psychopharmacology Flashcards
medications that affect behavior mimicking emotion
psychotropic drugs
max therapeutic effect you can achieve with any drug
efficacy
amount of drug needed to attain max drug affect
potency
time it takes for half of the drug to go through the blood stream
half life
happens when you take someone off of a medication
rebound effect
symptoms you have when you remove drug from the pt system
withdrawals
a movement disorder
akathisia
chemical messengers between neurons which triggers a response form one neuron to another
neurotransmitters
*believed to play major role in mental illness
most psychotropic medications work by either ________ or _______ action at the ______ ________
agonistic; antagonistic; neural synapse
what are the 4 groups of neurotransmitters
monoamines, amino acids, peptides, and cholinergics
what are the 4 monoamines of neurotransmitters
dopamine
norepinephrine
serotonin
histamine
what are the functions of dopamine (has many receptors)
fine muscle movement, decision making, release of hormones form hypothalamus, integration of emotions and thoughts
if there is an increase in dopamine it causes…
schizophrenia and mania
if there is a decrease in dopamine it causes…
parkinsons and depression
what are the functions of norepinephrine (has many receptors)
mood, attention, arousal, stimulation of SNS (fight of flight response)
if there is an increase in norepinephrine it causes…
mania, anxiety, and schizophrenia
if there is a decrease in norepinephrine it causes…
depression
what are the functions of serotonin (has many receptors)
sleep regulation, hunger, mood, perception of pain, libido, aggression, hormonal activity
if there is an increase in serotonin it causes…
anxiety
if there is a decrease in serotonin it causes…
depression
what are the functions of histamine (only has 2 receptors)
alertness, gastric secretions, inflammation response
if there is a decrease in histamine it causes…
sedation and weight gain
what are the 2 amino acids of neurotransmitters
aminobutyric acid
glutamate
what is the function of aminobutyric acid (only has 2 receptors)
decreased anxiety, excitement or aggression; affects pain perception, anticonvulsant and muscle relaxing properties; potentially impairs cognition and psychomotor function
if there is an increase in aminobutyric acid it causes…
reduction of anxiety
if there is a decrease in aminobutyric acid it causes…
mania, anxiety, schizophrenia
what is the function of glutamate (only has 2 receptors)
receptor AMPA plays role in learning
if there is an increase in glutamate it causes…
if prolonged in receptor NMDA can result in neurotoxicity and neurodegeneration as seen in alzheimers
if there is a decrease in glutamate it causes…
in NMDA can lead to psychosis
what is the cholinergic of neurotransmitters
acetylcholine
what is the function of acetylcholine (only has 2 receptors)
learning and memory, regulation of mood, affects sexual and aggressive behavior
if there is an increase in acetylcholine it causes…
depression
if there is a decrease in acetylcholine it causes…
alzheimers and parkinson disease, huntingtons chorea
what are the 3 antidepressants categories we will talk about
SSRIs, TCAs, and MAOIs
what are the 8 SSRIs
fluoxetine fluvoxamine paroxetine sertraline citalopram escitalopram vilazodone vortioxetine
what is the MOA for SSRIs
inhibit repute of serotonin making it available longer in the synapse
what is the time to effectiveness of SSRIs
2-3 weeks
what are side effects of SSRIs
tremors nausea headache insomnia, drowsiness sexual dysfunction anxiety/agitation dry mouth diarrhea hyponatremia
what are patient teachings of SSRIs
take med with food in the morning
do not stop abruptly
inform patient they have to take the med long enough before deciding it does not work
teach signs of serotonin syndrome
what are the 5 TCAs
amitripyline nortriptyline desipramine imipramine doxipin
what is the MOA of TCAs
inhibits reuptake of serotonin and norepinephrine (and block cholinergic receptors)
what is the time to effectiveness of TCAs
4-6 weeks
what are the side effects of TCAs (remember these are very LETHAL in overdoses)
weight gain toxicity decreased seizure threshold sexual dysfunction orthostatic hypotension sweating mydriasis
what are pt teachings of TCAs
avoid alcohol lethal take in evening (sedating effects) use caution when driving takes several weeks to be therapeutic
what are the 4 MAOIs
phenelzine
tranylcypromine
isocarboxazid
selegiline
what is the MOA of MAOIs
inhibits enzyme that degrades NE, dopamine, and serotonin
what are the side effects of MAOIs
muscle cramps weight gain sexual dysfunction anticholinergic effects food interactions
what are pt teaching of MAOIs
follow tyramine free diet
dietary restrictions continue for at least 2 weeks after drug discontinued
use caution when driving
what foods have tyramine in them
aged cheese, aged meats (pepperoni, sausage), foods with yeast (pizza), soy, beer, wine, avocados, bananas
what crisis could happen when taking MAOIs
hypertensive crisis
what are symptoms of hypertensive crisis
nausea chills fever restlessness dilated pupils motor agitation vomiting sweating severe hypertension nuchal rigidity occipital headache severe nosebleeds
how can we lower the chance of hypertensive crisis
since tyramine is a very potent vasocompressor if we limit the amount by the food we ingest then this will lower the chances
this syndrome is caused by one or more medications with serotonin-enhancing properties
serotonin syndrome
what are symptoms of serotonin syndrome
fever trremors anxiety mood change diarrhea sweating irritability abd pain altered mental state death
what are nursing interventions when we suspect serotonin syndrome
stop/discontinue med
admin serotonin receptor blockade
pt will need to be hospitalized until all symptoms are under control
what is the difference in MOA between conventional and atypical antipsychotic meds
conventional is a dopamine receptor antagonist while atypical is a serotonin-dopamine antagonist
conventional antipsychotics control ______ symptoms while atypical antipsychotics control both ______ and _______ symptoms
positive; positive and negative
what are the main side effect differences between conventional and atypical antipsychotics
conventional has increased prolactin levels, EPS/Tardive dyskinesia while atypical has excessive weight gain in abd, diabetes
which antipsychotic is choses first
second generation (atypical) unless a pt is successfully already on first generation we do not want to change it on them
which generation of antipsychotics has a more likelihood of EPS
first gen (conventional)
what are pt teaching of conventional antipsychotics
limit sun exposure, use sunscreen, wear sunglasses, chance position slowly due to hypotention
may take 2-4wk if not months for full effect
what are the pt teaching of atypical antipsychotic meds
monitor weight gain exercise measure abd growth observe for signs of diabetes observe for signs of infection
what are extrapyramidal side effects (EPS)
acute dystonia
akithisia
pseudoparkinsonism
are EPS symptoms reversible with appropriate treatment
yes
what is considered LATE and PERMANENT EPS
tardive dyskinesia
what is the main cause of tradeoff dyskinesia
long term use of conventional antipsychotics
tardive dyskinesia is _______ but can ______ down when pt is taken off the med
irreversible; slow
what are neuroleptic malignant syndrome symptoms
tachycardia/tachypnea muscle rigidity drooling sudden high fever diaphoresis labile BPs decreased LOC up to coma
what are nursing interventions of pt with symptoms of neuroleptic malignant syndrome
send to ICU
stop med
may use dantrolene or bromocriptine (muscle relaxant)
increase fluid intake
treat fever
treat BP
*usually resolved quickly once med is stopped
what main drug category is used for antianxiety
benzodiazepines (pam’s)
what are benzos used for
anxiety, also used for insomnia, alcohol withdrawal, seizures, and preoperative sedation
what are side effects of benzos
sedation, drowsiness, impaired memory and poor concentration, tolerance and dependence
what is the antidote for benzos
flumazenil
benzodiazepines have a _____ onset and most commonly prescribed med for _____ anxiety
rapid; acute
another antianxiety med, buspirone, is used for more _____ states of anxiety since it takes ______ to take effect
chronic; longer
*buspirone is non addicting and non sedating unlike benzos
what is the FIRST LINE of medication tx for CHRONIC anxiety disorders
SSRIs (due to fewer side effects, quicker acting and more effective than TCAs)
mood stabilizers are used to treat
bipolar mania, mood disorders
what are first line mood stabilizers
lithium and divalproex sodium (anticonvulsant)- has a quick response to it
if pt is taking lithium they need to make sure they are taking in ______ amount of ____ but not too much, if they take in too much ____ the body is going to release the _____
normal; salt; salt; lithium
what are pt teaching of lithium
do not take if pregnant
take with food to decrease GI upset
stress fluid and sodium intake
monitor blood levels
what is the blood level of acute mania
0.6-1.2
what is the maintenance blood level of lithium
0.4-1
if there is a lithium toxicity when we draw up the blood what should we do
stop the drug if level is high
can treat with urea, mannitol, and urophlin
what is the first line drug for anticonvulsants
divalroex sodium
what is considered rapid cyclers of anticonvulsants
carbamazepine
what pt teaching should be done for anticonvulsants
report pregnancy
monitor blood levels
do NOT stop abruptly
oral suspension should be shaken properly
