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Pharm Test 4 > Psychotherapeutic Agents > Flashcards

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)

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1
Q

Psychotherapeutic

A

Treatment of emotional and mental disorders

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2
Q

3 main emotional and mental disorders

A

Psychosis
Affective disorders
Anxiety

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3
Q

Psychosis

A

Severe emotional disorder often impairs mental function and adl’s

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4
Q

Affective disorders

A

Mood disorders

Changes in mood and range from mania to depression

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5
Q

Anxiety

A

Unpleasant state of mind chiefly characterized by a sense of dread and fear

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6
Q

Biochemical imbalance

A

Abnormal levels of endogenous chemicals in the brain

Neurotransmitters like norepinephrine, dopamine, histamine, serotonin, acetylcholine

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7
Q

What drug types do you take for insomnia and anxiety

A

Anxiolytics and sedative hypnotic agents

CNS depressants

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8
Q

Anxiolytics

A

Anti anxiety

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9
Q

Sedative

A

Reduces nervousness, excitability, irritability without causing sleep

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10
Q

Hypnotic

A

CAUSES SLEEP

more potent than sedatives

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11
Q

Sedative-hypnotics

A

Calms you down and keeps you asleep

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12
Q

Barbiturates for anxiety and insomnia

A

First hypnotic

CNS depressant

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13
Q

Indications of barbiturates

A

Sleep and seizure control

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14
Q

Side effects of barbiturates

A

Disturbed rem sleep
Nightmares
Very addictive and easy to overdose
Withdrawal is severe

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15
Q

Why are barbiturates very rarely used now

A

Their severe side effects

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16
Q

Examples of barbiturates for sleep or preop

A

Seconal (secobarbital)

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17
Q

Barbiturates for seizures

A

Luminal (phenobarbital)

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18
Q

Benzodiazepines for anxiety and insomnia

A

Most commonly prescribed

Fairly good side effects, efficacy, and safety

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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

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20
Q

Indications of benzodiazepines

A 
Anxiety
Insomnia
Muscle spasm 
EMERGENT seizures 
Treat alcohol addiction
Provide anesthesia (combination of other drugs)
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21
Q

Contraindications of benzodiazepines

A

Fairly safe

Pregnancy, glaucoma, geriatric population

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22
Q

Side effects of benzodiazepines

A

Very few

All CNS related

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23
Q

Interactions of benzodiazepines

A

CNS depressants

MAOIs

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24
Q

Examples of benzodiazepines

A

Valium (diazepam)
Xanax (alprazolam)
Ativan (lorazepam)

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25
Q

What would symptoms of benzodiazepines overdose be

A

Drowsiness
Sedation
Respiratory depression

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26
Q

What would you treat an overdose of benzodiazepines with

A

Flumazenil (romazicon)

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27
Q

What are non-benzodiazepines hypnotic agents used for

A

Only for sleep

Help getting you to sleep and keeping you to sleep

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28
Q

Benefits of non-benzodiazepines hypnotic agents

A

Short half-life
Less groggy in morning
Less abuse potential

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29
Q

Ambien (zolpidem)

A

Non-benzodiazepine hypnotic agent

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30
Q

Antidepressants can also be used for

A

Anxiety

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31
Q

Tricyclic antidepressant (TCA)

A

For panic disorder

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32
Q

Selective serotonin reuptake inhibitor (SSRI)

A

Panic disorders
Phobias
OCD

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33
Q

Affective disorders

A

Depression and bipolar

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34
Q

Depression

A

5-10% of us adult population

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35
Q

Sad

A

Seasonal affective disorder

Decrease in melatonin

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36
Q

What are three things to know about antidepressant agents

A

May take 2-6 weeks for full effect
Sometimes used to treat anxiety disorders
Sometimes used to treat chronic pain

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37
Q

MAOI’s action

A

Inhibits breakdown of sympathetic neurotransmitters

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38
Q

How do Atypical Antidepressants work

A

All work slightly different
Work by blocking reuptake of neurotransmitters
OR increase the release of neurotransmitter

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39
Q

Two trade names of buproprion? What are they used for?

A

Wellbutrin- major depression

Zyban- smoking cessation

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40
Q

Action of Wellbutrin & Zyban (buproprion)

A

Blocks reuptake of norepinephrine and serotonin

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41
Q

Indications for Zyban

A

Smoking cessation

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42
Q

Indication for Wellbutrin

A

Major depression

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43
Q

Side effects of Wellbutrin & Zyban (buproprion)

A

Weight gain, GI disturbances, headache

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44
Q

What are there less of with Wellbutrin & Zyban (buproprion)

A

Less sexual side effects

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45
Q

What atypical antidepressant is Nikki on? What does it do

A

Desyrel (trazadone)

Blocks reuptake of serotonin, on it for depression

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46
Q

Indications of Cymbalata (duloxetine)

A

Major depression
**chronic pain syndromes
GAD
Diabetic neuropathy

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47
Q

What is the action of Cymbalata (duloxetine)

A

Blocks reuptake of serotonin and norepinephrine

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48
Q

Side effects of Cymbalata (duloxetine)

A

Nausea, dry mouth, constipation, insomnia

49
Q

What does Bipolar Depression display? What is it characterized by?

A

Displays signs of depression as well as “mania”. An emotional state characterized by high psychomotor activity and irritability.

50
Q

In Bipolar Disorder what do you need to distinguish the episodes of mania from

A

Drug abuse and schizophrenia

51
Q

What may you see with somebody that is in a manic stage

A

May go days without eating and have to be moving all the time

52
Q

Two classes of Bipolar Agents

A

Eskalith (lithium)

Antiseizure medications

53
Q

What does lithium treat

A

Bipolar disorder

54
Q

How long does lithium take to reach therapeutic levels

A

2-3 weeks

Lithium has a narrow therapeutic index; serum levels need to be monitored routinely

55
Q

What is the action of lithium thought to be

A

Thought to alter the activity of neurons containing dopamine, norepinephrine, and serotonin

56
Q

Side effects of lithium

A

Dizziness, fatigue, short-term memory loss, GI distress, slight tremors

57
Q

Nursing considerations for lithium

A
  • 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
Q

What are used in adjunct therapy with lithium

A

Antiseizure medications (off label use)

59
Q

Two classes of Attention Deficit Hyperactivity Disorder (ADHD)

A

CNS stimulants

Nonstimulants

60
Q

Two examples of CNS stimulants used for ADHD

A

Ritalin

Adderall

61
Q

Side effects of CNS Stimulants

A

Insomnia, nervousness, weight loss, anorexia, irritability, palpitations

62
Q

Action of CNS Stimulants

A

Stimulate specific areas of the CNS that heighten alertness and increase FOCUS

63
Q

Characteristics of CNS stimulants

A

Traditional agents
Schedule II controlled substances
*high abuse, no refills
Increasing abuse among teens

64
Q

Example of a Nonstimulant used for ADHD

A

Strattera (atomoxetine)

65
Q

Is Strattera a Schedule II substance

A

No. Nonstimulants are not Schedule II substances

66
Q

Side effects of Nonstimulants

A

Headache, insomnia,decreased appetite, upper abdominal pain, increased risk for suicide ideation

67
Q

Psychosis characterized by abnormal thoughts and thought processes, disordered communication, withdraw from other people and the outside environment and a high risk of suicide

A

Schizophrenia

68
Q

What are symptoms of Psychosis thought to be associated with

A

Dopamine type 2 receptors

69
Q

What is the difference in positive and negative symptoms with Psychosis

A

Positive- add onto the normal behavior: hallucinations, delusions, conceptual disorganization

Negative-subtract from normal behavior: apathy, social withdraw, blunted affect, poverty of speech, catatonia

70
Q

What is catatonia

A

Where they just sit and stare at you

71
Q

What are Antipsychotics also known as

A

Tranquilizers or neuroleptics

72
Q

Indications of Antipsychotics

A 
Depressive and drug induced psychosis 
Schizophrenia
Autism
Extreme mania; bipolar disorder
Movement disorders (Tourettes)
73
Q

Indications of MAOI’s

A

Major depression

74
Q

Side effects of MAOI’s

A

Like being on speed
Orthodtatic hypotension, headache, insomnia

Rarely used due to side effects

75
Q

What is the serious concern for MAOI’s

A

Hypertensive crisis when taken with food/beverages containing the amino acid tyramine

76
Q

Tyramine found in food

A

Cheese, red wines, aged/fermented meats, fish, poultry, smoked/pickled meats, fish, poultry, some alcohol

77
Q

Overdose on MAOI’s

A

Usually takes 12 hours for symptoms to manifest
Generally neurological and cardiovascular

Treat: symptomatic and supportive

78
Q

Nursing considerations for MAOI’s

A 
Dietary restrictions 
Wear medic alert bracelet 
Change positions slowly 
May cause sedation 
Increased Bp
79
Q

Nardil (phenelzine)

80
Q

Tricyclic antidepressants

A

Inhibit reuptake of norepinephrine and serotonin at receptor

81
Q

Indications of TCA

A

Major depression
Milder situational depression
Panic attacks
Bedwetting

82
Q

Side effects of TCA

A

Orthostatic hypotension
Sedation
Drying effects
Suicide potential

83
Q

Overdose of TCA’s

A

Death usually occurs before reaching the hospital usually due to CNS or cardiovascular

84
Q

Nursing considerations for TCA’s

A

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
Q

Elavil (amitriptyline)

86
Q

SSRI’s action

A

Inhibit uptake of serotonin

Allowing increased levels of serotonin

87
Q

Indications of SSRI’s

A

All types of depression

Eating disorders

88
Q

Side effects of SSRI’s

A

Few because they are selective

89
Q

Serotonin syndrome

A

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
Q

Symptoms of serotonin syndrome

A

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
Q

Prozac (fluoxetine)

92
Q

Zoloft (sertraline)

93
Q

Classes of Antipsychotics

A

Phenothiazines & Non-Phenothiazines

Atypical Antipsychotics

94
Q

What symptoms do Phenothiazines & Non-Phenothiazines primarily control

A

Primarily control “positive” symptoms of schizophrenia

95
Q

Action of Phenothiazines and Non-Phenothiazines

A

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
Q

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=

A

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
Q

Constant pacing with receptive, compulsive movements

98
Q

Severe spasms, particularly the back muscles, tongue, and facial muscles; twitching movements

99
Q

What are EPS? When may you see them?

A

Extrapyramidal symptoms

Involves involuntary motor symptoms similar to those associated with PD, akathisia, and acute dystonia

100
Q

What is Tardive dyskinesia? When does it appear?

A

Appears after long term use; involves involuntary contractions of oral and facial muscles (tongue thrusting) and wave like movements of extremities

101
Q

Thorazine (chlorpromazine)

A

Phenothiazine

Typical antipsychotic

102
Q

Haldol (haloperidol)

A

Non-Phenothiazine

Typical antipsychotic

103
Q

When is Haldol given a lot

A

In emergency situations

104
Q

What are 3 things you see with Non-Phenothiazines like Haldol

A

Less sedation
Hypotension
Anticholinergic effects

105
Q

Phenothiazines and Non-Phenothiazines are considered “_________” or ________

A

Typical or conventional

106
Q

What generation are Atypical Antipsychotics

A

Second generation

107
Q

Action of Atypical Antipsychotics

A

Block specific dopamine, serotonin, and alpha receptors in the brain. More loosely bound to D2 receptors; less EPS symptoms

108
Q

Do Atypical Antipsychotics improve the positive or negative symptoms of schizophrenia

A

They improve BOTH

109
Q

Side effects of Atypical Antipsychotics

A

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
Q

Zyprexa (olanzapine)

A

Atypical Antipsychotic

111
Q

Action of Zyprexa (olanzapine)

A

Blocks dopamine&serotonin&histamine&alpha 1 and 2

112
Q

Indications of Zyprexa (olanzapine)

A

Schizophrenia and bipolar mania

113
Q

Side effects of Zyprexa(olanzapine)

A

Drowsy, dizzy, agitation, insomnia, HA, hostility

114
Q

Action of Abilify (aripiprazole)

A

Dopamine and serotonin agonist

115
Q

Indications for Abilify (aripiprazole)

A

Psychotic disorders, bipolar disorder

116
Q

Side effects of Abilify (aripiprazole)

A

HA, insomnia, weight gain

117
Q

Melatonin

118
Q

Kava kava

119
Q

Valerian

120
Q

St. John’s Wort

A

Depression

Pharm Test 4 (7 decks)

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