Pharmacology! Flashcards
1
Q
Which meds is okay to drink with alcohol???
A
NEVER okay to drink alcohol with ANY PSYCH meds !!!!
2
Q
What are the 4 main
A
3
Q
When ur patient start on Antidepression, they will have an increase risk for WHAT?????? WHAT TERM DO THEY CALL IT?? **
A
BLACK BOX = Suicidal Ideation!!!!!** Because when they’re severely depressed, they have no energy to carry out their plan. But NOW that they have energy, they’ll have energy to carry out their plan of killing themselves!
4
Q
If a patient who has been taking Antidepressant come in after a week of use and say that his meds are not working, what would you do??
A
Explain to patient that It’s gonna take a little bit for the meds to work!!!!! ** DON’T INCREASE THE DOSE!!
5
Q
What’s the main difference between second-generation antipsychotics and first generation when it comes to the side effects???
A
SGA WON’T have as SEVERE side effects as FGA, but they do still have side effects!!!
6
Q
What are Benzodiazepines drugs?
A
- Alprazolam
- Diazepam
- Lorazepam
- Olanzepam
- Chlordiazepoxide
7
Q
What are the 3 main things under Benzodiazepines??
A
- MOST PRESCRIBED meds for anxiety
- HIGH POTENTIAL for developing dependency!!!!
- FALL RISK!!
8
Q
What are the manifestations of benzos?
A
“SPIND- Paradoxic response”
- Sedation
- Poor concentration
- Impaired memory
- Next day sedation
- Drowsiness
- Paradoxic Response: Insomnia, Euphoria, Exciting, Anxiety, and Rage!
9
Q
What do you give for Benzos Toxicity (for antidote)??? What can it produce/cause???
A
Flumazenil! Can cause seizures in pt with Seizure Disorders and taking Tricyclic antidepressants!!
10
Q
What are the teaching points for Benzos?
A
- AVOID Alcohol (it can increase effects)
- AVOID DRIVING & Making Critical Decisions
- Prolong use = body adapts = Tolerance & Dependency!!
- DON’T stop abruptly. Use TAPER SCHEDULE
- Can cause addiction
- Fall risk
11
Q
What 3 things does Buspirone do??
A
- Serotonin Agonist
- DOESNT CAUSE THE DEPENDENCY!!!!!
- Take several weeks to work!!!
12
Q
Is it EVER okay for patients to take other medications without talking abt it to their HCP??
A
NO!!
13
Q
When taking antidepressants, what side effect can it increase that’s ESPECIALLY in children????
A
ESPECIALLY IN CHILDREN, it can cause Increase thoughts of suicide!!!!!
14
Q
How do you assess a patient that has an Activation Syndrome??????????
A
It is an increase in suicidal thoughts!! Common cause of Activation Syndrome is SSRI or Antidepressants!!!! So, look if they:
1. Give away precious belongings!
2. Call friends to say goodbye
3. Requesting to write a will
15
Q
What is Black Box?? What common drug Class CAUSES this??
A
Black Box means increase in suicidal ideation!!! Antidepressants CAN CAUSE THIS!!!
16
Q
Which syndrome causes that Electric Shock feeling??? WHY is it???????*****
A
Antidepressant Discontinuation Syndrome!!! This is the syndrome when you ABRUPTLY STOP YOUR ANTIDEPRESSANTS!!!!!1
17
Q
If you have a patient who has a limited sodium intake, what medication will you NOT give to them??
A
LITHIUM!!!!!!
18
Q
What nursing interventions should you do for a patient who has Neuroleptic Malignant Syndrome???? WHY?
A
It’s A MEDICAL EMERGENCY!!!!!!!!! SO,
1. Hold the Antipsychotic medication
2. Notify Provider
3. Transfer to the ICU!!!
19
Q
When should you LIMIT BENZODIAZEPINES (Anxiolytics)?????
A
LIMIT TO 3 WEEKS ONLY!!!!!!!
20
Q
What syndrome is a MEDICAL EMERGENCY????
A
Neuroleptic Malignant Syndrome
21
Q
What are Benzos drugs that have LONG and SHORT Half lives???? Which ones should we take/better to take??
A
- Lorazepam (Adevan) have SHORTER half life so it’s harder to overdose in it and we PREFER to use this because it clear the system a lil quicker!!!!!!
- Diazepam (Valium) has the HIGHEST half life!! Since it has a long half life, you DONT need to give it as much!!!!!!!!!!!
22
Q
A
23
Q
How long does it take for Antidepressants to work??
A
Several weeks!!
24
Q
Which drug classification of Antidepressants has FALLEN out? WHY?
A
MAOIs has fallen out because it has so many drug to drug interactions AND lots of food to avoid!
25
What drug should MAOIs AVOID???
Avoid taking MAOIs with TCAs!!!!!!
26
How does TCA work? or What will TCA Inhibit?
TCA inhibits the reuptake of Serotonin and Norepinephrine!!
27
Out of all of the Antidepressants, which drug class cause a HIGHER risk for OVERDOSE and Commit suicide??? To what patients should you not use this on then?
TCA!!!!!!! Don’t give to patients who is already suicidal!!!!
28
Can TCAs make you sleepy? When should you take TCA?????
TCA makes you sleepy, so take it at NIGHT!!!!
29
What happens if you Stop Antidepressants ABRUPTLY???? What are the Manifestations????
Can cause Antidepressants Discontinuation Syndrome (ADDS)!!! Manifestations:
1) Difficulty Sleepin
2) Anxiety
3) Depression
4) flu like symptoms
5) “shock” feelings
30
What is ADDS (Antidepressants Discontinuation Syndrome)? what are the manifestations?
Happens when you ABRUPTLY STOP ANTIDEPRESSANTS! Manifestations:
1) Difficulty sleeping
2) Anxiety
3) Depression
4) Flu like symptoms
5) “Shock” feelings
31
What are the manifestations of Serotonin Syndrome? What causes it?????***
Manifestations:
1) Tachycardia & Blood pressure Increased
2) Restlessness
3) Dilated Pupils
4) Sweating
5) Muscle Rigidity!
Common Causes;
1) Intentional Overdose
2) Taking MAOIs together with SSRIs!!!!
3) Taking Fluoxetine with St. John Warts!!!!!
32
What do Anxiolytics treat?
Treat manifestations of anxiety, not the cause!
33
What are the manifestations of Benzos???
“SPIND- Parodoxical response”
Manifestations related to CBS depression:
Sedation
Poor cooperation
Impaired memory
Next day sedation
Drowsiness
Parodoxical response: Insomnia, Euphoria, Excitation, Anxiety, & Rage!
34
What drug do you use for Benzos Tocicity? (Antidote) What are the causes?
Flumazenil! It can produce seizures in pt with seizure disorder or taking trycicylic antidepressants (TCA)!
35
What are the teaching points for those taking Benzos?
1. DONT drink Alocohol! Benzos increases the effects of alcohol
2. DONT drive and can’t be making critical decisions. sedation effects can disrupt with activities!
3. Prolonged use = body adapts = causes Tolerance and Dependancy!
4. DONT STOP ABRUPTLY after prolonged use! Patient must use a taper schedule!
5. RISK FOR ADDICTION
6. FALL RISK
35
What are the two Anxiolytics class drug?
Benzos and Busprion
36
Other than Benzos, what is the other class drug for anxiolytics? What do u need to know about it?
Busprion!
1. Serotonin receptors agonist
2. DOESNT cause DEPENDANCY
3. TAKES SEVERAL WEEKS TO WORK
37
What do you need to know for Those who are just starting or increasing their Antidepressants????? Why?
Anyone starting or increasing the dosage of ANY antidepressants should be closely watched for WORSENING DEPRESSION AND INCREASED RISK FOR SUICIDAL!!!!! THIS IS ALSO CALLED BLACK BOX AND IS COMMON IN CHILDREN!!!!!!*** This happens Because now they’ll have the energy to carry out their plan!!
38
What are the class drugs for antidepressants?????
MAOIs
TCA
SSRI
SSNI
(Heterocyclic)
39
What are the drugs of Monoamine Oxidase Inhibitors?
Phenelzine
Selegline Transdermal System
40
WHY IS MAOIs HAVE FALLEN OUT???? Why won’t a lot of pt not take this???****
MAOIs have fallen out because it has A LOT OF DRUG TO DRUG interaction and many food to avoid!!!!!!
41
What are the side effects of MAOIs????
1. Weight Gain
2. Sexual dysfunction
3. Insomnia
4. Day time sedation
l
42
What are the Teachings for MAOIs?????
1. AVOID taking with TCA!!!
2. AVOID OTC drugs that has Ephedrine!!
3. AVOID Tyramine foods DUE TO INCREASED RISK for HYPERTENSIVE CRISIS!!
43
Which drug is it that needs to avoid Tyramine food??? WHY??******
MAOIs! Because it increased risk for HYPERTENSIVE CRISIS!!!!
44
What are foods high in Tyramine? What are the alternatives?
45
What is TCA inhibiting????***
Inhibits the Reuptake of Serotonin & Norepinephrine!!!!!!!!
46
TCA drugs have high risk of what??? To which patients would u not give this to???***
TCA has HIGHER risk TO COMMIT SUICIDE OR OVERDOSE!!!!!!! So don’t give this to patient who is already suicidal!!!
47
What are the drugs of TCA?
Amitriptyline
Imipramine
Desipramine
Doxepine
48
What are the side effects of TCA?
1.Dry mouth
2. Constipation
3. Orthostatic hypotension
4. Tolerance to the anticholinergic effects of TCAs
5. TCA MAKES YOU SLEEPY, SO TAKE IT AT NIGHT***
49
When should you be giving TCA?? Why???***
TCA makes you SLEEPY, so take it at NIGHT
50
FOR SSRIs what would you be inhibiting?
SSRIs inhibit the Serotonin Reuptake!!
51
What are the drugs of SSRIs?
Citalipram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
52
What are the side effects of SSRIs????**
(Same as SNRI) “NAS”ty
1. Nausea
2. Agitation****
3. Sexual Dysfunction
53
What syndrome can you develop when Taking too much of Antidepressants, especially SSRIs????*** ? What are the Manifestations????
ACTIVATION SYNDROME!!!! basically the same thing as black box/increased in suicidal ideation.
Manifestations:
1. Irritability, Impulsivity, Agitation, Aggresiveness, Anxiety
2. Increased risk of suicidal ideation = black box (esp in CHILDREN)
54
What does SNRIs inhibit???**
Blocks the Serotonin & Norepinephrine reuptake!!!!!
55
What are the drugs of SNRI?
1. Duloxetine
2. Venlafaxine
3. Desvenlafaxine
56
What are the side effects of SNRI?
1. Similar to SSRIs
2. & APPETITE SUPPRESSION
57
What is the Activation syndrome? What are the manifestations?
Cause by antidepressants, especially SSRIs!
Manifestationsifestations:
1. Irritability, Impulsivity, Agitation, Aggresiveness, Anxiety
2. Increased risk of suicidal ideation = black box (esp in CHILDREN)
58
What is the MOA & Therapeutic use of Antidepressants?
Treat Depression & Anxiety such as :
1. Major depression
2. Bipolar Disorder
3. GAD (Generalized Anxiety Disorder)
59
What are the patient teachings for Antidepressants?????
1. TAKES SEVERAL WEEKS TO WORK!!!***
2. If experiencing sedation, take meds at night!! Esp with TCA since it makes em rlly sleepy!!!!!!
3. If not then TAKE IT IN THE MORNING!! Because if u have restlessness at night it’ll interrupt ur sleeping
4. IF NAUSEA, take it with food
5. Patient should take time to see how they tolerate the meds side effects BEFORE engaging in activities that require alertness like DRIVING! ESPECIALLY when taking Buproprion**
6. Don’t stop abruptly because it can cause ADDS (antidepressants discontinuation syndrome)!!!!!!
7. Can cause Serotonin Syndrome!!!!!
8. Avoid OTC drugs that have Ephedrine
60
What is ADDS (Antidepressant Discontinuation Syndrome)? What are the manifestations????**
Syndrome when you stop Antidepressants abruptly!!
Manifestations:
1. Difficulty sleeping
2. Anxiety
3. Depression
4. FLU LIKE SYMPTOMS***
5. “Shock” like feeling!!!****
61
What’s that electrical shock like feeling you get??? How do you get this???***
This is part of the ADDS manifestations! And you get it if you abruptly stop your Antidepressants medications!!!!!!!!
62
What are the manifestations of Serotonin Syndrome??** WHAT ARE THE COMMON CAUSES???*
Manifestations:
1. Tachycardia & BP up
2. Restlessness
3. Swearing
4. Dilated pupils
5. Muscle rigidity & loss of muscle coordination
common causes:
1. Intentional Overdose
2. TAKING MAOIs and SSRIs!!!
3. Combining FLUOXETINE with St. John Warts!!!!
63
Wht are the common causes of Serotonin Syndrome??
You get this when:
1. Intentional overdose
2. Combining MAOIs with SSRI!!!
3. Combining FLUOXETINE with St. John Warts!!!
64
Combing what drug with St. John wart can cause serotonin syndrome?
Combining with a fluoxetine!!!! (SSRI)
65
What are drugs of Heterocyclics????****
Buproprion
Mirtazapine
Trazadone
66
What is Antipsychotics used for and by blocking what????***
Treats Schizophrenia and other psychotic related disorders BY BLOCKING Dopamine Receptors!!!!!!!!***
67
What are the First Generation Antipsychotics/FGA?
1. Haloperidol/Haldol
2. Fluphenazine
3. Loxapine
4. Chlorpromazine
68
What does Second Generation block???????***
Blocks Serotonin-Dopamine receptors!!!!
69
Why is SGA more favorable to use??????***
It has less side effects and treats more positive & negative schizophrenia symptoms!!!
70
What are the 3 things to know about SGA??!!!
1. Blocks the Dopamine receptors TO A LESSER DEGREE & Inhibits the reuptake of Serotonin!!!
2. Treats positive and Negative schizophrenia
3. NOT AS POTENT AS FGA, BUT HAS LESSER SEVERITY OF SIDE EFFECTS
71
Which antipsychotics more potent???? which one do people prefer?
FGA is more POTENT. people prefer SGA because it has lesser severity of side effects and treats more positive and negative schizophrenia
72
What are the SGA DRUGS?
Clozapine
Quetiapine
Olanzapine
Lurasidone
Paliperidone
Risperidone
Ziprasidone —> rarely cause EPS
73
Which of the SGA drug rarely causes EPS??????
Ziprasidone!!!!!!!!!
74
What are the TGA drugs?
ABC
1. Aripiprazole
2. Brexpiprazole
3. Cariprazine
75
What are the side effects of ANTIPSYOTICS????
1) Metabolic effects:
1. Increased Blood sugar
2. Increased Blood Pressure
3. Increased Cholesterols
4. Obesity
2) Anticholinergic effects:
1. Dry mouth
2. Constipation
3. Orthostatic Hypotension
4. Urinary Hesistancy/retention ****
5. Tachycardia*
6. Drowsiness*
7. Blurred vision
8. Gynecomastia, bc of increased prolactin
9. Menstrual irregularities
10. Decreased sex drive
11. WEIGHT GAIN
3) EXTRAPYRAMIDIAL SYMPTOMS
4) NEUROLEPTIC MALIGNANT SYNDROME
5) AGRANULOCYTOSIS
76
For exteapyramidial symptoms (EPS) that’s one of the adverse effects of antipsychotics, what are the different types??
1. Dystonia:
1) Muscle rigidity & cramping/spasm
2)** Stiff, thick tongue with difficulty of swallowing that can cause LARYNGOSPASM and RESPIRSTORY DIFFICULTIES!!!
2. Akathisia:
1) Intense need to move about/ intense restlessness
2) suicidial ideation!!
3. Pseudo Parkinsonism:
1) Similar symptoms of Parkinson’s disease
2) slumped posture
3) Masklike facies: Lack of facial expressions w/ starring eyes and slightly open mouth
4) decreased arm swing
5) Shuffling, festiating gait with small steps
6) Cogwheel rigidity (ratchet-like movements of joints)
7) Drooling & Tremor
8) Bradycardia
9) Corse pill-rolling movements of the fingers while @ rest!!!!!
4. Parkinsonism
1) Treated by changing to an antibiotics that had lower incidence of EPS or by adding Oral anticholinergic agents or Amantadine
5. Tardive Dyskinesia: abnormal involuntary movements like
1) Smacking lips
2) Thrust their tongues
3) Tilt their heads
77
What are the drugs to treat EPS Side effects?????********
ABC
1. Amantadine
2. Benadryl
3. Cogentive
78
Which drug of SGA will rarely cause EPS????*
Ziprasidone
79
What are the “general” side effects of Antipsychotics??
“SPA”
Sedation
Photosensitivity**
Anxiety & Pain
80
What is Dytonia????
(part of EPS)
1. Muscle rigidity & Cramping/spasm
2. Stuff, thick tongue w/ difficulty swallowing that can cause LARYNGOSPASM and RESPIRSTORY DIFFICULTY
81
What is Akathisia?
(Part of EPS)
1. Intense need to move about / Intense restlessness
2. Increase suicidal ideation
82
What is Pseu Parkinsonism?
(Part of EPS)
1. Symptoms similar to Parkinson’s disease
2. Slumped posture
3. Masklike facies: lack of facial expression w/ starring eyes an slightly open mouth!
4. DECREASED arm swing
5. Shuffling, festiatinng gait w small steps
6. Cogwheel Rigidity (ratchet-like movement of the joints)
7. Drooling &tremor
8. Bradycardia
9. Coarse pill rolling movements of the fingers while at rest
83
How should parkinsonism be treated
Treated by changing to antipsychotics with less incidence of EPS OR give Oral anticholinergic agent like Amantadine!
84
What is Tardive Dykinesia (TD)?
Abnormal involuntary movement like
1. Smacking lips
2. Thrust their tongues
3. Tilt their heads
85
What is Neuroleptic Malignant Syndrome???******* What are the manifestations and CAUSES??????
(part of adverse affect of antipsychotics)
Manifestations:
Fever, Muscle rigidity, Altered mental status, Vital sign instability,
Encephalopathy, Elevated Creatinine Kinase, Delirium, and Diaphoresis!!!
Causes:
1. Initial exposure OR abruptly stopping antipsychotics!!!**
2. The potency of FGA, ESPECIALLY HALOPERIDOL!!!!******
3. DEHYDRATION, POOR NUTRITION, and other mental illness!!!!****
86
What causes Agranulocytosis????
Taking antipsychotics, especially Clozapine (sga)!!!!!
87
What is the patient education for Antipsychotics????*
1. CONTINUE the treatment even After manifestations has resolved!!!
2. talk to HCP about signs and symptoms
3. Have a SUPPORT system to detect early signs of relapse!!!
88
What is the most established mood stabilizer and how does it work?
LITHIUM! It works by REGULATING the reuptake of MONOAMINE neurotransmitter!!!!!
89
What’s the therapeutic levels of lithium and when can it be toxic/u start showing symptoms? What is Lithium adverse affects???
Therapeutic: 0.5-1.5
Toxicity: >1.5
Lithium Adverse Effects:
- Diarrhea
- Nausea with increase thirst
- Hand Tremor
- Weight gain
- Anorexia
- Polydipsia
- Polyuria
- METALLIC TASTE***
90
When will Lithium start working and What TESTS are taken to monitor?????
- Weekly or every Two week until therapeutic!
- Kidneys and Liver Tests should be monitored!!!!
91
What are the two mood stabilizers????
Lithium and Anticonvulsants
92
What are the drugs of Anticonvuksants???? What one drug cause the Rash??? In what age group would the rash be even serious/greater??
Carbamazepine
Valproic acid
Toprimate
Lamotrigine!!!!!
- Can cause: SERIOUS RASH requiring hospitalization, including STEVEN JOHNDON SYNDROME and rarely life threatening Toxic Epidermic Nexrolysis!!!! Serious rash is even greater in children YOUNGER than 16 yrs old!!!!!!!
93
Which drug can cause some serious rash requiring hospitalization????? What can
LAMOTRIGINE (anticonvulsant— mood stabilizer)
94
What condition can Lamotrigine cause????
SERIOUS RASH requiring hospitalization, including STEVEN JOHNDON SYNDROME and rarely life threatening Toxic Epidermic Nexrolysis!!!!
Serious rash is even greater in children YOUNGER than 16 yrs old!!!!!!!
95
What are the side effects of Anticonvulsant??
SDW
Sedation, Dry mouth, Weight gain or loss
96
What are the patient teachings for Mood Stabilizers??????
- Use non- pharmacological interventions to help reduce stres
- relapse is possible if pt experiencing unmanageable physical or psychological stress
- Pt taking Lithium needs to consume 2-3 liters of water per day to help kidneys excrete the lithium and decrease risk of toxicity
- Consume SALT in the DIET!!!
97
Both Lithium and anticonvulsants inhibit which process??? What is it?
Kindling process!!!
98
Which drug class side effect is blurred vision, urinary hesistancy/retention??
Antipsychotic’s Anticholinergic side effects?
99
What are the symptom management and interventions of EPS???????******
1. Relieved with anticholinergic drugs like Benztropine (Cogentin) and Diphenhydramine (Benadryl)
2. For TD, use anticholinergic Valbenazine
3. Monitor if EPS doesn’t resolve after antipsychotic medication has been administered
4. NURSE SHOULD ADMINISTER AIMS (Abnormal Involuntary Movement Scale) TO ASSESS THE LEVEL OF TARDIVE DYSKINESIA (TD)
100
What is AIMS for?
To test level of TD/ tardive dyskinesia
101
WHAT ARE THE GENERIC NAME OF THE ANTICHOLINERGIC DRUGS THAT TREAT EPS!????
1. Benztropine (Cogentive)
2. Diphenydramine (Benadryl)
102
What do you need to know about non benzos in Sedative-hypnotics???
1. less adverse reactions than benzos
2. ACTIVATE MELATONIN RECEPTORS!!!**
3. Helping wth difficulty sleeping. EX: Ramelteon!!!
103
What are the adverse effects of Sedatives-Hypnotics??
1.) adverse effects:
- Fatigue, headache. nausea, dizziness
2.) MORE SERIOUS SE:
1. Sleep driving
2. Sleep walking!
3. Amnesia
4. Hallucination
5. Suicidal ideation!
104
What are the pt teachings for Hypnotics-sedatives???
1. Caution driving. Never take meds before driving
2. SHORT TERM TREATMENT FOR IMNOSIA
3. YOU NEED TO BE IN BED!!!!! IT CAUSES YOU TO BE SLEEPY SO DONT DO OTHER ACTIVITIES RIGHT AFTER
105
What are the 5 common barriers to maintaining meds medication management???*******
1. Long term, chronic illness requires ongoing treatment
2. Symptoms of poor insight and confusion
3. “Faulty” thinking
4. Major side effects/interactions of meds
5. Stereotyping & discrimination against mental illness!!!
