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Pharmacology > Psychotherapeutic drugs ex 4 > Flashcards

Psychotherapeutic drugs ex 4 Flashcards

1
Q

positive symptoms

A

hallucinations
delusions
agitation
disordered speech
bizarre beahviors

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2
Q

negative symptoms

A

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

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3
Q

cognitive symptoms

A

disordered thinking
lack of focus
learning disability
memory problems

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4
Q

first gen antipsychotics MOA

A

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

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5
Q

first gen antipsychotics take how long?

A

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

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6
Q

first gen antipsychotics classified by?

A

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

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7
Q

Acute Dystonia

A

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

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8
Q

Parkinsonism

A

occurs within 1 month looks like parkinson’s

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9
Q

Akthisia

A

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

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10
Q

Tardive Dyskinesia

A

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

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11
Q

Other FGA adverse effects

A

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

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12
Q

FGA interactions

A

anticholinergic drugs
CNS depressants
Levodopa and direct dopamine receptro agonists

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13
Q

Second Generation Antipsychotics (SGAs) MOA

A

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

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14
Q

SGA adverse effects

A

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

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15
Q

Goals of Therapy

A

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

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16
Q

shared properties of antidepressants

A

initial response 1-3 weeks max 12 weeks

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17
Q

4 antidepressants and protoype

A

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

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18
Q

Selective Serotonin Reuptake Inhibitor (SSRIs) fluoxetine MOA

A

Prevent reuptake of serotonin

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19
Q

(SSRIs) fluoxetine pharmacokinetics

A

PO 94% protein bound 9 day half life

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20
Q

(SSRIs) fluoxetine adverse effects

A

N/V
sexual dysfunction
weight gain
withdrawal
serotonin syndrom

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21
Q

(SSRIs) fluoxetine interactions

A

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

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22
Q

(SSRIs) fluoxetine nursing considerations

A

dont stop abruptly,
suicide risk
serotonin syndrome

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23
Q

serotonin syndrome

A

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

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24
Q

Tricyclic Antidepressants (TCAs): amitriptyline (Elavil) MOA

A

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

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25
Q

(TCAs): amitriptyline (Elavil) adverse effects

A

O hypoTN
sedation
anticholinergic effect
sweating
seizures
hypomania

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26
Q

(TCAs): amitriptyline (Elavil) interactions

A

MAOIs (sever HTN)
anticholinergics
CNS depressants

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27
Q

(TCAs): amitriptyline (Elavil) nursing considerations

A

monitor BP
night time dosing
monitor for adverse side effects

28
Q

MonoAmine Oxidase inhibitors (MAOIs) phenelzine MOA

A

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

29
Q

(MAOIs) phenelzine adverse effects

A

CNS stimulation
O HypotTN
HTN crisis from dietary tyramine

30
Q

atypical antidepressants: bupropion MOA

A

prevents reuptake of NE and Dopamine

31
Q

atypical antidepressants: bupropion adverse effects

A

seizures,
CNS stimulation

32
Q

atypical antidepressants: bupropion benefits

A

weight loss
increased libido

33
Q

atypical antidepressants: bupropion interactions

A

some SSRIs
MAOIs

34
Q

mood stabilizer

A

lithium

35
Q

lithium MOA

A

unclear

36
Q

lithium pharmacokinetics

A

short half life, affected by Na levels

37
Q

lithium toxicity

A

> 1.5

38
Q

lithium interactions

A

thiazide loop diuretics
NSAIDS
anticholinergics

39
Q

lithium nursing consderations

A

give with food
monitor ther range 0.6-1.0

40
Q

sedatives and hypnotics examples

A

benzodiazepines, benzodiazepine like drugs, barbiturates

41
Q

sedatives and hypnotics cause/use

A

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

42
Q

benzodiazepines MOA

A

potentiate effects of GABA. inhibitory neurotransmitter

43
Q

benzodiazepines uses

A

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

44
Q

benzodiazepines pharmacokinetics

A

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

45
Q

benzodiazepines expected/adverse effects

A

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

46
Q

benzodiazepines interactions

A

CNS depressants

47
Q

benzodiazepines tolerance/dependance

A

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

48
Q

benzodiazepines nursing considerations

A

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

49
Q

benzodiazepines acute toxicity rare in

A

oral overdose
drowsiness, lethargy, confusion

50
Q

benzodiazepines acute toxicity common in

A

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

51
Q

antidote for benzodiazepines acute toxicity is

A

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

52
Q

common benzodiazepines

A

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

53
Q

benzodiazepines-like drugs: zolpidem MOA

A

potentiates effects of GABA, an inhibitory neurotransmitter

54
Q

benzodiazepines-like drugs: zolpidem use

A

insomnia (not anxiety)

55
Q

benzodiazepines-like drugs: zolpidem adverse effects

A

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

56
Q

Barbiturates: phenobarbital MOA

A

enhances and mimics action of GABA

57
Q

Barbiturates: phenobarbital uses

A

seizure control and anesthesia (no longer used for insomnia)

58
Q

Barbiturates: phenobarbital expected/adverse effects`

A

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

59
Q

Barbiturates phenobarbital toxicity s/sx

A

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

60
Q

What is used to treat generalized anxiety disorder

A

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

61
Q

anxiolytic:

A

buspirone

62
Q

buspirone MOA

A

unclear
bind to serotonin and some dopamine receptors

63
Q

benefits of buspirone

A

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

64
Q

buspirone uses

A

anxiety control

65
Q

buspirone pharmacokinetics

A

food delays absorption

66
Q

adverse effects of buspirone

A

nausea
dizziness
sedation for some, excitement for others

67
Q

buspirone interactions

A

grapefruit juice
erythromycin
ketoconazole

Pharmacology (8 decks)

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