pharmacology 2 Flashcards
levels of anxiety
mild, moderate, severe and panic
virtually always maladaptive defense mechanisms
splitting and displacement
defense mechanisms
Conscious and unconscious attempts to manage anxiety
are defense mechanisms healthy?
as long as they aren’t maladaptive, yes
Buspirone (Buspar)
anxiolytic
the long term antianxiety agent of choice
lower dependency issues, can be used for long term treatment
good for worry, bad for tension
take with food to prevent nausea.
not for panic attacks, takes 2-3 weeks to reach full effect
drugs for short term use in panic episodes
Antianxiety agents, such as benzodiazepines
potential for abuse, addiction, and tolerance is high
Hydroxyzine (Atarax, Vistaril)
an antihistamine
It is used in the treatment of itchiness, insomnia, anxiety, and nausea
benzodiazepines
Alprazolam (Xanax) - for agoraphobia and panic
Clorazepate (Tranxene)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Diazepam (Valium) AND Lorazepam (Ativan) - often used for alcohol withdrawal
Oxazepam (Serax)
Temazepam (Restoril)
paradoxical effect to Benzodiazepines
around 10% of people become disinhibited rather than calm and sedated
complications of benzodiazepines
CNS depression and decreased cognitive abilities (do not drive or operate machinery until effect is known)
Respiratory depression if mixed with alcohol and other CNS depressants
Anterograde amnesia (do not make important decisions after taking medication) Ambien seems to be the worst
Abrupt discontinuation can lead to seizures, coma and death
– can often over sedate a patient –
benzodiazepines often used for severe alcohol withdrawal
Diazepam (Valium) (longer half life) and Lorazepam (Ativan) (shorter half life)
antidote for benzodiazepine overdose
Flumazenil IV
Citalopram (Celexa)
SSRI
Escitalopram (Lexapro)
SSRI
Fluoxetine (Prozac)
SSRI
like sertraline (zoloft) can be energizing initially, so that can increase anxiety. it subsides
Fluvoxamine (Luvox)
SSRI
Paroxetine (Paxil)
SSRI – helpful in GAD, more calming than the other SSRIs
Sertraline (Zoloft)
SSRI
like fluoxetine (prozac) can be energizing initially, so that can increase anxiety. it subsides
what is the first line choice for many anxiety disorders after busparone?
SSRIs
SSRI administration notes
can be energizing initially, usually subsides
4 weeks to be full effect
taper discontinuation
Generally no/low overdose potential – good for clients with a history of SI
SSRI side effects
sexual dysfunction, weight gain
Bruxism (use a mouth guard)
can increase liver/kidney issues
GI bleeding history (affects blood coagulation)
Hyponatremia risk when combined with diuretics
SSRI black box warning
rare but not reversible
Increased suicidal risk when energy improves but still suicidal - now “happy to act on their plan”
Slight increase suicides in clients 24 years old and younger compared to other age groups but the difference is not statistically significant
Serotonin Syndrome signs and symptoms
Onset in 2-72 hours
Delirium, sudden onset of confusion, agitation
myoclonus – muscle spasms, rigidity
gI pain and diarrhea
hypertension, tachycardia, fever (with diaphoresis)
seizures, apnea, death
increased risk for serotonin syndrome
St. John’s Wort
MAOIs or TCAs
Lithium
Opioids
Copious caffeine (coffee, black tea, soft drinks with caffeine), caffeine also increases anxiety and should be avoided
Migraine medication
ECT
how to treat serotonin syndrome
Hold medications and notify PCP
Treat symptoms: i.e., propranolol, anticonvulsants, induce paralysis
Cooling blankets
Duloxetine (Cymbalta)
SNRI
Venlafaxine (Effexor)
SNRI – mixed anxiety and depression, nerve pain
possible meds if the client has a bipolar disorder with anxiety
Gabapentin (Neurontin), Anticonvulsants
Pregabalin (Lyrica), Anticonvulsants
Clonidine (Catapres)
Alpha2 Agonist – panic attacks
Propranolol (Inderal)
Beta-blocker – social and performance anxiety
Prazosin (Minipress)
Alpha1 Agonist - used for nightmares in PTSD
Anticholinergic side effects
Extrapyramidal Side Effects: pseudoparkinsonism (examples: drooling, mask facies, shuffling, tremor …), acute dystonic reaction, akathisia, tardive dyskinesia
cardiac (alpha blocks) – check orthostatic BP and pulse, may need ECG to check for Q-T interval
agranulocytosis (report flu like symptoms) Neuroleptic Malignant Syndrome – rare but dangerous
Metabolic Syndrome
Hyperprolactinemia– even in males, can cause amenorrhea in females, lactation in all
Cholestatic jaundice – rare, reversible
Anticholinergic side effects
Extrapyramidal Side Effects: pseudoparkinsonism (examples: drooling, mask facies, shuffling, tremor …), acute dystonic reaction, akathisia, tardive dyskinesia
cardiac (alpha blocks) – check orthostatic BP and pulse, may need ECG to check for Q-T interval
agranulocytosis
Neuroleptic Malignant Syndrome – rare but dangerous
Metabolic Syndrome
Hyperprolactinemia– even in males, can cause amenorrhea in females, lactation in all
Cholestatic jaundice – rare, reversible
anticholinergic adverse drug reactions
anticholinergic toxicity
acute dystonic reaction (CONGENTIN STAT)
agranulocytosis (report flu like symptoms)
neuroleptic malignant syndrome
cholestatic jaundice
what to do about dry mouth
hard sour candy (xylitol better than sugar), glycerin swaps, ice chips and water sips
what to do about mydriasis (dilated pupils)
Photosensitivity – limit sunlight, sunscreen, sunglasses, sun hat
Blurred vision: magnifiers, may improve in 2 weeks
what to do about dry eyes
artificial tears
what to do about sexual dysfunction
artificial lubricants
what to do about constipation
fiber, water, exercise, monitor b.m. frequency and bowel sounds
what to do about urinary retention
bladder scan
Anticholinergic Toxicity s/s
dry, hot and red
emergency
Unstable VS
No peristalsis or micturition
Repetitive motor movements
Seizures
Delirium (increased psychosis)
treatment for anticholinergic toxicity
cooling, catheterize, sedation (benzodiazepines), physostigmine
Acute Dystonic Reaction
Opisthotonos – ‘titanic’ tetany body arching
Oculogyric crisis – eyes roll upwards, backwards, and lock
Laryngeal dystonia – may not be able to breath
acute dystonic reaction treatment
benztropine (Cogentin) IM to relax muscles and prevent muscle damage, maintain airway if needed
Agranulocytosis
less than 100 neutrophils (you’re supposed to have 1500+)
Flu like symptoms: sore throat, fever, malaise – report right away, may see these before abnormal lab test results
Highest risk for clozapine
Neuroleptic Malignant Syndrome
can be sudden onset, but not always
high fever – “CARDINAL” symptom
diaphoresis, altered mental status
muscle rigidity
Increased CPK levels from muscle breakdown
can die if not treated
neuroleptic malignant syndrome possible treatment
may include Bromocriptine for muscle rigidity and fever, dantrolene for muscle spasms
antipsychotic black box warning
older adults, especially those with dementia have an increased risk of death (usually related to heart failure and pneumonia)
typical (first generation) antipsychotics
Chlorpromazine (CPZ, Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol) – common IM against clients will for psych emergencies
Loxipine (Loxitane) - lox is an old person breakfast
Mesoridazine (Serentil)
Molindone (Moban)
Perphenazine (Trilafon)
Pimozide (Orap)
Thioridazine (Mellaril)
Thiothixene (Navane)
Trifluoperazine (Stelazine)
(z/x/ i/e ne and haldol for some reason)
atypical (second generation) antipsychotics
Aripiprazole (Abilify)
Asenapine (Saphris)
Clozapine (Clozaril)
Lurasidone (Latuda)*
Olanzapine (Zyprexa)*
Olanzapine + Samidorphan (Lybalvi) (Samidorphan is an opioid antagonist)*
Paliperidone Palmate (Invega Sustena)
Quetiapine (Seroquel)*
Risperidone (Risperdal)*
Ziprasidone (Geodon)
2016: Cariprazine (Vraylar)* - capri sun for kids
(zoles, dones, and pines)
*Also used to help decrease mania/hypomania in clients with a Bipolar Disorder
Asenapine (Saphris)
second generation anti psych
- sublingual, the patient should not eat or drink for 10 minutes before and after
Long-Acting Injections
PERSERIS® (per-SAIR-iss) (risperidone)
Inject a ‘gel pillow’ SQ, biodegrades, lasts one month - okay if there’s still a bump by next dose
Typical/FGA quick review
Primarily treat: Positive symptoms
Have a higher risk, compared to SGAs, for: EPSE
Can make Negative symptoms worse
Atypical/SGA quick review
Primarily treat: Negative symptoms
Have a higher risk, compared to FGAs, for: Metabolic Syndrome
side effects of antipsychotics
sedation, extrapyramidal side effects (pseudoparkinism, dystonic reactions), opisthotonos (arched back torso), oculogyric crisis (eyes roll upwards, backwards, and lock), laryngeal dystonia (may not be able to breathe), akathisia, hypotension, prolonged Q-T interval, being dry,
adverse reactions of antipsychotics
acute dystonic reactions ((STAT benztropine (Cogentin) IM, diphenhydramine (Benadryl) can help as well), cardiac arrest,
zoloft can give you zoomies
suzanne said to remember it can make you hyper in the first few weeks
