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3. Nursing Pharmacology > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

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1
Q

Anxiety Medications

2 types

A
  • Two main types:
  • Benzodiazepine sedative hypnotic anxiolytics
  • Atypical anxiolytic/non barbiturate anxiolytics
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2
Q

other anxiety meds

A

•Others:

  • SSRI - Venlafaxine
  • TCA
  • MAOI
  • CNS stimulates – Ritalin
  • Antihistamines – hydroxyzine pamoate (Vistaril)
  • Beta blockers – Propranolol – social phobias – off label
  • Anticonvulsants – Gabapentin – off label

•

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3
Q

Medication Classification : Benzodiazepine

A
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Diazepam (Valium) -
  • Chloridiazepoxide (Librium)
  • Clorazepate (Tranxene)
  • Oxazepam (Serax)
  • Clonazepam (Klonopin)
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4
Q

Benzodiazepine

action

A

Enhances the inhibitory effect of gamma-aminobutyric acid (GABA) in the CNS – rapid and long term relief of anxiety and alcohol withdrawal

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5
Q

benzodiazepine

SE

A

Side Effects:

  • CNS depression
  • Addiction
  • Tolerance
  • Anterograde amnesia
  • Toxicity
  • Paradoxical response – opposite effect
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6
Q

Atypical Anxiolytic/Nonbarbituate

A
  • Buspirone (Buspar) – Longer use – may take 2-3 weeks to take effect
  • Mechanisms unknown – binds to serotonin and dopamine receptors.
  • Less Potential for abuse – does not result in sedation
  • Uses: Anxiety
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7
Q

Buspirone (Buspar)

contraind/caution

A
  • Do not use with MAOI or until 14 days after MAOI DC
  • Avoid use of erythromycin, ketoconazole and grapefruit juice may increase the effects of this class of medication
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8
Q

receptors and action

A

Dopamine – emotional response, movement

Serotonin – Mood, sexual desire, some social behavior

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9
Q

Anxiolytics – Nursing Interventions

A
  • Monitor vital signs
  • Encourage client to rise slowly to avoid dizziness
  • Advise not to drive a motor vehicle or operate dangerous equipment
  • Benzodiazepines are for short term use only due to risk of addiction
  • Warn client not to concurrently take CNS depressants, alcohol, other anxiolytics
  • Should take with meals or shortly thereafter to decrease GI discomfort
  • Warn client against abrupt discontinuation of medication
  • Buspar—may take a couple of weeks to be effective
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10
Q

Medications Classifications for Depression

A

—Tricyclic antidepressants - norepinephrine and serotonin reuptake with anticholinergic side effects

—

  • —SSRI* – serotonin - agitation anxiety etc reactions
  • —MAOIs* – prevent breakdown of norepinephrine, serotonin and dopamine -

—SNRI – Depression and anxiety

—

—Atypical Antidepressants

“Start low and go slow”

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11
Q

Tricyclic Antidepressants (TCA)

A

•Block serotonin and norepinephrine making more of these transmitters available to body.

•Anticholinergic side effects common

  • Dry mouth
  • Constipation
  • Urinary retention
  • Increased appetite
  • Orthostatic hypotension
  • Other treatments – Neuroleptic pain, anxiety, insomnia, fibromyalgia
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12
Q

Tricyclic Antidepressants (TCA)

know this meds

A

§Amitriptyline (Elavil)

§Doxepine (Silenor)

§Trimipramine (Surmontil)

§Nortriptyline

§

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13
Q

Selective Serotonin Reuptake Inhibitors (SSRI)

A
  • Blocks reabsorption of serotonin releasing more of the neurotransmitter to the body.
  • Serotonin syndrome – rare but can occur
  • Withdrawal Syndrome – taper dose
  • Hyponatremia - < 135 mEq/L
  • Bruxism – teeth grinding
  • Treatment:
  • Major depression Disorder
  • Anxiety
  • Bulimia
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14
Q

Selective Serotonin Reuptake Inhibitors (SSRI)

medications

A

citralopram (Celexa)

escitalopram (Lexapro)

paroxetine (Paxil)

sertraline (Zoloft)

fluoxetine (Prosac)

-Avoid grapefruit juice = increases risk of toxicity

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15
Q

Monoamine Oxidase Inhibitors (MAOI)

A

•Phenelzine

•Increase the amount of Norepinephrine, dopamine, and serotonin in the body.

•Side Effects

  • Orthostatic hypotension
  • CNS simulation – anxiety
  • Hypertensive crisis – Limit tyramine type foods*

•Nursing Care

  • Use with caution in diabetes, seizures, or TCA
  • Contraindicated if taking SSRI- stop 2 weeks prior
  • Treatment of depression and bulimia
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16
Q

Atypical Antidepressants

A

•Atypical antidepressants are not typical — they don’t fit into other classes of antidepressants. They are each unique medications that work in different ways from one another.

•Bupropion (Wellbutrin) – allows more dopamine into the body. – good for low energy caused by depression or to quit smoking (Zyban).

•Can worsen anxiety, HA, nausea and loss of appetite, insomnia, increased heart rate,

17
Q

Atypical Antidepressants- SNRI

A
  • Venlafaxine (Effexor)*
  • Duloxetine (Cymbalta)*
  • Desvenlafaxine (Pristiq)*

•Medications belongs to a group of medicines known as serotonin and norepinephrine reuptake inhibitors (SNRI).

•Side Effects

  • HA, Nausea, agitation, anxiety, insomnia
  • Hyponatremia
  • Bleeding
  • Taper all antidepressants

-Watch St. John’s wort may increase risk of serotonin syndrome

18
Q

Atypical Antidepressants

•Mirtrazapine (Remeron)

A

•Mirtrazapine (Remeron)

  • Serotonin and norepinephrine reuptake inhibitors (SNRI)
  • Generally taken 30 minutes before bed because it can make you sleepy. Additional side effects, among others, may include:

•Increased appetite

•Weight gain

  • Increased cholesterol and triglycerides
  • Sleepiness
  • Less sexual dysfunction as a side effect than with SSRI
19
Q

Atypical Antidepressants

Trazodone (Desyrel)

A

•Trazodone (Desyrel) is used to treat depression and for sleep. It is thought to work by increasing the activity of serotonin in the brain.

• Side Effects

  • Blurred vision
  • Headache
  • Extreme tiredness (fatigue)
  • Nausea
  • Muscle aches or pains
  • Diarrhea

•Irregular heartbeat

•Sudden drop in blood pressure when standing (orthostatic hypotension)

20
Q

Antidepressant Medications – Nursing Interventions

A
  • Monitor vital signs
  • Monitor mood for drug effectiveness
  • Monitor for suicidal tendencies, seizures
  • Warn about foods that contain tyramine can cause a hypertensive crisis with MAOIs
  • Encourage client to take drug as prescribed – do not stop abruptly
  • Avoid CNS stimulants (including alcohol), CNS depressants, cold medicines
  • Warn client against driving or using dangerous mechanical equipment until drug effect is known
  • Advise client that a therapeutic response usually occurs in 2-4 weeks
  • Inform client that herbs (St. John’s wort, ginseng, etc) may interact with antidepressants
21
Q

Antipsychotics – First Generation Conventional

meds

A
  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Fluphenazine (Prolixin)
22
Q

Antipsychotics – First Generation Conventional

action

A

Action: Block dopamine, acetylcholine, histamine, and norepinephrine receptors in brain

23
Q

Antipsychotics – First Generation Conventional

uses

A

Uses: Acute and chronic psychotic disorders, Schizophrenia, Bipolar – manic phase, Tourette’s disorder

Prevention of nausea and vomiting through blocking or dopamine

24
Q

Antipsychotics – First Generation Conventional

SE

A

Side Effects: Agranulocytosis < 500 ( Fever, Sore throat), Anticholinergic effects, EPS (Acute dystonia, parkinsonism, akathisia, tardive dyskinesia, NMS, orthostatic hypotension, sedation, seizures, cardiac arrhythmias(Potassium)

25
Q

Typical Antipsychotics – Side Effects

A
  • Drowsiness, anticholinergic effects
  • Extrapyramidal symptoms (Parkinson’s like symptoms)
  • Tremors, rigidity, pill rolling, shuffling gait, restlessness (akathisia)
  • Treatment: Benztropine (Cogentin)

•Tardive Dyskinesia

  • Tongue movements, foot tapping, shoulder shrugging
  • Treatment: Stop the drug

•Neuroleptic Malignant Syndrome (NMS)

  • High fever, ↑↑ CPK, muscle rigidity
  • Life threatening!!!
  • Treatment: Stop the drug; Call the physician; Supportive therapy
26
Q

Antipsychotics – Second Generation (Atypical)

meds

A
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
27
Q

Antipsychotics – Second Generation (Atypical)

actions

A

Actions: Blocking serotonin and lesser degree dopamine, they also block norepinephrine, histamine, and acetylcholine.

28
Q

Antipsychotics – Second Generation (Atypical)

uses

A

Uses: Negative and positive symptoms of schizophrenia spectrum disorders, psychosis induced by levodopa therapy, a relief of psychotic manifestations in other disorders such as bipolar.

29
Q

Antipsychotics – Second Generation (Atypical)

SE

A

Side Effects: Loss of glucose control, weight gain. Hypercholesterolemia and increased risk of hypertension and CV disease, anticholinergic effects, agitation, sedation, insomnia, Mild EPS tremor

30
Q

Antipsychotics Nursing Interventions

A
  • Monitor vital signs
  • Monitor client for “cheeking” medications
  • Give oral drugs with food or milk
  • Monitor for EPS, NMS, TD
  • Assess WBC with Clozaril
  • Warn client that drug may take 3 to 6 weeks to achieve effectiveness – watch for thoughts of suicide
  • Warn client not to combine drug with alcohol, narcotics, or other CNS depressants
  • Warn against sudden discontinuation of

antipsychotics to avoid sudden recurrence of psychotic symptoms

•

31
Q

Mood Stabilizer

A

•Lithium Carbonate – works in 7-14 days

•Action: preserves or increase the ability of brain structures involved in emotional regulation, prefrontal cortex, hippocampus and amygdala – protects. Reduces dopamine and glutamate but increases GABA

•Uses: Bipolar, alcoholism, bulimia, schizophrenia

  • Side effects: GI distress, fine hand tremors, polyuria, weight gain, hypothyroidism (long term), electrolyte imbalance and hypotension
  • Lithium toxicity > 1.5 (Normal range = 0.4 to 1.0 mEq/L)
  • Monitor: Diuretics, NSAIDS, Anticholinergics (Antihistamines, TCA) – urinary retention and polyuria, NA and CL. Encourage 2000-3000 ml fluids a day.
32
Q

Mood Stabilizer: Lithium Nursing Interventions

A
  • Monitor vital signs, sodium levels
  • Monitor for drug effectiveness, suicidal

tendencies

  • Monitor urine output, renal function tests
  • Encourage adequate fluid intake (1-2 L daily)
  • Take with food to decrease GI irritation
  • Monitor lithium levels every 1-2 months (0.5 to 1.5 mEq/L);

•Report Lithium Levels > 1.5

•Toxic side effects: persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmias, seizures

3. Nursing Pharmacology (22 decks)

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