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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
Q

Antidepressants: MAOIs

A

Neurotransmitters
serotonin, norepinephrine, and dopamine

26
Q

Antidepressants: MAOIs Medications

A

Nardil/Phenelzine
Parnate/Tranylcypromine
Marplan/Isocaroxazid

27
Q

Side Effects/Adverse Reactions of Antidepressants: MAOIs

A

MAOI’s not preferred due to food restrictions
Hypertensive crisis when taken with tyramine containing foods
Seratonin syndrome when taken with SSRIs

28
Q

Special Precautions with MAOIs (Antidepressants)

A

No food with tyramine (e.g. fermented foods like cheese, wine, sauerkraut)
No taking w/ SSRIs

29
Q

Antidepressants: TRICYCLICS

A

Neurotransmitters
Serotonin and norepinephrine
Used to treat OCD

30
Q

Antidepressants: TRICYCLICS Medications

A

Elavil/Amitriptyline
Anafranil/Clomipramine (anaf-ranil)
Surmontil/Trimipramine (soar-man-til)
Silenor/Doxepin (like elanor)

31
Q

Side Effects/Adverse Reactions of Antidepressants: TRICYCLICS

A

Lethal in high doses (Suicide risk)
High GI absorption (toxicity)
Seratonin syndrome when taken with SSRIs/MAOIs
Orthostatic hypotension (like Benzos and clozapine)

32
Q

Nursing Priorities for TRICYCLICS (Antidepressants)

A

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
Q

Atypical Anti-Depressants

A

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
Q

List the three Anti-Depressants

A

SSRIs
MAOIs
Tricyclics

35
Q

Anti-Anxiety: BENZODIAZEPINES

A

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
Q

Anti-Anxiety: BENZODIAZEPINES Medications

A

-lams and -pams and chlordiazepoxide
Alprazolam (Xanax)
Chlordiazepoxide (Librium),
Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)

37
Q

Side Effects/Adverse Reactions of BENZODIAZEPINES (Anti-Anxiety)

A

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
Q

Anti-Anxiety: BENZODIAZEPINE Withdrawal Symptoms

A

Anxiety
Seizures
Insomnia
Tremor
Hallucinations
Dependancy

39
Q

Special Precautions for Anti-Anxiety: BENZODIAZEPINE

A

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
Q

Nursing Priorities for Anti-Anxiety: BENZODIAZEPINE

A

Education about side effects and special precautions

41
Q

Anti-Anxiety: BUSPAR (BUSPIRONE)

A

Neurotransmitters
Serotonin and dopamine

42
Q

Special Precautions for Anti-Anxiety: BUSPAR (BUSPIRONE)

A

takes 2-3 weeks to take effect. Not used for acute anxiety

43
Q

SARI Atypical Antidepressant

A

Neurotransmitter: Serotonin and Norepinephrine

Medication: TRAZODONE / DESYREL

44
Q

Side Effects/Adverse Reactions for SARI Atypical Anti-Depressant

A

No limitations because given at a low dose
Highly sedative, so take at night

45
Q

Mood Stabilizers/Bipolar Medication: ANTIMANIA

A

LITHIUM (a salt)

46
Q

Side Effects/Adverse Reactions for LITHIUM

A

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
Q

LITHIUM: Mild Symptoms (GI)

A

nausea & vomiting,
abdominal pain,
diarrhea,
increased thirst

48
Q

LITHIUM: Mild Symptoms (Neuro)

A

tremors,
muscle weakness,
ataxia or lack of coordination in hands, arms, legs or body,
confusion,
drowsiness/insomnia
slurred speech

49
Q

LITHIUM: Severe Toxicity

A

Coma
Seizures
Blurred vision

50
Q

Special Precautions for LITHIUM (Antimania)

A

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
Q

ANTI-CONVULSANTS Mechanism of Action

A

(mood stabilizer, bipolar medication)
Decreases firing of neurons

52
Q

ANTI-CONVULSANTS Medications

A

Valproic Acid (Epival/Depakote)
Carbamazepine (Tegretol): carb-amze-pine like carbs, maze, pine
Lamotrigine (Lamictal): limo-tri-gene

53
Q

Which medications have an anticholinergic side effect?

A

Atypical antipsychotics (risperidone is little)
SSRIs

54
Q

Which medications have orthostatic hypotension as a side effect?

A

Clozapine, Tricyclics, Benzos

55
Q

Which medication can cause hypertensive crisis when ____?

A

MAOIs when taken with tyramine containing foods

56
Q

Which medications impact serotonin and norepinephrine?

A

Atypical Antipsychotics
Trazodone
Effector XR
Tricyclics

57
Q

What is the difference between buspirone and bupropion?

A

Buspirone (buspar) is an antianxiety that impacts serotonin and dopamine

Bupropion (wellbutrin) is an aytpical antidepressant that impacts only dopamine

58
Q

Which medication should you NOT operate heavy machinery?

A

Benzodiazepines

59
Q

What is Zuclopenthixol (Clopixal Acuphase)?

A

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
Q

What category is Trazodone/Desyrel under?

A

Atypical Anti-Depressants
Anti-Anxiety (in small doses)

N3132 MENTAL HEALTH (10 decks)

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