Psychotherapeutic Drugs Flashcards
What type of drugs treat anxiety?
Anxiolytics
What type of drugs treat affective disorders? What conditions do they treat?
Antidepressants (depression) Mood stabilizers (bipolar)
What condition is a psychosis disorder? What is used to treat it?
Schizophrenia (antipsychotics)
What are the 5 main anxiety disorders?
Panic disorder without agoraphobia Generalized anxiety disorder OCD social anxiety PTSD
What are the Sx of a pt with a panic disorder?
Increased HR
Hyperventilation
SOB
sweating
What is agoraphobia?
Specifically avoiding certain environments or situations due to possible anxiety attack
What is classifies an individual with General Anxiety Disorder (GAD)?
- Pt gets anxiety from regular everyday things
- interferes with everyday life
- last longer than 6 months
What are the Sx of GAD?
Fatigue
Irritability
What is Obsessive compulsive disorder? Example?
A compulsion to do something to deal with an obsession
Germaphobe
Obsession-germs
Complusion-washing hands all the time
What is an example of a social phobia?
Public speaking
What type of pt often experience PTSD?
Military
First responders
Police
What can cause PTSD? What are Sx of it?
An event can cause it
Sx
Flash backs
Night terrors
What physiological event causes anxiety? How can it be caused?
Overactive limbic system
Due to
limbic system overacting
personal insecurities
Psychological conflicts
What are the Sx of anxiety?
Sweat palms Trembling Nausea No appetite Tachycardia Emotional
What part of CNS effect anxiety?
Limbic system
What part of PNS effects anxiety?
Sympathetic system
What is the MOA for anxiolytics?
GABA-A (increasing Cl- permeability)
What is the Fxn of benzodiazepines?
Depress activity of brainstem and limbic system
What are the 4 SOA for Benzodiazepines? What type of drugs are used there?
Limbic system-anxiolytics
RAS-sedative, hypnotic
Spinal cord-muscle relaxants
Cerebral cortex- anticonvulsants
What are benzodiazepines indicated for?
Alcohol w/drawl
Conscious sedation
What type of benzodiazepines are long acting?
Chlordiazepoxide
Clonazepam
Diazepam
What type of long acting benzodiazepine is used for alcohol withdrawal?
Chlordiazepoxide
What type of benzodiazepines are short acting?
Alprazolam
Lorazepam
What is Buspirone(BuSpar)? MOA? How often is it administered? Why is it used more than benzodiazepines?
Miscellaneous anxiolytic
Blocks 5HT1a auto receptor
Administered BID (2x daily)
Less abuse potential than benzodiazepines
What can cause increased risk of schizophrenia?
Environment=drug abuse
Genetics=both parents having schizophrenia (40x chance increase)
What do positive Sx mean?
Sx that are added to a pt
What do negative Sx mean?
Sx, attitudes and personality that is taken away from pt.
What are the positive Sx of schizophrenia?
Delusions
Hallucinations
Thought disorders
Bizarre behavior
What type of hallucinations are seen in schizophrenic pt?
Tactile, auditory, visual
What age does schizophrenia usually develop in?
16-30yo
What percent of Americans have schizophrenia?
1.1%
What are the negative Sx of schizophrenia?
Flattened emotions (robotic) Emotional/social withdrawal
What are the cognitive Sx of schizophrenia?
Short term memory decrease
Attention deficit
-can’t remember or learn new things
What is the physiology of schizophrenia?
Increased 5HT and DA in the limbic and cortical pathway
What are possible neuropathways affected by schizophrenia? What do those area effect?
Mesolimbic-mood and behavior
Mesocortical-pleasure and reward
Nigrostristal-movement center
Tuberoinfundibular-connected to hypothalamus and pituitary
What does PRL do?
Milk production
Breast development
Decrease GnRH
Decrease libido
What is another name for DA? What does it do?
PIH
It inhibits prolactin
What types of drugs are used for schizophrenia?
5HT2a and DA2 antagonist
What are the 2 types of antipsychotics? What do they do?
Typical-DA2 antagonists (block DA2 receptors)
Atypical-5HT2a antagonists(block 5HT2a receptors)
How long do antipsychotics take to onset?
2-3 weeks
What is phenothiazine drugs? What does it effect? EPS?
Typical antipsychotic
Peripheral effect(highest)
Less EPS
What is butyrophenons drugs? What does it effect? EPS?
Typical antipsychotic
Less peripheral effect
More EPS
What is Thioxanthenes drugs? What does it effect? EPS?
Typical antipsychotic
Less peripheral effect
More EPS
What is chlorpromazine(Thorazine)? What is it used for?
Phenothiazine
Used for schizophrenia/Mental institution drug you can take home
What is thioridazine(Mellaril)? What is it used for?
Phenothiazine
Used for schizophrenia/mental institution drug you can take home
What are the 2 types of phenothiazine medications you can take home?
Chlorpromazine
Thioridazine
What are the 2 effects of typical antipsychotic drugs? How long does it take to onset?
Reduce mania
Reduce agitation
2-3 weeks
What type of receptors does typical antipsychotics block? What does is a ADR of that receptor being blocked?
DA2, 5HT2a and alpha receptors=orthostatic hypotension
Muscarinic receptors=constipation
Histamine-1 receptor= sleepiness
What does EPS stand for? What does it mean?
Extrapyramidal syndrome
Movement disorder
What is dystopia?
Facial/neck spams
What is akathesia?
Severe restlessness of thighs and abs
What is Parkinsonism?
Resting tremors
What is tardive dyskinesia?
Involuntary movements of lips, jaw, tongue and extremities
Usually large movements
What are the 4 different types of EPS?
Dystopia
Akathesia
Parkinsonism
Tardive Dyskinesia
Which type of typical antipsychotics drugs cause EPS?
Butyrophenones= Haloperidol(Haldol)
Thioxanthenes= Thiothixene(Navane)
What is the MOA for atypical antipsychotics?
Block 5HT2a receptors more than DA2 receptors
What are the 7 different atypical antipsychotics?
Aripiprazole(Abilify) Olanzapine(Zyprexa) Quetiapine(Seroquel) Risperidone(Risperdal) Ziprasidone(Goedon) Paliperidone(Invega) Lurasidone(Latuda)
What is the preferred therapy for schizophrenia?
Atypical antipsychotic
What is the benefit to ADR for atypical antipsychotics?
ADR
- weight gain
- hyperglycemia
- hyperlipidemia
Benefits
- less peripheral
- less EPS
What are the 3 types of depression and examples?
Reactive depression
-goes away without drugs
Major Depressive Disorder(MDD)
-d/t biochemical imbalance
Bipolar Mood disorder
-alternating mania and depressive moods
What is mania?
Very high highs followed by very low lows
What is the major cause of depression?
Decreases levels of NE and 5HT in brain
What are the 3 classes of antidepressants?
SSRIs
Atypical SSRIs
TCAs
MAOIs
How do SSRIs work?
Inhibit 5HT reuptake to increase serotonin in synapse
What are the 2 different types of atypical SSRIs? What do they do?
SNRIs
-inhibit 5HT/NE reuptake to increase in synapse
NDRIs
-inhibit NE/DA reuptake to increase in synapse
What is the MOA for antidepressants?
Blocks reuptake of neurotransmitters
Where to SSRIs work?
Limbic and cortical areas of the brain
What are the 6 typical SSRIs? What do they stimulate?
Citalopram(Celexa) Escitalopram(Lexapro) fluoxetine(Prozac) paroxetine(Paxil) sertraline(Zoloft) Vortioxetine(Trintellix)
Stimulates CNS
What are the indications for typical SSRIs?
MDD
PTSD
OCD
Premenstrual Dysphoric disorder(extremely moody)
What is used to Tx premenstrual dysphoric disorder?
Fluoxetine(Prozac)
Sertraline(Zoloft)
What are the ADRs of typical SSRIs?
- decreased libido(sexual dysfunction)
- suicidal thoughts(first 2-3 weeks)
- serotonin syndrome
What is serotonin syndrome? What are the Sx?
Increased serotonin in body increases sympathetic response
Sx
- tachycardia
- hyperthermia
- muscle spasms
- diaphoresis
What are the name of the 6 SNRIs that are atypical SSRIs?
Venlafaxine(Effexor), desvenlafaxine(Pristiq) levomilnacipran(Fetzima) duloxetine(Cymbalta) Trazodone(Desyrel) vilazodone(Vllbryd)
What SNRI is used to induce sleep?
Trazadone(Desyrel)
What is the NDRI that helps a pt stop smoking?
Bupropion(Wellbutrin)
What are pharmacogenomic/pharmacogenetics? What is it based on?
Using genetics to determine the best medication to give
Based on pharmacodynamics and pharmacokinetics
What are the two types of TCAs? What do they do?
Tertiary amine(increase 5HT more than NE)
Secondary amine(increase NE more than 5HT)
What is Nortriptyline(pamelor)?
TCA-Secondary amine
What is Amitriptyline(Elavil)?
TC-tertiary amine
What are the 4 ADR of TCAs?
Constipation
Orthostatic hypotension
Sleepy
Alterations in EKG
What is another name for TCAs?
Tricyclics
What is the DOC for mania? What does it do?
Lithium
Lowers Na+
What is the normal range of lithium levels?
0.6-1.2 mEg/L
What is the DOC for MDD? If that drug doesn’t work what medication is given?
SSRIs
Then atypical SSRIs
When administering anti-anxiety medication, what should a nurse closely monitor for elderly pt?
CNS depression
Liver and kidney function
What would a nurse tell a teen pt parent about taking antidepressants?
2-3 weeks to onset
Possible suicide tendencies
Why would a nurse assist with ambulation of a older pt taking antidepressants?
ADR can cause drowsiness and postural hypotension
When going out into the sun a pt on phenothiazine should?
Wear sunscreen because phenothiazine increase photo sensitivity
What shouldn’t be taken with antipsychotics line phenothiazine?
Alcohol and CNS depressants
What are the 4 uses for benzodiazepine?
Anti anxiety
Seizures
Preoperative med
Alcohol withdrawal
What atypical SSRI helps with sleep?
Trazadone(Desyrel)
What time should antidepressants be taken? Morning or night?
Mornings
What Tx mania and bipolar disorder?
Lithium
What loads the gun and pulls the trigger?
Genetics loads the gun and environment pulls the trigger
