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Module 6 > Phsycopharmemeds > Flashcards

Phsycopharmemeds Flashcards

1
Q

Monoamines

A

Dopamine (DA)
Norepinephrine (NE)
Serotonin (5HT)
Histamine (H)

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2
Q

Amino acids

A

Y-aminobutyric acid (GABA)
Glutamate (NMDA/AMPA)

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3
Q

Cholinergics

A

Acetylcholine (ACh)

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4
Q

Psychoactive meds

A

Antidepressants
Mood stabilizers
Antipsychotics
Anxiolytics

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5
Q

Antidepressants

A

SSRI
TCAs
MAOIs
SNRI’s

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6
Q

Dopamine (DA)

A

Fine muscle movement
Decision making
Sex hormones ( thyroid , adrenal)
Integration of emotions and thoughts

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7
Q

Excessive dopamine

A

Schizophrenia
Psychosis
Mania

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8
Q

Lack of dopamine

A

Contributes to Parkinson’s and depression

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9
Q

Norepinephrine (NE)

A

Mood
Attention
Arousal
SNS stimulation

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10
Q

Excess norepinephrine (NE)

A

Mania
Anxiety
Psychosis
Heightened arousal state ( high startle response such as PTSD)

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11
Q

Lack of norepinephrine (NE)

A

Depression
Lowered arousal state ( person not responsive as they should be)

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12
Q

Serotonin (5HT)

A

Sleep regulation
Hunger
Mood
Pain perception
Libido
Aggression
Hormonal activity

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13
Q

excess serotonin (5HT)

A

Anxiety

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14
Q

Lack of serotonin (5HT)

A

Depression

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15
Q

Histamine (H)

A

Alertness
Gastric secretion stimulation
Inflammation response

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16
Q

Excess histamine (H)

A

Sleep disturbances
Anxiety

Histamines make you alert

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17
Q

lack of histamine (H)

A

Sedation
seizures

Antihistamines make you sleepy

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18
Q

Y- Aminobutyric acid (GABA)

A

Decreases anxiety
Decreases excitement
Decreases aggression
Anticonvulsant

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19
Q

Excess of y-aminobutyric acid ( GABA)

A

Reduction of anxiety

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20
Q

Lack of y- aminobutyric acid

A

Mania
Anxiety
Psychosis

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21
Q

Glutamate

A

Memory
Emotions
Cognition

Excitatory neurotransmitter

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22
Q

Excess glutamate

A

Increased perception of pain
Anxiety
Restlessness

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23
Q

Lack of Glutamate

A

Low energy
Difficulty concentrating
Insomnia
Psychosis

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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

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25
Q

Person w increase acetylcholine (Ach) cholinergic response acronym

A

Sludge
Salivation
Lacrimation
Urinary increase
Defecation increase
GI upset
Emesis

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26
Q

What inhibits acetylcholine (Ach) effect

A

Anticholinergics

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27
Q

Anticholinergic effects

A

Blurred vision
Increase HR
Dialated pupils
Dry mouth
Decrease urinary output
Constipation

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28
Q

Excess acetylcholine (Ach)

A

Depression

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29
Q

Lack of acetylcholine (Ach)

A

Alzheimer’s
Parkinson’s
Huntington’s chorea

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30
Q

Mood stabilizers

A

Lithium
Anticonvulsants

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31
Q

Antipsychotics

A

1st gen (typical) (conventional)

2nd gen(atypical) (unconventional)

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32
Q

Anxiolytics

A

Benzodiazepines
Antihistamines
Anticonvulsants
Beta blockers

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33
Q

Treatment purposes for antidepressants?

A

Major depression
Bipolar depression
Psychotic depression
Panic disorder
Some anxiety disorder

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34
Q

SSRIs meds

A

Fluoxetine ,fluvoxamine
Paroxetine
Sertraline
Escitalopram ,citalopram
Vilazodone

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35
Q

SSRI what does it do

A

They stop the re uptake of serotonin and make the neurotransmitter sit out a bit longer to see if it would get picked up

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36
Q

SNRI what does it do

A

Inhibits the re uptake of serotonin and norepinephrine

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37
Q

First in line antidepressant for major depression or panic disorder

A

SSRI

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38
Q

What would we expect to see when someone is taking an anti depressant

A

Mood improvement
Decrease depression
Decrease anxiety

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39
Q

Side effects of SSRI

A

Tremors
Nausea
Headache
Insomnia, drowsiness
Sexual dysfunction
Bruxism
Anxiety(women) /agitation
Dry mouth
Diarrhea
Hyponatremia

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40
Q

Which med can cause bruxism (grinding of teeth)

A

Paroxetine

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41
Q

T or f dont take food with SSRI

A

False.. take w food can cause nausea and it helps with side effect

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42
Q

What should you avoid while taking SSRI

A

Alcohol, antihistamines

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43
Q

What should you teach about SSRI

A

do not stop taking abruptly…may cause withdrawal /discontinuation syndrome ( may lead to psychosis or suicidal ideation)

Let physician know if suicidal thoughts increase

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44
Q

How long does it take for SSRI to be therapeutic

A

1-3 weeks

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45
Q

When does the FULL therapeutic effect take place with SSRI?

A

2-3 mo

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46
Q

When we have an in patient that was just ordered to take SSRI. What are we going to do?

A

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.

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47
Q

What happens when taking SSRI with out her serotonin blocking agents ?

A

May cause serotonin toxicity

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48
Q

Discontinuation syndrome

A

Does not happen when you have been on SSRI for a wk but more so if you take it consistently and then abruptly stop

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49
Q

S/s of discontinuation syndrome

A

Anxiety, insomnia , vivid dreams, headaches, dizziness, tiredness, irritability, flu like symptoms , achy muscles , and chills, nausea , electric shock sensations and return of depression symptoms

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50
Q

Black box warning SSRI

A

Increase risk of suicide

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51
Q

Others meds that can cause serotonin toxicity

A

SSRI, MAOIs, lithium, Tristan, buspirone, tramadol, OTC cold/cough meds

52
Q

What should you use cautiously w SSRI

A

CYP450 enzyme inhibitor or inducers (ketoconzole or rifampim)

53
Q

Serotonin syndrome s/s SHIVERS

A

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
Q

What do we administer for serotonin syndrome that is a receptor blockade?

A

Zofran/ondesterone

55
Q

What is given for muscle rigitidiy for serotonin syndrome

A

Dantrolene or diazepam

56
Q

What else is given for serotonin syndrome

A

Cyproheptadine (histamine 1 receptor antagonist)

57
Q

tricyclic antidepressant (TCA)

A

All end in ine except doxepin

58
Q

Two TCA that are FDA approved for ages 8 and up

A

Imipramine
Clomipramine

59
Q

What should you avoid while taking TCAs

60
Q

Why is TCA given in smaller amounts?

A

Lethal overdose— highly lipid soluble .. rapidly absorbed

61
Q

When is the best time to take TCA

A

In the evening .. sedation effects& use caution when driving

62
Q

How long does it take for TCA to be therapeutic

63
Q

What is important to teach for TCA

A

Adherence to med regimen

64
Q

TCA mode of action

A

Inhibits reuptake of serotonin (5-HT) & norepinephrine (NE) & blocks cholinergic receptor

65
Q

Side effects of TCA

A

Sedation
Mydriasis
Weight gain
Sweating
Toxicity
Sexual dysfunction
Decreased seizure threshold
Orthostatic hypotension
Anticholinergic effect

66
Q

Since TCA decreases the seizure threshold what is important to note?

A

Not to prescribe to someone who has a history of seizures

67
Q

MAOIs ( monoamine oxidase inhibitors)

Mode of action

A

Inhibits enzyme that degrades NE , dopamine and 5-HT

( so it keeps monoamine from breaking down )

68
Q

MAOIs drugs

In Philippians they surf

A

Isocarbozid ** main one we see
Phenelzine
Tranylcypromine
Selegiline

69
Q

Which MAOI drug comes in the transdermal form and what does it treat

A

Selegiline - depression

70
Q

Side effects MAOIs

A

Muscle cramps
Weight gain
Sexual dysfunction
Anticholinergic effects
Serious food /drug interactions (tyramine) ***

71
Q

What foods with tyramine should you avoid

A

Aged cheese and meats
Foods w yeast
Soy
Beer n wine
Avocados and bananas

72
Q

MAOI teaching

A

Lethal in OD
Notify physical when taking other meds
Use caution when driving

73
Q

How long should you avoid tyramine for when you stopped taking MAOI

A

At least 2 weeks after discontinuation

74
Q

Hypertensive crisis symptoms

A

N&V
Chills
Sweating
Fever
Severe hypertension
Restlessness
Nuchal rigidity **
Dilated pupils
Occipital headache **
Motor agitation
Severe nose bleed(due2hypertension)

75
Q

SNRI * meds

A

Venlafaxine
Duloxetine

Work for anxiety and neuro pain ( not a lot of time on )

76
Q

SNDI meds

A

Mirtazapine
& usually used in conjunction with SSRI (not a lot of time on )

77
Q

SNRI side effect

A

Fewer anticholinergics effects ( did not spend a lot of time on)

78
Q

1st gen meds

A

Haloperidol
Thioridazine
..

79
Q

1st gen MOA

A

Blockade of dopamine

80
Q

Which generation controls positive symptoms such as hallucinations, delusions and aggressive behaviors?

A

1st generation/conventional/typical

81
Q

MOA of 2nd gen

A

Does not block as much dopamine so less side effects

82
Q

Which gen controls both positive and negative symptoms

A

2nd gen/atypical/ unconventional

83
Q

1st gen side effects

A

Anticholinergic effects
Weight gain
Sexual/reproductive organ issues
Increase prolactin (milk)
Seizures
Sedation
Tachycardia & or prolong qt
Orthostatic BP
EPS/tardive dyskinesia

84
Q

2nd gen side effects

A

Less anticholinergic efffects
Weight gain
Type2 DM
Dyslipiemia
Anxiety
Headache
Sedation

85
Q

How long does it take for 1st gen for ful effect or reduction of symptoms ?

A

2-4 weeks (if not months)

86
Q

What should we teach to limit for 1st gen

A

Sun exposure wear sunglasses

87
Q

EPS

A

Psuedoparkinsim
Acute dystonia
Akathisia
Tardive dyskinesia

88
Q

Benzodiazepines

A

All end in “AM” (alprazolam , oxazepam , Triazolam , etc)
Except chloradizepoxide

89
Q

Benzo’s uses

A

Useful for short term anxiety or acute

90
Q

What is important to remember about benzos

A

People get addicted easily , so do not combine with opioid med

Also potentiates the effect of alcohol

91
Q

What can benzo be linked to

A

Rebound anxiety
Dementia
Increase fall risk
High mortality rate

92
Q

What are the effects of benzos on the elderly?

A

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
Q

Side effect of benzo

A

Sedation , dizziness, fatigue , impaired driving
Impaired congnitive function, CNS depression

94
Q

What should you avoid while taking benzo

A

Alcohol and driving ( or drive cautiously )

95
Q

What can discontinuing benzo abruptly do ?

A

Withdrawal syndrome which can be fatal and cause seizures

96
Q

What does benzo treat ?

A

Only the symptoms of anxiety but not the underlying probs

97
Q

Benzo withdrawal syndrome after short term use

A

Anxiety
Insomnia
Sweating
Treamors
Dizziness

98
Q

Long use of benzo withdrawal syndrome

A

Panic
Paranoia
Delirium
HTN
Muscle twitches
Seizures

99
Q

Buspirone

A

Anti anxiety
Works good
Non addicting

100
Q

Side effects of buspirone

A

Mostly mild
Dizziness
Nausea
Headache
Nervousness
Lightheaded
Excitement

101
Q

How long does it take for therapeutic response for buspirone

A

2-4 weeks but could take several weeks to fully work

102
Q

What should you avoid while taking buspirone and how long do you need to be off of it before you can start taking buspirone

A

MAOI and for at least 2 wks

103
Q

Hydroxyzine palmoate

A

Good alternative from benzo .. works right away for acute anxiety and only takes 20-30 min to kick it.

104
Q

Side effects for hyrdoxyzine palmate

A

Drowsiness
Headache
Dry. Mouth

105
Q

Other pt teaching for hydroxyzine pamoate

A

Don’t take this anti anxiety w other CNS depression meds

106
Q

What antihistamine can be taken for anxiety

A

Hydroxyzine

107
Q

What anticonvulsant can be taken for anxiety

A

Gabapenten

108
Q

When can antipsychotics be given for anxiety

A

When its low dose

109
Q

When is beta blockers good for anxiety

A

Good for pt with ptsd or situational anxiety

110
Q

Kava kava for anxiety

A

NOPE

R/T PSYCHOSIS & LIVER DAMAGE

111
Q

Valerian root for anxiety

A

NOPE ..r/t ineffective, potentiates CNS depressants

112
Q

What can you teach to someone taking melatonin for anxiety

A

May work but causes vivid / bizarre dreams

113
Q

Anticonvulsant

A

Mood stablizers

Valproic acid
Lamotrigine
Carbamazepine
Oxycabazepine
Gabapentin
Topiramate

114
Q

when can a mood stabilizer be used

A

Bi polar disorders characterized by intense energy , mania, intense depression , grandiosity

115
Q

S/s for lithium may be mild but what should we look out for

116
Q

Acute lithium level

A

0.5-1.2 mEQ /L

117
Q

Maintence lithium level

A

06 -1.0 mEq/L

118
Q

Toxic lithium level mEq/L

A

Greater than 1.5. MEq/L

119
Q

Once lithium levels get to 2.5 to 2 what are we concerned about

A

Nausea , vomiting, diarrhea,worsening GI .. can lower our fluid volume which leads to increase lithium levels in our system.

120
Q

How long does it take for lithium to come into effect

A

May begin 5-7 days or at most 2-3 wks

121
Q

What should pt be mindful of when taking lithium

A

Fluid and. Sodium intake

122
Q

When taking anticonvulsants what should we teach

A

Report sore throat early on

S/s of agranulocytosis (life threatening)

123
Q

Valproic acid and carbamazepine are used for mood stabilizers what do we want to do before administering

A

Monitor blood levels

124
Q

Valproic acid side effects

A

Blood dyscrasias
Hepatoxicity
Pancreatitis

125
Q

Carbamazepine
Adverse effects

A

Agranulocytosis
Aplastic anemia

Module 6 (21 decks)

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