psychotherapeutic medications Flashcards
1st gen antipsychotics
HALOPERIDOL
- high potent
- MOA: produces strong blockade of dopamine in the CNS
- blocks dopamine, ACH, histamine & norepi
- can cause EPS
adverse effects of Haloperidol
- General Sedation
- Orthostatic hypotension
- anticholinergic effects (dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia)
- Extrapyramidal Symptoms (EPS)
- Acute dystonia- spasm of tongue and neck
- Pseudo Parkinsonism- TRAP
- Akathisia- pacing & restlessness
- Tardive dyskinesia (TD)- twisting or worm-like movement of tongue or lip-smacking/most potential to be permanent
Neuroleptic Malignant Syndrome
- Life threatening
emergency - High grade fever
- BP fluctuations
- Dysrhythmias
- Muscle rigidity
- Change in Level of
Consciousness (LOC)
nurse/ pt edu. for haloperidol
Neuroleptic Malignant syndrome:
Give Dantrolene, ASA, Tylenol, cooling blankets and stop the med
Patients with schizophrenia are often non-compliant with medications and require inter-disciplinary team management
Anticholinergic agents and benzodiazepines are the most commonly used agents to reverse or reduce symptoms in an acute dystonic reaction
- Diphenhydramine
second gen antipsychotic
adverse effects
OLANZAPINE
- Sedation, orthostatic hypotension, dry mouth, blurred vision, constipation (Muscarinic blockade)
- Metabolic Effects
- Weight gain (H1), Diabetes, Dyslipidemia (linked to heart attacks and strokes)
- report wt gain, eat right & exercise
olazapine MOA
Produce moderate blockade of dopamine receptors strong blockade of serotonin receptors
Serotonin > Dopamine = less incidence of EPS and TD
Also blocks Norepinephrine, histamine (H1) & acetylcholine
Risk of EPS is lower but carry a significant risk of metabolic effects
Weight gain, diabetes, and dyslipidemia, cardiovascular events, and early death
SSRI
sertraline uses
MDD, bipolar, OCD, panic disorder, bulimia & PMDD
SSRI
Adverse effects
- sexual dysfunction
- wt gain
- sleepiness
- hyponatremia
serotonin syndrome can occur 2 to 72 hours after onset
PT. EDUCATION FOR SSRI
- wean off slowly
- monitor for hyponatremia
- report SS symptoms & MAOIS increase risk
SNRI MOA
DULOXETINE
- serotonin and norepinephrine re-uptake inhibitor
- used for MDD when SSRIs dont work
- takes 2-4 weeks
adverse effects of SNRIs
- dry mouth
- constipation
- nausea
- insomnia
- somnolence
- fatigue
- diaphoresis
- blurred vision
- anorexia
TCA MOA
- block the reuptake of norepinephrine and serotonin
- can take 1-3 weeks to see results, take @bedtime, ECG scan
use of TCA
- depression, bipolar disorder
- neuopathic pain
adverse effects of TCA
- orthostatic hypotension
- anticholinergic effects
- sedation
- seizures
- confusion in the elderly
MAOI MOA
Block MAO-A in the brain, thereby increasing Norepinephrine (NE) and serotonin available for impulse transmission
MAOI use
depression, bulimia nervosa, agoraphobia (fear of places/situations), ADHD, OCD
adverse effects of MAOI
CNS stimulation (anxiety, agitation, mania)
- Orthostatic hypotension
- Hypertensive Crisis
- From eating tyramine
- MOST Dangerous
drug-drug interaction of MAOI
- Ephedrine, amphetamine, cocaine (HTN crisis)
- Tricyclic anti-depressants (HTN crisis)
- Serotoninergic drugs (Increases risk of serotonin syndrome)
- Anti-hypertensive drugs (Can lower blood pressure)
- Meperidine (Demoral) (Can cause hyperpyrexia)
foods with tyramine
- Some Beers & Chianti wine
- Yeast Extracts
- Most Cheeses
- Fermented sausages (salami, pepperoni, bologna
- Aged Fish or meat (smoked)
- Avocados
- Figs & Bananas
- Be careful with Caffeine & chocolate
Bupropion MOA
blocks dopamine and norepi reuptake
used for MSS, SAD, aid to stop smoking
bupropion
does not cause sexual dysfunction effects & symptoms can be seen resolved in 1-3 weeks
lithium MOA
bipolar disorder, bulimia, alcoholism
alters distribution of certain ions (calcium, sodium, magnesium) that are critical to neuron function; 2) Altered synthesis and release of norepinephrine, serotonin, and dopamine
lithium adverse effects
- N/V/D, continues hand tremor, GI upset, muscle weakness, thirst, polyuria, lethargy, slurred speech, ECG changes
- Death at levels above 2.5 can occur
- Contraindicated during pregnancy:
- Teratogenesis category D (avoid during the first trimester of pregnancy)
lithium drug interaction
Diuretics (promote sodium loss- hyponatremia)
NSAIDs (increase lithium levels by increasing renal absorption of lithium)
Anti-cholinergic drugs (can cause urinary hesitancy and coupled with polyurea can create patient discomfort)
Pt. EDUCATION FOR LITHIUM
antimanic effects begin 5-7 days after treatment onset with full benefits 3 weeks
Lithium specific:
* Monitor blood levels regularly
- Drink 2-3 liters of fluid/ day
- Take with food and maintain a normal sodium intake
- Low serum Sodium increases risk of lithium toxicity
Therapeutic Range:
Initial 0.8 -1.4 meq/L
Maintenance 0.4-1.0 meq/L
Toxic level > 1.5 meq/L.
Dialysis for toxic levels above 2.5 meq/L
Monitor levels every 2-3 days until stable then every 3-6 months for maintenance (12 hours after evening dose)
