Psychopharm Flashcards
What foods are high in serotonin
turkey tomatoes sunflower seeds avocados pineapples
When giving SSRI’s what bad reaction shoudl we monitor fo r
serotonin syndrom
What are the mani’s of serotonin syndrome
altered LOC sweating fever Tachycardia HTN hyperreflexia Diarrhea
Treatment for serotonin syn
Stop medication
Provide IV fluids
Cooling blankets
Antipyretics
What things increase risk of serotonin syn
MAOIs
TCA’s
St. Johns wort
What is a consideration for someone taking MAOIs and is starting SSRI’s or bupropion
discon the MAOI’s 14 days prior to starting the SSRI’s or bupropion
What medication do SSRI’s increase
warfarin
What medications increase SSRI levels
TCA’s
lithium
Do NSAIDS and anticoag’s taken with SSRI’s increasse risk fo bleeding
yes
What are TCA’s
tricyclic antidepressents
What do TCA’s do
inhbiit reuptake of serotonin and norepinephrine
sometimes blocks histamine and acetylcholine
What are some common side effects of TCA’s
anticholinergic effects like dry mouth photophobia blurred vision constipation
What are some serious side effects of TCA’s
cardia toxicity
What are some examples of TCA’s
amitriptyline
Amoxapine
What is a consideration with MAOI’s and TCA’s
severe HTN is a risk so dont take together
What medications are contraindicated with TCA’s
antihistamines opioids benzodiazepines alc MAOI's
What problems does TCA’s and opioids benzodiazepines alc cause
increased CNS depression
What do MAOI’s do
MAOIs increases the availability of norepinephrine dopamine, and serotonin
What foods should you avoid with MAOI’s and why
aged cheese red wine soy sauce salami bananas sauerkraut bec they have tyramine or tryptophan
What are some common side effects of MAOI’s
anticholinergic effects like dry mouth photophobia blurred vision constipation anx orthostatic hypotension
What is a serious side eff of MAOI’s
HTN crisis
What are some examples of MAOI’s
isocarboxzid
phenelzine
Tranylcypromine
What is a consideration with MAOI’s and antihypertensives
hypotension may develop
What should you do for MAOI and antihypertensive pats
monitor BP and notify MD of significant drop
What analgesic may cause hyperpyrexia when given with MAOIs
meperidine
What food may increase the risk of HTN with MAOI’s and why
caffeine and phenylethylamine
bec they cause vasoconstriction
What conditions is bupropion contraindicated
pregnancy seizure disorders MAOIs anorexia nervosa bulimia nervosa
What classes of meds are given as anti anx
benzodiazepines,
barbiturates,
beta-blockers
What are some common SE of anti anx meds
sedation
confusion
tolerance
What are some short acting benzodiasepine s
lorazepam
oxazepam
alprazolam
What are some long acting benzo’s
diazapam
chlordiazepoxide
What are some short acting barbiturates
methohexital
thiopentone
What are some long acting barb’s
phenobarbital
amobarbital
What are some common SE of mood stabilizers (antimanics)
sedation
WeightG
GI distress
thristiness
What are some serious SE of mood stabilizers
hepatotoxicity
What are some mood stabilizers
lithium
valporic acid
Carbamazepine
How long does lithium take to start workign
5-7 day s
What is the care for pats takign lithium
Get lab lev after 12hours of first dose - Hold until lab levels are confirmed
monitor for sign of toxiciity
labs ev 2-3 days for therapeutic levels
labs ev 1-3 months for maintenance level
monitor sodium levels and signs of dehydration
Dont skimp on dietary sodium
drink 6-8 glasses of water per day
use cautiously with heart and renal pats
What are the early signs of lithium tox (less than 1.5mEq/L)
dia
N/V
polyuria
mus weakness
What are some signs of lithium tox from 1.5 to 2 mEq’s
confusion
tremors
poor coordination
What are some signs of lithium tox from 2-2.5 mEq’s
extreme polyuria
tinnitus
seizure coma death
What is the therapeutic level of lithium
0.5-1.5
What is some teaching for lithium meds
category D preg risk
so no breast feeding when taking it
What is a consideration for starting carbamazepine
Monitor blood levels weekly for the first 8 weeks
What are some CNS stimulants
amphetamine
methylphenidate
What are antipsychotics used to treat
hallucinations nightmares delusions paranoia agitation alt ment stat
What are some SE of first gen or conventional antipsychotics
extrapyrimidal effects like
Dystonia- sudden mus spasms of the eyes back and neck
restlessness (akathesia)
parkinsons like problems liek pill rolliing tremors and shuffling gait
tardive dyskinesia: involuntary movements like lip smacking chewing tongue protrusion
What is usu given for dystonia from antipsycho’s
benadryl or benztropine
What is usu given for restlessness from antipsycho’s
lorazepam
When does dystonia, akathesia, and pseudoparkinsonism from antipsycho’s set in
4hrs for dystonia
4 weeks for pseudoparkisonisms
4 weeks akathesia
What is a common ending for 1st gen antipsychotics
azine
What type of med class is hadol and how strong is it
antipsychotic and its one of the strongest
Bec antipsychotics effect dopamine what hormone is affected and what are some conditions taht can result from this inference
prolactin doesnt get inhibited
galactorrhea and gynecomastia
What are some advantages of second gen antipsycho’s
High tolerability rate Reduction of negative symptoms Lower rate of relapse Improve cognition with schizophrenia Decrease suicidal thoughts Decrease anxiety and depression less chance of ExtraPyr SE doesnt cause galactorrhea
What are some disadvantages of second gen antipsycho’s
Metabolic dysregulation leading to diabetes
High cholesterol and cardiac disease
Hypertension
Low self image
What might be given prophylactically with pats who are receiving second gen antipsycho’s
metformin
Why is low self esteem a problem with 2nd gen antipsychs and what do we educate for it
weight gain is common
exercise
What are some common SE of second gen antipsycho’s
Weight G
sedation
hypersalivation
anticholernegic effects
What are some serios SE of 2nd gen antipsych
neuroleptic malignant syndrome
sudden death from QT prologation from ziprasidone quetiapine
What are some 2nd gen antipsych
clozapine
risperidone
quetiapine
What type of patient is clozapine helpful
suidcidal schizophrenia pats
What 2nd gen antipsych still has the risk of increased prolactin
risperidone
ziprasidone
What med is given to treat pseudoparkinsonism
amantadine
What med might be given to counteract the low dopamine levels from first gen antipsychs
levodopa
mani’s of neuroleptic malignant syndrome
fever >103 HTN tachycardia mus rigidity elevated Creatine Kinase (CK) and WBC levels
What are the mani’s of serotonin syndrom e
fever HTN tachycardia hyper reflexia diarrhea
What is the treatment for NMS
discon the med
mon vital signs
meds for fever
transfer to ICU
What is the fisrt choice med for NMS and why
bromocryptine
bec it reduces fever and hypertonia
What med is given to reduce muscle breakdown in NMS pats
dantrolene
What is a consideration for a NMS pat that was taking decanoate
they may be in recovery for 7-10 days
What are the meds for tardive dyskinesia
none so far so advocate for less meds
What are some side effects of anticonvulsants
NV
drowsiness or dizziness
blood problems
risk of suicide
