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NURS 3132: Mental Health > Pharmocology > Flashcards

Pharmocology Flashcards

1
Q

What medications are used for anxiety?

A
  • benzodiazepines
  • buspirone (BuSpar)
  • selective serotonin reuptake inhibitors (SSRIs - antidepressants)
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2
Q

What are some examples of benzodiazepines?

A

suffix: lam/pam

Alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam
diazepam (Valium)
lorazepam (Ativan)
oxazepam (Serax)

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3
Q

What are the uses for benzodiazepines

A
  • anxiety and anxiety disorders***
  • Alcohol (ETOH) withdrawal***
  • insomnia,
  • skeletal muscle relaxation,
  • seizure disorders
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4
Q

What is the actions of benzodiazepines?

A
  • amplify GABA effects (inhibitory neurotransmitter)
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5
Q

What are some nursing considerations for benzodiazepines?

A
  • used to induce sleep rapidly
  • need to be tapered off
  • do not use with alcohol, opioids, CNS depressants = extreme sedation/ overdose
  • caffeine can counteract effect of benzos
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6
Q

What are some side effects of benzodiazepines? (6)

A
  • Drowsiness, sedation, ataxia, dizziness
  • Feelings of detachment, irritability or hostility
  • Anterograde amnesia: a type of memory loss that occurs when you can’t form new memories
  • Cognitive effects with long-term use
  • Tolerance, dependency, rebound insomnia/anxiety
  • Rarely nausea, headache, confusion, depression
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7
Q

What are the withdrawl symptoms of benzos? (13)

A
  • Agitation/irritability
    • Anorexia
    • Hyperactivity
    • Insomnia
    • Nausea, vomiting
    • Sensitivity to light, sounds
    • Tinnitus
    • Anxiety
    • Autonomic arousal
    • Dizziness
    • Generalized seizures
    • Hallucinations
    • Headache
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8
Q

T or F: Elderly patients more vulnerable to side effects because the aging brain is more sensitive to sedatives

A

true

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9
Q

What is Busiprone (buSpar)

A
  • antianxiety drug
  • Does not exhibit muscle-relaxant or anticonvulsant activity, interaction with CNS depressants, or sedative-hypnotic properties
  • Not effective to manage drug or alcohol withdrawal or panic disorder
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10
Q

What are the first-line therapy for anxiety?

A

selective serotonin reuptake inhibitors (SSRIs) - antidepressants

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11
Q

What are medications used for depression?

A
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin norepinephrine reuptake inhibitors (SNRIs)
  • tricyclic antidepressants (TCAs)
  • monoamine oxidase inhibitors (MAOIs)
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12
Q

What are some examples of SSRIs?

A
  • suffix: ine
  • Prozac/Fluoxetine
  • Paxil/Paroxetine
  • Celexa/Citalopram **
  • Luvox/Fluoxamine
  • Zoloft/Sertraline
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13
Q

What is the action of SSRIs?

A
  • Preventing/inhibiting reuptake of neurotransmitter serotonin
  • making it more available at synapses (more levels of serotonin)
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14
Q

What are indications for SSRIs?

A

depression, anxiety/panic, compulsion, PTSD

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15
Q

What are side effects of SSRIs? (5)

A
  • GI disturbances (nausea and vomiting) - take with food
  • Low libido or erectile dysfunction
  • Weight gain
  • Insomnia
  • Dry mouth
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16
Q

How long does it take for antidepressants to work?

A

4-6 weeks

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17
Q

What are the signs of SSRI withdrawl?

A
  • flulike symptoms
  • Stomach pain, diarrhea, nausea, trouble sleeping, dizziness, ataxia, numbness and tingling
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18
Q

What are some nursing considerations for SSRIs?

A
  • titrate off slowly to avoid withdrawl

-Do not take with MAOIs = serotonin syndrome

-other to not take with: Opioid, OTC cold medications, alcohol, migraine meds (triptans), St. John Worts (herbal medication)

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19
Q

What are examples of SNRIs?

A
  • Duloxetine
  • Venlafaxine
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20
Q

What is the action of SNRIs?

A
  • increases serotonin and norepinephrine by blocking reuptake into cells
  • Can also be used for chronic pain
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21
Q

nursing considerations for SNRIs

A
  • Can lead to serotonin syndrome
  • Avoid ST. John’s Wort: increases serotonin levels
  • Avoid MAOIs
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22
Q

What are examples of TCAs?

A
  • Elavil/Amitriptyline
  • Anafranil/Clomipramine
  • Surmontil/Trimipramine
  • Silenor/Doxepin
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23
Q

What neurotransmitters do TCAs effect?

A

serotonin and norepinephrine

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24
Q

What are side effects of TCAs? (8)

A
  • Blurred vision
  • Urinary retention***
  • Dry mouth
  • Constipation
  • Sweating
  • Seizures
  • Sedation
  • Orthostatic hypotension
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25
Q

T or F: TCAs are lethal in overdose

A

True

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26
Q

What are some nursing considerations for TCAs?

A
  • Slow position changes
  • Drink fluids
  • Eat fiber
  • do not take with MAOIs
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27
Q

What are some examples of MAOIs

A
  • Nardil/Phenelzine
  • Parnate/Tranylcypromine
  • Marplan/Isocaroxazid
28
Q

What is the action of MAOIs and what kind of neurotransmitters does it effect?

A
  • Action: Blocking particular enzyme which is helping prevent too little of serotonin, norepinephrine and dopamine
29
Q

What are nursing considerations for MAOIs?

A
  • Drugs: do not mix with SSRIs - can lead to serotonin syndrome (Or any other antidepressants)
  • Food: fermented food = hypertensive crisis (wine, cheese, sauerkraut)
  • Others: beer, chocolate, no meat
30
Q

T or F: Antidepressants may inadvertently switch patients with bipolar illness into mania

A

True

31
Q

What are medications used for mania or bipolar disorders (aka mood stabilizers)

A
  • lithium
  • anticonvulsants
32
Q

What is the first line of treatment for acute mania or bipolar disorders?

A

lithium

33
Q

What are the normal side effects of lithium?

A
  • weight gain
  • CNS: fine hand tremor (50% of patients), fatigue, headache, mental dullness, and lethargy
  • Endocrine: thyroid dysfunction
  • Gastrointestinal: gastric irritation, anorexia, cramps, nausea, vomiting, diarrhea
  • Renal: polyuria (frequent urination), polydipsia (urge to drink too much because of dry mouth), and edema
34
Q

What are the levels for normal, early, advanced, and severe lithium intoxication?

A

normal: 0.6 - 1.2 mEq/L

  • note: anything greater than 1.5 mEq/L = lithium toxicity

early: <1.5 mEq/L

Advanced: 1.5-2.0 mEq/L

Severe: > 2.5 mEq/L

35
Q

polyuria, polydipsia, and fine hand tremor = _______(early, advanced, severe) lithium toxicity

A

early

36
Q

anorexia, nausea, vomiting, diarrhea, coarse hand tremor, twitching, lethargy, dysarthria, hyperactive deep tendon reflexes, ataxia, tinnitus, vertigo, weakness, drowsiness = _______ (early, advanced, severe) lithium toxicity

A

advanced

37
Q

fever, oliguria (decreased urine output), hypotension, irregular pulse, ECG changes, impaired consciousness, seizures, coma, death = = _______ (early, advanced, severe) lithium toxicity

A

severe

38
Q

What are some common causes of increased lithium levels?

A
  • Decreased sodium intake
  • Diuretic therapy
  • Decreased renal functioning
  • Fluid and electrolyte loss, sweating, diarrhea, dehydration, fever, vomiting

-Medical illness

-Overdose

  • Nonsteroidal anti-inflammatory therapy
39
Q

What is the treatment for lithium toxicity?

A
  • hold all doses
  • Quickly check vital signs, level of consciousness; provide oxygen and stabilization procedures
  • Monitor lithium blood level, electrolytes, kidney function tests, complete blood count, ECG
  • Vigorously hydrate; use emetic, GI suctioning if overdose
40
Q

How do anticonvulsants work for bipolar disorders?

A

enhancing effects of inhibitory neurotransmitter GABA and by desensitizing “kindling” effect in bipolar illness

41
Q

What are examples of anticonvulsants?

A
  • Carbamazepine
  • topiramate
  • lamotrigine
  • Divalproex (Epival)
42
Q

What are some side effects of carbamazepine (anticonvulsant)?

A

nausea, vomiting, dizziness, constipation, dry mouth

  • Stevens-johnson syndrome (serious)
43
Q

What are some nursing considerations for carbamazepine (anticonvulsant)?

A
  • May make you more sensitive to sun
  • Alcohol or cannabis can make you more dizzy or drowsy
  • Birth control may not work if used with medication (May cause defects if pregnant)
  • Avoid MAOIs
44
Q

What are the uses for antipsychotics?

A
  • psychosis
  • schizophrenia
  • dementia
  • short-term: severe depression
45
Q

What are the target symptoms for typical and atypical antipsychotics?

A
  • typical: positive only (excess or distortion of normal function)
  • atypical antipsychotics: positive and Negative symptoms (decrease or loss of normal function)
46
Q

What are some examples of first generation (typical) antipsychotics?

A
  • suffix: zine
  • Phenothiazines: Chlorpromazine (Thorazine), thioridazine (Mellaril), mesoridazine (Serentil), perphenazine (Trilafon), trifluoperazine (Stelazine), fluphenazine
  • Thiothixene (Navane)
  • Butyrophenone: haloperidol (Haldol) ***
  • Dibenzoxazepine: loxapine (Loxitane)
  • Diphenylbutylpiperidine: pimozide (Orap)
47
Q

What is the action of antipsychotics?

A

Dopamine antagonists (D2 receptor antagonists): block dopamine receptors = less dopamine

48
Q

T or F: first generation (typical) antipsychotics are 1st line treatment

A

F: atypical 2nd gen are 1st line

49
Q

What are some examples of 2nd generation (atypical) antipsychotics?

A
  • suffix: pine/done
  • Clozapine (Clozaril)
  • Paliperidone (Invega)
  • Risperidone (Risperdal, Consta, M-Tabs)
  • Olanzapine (Zyprexa, Zydis)
  • Quetiapine (Seroquel)
  • Zuclopenthixol – (Accuphase)
  • Apriprazole (abilify)
50
Q

What are the some differences between atypical and typical antipsychotics?

A
  • typical: only pos. symptoms, has EPS
  • atypical: pos and neg symptoms, less risk of EPS
51
Q

What are anticholinergic effects of antipsychotics?

A
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
52
Q

What are endocrine/sexual side effects of antipsychotics?

A
  • Increased prolactin
  • Decreased sexual drive
  • Retrograde ejaculation
  • Erectile dysfunction
53
Q

What are the serious side effects of antipsychotics?

A
  • Extrapyramidal side effects (EPS)
  • Neuroleptic malignant syndrome
  • metabolic syndrome
54
Q

What are Extrapyramidal side effects (EPS)?

A
  • Dystonia (acute dystonic reactions) - continuous spasms + muscle contractions (back, neck, eyes)
  • Akathisia - restlessness
  • Parkinsonism (parkinsonian syndrome) - rigidity, slow movements (bradykinesia), tremors, impaired posture and balance
  • Bradykinesia - slowing of movement
  • Tardive Dyskinesia - irregular jerky movements, in lower face and distal extremities (Can be chronic**)
55
Q

What is neuroleptic malignant syndrome? (NMS)

A

Rare and potentially fatal side effect of antipsychotic meds (dopamine receptor blockers), such as Haloperidol/Haldol

56
Q

What are S&S of neuroleptic malignant syndrome?

A

fever

altered mental status (reduced consciousness),

muscle rigidity

labile hypertension

tachycardia

sweating (diaphoresis)

autonomic dysfunction

57
Q

What are some medications that can treat EPS?

A
  • Benztropine (Cogentin)
  • Procyclidine (Kemadrin)
  • Trihexyphenidyl (Artane)
58
Q

What is clozapine?

A
  • atypical antipsychotic that needs to be monitored thoroughly
59
Q

What are the side effects of clozapine?

A
  • Neutropenia or agranulocytosis
  • Decreases seizure threshold
  • Risk of myocarditis
60
Q

What blood work do you need done when taking clozapine?

A
  • white blood cells
  • absolute neutrophil count
61
Q

When would you stop clozapine therapy?

A

WBC < 3.0 x 10^9/L

neutrophils <1.5 x 10^9/L

62
Q

What is serotonin syndrome? What would cause it?

A

too much serotonin

Cause: Antidepressant, pain meds, LSD, herbal supplements, cold meds - anything that resists serotonin reuptake

63
Q

What are the S&S of serotonin syndrome? (7)

A
  • Tachycardia
  • Elevated BP
  • Irritability
  • Seizures (tremors/twitching/rigid muscles)
  • Diarrhea
  • Sweating
  • Nervous (anxiety)
64
Q

What is metabolic syndrome?

A

cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes

65
Q

What are the S&S of metabolic syndrome?

A
  • low HDL cholesterol
  • visceral obesity (fat around waist)
  • insulin resistance (leads to high blood sugar)
  • hypertension
  • high triglycerides

NURS 3132: Mental Health (7 decks)

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