Psychiatric Drugs Flashcards
Anti-pychotics
-Treats psychotic disorders, particularly schizophrenia
Antiolytics
- Treats anxiety disorders, insomnia, nausea and vomiting in cancer therapy
Antidepressants
Treat depression-reactive, major and bipolar disorders
Mood Stabilizers
Are antidepressants and treat bipolar disorders
How are moods and emotions communicated throughout the central nervous system
- Chemical neurotransmitters
How does an impulse travel?
- Travels through the presynaptic neuron across the synaptic cleft and binds to a receptor on a post synaptic neuron
Dopamine
- Cognition, emotional responses, motivation, movement, attention
Serotonin
- Role in mood, sleep rhythms and arousal
Norepinephrine
- Controls arousal, vigilance, mood, anxiety, fight or flight
Gamma-aminobutyric acid GABA
- Regulates anexity
Psychosis
- Losing contact with reality, manifested in mental or psychiatric disorders.
- Thought to be due to an imbalance of neurotransmitter dopamine in the brain
Symptoms of psychosis
- Difficulty in processing information
- Delusions
- Hallucinations
- Catatonia
- Aggressive/violent behavior
- Incoherence
Delusion
A false belief in which one’s own thoughts, feelings, or fears cannot be distinguished from reality.
- Present in form of delusions of control, grandeur, persecution
Hallucinations
- A false perception having no relation to reality
- Could be visual, auditory, tactile, gustatory or olfactory
Schizophrenia- what kind of disease is it?
What are the categories for symptoms?
Chronic disease (major category of psychosis) has Positive and Negative symptoms
Positive Symptoms
- Exaggeration of normal function
- Additive
- Agitation, hallucinations
Negative Symptoms
- Diminished
- Decreased loss of function
- Social withdrawal or loss of speech
Antipsychotics- how do they work?
- What are the categories?
- Block dopamine receptors
- Typical aka traditional or Atypical aka second generation
Typical (traditional) First Generation Antipsychotics
Phenothiazines
Nonphenothiaznes
Antipsychotics block what?
- D2 receptors
Typical (Phenothiazines)- detailed action?
They are anti-psychotics that have a strong affinity for the D2 and they have an increased incidence of extra pyramidal symptoms????
Atypical Antipsychotics Action
They have weak affinity for the D2 receptors and decreased incidence of EPS
Symptoms of pseudo-parkinsomism
- Stooped posture
- Shuffling gait
- Fidgety
- Pill rolling
- Tremors at rest
- Bradykinesia
Akthisia symptoms
- Restless
- Trouble standing still
- Paces the floor
- Feet in constant motion, rocking back and forth
Acute Dystonia Symptoms
- Facial grimacing
- Involuntary upward eye movement
- Muscle spams of the tongue, face, neck and back (back muscle spasms cause trunk to arch forward)
Tardive Dyskinesia Symptoms
- Protrusion and rolling of the tongue
- Sucking and smacking movements of the lips
- Chewing motion
- Facial dyskinesia
- Involuntary movements of the body and extremities
Adverse Reactions of Antipsychotics
- Reactions common early in treatment
- Acute Dystonia
- Akathisia
Acute Dystonia - adverse reactions
- Occurs within a week of taking the medications
- Treat with anticholinergic or anti-parkinsonism drugs
- ex. cogentin or benztropine or benzodiazepines or ativan
Akathia
- Can occur early in treatment
- Treat with benzodiapines and Lorazepam (Ativan) ot beta blockers and propanolol (Inderal)
Tardive Dyskinesia - What is it?
How do we treat it?
When does it manifest?
What factors influence it?
- Typically more than a year
- A very serious adverse reaction and the drug should be stopped
- The reaction is more frq and serve in older adults
- Depends on the dose and the duration
- Treatments: high doses Vitamin E may be helpful or other benzodiazapines like Ca channel blockers or beta blockers
Neuroleptic Malignant Syndrome (NMS)- Symptoms
- Sudden high fever
- Muscle rigidity
- Altered mental status
- BP fluctuations- tachycardia and dysrthymia
- Seizures
- Rhabdomyolysis ( skeletal muscle destruction)
- Acute Renal Failure due to the skeletal muscle destruction
- Coma
- Respiratory fail
Treatments for NMS
- Immediate withdrawal of antipsychotics
- Hydration
- Antipyretics
- Muscle relaxants
- Benzodiazephine
How do the three groups of phenothiazine differ?
- Mostly due to side effects
What are the three groups of phenothiazines?
- Aliphatic: Chlorpromazine- Thorazine
- Piperazine: Fluphenazine- Prolixin
- Piperidine: Thioridazine- Mellarli
Side Effects of Aliphatic: Chlorpromazine- Thorazine
- Strong sedative effect
- Lowers BP
- Moderate EPS
Side Effects of Piperazine: Fluphenazine- Proli
- Low sedative effect
- Strong antiemetic effect ( dec the urge to vomit)
- Little effect on BP
- Greater EPS than other phenothiazines
Side Effects Piperidine: Thioridazine- Mellarli
- Few EPS
- Can cause life threatening dysrhythmia
Haloperidol (Haldol)
- Type of nonphenothoazine
- Freq used
- Similar to phenothiazines
- Potent antipsychotic so smaller dosage is used
- Prolonged QTc so leads to arrhythmias
What are the advantages of atypical antipsychotics
- Treats both positive and negative symptoms
- Less likely to cause EPS or tardive dyskinesia
What is the mechanism of function for atypical antipyschotics
- The block serotonin and dopaminergic D4 receptors
Risperidone (Risperdal) uses
- Atypical antipsychotic
- Used to manage psychosis and schizophrenia
Risperidone (Risperdal) Side Effects
- Sedation
- H/A
- Photosensitivity
- EPS
- Seizures
- Dry mouth
- Weight gain
- Tachycardia
- Orthostatic hypotension
- Urinary retention
- Sexual dysfunction
What assessment do you do for people receiving antipsychotics
- Vital Signs and weight
- Drug hx- check for allergies and may need to increase anticonvulsant dose
- Mental status, cardiac, eye and respiratory
What nursing diagnosis can we give someone who is psychotic?
- Disturbed thought processes related to delusions
- Disturbed sensory- perceptual responses related to biochemical imbalances (hallucinations)
- Non-compliance related to loss of motivation
What is in the planning phase for the psychotic patient?
Patient’s condition (psychosis) will improve with psychotherapy and drugs
Interventions for psychosis
- BC orthostatic hypotension is typical so check vital signs
- monitor for adherence
- check for EPS
- assess for neuroleptic malignant syndrome
- monitor WBC
- let PT know that it may take 3-6 weeks for the meds to take effect
- warn them not to use alcohol, narcotics, or other CNS depressants
- tell them not to suddenly discon.
Anxiolytics
used to treat anxiety and insomnia
Types of anexity
1- not caused by a medical or drug
2- related to drug use, medical/psych disorders
For which anexity are anxiolytics not given?
type 2
How is long term use of aniolytics?
- discouraged
- tolerance builds in weeks or months
- non pharm measures should be used b4 this med
Benzodiazephines - what are the users?
- Anticonvulsants
- Sedative- hypnotics
- Pre-op drugs
- Anxiolytics
Examples of Benzodiazephines
Lorazepam- ativan
diazepam- valium
Lorazepam- ativan
-Actions?
- inc the GABA effects
- binds to specific benzodiazephine receptor
- postsynaptic receptor becomes more sensitive to GABA
- inhibits rapid neurotransmitters
- decreases signs and symptoms of anexity
Pharmacokinetics of lorazepam
- rapid absorption
- high PB 91%
- half life- 12-14 hours
- excreted in urine
Lorazepam- Ativan: Side Effects
weakness confusion blurred vision N/V anorexia sleep disturbances restlessness hallucainations anorexia
Ativan aka lorazepam adverse effects
hypertension
hypotension
- cannot discontinue abruptly: withdrawal symptoms= agitation, muscle tremors, cramps, nausea, sweating, drug is tapered over time
Depression:
mood disorder:
depressed mood, despair, insomnia, loss of interest in normal activities, fatigue, dec ability to think, suicidal thoughts
pathophysiology of depression
insufficient amount of monamine neurotransmitters such as serotonin, dopamine, norepinephrine
etiology of depression
genetic predisposition
social and environmental factors
3 types of depression
bipolar affective disorder
reactive
major
reactive depression
sudden onset after precipitating event
may last for months
major depression
loss of interest in life
inability to complete tasks
deep depression
bipolar affective disorder
mood swings between manic and depressive aka euphoric and dysphoria
herbal supplements for depression
St. John’s Wart-dec the reuptake of serotonin, norepinephrine and dopamine
Gingko Biloba
- use of this substance needs to be discontinued 1-2 weeks before surgery
- the patient should check with the health care provider regarding herbal treatments
4 types of antidepressants
- Tricyclics (TCA)
- Selective serotonin reuptake inhibitors (SSRI)
- Atypical antidepressants
- Monoamine oxidase inhibitors (MAOIS)
Tricyclics
ex. Elavil aka amitriptyline
blocks uptake/reuptake (removal of) norepinephrine and serotonin
effective and less expensive than SSRI
elevate mood, inc intrerest and dec insomnia
usually given at night to dec problems
