Psychotherapeutic Agents Flashcards
0
Q
Psychotropic
A
Drugs to help people who can’t carry out adl’s and interact with others (bipolar and skitzophrenic)
1
Q
Psychotherapeutic
A
Treatment of emotional and mental disorders
2
Q
3 main emotional and mental disorders
A
Psychosis
Affective disorders
Anxiety
3
Q
Psychosis
A
Severe emotional disorder often impairs mental function and adl’s
4
Q
Affective disorders
A
Mood disorders
Changes in mood and range from mania to depression
5
Q
Anxiety
A
Unpleasant state of mind chiefly characterized by a sense of dread and fear
6
Q
Biochemical imbalance
A
Abnormal levels of endogenous chemicals in the brain
Neurotransmitters like norepinephrine, dopamine, histamine, serotonin, acetylcholine
7
Q
What drug types do you take for insomnia and anxiety
A
Anxiolytics and sedative hypnotic agents
CNS depressants
8
Q
Anxiolytics
A
Anti anxiety
9
Q
Sedative
A
Reduces nervousness, excitability, irritability without causing sleep
10
Q
Hypnotic
A
CAUSES SLEEP
more potent than sedatives
11
Q
Sedative-hypnotics
A
Calms you down and keeps you asleep
12
Q
Barbiturates for anxiety and insomnia
A
First hypnotic
CNS depressant
13
Q
Indications of barbiturates
A
Sleep and seizure control
14
Q
Side effects of barbiturates
A
Disturbed rem sleep
Nightmares
Very addictive and easy to overdose
Withdrawal is severe
15
Q
Why are barbiturates very rarely used now
A
Their severe side effects
16
Q
Examples of barbiturates for sleep or preop
A
Seconal (secobarbital)
17
Q
Barbiturates for seizures
A
Luminal (phenobarbital)
18
Q
Benzodiazepines for anxiety and insomnia
A
Most commonly prescribed
Fairly good side effects, efficacy, and safety
19
Q
Actions of benzodiazepines
A
Affects hypothalamus, thalamus, and limbus system
Inhibits stimulation of brain
Useful in controlling anxiety and agitation
Increases seizure threshold
20
Q
Indications of benzodiazepines
A
Anxiety Insomnia Muscle spasm EMERGENT seizures Treat alcohol addiction Provide anesthesia (combination of other drugs)
21
Q
Contraindications of benzodiazepines
A
Fairly safe
Pregnancy, glaucoma, geriatric population
22
Q
Side effects of benzodiazepines
A
Very few
All CNS related
23
Q
Interactions of benzodiazepines
A
CNS depressants
MAOIs
24
Examples of benzodiazepines
Valium (diazepam)
Xanax (alprazolam)
Ativan (lorazepam)
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What would symptoms of benzodiazepines overdose be
Drowsiness
Sedation
Respiratory depression
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What would you treat an overdose of benzodiazepines with
Flumazenil (romazicon)
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What are non-benzodiazepines hypnotic agents used for
Only for sleep
Help getting you to sleep and keeping you to sleep
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Benefits of non-benzodiazepines hypnotic agents
Short half-life
Less groggy in morning
Less abuse potential
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Ambien (zolpidem)
Non-benzodiazepine hypnotic agent
30
Antidepressants can also be used for
Anxiety
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Tricyclic antidepressant (TCA)
For panic disorder
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Selective serotonin reuptake inhibitor (SSRI)
Panic disorders
Phobias
OCD
33
Affective disorders
Depression and bipolar
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Depression
5-10% of us adult population
35
Sad
Seasonal affective disorder
Decrease in melatonin
36
What are three things to know about antidepressant agents
May take 2-6 weeks for full effect
Sometimes used to treat anxiety disorders
Sometimes used to treat chronic pain
37
MAOI's action
Inhibits breakdown of sympathetic neurotransmitters
38
How do Atypical Antidepressants work
All work slightly different
Work by blocking reuptake of neurotransmitters
OR increase the release of neurotransmitter
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Two trade names of buproprion? What are they used for?
Wellbutrin- major depression
| Zyban- smoking cessation
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Action of Wellbutrin & Zyban (buproprion)
Blocks reuptake of norepinephrine and serotonin
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Indications for Zyban
Smoking cessation
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Indication for Wellbutrin
Major depression
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Side effects of Wellbutrin & Zyban (buproprion)
Weight gain, GI disturbances, headache
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What are there less of with Wellbutrin & Zyban (buproprion)
Less sexual side effects
45
What atypical antidepressant is Nikki on? What does it do
Desyrel (trazadone)
| Blocks reuptake of serotonin, on it for depression
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Indications of Cymbalata (duloxetine)
Major depression
**chronic pain syndromes
GAD
Diabetic neuropathy
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What is the action of Cymbalata (duloxetine)
Blocks reuptake of serotonin and norepinephrine
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Side effects of Cymbalata (duloxetine)
Nausea, dry mouth, constipation, insomnia
49
What does Bipolar Depression display? What is it characterized by?
Displays signs of depression as well as "mania". An emotional state characterized by high psychomotor activity and irritability.
50
In Bipolar Disorder what do you need to distinguish the episodes of mania from
Drug abuse and schizophrenia
51
What may you see with somebody that is in a manic stage
May go days without eating and have to be moving all the time
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Two classes of Bipolar Agents
Eskalith (lithium)
| Antiseizure medications
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What does lithium treat
Bipolar disorder
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How long does lithium take to reach therapeutic levels
2-3 weeks
| Lithium has a narrow therapeutic index; serum levels need to be monitored routinely
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What is the action of lithium thought to be
Thought to alter the activity of neurons containing dopamine, norepinephrine, and serotonin
56
Side effects of lithium
Dizziness, fatigue, short-term memory loss, GI distress, slight tremors
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Nursing considerations for lithium
- do not change diet or decrease fluid intake, because any changes can affect therapeutic drug levels
- avoid alcohol
- do not stop taking ABRUPTLY
- drink plenty of water to prevent dehydration
58
What are used in adjunct therapy with lithium
Antiseizure medications (off label use)
59
Two classes of Attention Deficit Hyperactivity Disorder (ADHD)
CNS stimulants
| Nonstimulants
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Two examples of CNS stimulants used for ADHD
Ritalin
| Adderall
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Side effects of CNS Stimulants
Insomnia, nervousness, weight loss, anorexia, irritability, palpitations
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Action of CNS Stimulants
Stimulate specific areas of the CNS that heighten alertness and increase FOCUS
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Characteristics of CNS stimulants
Traditional agents
Schedule II controlled substances
*high abuse, no refills
Increasing abuse among teens
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Example of a Nonstimulant used for ADHD
Strattera (atomoxetine)
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Is Strattera a Schedule II substance
No. Nonstimulants are not Schedule II substances
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Side effects of Nonstimulants
Headache, insomnia,decreased appetite, upper abdominal pain, increased risk for suicide ideation
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Psychosis characterized by abnormal thoughts and thought processes, disordered communication, withdraw from other people and the outside environment and a high risk of suicide
Schizophrenia
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What are symptoms of Psychosis thought to be associated with
Dopamine type 2 receptors
69
What is the difference in positive and negative symptoms with Psychosis
Positive- add onto the normal behavior: hallucinations, delusions, conceptual disorganization
Negative-subtract from normal behavior: apathy, social withdraw, blunted affect, poverty of speech, catatonia
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What is catatonia
Where they just sit and stare at you
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What are Antipsychotics also known as
Tranquilizers or neuroleptics
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Indications of Antipsychotics
```
Depressive and drug induced psychosis
Schizophrenia
Autism
Extreme mania; bipolar disorder
Movement disorders (Tourettes)
```
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Indications of MAOI's
Major depression
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Side effects of MAOI's
Like being on speed
Orthodtatic hypotension, headache, insomnia
Rarely used due to side effects
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What is the serious concern for MAOI's
Hypertensive crisis when taken with food/beverages containing the amino acid tyramine
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Tyramine found in food
Cheese, red wines, aged/fermented meats, fish, poultry, smoked/pickled meats, fish, poultry, some alcohol
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Overdose on MAOI's
Usually takes 12 hours for symptoms to manifest
Generally neurological and cardiovascular
Treat: symptomatic and supportive
78
Nursing considerations for MAOI's
```
Dietary restrictions
Wear medic alert bracelet
Change positions slowly
May cause sedation
Increased Bp
```
79
Nardil (phenelzine)
MAOI
80
Tricyclic antidepressants
Inhibit reuptake of norepinephrine and serotonin at receptor
81
Indications of TCA
Major depression
Milder situational depression
Panic attacks
Bedwetting
82
Side effects of TCA
Orthostatic hypotension
Sedation
Drying effects
Suicide potential
83
Overdose of TCA's
Death usually occurs before reaching the hospital usually due to CNS or cardiovascular
84
Nursing considerations for TCA's
Takes several weeks to achieve full therapeutic
Changes positions slowly
Avoid using alcohol and CNS depressants
Do not discontinue abruptly
Notify doctors if suicide thoughts increase
85
Elavil (amitriptyline)
TCA's
86
SSRI's action
Inhibit uptake of serotonin
| Allowing increased levels of serotonin
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Indications of SSRI's
All types of depression
| Eating disorders
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Side effects of SSRI's
Few because they are selective
89
Serotonin syndrome
May occur when the client is taking another medication that affects the metabolism, synthesis, or reuptake of serotonin, causing serotonin to accumulate in the body
90
Symptoms of serotonin syndrome
May occur as early as 2 hours after first dose or many weeks later
Mental status change, hypertension, tremors, sweating, hyperpyrexia, ataxia
Severe: respiratory distress and if left untreated =death
91
Prozac (fluoxetine)
SSRI
92
Zoloft (sertraline)
SSRI
93
Classes of Antipsychotics
Phenothiazines & Non-Phenothiazines
| Atypical Antipsychotics
94
What symptoms do Phenothiazines & Non-Phenothiazines primarily control
Primarily control "positive" symptoms of schizophrenia
95
Action of Phenothiazines and Non-Phenothiazines
Thought to act by preventing dopamine and serotonin from occupying their RECEPTOR sites in certain regions of the brain responsible for emotions, cognitive function, and motor function
96
With Phenothiazines & Non-Phenothiazines what side effects do you see when you
Block alpha receptors=
Block histamine receptors=
Block serotonin receptors and block dopamine receptors in the CTZ & peripherally block vagus nerve in GI tract=
Block alpha receptors=HYPOTENSION
Block histamine receptors=ANTICHOLINERGIC SIDE EFFECTS
Block serotonin receptors and block dopamine receptors in the CTZ & peripherally block vagus nerve in GI tract= ANTIEMETIC EFFECTS
97
Constant pacing with receptive, compulsive movements
Akathisia
98
Severe spasms, particularly the back muscles, tongue, and facial muscles; twitching movements
Dystonia
99
What are EPS? When may you see them?
Extrapyramidal symptoms
| Involves involuntary motor symptoms similar to those associated with PD, akathisia, and acute dystonia
100
What is Tardive dyskinesia? When does it appear?
Appears after long term use; involves involuntary contractions of oral and facial muscles (tongue thrusting) and wave like movements of extremities
101
Thorazine (chlorpromazine)
Phenothiazine
| Typical antipsychotic
102
Haldol (haloperidol)
Non-Phenothiazine
| Typical antipsychotic
103
When is Haldol given a lot
In emergency situations
104
What are 3 things you see with Non-Phenothiazines like Haldol
Less sedation
Hypotension
Anticholinergic effects
105
Phenothiazines and Non-Phenothiazines are considered "_________" or ________
Typical or conventional
106
What generation are Atypical Antipsychotics
Second generation
107
Action of Atypical Antipsychotics
Block specific dopamine, serotonin, and alpha receptors in the brain. More loosely bound to D2 receptors; less EPS symptoms
108
Do Atypical Antipsychotics improve the positive or negative symptoms of schizophrenia
They improve BOTH
109
Side effects of Atypical Antipsychotics
Specific to each agent
- Lower risk of EPS and TD
- Treatment can begin earlier
- Some appetite stimulating effects
- Effects may differ depending on receptors and individual
110
Zyprexa (olanzapine)
Atypical Antipsychotic
111
Action of Zyprexa (olanzapine)
Blocks dopamine&serotonin&histamine&alpha 1 and 2
112
Indications of Zyprexa (olanzapine)
Schizophrenia and bipolar mania
113
Side effects of Zyprexa(olanzapine)
Drowsy, dizzy, agitation, insomnia, HA, hostility
114
Action of Abilify (aripiprazole)
Dopamine and serotonin agonist
115
Indications for Abilify (aripiprazole)
Psychotic disorders, bipolar disorder
116
Side effects of Abilify (aripiprazole)
HA, insomnia, weight gain
117
Melatonin
Sleep
118
Kava kava
Anxiety
119
Valerian
Anxiety
120
St. John's Wort
Depression
