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Psychotherapeutic Drugs Flashcards

1
Q

Psychotherapeutic Drugs

A

Used in the treatment of emotional and mental disorders

Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress.

When emotions significantly affect an individual’s ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option.

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2
Q

Three mental health disorders

A

Anxiety
Affective disorders
Psychotic disorders

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3
Q

Types of psychotherapeutic drugs

A

Anxiolytic drugs
Mood-stabilizing drugs
Antidepressant drugs
Antipsychotic drugs

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4
Q

Anxiety

A

An unpleasant state of mind characterized by a sense of dread and fear

May be based on anticipated experiences or actual past experiences

May be exaggerated responses to imaginary negative situations

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5
Q

Anxiety Disorders

A

Distinct disorders

-Separation anxiety disorder
-Selective mutism
-Specific phobia
-Social anxiety disorder (social phobia)
-Panic disorder
-Panic attack
-Agoraphobia
-Generalized anxiety disorder
-Substance- or medication-induced anxiety disorder

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6
Q

Affective Disorders (Mood Disorders)

A

Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions)

Some patients may exhibit both mania and depression: bipolar disorder (BPD)

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7
Q

Psychosis

A

Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living.

Hallmark: loss of contact with reality

Examples:
Schizophrenia
Depressive and drug-induced psychoses

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8
Q

Anxiolytic Drug: 1 medication

A

Reduce anxiety by reducing overactivity in the central nervous system (CNS)

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9
Q

Benzodiazepines

A

Depress activity in the brainstem and limbic system

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10
Q

Miscellaneous drug: buspirone (BuSpar®)

*Don’t need to know

A

Nonsedating and non–habit forming

May have drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)

Do not administer with monoamine oxidase inhibitors (MAOIs)

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11
Q

3 Benzodiazepines

A

alprazolam (Xanax®)

diazepam (Valium®)

lorazepam (Ativan®)

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12
Q

Benzodiazepines: Adverse Effects

A

Benzodiazepines’ adverse effects are an overexpression of their therapeutic effects.

-Decreased CNS activity, sedation, amnesia
-Hypotension
-Drowsiness, loss of coordination, dizziness, -headaches
-Nausea, vomiting, dry mouth, constipation

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13
Q

Benzodiazepines: Overdose treatment

A

Flumazenil may be used to reverse benzodiazepines’ effects.

Symptomatic and supportive. Dangerous when taken with other sedatives or alcohol.

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14
Q

Benzodiazepines: Interactions

A

Alcohol and CNS depressants can result in additive CNS depression and even death.

Interactions are more likely to occur in patients with renal or hepatic compromise.

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15
Q

alprazolam (Xanax)

A

Most commonly used as an anxiolytic

Indicated for generalized anxiety disorder (GAD), short-term relief of anxiety symptoms, panic disorder and anxiety associated with depression

Adverse effects: confusion, ataxia, headache, and others

Interactions: alcohol ,antacids, oral contraceptives, and others

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16
Q

diazepam (Valium)

A

Indications: relief of anxiety, management of alcohol withdrawal, reversal of status epilepticus, preoperative sedation, and as an adjunct for the relief of skeletal muscle spasms

Avoid in patients with hepatic dysfunction.

Adverse effects: headache, confusion, slurred speech, and others

Interactions: alcohol, oral contraceptives, and others

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17
Q

lorazepam (Ativan)

A

Intermediate-acting benzodiazepine

Can be given intravenously or intramuscularly; useful in the treatment of an acutely agitated patient

Continuous infusion for agitated patients who are undergoing mechanical ventilation

Used to treat or prevent alcohol withdrawal

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18
Q

Miscellaneous Anxiolytic

buspirone hydrochloride

*DONT NEED TO KNOW

A

Unknown mechanism of action
Administered on a scheduled basis

Adverse effects:
-Paradoxical anxiety
-Blurred vision
-Dizziness
-Headache
-Nausea

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19
Q

Mood-Stabilizing Drugs

A

Lithium carbonate and lithium citrate

Used to treat bipolar disorder (cycles of mania, hypomania, depression)

Other drugs may be used in combination with lithium

-Benzodiazepines
-Antipsychotic drugs
-Antiepileptic drugs
-Dopamine receptor agonists

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20
Q

Lithium

A

Drug of choice for the treatment of mania

Thought to potentiate serotonergic neurotransmission

Narrow therapeutic range – needs blood monitoring: acute mania—lithium serum level of 1 to 1.5 mmol/L. Maintenance serum levels should range between 0.6 mmol/L and 1.2 mmol/L.

Levels exceeding 1.5 to 2.0 mmol/L begin to produce toxicity (severe reaction exceeding 2.0 mmol/L), including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death.

Keeping the sodium level in the normal range (135 to 145 mmol/L) helps maintain therapeutic lithium levels.

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21
Q

Lithium Adverse effects

A

Most serious adverse effect is cardiac dysrhythmia.

Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension

Long-term treatment may cause hypothyroidism.

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22
Q

Antidepressants 1st generation

A

Tricyclics
Tetracyclics
MAOIs

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23
Q

Second-generation antidepressants

A

SSRIs
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous

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24
Q

Tricyclic Antidepressants

1 drug and facts

A

Have largely been replaced by SSRIs as first-line antidepressant drugs

Considered second line drugs
-For patients for whom SSRIs or other newer generation antidepressants fail
-As adjunct therapy with newer-generation antidepressants

amitriptyline (Elavil®)

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25
Q

Tricyclic Antidepressants: Mechanism of Action

A

Block reuptake of neurotransmitters, causing accumulation at the nerve endings

It is thought that these drugs may help regulate malfunctioning neurons.

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26
Q

Tricyclic Antidepressants: Indications

A

Neuropathic pain, insomnia

Childhood enuresis (imipramine)

Obsessive compulsive disorders (OCDs) (clomipramine)

Sometimes, anorexia

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27
Q

Tricyclic Antidepressants: Adverse Effects

A

Sedation
Impotence
Orthostatic hypotension

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28
Q

Tricyclic Antidepressants: Overdose results in?

A

Lethal; 70 to 80% die before reaching the hospital.

CNS and cardiovascular systems are mainly affected.

Death results from seizures or dysrhythmias.

29
Q

Tricyclic Antidepressants:Overdose treatment

A

No specific antidote

Decrease drug absorption with activated charcoal.

Speed elimination by alkalinizing urine.

Manage seizures and dysrhythmias.

Provide basic life support.

30
Q

amitriptyline (Elavil)

A

Oldest and most widely used of all the tricyclic antidepressants

Original indication: depression

Commonly used to treat insomnia and neuropathic pain

Contraindications: known drug allergy, pregnancy, and recent myocardial infarction.

Adverse effects: dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias

31
Q

Monoamine Oxidase Inhibitors (MAOIs)

A

Nonselective: phenelzine sulphate and tranylcypromine sulphate

Selective: selegiline hydrochloride

Rarely used for depression

Used for Parkinson’s disease

Disadvantage: potential to cause hypertensive crisis when taken with tyramine

32
Q

MAOIs and Tyramine

A

Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death

Patients must avoid foods that contain tyramine!

33
Q

Foods that contain tyramine!

A

Aged, mature cheeses (cheddar, blue, Swiss)

Smoked, pickled, and aged meats, fish, and poultry (herring, sausage, corned beef, salami, pepperoni, paté)

Yeast extracts

Red wines (e.g., Chianti, burgundy, sherry, vermouth)

Italian broad beans (fava beans)

34
Q

Second-Generation Antidepressants

A

bupropion (Wellbutrin®)

SNRI – duloxetine hydrochloride (Cymbalta)

SSRIs
–fluoxetine (Prozac®)

35
Q

Second-Generation Antidepressants Indications

A

Depression

BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, the neurologic disorder myoclonus, and various substance misuse problems such as alcoholism

36
Q

Second-Generation Antidepressants

A

Adverse effects: insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction

Watch for excessive effects of serotonin on the CNS – Serotonin Syndrome

37
Q

duloxetine hydrochloride (Cymbalta®)

A

Indications: depression, generalized anxiety disorder (GAD), and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis

Adverse effects: dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity.

Drug interactions: SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury)

Can worsen uncontrolled angle-closure glaucoma

38
Q

bupropion hydrochloride

A

Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation

Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy

Zyban®: approved for smoking cessation treatment and was the first nicotine-free prescription medication used to treat nicotine dependence

39
Q

fluoxetine (Prozac)

A

Prototypical SSRI

Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder

Contraindications: known drug allergy and concurrent MAOI therapy

Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

40
Q

mirtazapine (Remeron®)

**Don’t need to know

A

Promotes the presynaptic release of serotonin and norepinephrine in the brain

Sedation

Indications: depression (including that associated with BPD), sexual adverse effects in male patients receiving SSRI therapy (reduction), and an appetite stimulant

Contraindications: drug allergy and MAOIs

Adverse effects: drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia

Drug interactions: additive CNS depressant effects with alcohol and cytochrome P-450 (CYP) inhibitors

41
Q

Antipsychotics

A

Drugs used to treat serious mental illness

-Drug-induced psychoses, schizophrenia, and autism
-Also used to treat extreme mania (as an adjunct to lithium), BPD, depression that is resistant to other therapy, certain movement disorders (e.g., Tourette’s syndrome), and certain other medical conditions (e.g., nausea, intractable hiccups)

42
Q

Antipsychotics

3 classes and examples

A

Conventional, or first-generation antipsychotics: phenothiazines – haloperidol

Second-generation antipsychotics

Atypical antipsychotics – clozapine, resperidone

43
Q

Antipsychotics

A

Conventional, or first-generation antipsychotics: phenothiazines – haloperidol

Second-generation antipsychotics

Atypical antipsychotics – clozapine, resperidone

44
Q

Antipsychotics: Mechanism of Action

A

Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function

Dopamine levels in the CNS are decreased.

Result: tranquilizing effect in psychotic patients

45
Q

Positive Symptoms of Schizophrenia

A

Positive symptoms: hallucinations, delusions, and conceptual disorganization

46
Q

Negative Symptoms of Schizophrenia

A

Negative symptoms: apathy, social withdrawal, blunted affect, poverty of speech, and catatonia

47
Q

All antipsychotics show efficacy in improving the ______ symptoms of schizophrenia.

Conventional drugs are less effective in managing ______ symptoms.

_______ antipsychotics have greater efficacy in treating both positive and negative symptoms.

A

All antipsychotics show efficacy in improving the positive symptoms of schizophrenia.

Conventional drugs are less effective in managing negative symptoms.

Atypical antipsychotics have greater efficacy in treating both positive and negative symptoms.

48
Q

Antipsychotic Drugs: Indications

A

Psychotic illness, most commonly schizophrenia

Anxiety and mood disorders

prochlorperazine (antiemetics)

49
Q

Antipsychotic Drugs: Adverse Effects

A

Agranulocytosis and hemolytic anemia

CNS effects:
Drowsiness
Neuroleptic malignant syndrome (NMS)

Extrapyramidal symptoms (EPS): pseudoparkinsonism-akathisia, acute dystonia treated with benztropine (Kynesia®) and trihexyphenidyl hydrochloride
Tardive dyskinesia

NMS:
Potentially life threatening
High fever, unstable blood pressure, myoglobinemia

EPS:
Involuntary muscle symptoms similar to those of Parkinson’s disease
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)

50
Q

EPS symptoms are treated with?

A

Treated with benztropine (Cogentin®) and trihexyphenidyl (Artane®)

51
Q

Tardive dyskinesia

A

Involuntary contractions of oral and facial muscles

Choreoathetosis (wavelike movements of extremities)

Occurs with continuous long-term antipsychotic therapy

52
Q

Adverse Effects: Antipsychotic Drugs

A

Tardive dyskinesia
Insulin resistance
Weight gain
Changes in serum lipid levels
Cardiometabolic syndrome

53
Q

haloperidol

A

Indications: long-term treatment of psychosis

Contraindications: hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken

Oral, intramuscular

Useful in treating patients with schizophrenia who were nonadherent to their drug regimen

54
Q

Atypical Antipsychotics

A

clozapine (Clozaril®)
risperidone (Risperdal®)

55
Q

Atypical Antipsychotics:Mechanism of Action

A

Block specific dopamine receptors: dopamine-2 (D2) receptors

Also block specific serotonin receptors: serotonin-2 (5-HT2) receptors
–This is responsible for their improved efficacy and safety profiles.

56
Q

clozapine (Clozaril®)

A

Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain

Associated with minor or no EPS

Adverse effects: blood dyscrasias

57
Q

risperidone (Risperdal®)

A

Indication: schizophrenia (including negative symptoms)

Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day.

Oral and long-acting injectable forms

58
Q

Herbal Products: St. John’s Wort

A

Used for depression, anxiety, sleep disorders, nervousness

May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity

Severe interactions if taken with MAOIs and SSRIs; many other drug interactions

Food–drug interaction with tyramine-containing foods

59
Q

Psychotherapeutic Drugs: Nursing Implications

A

Before beginning therapy, assess the physical and emotional status of patients.

Obtain baseline vital signs, including postural blood pressure readings.

Obtain liver and renal function tests.

Assess for possible contraindications to therapy, cautious use, and potential drug interactions.

Assess for level of consciousness, mental alertness, and potential for injury to self and others.

Check the patient’s mouth to make sure oral doses are swallowed.

Provide the patient with simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected.

Advise patients to avoid abrupt withdrawal.

Advise patients to change positions slowly to avoid postural hypotension and possible injury.

The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills.

Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal.

60
Q

Psychotherapeutic Drugs: Important Consideration

A

Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts.

61
Q

Antianxiety drugs

A

With older adult patients, monitor closely for oversedation and profound CNS depression.

62
Q

Antidepressants

A

Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants.

Inform patients that it may take several weeks to see therapeutic effects.

Monitor patients closely during this time, assess for suicidal tendencies, and provide support.

Assist older adult and weakened patients with ambulation and other activities because falls may occur due to drowsiness or postural hypotension.

To avoid interactions with anaesthetic drugs, tricyclics may need to be weaned and discontinued before a patient undergoes surgery.

Monitor for adverse effects and discuss with patients.

Caffeine and cigarette smoking may decrease the effectiveness of medication therapy.

When MAOIs are given, teach the patient and family about tyramine-containing foods and the signs and symptoms of hypertensive crisis.

63
Q

Antipsychotics—phenothiazines (e.g. chlorpromazine, etc.)

A

Instruct patients to wear sunscreen because of photosensitivity.

Tell patients to avoid taking antacids within 1 hour of a dose.

Inform patients to avoid alcohol and other CNS depressants with these medications.

64
Q

Antipsychotics—phenothiazines

A

Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups. Report these symptoms to the physician

Oral forms may be taken with meals to decrease GI upset.

May cause drowsiness, dizziness, or fainting. Instruct patients to change positions slowly.

65
Q

Monitor for therapeutic effects

A

Monitor mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns.

Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement.

66
Q

For anxiolytics: therapeutic effects

A

Improved mental alertness, cognition, and mood

Fewer anxiety and panic attacks

Improved sleep patterns and appetite

Less tension and irritability; fewer feelings of fear,
impending doom, and stress

More interest in self and others

67
Q

For antidepressants: therapeutic effects

A

Improved sleep patterns and nutrition

Increased feelings of self-esteem

Decreased feelings of hopelessness

Increased interest in self and appearance

Increased interest in daily activities

Fewer depressive manifestations or suicidal thoughts or ideations

68
Q

For antipsychotics: therapeutic effects

A

Improved mood and affect

Alleviation of psychotic symptoms and episodes

Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope

69
Q

For lithium: therapeutic effects

A

Less mania

Therapeutic lithium levels of 0.6 to 1.2 mmol/L

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