Psychopharm Flashcards
2 bad things about amphetamines
Addictive, toxicity
Whatbis important for the nurse to assess related to psychomedications?
List of the meds they are taking including prescribed OTC, herbal, and their allergies
What is important after giving the medication?
Monitor side effects and adverse reactions, evaluate effectiveness
What is some pt education you should do when giving pt drugs?
- Why when and how the med should be taken
- Who and when to contact with questions
- Expected side effects/adverse reactions
What are some examples of neurotransmitters?
Epinephrine, dopamine, serotonin
Whatbare antianxiety agents also called?
Anxiolytics (minor tranquilizers)
What are anxiolytics used for?
Acute anxiety states (not long term)
Depress CNS
All anxiolytics depress the CNS except for?
Buspirone!
What is the most commonly prescribed anxiolytic class?
Benzodiazepines
Can anxiolytics/CNS depressants be taken with another CNS depressant?
No, take them by themselves
What to avoid when taking anxiolytics?
Alcohol, caffeine, opioid/cough meds, herbal depressants
What to do if pt becomes confused while taking anxiolytics?
Stop the med, taper off
Alprazolam (Xanax) class
Antianxiety
Clonazepam (Klonopin) class
Antianxiety
Diazepam (Valium) class
Antianxiety
Lorazepam (Ativan) class
Antianxiety
Oxazepam (Serax) class
Antianxiety
Midazolam (Versed) class
Antianxiety
SE of antianxiety meds
Orthostatic hypotension
drowsiness
dry mouth
paradoxical excitement (opposite of what we want)
blood dyscrasias (easy bruising, sore throat, fever)
How long can antianxiety meds be used for?
About 4 months
After 4 months need to look at meds for long term use
Is buspirone (Buspar) a benzodiazepine?
No
What is one uses of benzodiazepines?
Depress the CNS
Does buspirone depress the CNS?
No
How long should you take buspirone?
7-10 days to see improvement
3-4 weeks to reach the optimal level
Does buspirone have addiction potential?
No
What to avoid when taking buspirone?
Alcohol, CNS depressants, grapefruit juice
Pt education for antianxiety meds
- Do NOT stop abruptly, taper off slowly for 2-6 weeks
- Avoid alcohol, caffeine, smoking, and other CNS depressants
- Take with food/milk
- Avoid herbals (kava, valerian, melatonin, chamomile)
Buproprion (Welbutrin) class
Atypical antidepressants
What do atypical antidepressants treat?
Schizophrenia or bipolar
Antidepressants action
Increase concentration of norepinephrine, serotonin, and dopamine by blocking reuptake, inhibit the release of monoamine oxidase (MAO)
What class of antidepressants have the least side effects?
SSRIs
What do you need to avoid when taking SSRIs?
Alcohol and other CNS depressants
How long does it take for SSRIs side effects to decrease?
2-4 weeks
What do you need to monitor for pt that are taking SSRIs?
Suicidal ideation
Fluoxetine (Prozac) class
SSRIs
Sertraline (Zoloft) class
SSRIs
Paroxetine (Paxil) class
SSRIs
Citalopram (Celexa) class
SSRIs
Escatilopram (Lexapro) class
SSRIs
What adverse reaction will occur when taking SSRI with buspirone/TCAs/st John’s wort/selegiline?
Serotonin syndrome
Serotonin syndrome s/s
Diarrhea, restlessness, agitation, vital fluctuation
Late s/s: seizures, hyperthermia, uncontrolled shivering, myoclonus (involuntary muscle contraction throughout the body)
What is myoclonus?
Involuntary muscle contraction throughout body
What adverse reaction happens when taking SSRI with MAOIs?
Hypertensive crisis
Venlafaxine (Effexor) class
SNRIs
Duloxetine (Cymbalta) class
SNRIs
Desvenlafaxine (Pristiq) class
SNRIs
Side effects of SNRIs other than the common ones
Hypertension, suicidal ideation, SJS
what do TCAs do?
Block uptake of norepinephrine and serotonin in the brain, elevate mood, increase ADLs
Amitriptylline (Elavil) class
TCA
Imipramine (Tofranil) class
TCA
Trimipramine (Surmontil) class
TCA
Despiramine (Norpramin) class
TCA
Protriptyline (Vivactil) class
TCA
What are TCAs used for?
OCD, panic attacks, major depression
What are some side effects of TCAs?
Photosensitivity
Orthostatic hypotension
Blurred vision
Constipation
Sexual dysfunction
Suicidal ideation
Weight gain
What can you do if your pt is on TCAs but has been trying hard to lose weight for the last several weeks?
Educate them so they know they will not be able to lose weight while taking TCAs
We can ask the doctor for another antidepressant if pt is really trying to lose weight!
What is the first antidepressants ever made?
MAOIs
What do MAOIs do?
Increase norepinephrine, epinephrine, dopamine, and serotonin
Tranylcypromine sulfate (Parnate) class
MAOI
Isocarboxazid (Marplan) class
MAOI
Selegiline (Emsam) class
MAOI
Phnelzine Sulfate (Nardil) class
MAOI
What do pt need to avoid while taking MAOIs?
Foods that are high in tyramine
Side effects of MAOIs
Orthostatic hyper!tension! Hypertensive crisis (>180/120, can lead to heart attack, stroke, and death)
Anticholinergic effects (dryyyyyy)
If opioid overdose happens, what can be administered?
Naloxone (Narcan)
what are 2 adverse reactions of antidepressants?
Serotonin syndrome
Neuroleptic malignant syndrome
Common side effects of antidepressants
Dry mouth, sedation, nausea, sexual dysfunction
Neuroleptic malignant syndrome s/s
Seizure, altered mental status, muscle rigidity, sudden high fever, bp fluctuations, high hr, dysrhythmias, rhabdomyolysis, acute renal failure, resp failure, coma
What to do when neuroleptic malignant syndrome occur?
Stop the antipsychotic!
Hydration, hypothermic blankets, antipyretics
Benzodiazepines, muscle relaxants
What do bipolar mania have?
Cycles of low (depression) and high (manic)
Lithium carbonate class
Mood stabilizers
What is lithium’s narrow therapeutic range?
0.6-1.2
What electrolyte does your body need while taking lithium?
Sodium!
What happens when your sodium is low while taking lithium?
Higher risk for lithium toxicity
What drug to avoid while taking lithium?
NSAIDs (ibuprofen, neproxen, aspirin) b/c lithium toxicity
Carbamazepine (Tegretol) class
Mood stabilizer
Divalproex (Depakote) class
Mood stabilizer
Lamotrigine (Lamictal)
Mood stabilizer
Ziprasidone (Geodon) class
Mood stabilizer
Aripiprazole (Abilify) class
Mood stabilizer
Side effects of mood stabilizers
Drowsiness, dizziness, nausea, vomiting, headache, dry mouth, weight loss/gain
What are antipsychotic agents also called?
Neuroleptics
A bad adverse reaction with certain antipsychotics
Agranulocytosis
What are some s/s of DRESS?
Rash, fever, swollen lymph nodes
Hormonal side effects of antipsychotics
Galactorrhea (having milk while not pregnant)
Amenoria (no periods)
Gynecomastia (male breast dev)
Olanzapine (Zyprexa) class
Antipsychotics
Quetiapine (Seroquel) class
Antipsychotics
Risperidone (Risperdal) class
Antipsychotics
Haloperidol (Haldol) class
Antipsychotics
Side effects of antipsychotics
Constipation, NVD, dry mouth, insomnia, sedation, sexual dysfunction, weight gain
Whatbisnextra pyramids symptoms (EPS)?
A side effect of antipsychotics
What symptoms do EPS include?
Pseudoparkinsonism (drooling, tremors, shuffling gait)
Tardive dyskinesia (ex: involuntarily chewing motion)
Dystonia(uncontrolled muscle contraction)
Akinesia(loss of ability to move muscles)
Akathisia(muscle restlessness)
What can the nurse do when EPS occurs?
Can change meds or treat EPS
What can you use to block pseudoparkinsonism and dystonia?
Use benztropine (Cogentin) to block the cholinergic activity.
Oral: onset 2-3 days
IM/IV: onset within minutes
What are sedative hypnotics used for?
Short term management of anxiety and insomnia
What does sedative hypnotics do?
Depress CNS
May produce tolerance or dependence except for Ramelteon (Rozerem) (not a controlled substance)
Contraindications of sedative hypnotics
Severe hepatic/cardiac/renal/resp disease or insufficiency
Children and older adults
What to avoid when taking sedative hypnotics?
Alcohol and other CNS depressants
What to do after giving ot sedative hypnotics?
Continuously monitor for abnormal thinking and behavior changes
Always look for black box warning
Butabarbital (Butisol) class
Sedative hypnotics
Phenobarbital (Sezaby) class
Sedative hypnotics
Temazepam (Restoril) class
Sedative hypnotics
Eszopiclone (Lunesta) class
Sedative hypnotics
Zolpidem (Ambien) class
Sedative hypnotics
What schedule of controlled substance is amphetamine?
2
What is the FDA approval video game for ADHD?
EndeavorRx
Amphetamine (Adderall) class
ADHD agents
Methylphenidate (Ritalin) class
ADHD agents
Atomoxetine (Strattera) class
ADHD agents
Lisdexamfetamine (Vyvanse) class
ADHD agents
When should pt take ADHD agents?
At night b/c they are sedative
When taking lithium, what needs to be done once a month?
Report for blood tests
Gabapentin (Neurontin) class
Mood stabilizer