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Mental Health > Pharmacology & the Responsibilities of the PMHN > Flashcards

Pharmacology & the Responsibilities of the PMHN Flashcards

1
Q

4 Phases of Drug Treatment

A
  1. Initiation phase
  2. Stabilization phase
  3. Maintenance phase
  4. Discontinuation phase
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2
Q

Key Nursing Responsibilities in the 4 Phases of Drug Treatment (3)

A
  • Do a baseline assessment prior to initiating medication
  • Proactively monitor and treat side-effects
  • Education of patients and families
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3
Q

Major classes of psychiatric medications

A
  • Antipsychotics
  • Mood stabilizers
  • Antidepressants
  • Antianxiety
  • Stimulants
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4
Q

Antipsychotics

A
  • First Gen (typical)
    Early 50s, discovered for psychosis or schizophrenia, chlorpromazine
  • Second Gen (atypical)
  • Third Gen (atypical)
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5
Q

Mood Stabilizers

A
  • Antimania
  • Anticonvulsants
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6
Q

Antidepressants

A
  • TCAs
  • SSRIs
  • SNRIs + NSSRIs
  • MAOIs
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7
Q

Antianxiety

A
  • Benzodiazepines
  • Non-benzos
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8
Q

Stimulants

A
  • Methylphenidate (Ritalin)
  • Modifinil (provigil)
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9
Q

Knowledge Base Before Administration of Medication

A
  • Classification of the medication you are giving
  • Common & serious side effects
  • Nursing responsibility specific to medication
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10
Q

Antipsychotic Medication Side Effects (Common) 6

A

Cardiovascular
Anticholinergic
Weight gain
Endocrine and sexual side effects
Blood disorders
Miscellaneous

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11
Q

Antipsychotic serious side effects

A

Neuroleptic Malignant Syndrome (NMS)
- a syndrome caused by neuroleptic medications that are dopamine receptor blockers. The classic signs are:
- hyperthermia
- lead-pipe rigidity
- changes in mental status
- autonomic nervous system changes

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12
Q

Acute Medication-related movement disorders: EPS

A

Extrapyramidal symptoms: involuntary movements that you cannot control

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13
Q

Acute Medication-related movement disorders: Dystonia

A

Involuntary muscle spasms, abnormal postures, oculogyric crisis, toricollis

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14
Q

Acute Medication-related movement disorders: Parkinsonism

A

Rigidity, akinesia (slow movement), tremor, mask-like face, loss of spontaneous movements

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15
Q

Acute Medication-related movement disorders: Akineisa

A

loss or impairment of voluntary muscle movement

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16
Q

Acute Medication-related movement disorders: Akathisia

A

inability to sit still, restlessness

17
Q

Chronic medication-related movement disorders: Tardive Dyskinesia

A
  • Irregular, repetitive involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. Abnormal finger movements are common.
18
Q

Antimania Medications

A

Lithium Carbonate

19
Q

Antimania Anticonvulsants

A

Valproate
Carbamazepine
Gabapentin
Lamotrigine
Topiramate

20
Q

Lithium Carbonate Side Effects

A

thirst, metallic taste, urinary frequency, fine tremor, drowsiness, and mild diarrhea

21
Q

Lithium Carbonate Target Blood levels: Acute phase, and maintenance phase

A

Acute Phase: 0.8-1.4 mEq/L
Maintenance phase: 0.4-1 mEq/L

22
Q

Lithium toxicity (MSVDL)

A

Severe diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination

23
Q

Anticonvulsant Side Effects: Carbamazepine

A
  • dizziness, drowsiness, tremor, visual disturbances, nausea, and vomiting
  • minimized by treating in low doses
  • given with food
  • weight gain
  • Alopecia
  • Thyroid function may be altered usually after 6 to 18 months. observe for dry skin, constipation, bradycardia, hair loss, and cold intolerance
24
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A
  • Fluoxetine (Prozac)
  • sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Citalopram (celexa)
  • Escitalopram (Lexapro)
25
Q

SSRI Common Side Effects

A
  • Headache
  • Anxiety
  • Transient nausea
  • Vomiting
  • Diarrhea
  • weight gain
  • sexual dysfunction
  • increased suicidality
26
Q

SSRI Serious Side Effects: Serotonin Syndrome

A
  • Fever
  • Muscle rigidity, hyperreflexia, myoclonus
  • Tremors, diaphoresis
  • Confusion, agitation
27
Q

Tricyclic Antidepressants (TCAs)

A
  • Amitriptyline
  • Clomipramine
  • Doxepin
  • Imipramine
  • Trimipramine
    Can overdose and die
28
Q

TCA Common Side Effects

A
  • sedation
  • orthostatic hypotension
  • anticholinergic
29
Q

Other side effects of TCAs

A
  • tremors
  • restlessness, insomnia, confusion
  • pedal edema, headache, and seizures
  • blood dyscrasias
  • sexual dysfunction
    Adverse:
  • cardiotoxicity
30
Q

MAO inhibitors

A
  • considered third line treatments
  • used with people who have an atypical presentation of depression
  • phenelzine, isocarboxazid
31
Q

Side Effects of Antianxiety medications

A
  • sedation and CNS depression
  • tolerance and dependence (benzos)
  • avoid benzodiazepines in the elderly
  • used for anxiety
  • NOT long term
32
Q

Stimulants most common side effects

A
  • appetite suppression
  • insomnia
  • irritability
  • weight loss
  • nausea
  • Headache
  • Palpitations
  • Blurred vision
  • Dry mouth
  • constipation
  • dizziness
  • tachycardia
  • Tremors
  • Irregular heart rate
33
Q

Initiation Phase

A

Full health assessment

34
Q

Stabilization Phase

A
  • looking for the sweet spot = maximum effectiveness with minimal side effects
  • know side effects and target symptoms so we can communicate if we need to increase or decrease and interventions to mitigate side effects
  • communicate with the patient
  • Start with a test dose
  • Internal restlessness
  • Monitoring to see how a patient is responding
  • medications may be changed to a different medication
  • monitoring tests or blood work that is ordered
35
Q

Maintenance Phase

A
  • looking for exacerbation of the illness
  • best time to educate around medication and lifestyle (what are other things you can do and changes you can make because
36
Q

Discontinuation phase

A
  • weaning/titrating them off the medication
  • slowly decreasing medication
  • monitoring for return of target symptoms
37
Q

Medication for Schizophrenia (positive vs negative)

A

Positive (auditory hallucinations, delusions, paranoia) called positive because they’re obvious and we can see them.
Negative (hygiene, lack of motivation, lack of affect, blunting of affect, lack of ability to engage in a back and forth conversation, a person sitting in a chair and not doing much for hours) the atypical antipsychotics have a better effect on the negative symptoms
- the medication have a greater effect on positive or negative symptoms determines its effectiveness
- typicals treat the obvious, the positive
- atypicals address the negative symptoms better

Mental Health (11 decks)

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