psychotherapeutics Flashcards
Sedatives & Hypnotics (Barbiturates)
Example
Phenobarbital
Sedatives & Hypnotics (Barbiturates)
Action
Depresses sensory cortex, alters cerebella functions
Sedatives & Hypnotics (Barbiturates)
Contraindications
Pt with hypersensitivity to phenobarbital
dyspnea or airway compromised
Sedatives & Hypnotics (Barbiturates)
Adverse effects
hypoventilation
Somnolence (sleepy)
Nausea
Bradycaria
Anti Anxiety (Benzo and non Benzo) Example
Diazepam (Benzo) (Acute)
Hydroxyzine (non benzo) (chronic)
Sedatives & Hypnotics (Barbiturates)
use
Sedative
manage seizures
Anti Anxiety (Benzo and non Benzo) use
Manage anxiety
Anti Anxiety (Benzo and non Benzo) Action
Most depress cns
Benzo: binds to benzodiazopam receptors in gaba receptors
Non Benzo: act on the brains dopamine and serotonin receptors
Anti Anxiety (Benzo and non Benzo) Contraindications
Pt w/cns depression or pt w/ severe pain Glaucoma Pregnancy D Impaired liver or kidney Alcohol dependency Tricyclic antidepressant
Anti Anxiety (Benzo and non Benzo) Patient Management
Have pt lie down for 30 minutes after taking
use caution with older patients
Anti Depressant
TCA
Tricyclic Antidepressants
TCA Action
increases level of serotonins by inhibiting the reuptake and block the action of acetylcholine
TCA
Adverse reactions
dry mouth, blurred vission hypotension urine retention constipation orthostatic hypotension
TCA Contraindication
hypersnsitivity to TCA
within 14 days of maoi
Following MI
TCA Example
Amitriptyline
Anti Depressant MAOI
Monoamine Oxidase Inhibitors ( old version of anti depressants)
MAOI Action
inhibits the activity of monoamine oxidase resulting in
increased endogenous neurohormones
MAOI adverse reactions
Food interactions, Vertigo Nausea Constipation Dry Mouth Headache Over activity (hyper)
MAOI Contraindications
CVA disease
Hypertension
CHF
Elderly
MAOI Example
Nardil
Antidepressant SSRI
Selective serotonin reuptake inhibitors (common)
SSRI action
increase serotonin by inhibiting neuronal uptake to cns
SSRI Adverse reactions
Nausea, Vomiting
Sexual dysfunction
Insomnia
SSRI Contraindication
Fluoxetine is less effective in pt who smokes
SSRI Examples
Fluoxetine (prozac)
sertraline (zoloft)
Anti depressant
SNRI
Serotonin-norepinephrine reuptake inhibitor (similar to adrenalin)
Antipsychotic
Action
Block dopamine receptors
Most antipsychotics exept for haloperidol are what?
phenothiazine
What medication is a butyrophenone?
Haloperidol
Second generation like Olanzapine, Clozapine, Quetiapine and risperidone have what?
Fewer adverse reactions
Antipsychotic use
Treatment in acute and chronic psychosis
The use of Chlorpromazine is also used to treat what?
Intractable hiccups
Clozapine is limited to what illness?
Schizophrenia
Anti Psychotic Adverse effects
Dry Mouth Hypotension sedation photophobia/sensitivity headache Extrapyramidal -parkinsons like sympyoms Akathisia Acute Dystonia acute Tardive Dyskinesia
What is akathisia?
Extreme restlessness
What is dystonia?
Facial grimacing and twisting of the neck
What is Tardive dyskinesia
Irreversible involuntary dyskinetic movements, rhythmic movements of the tongue and mouth
Neuroleptic malignant syndrome is mainly seen with what medication?
Haloperidol
Requires intensive symptomatic treatment
Antipsychotic contraindications
Severely depressed
Hypotension
Antipsychotic patient management
Assess deviation from normal
poor eye contact
Monotone
Antipsychotic examples
Prochlorperazine
Haloperidol
CNS Stimulants
Sub class
Amphetamines and anorexiants
CNS Stimulant action
Produce CNS stimulation by increasing levels of neurotransmitters in the CNS
Produce CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, and a diminished sense of fatigue.
In children with ADHD these agents decrease restlessness and increase attention span
CNS Stimulant use
The treatment of narcolepsy and as adjunctive treatment in the management of attention deficit hyperactivity disorder (ADHD).
CNS Stimulant Adverse reactions
Headache, dizziness, apprehension Over stimulation of the CNS Insomnia, tachycardia, blurred vision, blurred vision
CNS Stimulant Contraindication
Moderate to severe, Hypertension, stroke Glaucoma Hypersensitivity to Amphetamines: Risk of physical dependence
CNS Patient management
Take the drug in the morning 30-45 minutes before breakfast and before lunch.
Insomnia and anorexia usually disappear during continued therapy.
May be given on only school days.
Do NOT increase the dose or take the drug more frequently.
Decrease coffee or caffeine.
CNS stimulant examples
Methylphenidate HCL: Concerta (amphetamine)
Dextroamphetamine: Adderall (amphetamine)
Phentermine: Ionamin (anorexiant )
