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Mental Health > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Mode of Action

A

What the drug does to the body

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2
Q

Mechanism of Action

A

How the drug works in terms of symptoms, cure of disease and the symptoms the drug does.

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3
Q

Most important neurotransmitters

A

Acetylcholine
Dopamine
Serotonin
Glutamate

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4
Q

Acetylcholine: 2 important subdivisions and important receptor

A

2 Subdivisions:
nicotinic and muscarinic cholinergic receptors
Important:
M1 postsynaptic receptor for mediating effect in memory function

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5
Q

Dopamine

A

Controls movement
Involved in pleasurable sensation, euphoria, delusions and hallucinations
Intervenes positive and negative psychotic symptoms
Release of prolactin, promotes breastmilk

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6
Q

What is the relationship between dopamine and acetylcholine?

A

Reciprocal relationship

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7
Q

Serotonin

A

Inhibitory catecholamine
Receptors start with “5-HT”
Intervenes with cognitive effects, emotions, pains, memory, anxiety, sleep-wake cycles and inhibits dopamine release.

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8
Q

Glutamate

A

Major excitatory neurotransmitter

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9
Q

Remission phase

A

Focuses on the return of baseline functions and no symptoms.

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10
Q

Maintenance phase

A

Prevents recurrence of illness

Increases pt functioning while decreasing symptoms

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11
Q

Recovery phase

A

Emphasizes individual growth and achievement despite having a mental illness.

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12
Q

Psychosis: 5 symptoms dimensions

A 
Positive 
Negative 
Cognitive Function Impairment
Aggressive and Hostile
Depressive and Anxious
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13
Q

Conventional (1st generation) vs atypical antipsychotics (2nd generation)

A

1st generation: block D2 receptors

2nd generation: lower potential for EPS (extrapyramidal effects), does not affect negative and cognitive symptoms.

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14
Q

Antipsychotic Meds Indication

A

Schizophrenia & schizoaffective disorders
Delusional disorders
Adjunct therapy for Bipolar disorder

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15
Q

Antipsychotic Meds Goal of Therapy

A

Pt needs to follow through with long term care

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16
Q

What habit affects the absorption of antipsychotic meds?

A

Cigarette smoking increases drug metabolization and pts would require higher doses.

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17
Q

Antipsychotic Meds Clinical Use and Efficacy

A

Use the lowest dose for shortest time.
Positive symptoms are relieved within hours while affective symptoms takes 2-4 weeks to be relieved.
Cognitive and Perceptual symptoms take 2-8 weeks for response.
Negative symptoms take longer to respond.
Always start with 3-4 divided dose/day and wean down to 1-2 dose/day.

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18
Q

Serum level of monitoring indications

A

No response after 6 weeks
Severe or unusual adverse reaction
Physically ill, older adults and young children

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19
Q

Extrapyramidal Effects (EPS): 4 symptoms

A

Dystonia
Pseudoparkinsonism
Akathisia
Tardive Dyskinesia

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20
Q

Dystonia: when does it normally occur, what reverses it and what does it look like.

A

Occur in the initial treatment regimen
Reversed with IM diphenhydramine ( Benadryl) or benztropine (Cogentin)
Spasms of eye, neck, back, tongue or other muscles.

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21
Q

Pseudoparkinsonism: what reverses it and what does it look like.

A

Tx: reduce antipsychotic dose or change med, or oral antiparkinsonian agent
Decreased movements. muscle rigidity, resting hand tremor, drooling and masklike face and shuffling gait.

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22
Q

Akathisia: How does it look like and Tx.

A

Restlessness. pacing, rocking and inability to sit still.

Tx: Propranolol and benzodiazepam.

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23
Q

What do you monitor if the pt takes propranolol?

A

Monitor BP

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24
Q

Tardive dyskinesia and Tx

A

Severe abnormal movements of any voluntary muscle group that occurs after a long dopamine blockade
No effective Tx.

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25
Q

Tardive dyskinesia and EMS

A

When tardive dyskinesia occurs, decreasing the med dose worsens tardive dyskinesia but improves EMS.
Increasing dose improves tardive dyskinesia but worsens EPS.

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26
Q

Neuroleptic Malignant Syndrome (NMS)

A 
MEDICAL EMERGENCY
Decreased LOC, 
increased muscle tone and autonomic dysfunction (hyperreflexia, labile HTN, tachycardia, tachypnea, diaphoresis, and drooling) , 
Fever
myoglobinuria, 
leukocytosis 
elevated creatine phosphokinase levels.
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27
Q

Neuroleptic Malignant Syndrome (NMS) Tx:

A

Discontinue antipsychotic meds
Hydrate with IV fluids
Give Tylenol and cooling blankets for Hyperthermia
IV Heparin for PE if PRN
Manage arrythmias
Monitor Renal Function
Give IV dantrolene (Dantrium), muscle relaxant
Possible dopaminergic drugs (Bromocriptine, amantadine)
Wait 1-2 weeks before restarting antipsych meds

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28
Q

Cardiovascular Side Effects

A

Postural hypotension, esp. older adults
Arrhythmias and Palpitations
Changes in QT intervals - monitor with EKG.

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29
Q

Low Potency Typical Antipsychotics

A 
Sedation / Drowsiness
Weight gain
Photosensitivity
Poikilothermic
Galactorrhea and Gynecomastia
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30
Q

Haloperidol as a short-acting typical (Conventional) Antipsychotics

A

Used for short term symptoms of agitation.
Given IV and IM
Caution with elderly pts

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31
Q

Fluphenazine Deconate Injection

A

Long-Acting Injectible Typical Antipsychotics
Given IM or subQ
Feel effects within 48-96 hours

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32
Q

Haloperidol Decanoate Injection

A

Long-Acting Injectible Typical Antipsychotics
Deep IM
Given every 4 weeks

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33
Q

Clozapine: Drug Class, Mechanism of Action, Clinical Use

A

Atypical Antipsychotics
Not a first-line therapy due to agranulocytosis
High receptor affinity for D4 and 5-HT2
Used for refractory illness

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34
Q

Clozapine: Risks and Side Effect

A 
Risk for Agranulocytosis- decrease or lack of agranulocytic WBCs.
Side Effects:
Sedation, 
Anticholinergic effects, 
orthostatic hypotension, 
weight gain, 
hypersalivation and 
risk for seizures.
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35
Q

Anticholinergic effects

A 
Dry mouth
Blurry vision
Constipation 
Urinary retention
Ejaculatory inhibition
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36
Q

Risperidone: Drug Class, Receptor, Clinical Use, Side Effects

A

Atypical Antipsychotics
Blocks dopamine (D2) receptors
Treats both positive and negative symptoms
Used for older pts and has few anticholinergic effects
Side Effects: insomnia, hypotension, agitation, headache and hyperthermia

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37
Q

Olanzapine: Drug Class, Receptor, Clinical Use, Side Effects

A

Atypical Antipsychotics
Greater D2 blocker and weaker D4 and a-adrenergic blockade
Treats both positive and negative symptoms of schizophrenia, monotherapy for bipolar
Side Effects: Sedation, anticholinergic effects, weight gain, adult onset DM, risk for seizures and hyperprolactinemia

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38
Q

Quetiapine: Drug Class, Receptor, Clinical Use, Safety

A

Atypical Antipsychotics
Multiple receptors
Treatment of schizophrenia
Monitor cholesterol and triglycerides for elevation

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39
Q

Ziprasidone: Drug Class, Receptor, Clinical Use

A

Atypical Antipsychotics
5HT and D2 antagonist, protects against EPS and inhibits norepinephrine reuptake
Treatment of acute agitation of schizophrenia

40
Q

Ziprasidone: Contraindication, Side Effects

A

Contraindicated pts with heart problems
Increased risk of death with dementia-related psychosis
Take with food
Side Effects: GI discomfort, drowsiness, EPS, akathisia, dizziness, dystonia, hypertonia, tachycardia and postural hypotension, rash, fungal dermatitis, and abnormal vision and upper respiratory function.

41
Q

Antidepressants: Indications

A 
Major Depression 
Anxiety
OCD
Panic
Bulimia
Anorexia
PTSD
Bipolar
Social Phobia
IBS
Enuresis
Neuropathic pain
Migraine headache
ADHD
Smoking cessation
Autism
42
Q

Downregulation of Antidepressants

A

Increased neurotransmitter in synapse but less neurotransmitter in synapse

43
Q

Major Classes of Antidepressants

A

Selective Serotonin Reuptake Inhibitor (SSRIs)
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)

44
Q

Selective Serotonin Reuptake Inhibitor (SSRIs): Receptor and efficacy

A

First-line treatment of antidepressants
Inhibiting reuptake of 5HT
Efficacy depends on pt’s tolerance to adverse effects and cost

45
Q

Serotonin Syndrome

A 
Life threatening due to interactions with other drugs
Confusion
Hypomania
Restlessness
Myoclonus
Hyperreflexia
Diaphoresis
Shivering
Tremor
Diarrhea
46
Q

Serotonin Syndrome Tx

A

Discontinue med that increases serotonin

Suppoertive measures

47
Q

Selective Serotonin Reuptake Inhibitor (SSRIs): Side Effects

A 
Side effects are most severe beginning of tx
GI upset
Insomnia
restlessness
irritability
headache
Sexual dysfunction
EPS
Not lethal with overdose
48
Q

Tricyclic Antidepressants (TCAs): Receptor, Side Effects

A

Second-line therapy
Blocks reuptake of 5-HT and norepinephrine
Anticholinergic side effects, Orthostatic hypotension

49
Q

Tricyclic Antidepressants (TCAs): Monitoring parameters

A

Take at bedtime because of sedative effect
Use EKG before therapy - possible cardiotoxicity
Risk of fatality with overdose
Avoid with elderly pts

50
Q

Monoamine Oxidase Inhibitors (MAOIs): Mode of Action, Efficacy

A

Block enzyme for degrades norepinephrine, serotonin and dopamine.
Increases postsynaptic downregulation
Used as last resort, resistant to TCAs
Rapidly absorbed and half-life is 24 hours

51
Q

Monoamine Oxidase Inhibitors (MAOIs): Contraindication

A 
Cerebrovascular defects
Cardiovascular disease
Pheochromocytoma - tumor in adrenal medulla
Pregnancy
Older than 65yrs old
52
Q

Monoamine Oxidase Inhibitors (MAOIs): Hypertensive Crisis, Symptoms and Tx

A

MAOIs inhibit monoamine oxidase, they decrease the breakdown of tyramine from ingested food, thus increasing the level of tyramine in the body. Excessive tyramine can elevate blood pressure and cause a hypertensive crisis
Symptoms include: Headache, Stiff neck, Sweating, Nausea and vomiting,
Treatment: Nifedipine, and Monitor vital signsq10-15 min

53
Q

Monoamine Oxidase Inhibitors (MAOIs): Dietary Restrictions - Prohibited

A

Aged cheese, ripe avocados

  • Ripe figs, anchovies, bean curd
  • Broad beans, yeast, liver
  • Deli meats, pickled herring
  • Meat extracts, fermented foods
  • Chianti and sherry
54
Q

Monoamine Oxidase Inhibitors (MAOIs): Dietary Restrictions - Moderate Use:

A

Cottage cheese, cream cheese

  • Yogurt, sour cream
  • Coffee, chocolate
  • Spinach, raisins, tomatoes, eggplant
55
Q

Monoamine Oxidase Inhibitors (MAOIs): Restricted Use

A 
Anti-asthmatics
Antihypertensives
Epinephrine
Allergy, hay fever decongestants
Cough and cold products
Buspirone
Meperidine
SSRIs
Yohimbine
56
Q

Monoamine Oxidase Inhibitors (MAOIs): Side Effects and Toxicity

A 
Orthostatic hypotension
Edema
Sexual dysfunction 
Weight gain
Insomnia
Confusion and feeling drunk is excessive dose
57
Q

Monoamine Oxidase Inhibitors (MAOIs): Pt Teaching and Nursing Responsibilities

A

Teach pt and family about foods to avoid, - give handouts
Teach pts not to take any additional medication without consulting HCP, Dentist and Pharmacist
Teach pt about hypertensive crisis and toxicity
Wait 5 weeks before starting MAOI after discontinuing fluoxetine.
Must be tapered, do not stop abruptly

58
Q

Other Antidepressants

A

Venlafaxine (Effexor) – Serotonin-norepinephrine reupdate inhibitor (SNRI)
Nefazodone -
Trazodone – Serotonin modulator
Bupropion – Aminoketone (related to tricyclic, tetracyclic and SSNRI)
Mirtazapine - Noradrenergic and specific serotonergic antidepressant
Saint John’s Wort

59
Q

Time Course of Antidepressants

A

1st wk: decreased anxiety, improved sleep, pt unaware of changes
1-3 wk: increased activity, sex drive, and self-care abilities, improved concentration and memory and psychomotor retardation resolves
2-4wks: relief of depressed mood, less hopeless, and suicidal ideation subsides

60
Q

Antidepressants with kids

A

Can increase suicidal thinking and behavior

Can happen in adults as well but monitor the kids

61
Q

Mood Stabillizers

A 
Lithium
Valproate
Carbamazepine
Oxcarbazepine
Lamotrigine
Topiramate
Gabapentin
Tiagabine
Zonisamide
Levetiracetam
62
Q

Lithium: Indication and Risks

A

Treatment for bipolar mania and depressed episodes
Narrow therapeutic range
Risk for toxicity in older pts
Combine with valproate as first line tx

63
Q

Lithium: Pt Teaching and Nursing Responsibilities

A

Monitor blood serum level to avoid adverse effects
Monitor renal function, thyroid function, urinalysis, CBC with differentials, serum electrolytes, ECG and weight.
Pregnancy test to women on child bearing age
Teach pt the side effects of lithium and potential drug interactions
Monitor fluid intake
Avoid salt-restricting diet

64
Q

Lithium: Side effects within therapeutic range

A 
Fine tremor
Nausea, vomiting, diarrhea
Mild polydipsia, polyuria
Lethargy, muscle weakness
Weight gain
Increased WBC
Acne, alopecia
Hypothyroidism
65
Q

Lithium: Side effects and range of Moderate toxicity

A

Lithium level >1.5 mEq/L

  • Coarsening of tremor
  • Worsening GI symptoms
  • Confusion, slurred speech
  • Sedation, lethargy
66
Q

Lithium: Side effects and range of Severe toxicity

A 
Lithium level >2.5 mEq/L
RISK FOR PERMANENT NEUROLOGIC IMPAIRMENT
- Arrhythmias
- Bradycardia
- Myocarditis
- Seizures
- Coma
- Death
67
Q

Rapid cycling bipolar

A

4 or more mood disorder episodes within 12 months

68
Q

Valproate: Drug class, indication and compare to lithium

A

Anticonvulsant med
First line tx of rapid cycling bipolar
Minor side effects and wider therapeutic range than lithium

69
Q

Valproate: side Effects

A 
Sedation
GI distress
Benign transaminase elevation
Osteoporosis
Tremor
Hair loss
Increased appetite
Weight gain
70
Q

Valproate: Pt teaching and nursing responsibilities

A

Monitor baseline liver functions and signs of hepatoxicity
Severe vomit, monitor serum amylase level and evaluate for pancreatitits
Take at bedtime
Anticoagulation therapy, monitor for clotting function
Monitor hepatic function and CBC every 6 months
Teach pt side effects, risks and what to look for

71
Q

Carbamezepine: Drug class, Indication

A

Anticonvulsants
Tx of acute bipolar mania
second-line treatment for bipolar disorder
Does not reach steady state until 4 weeks after initial therapy

72
Q

Carbamezepine: toxicity

A 
Dizziness
Ataxia
Sedation
Diplopia
Stupor 
Coma
Tx: gastric lavage and symptom management
73
Q

Carbamezepine: Pt teaching and Nursing responsbilities

A

Effects does not show until 4 weeks after initial dose
Monitor CBC and liver function test every 2 weeks
Teach pts to monitor for signs and symptoms of hematologic and hepatic abnormalities
Teach pt to call HCP when rash occurs

74
Q

Oxcarbazepine

A

Treatment for bipolar disorder
Alternate tx to carbamazepine
Risks for hyponatremia esp with older adults
Decreases T4 hormone in thyroid

75
Q

Lamotrigine

A

Treatment for rapid cycling bipolar disorder
Reduce the dose of lamotrigine by half if taken with valproate
risks for steven johnson syndrome

76
Q

Topiramate

A

Adjunctive therapy for seizures
Treatment for binge eating, bulimia, cluster headache, Tourette’s syndrome and trigeminal neuralgia
Risk for acute myopia and glaucoma
Caution with renal impairment pts and avoid pts with glaucoma
Risk for anemia

77
Q

Tx of Mania

A

Use of mood stabilizer

For agitation, benzodiazepine can be added to initial tx

78
Q

Bipolar pt with depression

A

Avoid TCAs

Monitor pt because antidepressant can cause pt to have mania

79
Q

Tx of Generalized Anxiety Disorder

A

Antidepressant
Benzodiazepine - rapid onset
Buspirone - longer onset

80
Q

Benzodiazepine Advantages

A

Rapid onset

81
Q

Benzodiazepine Disadvantages

A

Cognitive impairment
Decreased coordination
Potential Drug Abuse
Withdrawal symptoms

82
Q

Benzodiazepine Drug Names

A

Clonazepam
Lorazepam
Alprazolam

83
Q

OCD meaning

A

Persistent and recurrent thoughts, images, impulses and behaviors that are distressing to the individual and impair daily function

84
Q

OCD Tx

A 
Antidepressants: SSRIs and clomipramine
Cognitive Behavioral Therapy
Dopamine-blocking agents: Haloperidol
Busipirone
Lithium 
Clonazepam
85
Q

PTSD

A

Recurrent life symtoms in response to very serious life events

86
Q

PTSD Tx:

A

Antidepressants: SSRIs
Benzodiazepines: Clonazepam
Mood stabilizers

87
Q

Social Phobia

A

Most common anxiety disorder
Strong persistent anxiety that results from fear of scrutiny by others, embarrassment or humiliation
High incidence with alcohol abuse and depression

88
Q

Social Phobia Tx:

A 
Antidepressant: SSRIs
Benzodiazepine: Clonazepam and alprazolam
Gabapentin
Kava Kava
Valerian
89
Q

Pt Education for Anxiety

A

Educate pt that anxiety is a treatable illness
Educate about different types of medications, side effects, precautions and contraindications
Encourage pt to be part of decision making
Meds take several weeks to achieve maximum effects
Advise pt regarding drug-drug and drug-herb interactions
Encourage nonpharmacologic interventions
Caution pts with mixing alcohol with drinks, avoid driving or operating machinery

90
Q

Insomnia Medication

A 
Hypnotics: benzodiazepine
Nonbenzodiazepine hypnotics
Trazadone - avoid alcohol
Chloral Hydrate - avoid alcohol
Diphenhydramine - tolerance in 2 weeks and avoid in older adults
Melatonin - Avoid with other CNS drugs
Barbituates
Kava Kava 
Valerian
91
Q

benzodiazepine for insomnia

A

Triazolam - Difficulty falling asleep
Temazepam - awakens early who cannot stay asleep
Flurazepam - difficulty falling asleep and staying asleep. Possible rebound insomnia

92
Q

Nonbenzodiazepine for insomnia

A

Zolpidem - limit to 7-10 days and reevaluate pt
Zaleplon - For middle night to early morning, dizziness and headache
Eszopiclone -
Rozarem

93
Q

Trazodone insomonia

A

SSRI
For pts undergoing drug and alcohol detox
Side effects: sedation, orthostatic hypotension and priapism.

94
Q

Aggressive and Violent Behaviors

A

Sedate and calm pts and prevent self-harm or harm to others

Treat chronic aggressive behaviors

95
Q

Acute Agitation and Aggression

A

Antipsychotics: Haloperidol Ziprasidone Quetiapine Risperidone Olanzapine
Benzodiazepines
Traozodone

96
Q

Chronic Aggression

A

Schizophrenia: Antipsychotics
Mania: Lithium & Valproate
Seizure disorder: Carbamazepine & Valproate
Older adults: Trazodone

Mental Health (42 decks)

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