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Psych Exam 1 > Psychopharm > Flashcards

Psychopharm Flashcards

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1
Q

Mental Health disorder symptoms are thought to occur because of…

A

changes in levels of neurotransmitters

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2
Q

The aim of medical treatment is to…

A

restore levels of neurotransmitters to a level at which patient no longer experiences symptoms

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3
Q

Antidepressants action

A

elevate serotonin and/or norepinephrine

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4
Q

Antidepressants indications

A
  • depression
  • anxiety disorders
  • OCD
  • PTSD
  • Panic disorder
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5
Q

SSRI’s

A

Selective Serotonin Re-uptake Inhibitors

fluoxetine
paroxetine
fluvoxamine
citalopram
sertraline
escitalopram   vilazodone
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6
Q

SSRI Side Effects

A
  • mild overall side effect profile
  • may report GI symptoms
  • change in appetite/weight loss
  • HA
  • sexual dysfunction
  • may give person enough energy to act on thought os suicide
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7
Q

Serious Side Effects of SSRIs

A

Serotonergic Syndrome

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8
Q

Serotonergic Syndrome

A
  • caused by mixing MAOIs and SSRIs
  • overdose of SSRIs
  • Taking two antidepressants at once
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9
Q

Symptoms of Serotonergic Syndrome

A
  • agitation
  • sweating
  • fever
  • rigidity
  • tachycardia
  • hypotension
  • hyperreflexia
  • extreme conditions=coma/death
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10
Q

SNRIs

A
  • venlafaxine
  • desvenlafaxine
  • duloxetine
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11
Q

Other commonly used Antidepressants

A
  • bupropion (Wellbutrin)
  • mirtazapine (Remeron)
  • desyrel (Trazodone)
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12
Q

Tricyclic antidepressants

A

(TCA)

increase levels of serotonin and norepinephrine

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13
Q

TCAs

A

amitriptyline (Elavil)

imipramine (Tofranil)

doxepin (Sinequan)

desipramine (Norpramin)

nortriptyline (Pamelor)

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14
Q

Main Side effects of TCAs

A

*Anticholinergic

  • blurred vision
  • dry mouth
  • urinary hesitancy or retention
  • constipation
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15
Q

Other side effects of TCAs

A
  • orthostatic hypotension
  • EKG changes due to cardiotoxicity
  • sedation: due to blocking histamine
  • memory and concentration disturbances
  • HA
  • fatigue
  • impotence

**There is increased risk of fatal overdose with TCAs

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16
Q

MAOIs

A

Monoamine Oxidase Inhibitors

  • inhibit the breakdown of monoamines, specifically Serotonin and Norepinephrine by inhibiting the catabolic enzyme
  • also inhibits the metabolism of Tyramine (potent vasopressor
  • foods containing Tyramine may stimulate hypertensive events, possibly hypertensive crisis
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17
Q

MAOI names

A
  • isocarboxazid
  • phenelzine
  • tranylcypromine
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18
Q

Restricted Foods

A
  • aged cheeses
  • aged and cured meats
  • dried or pickled fish
  • liver
  • bananas
  • broad bean pods
  • sauerkraut
  • soy sauce and other soy condiments
  • draft beer
  • vitamins with Brewer’s yeast
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19
Q

Consume in Moderation

A
  • red or white wine
  • bottled or canned beer
  • chocolate
  • yogurt
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20
Q

Antipsychotics indication

A

treatment of acute and chronic psychosis

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21
Q

Antipsychotics action

A

dopamine antagonist

-blocks dopamine

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22
Q

Commonly Used Antipsychotics Atypicals

A
  • clozapine
  • risperidone
  • olanzapine
  • quetiapine
  • ziprasidone
  • aripiprazole
  • lurasidone
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23
Q

Atypical/SGA: Clozaril

A
  • most effective for + and - sx’s
  • first a typical–very effective but some serious adverse rxns
  • bone marrow suppression–can cause leukopenia–need weekly CBC with Diff q week for 1st 6 months–then q2wks
  • increased risk of Szs
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24
Q

Interdisciplinary collaboration

A
  • clozapine monitoring
  • physician enrolls patient in registry, orders lab work (weekly WBC/ANC)
  • nurse faxes lab work to pharmacy/physician as needed, monitors for symptoms of immunosuppression and delivers med
  • pharmacist does not dispense med until new lab values are rec’d
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25
Q

SE for Clozaril & Zyprexa

A
  • sedation
  • constipation
  • orthostasis
  • low EPS
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26
Q

Zyprexa may cause…

A

appetite increase and is contraindicated with DM

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27
Q

Risperdal

A
  • sedation
  • orthostasis
  • moderate EPS
  • anticholinergic–low
  • can cause elevated Prolactin levels
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28
Q

Seroquel

A
  • orthostasis
  • somnolence
  • wt gain
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29
Q

Geodon

A

nausea

-somnolence

30
Q

Abilify

A

nausea

  • HA
  • somnolence/insomnia
31
Q

Typical antipsychotics

A

first generation antipsychotics

  • effective only for POSITIVE sx’s of schizophrenia
  • may mask or worsen NEGATIVE Sx’s
  • classified as to potency (low, mid, high)
32
Q

Commonly Used Typical Antpsychotics

A
  • haloperidol
  • fluphenazine
  • trifluoperazine
  • thiothixene
  • loxapine
  • perphenazine
  • thioridazine
  • chlorpromazine
33
Q

Side effects of typical antipsychotics

A

Anticholinergic

34
Q

General side effects of typical antipsychotics

A
  • sedation (low)
  • postural hypotension (low)
  • dizzy (low)
  • lightheadedness (low)
  • decreased sweating
  • potentiation of CNS depressants
35
Q

Extrapyramidal Side Effects

A
  • akathisia
  • dystonias (cogwheeling test) (high)
  • Parkinsonian Sx’s
36
Q

Parkinson-like sx’s

A
  • blunted affect
  • mask-like expression
  • tremor
  • shuffling gait
37
Q

Tardive Dyskinesia

A
  • may be irreversible, may be prevented by use of low doses
  • vitamin E, valproate, clonidine, clozapine, cholinergic drugs

gabaminergic drugs may be useful in treating

  • discontinuation of the drug may lessen or reverse
  • AIMS test (standardized exam)
38
Q

NMS

A

Neuroleptic Malignant Syndrome

  • idiosyncratic rxn to an antipsychotic drug
  • potentially fatal
  • all psychotropics seem to have the potential to cause NMS
  • high dosages of high potency antipsychotic drugs have increased risk
  • poor nutrition, dehydration, and concurrent medical illness
39
Q

Major symptom of NMS

A
  • rigidity
  • high fever
  • elevated level of enzymes (particularly CPK)
  • diaphoresis
  • pallor
  • delirium
  • autonomic instability (such as unstable BP)
40
Q

Tx of NMS

A
  • immediate discontinuation of all antipsychotic meds

- supportive medical care–rehydration and hypothermic measures

41
Q

Depot Therapy

A
  • Haldol and Prolixin (Decanoate)
  • Risperdal now available
  • long half life (they are active for 2-4 weeks due to slow release from muscle tissue
  • called depot due to cyclical nature of tx
42
Q

Medications used for EPS/Acute Dystonia

A
  • Benztropine
  • Diphenhydramine
  • Lorazepam
43
Q

Antimanics

A

mood stabilizers

-indicated for bipolar 1 (chronic manic episodes)

44
Q

Lithium action

A

stabilizes the activity of electrolytes at the cell membrane and reduces cell excitability

45
Q

Lithium indication

A
  • prevention of manic episodes
  • for many years, drug of choice–very safe
  • eliminated by the kidneys in original form
  • need to ensure good kidney fx
46
Q

Need for lithium and sodium balance

A
  • lithium has a chemical structure that is similar to sodium
  • may compete at some sites
  • if sodium intake is decreased, lithium is reabsorbed by the kidneys
  • this leads to an increased risk of lithium toxicity
47
Q

Lithium can be…

A

nephrotoxic/thyrotoxic

48
Q

Need to monitor what with lithium

A

serum levels as well as periodic kidney/thyroid studies

49
Q

Therapeutic Window for lithium

A

Narrow therapeutic window

0.5-1.5 mEq/L

50
Q

Expected Side effects of Lithium

A
  • tremors
  • polydipsia
  • polyuria
  • dry mouth
  • GI upset
  • pulse irregularities
  • wt gain
51
Q

ADRs of Lithium

A
  • electrolyte imbalance
  • sodium balance important
  • S/E’s worsen as level rises
  • more severe sx’s usually correlated to levels from 2-3 mEq/L
52
Q

Lithium toxicity

A
  • vomiting
  • diarrhea
  • lethargy
  • ataxia
  • slurred speech
  • blurred vision
  • confusion
  • sz
  • coma
  • death
53
Q

Atypical Antipsychotics

A

indicated for bipolar 1

(acute manic episodes)

  • aripiprazole
  • olanzapine
  • quetiapine
  • risperidone
  • ziprasidone
54
Q

Anticonvulsants

A

These anticonvulsants have shown varied levels of effectiveness in management of bipolar illness and some are indicated for acute manic episodes as well as maintenance therapy.

55
Q

Anticonvulsants may raise…

A

the threshold at which neurobiological messages can trigger mood changes

56
Q

_______ and _________ required periodic serum levels

A

valproic acid and cabemazepine

-both have undesirable side effects and idiosyncrasies

57
Q

Anxiolytics

A

antianxiety agents

58
Q

Primary class anxiolytics

A

benzos

59
Q

benzo’s action

A

inhibit CNS excitability by binding to the benzo-GABA-chlorider receptor complex

-enhance the activity of GABA at the GABAa receptor

60
Q

Benzo indications

A
  • anxiety
  • agitation
  • insomnia
  • tension
  • panic disorder
  • agoraphobia
  • Szs
  • muscle spasms
  • dystonias
  • restless leg syndrome
61
Q

Benzo names

A
  • lorazepam/Ativan
  • alprazolam/Xanax
  • clonazepam/Klonopin
  • chloridiazepoxide/Librium
  • diazepam/Valium
62
Q

Benzo side effects

A
  • drowsy
  • fatigue
  • decreased concentration
  • confusion
  • disorientation
  • decreased coordination
63
Q

Major drawback to Benzos

A
  • tolerance and dependence
  • serious W/D complications
  • recommended for short term use only
64
Q

Benzo has synergistic effects when combined with….

A

ETOH

65
Q

Benzos not to be used for…

A

sleep apnea; use cautiously in COPD due to depression of the respiratory center of the brain

66
Q

buspirone

A

for anxiety

  • works on serotonin
  • also NE and DA
  • takes up to four weeks to reach effectiveness (no good for prn use)
67
Q

hydroxyzine

A

short term anxiety treatment

68
Q

propranolol

A

used sometimes for performance anxiety

stage fright

69
Q

Anti-aggression agents

A
  • antianxiety
  • antipsychotic
  • tegretol
  • lithium
  • beta blockers
70
Q

Augmentation

A

variety of meds can be used along with the primary pharmacological agent that may serve to boost its effect

commonly used: lithium, antianxiety, desyrel, antipsychotic, anticonvulsants

71
Q

Patient Education: Depression

A
  • take daily
  • 2-4 weeks to see noticeable effect
  • continue to take even after you feel better
  • do not stop without checking with HCP
  • contact HCP when questions arise
72
Q

Preventing noncompliance: schizophrenia

A
  • discuss adherence in nonthreatening nonjudgmental way
  • remember persuasion is better than coercion
  • focus on any possible day to day benefit of the drug
  • match idea of taking drug with achieving life goals

Psych Exam 1 (5 decks)

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