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T1 Flashcards

1
Q

Depot Medication - Advantage

A

Drug bypasses gastrointestinal absorption
No first-pass metabolism effect
Lower rates of relapse

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2
Q

Depot Medications - Disadvantages

A

Need to be administered deep into muscle tissue
Can irritate the skin and cause pain at injection site
Hold risk of severe and long lasting side effects if not screened properly

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3
Q

All depot medication should be administered as a deep ____

A

Intramuscular injection

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4
Q

Preferred sites for depot medications? (unless package indicates differently)

A

Gluteal sites

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5
Q

T/F - Dosage for short-acting injectable antipsychotic medication differs from therapeutic dosage of a depot medication

A

True

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6
Q

How can you know the difference between depot vs. other injections (?)

A

Label
Dosage
Thickness (depot will be thicker)

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7
Q

Nervous System Side Effects

A

EPS
Tardive dyskinesia
Anticholinergic side effects
Neuroleptic malignant syndrome
Sedation
Confusion
Headaches
Seizures
Sleep disturbances

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8
Q

EPS

A

Group of motor disturbances caused by dopamine being blocked in the nigrostriatal pathway
Typical antipsychotics are mostly to cause EPS
Some can be controlled with Antiparkinsonian medication

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9
Q

EPS - akathisia

A

Most common EPS
Motor-restlessness or inability to sit still
Condition is completely outside voluntary control (different from agitation)
Improves with benzodiazepine or propranolol

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10
Q

EPS - bradykinesia

A

“without movement or slowed movements”
Immobility or weakness
Complaints of fatigue
Lack of muscle movement
Can be confused w/ negative symptoms of schizophrenia
Increased dose of medication will increase symptoms

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11
Q

EPS - Pseudo-parkinsonism

A

Onset - first week of drug therapy
Loss in muscle movement (akinesia)
Mask like facial expression
Stooped posture
Muscle rigidity (COGHWEEL)
Tremors

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12
Q

EPS - Acute Dystonic Reactions

A

Sudden, uncoordinated prolonged abnormal tonic contractions of muscle groups

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13
Q

ADR - Torticollis or Retrocollis

A

Spasm of sternocleidomastoid muscle (muscles in neck)
Retrocollis - straight and constricted

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14
Q

Opisthotonos or Pleurthotonus (Pisa Sign)

A

Spasm of all muscles surrounding spine

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15
Q

Oculogyric crisis

A

Eyes roll upwards, severe muscle spasms, thick tongue, protrusion of tongue

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16
Q

Thickening or protrusion of tongue

A

Difficult to swallow

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17
Q

What do acute dystonic reactions respond well with?

A

Anticholinergics

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18
Q

Tardive Dyskinesia

A

Prominent with high potency and high doses of typical antipsychotics
Irreversible and no effective treatment
Caused by: chronic exposure to dopamine receptor blocking agents in nigrostriatal pathway
Can be monitored using Abnormal Involuntary Movement Scales

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19
Q

When is the best time to use AIMS?

A

After patient’s done sleeping

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20
Q

Signs of Tardive Dyskinesia

A

Constant chewing, facial grimacing, facial and tongue movement, limb movements

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21
Q

Anticholinergic Side Effects

A

In nigrostriatal pathway - dopamine blocks cholinergic receptors

Peripheral Anticholinergic Side Effects - dry mouth, constipation, urinary retention, blurred vision

Central Anticholinergic Side Effects - impaired concentration, confusion, attention deficit

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22
Q

Neuroleptic Malignant Syndrome

A

Hypodopaminergic state (severe low dopamine)
1% can be fatal
Risk
increase of antipsychotic medication
dehydration, physical exhaustion, malnutrition

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23
Q

Symptoms the NMS

A

EPS (muscle rigidity)
Increased body temperature (diaphoresis)
Change in consciousness
Fluctuating BP, tachycardia, decrease respirations

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24
Q

Treatment of NMS

A

Immediate discontinuation of drug
dopamine AGONIST bromocriptine
Fluids, electrolytes

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25
Endocrine System
Metabolism Sexual Hormone Dysregulation
26
Metabolism
Antipsychotics can cause weight gain, increased appetite Risk for diabetes and metabolic syndrome
27
Which two drugs have the highest metabolic side effects?
Olanzapine and Clozapine
28
Sexual Hormone Dysregulation
Blocking dopamine in the Tuberoinfundibular dopamine pathway - increase in prolactin concentrations = leading to hyperprolactinemia
29
Side effects of SHD
Disturbances in menstruation Lactation in women Gynecomastia (male breast enlargement) Rapid demineralization of bones Sexual dysfunction
30
Cardiovascular System
Orthostatic Hypotension OT interval Agranulocytosis
31
Orthostatic Hypotension
Blocking adrenergic receptors Sudden drop of BP from lying to sitting, lying to standing, or sitting to standing
32
QT Intervals
Antipsychotics and prolong QT Intervals Marker for arrhythmic risk Lead to cardiac arrest or transient loss of consciousness
33
Agranulocytosis
SERIOUS side effect Failure of bone marrow to make enough granulocytes (neutrophils) Sx include Fatigue Sore throat Ulcers in mouth or throat Fever and severe chills
34
Treatment of agranulocytosis
Blood tests to determine WBC count
35
Clozaril: Double Edged Sword
Benefits: Good effectiveness compared to other antipsychotics Effective in decreasing hallucinations and delusions Treatment for recurring suicidal behaviour Risks: May cause agranulocytosis Can interact with other drugs that decrease WBC count Weight gain and metabolic issues Cause constipation
36
Clozapine Protocol
Titrated up slowly If client is non-compliant for a period of time, titration needs to restarted Requires weekly WBC levels within first 6 months - after this period, it will be biweekly
37
Exocrine System
Photosensitivity Dermatological/Temperature Regulation Effects
38
Photosensitivity
Sensitivity to the sun Redness, blisters, and abnormal skin pigmentation
39
Dermatological/Treatment Regulation Effects
Hyperthermia Polydipsia - water intoxication Dermatitis Steven Johnson Syndrome
40
Miscellaneous System Side Effects
Gastrointestinal Ocular
41
Gastrointestinal
Change in appetite Antiemetic Hypersalivation Dysphagia
42
Ocular
Granular deposits Retinopathy Blurred vision
43
Severity
Severity of the risk of symptoms increases different types of antipsychotics Increases when dosages reach their upper limit or surpass their recommended dosages
44
Precautions and Drug Interactions
Known hypersensitivity Acute myocardial infarction History of myeloproliferative diseases Uncontrolled epilepsy CNS depression, stroke, or comatose
45
Cautions
Parkinson's disease Glaucoma, peptic ulcers Seizure disorders Alcohol misuse
46
Drug Interactions
CNS depressants Antidepressants Dopamine Agonists Antihypertensive Haldol and Lithium - causes encephalopathy
47
T/F Long term of effect of antipsychotics in children is not known
True
48
What are children and youth at greater risk of?
Weight gain, neurological side effects, dystonic reactions
49
Older Adults Considerations
Start dose LOW and titrate SLOW Watch for: sedation, EPS, TD, Anticholinergic effects Caution: pre-existing illness and polypharmacy
50
Pregnancy considers
Antipsychotics in third trimester - risk for abnormal muscle movement/withdrawal in newborn Risk Category C - cannot be ruled out Abnormal muscle movements/withdrawal: agitation, tremor, sleepiness
51
Trepanation
Cutting holes or drilling holes into brain - "letting demons escape" Treatment for madness, pain, headaches
52
Hydrotherapy
Warm Baths - used to treat insomnia, suicidal ideation, help to calm agitated clients Cold Baths - mania and psychosis Last 3 hours to a few days
53
Insulin Shock Therapy
Clients received high levels of insulin to induce coma
54
Metrazol Convulsive Therapy
Synthetic preparation of Camphor Small doses of camphor produced tachycardia, act as a diuretic, reduce appetite Large doses are lethal Used to induce coma in clients w/ schizophrenia
55
Prefrontal Lobotomy
Severed and damaged prefrontal lobe Speculated this type of surgery to remove harmful parts of the brain - schizophrenia, depression and anxiety
56
Electroconvulsive Therapy
Used to stimulate a seizure Non-pharmacological option for treatment
57
Pharmacology
Study of drugs that alter functions of living organisms
58
Drug therapy
Use of drugs to prevent, diagnose or treat signs, symptoms and disease processes
59
Medications
Drugs given for therapeutic purposes
60
Prototypes
First drug of a particular drug class to be developed
61
Regulatory Processes in Canada
Pre Clinical Studies Clinical trials Drug submission to health products and food branch Submission review Market authorization decision Public acess Surveillance and investigation
62
Ten Rights of Medication
Right medication Right client Right dose Right route Right time and frequency Right documentation Right reason/assessment Right to refuse Right evaluation Right client education
63
Pharmacokinetics
Movement of drug/medication throughout the body - and how the individual responds to it
64
Specific processes of pharmacokinetics (4)
Absorption Distribution Metabolism Excretion
65
Absorption
Factors that affect absorption: med form route of admin admin site blood flow gi function and presence of food and other drugs
66
What does distribution depend on?
Blood circulation
67
Distribution is affected by:
protein binding blood-brain barrier pregnancy lactation
68
Metabolism
Method that drugs are inactivated or bio transformed by the body Drugs are changed to: active metabolites inactive metabolites prodrugs
69
Excretion
elimination of medication from body relies on kidneys and bowels circulatory system - blood circulation lungs skin
70
Half Life
Length of time it takes for 1/2 the dosage of medication to be metabolized
71
Pharmacodynamics
What the drug does to the body or how the drug behaves
72
Receptor theory of Action
Most drugs exert their effect by chemically binding with receptors at cellular level
73
Psychopharmacology
Impact of drugs on the brain Impact of diseases on CNS Behavioural consequences of psychiatric medicine
74
PNS - Afferent Neurons
Nerve fibers responsible for bringing sensory information from outside world into the brain
75
PNS - Interneurons
"the ones in between" - connect spinal motor and sensory neurons
76
PNS - Efferent neurons
Responsible for carrying signals from brain to the PNS in order to initiate an action - removing hand from a hot pan
77
Structural Unit of Nervous System
Soma - cell body; command centre Dendrites - large and small branches; receive msgs from other neurons Axon - long tube - carries messages from soma to axon terminals; transmits impulses AWAY from soma Axon Terminals - found at end of axon, hold neurotransmitters
78
How do nerves send messages?
Action Potential
79
How do electrical charges occur?
Sodium Potassium Pump
80
Repolarization
Occur prior to the nerve being able to be depolarized again
81
Chemical is required between
2 neurons OR between a neuron and a gland/muscle
82
Post-Synaptic Effector
Proteins that are embedded in cell membrane and have binding sites for endogenous substances
83
How can post synaptic effector cell be activated again?
Reuptake Enzymes
84
Enzyme Alteration
Activation or inactivation in intracellular enzymes
85
Open or Close Ion Channels
Permeability of cell membrane
86
Neurohormone Alteration
Modifies release or inactivate neurohormones
87
Nature's Pharmacopeia
Brain makes its own antidepressants, anxiolytics and hallucinogens
88
Pscyhopharmacologic Action
Drugs act on a specific receptor site
89
When attached to a receptor. the drug can have one of two actions
Agonist Antagonist
90
Agonist
produces same biological action as neurotransmitter
91
Antagonist
blocks an action so more neurotransmitter will be in the synaptic gap
92
Affinity
Degree of strength in a bond between a drug and receptor Strong affinity = highly bond Poor affinity = less bond / means that another medication can "bump" it off and takes its place Think of the song Jolene
93
Selectivity
Ability of drug to be specific to a certain receptor Drug that's more selective = target treatment, decrease in side effects Drug that's NOT selective = cannot target treatment = increase side effects
94
Intrinsic Activity
Ability of drug to produce a biological response once attached to receptor
95
Polypharmacy
Multiple medications Risk to benefit ratio
96
Fetus is sensitive to drug effects because:
Size of fetus Few plasma proteins that can bind to drug molecules Weak capacity for metabolizing and excreting drugs
97
Thalidomide
Used to treat morning sickness to assist w/ sleep Banned - caused birth defects; deafness, blindness, cleft palate
98
Pharmacodynamics differences are caused by:
Difference in body composition Immature systems Genetic make up
99
Effective of drugs are also influenced by:
Total body water - fluid make up Fat stores Protein amounts

Pharmacology (3 decks)

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