Psychotherapeutic Drugs

Question 1

Main anxiolytic

Answer 1

Benzodiazepines: Diazepam and chlordiazepoxide

Question 2

Indications for chlordiazepoxide or diazepam

Answer 2

Anxiety disorders

Muscle relaxants

Alcohol withdrawal

Question 3

Nursing considerations for chlordiazepoxide and diazepam

Answer 3

Teaching: do not take with alcohol, don’t drive if sedated

Eliminated in liver: May become toxic

Addiction potential

Question 4

What is the anti mania drug

Answer 4

Lithium carbonate

Question 5

Indications for lithium carbonate

Answer 5

Bipolar: mania

Question 6

Side effects of lithium

Answer 6

Slight tremor, dull, headache, metallic, taste, polydipsia

Question 7

Nursing considerations for lithium carbonate

Answer 7

Takes several weeks to have effect on acute mania

Narrow therapeutic window: blood level 0.5 to 1.5 mEq/L

Salt is close chemistry of sodium.. if Na is too low, lithium levels go up

Question 8

What happens when lithium carbonate produces toxicity in the body

Answer 8

Disrupts muscle conduction: course tremor, GI upset, confusion, ataxia, coma, death

The person will look drunk: confused, slurred speech

Question 9

What are the categories of anti-depressants?

Answer 9

Monoamine oxidase inhibitors (MAOIs)

Tricyclics

Serotonin selective reuptake inhibitors (SSRIs)

Dopamine reuptake inhibitor

Norepinephrine and serotonin reuptake inhibitor (NSRI)

5HT2 receptor agonist

Noradrenergic agonist

Question 10

Therapeutic effects for benzodiazepine as an anxiolytic

Answer 10

Sedation, Anterograde amnesia, skeletal muscle relaxant

Question 11

What is the teaching for MAOIs?

Answer 11

Low tyramine diet (aged foods) and no decongestants

Suicide assessment!

Question 12

Why do you need a low tyramine diet while on a MAOI?

Answer 12

Too much tyramine in the body becomes a substance similar to epinephrine, that would cause the BP to rise to dangerous levels.

Question 13

Prototype for MAOIs for treating depression

Answer 13

Phenelzine

Question 14

Prototype for tricyclics

Answer 14

Amitriptyline

Question 15

How long does a tricyclic take to work?

Answer 15

2 weeks

Question 16

Nursing considerations for tricyclics

Answer 16

Suicide assessment!! It’s toxic in doses equivalent to a 3 week supply

Question 17

What is the action (therapeutic effect) of all antidepressants?

Answer 17

Improve energy first

Other symptoms of depression lifts.. THEN depression mood lifts

Question 18

Side of effects of tricyclics

Answer 18

Sedation.. but it eventually wears off

Question 19

Prototype for an SSRI

Answer 19

Fluoxetine

Question 20

Nursing considerations for SSRI

Answer 20

Not as toxic as tricyclics (hard to OD)

Suicide assessment

Question 21

Adverse effects for SSRI

Answer 21

Sexual dysfunction in both sexes

Question 22

What are the 2 antipsychotic drugs?

Answer 22

Typical phenothiazines

Atypical antipsychotics

Question 23

What is the prototype for the typical phenothiazines?

Answer 23

Prototype at low potency: chlorpromazine

Prototype at high potency: haloperidol

Question 24

What is the indications for the typical phenothiazines

Answer 24

Positive symptoms of psychosis like hallucinations

Question 25

Side effects of typical phenothiazines

Answer 25

EPS (extrapyramidal side effects) and anticholinergic side effects High potency = high EPS Low potency = low EPS

Question 26

Why do we prescribe haldol with an anticholinergic

Answer 26

Because it is very likely to cause acute dystonic reaction (a type of EPS)

Question 27

What side effect is most likely to cause patients to stop taking their antipsychotic

Answer 27

Akathisia

Question 28

Nursing considerations for Thorazine and haldol

Answer 28

Teach: risk and symptoms of tardive dyskinesia

Question 29

What is akathisia

Answer 29

Can’t sit still Inner restlessness

Question 30

What is acute dystonic reaction

Answer 30

Painful muscle stiffness in the head and neck- torticollis Severe reaction may prevent swallowing and presents choke risk.

Question 31

What is neuroleptic malignant syndrome?

Answer 31

Severe muscle stiffness, fever, unstable blood pressure

Question 32

Prototype for the atypical antipsychotic

Answer 32

Clozaril

Question 33

Indications for Clozaril

Answer 33

Negative symptoms of psychosis, like apathy, lack of motivation (Maybe schizophrenia?)

Question 34

Nursing considerations for clozaril specifically

Answer 34

Weekly WBC counts for at least a year because risk of agranulocytosis

Question 35

What is the biggest nursing challenge for the atypical antipsychotics?

Answer 35

Weight gain (metabolic syndrome)