Phsycopharmemeds Flashcards
1
Q
Monoamines
A
Dopamine (DA)
Norepinephrine (NE)
Serotonin (5HT)
Histamine (H)
2
Q
Amino acids
A
Y-aminobutyric acid (GABA)
Glutamate (NMDA/AMPA)
3
Q
Cholinergics
A
Acetylcholine (ACh)
4
Q
Psychoactive meds
A
Antidepressants
Mood stabilizers
Antipsychotics
Anxiolytics
5
Q
Antidepressants
A
SSRI
TCAs
MAOIs
SNRI’s
6
Q
Dopamine (DA)
A
Fine muscle movement
Decision making
Sex hormones ( thyroid , adrenal)
Integration of emotions and thoughts
7
Q
Excessive dopamine
A
Schizophrenia
Psychosis
Mania
8
Q
Lack of dopamine
A
Contributes to Parkinson’s and depression
9
Q
Norepinephrine (NE)
A
Mood
Attention
Arousal
SNS stimulation
10
Q
Excess norepinephrine (NE)
A
Mania
Anxiety
Psychosis
Heightened arousal state ( high startle response such as PTSD)
11
Q
Lack of norepinephrine (NE)
A
Depression
Lowered arousal state ( person not responsive as they should be)
12
Q
Serotonin (5HT)
A
Sleep regulation
Hunger
Mood
Pain perception
Libido
Aggression
Hormonal activity
13
Q
excess serotonin (5HT)
A
Anxiety
14
Q
Lack of serotonin (5HT)
A
Depression
15
Q
Histamine (H)
A
Alertness
Gastric secretion stimulation
Inflammation response
16
Q
Excess histamine (H)
A
Sleep disturbances
Anxiety
Histamines make you alert
17
Q
lack of histamine (H)
A
Sedation
seizures
Antihistamines make you sleepy
18
Q
Y- Aminobutyric acid (GABA)
A
Decreases anxiety
Decreases excitement
Decreases aggression
Anticonvulsant
19
Q
Excess of y-aminobutyric acid ( GABA)
A
Reduction of anxiety
20
Q
Lack of y- aminobutyric acid
A
Mania
Anxiety
Psychosis
21
Q
Glutamate
A
Memory
Emotions
Cognition
Excitatory neurotransmitter
22
Q
Excess glutamate
A
Increased perception of pain
Anxiety
Restlessness
23
Q
Lack of Glutamate
A
Low energy
Difficulty concentrating
Insomnia
Psychosis
24
Q
Acetylcholine (Ach)
Cholinergic
A
Learning, memory , mode regulation, sexual aggressive behavior, PNS stimulant
Contracts smooth muscles, dilates blood vessels, increases bodily secretions and lowers the heart rate
25
Person w increase acetylcholine (Ach) cholinergic response acronym
Sludge
Salivation
Lacrimation
Urinary increase
Defecation increase
GI upset
Emesis
26
What inhibits acetylcholine (Ach) effect
Anticholinergics
27
Anticholinergic effects
Blurred vision
Increase HR
Dialated pupils
Dry mouth
Decrease urinary output
Constipation
28
Excess acetylcholine (Ach)
Depression
29
Lack of acetylcholine (Ach)
Alzheimer’s
Parkinson’s
Huntington’s chorea
30
Mood stabilizers
Lithium
Anticonvulsants
31
Antipsychotics
1st gen (typical) (conventional)
2nd gen(atypical) (unconventional)
32
Anxiolytics
Benzodiazepines
Antihistamines
Anticonvulsants
Beta blockers
33
Treatment purposes for antidepressants?
Major depression
Bipolar depression
Psychotic depression
Panic disorder
Some anxiety disorder
34
SSRIs meds
Fluoxetine ,fluvoxamine
Paroxetine
Sertraline
Escitalopram ,citalopram
Vilazodone
35
SSRI what does it do
They stop the re uptake of serotonin and make the neurotransmitter sit out a bit longer to see if it would get picked up
36
SNRI what does it do
Inhibits the re uptake of serotonin and norepinephrine
37
First in line antidepressant for major depression or panic disorder
SSRI
38
What would we expect to see when someone is taking an anti depressant
Mood improvement
Decrease depression
Decrease anxiety
39
Side effects of SSRI
Tremors
Nausea
Headache
Insomnia, drowsiness
Sexual dysfunction
Bruxism
Anxiety(women) /agitation
Dry mouth
Diarrhea
Hyponatremia
40
Which med can cause bruxism (grinding of teeth)
Paroxetine
41
T or f dont take food with SSRI
False.. take w food can cause nausea and it helps with side effect
42
What should you avoid while taking SSRI
Alcohol, antihistamines
43
What should you teach about SSRI
do not stop taking abruptly...may cause withdrawal /discontinuation syndrome ( may lead to psychosis or suicidal ideation)
Let physician know if suicidal thoughts increase
44
How long does it take for SSRI to be therapeutic
1-3 weeks
45
When does the FULL therapeutic effect take place with SSRI?
2-3 mo
46
When we have an in patient that was just ordered to take SSRI. What are we going to do?
Probably keep a close observation of suicide ideation. We are not going to put them on and let them go. But keep them for at least two days and have a close eye on them. It can happen to even people who have never had a suicide thought in their life. It can have a paradoxal effect on younger people.
47
What happens when taking SSRI with out her serotonin blocking agents ?
May cause serotonin toxicity
48
Discontinuation syndrome
Does not happen when you have been on SSRI for a wk but more so if you take it consistently and then abruptly stop
49
S/s of discontinuation syndrome
Anxiety, insomnia , vivid dreams, headaches, dizziness, tiredness, irritability, flu like symptoms , achy muscles , and chills, nausea , electric shock sensations and return of depression symptoms
50
Black box warning SSRI
Increase risk of suicide
51
Others meds that can cause serotonin toxicity
SSRI, MAOIs, lithium, Tristan, buspirone, tramadol, OTC cold/cough meds
52
What should you use cautiously w SSRI
CYP450 enzyme inhibitor or inducers (ketoconzole or rifampim)
53
Serotonin syndrome s/s SHIVERS
Shivering
Hyper reflex is and myoclonus (rhabdomyolysis)
Increase temp
Vital signs not stable ( tachycardia,tachypnea, labile BP)
Encephalopathy (agitation,delirium& confusion
Restlessness & incoordination
Sweating
54
What do we administer for serotonin syndrome that is a receptor blockade?
Zofran/ondesterone
55
What is given for muscle rigitidiy for serotonin syndrome
Dantrolene or diazepam
56
What else is given for serotonin syndrome
Cyproheptadine (histamine 1 receptor antagonist)
57
tricyclic antidepressant (TCA)
All end in ine except doxepin
58
Two TCA that are FDA approved for ages 8 and up
Imipramine
Clomipramine
59
What should you avoid while taking TCAs
Alcohol
60
Why is TCA given in smaller amounts?
Lethal overdose— highly lipid soluble .. rapidly absorbed
61
When is the best time to take TCA
In the evening .. sedation effects& use caution when driving
62
How long does it take for TCA to be therapeutic
4-8 weeks
63
What is important to teach for TCA
Adherence to med regimen
64
TCA mode of action
Inhibits reuptake of serotonin (5-HT) & norepinephrine (NE) & blocks cholinergic receptor
65
Side effects of TCA
Sedation
Mydriasis
Weight gain
Sweating
Toxicity
Sexual dysfunction
Decreased seizure threshold
Orthostatic hypotension
Anticholinergic effect
66
Since TCA decreases the seizure threshold what is important to note?
Not to prescribe to someone who has a history of seizures
67
MAOIs ( monoamine oxidase inhibitors)
Mode of action
Inhibits enzyme that degrades NE , dopamine and 5-HT
( so it keeps monoamine from breaking down )
68
MAOIs drugs
In Philippians they surf
Isocarbozid ** main one we see
Phenelzine
Tranylcypromine
Selegiline
69
Which MAOI drug comes in the transdermal form and what does it treat
Selegiline - depression
70
Side effects MAOIs
Muscle cramps
Weight gain
Sexual dysfunction
Anticholinergic effects
Serious food /drug interactions (tyramine) ***
71
What foods with tyramine should you avoid
Aged cheese and meats
Foods w yeast
Soy
Beer n wine
Avocados and bananas
72
MAOI teaching
Lethal in OD
Notify physical when taking other meds
Use caution when driving
73
How long should you avoid tyramine for when you stopped taking MAOI
At least 2 weeks after discontinuation
74
Hypertensive crisis symptoms
N&V
Chills
Sweating
Fever
Severe hypertension
Restlessness
Nuchal rigidity **
Dilated pupils
Occipital headache **
Motor agitation
Severe nose bleed(due2hypertension)
75
SNRI * meds
Venlafaxine
Duloxetine
Work for anxiety and neuro pain ( not a lot of time on )
76
SNDI meds
Mirtazapine
& usually used in conjunction with SSRI (not a lot of time on )
77
SNRI side effect
Fewer anticholinergics effects ( did not spend a lot of time on)
78
1st gen meds
Haloperidol
Thioridazine
..
79
1st gen MOA
Blockade of dopamine
80
Which generation controls positive symptoms such as hallucinations, delusions and aggressive behaviors?
1st generation/conventional/typical
81
MOA of 2nd gen
Does not block as much dopamine so less side effects
82
Which gen controls both positive and negative symptoms
2nd gen/atypical/ unconventional
83
1st gen side effects
Anticholinergic effects
Weight gain
Sexual/reproductive organ issues
Increase prolactin (milk)
Seizures
Sedation
Tachycardia & or prolong qt
Orthostatic BP
EPS/tardive dyskinesia
84
2nd gen side effects
Less anticholinergic efffects
Weight gain
Type2 DM
Dyslipiemia
Anxiety
Headache
Sedation
85
How long does it take for 1st gen for ful effect or reduction of symptoms ?
2-4 weeks (if not months)
86
What should we teach to limit for 1st gen
Sun exposure wear sunglasses
87
EPS
Psuedoparkinsim
Acute dystonia
Akathisia
Tardive dyskinesia
88
Benzodiazepines
All end in “AM” (alprazolam , oxazepam , Triazolam , etc)
Except chloradizepoxide
89
Benzo’s uses
Useful for short term anxiety or acute
90
What is important to remember about benzos
People get addicted easily , so do not combine with opioid med
Also potentiates the effect of alcohol
91
What can benzo be linked to
Rebound anxiety
Dementia
Increase fall risk
High mortality rate
92
What are the effects of benzos on the elderly?
Paradoxal effect
Causes them to be hyper sexual ,agitated, disinhibited
Since they are older they have diminished metabolisms so they will be on benzo experience longer
93
Side effect of benzo
Sedation , dizziness, fatigue , impaired driving
Impaired congnitive function, CNS depression
94
What should you avoid while taking benzo
Alcohol and driving ( or drive cautiously )
95
What can discontinuing benzo abruptly do ?
Withdrawal syndrome which can be fatal and cause seizures
96
What does benzo treat ?
Only the symptoms of anxiety but not the underlying probs
97
Benzo withdrawal syndrome after short term use
Anxiety
Insomnia
Sweating
Treamors
Dizziness
98
Long use of benzo withdrawal syndrome
Panic
Paranoia
Delirium
HTN
Muscle twitches
Seizures
99
Buspirone
Anti anxiety
Works good
Non addicting
100
Side effects of buspirone
Mostly mild
Dizziness
Nausea
Headache
Nervousness
Lightheaded
Excitement
101
How long does it take for therapeutic response for buspirone
2-4 weeks but could take several weeks to fully work
102
What should you avoid while taking buspirone and how long do you need to be off of it before you can start taking buspirone
MAOI and for at least 2 wks
103
Hydroxyzine palmoate
Good alternative from benzo .. works right away for acute anxiety and only takes 20-30 min to kick it.
104
Side effects for hyrdoxyzine palmate
Drowsiness
Headache
Dry. Mouth
105
Other pt teaching for hydroxyzine pamoate
Don’t take this anti anxiety w other CNS depression meds
106
What antihistamine can be taken for anxiety
Hydroxyzine
107
What anticonvulsant can be taken for anxiety
Gabapenten
108
When can antipsychotics be given for anxiety
When its low dose
109
When is beta blockers good for anxiety
Good for pt with ptsd or situational anxiety
110
Kava kava for anxiety
NOPE
R/T PSYCHOSIS & LIVER DAMAGE
111
Valerian root for anxiety
NOPE ..r/t ineffective, potentiates CNS depressants
112
What can you teach to someone taking melatonin for anxiety
May work but causes vivid / bizarre dreams
113
Anticonvulsant
Mood stablizers
Valproic acid
Lamotrigine
Carbamazepine
Oxycabazepine
Gabapentin
Topiramate
114
when can a mood stabilizer be used
Bi polar disorders characterized by intense energy , mania, intense depression , grandiosity
115
S/s for lithium may be mild but what should we look out for
Vomiting
116
Acute lithium level
0.5-1.2 mEQ /L
117
Maintence lithium level
06 -1.0 mEq/L
118
Toxic lithium level mEq/L
Greater than 1.5. MEq/L
119
Once lithium levels get to 2.5 to 2 what are we concerned about
Nausea , vomiting, diarrhea,worsening GI .. can lower our fluid volume which leads to increase lithium levels in our system.
120
How long does it take for lithium to come into effect
May begin 5-7 days or at most 2-3 wks
121
What should pt be mindful of when taking lithium
Fluid and. Sodium intake
122
When taking anticonvulsants what should we teach
Report sore throat early on
S/s of agranulocytosis (life threatening)
123
Valproic acid and carbamazepine are used for mood stabilizers what do we want to do before administering
Monitor blood levels
124
Valproic acid side effects
Blood dyscrasias
Hepatoxicity
Pancreatitis
125
Carbamazepine
Adverse effects
Agranulocytosis
Aplastic anemia
