
What is it mainly used for?
Give an example
1. Block reuptake of serotonin and enhance transmission
2. Do not block uptake of dopamine or norepinephrine
3. Do not block cholinergic and alpha1 adrenergic receptors
4. Mostly used for major depressive disorders
- also used for anxiety disorders and migraines
Example: Fluoxetine (Prozac)
72
SSRIs are __ metabolized
hepatically
73
SSRIs are more commonly used for depression than __
TCAs
74
SSRIs are more __ than TCAs
costly
75
SSRIs have __ side effects than TCAs
less
76
What are the side effects of SSRIs?
1. Dry mouth
2. Blurred vision
3. Insomnia, nervousness
4. Headache
5. Nausea, anorexia, diarrhea
6. suicidal ideation
7. sexual dysfunction
77
__ and __ interferes with SSRIs like fluoxetine (Prozac)
```
May cause:
1.
2.
3.
4.
```
Feverfew ; St. John's wort
1. dizziness
2. H/A
3. sweating
4. agitation
78
Atypical antidepressants are __ generation antidepressants
What are they used for?
What do they affect?
Give an example
second
major depression, reactive depression and anxiety
1 or 2 of the neurotransmitters - serotonin, norepinephrine, or dopamine
bupropion (Wellbutrin) which is also used for smoking cessation
79
Monoamine Oxidase Inhibitors (MAOIs)
the enzyme Monoamine Oxidase (MAO) inactivates: (4) neurotransmitters -
1. norepinephrine
2. dopamine
3. epinephrine
4. serotonin
80
MAOIs are __ and therefore inhibits both __ and __ and ___levels of neurotransmitters which relieves the symptoms of depression
nonselective;
MAO-A and MAO-B
increases
81
Are MAOIs just as effective as TCAs?
YES
82
MAOIs are only taken by __% of clients on antidepressants b/c of their __ __
1%
adverse effects
83
MAOIs are used when client is unresponsive to __ or __ __
they are used in __ , __ , and __ depression
TCAs or atypical antidepressants
mild, reactive, atypical
84
What is an example of a MAOI?
tranylcypromine sulfate (Parnate)
85
MAOIs interactions include:
Food ->
Drug ->
Food: Tyramine foods can cause hypertensive crisis or sympathomimetic-like effects
Drug: Any CNS stimulants or sympathomimetics can cause hypertensive crisis
86
MAOIs: Tyramine Foods to Avoid
1. Cheese
2. Bananas
3. Raisins
4. Pickled foods
5. Red wine
6. Beer
7. Cream
8. Yogurt
9. Chocolate
10. Coffee
11. Italian green beans
12. Liver
13. Yeast
14. Soy Sauce
87
MAOIs: Interventions (2)
1. Frequent BP monitoring
| 2. Client education re: drugs and foods to avoid including OTC drugs
88
Antidepressants: Assessment (4)
1. Baseline V/S & wt
2. Check liver and renal function
3. Hx of episodes of depression
4. Drug hx
89
```
Mood stabilizers: Lithium
What is it used to treat?
What is it most effective at doing?
Is it expensive?
What is its therapeutic range?
What does it deplete?
```
1. Lithium is an antidepressant to treat bipolar disorder
2. most effective in controlling manic phase
3. inexpensive
4. must be closely monitored - narrow therapeutic range 0.5-1.5 mEq/L (levels > 1.5 are toxic)
5. Depletes serum sodium levels - must monitor sodium level
90
Lithium toxicity can lead to what 4 things?
1. nausea
2. vomiting
3. cardiac dysrhythmias
4. cardiac arrest
the cardiac dysrhythmias and cardiac arrest are secondary to some of that Na depletion
91
Lithium drug interactions
| There will be an increased lithium level if taken with: (7)
1. thiazides
2. methyldopa
3. haloperidol
4. NSAIDs
5. antidepressants
6. theophylline
7. phenothiazines
92
Side effects/adverse reactions of Lithium
1. headache, drowsiness, dizziness
2. hypotension, dysrhythmias
3. restlessness, slurred speech
4. dry mouth, metallic taste, GI distress
5. tremors, muscle weakness
6. edema of hands and ankles
7. increased urination, blood dycrasias, nephrotoxicity
93
Nursing interventions for patient on Lithium (6)
1. Monitor vital signs, sodium levels
2. monitor for drug effectiveness, suicidal tendencies
3. monitor urine output, renal function tests
4. encourage adequate fluid intake (1 to 2 L daily)
5. take with food to decrease GI irritation
6. Monitor lithium levels every 1 to 2 months
94
Lithium toxic side effects: (8)
1. persistent nausea, vomiting, diarrhea
2. blurred vision
3. tinnitus
4. ataxia
5. increasing tremors
6. confusion
7. dysrhythmia
8. seizures
