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psychotherapeutic medications Flashcards

1
Q

1st gen antipsychotics

HALOPERIDOL

A
  • high potent
  • MOA: produces strong blockade of dopamine in the CNS
  • blocks dopamine, ACH, histamine & norepi
  • can cause EPS
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2
Q

adverse effects of Haloperidol

A
  • 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)
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3
Q

nurse/ pt edu. for haloperidol

A

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
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4
Q

second gen antipsychotic
adverse effects

  OLANZAPINE
A
  • 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
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5
Q

olazapine MOA

A

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

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6
Q

SSRI
sertraline uses

A

MDD, bipolar, OCD, panic disorder, bulimia & PMDD

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7
Q

SSRI

Adverse effects

A
  • sexual dysfunction
  • wt gain
  • sleepiness
  • hyponatremia

serotonin syndrome can occur 2 to 72 hours after onset

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8
Q

PT. EDUCATION FOR SSRI

A
  • wean off slowly
  • monitor for hyponatremia
  • report SS symptoms & MAOIS increase risk
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9
Q

SNRI MOA

DULOXETINE

A
  • serotonin and norepinephrine re-uptake inhibitor
  • used for MDD when SSRIs dont work
  • takes 2-4 weeks
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10
Q

adverse effects of SNRIs

A
  • dry mouth
  • constipation
  • nausea
  • insomnia
  • somnolence
  • fatigue
  • diaphoresis
  • blurred vision
  • anorexia
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11
Q

TCA MOA

A
  • block the reuptake of norepinephrine and serotonin
  • can take 1-3 weeks to see results, take @bedtime, ECG scan
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12
Q

use of TCA

A
  • depression, bipolar disorder
  • neuopathic pain
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13
Q

adverse effects of TCA

A
  • orthostatic hypotension
  • anticholinergic effects
  • sedation
  • seizures
  • confusion in the elderly
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14
Q

MAOI MOA

A

Block MAO-A in the brain, thereby increasing Norepinephrine (NE) and serotonin available for impulse transmission

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15
Q

MAOI use

A

depression, bulimia nervosa, agoraphobia (fear of places/situations), ADHD, OCD

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16
Q

adverse effects of MAOI

A

CNS stimulation (anxiety, agitation, mania)

  • Orthostatic hypotension
  • Hypertensive Crisis
  • From eating tyramine
  • MOST Dangerous
17
Q

drug-drug interaction of MAOI

A
  • 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)
18
Q

foods with tyramine

A
  • 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
19
Q

Bupropion MOA

A

blocks dopamine and norepi reuptake

used for MSS, SAD, aid to stop smoking

20
Q

bupropion

A

does not cause sexual dysfunction effects & symptoms can be seen resolved in 1-3 weeks

21
Q

lithium MOA

A

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

22
Q

lithium adverse effects

A
  • 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)
23
Q

lithium drug interaction

A

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)

24
Q

Pt. EDUCATION FOR LITHIUM

A

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)

25
Q

Benzodiazepines:
MOA
Alprazolam (Xanax)
Lorazepam (Ativan)
Diazepam (Valium)

A

anxiety disorder
Enhances the action of gamma-amino butyric acid (GABA) in the CNS (BRAIN)

26
Q

adverse effects of benzos

A
  • Drowsiness
  • Dizziness
  • Vertigo
  • Lethargy
  • Paradoxical excitement
  • insomnia, excitation, euphoria, anxiety, rage
  • “Hangover effect”
27
Q

pt/nurse education for benzo

A
  • Therapeutic effects can take 2-3 weeks
  • REM rebound and a tired feeling the next day

Use with caution in the elderly; increases fall risk; on the Beers Criteria medication list

Patients should be instructed to avoid alcohol and other CNS depressants

Do not stop abruptly if taken long term, wean and watch for rebound insomnia

Safety is important
* Keep side rails up
* Assist patient with
ambulation (especially the elderly)
* Keep call light within reach
* Monitor for side effects

Insomnia:
* Give 15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep

Anxiety:
* Taken prn in higher doses for anxiety/panic attacks

28
Q

Methylphenidate- STIMULANT (ADHD) MOA

A

Release Norepinephrine (NE) and dopamine in the Brain and inhibit the reuptake

29
Q

Methylphenidate

adverse effects

A

CNS Stimulation (insomnia & restlessness)

weight loss

CV: dysrhythmias, tachycardia, elevated BP, angina

paranoid psychosis (most severe)

Difficulty sleeping (if taken late in the day)

30
Q

Methylphenidate edu

A

abuse and physical dependence

  • Schedule II drugs
  • Use smallest dose
  • avoid giving late at night
  • Minimize dietary caffeine (CNS stimulant)
  • Take AM dose after breakfast & PM early afternoon to minimize interference with eating
  • Closely monitor growth and weight gain in the pediatric population

Monitor closely for difficulty sleeping (insomnia) especially in the pediatric population

31
Q

Atomoxetine (Strattera)

MOA

A

selective inhibitor of norepinephrine reuptake and causes norepinephrine to accumulate at synapses

32
Q

Atomoxetine (NON-STIMULANT)

adverse effects

A

Less side effects than stimulants

Most common: GI reactions, decreased appetite, dizziness, somnolence, mood swings, trouble sleeping

can cause suicidal thinking in children and adolescents but does not occur in adults

Small risk of severe liver injury

Can raise or lower blood pressure

Drug interactions:

combined with MAOIs can cause hypertensive crisis

33
Q

PT/NURSE EDU for atomoxetine

A

Use smallest dose required and avoid giving late at night

Minimize dietary caffeine (CNS stimulant)

Take AM dose after breakfast & PM early afternoon to minimize interference with eating

Closely monitor growth and weight gain in the pediatric population

Pharm (11 decks)

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