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NURS 252 > psychotherapeutic drugs: chapter 17 > Flashcards

psychotherapeutic drugs: chapter 17 Flashcards

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
Q

what is a key tricyclic antidepressant drug

A

amitriptyline

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26
Q

what can occur if maoi’s are taken alongside stimulant medications or things containing tyramine

A

hypertensive crisis

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27
Q

what are 2 nonselective maoi’s

A

phenelzine, tranylcypromine

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28
Q

what is 1 selective maoi

A

selegiline

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29
Q

mechanism of action of maoi’s

A

prevent the breakdown of dopamine, serotonin, and norephinephrine

30
Q

what are 4 manifestations of maoi toxicity/overdose

A

tachycardia, circulatory collapse, seizures, coma

31
Q

what treatment is indicated for maoi toxicity/overdose

A

eliminate the drug and protect the brain and heart

32
Q

mechanism of action of ssri’s

A

inhibit reuptake of serotonin

33
Q

mechanism of action of snri’s

A

inhibit reuptake of serotonin and norepinephrine

34
Q

how long does it take for ssri’s and snri’s to have an effect

A

several weeks

35
Q

what is a major drug interaction of ssri’s

A

maoi’s

36
Q

what is a key adverse effect of second generation antidepressants such as ssri’s and snri’s

A

serotonin syndrome

37
Q

what is serotonin syndrome

A

excessive serotonin effects on the cns

38
Q

what are 5 manifestations of serotonin syndrome

A

delirium, tachycardia, hyperthermia, seizures, rhabdomyolysis

39
Q

what drug is a protypical ssri

A

fluoxetine

40
Q

what drug is a norepinephrine-dopamine reuptake inhibitor

A

bupropion

41
Q

what is another form of bupropian that is indicated for smoking cessation

A

zyban

42
Q

which second generation antidepressant can worsen uncontrolled angle closure glaucoma

A

duloxetine

43
Q

what is a class of conventional (first generation) antipsychotic drugs and give a specific example of a drug in this class

A

phenothiazines such as haloperidol

44
Q

what are two specific atypical antipsychotic drugs

A

clozapine, risperidone

45
Q

mechanism of action of all antipsychotic drugs

A

block dopamine receptors which decreases dopamine concentration in the cns

46
Q

which antipsychotic drugs reduce positive symptoms of schizophrenia

A

all of them

47
Q

which antipsychotic drugs can treat negative symptoms of schizophrenia

A

atypical

48
Q

what are 3 positive symptoms of schizophrenia

A

hallucinations, delusions, disorganization

49
Q

what are 4 negative symptoms of schizophrenia

A

apathy, social withdrawal, poverty of speech, catatonia

50
Q

what is neuroleptic malignant syndrome

A

an adverse effect of antipsychotic drugs that results due to a dopamine blockade

51
Q

what are 5 manifestations of neuroleptic malignant syndrome

A

high fever, irregular bp and pulse, tachycardia, cardiac dysrhythmia, rhabdomyolysis

52
Q

what are 2 extrapyramidal symptoms

A

akathisia: motor restlessness
dystonia: painful muscle spasms

53
Q

what 2 drugs can be used to treat extrapyramidal symptoms

A

benztropine, trihexyphenidyl

54
Q

what is tardive dyskinesia

A

an adverse effect of antipsychotic drugs and is characterized by involuntary contractions of oral and facial muscles and wave like movements of extremities

55
Q

which antipsychotic drug is best indicated for schizophrenia when there is nonadherence. why

A

haloperidol due to its long duration of action

56
Q

which antipsychotic drug results in minor or no extrapyramidal symptoms. why

A

clozapine because it more selectively blocks the dopamine receptor in the mesolimbic region

57
Q

what antipsychotic drug can cause agranulocytosis

A

clozapine

58
Q

what is agranulocytosis

A

dangerous lack of wbc production

59
Q

what is done in terms of monitoring for agranulocytosis while a patient is on clozapine

A

weekly monitoring for the first 6 months

60
Q

what wbc level should clozapine be held

A

below 3.5x10^9/L

61
Q

at what dosage will risperidone cause extrapyramidal symptoms. are these levels toxic or therapeutic

A

therapeutic dosages of 1-6mg/day

62
Q

how long can it take to see the therapeutic effects of antidepressants

A

4-6 weeks

63
Q

what antidepressant class may need to be tapered and then discontinued before surgery

A

tricyclic antidepressants

64
Q

give 6 examples of foods/drinks that are high in tyramine

A

aged cheese, smoked or pickled meat, aged or fermented meat, yeast extracts, red wine, italian broad beans

65
Q

what is an acceptable level of haloperidol

A

4-22ng/mL

66
Q

what type of supplement should not be taken within 2hrs of an ssri or snri

A

fibre

67
Q

what 3 things should be immediately reported while on an antipsychotic medication; clozapine in particular. what can these 3 symptoms indicate

A

sore throat, fever, bleeding. these can indicate a drop in wbc

68
Q

4 indications for the use of st. john’s wart

A

depression, anxiety, sleep disorders, nervousness

69
Q

4 adverse effects of st. johns wart

A

gi upset, fatigue, dry mouth, phototoxicity

70
Q

3 key interactions of st. johns wart

A

maoi, ssri, tyramine

71
Q

2 key contraindications for st. johns wart

A

bipolar disorders, schizophrenia

NURS 252 (18 decks)

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