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Pharmacology Exam 1 > Psychotherapeutic Agents > Flashcards

Psychotherapeutic Agents Flashcards

Pharmacology Exam 1

1
Q

What does Psychotherapeutic agents do?

A

Treat but does not cure psychosis.
Prescribed for children and adults

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2
Q

Name two mental disorders that we needed to study for this chapter and explain what they do.

A

Schizophrenia: Causes Hallucinations, Paranoia, Delusions, Speech Abnormalities, Absence of typical social behavior.

Bipolar Disorder: Severe depression followed by extreme excitement. Strong genetic component. Caused by a biochemical imbalance which is then overcompensated by neurons and an inability to establish stability.

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3
Q

What is the drug mostly prescribed for Bipolar disorder?

A

Lithium

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4
Q

What are the suffixes to other Typical Antipsychotics?

A

-azine
Prochlorperazine
Thioridazine

Outlier is Haloperidol

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5
Q

What are the suffixes to other Atypical Antipsychotics?

A

-piprazole
Apriprazole
Brexpiprazole

-apine
Quetiapine

-idone
Risperidone

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6
Q

What does TYPICAL Antipsychotics do?

A

Block dopamine receptors thus preventing stimulation of postsynaptic neurons by dopamine.
They also limit the RAS system which limits stimuli coming into the brain - mediates overall level of consciousness.

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7
Q

What does ATYPICAL antipsychotics do?

A

They block both the dopamine and the serotonin receptors. when blocked more Serotonin accumulates.

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8
Q

What does Serotonin do?

A

Helps to prevent depression and alleviate unpleasant neurological effects.

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9
Q

How does Lithium work?

A

It is unknown how lithium affects mania, however we know that it alters the sodium transport in nerve and muscle cells. This influences the reuptake of neurotransmitters norepinephrine and dopamine.

It is important to remember that the kidney absorb more lithium during dehydration and hyponatremic states which may lead to Lithium toxicity.

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10
Q

What is Lithium used to treat?

A

Bipolar Disorder

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11
Q

What is Antipsychotics used to treat?

A

Schizophrenia, Hyperactivity, Agitated Behavior, Severe Behavior problems in children, Adjunct therapy to severe depression.

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12
Q

What considerations should be taken when children are prescribed Psychotherapeutic agents?

A

They are often used in combination with other CNS drugs.
The long term effect of using these drug are not known.
Adverse effects and development progress should be closely monitored.
Treatment should be a part of a interdisciplinary approach.
Lithium rarely used in children but if its the effects should be closely monitored.

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13
Q

What is a psychosis?

A

Perceptual and behavioral disorder

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14
Q

What considerations should be taken when adults are prescribed Psychotherapeutic agents?

A

Patients should have regular follow ups
Some medications require an ECG prior to monitor QT interval. A longer QT interval increases the risk for fatal arrythmias.
Lithium may be harmful in pregnancy and may cause congenial abnormalities in the developing fetus.

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15
Q

What considerations should be taken when older adults are prescribed Psychotherapeutic agents

A

Often require a reduced dosage
Toxic effects could happen so they should be monitored for this

Safety measured should be in place if they’re experiencing any CNS effects

These drug should NOT be used to trat behavioral/psychosis associated with dementia due to increased risk of death for unknown reasons.

Those with renal impairment should be monitored closely when taking lithium.

Those with heart disease and longer QT intervals should be monitored closes due to risk of fatal arrythmias.

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16
Q

What is the Pharmacokinetics of the antipsychotic drugs?

A

Intermuscular injection provides 4-5 times the active does as oral dose. So injections require a much smaller dose.

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17
Q

What are the contraindications to Antipsychotics? What type of patient or patient condition would we not want to give this to?

A

CNS effect (Depressed further with these drugs)

Blood Dyscrasias (Any disorder of the blood - dopamine could increase this effect)

Parkinson’s Disease (Can be worsened by these medications)
Prolonged QT intervals (these drugs can also cause this so we wouldn’t want to give this to a patient who is also suffering from this already due to risk of lethal arrythmias)

Black Box Warning : Death could occur in Dementia patients.

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18
Q

What factors would we be cautious of when prescribing antipsychotic drugs?

A

Conditions that could worsen by anticholinergic effect - dry mouth, urinary retention
Seizure disorders because these drugs could lower the seizure threshold.
Liver, Renal and cardiac disease

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19
Q

What are the drug-drug interactions to antipsychotics?

A

CNS depressants incl. alcohol
Anticholinergics

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19
Q

What are the adverse effects that may be seen with patients using Antipsychotic drugs?

A

The adverse effects are related to the dopamine blocking anticholinergic, antihistamine and antiadrenergic effect of the drug.

CNS effect: Drowsiness, weakness, Tremors

Extrapyramidal effect:
Pseudo parkinsonism - drooling and shuffling gait.
Dystonia - spasms of the muscles in the tongue, neck and back
Akathisia - continuous restlessness
Tardive Dyskinesia - abnormal muscle movement and or lip smacking.

Narcoleptic Malignant Syndrome - nervous system condition that causes high fever, muscle stiffness, rigidity and perfuse sweating and changes in vital signs - potentially irreversible

Prolonged QT intervals, hypotension & Orthostatic hypotension
Bone marrow suppression

Atypical : can cause weight gain and diabetes

Anticholinergic: constipation, dry mouth, urinary retention, nasal congestion, blurred vision.

Gynecomastia

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20
Q

What are the drug-drug interactions’ to Lithium?

A

Haloperidol
Carbamazepine
Diuretics due to sodium loss

Herbal: Psyllium

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21
Q

What are some cautions and adverse effects that should be taken into account with a patient taking Lithium?

A

L.I.T.H

Leukocytosis
Insipidus Diabetes
Tremors
Hypothyroidism

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22
Q

With the nursing process in mind, what assessment should be done prior to giving a patient Haloperidol?

A

Check Vitals
CNS: Orientation & affect
Cardiac
Abdominal

Labs: Renal and Hepatic. CBC (Complete Blood Count)
EKG

Haloperidol is a typical Antipsychotic

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23
Q

With the nursing process in mind, what assessment should be done prior to giving a patient Lithium?

A

Vitals
Skin, Mucous membranes, CNS, Abdominal, Urinary Output.
Labs: Renal Function, CBC, Thyroid function, Lithium levels, Sodium levels, EKG

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24
Q

With the nursing process in mind, what conclusions could be made prior to giving a patient Thioridazine?

A

Impaired physical mobility, Altered cardiac output, Fall risk, urinary retention, constipation risk

Typical Antipsycotic

25
Q

With the nursing process in mind, what conclusions could be made prior to giving a patient Lithium?

A

Impaired comfort, Acute pain, Injury risk, Impaired urinary elimination, altered thought process.

26
Q

With the nursing process in mind, what implementations should be made prior to giving a patient Risperidone?

A

If administered in parenteral form the patient should be laying down for 30 minutes.
Blood count and Glucose levels should be monitored.
Gradual dose reduction after long term use.

Safety and comfort: Positioning of legs and arms sugarless candy and ice chips for dry mouth. Void before administration due to risk of urinary retention

Risperidone is a Atypical antipsychotic

27
Q

With the nursing process in mind, what implementations should be made prior to giving a patient Lithium?

A

Monitor serum levels closely (small margin)
May be administered with food
Decrease dose after manic episode
Maintain adequate fluids and salt levels
Interventions for GI and CNS effect

28
Q

What happens when lithium levels are between 1.3 - 1.4?

A

Lethargy, Slurred speech, muscle weakness, vomiting.

29
Q

What happens when lithium levels are between 1.5 - 2 ?

A

Lethargy, Slurred speech, muscle weakness, vomiting AND ECG changes

30
Q

What happens when lithium levels are between 2 - 2.5 ?

A

Ataxia (loss of muscle coordination), clonic movements (seizures) and hyperreflexia

31
Q

What happens when lithium levels are over 2.5 ?

A

Complex multiorgan toxicity, Significant risk of death

32
Q

What can happen if an elderly patient with dementia is given an antipsychotic?

A

It could potentially result in death. Exact reason not known.

33
Q

Is Olanzapine typical or atypical?

A

Atypical

34
Q

Is risperidone typical or atypical?

A

atypical

35
Q

Is Thioridazine typical or atypical?

A

typical

35
Q

Is Prochlorperazine typical or atypical?

A

typical

36
Q

Is Aripiprazole typical or atypical?

A

atypical

37
Q

Is Haloperidol typical or atypical?

A

typical

38
Q

which block only one of the neurotransmitters? typical or atypical

A

typical

39
Q

which one block RAS? typical or atypical

A

typical

40
Q

Which block dopamine AND serotonin? typical or atypical?

A

atypical

41
Q

What system can blocking dopamine have an effect on?

A

Immune system. Can lead to dyscrasias which affects the blood.

42
Q

What are the extrapyramidal effects?

A

Psudoparkinsonism
Dystonia
Akathisia
Tardive Dyskinesia

43
Q

What is Psudoparkinsonism

A

Patient will have drooling and a shuffling gate

44
Q

What is Dystonia

A

Spasms of the muscles of the tongue neck and back

45
Q

what is Akathisia

A

Continuous restlessness

46
Q

What is Tardive Dyskinesia

A

Abnormal muscle movement or lip smacking.

47
Q

What is neuroleptic malignant syndrome?

A

Nervous system condition that that cause high fever, muscle stiffness rigidity and dysautonomia (perfuse sweating) It is potentially irreversible.

48
Q

What specific adverse effect may an atypical antipsychotic agent cause?

A

Diabetes and weight gain.

49
Q

When taking antipsychotic medication what should we advise the patients about regarding their urine?

A

It could have a red to purple tint to it

50
Q

what alters sodium transport in nerve and muscle cells?

A

Lithium

51
Q

What influences the reuptake of neurotransmitters norepinephrine and dopamine?

A

Lithium

52
Q

When does the kidney reabsorb more lithium?

A

When a person is dehydrated

53
Q

Lithium adverse effects can be remembered as L.I.T.H What does it stand for?

A

L - Leukocytosis = higher WBC count
I - Insipidus = Diabetes (thirst &urination)
T - Tremors/teratogenic/thyroid issues
H - Hypothyroidism

54
Q

what can too little lithium do to your body and what can too much do?

A

Too little can affect the thyroid and result in hypothyroidism and too much hyperthyroidism.

55
Q

What is the first sign of lithium toxcicity?

A

GI effect.

56
Q

How often might a patient that are taking both lithium and a diuretic have their lithium levels checked?

A

May be as often as once a day

57
Q

When do we need to increase and then decrease the lithium dose?

A

We increase during a manic state because it takes more lithium to get this state under control. Once the patient comes down from the manic state we decrease the dose.

58
Q

How to remember the suffix for typical antipsychotics. You can remember remember it by thinking about explaining something to someone that “its typical…

A

…as in” “azine”

59
Q

How to remember that “idone” is a suffix for atypical antipsychotics

A

” I’ve done (idone) something atypical”

Pharmacology Exam 1 (9 decks)

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