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N3132 MENTAL HEALTH > PHARMACOLOGY > Flashcards

PHARMACOLOGY Flashcards

1
Q

Typical Antipsychotics

A

Neurotransmitter(s)
Dopamine receptor blocker —> decreases dopamine

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2
Q

Typical Antipsychotic Medications

A

Haloperidol (Haldol) —> most common
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
Mesoridazine (Serentil)
Trifluoperazine (Stelazine)
Perphenazine (Trilafon)
Fluphenazine (Prolixin)

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3
Q

Side Effects/ Adverse Reactions of Typical Antipsychotics

A

Typical antipsychotics have high affinity for dopamine receptors which causes
serious side effects called extrapyramidal

  1. Pseudoparkinsonism
  2. Acute Dystonia (medical emergency)
  3. Akathisia
  4. Tardive Dyskinesia
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4
Q

Symptoms of Pseudoparkinsonism

A

Stooped posture
Shuffling gait
Bradykinesia (brady- = slow, -kinesia = movement)
Tremor at rest
Pill-rolling motion of the hand

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5
Q

Symptoms of Acute Dystonia (medical emergency)

A

Facial grimacing
Involuntary upward eye movement
Muscle spasms of the tongue face neck, and back (back muscles cause trunk to arch forward
Laryngeal spasms (throat tightened, voice change)

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6
Q

Symptoms of Akathisia

A

Restlessness
Trouble standing
Paces the floor
Feet in constant motion, rocking back and forth

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7
Q

Symptoms of Tardive Dyskinesia

A

Protrusion and rolling of the tongue
Sucking and smacking of lips
Chewing motion
Facial dyskinesia (dys- = bad/difficult, -kinesia = movement)
Involuntary movement of the body and extremities

(caused by long-term use of typical antipsychotics)

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8
Q

Nursing Priorities for Tardive Dyskinesia

A

lower dose of typicals

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9
Q

Nursing Priorities for Parkinsonism and Akathisia

A

Fall Risk Precautions

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10
Q

Nursing Priorities for Acute Dystonia

A

medical emergency. Treated primarily with a stat IM of COGENTIN (Benztropine Mesylate)

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11
Q

Atypical Antipsychotics

A

Neurotransmitter(s)
Affect both dopamine (decreased) and serotonin (decreased)

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12
Q

Atypical Antipsychotic Medications

A

Clozapine (Clozaril) —> Used for treatment resistant schizophrenia, meaning
when other medications are not working
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel) —> good for older adults

Depot Injections:
Risperdal Consta
Invega Sustenna
Abilify Maintena
Invega Trinza

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13
Q

Side Effects/Adverse Reactions of Atypical Antipsychotics ( SHORT-TERM: ANTICHOLINERGIC EFFECTS)

A
  • related to Clozapine, Olanzapine, and
    Quetiapine (all but Risperidone)
  • Note: Anticholinergic = anti-parasympathetic = sympathetic effects

BRAIN: drowsiness, dizziness, confusion, hallucinations
EYES: Blurred vision, dry eyes
MOUTH: dry mouth
SKIN: Skin-flushing, unable to sweat, overheating
HEART: rapid heart rate
BOWEL: constipation
BLADDER: urine retention (unable to empty bladder)

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14
Q

Side Effects/Adverse Reactions of Atypical Antipsychotics ( LONG-TERM: ANTICHOLINERGIC EFFECTS)

A

-Decreased salivation (dental caries, ulceration of gums and buccal mucosa)

-Decreased bronchial secretions (mucous plugging of small airways in patients with asthma or bronchitis)

-Decreased sweating (hyperthermia)
Increased pupil size (photophobia, precipitation of acute narrow angle glaucoma)

-Inhibition of accommodation (blurred vision, especially when reading small print)

  • Increased heart rate (angina, MI)
  • Difficulty urinating (bladder distention, urinary retention
  • Decreased gastrointestinal motility (Constipation)
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15
Q

Side Effects/Adverse Reactions of Atypical Antipsychotics : CLOZAPINE

A

Agranulocytosis – major side effect (drop in WBC count)
Increased risk for infection
Orthostatic hypotension – systolic BP drops when standings up because
blood vessels fail to constrict

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16
Q

Side Effects/Adverse Reactions of Atypical Antipsychotics : METABOLIC SYNDROME

A

Related to clozapine and zyprexa
Impair hunger, satiety and fullness cues, so likely to gain weight. So, high
likelihood of developing Type 2 Diabetes.

(Metabolic Syndrome: Visceral obesity, Insulin resistance, hypertension, high triglycerides, low HDL-Cholesterol)

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17
Q

Special Precautions for Clozapine (Atypical Antipsychotics)

A

Clozapine: regular blood work

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18
Q

Nursing Priorities for Clozapine

A

Clozapine: assess for infection, fever, etc. Start with low dose and increase
slowly while monitoring

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19
Q

Nursing Priorities for Zyprexa and Clozapine

A

Clozapine and zyprexa: educate about impaired hunger/satiety cues

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20
Q

Antidepressants: SSRIs

A

Neurotransmitters
Seratonin
This is the most common type

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21
Q

Antidepressants: SSRIs Medications

A

Prozac/Fluoxetine
Luvox/Fluoxamine
Paxil/Paroxetine
Zoloft/Sertraline
Celexa/Citalopram

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22
Q

Antidepressants: SSRIs Side Effects/ Adverse Reactions

A

Sexual dysfunction
GI upset when taken on empty stomach
Anticholinergic effects
Seratonin syndrome when mixed with MAOIs
Nervousness/Aggitation
Sedation

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23
Q

Special Precautions with Antidepressants: SSRIs

A

Take with food to avoid GI upset
No mixing with MAOIs
Take in the morning to avoid nervousness
Take in the evening if causes sedation

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24
Q

Nursing Priorities for SSRIs (Antidepressant)

A

Education

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25
Antidepressants: MAOIs
Neurotransmitters serotonin, norepinephrine, and dopamine
26
Antidepressants: MAOIs Medications
Nardil/Phenelzine Parnate/Tranylcypromine Marplan/Isocaroxazid
27
Side Effects/Adverse Reactions of Antidepressants: MAOIs
MAOI's not preferred due to food restrictions Hypertensive crisis when taken with tyramine containing foods Seratonin syndrome when taken with SSRIs
28
Special Precautions with MAOIs (Antidepressants)
No food with tyramine (e.g. fermented foods like cheese, wine, sauerkraut) No taking w/ SSRIs
29
Antidepressants: TRICYCLICS
Neurotransmitters Serotonin and norepinephrine Used to treat OCD
30
Antidepressants: TRICYCLICS Medications
Elavil/Amitriptyline Anafranil/Clomipramine (anaf-ranil) Surmontil/Trimipramine (soar-man-til) Silenor/Doxepin (like elanor)
31
Side Effects/Adverse Reactions of Antidepressants: TRICYCLICS
Lethal in high doses (Suicide risk) High GI absorption (toxicity) Seratonin syndrome when taken with SSRIs/MAOIs Orthostatic hypotension (like Benzos and clozapine)
32
Nursing Priorities for TRICYCLICS (Antidepressants)
Assess suicide risk because can be lethal Connect to healthcare provider - doctor will not give it to patients in high doses because of lethality GI absorption: gastric lavage (sucking) does not work, but charcol can slow it down
33
Atypical Anti-Depressants
Dopamine: Wellbutrin/Bupropion Serotonin and Norepinephrine: Trazodone/Desyrel (SARIs) Serotonin Receptor Antagonists and Reuptake Inhibitors Effexor XR/Venlafaxine (SNRI aka Serotonin and Norepinephrine Reuptake Inhibitors)
34
List the three Anti-Depressants
SSRIs MAOIs Tricyclics
35
Anti-Anxiety: BENZODIAZEPINES
GABA (gamma-aminobutyric acid) GABA slows down the firing of neurons, calming the brain Benzos attract more GABA to the post synaptic neuron Indications : Generalized anxiety disorder, Seizures, ETOH withdrawal
36
Anti-Anxiety: BENZODIAZEPINES Medications
-lams and -pams and chlordiazepoxide Alprazolam (Xanax) Chlordiazepoxide (Librium), Clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan) Oxazepam (Serax)
37
Side Effects/Adverse Reactions of BENZODIAZEPINES (Anti-Anxiety)
Irritability/Hostility Sedation/dizziness/confusion Change in cognition (long-term use) Rebound insomnia Dependancy/risk of addiction Respiratory depression when taken with other CNS depressants
38
Anti-Anxiety: BENZODIAZEPINE Withdrawal Symptoms
Anxiety Seizures Insomnia Tremor Hallucinations Dependancy
39
Special Precautions for Anti-Anxiety: BENZODIAZEPINE
Short term: Treatment with Benzodiazepines generally should be brief, during time of specific stress or for specific indication Don't mix with ETOH or other CNS Assess for risk of addiction No operating machinery (driving cars) Wean off slowly to avoid withdrawal symptoms
40
Nursing Priorities for Anti-Anxiety: BENZODIAZEPINE
Education about side effects and special precautions
41
Anti-Anxiety: BUSPAR (BUSPIRONE)
Neurotransmitters Serotonin and dopamine
42
Special Precautions for Anti-Anxiety: BUSPAR (BUSPIRONE)
takes 2-3 weeks to take effect. Not used for acute anxiety
43
SARI Atypical Antidepressant
Neurotransmitter: Serotonin and Norepinephrine Medication: TRAZODONE / DESYREL
44
Side Effects/Adverse Reactions for SARI Atypical Anti-Depressant
No limitations because given at a low dose Highly sedative, so take at night
45
Mood Stabilizers/Bipolar Medication: ANTIMANIA
LITHIUM (a salt)
46
Side Effects/Adverse Reactions for LITHIUM
Lithium toxicity caused by: Overdosing Metabolic changes: not able metabolize? Dehydration: leading to increaxed serum lithium levels Polypharmacy: taking a lot of different medications at once that may interacting in a negative way Hyponatremia – dietary induced low Na+ intake Severity of symptoms progress from GI, to neurological, to coma and death
47
LITHIUM: Mild Symptoms (GI)
nausea & vomiting, abdominal pain, diarrhea, increased thirst
48
LITHIUM: Mild Symptoms (Neuro)
tremors, muscle weakness, ataxia or lack of coordination in hands, arms, legs or body, confusion, drowsiness/insomnia slurred speech
49
LITHIUM: Severe Toxicity
Coma Seizures Blurred vision
50
Special Precautions for LITHIUM (Antimania)
Lithium Levels: Therapeutic levels: 0.8-1.4 mEq/L Maintenance: 0.4-1.3 mEq/L Toxic levels: greater than or equal to 1.5 mEq/L Heart: ECG (make sure there are no arrhythmias) Renal: creatinine clearance, electrolyte balance Liver: ALT Pregnancy: crosses placenta
51
ANTI-CONVULSANTS Mechanism of Action
(mood stabilizer, bipolar medication) Decreases firing of neurons
52
ANTI-CONVULSANTS Medications
Valproic Acid (Epival/Depakote) Carbamazepine (Tegretol): carb-amze-pine like carbs, maze, pine Lamotrigine (Lamictal): limo-tri-gene
53
Which medications have an anticholinergic side effect?
Atypical antipsychotics (risperidone is little) SSRIs
54
Which medications have orthostatic hypotension as a side effect?
Clozapine, Tricyclics, Benzos
55
Which medication can cause hypertensive crisis when ____?
MAOIs when taken with tyramine containing foods
56
Which medications impact serotonin and norepinephrine?
Atypical Antipsychotics Trazodone Effector XR Tricyclics
57
What is the difference between buspirone and bupropion?
Buspirone (buspar) is an antianxiety that impacts serotonin and dopamine Bupropion (wellbutrin) is an aytpical antidepressant that impacts only dopamine
58
Which medication should you NOT operate heavy machinery?
Benzodiazepines
59
What is Zuclopenthixol (Clopixal Acuphase)?
short acting antipsychotic to help stabilize. Helps CNS relax and they sleep for a 2-3 hours. They stabilize and are able to take oral medications Ativan/Haldal IM: Ativan is antianxiety and haldal is antipsychotic
60
What category is Trazodone/Desyrel under?
Atypical Anti-Depressants Anti-Anxiety (in small doses)

N3132 MENTAL HEALTH (10 decks)

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