Psych Deck 2 Flashcards
Stimulant MOA
block reuptake of NE and DA
Stimulants Indications
ADD/ADHD
Narcolepsy
Fatigue, depression (palliative care setting)
Stimulant Adverse effects
Anorexia, weight loss, appetite suppression Sleep disturbance Jitteriness Emotional lability Increased pulse and BP
Stimulant contraindications
diabetes, hyperthyroidism, hypertension, issues with aggression, bipolar disorder, psychosis
Non-stimulant alternative for ADHD
atomoxetine (Strattera)
Selective norepinepherine reuptake inhibitor
Not a controlled substance
Commonly used stimulants
Methylphenidate (Ritalin, Concerta) Dexmethylphenidate (Focalin) Amphetamines Dextroamphetamine (Dexedrine) Dextroamphetamine-amphetamine (Adderall) Lisdexamfetamine (Vyvanse)
Mood stabilizer drug class
Lithium
– Antiseizure Drugs
– Atypical Antipsychotics
mood stabilizers used in
bipolar disorder, impulsivity, aggression, depression, anxiety, mood liability, chronic pain, pszhoeffecive disorder
lithium long term use can
damage thyroid and kidneys
lithium MOA
Competes with sodium to enter cell- acts like sodium in the body • Cholinergic and GABA activity, dopamine receptor sensitivity, serotonergic activity, inhibits second messenger system
lithium blood levels
Blood levels: 0.6-1.5 mEq/L
lithium baseline labs
levels of renal, cardiac,
thyroid, and electrolytes.
Lithium can lead to
neuroprotective actions and
long-term plasticity in the brain
Monitor what with lithium
sodium levels, when
sodium is lost (dehydration,
excessive sweating, etc.)
lithium toxicity S/S
(ataxia, slurred
speech, tremor, N/V, tinnitus,
blurred vision)
Lithium overdose treated with
hemodialysis and supportive
care.
Lithium levels above ___ cause ___
Levels above 2.5 mEq/L can
cause coma, seizure, and death.
Things that effect lithium level
dehydration, excessive sweating, illness, AKI. Anything that effects fluid an electrolyte imbalance.
If there is a change in a lithium level we want to know
what caused that change
Lithium is excreated through
the kidneys
Lithium can lead to
long term palcicity and protective actions in the brain when treated early.
Lithium patient education
limit ETOH and caffene, avoid tasks requirein coodination, may cause dry mouth, maintain steady salt, fluid intake, report vomiting, diarrhea, muscle weakness, tremors, drowsiness, ataxia, monitor levels
Aticonvulsants
Carbamazepines
– Drugs that affect GABA: gabapentin, topiramate, lamotrigine
– Valproic Acid
REVIEW THESE FROM MODULE FOUR
Benzodiazepines MOA
enhancing the effect of GABA
Benzodiazapines ADR
withdrawal, dizziness, fall risk in elderly, cognitive effects long term
Common Benzodiazepine Uses
Insomnia Induce relaxation and loss of memory of medical procedures or surgery Reduce anxiety (anxiolytic) Panic disorders Treat or prevent seizures Alcohol withdrawal treatment Muscle relaxant
Benzo black box warning
2016 - avoid use with opioids
Non-benzodiazepine hypnotic examples
(zolpidem (Ambien), zaleplon (Sonata),
eszopiclone (Lunesta)
controlled substances - can cause withdrawal if stopped abruptly
ramelteon (Rozerem) MOA
melatonin receptor agonist
not a controlled substance
Benzo with highest addiction potential and why?
Alprazolam - shortest half life (6-12 hours)
Non-benzodiazepine hypnotic side effects
headache, dizziness, somnolence, nausea, mild transient anterograde amnesia
abnormal behaviors such as sleep driving, worsening depression
Zolpidem dosing for women/older adults vs men
Women/older adults max 5mg, men 10mg
Nonbenzodiazepine hypnotics patient education
take immediately before bed time
Get at least 6 hours of sleep
Use caution/avoid driving, heavy machinery
Do not combine with other sleep aides, alcohol
