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NURB 3150 > Psych drugs > Flashcards

Psych drugs Flashcards

1
Q

anxiety, trauma, stressor related disorders- classes of drugs

A
  • benzos
  • atypical anxiolytic/nonbarbituate anxiolytic
  • selective serotonin reuptake inhibitors (SSRI antidepressants)
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2
Q

benzo drugs

A
  • alpralzolam
  • diazepam
  • chlordiazepoxide
  • clorazepate
  • oxazepam
  • clonazepam
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3
Q

benzo moa

A

-enhances the inhibitory effects of gaba

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4
Q

benzo use

A
  • anxiety
  • seizure disorders
  • insomnia
  • muscle spasm
  • alcohol withdrawal
  • induction of anesthesia
  • amnesic prior to surgery/procedures
  • used for short term due to potential for dependence
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5
Q

benzo complications

A
  • cns depression
  • anterograde amnesia
  • oral toxicity: drowsiness, lethargy, confusion
  • iv toxicity: resp. depression, hypotension, cardiac/resp. arrest
  • withdrawal effects: anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, htn, muscle twitching, and seizure
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6
Q

benzo caution/contraindications

A
  • pregnancy risk
  • contraindicated in sleep apnea, resp. depression, glaucoma
  • caution in elderly and liver disease
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7
Q

benzo interactions

A
  • cns depressants

- grapefruit juice

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8
Q

benzo implications

A
  • antidote for oral toxicity is gastric lavage followed by activated charcoal
  • admin flumazenil for both types of toxicity
  • administer at bedtime if possible due to sedation
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9
Q

benzo education

A
  • avoid activities that require alertness
  • avoid alcohol
  • withdrawal effects are not common for short term use
  • if taken regularly and in high doses taper off over several weeks
  • store in a secure place to prevent misuse by others
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10
Q

atypical anxiolytic/nonbarbituate anxiolytic drug

A

buspirone

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11
Q

atypical anxiolytic/nonbarbituate anxiolytic moa

A
  • unknown
  • dependency less likely
  • doesn’t cause sedation or potentiate effects of other cns depressants
  • initial response takes a week, full effects takes 2-4 weeks, not for acute use
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12
Q

atypical anxiolytic/nonbarbituate anxiolytic complications

A
  • dizziness (self-limiting)
  • constipation
  • suicidal ideation
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13
Q

atypical anxiolytic/nonbarbituate anxiolytic contraindications

A

concurrent use with MAOIs or for 14 days after d/c MAOIs

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14
Q

atypical anxiolytic/nonbarbituate anxiolytic interactions

A

st john’s wort (herbals)

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15
Q

atypical anxiolytic/nonbarbituate anxiolytic education

A
  • effects dont occur immediately
  • take on a regular basis, not prn
  • tolerance, dependence, withdrawal are not an issue
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16
Q

selective serotonin reuptake inhibitors (SSRI) drugs

A
  • paroxetine: prototype for anxiety
  • sertraline
  • citalopram
  • escitalopram
  • fluoxetine: prototype for depression
  • fluvoxamine
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17
Q

SSRI moa

A

ANXIETY
-inhibits serotonin reuptake allowing more serotonin to stay at the junction of the neuron
-long half life
-up to 4 weeks to produce therapeutic effects
DEPRESSION
-blocks reuptake of monoamines, intensifying effects of serotonin
-first line treatment for depression
-takes 1-3 weeks or longer for effects

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18
Q

SSRI uses

A
  • anxiety

- depression

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19
Q

SSRI complications

A
  • weight changes (weight loss early, followed by weight gain)
  • gi bleeding
  • hyponatremia
  • serotonin syndrome (hallucination, fever, seizures, hyper/hypotension)
  • bruixism
  • withdrawal syndrome
  • postural hypotension
  • suicidal ideation
  • rash: specific for fluoxetine
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20
Q

SSRI complications specific to paroxetine

A
  • early: nausea, diaphoresis, tremor, fatigue, drowsiness
  • late: sexual dysfunction! (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest)
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21
Q

SSRI education

A
  • report problems with sexual function
  • report ae to the provider (may need to change dose/med)
  • pregnancy risk, except for paroxetine
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22
Q

SSRI implications

A
  • monitor for serotonin syndrome, usually occurs 2-72 hours after initiation of treatment
  • taper off slowly
  • effectiveness noted with improved mood
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23
Q

depressive disorders- drug classes

A
  • SSRIs
  • serotonin-norepinephrine reuptake inhibitors
  • atypical antidepressants
  • tricyclic antidepressants
  • monoamine oxidase inhibitors (MAOIs)
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24
Q

serotonin-norepinephrine reuptake inhibitors drugs

A
  • venlafaxine, prototype
  • desvenlafaxine
  • duloxetine
  • levomilnacipran
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25
Q

serotonin-norepinephrine reuptake inhibitors moa

A

blocks reuptake of norepinephrine and serotonin

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26
Q

serotonin-norepinephrine reuptake inhibitors indications

A
  • major depression

- pain due to fibromyalgia, osteoarthritis, diabetic neuropathy

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27
Q

serotonin-norepinephrine reuptake inhibitors complications

A
  • htn, tachycardia
  • withdrawal syndrome
  • sexual dysfunction
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28
Q

serotonin-norepinephrine reuptake inhibitors contraindications/precautions

A
  • pregnancy risk, avoid in third trimester, can cause infant to have withdrawal syndrome
  • contraindicated in concurrent use with SSRIs, MAOIs, or TCAs
  • taper off slowly
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29
Q

serotonin-norepinephrine reuptake inhibitors interactions

A
  • etoh

- john worts

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30
Q

atypical antidepressants drugs

A
  • bupropion, prototype
  • vilazodone
  • mirtazapine
  • nefazodone
  • trazodone ER
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31
Q

atypical antidepressants ae

A
  • headache
  • dry mouth
  • n/v
  • weight loss
  • anorexia
  • seizures, dont admit to those at risk for seizures
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32
Q

trazodone er

A
  • sedation is a potential problem

- priapism is potential ae, seek medical attention immediately

33
Q

tricyclic antidepressants (TCA) drugs

A
  • amitriptyline, prototype
  • imipramine
  • doxepin
  • nortriptyline
  • amoxapine
  • trimipramine
  • desipramine
  • clomipramine
34
Q

TCA moa

A
  • blocks reuptake of norepinephrine, serotonin, and acetylcholine
  • can take 10-14 days or longer before TCAs begin to work, max effects take 4-8 weeks
35
Q

TCA uses

A
  • depression

- ocd

36
Q

TCA ae

A
  • orthostatic hypotension
  • anticholinergic effects, chew sugarless gum & exercise regularly
  • sedation
  • toxicity: cholinergic blockade and cardiac toxicity (dysrhythmias, confusion, agitation, seizures, coma, death)
37
Q

TCA contraindications/caution

A

pts at risk for increased risk for suicide should get 1 week supply at a time due to lethality of toxic dose, no antidote

38
Q

TCA interactions

A
  • concurrent use with MAOIs or st johns worts

- concurrent use with antihistamines and anticholinergic agents, increases anticholinergic effects

39
Q

TCA implications

A
  • monitor for toxicity by cardiac dysrhythmias
  • admin at bedtime due to sedation is orthostatic hypotension
  • monitor for cheeking
40
Q

monoamine oxidase inhibitors (MAOIs) drugs

A
  • phenelzine

- isocarboxazid

41
Q

MOAIs moa

A
  • block MAOI enzymes in the brain, increasing norepinephrine, dopamine, serotonin, and tyramine available for transmission impulses
  • increase in tyramine can cause htn or hypertensive crisis if dietary and med restrictions aren’t implemented (tyramine isn’t absorbed in the liver when maoi is present, this causes htn crisis)
42
Q

MOAIs uses

A

depression

43
Q

MAOIs ae

A
  • orthostatic hypotension

- htn crisis, with presence of tyramine (cva, intensive vasoconstriction and stimulation of the heart, htn, tachycardia)

44
Q

MAOIs contraindications

A
  • SSRIs
  • heart failure
  • cvd
  • dont use within 10-14 days before or after surgery
45
Q

MAOIs education

A
  • avoid taking meds without approval from dr

- dietary and med restrictions should be continued 2 weeks after MAOI d/c

46
Q

tyramine food

A
  • aged cheese
  • pepperoni
  • salami
  • avocados
  • figs
  • bananas
  • smoked fish
  • protein dietary supplements
  • soups
  • soy sauce
  • red wine
  • some beers
47
Q

mood stabilizer drug

A

lithium carbonate

48
Q

mood stabilizer use

A
  • bipolar disorders

- controls episodes of acute mania and helps prevent the return of mania or depression

49
Q

mood stabilizer complications

A
  • gi distress: nausea, diarrhea, abd. pain
  • fine hand tremors
  • polyuria (treat with k sparing diuretic-spironolactone)
  • weight gain
  • renal toxicity
  • goiter and hypothyroidism!!
  • bradydysrhythmia, hypotension, electrolyte imbalances
  • lithium toxicity
50
Q

below 1.5 lithium toxicity

A
  • muscle weakness
  • fine hand tremors
  • slurred speech
  • lethargy
51
Q

early indication of lithium toxicity

A
  • mental confusion
  • poor coordination
  • coarse tremors
  • sedation
52
Q

advanced indications of lithium toxicity

A
  • extreme polyuria of dilute urine
  • tinnitus
  • involuntary extremity movements
  • blurred vision
  • ataxia
  • seizures
  • severe hypotension, can lead to death from resp complications
53
Q

severe indications of lithium toxicity

A
  • oliguria
  • seizures
  • rapid progressions of manifestations leading to coma and death
54
Q

mood stabilizer interactions

A
  • diuretics- low na decreases lithium leading to toxicity

- NSAIDS (ibuprofen, celecoxib)- increase lithium absorption, leads to toxicity

55
Q

preventing lithium toxicity

A
  • obtain lithium level with each dosage change, then once every 2-3 months with each dosage change
  • maintain level range: 0.6-1.2
  • levels greater than 1.5 can lead to toxicity
  • must admin 2-3 doses daily due to short half life
56
Q

treating severe lithium toxicity

A
  • hemodialysis
  • monitor cbc, electrolytes, renal function test, thyroid function test
  • adhere to lab appointment
  • adequate fluid and na intake!!!!
  • withold med and seek med attention
  • dont perform dehydrating activite
57
Q

mood stabilizer education

A
  • maintain adequate fluid and sodium intake
  • monitor s/s of hypothyroidism (cold, dry skin, low hr, weight gain)
  • avoid NSAIDs
58
Q

mood stabilizer implications

A
  • obtain t3t4 and tsh baseline prior to starting treatment and earlier
  • admin levothyroxine to manage hypothyroid effects
  • monitor for lithium effects
59
Q

antipsychotics: first generation (conventional) drugs

A
  • chlorpromazine (prototype)

- haloperidol

60
Q

antipsychotics: first generation (conventional) moa

A

-blocks dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery

61
Q

antipsychotics: first generation (conventional) uses

A
  • acute and chronic psychotic disorders

- bipolar disorders

62
Q

antipsychotics: first generation (conventional) extrapyramidal side effects

A
  • acute dystonia, can be life threatening
  • parkinsonism
  • akathisia, can’t sit/stand still, always pacing and agitated
  • tardive dyskinesia
63
Q

antipsychotics: first generation (conventional) other ae

A
  • neuroleptic malignant syndrome (sudden fever, muscle rigidity, loc change)
  • anticholinergic effects
  • orthostatic hypotension
  • agranulocytosis
  • severe dysrhythmias
64
Q

antipsychotics: first generation (conventional) implications

A
  • assess pt ability to differentiate between EPSs & worsening psychotic disorder
  • admin anticholinergics (diphenhydramine, benztropine), beta blockers, and benzos to control early EPSs
  • admin lowest dosage first to prevent td, monitor for it closely
  • if have neuroleptic malignant sydnrome stop med and admin dantrolene and bromocriptine to induce muscle relaxations
  • monitor bp and hr for orthostatic changes
  • obtain baseline ecg
  • if infection occurs obtain a baseline of wbc, d/c med if lab test indicate infection
65
Q

antipsychotics: second generation (atypical) drug

A

risperidone

66
Q

antipsychotics: second generation (atypical) uses

A
  • schizophrenia
  • psychotic episodes
  • bipolar disorders
67
Q

clozapine

A
  • antipsychotic med
  • no longer used as a first-line med due to its serious ae
  • agranulocytosis
  • obtain baseline wbc and monitor weekly, biweekly, to monthly per protocol
68
Q

CNS stimulant drugs

A
  • methylphenidate
  • dexmethylphenidate
  • dextroamphetamine
  • amphetamine mixture
  • lisdexamfetamine dimesylate
69
Q

CNS stimulant complications

A
  • cns stimulation: insomnia, restlessness
  • decreased appetite, weight loss, growth suppression
  • cv effects: dysrhythmias, chest pain, htn
  • toxicity: dizziness, palpations, htn, hallucinations, seizures
70
Q

CNS stimulant implications

A
  • monitor height & weight, compare to baseline
  • admin on regular schedule, place on alternating hips in the morning, leave it no longer than 9 hours
  • cognitive-behavioral therapy improves outcome
  • handwritten prescriptions needed for med refills
  • high potential for abuse, especially in adolescents
  • avoid etoh
71
Q

norepinephrine selective reuptake inhibitor meds

A
  • atomoxetine

- buproprion

72
Q

norepinephrine selective reuptake inhibitor uses

A
  • adhd

- depression

73
Q

norepinephrine selective reuptake inhibitor complications

A
  • suicidal ideation

- hepatotoxicity

74
Q

norepinephrine selective reuptake inhibitor implicaations

A
  • not changes in behavior r/t dosing and timing of meds
  • admin daily in the am or two divided in morning and afternoon
  • effectiveness noted by increase in focus, task completion, interaction with peers, and management of impulses
75
Q

meds to support abstinence from etoh (following withdrawal)

A

-disulfram

76
Q

intended effects of disulfram

A
  • type of behavioral therapy
  • concurrent use with etoh will cause acetaldehyde syndrome to occur (n/v, weakness, diaphoresis, palpitations, hypotension) can lead to resp depression, cv suppression, seizures, death
77
Q

meds to support withdrawal/abstinence from nicotine

A
  • bupropion

- varenicline

78
Q

meds to support withdrawal/abstinence from nicotine education

A

-notify for b/v, insomnia, new onset depression, suicidal thoughts, can causes neuropsychiatric effects (unpredictable behavior, mood changes, suicidal thoughts)

NURB 3150 (11 decks)

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