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NURS 252 > psychotherapeutic drugs: chapter 17 > Flashcards

psychotherapeutic drugs: chapter 17 Flashcards

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1
Q

general mechanism of action of anxiolytic drugs

A

reduce overactivity in the cns

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2
Q

mechanism of action of benzodiazepines (2)

A

depress activity in the brainstem and limbic system, increase gaba which blocks nerve transmission in the cns

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3
Q

3 manifestations of anxiolytic toxicity

A

excessive sedation, hypotension, seizures

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4
Q

what drug reverses the effects of benzodiazepines

A

flumazenil

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5
Q

3 anxiolytic drugs

A

alprazolam, diazepam, lorazepam

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6
Q

which anxiolytic drug should be avoided in those with severe liver dysfunction. why

A

diazepam because it can accumulate in the liver causing additive effects

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7
Q

why is lorazepam commonly administered

A

given to agitated patients and those undergoing mechanical ventilation

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8
Q

what is the main indication for the use of anxiolytics

A

short term treatment for anxiety

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9
Q

what is the main indication for mood stabilizing drugs such as lithium

A

bipolar disorder

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10
Q

mechanism of action of lithium

A

alter sodium ion transport in nerve cells which causes a shift in catecholamine metabolism

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11
Q

what serum blood level for lithium is the target for treatment of acute mania

A

1-1.5mmol/L

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12
Q

what is the serum blood level target for lithium for long term maintenance

A

0.6-1.2mmol/L

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13
Q

what ion is crucial to keep within normal range to help maintain therapeutic lithium levels. what is the normal range for this ion

A

sodium. normal range is 135-145mmol/L

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14
Q

at what blood level will mild to moderate toxicity levels occur when a patient is on lithium

A

1.5-2mmol/L

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15
Q

at what blood level will moderate to severe toxicity levels occur when a patient is on lithium

A

above 2mmol/L

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16
Q

what are 4 lithium toxicity manifestations

A

gi discomfort, tremor, confusion, seizures

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17
Q

what can long term use of lithium lead to

A

hypothyroidism

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18
Q

what is a key adverse effect of lithium

A

cardiac dysrhythmia

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19
Q

which classes of antidepressants are considered to be first line therapy

A

SSRI and SNRI

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20
Q

what class of antidepressants considered second line therapy

A

tricyclic antidepressants

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21
Q

mechanism of action of tricyclic antidepressants

A

block presynaptic reuptake of serotonin and norepinephrine which makes these hormones available for nerve impulse transmission

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22
Q

what is the treatment for tricyclic antidepressant toxicity/overdose (3)

A

there is no specific antidote. absorption of the drug can be minimized through administration of activated charcoal. treatment is supportive

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23
Q

how can cns damage be minimized in the case of tricyclic antidepressant toxicity/overdose

A

administration of diazepam

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24
Q

how can cardiovascular effects be minimized in the case of tricyclic antidepressant toxicity/overdose

A

administration of antidysrthymics

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25
what is a key tricyclic antidepressant drug
amitriptyline
26
what can occur if maoi's are taken alongside stimulant medications or things containing tyramine
hypertensive crisis
27
what are 2 nonselective maoi's
phenelzine, tranylcypromine
28
what is 1 selective maoi
selegiline
29
mechanism of action of maoi's
prevent the breakdown of dopamine, serotonin, and norephinephrine
30
what are 4 manifestations of maoi toxicity/overdose
tachycardia, circulatory collapse, seizures, coma
31
what treatment is indicated for maoi toxicity/overdose
eliminate the drug and protect the brain and heart
32
mechanism of action of ssri's
inhibit reuptake of serotonin
33
mechanism of action of snri's
inhibit reuptake of serotonin and norepinephrine
34
how long does it take for ssri's and snri's to have an effect
several weeks
35
what is a major drug interaction of ssri's
maoi's
36
what is a key adverse effect of second generation antidepressants such as ssri's and snri's
serotonin syndrome
37
what is serotonin syndrome
excessive serotonin effects on the cns
38
what are 5 manifestations of serotonin syndrome
delirium, tachycardia, hyperthermia, seizures, rhabdomyolysis
39
what drug is a protypical ssri
fluoxetine
40
what drug is a norepinephrine-dopamine reuptake inhibitor
bupropion
41
what is another form of bupropian that is indicated for smoking cessation
zyban
42
which second generation antidepressant can worsen uncontrolled angle closure glaucoma
duloxetine
43
what is a class of conventional (first generation) antipsychotic drugs and give a specific example of a drug in this class
phenothiazines such as haloperidol
44
what are two specific atypical antipsychotic drugs
clozapine, risperidone
45
mechanism of action of all antipsychotic drugs
block dopamine receptors which decreases dopamine concentration in the cns
46
which antipsychotic drugs reduce positive symptoms of schizophrenia
all of them
47
which antipsychotic drugs can treat negative symptoms of schizophrenia
atypical
48
what are 3 positive symptoms of schizophrenia
hallucinations, delusions, disorganization
49
what are 4 negative symptoms of schizophrenia
apathy, social withdrawal, poverty of speech, catatonia
50
what is neuroleptic malignant syndrome
an adverse effect of antipsychotic drugs that results due to a dopamine blockade
51
what are 5 manifestations of neuroleptic malignant syndrome
high fever, irregular bp and pulse, tachycardia, cardiac dysrhythmia, rhabdomyolysis
52
what are 2 extrapyramidal symptoms
akathisia: motor restlessness dystonia: painful muscle spasms
53
what 2 drugs can be used to treat extrapyramidal symptoms
benztropine, trihexyphenidyl
54
what is tardive dyskinesia
an adverse effect of antipsychotic drugs and is characterized by involuntary contractions of oral and facial muscles and wave like movements of extremities
55
which antipsychotic drug is best indicated for schizophrenia when there is nonadherence. why
haloperidol due to its long duration of action
56
which antipsychotic drug results in minor or no extrapyramidal symptoms. why
clozapine because it more selectively blocks the dopamine receptor in the mesolimbic region
57
what antipsychotic drug can cause agranulocytosis
clozapine
58
what is agranulocytosis
dangerous lack of wbc production
59
what is done in terms of monitoring for agranulocytosis while a patient is on clozapine
weekly monitoring for the first 6 months
60
what wbc level should clozapine be held
below 3.5x10^9/L
61
at what dosage will risperidone cause extrapyramidal symptoms. are these levels toxic or therapeutic
therapeutic dosages of 1-6mg/day
62
how long can it take to see the therapeutic effects of antidepressants
4-6 weeks
63
what antidepressant class may need to be tapered and then discontinued before surgery
tricyclic antidepressants
64
give 6 examples of foods/drinks that are high in tyramine
aged cheese, smoked or pickled meat, aged or fermented meat, yeast extracts, red wine, italian broad beans
65
what is an acceptable level of haloperidol
4-22ng/mL
66
what type of supplement should not be taken within 2hrs of an ssri or snri
fibre
67
what 3 things should be immediately reported while on an antipsychotic medication; clozapine in particular. what can these 3 symptoms indicate
sore throat, fever, bleeding. these can indicate a drop in wbc
68
4 indications for the use of st. john's wart
depression, anxiety, sleep disorders, nervousness
69
4 adverse effects of st. johns wart
gi upset, fatigue, dry mouth, phototoxicity
70
3 key interactions of st. johns wart
maoi, ssri, tyramine
71
2 key contraindications for st. johns wart
bipolar disorders, schizophrenia

NURS 252 (18 decks)

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