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Psychopharmacology Flashcards

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1
Q

Components of CNS

A 
brain and spinal cord
cerebrum
cerebellum
brain stem
limbic system
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2
Q

Cerebrum

A

cerebral hemispheres

  • frontal
  • temporal
  • parietal
  • occipital
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3
Q

Frontal Lobe

A

Prefrontal cortex (PFC)
“executive center”
-regulation of attention, behavior, and emotion, decision making
-cognition, perception, affect, behavior (predominant dysfunction in the PFC w/ schizophrenia)
-inattention, impulsivity, motor hyperactivity (weaker function and structure of PFC w/ ADHD)

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4
Q

Temporal Lobe

A

center for sense of smell and hearing

deficits of auditory processing (w/ schizophrenia)

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5
Q

Occipital Lobe

A

language generation
visual interpretation (depth perception)
memory processing

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6
Q

Parietal Lobe

A

interpret sensations of taste and touch

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7
Q

Cerebellum

A

coordination of movements

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8
Q

Limbic System

A

includes: thalamus, hypothalamus, hippocampus, and amygdala

emotional regulation

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9
Q

Neurobiologic Causes of Mental Illness

A
  • genetics
  • stress and the immune system (inflammatory response)
  • infection (viral theories and schizophrenia)

chemical imbalance

  • serotonin and depression
  • dopamine and schizophrenia
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10
Q

Neurotransmitters

A 
dopamine
serotonin
norepinephrine
epinephrine 
histamine
acetylcholine
glutamate
GABA
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11
Q

Serotonin

A

derived from: tryptophan

involved in: control of food intake, sleep and wakefulness, temperature regulation, pain control, sexual behavior, and regulation of emotions

role in: anxiety, schizophrenia, and mood disorders

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12
Q

SSRI

A

selective serotonin reuptake inhibitors

block the reuptake of serotonin from the synaptic cleft, and thus this NT stays longer in the gap than normal > increase in serotonergic activity

hallmark med = fluoxetine (Prozac)

equally as efficacious as TCAs, but w/ fewer SEs

takes 4-6wks to see full therapeutic effect

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13
Q

Dopamine

A

involved in: control of complex movements, motivation, cognition, regulation of emotional responses

antipsychotics block dopamine receptors > reduce dopamine activity

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14
Q

Histamine

A

function: chemical messenger responsible for allergic response, control of gastric secretions, cardiac stimulations, alertness
implications: schizophrenia, sleep disorders, Alzheimer’s

psychiatric medications (diphenhydramine, hydroxyzine, Doxepin, amitriptyline (TCA), antipsychotics) block histamine and result in:
-weight gain, sedation, hypotension, constipation, cognitive
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15
Q

Acetylcholine

A
  • controls sleep and wakefulness

- implications in Alzheimer’s disease

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16
Q

Glutamate

A

workin in an excitatory capacity in the brain

major mediator of cognition, memory, and learning

implication in Alzheimer’s

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17
Q

GABA (Gamma-aminobutyric acid)

A

involved in the inhibition of vigilance, anxiety, muscle tension and memory enhancement

implication: anxiety, sleep
* benzodiazepines: increase GABA function and induce sleep

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18
Q

Norepinephrine/Epinephrine

A

attention, learning, memory, sleep, wakefulness

implications: mood, person’s ability to concentrate, anxiety

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19
Q

Brain Imaging

A

Computed tomography (CT) - radiation

Magnetic resonance imaging (MRI) - risk from magnetic field

Positron emission tomography (PET) - radiation

Single-photon emission computed tomography (SECT) - radiation

  • brain imagining alone cannot be used to dx a mental health condition
  • used to r/o another medical condition
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20
Q

Psychopharmacology Med Classes

A 
Antipsychotics
Antidepressants
Mood stabilizers
Anxiolytics
Simulants
Medications for substance use disorders
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21
Q

Efficacy

A

maximal therapeutic effect that a drug can achieve

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22
Q

Potency

A

amount of drug needed to achieve maximum effect

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23
Q

Half-life

A

amount of time for half of the drug to be removed from the bloodstream

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24
Q

Off label use

A

use of a drug for a condition not approved by the FDA

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25
Q

Black box warning

A

separate warning which contains serious or life-threatening side effects

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26
Q

Discontinuation withdrawal

A

many medications need to be tapered before stopped (shorter half life might need to give more often)

27
Q

Antipsychotics: Use

A
  • psychosis (positive symptoms)
  • mood stabilization

off label: anxiety, insomnia, aggressive behavior

28
Q

Antipsychotic Meds

A

first generation (older, more associated w/ TD and EPS SEs)

  • chlorpromazine (Thorazine)
  • perphenazine (Trilafon)
  • fluphenazine (Prolixin)*
  • haloperidol (Haldol)*

second generation: have more metabolic SEs

  • clozapine (Clozaril)
  • risperidone (risperdal)*
  • olanzapine (Zyprexa)*
  • quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Paliperidone (Invega)*
  • Iloperidone (Fanapt)
  • asenapine (Saphris)
  • lurasidone (Latuda)

second generation meds that can used for mood disorder like bipolar depression:
-aripiprazole (Abilify)*

*available as depot

29
Q

Depot Injection

A

long acting injectables (LAI)

six antipsychotic meds are available as depot

30
Q

Antipsychotics: Black Box Warnings

A

elderly patients with dementia related psychosis: increased mortality risk w/ conventional (first generation) or atypical antipsychotics

most deaths d/t cardiovascular or infectious events

31
Q

EPS

A

Dystonia: seen in the neck, emergency, give IM benztropine

Drug-induced parkinsonism: tremors, shuffling gait, flat affect/ mask like face, slower movements in general

Akathisia: restlessness, can’t sit, pt will report this subjectively as well

TD: oral/facial movements (tongue protruding)
-in assessment of this ensure they do not have denture or gum and then distract them by having them touch their thumb to each finger.

*EPS is assessed via AIMS exam

32
Q

Medications Used to Treat EPS

A

benztropine (2-8mg per day)

benadryl

33
Q

NMS

A

neuroleptic malignant syndrome

infrequent/rare

potentially life-threatening condition

s/sx:

  • fever
  • rigid muscles
  • altered consciousness
34
Q

SE of Antipsychotics

A
  • EPS
  • TD
  • elevated prolactin > breast enlargement or tenderness (can happen in men) and decreased libido
  • common w/ risperidone (Risperdal)
  • weight gain
  • most significant w/ clozaril and olanzapine
35
Q

Clozaril: SE

A
  • wide Qtc (at risk for dysrhytmias)
  • weight gain (metabolic syndrome)
  • lower seizure threshold
  • agranulocytosis! (look at ANC values)
  • myocarditis (at onset of tx)
  • constipation!
  • low risk for EPS

baseline EKG before initiating tx

used when failed 4-6wk trial of two different antipsychotics at max dose

36
Q

Antidepressants: Uses

A

depression, anxiety, OCD

off label uses: chronic pain, migraines

37
Q

Antidepressants: Types

A
  1. Tricyclic
    - SE: sedation, orthostatic HTN, anticholinergic
  2. SSRI
  3. MAOIs
    - SE: hypertensive crisis w/ foods containing tyramines, many drug interactions
  4. Other antidepressants
38
Q

TCA

A
  • desipramine (Norpramin): used for children w/ bedwetting issues
  • amitriptyline (Elavil)
  • nortriptyline (Pamelor)
  • Doxepin
  • Mirtaxapine
  • Clomipramine: more efficacious w/ treating OCD
39
Q

MAOIs

A

Monoamine Oxidase Inhibitors
-phenelzine (Nardil)

potentially life-threatening hypertensive crisis w/ foods containing tyramine

40
Q

Other Antidepressants

A
  • bupropion (Wellbutrin)
  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine
  • Trazodone (Nefazodone - avoided b/c of life-threatening liver damage that can occur)
  • Vilazodone
41
Q

SSRI/SNRI: SE

A
  • GI upset at onset of tx
  • Sexual SE (anorgasmia, impotence, decreased libido)
  • sleep disturbances (take in morning to reduce this)
  • weight gain
  • akathisia
  • sweating
  • paroxetine (more sedation)
  • withdrawal syndrome
  • monitor for increases in BP
42
Q

TCA: SE

A

anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation, tachycardia

cholinergic blockade and cardiac toxicity in overdose situations

drug levels can be obtained

don’t give to someone who is high risk for suicide unless safety measures can be ensured (like handing them out daily to them)

43
Q

Bupropion

A

Wellbutrin

  • inhibit dopamin uptake
  • aid to quit smoking
  • used for depression and ADHD
  • sex and drug
  • weight loss
  • SEIZURE RISK (don’t use w/ seizure hx/ eating disorder)
44
Q

Trazodone

A

sleep

priapism

45
Q

Serotonin Syndrome: S/Sx

A

in order of appearance:

  • diarrhea
  • restlessness
  • extreme agitation
  • hyperreflexia
  • autonomic instability
  • myoclonus
  • seizures
  • rigidity
  • delirium, coma, death
46
Q

Antidepressants: Black Box Warning

A

increased risk for suicidality in children, adolescents, and young adults w/ MDD or other psychiatric disorders

  • observe all pt’s clinical worsening, sucidality, or unusual behavior changes
  • may advise families or caregivers to closely observe and communicate w/ the prescriber as needed
47
Q

Mood Stabilizers

A

used in tx of bipolar disorder

  • lithium
  • valproic acid
  • gabapentin (used for neuropathic pain, anxiety, adjunct in opioid and alcohol withdrawal)
  • carbamazepine (Tegratol)
  • Topiramate
  • Oxcarbamazepine (Trileptal)
  • lamotrigine
  • drug levels are important w/ mood stabilizers
  • can get 12 hours after last dose
48
Q

Lithium

A

-gold standard
-suicide protective
-serum levels needed
monitor renal and thyroid function (hypothyroid)
-avoid use of NSAIDs to prevent toxic accumulation

black box warning: NARROW THERAPEUTIC RANGE (0.8-1.2)

49
Q

Lithium: SEs

A 
tremor
polydipsia
metallic taste
fatigue
acne
alopecia
worsens psoriasis
toxic effects:
severe diarrhea
vomiting
drowsiness
muscle weakness
lack of coordination
ataxia
50
Q

Carbamazepine: SEs

A
  • interferes w/ birth control
  • hyponatremia
  • check LFT’s
  • sedation
  • teratogenesis (risk to developing fetus so this med might be avoided in women of child bearing age)
  • grapefruit juice = inhibitory > increase in blood levels

black box warning: aplastic anemia, agranulocytosis

51
Q

Lamotrigine

A

black box warning: steven’s Johnson’s rash

pt education

start low and go slow w/ dosing

52
Q

Valproic Acid: SE

A

can obtain level

black box warning: hepatotoxicity (check liver fxn), congenital malformations (caution in use w/ females or reproductive age), pancreatitis

most sedating so person might take at bedtime

bone marrow suppression (check CBC)

53
Q

Topiramate: SE

A

weight loss
dizziness
sedation
increased risk for renal calculi

54
Q

Anxiolytics

A

uses: pain, OCD, social anxiety, GAD

benzodiazepines:
- alprazolam
- chlordiazepoxide
- clonazepam
- diazepam (long half-life, used for alcohol withdrawal)
- oxazepam
- lorazepam

non-benzodiazepines:

  • buspirone
  • beta blockers
  • centrally acting alpha blockers
  • anticonvuslants
55
Q

Benzodiazepines: SEs

A
  • CNS depression (sedation, ataxia, decreased cognitive function)
  • risk of combination of CNS depressants
  • potentiation of the effects of alcohol
  • special considerations in the elderly
  • withdrawal secondary to dependency (potentially lethal - seizure, DTs)
  • pregnancy category D
  • controlled substance
  • lorazepam used for alcohol WD in pts with liver dysfunction b/c no active metabolites
56
Q

Zolpidem

A

benzo like med used for sleep

black box warning: sleep walking, sleep-driving, engagement in activities while not fully awake

57
Q

Stimulants

A

use: ADHD, narcolepsy

methylphenidate (Concerta)
amphetamine
dextroamphetamine

nursing interventions:

  • give early in the day (no later than 1600)
  • monitor weight
  • caffeine use
  • monitor for tics
58
Q

Other ADHD Medications

A
  • bupropion
  • atomoxetine (SNRI - FDA approved for ADHD)
  • black box warning: increased risk for suicidality in children/adolescents w/ ADHD
  • guanefacine
59
Q

Stimulants: SE

A
  • anorexia
  • weight loss
  • nausea
  • irritability

-precautions: psychosis, severe anxiety, cardiovascular hx, substance use

60
Q

Medications for Alcohol Use

A

Disulfiram - aversion therapy (prevent)
*works by making pt violently ill when they drink alcohol

Naltrexone - craving

Acamprosate - reduction in withdrawal symptoms

61
Q

Medications for Opioid use Disorder

A

buprenophine - agonist/antagonist

methadone - agonist

naltrexone - antagonist

62
Q

Medications for Tobacco Use Disorder

A

bupropion (branded as Zyban) - attenuating the effects of nicotine withdrawal

NRT

Varenicline:

  • nicotine receptor agonist > promotes release of dopamine to stimulate the pleasurable effects of nicotine
  • reduces craving and withdrawal
  • don’t give with NRT
63
Q

Medications for Stimulant Use Disorder

A

no FDA approved meds for stimulant use disorder

Psych (18 decks)

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