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AE1 > PHARM WEEK 1 PSYCH AGENTS > Flashcards

PHARM WEEK 1 PSYCH AGENTS Flashcards

1
Q

What are the 4 types of psychiatric agents?

A
  1. Antipsychotics
  2. Anxiolytics
  3. Antidepressants
  4. Mood stabilizers
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2
Q

Antipsychotics

A

psychotic disorders particularly schizophrenia

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3
Q

Anxiolytics

A

anxiety disorders, insomnia, cause and vomiting in cancer therapy

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4
Q

Antidepressants

A

depression-reactive, major and bipolar disorders

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5
Q

Mood stabilizers

A

antidepressant – bipolar disorders

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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

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7
Q

Physiology:

Impuse travels through the __ __ across the __ __ and binds to a __ on the __ __ neuron

A

presynaptic neuron

synaptic cleft

receptor

post synaptic

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8
Q

Dopamine

A
  1. cognition
  2. emotional responses
  3. motivation
  4. movement
  5. attention
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9
Q

Serotonin

A
  1. role in mood
  2. sleep rhythm
  3. arousal
  4. wakefulness
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10
Q

Norepinephrine

A
  1. control of arousal
  2. vigilance
  3. mood,
  4. anxiety
  5. fight-or-flight response (
    SNS response when we are stimulated through fear)
  6. wakefulness
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11
Q

Gamma-aminobutyric acid (GABA) :

A
  1. regulation of anxiety
  2. inhibitory to nervousness
  3. work to inhibit, calm down the brain, decrease the firing of the brain
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12
Q

Losing contact with reality, manifested in mental or psychiatric disorders =

A

psychosis

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13
Q

psychosis is thought to be due to

A

an imbalance of neurotransmitter dopamine and serotonin in the brain

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14
Q

psychosis usually has > 1 of these symptoms:

A
  1. difficulty in processing information
  2. difficulty coming to a conclusion
  3. delusions
  4. hallucinations
  5. incoherence
  6. catatonia
  7. aggressive/violent behavior
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15
Q

psychiatric meds target __ and __ receptors

A

dopamine and serotonin

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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

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17
Q

a false PERCEPTION having no relation to reality

may be visual, auditory, tactile, gustatory, or olfactory

A

hallucination

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18
Q

Schizophrenia is a __ __ of psychosis and is __.

A

major category

chronic

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19
Q

Schizophrenia’s positive symptoms

A

agitation, hallucinations

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20
Q

Schizophrenia’s negative symptoms

A

poverty of speech content , social withdrawal

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21
Q

Two types of antipsychotics:
1.
2.

A
  1. typical (traditional) (first generation)

2. atypical (second generation)

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22
Q

Examples of Typical Antipsychotics (First Generation)

A
  1. phenothiazines

2. nonphenothiazines

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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

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24
Q

All antipsychotics block __ __

A

D2 receptor

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25
Q

Typical (phenothiazines) antipsychotics have a __ _ for the __ receptors

This increases the incidence of __ __ ___

A

strong affinity

D2

Extra Pyramidal Symptoms

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26
Q

Atypical antipsychotics have a __ __ for the __ receptors

There is a decreased incidence of _ ___ __

A

weak affinity

D2

extra pyramidal symptoms

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27
Q

EPS:

Pseudoparkinsonism

A 
stooped posture 
shuffling gait 
rigidity 
bradykinesia 
tremors at rest 
pill-rolling motion of the hand
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28
Q

EPS:

Acute Dystonia

A

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

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29
Q

EPS:

Akathisia

A

Restless
Trouble standing still
Paces the floor
Feet in constant motion, rolling back and forth

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30
Q

EPS:

Tardive dyskinesia

A

Protrusion and rolling of the tongue
Sucking and smacking movements of the lips
Chewing motion
Facial dyskinesia
Involuntary movements o the body and extremities

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31
Q

Acute dystonia can occur within __ of taking drug.

You can treat this with:

A

days

anticholinergic or antiparkinsonism drugs like: Benztropine (Cogent)

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32
Q

Akathisia can occur __ in treatment

You can treat this with:

A

early

benzodiazepines, e.g. Lorazepam (Ativan) OR a

beta blocker like Propanolol (Inderal)

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33
Q

Tardive Dyskinesia can occur typically after __ __ . This is a serious __ __ and drug should be __!

Treatment may include:

A

1 year

adverse reaction
stopped!

Treatment: Other benzodiazepines like Ca++ channel blockers or Beta blockers

High doses of Vitamin E may be helpful

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34
Q

Neuroleptic Malignant Syndrome (NMS) is rare but potentially fatal and includes these symptoms:

A
  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
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35
Q

Treatment for NMS:

A
  1. Immediate W/D of antipsychotics
  2. Adequate hydration
  3. Hypothermic blankets
  4. Antipyretics
  5. Benzodiazepines
  6. Muscle relaxants
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36
Q

Phenothiazines - name the three groups

A
  1. Aliphatic: Chlorpromazine (Thorazine)
  2. Piperazine: Fluphenazine (Prolixin)
  3. Piperidine: Thioridazine (Mellaril)
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37
Q

Aliphatic: Chlorpromazine (Thorazine) side effects

A
  1. decreased BP

2. moderate EPS

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38
Q

Piperazine: Fluphenazine (Prolixin) side effects :

A
  1. low sedative effect
  2. strong antiemetic effect
  3. little effect on BP
  4. > EPS than other phenothiazines
39
Q

Piperidine: Thioridazine (Mellaril) side effects

A
  1. few EPS

2. can cause life threatening dysrhythmia

40
Q

__ meds are Nonphenothiazines.

What is an example?

A

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
Q

Advantages of atypical antipsychotics

A
  1. effective in treating both positive and negative symptoms
  2. less likely to cause EPS or tardive dyskinesia
42
Q

Action of atypical antipsychotics

A

blocks serotonin and dopaminergic D4 receptors

43
Q

Examples of atypical antipsychotics:

A 
1. Quetiapine (Seroquel) 
2 Risperidone (Risperdal) 
3. Ziprasidone (Geodon) 
4. Olanzipine (Zyprexa) 
5. Aripiprazole (Abilify)
44
Q

Risperidone

  • Use
  • Side effects/Adverse Rxns
A

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
Q

Antipsychotics: Assessment

A
  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
Q

Antipsychotics: Nursing diagnoses

A
  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
Q

Antipsychotics: planning

Client’s psychotic behavior with improve with __ and __

A

drugs and psychotherapy

48
Q

Antipsychotics: interventions

7

A
  1. Check V/S
    - orthostatic hypotension w/ typical
  2. Monitor for adherence
  3. Observe for EPS
  4. Assess for NMS
  5. Monitor WBCs
  6. Warn patients that it may take 3-6 weeks to achieve effectiveness
  7. Warn client not to combine drug with alcohol, narcotics, or other CNS depressants
  8. Warn against sudden discontinuation of antipsychotics to avoid sudden recurrence of psychotic symptoms
49
Q

Anxiolytics treat __ and __.

They are not usually given for __ __.

A

anxiety ; insomnia

secondary anxiety

50
Q

What are the two types of anxiety?

A

Primary anxiety: not caused by medical condition or drug use

Secondary anxiety: related to drug use, medical/psych disorders

51
Q

What are cautions for anxiolytics? (3)

A
  1. long term use discouraged
  2. tolerance in weeks or months
  3. nonpharmacologic measures should be used first
52
Q

What are the 4 uses of benzodiazepines?

What are 2 examples of benzodiazepines?

A
  1. Anticonvulsants (dose increased)
  2. Sedative - hypnotics
  3. Pre-op drugs
  4. Anxiolytics (smaller dose)

Examples:

  1. Lorazepam (Ativan)
  2. Diazepam (Valium)
53
Q

Lorazepam (Ativan): Actions (5)

A
  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
Q

Lorazepam (Ativan): Pharmacokinetics:

A
  1. Rapid GI absorption
  2. High PB (protein-bound) 91%
  3. T 1/2: 12-14 hours
  4. Excreted in urine
55
Q

Lorazepam (Ativan): Side effects

A
  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
Q

Lorazepam (Ativan) : Adverse reactions

A
  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
Q

Depression is a mood disorder that involves: (4)

A
  1. Depressed mood, despair, insomnia
  2. loss of interest in normal activities
  3. fatigue, decreased ability to think
  4. suicidal thoughts
58
Q

Pathophysiology of depression

A

insufficient amount of monamine neurotransmitters (norepinephrine, serotonin, dopamine)

59
Q

Depression can have a __ predisposition and can be caused by __ and __ factors

A

genetic

social; environmental

60
Q

What are the three types of depression?

A
  1. reactive
  2. major
  3. bipolar affective disorder
61
Q

Reactive depression

A

sudden onset after a precipitating event; may last for months

62
Q

Major depression

A

loss of interest in life;
inability to complete tasks
deep depression

63
Q

Bipolar affective disorder

A

mood swings between manic (euphoric) and depressive (dysphoria)

64
Q

Herbal supplements for depression : (2)

A
  1. St. John’s Wort

2. Gingko Biloba

65
Q

St. John’s Wort

A

can decrease repute of the neurotransmitters serotonin, norepinephrine, and dopamine

66
Q

Gingko Biloba

A

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
Q

What are the 4 types of antidepressants?

A
  1. tricyclics (TCA)
  2. Selective serotonin reuptake inhibitors (SSRIs)
  3. Atypical antidepressants
  4. Monoamine oxidase inhibitors (MAOIs)
68
Q

Tricyclics (TCAs)

A
  1. used to treat major depression
    - Example: amitriptyline (Elavil)
  2. Blocks uptake/reuptake (removal of) norepinephrine & serotonin
  3. Effective &
69
Q

Amitriptyline (Elavil)
(tricyclic antidepressants)
-Interactions

A

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
Q

Amitriptyline (Elavil)

-Side effects/ adverse reactions

A
  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
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

What does it block?
What does it not block?
What is it mainly used for?

Give an example

A
  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
Q

SSRIs are __ metabolized

A

hepatically

73
Q

SSRIs are more commonly used for depression than __

A

TCAs

74
Q

SSRIs are more __ than TCAs

A

costly

75
Q

SSRIs have __ side effects than TCAs

A

less

76
Q

What are the side effects of SSRIs?

A
  1. Dry mouth
  2. Blurred vision
  3. Insomnia, nervousness
  4. Headache
  5. Nausea, anorexia, diarrhea
  6. suicidal ideation
  7. sexual dysfunction
77
Q

__ and __ interferes with SSRIs like fluoxetine (Prozac)

May cause: 
1. 
2.
3.
4.
A

Feverfew ; St. John’s wort

  1. dizziness
  2. H/A
  3. sweating
  4. agitation
78
Q

Atypical antidepressants are __ generation antidepressants

What are they used for?

What do they affect?

Give an example

A

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
Q

Monoamine Oxidase Inhibitors (MAOIs)

the enzyme Monoamine Oxidase (MAO) inactivates: (4) neurotransmitters -

A
  1. norepinephrine
  2. dopamine
  3. epinephrine
  4. serotonin
80
Q

MAOIs are __ and therefore inhibits both __ and __ and ___levels of neurotransmitters which relieves the symptoms of depression

A

nonselective;
MAO-A and MAO-B
increases

81
Q

Are MAOIs just as effective as TCAs?

A

YES

82
Q

MAOIs are only taken by __% of clients on antidepressants b/c of their __ __

A

1%

adverse effects

83
Q

MAOIs are used when client is unresponsive to __ or __ __

they are used in __ , __ , and __ depression

A

TCAs or atypical antidepressants

mild, reactive, atypical

84
Q

What is an example of a MAOI?

A

tranylcypromine sulfate (Parnate)

85
Q

MAOIs interactions include:
Food ->
Drug ->

A

Food: Tyramine foods can cause hypertensive crisis or sympathomimetic-like effects

Drug: Any CNS stimulants or sympathomimetics can cause hypertensive crisis

86
Q

MAOIs: Tyramine Foods to Avoid

A
  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
Q

MAOIs: Interventions (2)

A
  1. Frequent BP monitoring

2. Client education re: drugs and foods to avoid including OTC drugs

88
Q

Antidepressants: Assessment (4)

A
  1. Baseline V/S & wt
  2. Check liver and renal function
  3. Hx of episodes of depression
  4. Drug hx
89
Q 
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?
A
  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
Q

Lithium toxicity can lead to what 4 things?

A
  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
Q

Lithium drug interactions

There will be an increased lithium level if taken with: (7)

A
  1. thiazides
  2. methyldopa
  3. haloperidol
  4. NSAIDs
  5. antidepressants
  6. theophylline
  7. phenothiazines
92
Q

Side effects/adverse reactions of Lithium

A
  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
Q

Nursing interventions for patient on Lithium (6)

A
  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
Q

Lithium toxic side effects: (8)

A
  1. persistent nausea, vomiting, diarrhea
  2. blurred vision
  3. tinnitus
  4. ataxia
  5. increasing tremors
  6. confusion
  7. dysrhythmia
  8. seizures

AE1 (12 decks)

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