Psych meds Flashcards
What is the most common med to treat anxiety?
Benzodiazepines (-am family; midazolam, alprazolam, dazepam)
MOA of benzodiazepines
acts on GABA to enhance effects on neurons
ADR of benzodiazepines
excessive sedation, significant hypotension with IV, amnesia, or paradoxical reactions (insomnia, etc)
antidote for benzodiazepine
flumazenil
therapeutic effects of benzodiazepine
CNS depression, sedation, muscle relaxation
what is the drug of choice for generalized anxiety?
buspirone
MOA of buspirone
act on serotonin to have anxiolytic effect without sedation; less dependency, can take daily
antihistamines for anxiety
may use as a mild tranquilizer
ADR of antihistamines
excessive drowsiness, dry mouth, secretions
what antihistamine is given for anxiolytic effect/ tranquilizer?
hydroxyzine (IM z track admin); use as take down drug in crisis
NE Reuptake Inhibitor use
ADHD main use; off-label for some anxiety disorders
NE Reuptake Inhibitor MOA
block uptake of NE resulting in more NE in the blood to increase energy and focus
NE Reuptake Inhibitor ADRs
nausea, dry mouth, insomnia, BP elevates
NE Reuptake Inhibitor specific drug for anxiety
atomoxetine
how long does it take for full effects of benzodiazepines?
1-2 weeks; longer if combo with antidepressants
Do’s and Don’ts of Anxiety
DO NOT… stop therapy abruptly, take with OTC cough/cold meds with CNS depressants, drink alcohol, drive heavy machinery
DO… teach pt to seek counseling and learn healthy coping skills
who is given mood stabilizer drugs?
bipolar pts and manic pts
MOA of mood stabilizers
alters level of neurotransmitters in brain to control manic behavior (exact MOA unknown); alter in sodium transport in nerve and muscle cells
what is the primary mood stabilizing drug?
lithium
ADR of lithium use
slowed reflexes/reaction time, lithium toxicity; long use can lead to hypothyroidism
what are the S&S of lithium toxicity?
polyuria, memory deficits, confusion, tremors, muscle weakness, CV collapse, coma
acute mania therapeutic level of lithium
1-1.5 mEq / L
long term maintenance therapeutic level of lithium
0.6-1.2 mEq / L
Factors affecting lithium levels
-Sodium deficiency (increase reabsorption and risk for lithium toxicity)
- Sodium excess (decrease reabsorption and risk for non-therapeutic levels)
- NSAIDs and diuretic use- increase levels
- Cannot give in single dose (low therapeutic index and short half life)
-Need good kidney function to take med
Misc mood stabilizers
valproates, carbamazepine, antipsychotics for severe mania episodes
valproates MOA
possible GABA elevation; does not need frequent monitoring, but higher incidence of suicides; may use in combo with lithium
valproate drugs
Divalproex sodium and Valproic acid
antipsychotic drugs for severe mania
Aripiprazole
Lurasidone - safer in pregnancy
Brexpiprazole
Symbyax (Combo of olanzapine (antipsychotic) and fluoxetine (antidepressant) ; Effective in improving bipolar disorder without increasing mania
Antidepressants Black Box Warning
suicidal thoughts and behaviors; increase risk in children, adolescents, and young adults
what are TCAs?
Tricyclic Antidepressants; 1st generation of 1950s
TCAs MOA
Corrects the imbalance of serotonin and NE; Blocks inactivation of NE and serotonin in the brain which increases levels of the neurotransmitters
TCA ADRs
orthostatic hypotension, arrhythmias, dry mouth, urinary retention, constipation, sedation, confusion, weight gain
TCA drugs
Amitriptyline - low dose for depression treatment, more used for pain
Imipramine - give to kids who wet the bed
what are MAOI’s?
Monoamine Oxidase Inhibitors
MOAI’s mechanism?
Blocks monoamine oxidase, an enzyme that inactivates catecholamines to increase NE levels
MAOI drugs
Tranylcypromine
Phenelzine
MAOI ADRs
anorexia, orthostatic hypotension, dizziness, insomnia
severe drug to food interaction of MAOI’s?
Hypertensive crisis = MAOIs taken with tyramine containing foods (aged/smoked meats, cheese, and red wine)
what are SSRIs?
Selective Serotonin Reuptake Inhibitors
What are SSRIs highly bound to? what does it indicate?
albumin; low albumin = more effect of drug
SSRI MOA?
Block uptake of serotonin back into synaptic cells —> more free serotonin for activity
what is the advantage of SSRIs over TCA?
not as many anticholinergic or antiadrenergic effects
SSRIs ADRs
CNS stimulation, N/V/D, weight loss initially then weight gain as therapy progresses; skin rash
SSRI drugs
Fluoxetine
Paroxetine
Sertraline
Trazodone (serotonin antagonist) - not SSRIs but the same effects achieved
what are SNRI?
Serotonin/NE Reuptake Inhibitor
MOA of SNRI
Results in more serotonin, NE, and dopamine
ADR of SNRI
nausea, dry mouth, increase BP, tiredness, low libido, and ED
SNRI drugs
Venlafaxine- off label use for ADHD
Desvenlafaxine
Duloxetine - clinically trialed for pain management for fibromyalgia and musculoskeletal pain
Misc antidepressants
bupropion, mirtazapine
bupropion
Weakly inhibits reuptake of dopamine, NE, and serotonin; used in smoking cessation
mirtazapine
Noradrenergic and specific serotonergic antidepressant; Strongly blocks alpha 2 receptors to result in increase release of NE and serotonin; antihistamine effects
ADRs = increase sedation (can be sleep aid), weight gain
how long before desired effects achieved for antidepressants?
4-6 weeks
what is important to determine before starting MAOI therapy? why?
a good drug history; antidepressants cannot be taken within 2 weeks of MAOI therapy
pt teaching with MAOI
dietary precautions, many drug to drug interactions
other nursing considerations
Monitor VS, suicide precautions (BBW) (provide safety measures)
Risk of suicide is highest when patient begins to get energy again
Do not abruptly discontinue → withdrawal symptoms
Encourage counseling
what is serotonin syndrome?
Hyperactivity of serotonin resulting from drug to drug interactions or high levels of one serotonin increasing drug
S&S of serotonin syndrome
agitation, hyperreflexia, fever, diaphoresis, tachycardia, seizures (may cause death)
what can antipsychotic meds be used for?
acute psychoses and schizophrenia; may also be used as take down drug in pts with acute aggression and agitation
positive symptoms
irrational behavior, out of touch with reality, delusional, hallucinating, repetitive and uncontrollable movements, loose association, communication impairment
negative symptoms
social and emotional withdrawal, poor judgement, poor self care, avolition, flat affect, apathy
general MOA of antipsychotics
primarily block neurotransmitters, mainly dopamine and serotonin, varying degrees of anticholinergic and alpha antagonistic effects
general ADRs of antipsychotics
dry mouth, constipation, tachycardia (anticholinergic effects); hypotension, drowsiness, seizures, bone marrow depression and EPS, TD, some pts may experience NMS
Black Box Warning on Antipsychotic meds
dementia related psychosis; increase risk of death in elderly with dementia due to CV events (stroke)
what is EPS?
extrapyramidal symptoms; inability to sit still, involuntary muscle movements, tremors, drooling, stiff muscle, and facial movements
treatment for EPS
diphenhydramine or benztropine
what is TD
tardive dyskinesia; protrusion of tongue, slow rhythmic involuntary movements mainly of facial muscles (usually irreversible)
treatment of TD
deutrabenazine and valbenazine
what is NMS
neuroleptic malignant syndrome; a rare, potentially fatal, complication within hours of treatment with antipsychotics or occur years later
symptoms of NMS
LEAD-PIPE MUSCLE RIGIDITY, severe temp elevation, dysrhythmias, seizures, may lead to death
treatment of NMS
dantrolene
what do typical antipsychotics treat?
only positive symptoms
what is the main class of typical antipsychotics?
phenothiazine/phenothiazine-like
main drugs of phenothiazine class
chlorpromazine; common for takedown of acutely psychotic pt or irrational acting pt
piperazine
piperidine
main drug of phenothiazine-like class
haloperidol; common use for long term therapy in schizophrenia
ADRs of haloperidol
high EPS effects; potentially fatal arrhythmias (must be on ECG monitor if med is IV)
what are atypical antipsychotics?
treats both positive and negative symptoms; less EPS and NMS risk; preferred drug class
MOA of 2nd generation antipsychotics (atypical)
block dopamine and serotonin receptors
ADR of atypicals
little to no EPS, may result in diabetes, lipid problems, dysrhythmias
first med started in atypicals/ what is the prodrug?
clozapine
clozapine
drug of last resort
Risk Evaluation Mitigation Strategy (REMS) requires additional documentation and consents due to risks of drug
ADRs of clozapine
serious bone marrow depression, necessitating WBC evaluation every 1-2 weeks; can lead to serious infection risk if pt develops agranulocytosis
when would we stop clozapine permanently?
if WBC drops below 2000
common 1st line treatment for atypical antipsychotics
aripiprazole (monthly injections), brexpiprazole
ziprasidone IM for take down
quetiapine for bipolar and psychotic disorders (highly abused)
asenapine sublingual for clients who are difficult to give meds to
nursing considerations for antipsychotics
monitor VS, behaviors, EPS status
safety precautions (meds cause drowsiness, impaired coordination)
pt teaching = need for concurrent blood work, do not abruptly stop meds, life long therapy
caution with antipsychotics and elderly pts due to increase risk for stroke
medications for alcohol abuse/treatment
disulfiram and naltrexone
disulfiram MOA
inhibit aldehyde dehydrogenase (accumulation of acetaldehyde); cause severe vomiting if taken with alcohol; always withdraw from alcohol first then treat with this drug
naltrexone MOA
opiate antagonist that decreases craving for alcohol; given for maintenance drug after patient goes through withdrawals
medications for nicotine abuse
varenicline (smoke for first 7 days then stop on 8th day; no go for public transport operators due to insomnia)
bupropion
medication for opiate abuse
methadone- prevent withdrawal syndrome
buprenorphine- may use with or without naloxone
examples of observed behaviors with abuse
preference in assignment , absenteeism, behavior on the job
preference in assignment with alcohol abuse
often prefer less demanding areas and/or more independent role
preference in assignment with drug abuse
often prefer high-volume drug use areas with lack of supervision
absentee in alcohol abuse
frequent call-ins, tardiness, following scheduled days off
absentee in drug abuse
workaholic, volunteer for extra shifts
behavior on job with alcohol abuse
arrive late and leaves early; frequent breaks and trips to lounge, declines offer to join peers on breaks, inconsistent and erratic performance
behavior on job with drug abuse
arrive early and stay later; frequent breaks and trips to lounge, declines offer to join peers on breaks, inconsistent and erratic performance
