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NSG 470 > Psych Drugs Exam 3 > Flashcards

Psych Drugs Exam 3 Flashcards

1
Q

Benzo MOA

A

-Used for anxiety disorders
-Enhances GABA producing inhibitory effects
-GABA receptor agonist

-Rapid relief of anxiety

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2
Q

Benzo SE

A

-CNS depression
-Anterograde amnesia

-Acute toxicity: Lethargy, confusion , resp depression, cardiac or resp arrest
-Paradoxical response: Anxiety, restlessness, insomnia, excitation, rage

-Withdrawal: Anxiety, insomnia, diaphoresis, tremors lightheadedness

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3
Q

Benzo contra-indications

A

-Schedule IV controlled substance, risk of dependence: preferred in the short term
-Contraindicated in pt with sleep apnea, resp depression, glaucoma

-Caution in pt with liver disease, mental illness and substance use disorder
-Interacts with CNS depressants: alc, opiods –> resp depression

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4
Q

What do you take benzos for

A

-Generalized anxiety disorder
-Panic disorder
-Seizure disorder
-Insomnia
-Muscle spasms
-Alc withdrawal
-Anesthesia induction
-Amnesic before surgery

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5
Q

Alprazolam (XANAX)

A

Benzo

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6
Q

Diazepam (Valium)

A

Benzo

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7
Q

Lorazepam (Ativan)

A

Benzo

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8
Q

Clonazepam (Klonpin)

A

Benzo

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9
Q

SSRI

A

-Inhibits serotonin reuptake, making its effects more pronounced
-More serotonin in the receptor the greater the effect

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10
Q

SSRI SE

A

-Take in morning for minimizing sleep disturbances
-Sexual dysfunction (Decreased libido)
-CNS stimulation (Anxiety, insomnia, agitation weight loss (early) and gain (late)
-Rash
-Hyponatremia
-Sleepiness
-Faintness, lightheadedness
-GI bleeding
-Brixism
-Alopecia
SEROTONIN SYNDROME (2-72 hr after initial treatment)

-Withdrawal: headache,N+V visual disturbances, anxiety, dizziness tremors

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11
Q

SSRI contraindications

A

-Pregnancy (birth defects, newborn pulmonary htn)
-Contraindicated with MAOIs and TCA, St john wort, tramdol –> setatonin syndrome
-Caution with liver, renal, cardiac dysfunction, seizures, diaberes, ulcers, GI bleeding, Alc

-Can caused prolonged QT interval in cardiac pt
-Caused increased risk for bleeding in antiplt therapy
-Lithium and TCA can increase in level

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12
Q

What is SSRI for

A

-MDD
-GAD, Panic disorders
-OCD
-PTSD
-Social anxiety
-Bulimia nervosa
-Premenstrual dysphoric disorders

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13
Q

Fluoxetine (Prozac)

A

SSRI
-Specifically: Panic, OCD

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14
Q

Paroxetine (Paxil)

A

SSRI

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15
Q

Citalopram (Celexa)

A

SSRI

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16
Q

Sertraline (Zoloft)

A

SSRI
-Specifically: Panic, ocd, SAD, PTSD

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17
Q

Escitalopram (Lexapro)

A

SSRI
-Specifically: GAD, OCD

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18
Q

Fluvoxamine (Luvox)

A

SSRI
-Specifically: SAD, OCD

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19
Q

SNRI(SSNRI) MOA

A

Inhibits the reuptake of Norepi and serotonin, leading to greater effects
-More time in the receptor more effect

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20
Q

SNRI(SSNRI) SE

A

Nausea
Vomiting
Diarrhea,
Dry mouth, yawning
Anxiety
Tremors
Tachycardia
Vision changes
Diaphoresis
Suicidal ideation
HTN
Chest Pain
Weight changes
Rash
Ecchymosis

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21
Q

SNRI(SSNRI) contraindications

A

-Hypersensitivity to serotonin drugs, use with MAOI drugs

-Risk of serotonin syndrome
-Dont drink alc with it

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22
Q

SNRI (SSNRI) Interactions

A

-Antiplt therapy can increase risk of bleeding
-Lithium and TCA levels can increase with use

-Use with other serotonin drugs, (MAOI), lithium, St john wort –> serotonin syndrome

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23
Q

SNRI (SSNRI) notes

A
  • Dont take with alc
    -Take with food and water
    -Dont stop suddenly, withdrawal
    -May affect glycemic control
    -May cause neonatal substances
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24
Q

Venlafaxine

A

-Effexor (Brand name)
-SSNRI (SNRI)

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25
Q

Desvenlafaxine

A

(Pristiq)
-SSNRI (SNRI)
-May cause GI bleed, increased cholesterol levels

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26
Q

Duloxetine

A

Cymbalta (Brand name)
-SSNRI (SNRI)
-May cause hypoglycemia, orthostatic hypotension within the first week of use
-Pt with liver disease or drink excessive alc shouldnt use

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27
Q

Bupropion (Wellbutrin, Zyban): MOA

A

-Inhibit dopamine reuptake (Supposedly)

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28
Q

Atypical antidepressants: SE

A

Headache
-Dry mouth
-GI distress
-Tachycardia
-Nausea
-Restlessness
-Insomnia
-Loss of appetite, weight loss
-Seizures
-HTN

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29
Q

Atypical antidepressants: Contraindications

A

MAOI, Seizures, eating disorders

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30
Q

Atypical antidepressants: Interactions

A

MAOI: Toxicity, need to wait 2 weeks after stopping to avoid

-Suicidal ideation in children, adolescence that have depression or other psyche disorders

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31
Q

Bupropion (Wellbutrin, Zyban)

A

-Inhibits dopamine reuptake
-Atypical antidepressant
-Also used for smoking cessation

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32
Q

Trazodone

A

-Desyrel (Brand name)
-Inhibits reuptake of NE and Serotonin
-Need to report flu like S+S

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33
Q

Mirtazapine

A

-Remeron (Brand name)
-Atypical antidepressant
-Increases release of NE and serotonin
-Used for sleep in low doses
-Need to report flu like S+S

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34
Q

TCA MOA

A

-Inhibit reuptake of Serotonin and NE intensifying effects

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35
Q

TCA; SE

A

-Orthostatic hypotension
-Sedation
-Decreased seizure threshold
-Diaphoresis
-Anticholinergic effects
-Toxicity: cholinergic blockage, cardi tox, dysrhythmias

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36
Q

Contraindicatons TCA

A

-Preg
-Suicide risk pt, Risk of toxicity
-Seizures

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37
Q

Caution TCA

A

-CAD, diabetes, liver, kidney or resp disorders
-Urinary retention or obstruction
-Angle closure glaucoma
-BPH
-Hyperthyroidism

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38
Q

Interactions TCA

A

MAOI or St. John wort (serotonin syndrome)
-Antihistamines or other anticholinergics have additive effects

39
Q

TCA Purpose

A

-Depression
-Anxiety
-Insomnia
-Neuropathic pain
-Fibromyalgia

40
Q

MAOI: MOA

A

Blocks MAO in the brain which increases serotonin, dopamine, and NE available
-May take 1-3 weeks to begin producing effects, up to 2-3 weeks for the full effect

41
Q

Amitriptyline

A

-Elavil (Brand name)
-TCA

42
Q

Imipramine

A

-Tofranil (Brand name)
-TCA

43
Q

Doxepin

A

-Sinequan (Brand name)
-TCA

44
Q

Nortriptyline

A

-Aventyl, pamelor
-TCA

45
Q

MAOI SE

A

CNS stimulation
-Orthostatic hypotension
-HTN crisis when taken with tyramine
-Local rash
-Suicidal ideation

46
Q

MAOI contraindications

A

-Preg
-SSRI
-Pheochromocytoma, HF, RF, CVD, Cerebral vascular disease

47
Q

MAOI Cautions

A

-Diabetes (Hides hypoglycemia)
-Seizure
-TCA

_foods with tyramine

48
Q

MAOI interactions

A

-Tyramine: foods containing it can cause a HTN crisis

49
Q

Antidote for a MAOI HTN crisis

A

-Phentolamine (regitine), or nifedipine (procardia)

50
Q

Mood stabilizer MOA

A

-Serotonin receptor blockade and other neurochemical changes in brain

-May slow neuronal atrophy and promote neuronal growth

51
Q

Mood stabilizer SE

A

-GI distress
-Fine hand tremors
-Polyuria
-Weight gain
-Renal tox
-Goiter, hypothyroidism
- Bradydysrhythmia
-Hypotension
-Electrolyte/ fluid imbalance

52
Q

Mood stabilizer, Lithium: Mild toxicity SE

A

-<1.5 mEq/L
-Diarrhea, nausea, vomiting , thirst, fine hand tremors, muscle weakness, slurred speech, polyuria

53
Q

Mood stabilizer, Lithium: Moderate Toxicity SE

A

-1.5-2
-GI distress, mental confusion, poor coordination, coarse tremors

54
Q

Mood stabilizer, Lithium: Severe toxicity SE

A

-(2-2.5)
-Extreme polyuria of dilute urine , tinnitus, blurry vision, ataxia, seizures, severe hypotension, coma, resp complications
-Death
-Symptoms to coma and death with >2.5

55
Q

Contraindications Mood stabilizer

A

-Pregnancy, breast feeding

56
Q

Cautions Mood stabilizer

A

-Renal dysfunction, heart disease, dehydration , sodium depletions

57
Q

Mood stabilizer interactions

A

-NSAIDS -> Increased lithium excretion
-Increased lithium excretion -> Renal toxicity; use with anticholinergics
-Renal toxicity -> Urinary retention, polyuria, abdominal discomfort

58
Q

Mood stabilizer Purpose

A

-Bipolar disorder
-Acute mania
-Reduces suicide risk
-Psychotic disorders
-Alc use disorder
-Bulimia nervosa

59
Q

Mood stabilizer notes

A

Need frequent blood draws
-2000-3000 ml of fluid daily
-Monitor sodium and weight
-Monitor lithium levels (2-3 weeks)

-Treatment may include emetics, gastric lavage or hemodialysis (high levels)

60
Q

Lithium Carbonate

A

-Lithane (Brand name)
-Eskalith (Brand name)
-Lithobid (Brand name)
-Carbolith (Brand name)
-Mood stabilizer

61
Q

Anticonvulsants MOA: Valproic acid

A

-potentiate GABA
-Gaba effects are greater

62
Q

Anticonvulsants MOA: Carbamazepine

A

-Slows Na+ and Ca2+ reentry, slowing nerve conduction

63
Q

Anticonvulsants MOA: Lamotrigine

A

-Inhibits glutamate
-(glutamate is responsible for excitation)

64
Q

Valprotic acid: SE

A

-GI distress
-Pancreatitis
-Hepatotoxicity
-Thrombocytopenia
-Teratogenesis

65
Q

Carbamazepine: SE

A

-Cognitive effects
-Blood abnormalities (Leukopenia, anemia, thrombocytopenia)
-Teratogenicity
-Hypo-osmolarity -> ADH loss, fluid loss, fluid overload
-Skin disorders

66
Q

Lamotrigine SE

A

-Dizziness
-HA
-N+V
-Double vision
-Skin disorders

67
Q

Anticonvulsants Contraindications

A

-Pregnancy
-Carbamazepine, with bone marrow suppression or bleeding disorders

-Valproic acid with liver disorders

68
Q

Anticonvulsants interactions

A

None listed

69
Q

Anticonvulsants purpose

A

-Treatment and prevention of relapse of mania and depressive episodes
-Mixed mania
-Rapid cycling bipolar disorders
-Schizophrenia

-“mood stabilizers”

70
Q

Valproic Acid

A

-Depakote (Brand name)
-Anticonvulsants
-Inhibits gaba

71
Q

Carbamazepine

A

-Tegretol (Brand name)
-Equetro (Brand name)
-Anticonvulsants
-Slows Na and Ca reabsorption

72
Q

Lamotrigine

A

Lamictal (Brand name)
-Anticonvulsant
- Inhibits glutamine

73
Q

2nd gen antipsychotics MOA

A

Blocks receptors for serotonin and dopamine, NE and histamine

74
Q

2nd gen antipsychotics SE

A

-New onset diabetes mellitus
-Weight gain
-Hypercholesterolemia with increased risk for heart disease
-HTN
-Orthostatic hypotension
-Anticholinergic effects
-Agitation
-Dizziness
-Sedation
-Sleep disruption
-Mild EPS (ex-tremor)

75
Q

2nd gen antipsychotics: Contraindications

A

Dementia
Risperidone, Preg

76
Q

2nd gen antipsych: Cautions

A

-Avoid alc
-CVD cerebrovascular diseases, seizures, DM

77
Q

2nd gen antipsych: Interactions

A

-Immunosuppressive medications can further suppress with clozapine;
-TCA can prolong QT interval and cardiac dysrhythmias
-Barbs, phenytoin and fluconazole disrupt hepatic metabolism

78
Q

2nd gen antipsych notes

A

Oral disinter-grating tablets are available for pt with history of cheeking or pocketing meds, or have a hard time swallowing

-when you give Asenapine you cant eat 10 min before or after

79
Q

Risperidone

A

-Risperdal (Brand name)
-2nd gen antipsych
-Available to give IM every q2-4 wk for less adherent pt

80
Q

Olanzapine

A

-Zyprexa (Brand name)
-2nd gen antipsych

81
Q

Quetiapine

A

-Seroquel (Brand name)
-2nd gen antipsych

82
Q

Aripiprazole

A
  • Abilify (Brand name)
    -2nd gen antipsych
83
Q

Ziprasidone

A

-Geodon (Brand name)
-2nd gen antipsych

84
Q

Dantrolene

A

-Dantrium
-Treats muscle rigidity
-Used in Serotonin Syndrome

85
Q

Diazepam

A

-Valium
-Used to treat muscle rigidity
-Used in Serotonin Syndrome

86
Q

Propranolol

A

-Used in Serotonin Syndrome to block 5HT receptors
-Beta blocker, promotes vasodilation as well

87
Q

Phenelzine

A

-Nardile (Brand name)
-MAOI

88
Q

Tranylcypromine

A

-Parnate (Brand name)
-MAOI

89
Q

Selegiline

A

(Emsam) (Brand name)
-MAOI
-Transdermal

90
Q

Clonazepam

A

-Klonopin (Brand name)
Anxiolytics
-Used for treatment resistant mania and psychomotor agitation

91
Q

Lorazepam

A

-Ativan (Brand name
-Anxiolytics
-Used for treatment resistant mania and psychomotor agitation

92
Q

Diazepam

A

-Valium (Brand name)
-Anxiolytics
-Used for treatment resistant mania and psychomotor agitation

93
Q

Alprazolam

A

-Xanax (Brand name)
-Anxiolytics
-Used for treatment resistant mania and psychomotor agitation

NSG 470 (26 decks)

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