Psychiatric Key Concepts Flashcards
Briefly describe anxiety as a disorder
Apprehension, nervousness, tension that occurs when one perceives a situation to be threatening to one’s physical, emotional, social, or economic well being. Includes phobias, panic, OCD and PTSD.
What classification of medications is used to treat anxiety, What family of drugs specifically
Benzodiazepines
AM family
What is the antidote to benzodiazepines
Flumazenil
What is a medication commonly used to treat general anxiety disorder?
Buspirone
Acts on serotonin instead of GABA, anxyolitic without CNS depresssion, less sedation and dependance than benzos
Lithium Key facts
Therapeutic Level
Acute Mania 1-1.5
Long term maintenance 0.6-1.2
-Do not start med if unable to monitor level
-used in bipolar patients/treat mania
-action:alters levels of neurotransmitters in the brain resulting in control of manic behavior
-ADR:slowed reflexes and reaction time, urinary frequency, lithium toxicity
Decreased Sodium = increased lithium
increased sodium=decreased lithium
NSAID AND DIURETICS increase lithium levels because they can damage the kidneys
What other types of medications can treat mood disorders
-Valproates - disadvantage of higher incidence of suicide than with lithium advantage of not needing frequent monitoring, may be used in combo with lithium. ex: divalproex, valproic acid.
-atypical antipsychotics - ex: aripiprazole, brexpriazole
- patients with bipolar may also be on antidepressant
-should not be monotherapy, monitor it does not result in increased mania
What is EPS?
-Extrapyramidal Symptoms
-Impaired motor function, muscle rigidity, drooling, involuntary muscle movements
-EPS TREATMENT: DIPHENHYDRAMINE OR BENZTROPINE @ BEDTIME
What are the main classes of antidepressants?
TCA, MAOI, SSRI, SNRI
BLACK BOX WARNING: SUICIDAL THOUGHTS AND BEHAVIORS
TCA key facts
TRICYCLIC ANTIDEPRESSANTS
-correct the imbalance in concentrations of neurotransmitters, serotonin and norepi
ADR: orthostatic hypotension, arrhythmias, anti-cholinergic effects of dry mouth, urinary retention, constipation
-CAN BE TOXIC IF OVERDOSE DUE TO ADVERSE CARDIAC EFFECTS
ex: amitriptyline, imipramine
MAOI key facts
MONOAMINE OXIDASE INHIBITORS
-block monoamine oxidase which is what normally inactivates catecholamines: “block the blocker”, end result is norepi levels
-ex: tranylcypromine, phenelzine
-LIFE THREATENING HYPERTENSIVE CRISIS IF TAKEN CONCURRENTLY WITH TYRAMINE CONTAINING FOODS (AGED OR SMOKED MEATS, CHEESE, RED WINE)
SSRI key facts
SELECTIVE SEROTONIN REUPTAKE INHIBITOR
-most commonly used today
-blocks uptake of serotonin back into synaptic cells, resulting in more free serotonin for activity
-ex: fluoxetine, paroxetine, sertraline
SNRI key facts
SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITOR
-end result of more NE, more dopamine, depending on drug
-can increase BP
-Ex: vanlafaxine, desvenlafaxine,duloxetine
all antidepressants key facts
-usually 4-6 weeks before desired effect is achieved
-most antidepressants can’t be taken within 2 weeks of MAOI therapy
-monitor VS, provide safety measures including suicide precautions
-risk of suicide is greatest once patient is energetic again
-dont stop meds abruptly
What is Serotonin Syndrome? What are the classic signs and symptoms?
A serious drug reaction, a condition primarily of hyperactivity, too much serotonin in the body
-occurs in individuals taking high levels of one or a DDI with more than one drug ex: ssri + tramadol for pain
-S&S: agitation, hyper reflexia, fever, diaphoresis, tachycardia, seizures, death
What are typical antipsychotic medications? what are the main considerations for medications like these? list examples of medications
-PHENOTHIAZINES (3 SUBCLASSES) end in “zine”
-chlorpromazine (thorazine) drug commonly used for “take down” OLDEST rarely used anymore
What is Haloperidol?
phenothiazine like typical antipsychotic
-commonly used for long term therapy in schizophrenia
-HIGH EPS side effects
-if IV must be on ECG monitoring
What is Tardive Dyskinesia?
protrusion of tongue, chewing movements and other slow rhythmic involuntary movements; may occur with long term use of antipsychotics; usually irreversible
TD treatment: DEUTETRABENAZINE AND VALBENAZINE
What is Neuroleptic Malignant Syndrome?
-A rare but potentially FATAL complication that may occur within hours of treatment or years later with some antipsychotics (usually “typical antipsychotics”)
-S&S: lead pipe muscle rigidity, severe temp elevation, dysrhythmias, seizures, death
-looks like malignant hypothermia but the cause is antipsychotics not anesthesia
TREATMENT- dantrolene
What are the atypical antipsychotic medications? what are the main considerations?
-treats both positive and negative symptoms of schizophrenia , useful in mood stabilization for manic patients.
-GENERALLY LITTLE TO NO EPS BUT CAN RESULT IN DIABETES, LIPID PROBLEMS, OBESITY, DYSRHYTHMIAS- METABOLIC SYNDROME
-1st drug of choice in newly diagnosed patient
-ex: risperidone(risperadol), olanzapine, aripiprazole(abilify)
-quetiapine- baby heroin
-clozapine
-monitor VS, affect and behavior, monitor EPS status
What is the biggest adverse drug affect with clozapine?
-Last resort REMS program
-serious bone marrow suppression necessitating WBC evaluation every 1-2 weeks “agranulocytosis”
-if WBC drops below 2000, permanently discontinue
smoking cessation
nicotine replacement therapy, bupropion, varenicline, can smoke first 7 days , NO GO for pilots, mass transit workers due to side effect of insomnia
ALCOHOL
DISULFIRAM- alcohol deterrent causes extreme vomiting
NALTREXONE- decreases craving for alcohol
OPIATE ADDICTION
buprenorphine +/- naloxone to help taper the client off of opiates without having severe withdrawal symptoms, methadone to help prevent withdrawal symptoms
naltrexone > maintenance, keeps a client from getting high if they abuse seizure management
