Psychotherapeutic drugs ex 4 Flashcards by Ashley Maley

positive symptoms

hallucinations
delusions
agitation
disordered speech
bizarre beahviors

How well did you know this?

Not at all

Perfectly

negative symptoms

social withdrawal
poor self-care
lack of motivation
poverty of speech
blunted affect

How well did you know this?

Not at all

Perfectly

cognitive symptoms

disordered thinking
lack of focus
learning disability
memory problems

How well did you know this?

Not at all

Perfectly

first gen antipsychotics MOA

block several receptors in the CNS - dopamine, acetylcholine, histamine, norepinephrine

How well did you know this?

Not at all

Perfectly

first gen antipsychotics take how long?

2-4 weeks, several months for full effect
inhibits positive symptoms best

How well did you know this?

Not at all

Perfectly

first gen antipsychotics classified by?

potency; low,med,high
contributes to severity of adverse effects

How well did you know this?

Not at all

Perfectly

Acute Dystonia

adverse effect of FGA
occurs hours to days, spasms of tongue, face, neck, back muscles

How well did you know this?

Not at all

Perfectly

Parkinsonism

occurs within 1 month looks like parkinson’s

How well did you know this?

Not at all

Perfectly

Akthisia

occurs within 2 months, pacing, restless, agitated, squirming

How well did you know this?

Not at all

Perfectly

Tardive Dyskinesia

occurs within months to years
involuntary twisting, movements of tongue and face, progresses to difficulty speaking swallowing down to body

How well did you know this?

Not at all

Perfectly

Other FGA adverse effects

neuroleptic malignant syndrome: lead pipe, muscle rigidity, sudden very high fever, labile BP
anticholinergic effect
O hypotension

How well did you know this?

Not at all

Perfectly

FGA interactions

anticholinergic drugs
CNS depressants
Levodopa and direct dopamine receptro agonists

How well did you know this?

Not at all

Perfectly

Second Generation Antipsychotics (SGAs) MOA

block dopamine and serotonin receptors in CNS
takes 2-4 weeks, several months for full efect
$$$

How well did you know this?

Not at all

Perfectly

SGA adverse effects

Metabolic effects: weight gain, diabetes, HDL
Neuroleptic Malignant syndrome
myocarditis

How well did you know this?

Not at all

Perfectly

Goals of Therapy

suppress acute episode, prevent exacerbations, promote high quality of life and function

How well did you know this?

Not at all

Perfectly

shared properties of antidepressants

initial response 1-3 weeks max 12 weeks

How well did you know this?

Not at all

Perfectly

4 antidepressants and protoype

SSRIS: fluoxetine
TCA: Imipramine
MAOIs: Phenelzine
Atypical: Buproprion

How well did you know this?

Not at all

Perfectly

Selective Serotonin Reuptake Inhibitor (SSRIs) fluoxetine MOA

Prevent reuptake of serotonin

How well did you know this?

Not at all

Perfectly

(SSRIs) fluoxetine pharmacokinetics

PO 94% protein bound 9 day half life

How well did you know this?

Not at all

Perfectly

(SSRIs) fluoxetine adverse effects

N/V
sexual dysfunction
weight gain
withdrawal
serotonin syndrom

How well did you know this?

Not at all

Perfectly

(SSRIs) fluoxetine interactions

MAOIs - drugs that increase serotonin activation
TCAs and lithium
Antiplatelete and anticoagulants

How well did you know this?

Not at all

Perfectly

(SSRIs) fluoxetine nursing considerations

dont stop abruptly,
suicide risk
serotonin syndrome

How well did you know this?

Not at all

Perfectly

serotonin syndrome

altered mental status - agitation, confusion, disorientation
increases SNS activity - sweating, termoy, fever, incoordination

How well did you know this?

Not at all

Perfectly

Tricyclic Antidepressants (TCAs): amitriptyline (Elavil) MOA

prevent reuptake of NE and or seratonin
used for depression, insomnia, and pain

How well did you know this?

Not at all

Perfectly

(TCAs): amitriptyline (Elavil) adverse effects

O hypoTN sedation anticholinergic effect sweating seizures hypomania

(TCAs): amitriptyline (Elavil) interactions

MAOIs (sever HTN) anticholinergics CNS depressants

(TCAs): amitriptyline (Elavil) nursing considerations

monitor BP night time dosing monitor for adverse side effects

MonoAmine Oxidase inhibitors (MAOIs) phenelzine MOA

irreversibly inhibits MAO and allows more uptake of NE and serotonin used for depression and OCD as last choice

(MAOIs) phenelzine adverse effects

CNS stimulation O HypotTN HTN crisis from dietary tyramine

atypical antidepressants: bupropion MOA

prevents reuptake of NE and Dopamine

atypical antidepressants: bupropion adverse effects

seizures, CNS stimulation

atypical antidepressants: bupropion benefits

weight loss increased libido

atypical antidepressants: bupropion interactions

some SSRIs MAOIs

mood stabilizer

lithium

lithium MOA

unclear

lithium pharmacokinetics

short half life, affected by Na levels

lithium toxicity

>1.5

lithium interactions

thiazide loop diuretics NSAIDS anticholinergics

lithium nursing consderations

give with food monitor ther range 0.6-1.0

sedatives and hypnotics examples

benzodiazepines, benzodiazepine like drugs, barbiturates

sedatives and hypnotics cause/use

some levels of CNS depression main use it control of anxiety - anxiolytics for anxiety - hypnotics for insomnia

benzodiazepines MOA

potentiate effects of GABA. inhibitory neurotransmitter

benzodiazepines uses

anxiety insomnia, muscle spasms, seizures, ETOH withdrawal, anesthesia induction

benzodiazepines pharmacokinetics

PO,IM, and IV well absorbed highly lipid soluble (crosses BBB) ' metabolized by liver

benzodiazepines expected/adverse effects

CNS depression : reduce anxiety, promote, sleep, muscle relaxation Cardiac: PO no effect, IV hypotension --> Cardiac arrest Respiratory: mild

benzodiazepines interactions

CNS depressants

benzodiazepines tolerance/dependance

cross tolerance for those who have tolerance to barbiturates, alcohol, and opioid potential for abuse withdrawal likely in long term use

benzodiazepines nursing considerations

fall risk BP residual sedation (no driving)' teratogenic dont mix with other CNS depressants

benzodiazepines acute toxicity rare in

oral overdose drowsiness, lethargy, confusion

benzodiazepines acute toxicity common in

IV overdose profound hypotension, cardiac and resp arrest life threatening!

antidote for benzodiazepines acute toxicity is

flumazenil (Romazicon) rapid IV over 15 seconds short T1/2 ~ frequent dosing reverses sedation, but not resp depression may cause seizures

common benzodiazepines

alprazolam (Xanax) clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan)

benzodiazepines-like drugs: zolpidem MOA

potentiates effects of GABA, an inhibitory neurotransmitter

benzodiazepines-like drugs: zolpidem use

insomnia (not anxiety)

benzodiazepines-like drugs: zolpidem adverse effects

daytime drowsiness dizziness sleep related behaviors (sleep walking/driving) no resp depression, but don't combine with CNS depressants long term use --> tolerance and dependence

Barbiturates: phenobarbital MOA

enhances and mimics action of GABA

Barbiturates: phenobarbital uses

seizure control and anesthesia (no longer used for insomnia)

Barbiturates: phenobarbital expected/adverse effects`

CNS depression: sedation --> anesthesia Cardiac: hypotension & bradycardia --> severe hypotension/arrest CYP P450 enzymes (inducer) tolerance/dependence teratogenic

Barbiturates phenobarbital toxicity s/sx

respiratory depression, coma, pinpoint pupils, hypotension, hypothermia no specific antidote

What is used to treat generalized anxiety disorder

SRIs SSRIs SNRis benzodiazepines (not first line) anxiolytic drug: Buspirone

anxiolytic:

buspirone

buspirone MOA

unclear bind to serotonin and some dopamine receptors

benefits of buspirone

no abuse potential no cross dependence with benzos therapeutic effect takes 1 week not a CNS depressant, just as effective

buspirone uses

anxiety control

buspirone pharmacokinetics

food delays absorption

adverse effects of buspirone

nausea dizziness sedation for some, excitement for others

buspirone interactions

grapefruit juice erythromycin ketoconazole