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PsychoPharmacology Flashcards

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1
Q

CLASSES OF PSYCHOACTIVE DRUGS

A
  1. antidepressants
  2. antipsychotics
  3. antiparkinsonian
  4. antianxiety
  5. antimanics (mood stabilizers)
  6. CNS stimulants
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2
Q

ANTIDEPRESSANTS ACTION

A

elevate serotonin and or norepinephrine levels

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3
Q

ANTIDEPRESSANTS INDICATIONS

A
  • DEPRESSION
  • ANXIETY DISORDERS
  • OCD
  • PTSD
  • PANIC DISORDER
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4
Q

SELECTIVE SEROTOINI RE-UPTAKE INHIBITORS (SSRI) ANTIDEPRESSANTS

A
  • fluoxetine (Prozac)
  • paroxetine
  • citalopram (celexa)
  • sertraline(Zoloft)
  • escitalopram (Lexapro)
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5
Q

SSRI SIDE EFFECTS

A
  • may report GI symptoms
  • change in appetitie /weight loss
  • headache
  • sexual dysfunction

may give person enough energy to act on thoughts of suicide

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6
Q

SERIOUS SIDE EFFECTS OF SSRI

A

-serotogenic syndrome caused by:
mixing MAOI’s and SSRI’s
overdose of SSRI’s
taking two antidepressants at once

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7
Q

SYMPTOMS OF SEROTONERGIC SYNDROME

A 
agitation 
sweating 
fever
rigidity 
tachycardia
hypotension 
hyperreflexia
in extreme conditions coma/death
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8
Q

SEROTONIN AND NOREPINEPHRINE RE-UPTAKE INHIBITORS SNRI’S

A

VENLAFAXINE (EFFEXOR) - WATCH BP
DESVENLAFAXINE
DULOXETINE (CYMBALTA)

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9
Q

TRICYCLIC ANTIDEPRESSANTS

A

-increase levels of serotonin and norepinephrine

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10
Q

NAMES OF TRICYCLIC ANTIDEPRESSANTS

A 
amitriptyline 
imipramine
doxepin 
desipramine
nortriptyline
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11
Q

TRICYCLIC Antidepressants side effects

A

-blurred vision
-dry mouth
constipation
urinary retention

-ORTHOSTATIC HYPOTENSION
-EKG CHANGES DUE TO TOXICITY
SEDATION DUE TO HISTAMINE RECEPTOR
-MEMORY AND CONCENTRATION DISTURBANCES
- HEADACHES
-FATIGUE
- IMPOTENCE

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12
Q

MONOAMINE OXIDASE INHIBITORS MOAI’S

A
  • 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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13
Q

MAO INHIBITORS

A
  • tranylcypromine
  • pheneizine
  • isocarboxzid
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14
Q

RESTRICTED FOODS for MAOI

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 yeast
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15
Q

ANTIPSYCHOTICS INDICATION AND ACTION

A

indication - treatment of acute and chronic psychosis

action - dopamine antagonist , blocks dopamine

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16
Q

ATYPICAL ANTIPSYCHOTICS

A

now also known as second generation antipsychotics

most often prescribed currently due to side effect profile

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17
Q

COMMONLY USED ANTIPSYCHOTICS ATYPICALS (Second generation)

A 
clozapine
risperidone
olanzapine 
quetiapine
ziprasidone
aripiprazole
lurasidone
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18
Q

ATYPICAL/SGA

A
  • aruguably the most effective for positive and negative symptoms
  • first atypical very effective but some serious adverse reactions
  • bone marrow suppression can cause leukopenia need weekly CBC with Diff every week for 1st 6months then every 2 weeks
  • increased risk of seizures
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19
Q

ATYPICAL/SGA

A
  • aruguably the most effective for positive and negative symptoms
  • first atypical very effective but some serious adverse reactions
  • bone marrow suppression can cause leukopenia need weekly CBC with Diff every week for 1st 6months then every 2 weeks
  • increased risk of seizures
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20
Q

INTERDICIPLINARY COLLABORATION

A
  • clozapine monitoring
  • physician enrolls patient in registry, orders lab work
  • nurse faxes lab work to pharmacy /physician as needed , monitors for symptoms of immunosuppression and delivers med
  • pharmacist does not dispense medication until new lab values are received
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21
Q

COMMON SIDE EFFECTS ATYPICALS/SGA

A

clozaril and zyprexa- sedation, constipation, orthostatis ,low EPS

zyprexa- may cause appetite increase and is contraindicated with diabetes

Risperdal- sedation, orthostasis moderate EPS, ANTICHOLENERGIC -LOW CAN CAUSE ELEVATED PROLACTIN LEVELS

aeroquel- orthostais , somnolence, wt gain

Geodon- nausea, somnolence, increased QTC , EKG changes

Ability- nausea , H/A , somnolence/ insomnia

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22
Q

METABOLIC EFFECTS OF CLOZAPINE

A

WEIGHT GAIN
TYPE 2 DIABETES
DYSLIPIDEMIA
MYOCARDITIS , PERICARDITIS

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23
Q

metabolic effects of olanzapine

A

WEIGHT GAIN
TYPE 2 DIABETES
DISLIPIDEMIA

24
Q

METABOLIC EFFECTS OF QUETIAPINE

A

WEIGHT GAIN
TYPE 2 DIABETES
QT PROLOGATION

25
Q

METABOLIC EFFECTS OF RISPERDONE

A

WEIGHT GAIN
TYPE 2 DIABETES
QT PROLONGATION

26
Q

ZIPRASIDONE

A

QT PROLOGATION

27
Q

FIRST GENERATION TYPICAL ANTIPSYCHOTICS

A
  • effective only for positive symptoms of schizophrenia (hallucinations, delusions,etc)
  • may mask or worsen negative symptoms ( blunt affect, apathy,social withdrawl)
  • classified as to potency : low, mid,high
    (affects S/E profile)
28
Q

COMMONLY USED ANTIPSYCHOTICS

A 
haloperidol
fluphenazine 
trifluoperazine
thiothixene
loxapine
perphenazine
thioridazine
chlorpromazine
29
Q

SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS

A

ANTICHOLINERGIC

  • BLURRED VISION
  • CONSTIPATION
  • DRY MOUTH
  • URINARY RETENTION
  • CONSTIPATION
30
Q

GENERAL SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS

A 
common/early 
-sedation
 - postural hypotension 
- dizziness
- lightheadedness 
-decreased sweating 
potentiation of CNS depressants
31
Q

EXTRAPYRAMIDAL SIDE EFFECTS

A

AKATHISIA -RESTLESSNESS
DYSTONIAS
PARKINSONIAN SYMPTOMS

32
Q

TARDATIVE DYSKINESIA

A
  • may be irreversible - may be prevented by use of low doses . Vitamin E,valproate, clonidine clozapine cholinergic drugs
  • GABAMINERGIC drug (benzos) may be useful in treating
  • discontinue the drug may lessen or reverse symptoms
  • AIMS Test ( standardized exam)
33
Q

NEUROLEPTIC MALIGNANT SYNDROME

A

-an idiosyncratic reaction to an antipsychotic drug

  • potentially fatal
  • all psychotropics of high potency antipsychotic drugs have increased risk
  • poor nutrition , dehydration , and concurrent medical illness
34
Q

MAJOR SYMPTOMS OF NEUROLEPTIC MALIGNANT SYNDROME

A 
rigidity 
high fever 
elevated level of enzymes (cpk)
diaphoresis
pallor
delirium 
autonomic instability ( unstable BP)
35
Q

TREATMENT OF NMS

A

immediate discontinuation of all antipsychotic medications

supportive medical care -rehydration and hypothermic measure

36
Q

DEPOT THERAPY

A
  • Haldol and proxlixin
  • respirdone now available
  • injectable , oil based form
  • long half life they are active for 2-4 weeks due to slow release from muscle tissue
  • called depot due to cyclical nature of treatment
37
Q

MEDICATIONS USED FOR EPS

A

MEDICATIONS USED FOR ACUTE DYSTONIA MOST COMMNLY INCLUDE

  • BENZTROPINE
  • DIPHENHYDRAMINE
  • LORAZEPAM
38
Q

ANTIMANICS MOODS STABILIZERS

A

-indicated for bipolar (chronic manic episodes)

LITHIUM
ACTION: stabilizes the activity of electrolytes at the cell membrane and reduces cell excitability

INDICATION: prevention of manic episodes

  • for many years drug of choice
  • eliminated by the kidneys in riginal form
  • need to ensure good kidney function
39
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
  • lithium has narrow therapeutic window
40
Q

LITHIUM

A
  • can be nephrotoxic/ thyrotoxic
  • need to minitor serum levels as well as periodic kidney / thyroid studies
  • narrow therapeutic window - between 0.5-1.5
41
Q

SIDE EFFECTS OF LITHIUM

A 
tremors
polydipsia
polyuria
dry mouth 
GI upset 
pulse irregularities
 weight gain
42
Q

ADVERSE EFFECTS

A

electrolyte imbalance
sodium balance importanat
side effects worsen as levek rises
more severe symptoms usually symptoms correlated to levels from 2-3

43
Q

LITHIUM TOXICITY

A 
vomiting 
diarrhea
lethargy
ataxia
slurred speech 
blurred vision 
confusion 
seizures 
coma
death
44
Q

ATYPICAL ANTIPSYCHOTICS

A

indicated for bipolar 1 (acuta manic episodes)

  • risperidone
  • ziprasidone
  • olanzapine
  • aripiprazole
  • quetiapine
45
Q

ANTICONVULSANTS

A 
valporic acid 
gabapentin 
topiramate 
lamotrigine
carbamazepine
46
Q

HOW ANTICONVULSANTS WORK

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 maintanenece therapy

may raise the threshold at which neurobiological messages can trigger mood changes

47
Q

ANTINXIETY AGENTS PRIMARY CLAS (BENZODIAZEPINES

A

ACTION - inhibit CNS excitability by binding to the receptor complex

enhance the activity of GABA at the GABAa receptor

48
Q

BENZODIAZEPINES INDICATIONS

A 
anxiety 
agitation 
insomnia
tension 
panic disorder 
seizures
dystonias
muscle spasms 
agoraphobia
49
Q

BENZODIAZEPINES

A 
LORAZEPAM 
ALPRAZOLAM 
CLONAZEPAM 
DIAZEPAM 
CHLORDIAZEPAM
50
Q

SIDE EFFECTS OF BENZOS

A 
drowsiness
fatigue
decreased concentration 
confusion 
decreased coordination 
disorientation
51
Q

BENZO NOTES

A

major drawback is tolerance and dependence
synergistic effects when combined with ETOH
not to be used for sleep

52
Q

OTHER AXIETY AGENTS

A

SSRI’S
BUSPIRONE
PROPRANOLOL
HYDROXYINE

53
Q

ANTI-AGRESSION AGENTS

A
  • antiaxiety agents
    -tegretol
    -lithium
    -beta blockers( Inderal, Lopressor)
    -lithium
    -antipsychotics
    others
    -trazodone
    -Prozac
    -klonopin
    -combinations
54
Q

AUGMENTATION

A
  • a variety of medications can be used along with the primary pharmacological agent that may serve to boost its effect
  • commonly used: lithium, antianxiety, desyrel, antipsychotics, anticonvulsants
55
Q

COMMON NURSING INTERVENTIONS

A
  • document first dose response to new medication
  • monitor subsequent response to treatment
  • collaborate to ensure that long term monitoring completed as needed
56
Q

PATIENT EDUCATION

A
  • patients more likely to continue treatment if given these five instructions
  1. take antidepressant daily
  2. antidepressants must be taken for at least 2-4 weeks to see a noticeable effect
  3. continue to take the antidepressant even if you feel better
  4. do not stop taking without checking with your doctor first
  5. follow instructions to contact your healthcare provider when questions arise about antidepressants
57
Q

PREVENTING NONCOMPLIANCE : SCHIZPHRENIA

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

Psych (8 decks)

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