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Module 6 > UNIT 2-Psychopharmacology > Flashcards

UNIT 2-Psychopharmacology Flashcards

1
Q

What is a psychotrophic drug?

A

Drugs that affect the persons behavior, cognition, emotional state

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2
Q

What is efficacy?

A

The ability to produce a desired or intended result

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3
Q

What is akathisia?

A

A feeling of muscle quivering, restlessness, and inability to sit still, sometimes the side effect of antipsychotic or antidepressant medication.

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4
Q

Why is lipid solubility important in pharmacology?

A

Drugs w. increased solubility tend to have more intense effects are at increased risk of overdose

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5
Q

The brain monitors….

A

Changes in the external world & composition of body fluids

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6
Q

The brain regulates?

A
  1. Contractions of muscles
  2. internal organs
  3. basic drives (hunger, thirst, sex, agression, self-protection)
  4. Mood & emotions
  5. Sleep cycles
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7
Q

The brain mediates?

A
  1. Conscious sensation
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8
Q

The brain stores and retrieves

A

memories

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9
Q

The brain performs

A

intellectual function

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10
Q

The brain produces & interprets

A

language

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11
Q

The brain processes

A

visual & auditory data

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12
Q

The frontal lobe of the brain…

A
  1. Though processes: such as descision making, judgement, motivation, insight, social judgement, develope and carry out plans, many executive functions originate here including personality development
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13
Q

Temporal lobe of the brain…

A
  1. Language comprehension stores sounds into memory, connects with limbic system (emotional brain)
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14
Q

The parietal lobe of the brain….

A
  1. Recieves & identifies sensory information, concept formation, abstraction, preoprioception with body awareness, reading and math skills, right and left orientation.
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15
Q

The cerebellum of the brain…

A

Regulates skeletal musce (coordination & contraction) & maintains equilibruim

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16
Q

The midbrain of the brain…

A
  1. Pupillary reflex & eye movement
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17
Q

The pons of the brain…

A

Processing station in auditory pathway

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18
Q

The medulla oblongata

A

Reflex center control (balance, hr/rr/and depth, coughing, sneezing, swallowing vomiting, maintains blood pressure

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19
Q

Proprioception is…

A

our ability to know where we are in space… its what allows us to sit down without looking behind us

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20
Q

The purpose of psychoactive medications is too…

A

manage problem symptoms and behaviors

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21
Q

True or false: As long as a patient is not a harm to themselves or others they have the right to refuse there medication.

A

true

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22
Q

What are neurons?

A

Interconnected nerve cells

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23
Q

What are neurotransmitters?

A
  1. Chemical messengers between neurons which trigger a response from one neuron to another
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24
Q

What is a neurotransmission?

A

Conduction an electrical impulse from one end of the neuron to another

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25
Q

True or false: Alot of the medications used in psycopharmacology affect the quality of the neurotransmitters or how they are moved around?

A

true

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26
Q

What is a synaptic transmission?

A

When the electrical impulse reaches the end of a neuron, the neurotransmisster is released at the axon terminal & diffuses across the synapse to the postsynaptic neuron

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27
Q

What are inhibitory neurotransmitters?

A

inhibits action in the post-synaptic cell

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28
Q

What are the excitatory neurotransmitter?

A
  1. Promotes action in post-synaptic cell
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29
Q

What happens if you have too many neurotransmitters in the synapse and they arent able to be picked up by the next cell?

A

They can’t be just left out there…. after some time in the synapse the sender will reuptake the neurotransmitters.

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30
Q

What are the classess of neurotransmitters?

A

Monoamines
Amino acids
Cholinergics
Peptides

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31
Q

What are 4 examples of a monamine neurotransmitter?

think “Dan Needs Serious Help”

A
  1. Dopamine (DA)
  2. Norepinephrine (NE)
  3. Serotonin (5HT)
  4. Histomine (H)
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32
Q

What are 2 examples of amino acids neurotransmitter?

A
  1. GABA y-aminobutyric acid
  2. Glutamate (NMDA/AMPA)
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33
Q

What is an example of a cholinergic neurotransmitter?

A

Acetylcholine (Ach)

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34
Q

What are 3 different types of peptides neurotransmitter?

A
  1. Substance P (SP)
  2. Somatostatin (SRIF)
  3. Neutotensin (NT)
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35
Q

What is dopamine?

A

Important neurotransmitter involved in cognition, motivation, and managment. It controls emotional responses and the brains reward and pleasure centers, stimulates the heart and increases blood flow to vital organs

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36
Q

What is the function of Dopamine (DA)

A
  1. Fine muscle movement
  2. Decsion-making
  3. Release of hormones (sex, thyroid & adrenal)
  4. Intergration of emtions and thoughts
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37
Q

An increase in dopamine can cause?

A
  1. Schizophrenia
  2. Mania
  3. Psychosis
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38
Q

A deficency in dopamine can cause?

A
  1. Parkinson’s
  2. depression
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39
Q

What is Norepinephrine?

A

Aneuro transmitter released from the noadrenegic neurons

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40
Q

What are the functions of NE

A
  1. Mood
  2. Attention
  3. Arousal
  4. SNS stimulation

This stimulation of our sympathatic nervous system

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41
Q

An excess in NE can result in?

A
  1. mania
  2. anxiety
  3. psychosis
  4. hightened arousal state
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42
Q

A deficency of NE can cause?

A
  1. depression
  2. lowered arousal state
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43
Q

What are the functions of serotonin (5HT)

A

Helps with
1. Sleep regulation
2. hunger
3. mood
4. pain perception
5. libiddo
6. agression
7. hormonal activity

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44
Q

What does a excessive amount of serotonin (5HT) cause?

A

Anixety

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45
Q

What does a deficeincy of serotonin (5HT) cause?

A

Depression

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46
Q

What is serotonin (5-ht)

A

Found in the brain and spinal cord, helps regulate mood, arousal, attention, behavior and body temp

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47
Q

What is histamine (H)?

A

Neurotransmitter

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48
Q

What is the function of histomine (H)

A
  1. Alertness
  2. Gastric secretion stimulation
  3. Inflammation response
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49
Q

What will excessive histamine cause?

A
  1. sleep distrubances
  2. Anxiety
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50
Q

What will a deficency of histimine cause?

A
  1. Sedation
  2. Seizures
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51
Q

What are two amino acids?

A

GABA & Glutamate

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52
Q

What is the function of Y-aminobutyric acid (GABA)?

A
  1. Decreases anxiety
  2. Decreases excitement
  3. Decreases agression
  4. Anitconvulsant
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53
Q

What can an excesses of GABA cause?

A

Reduction of anxiety

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54
Q

What can a defeciency of a GABA cause?

A
  1. Mania
  2. Anxiety
  3. Psychosis
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55
Q

What is the function of glutamate?

A
  1. Memory
  2. Emotions
  3. Cognition
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56
Q

What happens if you have an excess of glutamate?

A

1.Increased perception of pain
2.Anxiety
3.Restlessness

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57
Q

What happens if you have defeciency in glutamate?

A
  1. low energy
  2. difficulty concentrating
  3. Insomnia
  4. Psychois
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58
Q

What is an example of a cholinergics?

A

Acetylcholine

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59
Q

What is acetylcholines functions?

A
  1. Learning
  2. Memory
  3. Mood regulation
  4. Sexual and agressive behavior
  5. PNS stimulant
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60
Q

An excess amount of acetylcholine can cause?

A

Depression

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61
Q

What can a deficency of acetylcholine cause?

A
  1. Alzheimer’s
  2. Parkinson’s
  3. Huntingtons chorea
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62
Q

SLUDGE (dont ask this card)

A

s-salivation
L-lacramation
U- urination increase
D-defication increase
E- emisis

Basically juicy with a cholinergic

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63
Q

What are 4 types of antidepressants

A
  1. TCA
  2. MAOIs
  3. SSRIs
  4. SNRIs
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64
Q

What are 2 types of mood stabilizers?

A
  1. Lithium
  2. Anticonvulsants
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65
Q

What are 2 types of antipsychotics?

A
  1. 1st generation- typical (conventional)
  2. 2nd generation-atypical (unconventional)
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66
Q

What are 4 types of anxiolytics?

A
  1. Benzodiazapine
  2. Antihistamines
  3. Anticonvulsants
  4. Beta Blockers
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67
Q

What is the treatment purpose of an antidepressants?

A
  1. Major depression
  2. Panic disorder
  3. Some anxiety disorders
  4. Bipolor depression
  5. Psychotic depression
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68
Q

What are the different classess of antidepressants? list 8

A
  1. SSRIs (selective seriotonin reuptake inhibitor)
  2. SNRI (selective seriotonin norepinephrine reuptake inhibitors)
  3. SNDI (serotonin-norepinephrine disinhibitors)
  4. NDRI ( Neorepinephrine-dopamine reuptake inhibitors)
  5. SARI (serotonin antagonists/reuptake inhibitors)
  6. NRI
  7. MAOIS
  8. TCA
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69
Q

what is the drug of choice typically for major depression and panic disorder?

A

Antidepressant- SSRIs

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70
Q

What is the expected outcome of taking an antidepressant?

A
  1. mood improvement
  2. decreased depression and anxiety levels
71
Q

What is the function of SSRIs?

A

Inhibit the reuptake of serotonin, making it stay longer in the synapse.

72
Q

What are examples of SSRI’S
8

A

1. Fluoxetine (prozac)
2. Fluvoxamine (luvox)
3. Paraoxetine (paxil)
4. Sertraline (zoloft)
5. Citalopram (celexa)
6.** escitalopram (lexapro)**
7. Vilazodone (vibrid)
8. Vortioxetine (trintellix)

73
Q

What is the function of SNRIs?

A

block the reuptake of both serotonin and neorepinephrine, but remains controversial whether the dual action results in greater effcacy than SSRI

74
Q

What is the function of SNDIs

A

increase norepinephrine and serotonin transmission by blocking presynaptic a2- non adrenergic receptors.

75
Q

What is the function of a NDRI?

A
  1. does not act on serotonin system. It is a noreepineephrine dopamine reuptake inhibitor, and it it also inhibits nictnic acetylcholine receptors to reduce the addictiveness of nicotoine.
76
Q

What are some side effects of SSRIs?

A
  1. Tremors
  2. Nausea ( typically short lived- take with food)
  3. Headache
  4. Insomnia, drowsiness
  5. sexual dysfunction
  6. bruxism (especially w. paraoxetine) grininding of teeth
  7. Anxiety/agitiation
  8. dry mouth (sips of water and surgar candy)
  9. diarrhea
  10. hyponatrremia
77
Q

```

Patient teaching for SSRIs include?

A
  1. Take w/food & in the AM
  2. Avoid alcohol and antihistamines
  3. Adherence to medication regimen
  4. **medictions SHOULD NOT BE DISCONTINUED ABRUPTLY to prevent withdrawl/discontinuation syndrome
  5. Takes 1-3 weeks to be theraputic; full therapeutic effects may take 2-3 months for some meds**
  6. Let physican know if thoughts of suicide increase
  7. If taken with other serotonin blocking agents may cause serotonin toxicity (CROSS TAPER)
  8. Use cautiously with CYp450 enzyme inhibitors or inducers (ketoconazole or rifampin)
78
Q

What are symptoms of discontinuation syndrome?

A
  1. anxiety
  2. insomnia
  3. vivid dreams
  4. headache
  5. dizziness
  6. tiredness
  7. irritability
  8. flu like symptoms- achy muscle, chilss, nausea, electric shock sensations and return of depression symptoms
79
Q

What is the black box warning for SSRIs?

A

Increased risk of suicide

80
Q

Why might a doctor have a patient stop taking SSRI before a procedure?

A

can effect the way they clot

81
Q

using SHIVERS what are the symptoms of serotonin syndrome (toxicity)?

A

S-Shivering
H- Hyperreflexia and myoclonus
I- increased temp
V- Vital signs instability (tachycar and tachypen & labile bp)
E- encephalopahy (agitiation, delerium & confusion)
R- Restlessness & incoordination
S- Sweating

82
Q

True or false: Discontinuation syndrome will happen to someone who stops taking SSRIs after taking them for the 1st time for 1 week?

A

False- happens to people who have been on SSRIs for extended periods of time.

83
Q

Nursing interventions for serotonin syndrome?

What drug might we give?

A
  1. Discontinue- offending agent
  2. Maintain- safe environment
  3. Monitor- physical and mental status
  4. Administer- Serotonin receptor blockade, Dantrolene or diazepam for muscle rigidity, cyproheptadine (histamine 1 receptor antagonist)
  5. Provide- Reassurance to patient
84
Q

True or false: SSRIs can have a paradoxcical effect on patients who start SSRI therapy esp if under 21 years of age as it can cause a severe sudden onset of SI.

A

True- we will monitor patients extremely close because it can affect anyone even if they have never been suicidal

85
Q

What are some examples of TCA (Tricyclic antidepressants)
(Mine/line)

A
  1. Imipramine
  2. amitriptyline
  3. doxein
  4. desipramine
  5. nortiptyline
  6. clomipramine
  7. maprotiline
  8. Proptriptyline
  9. trimipramine
  10. amoxapine

Imipramine, clomipramine are approved for 8 and up

86
Q

What is the MOA of TCA?

A
  1. Inhibits the reuptake of serotonin (5HT) & norepinephrine (NE) * blocks the cholinergic receptors
87
Q

What are the side effects of TCAs?

A
  1. sedation
  2. mydriasis- dilated pupils
  3. Weight gain
  4. sweating
  5. toxicity
  6. sexual dysfunction
  7. decreased seizure threshold
  8. orthostatic hypotension
  9. Anticholinergic effect
88
Q

True or false- lexapro causes bad discontinuation syndrome

89
Q

Are TCA’s high or low in lipid solubility?

90
Q

What is our patient teaching for TCA’s?

A
  1. Avoid alcohol
  2. LETHAL IN OVERDOSE!!!!!
  3. take in the evening
  4. use caution when driving
  5. takes 4-8 weeks to be therapeutic
  6. adherence to medication regimen
91
Q

What is a MAOI and what is its MOA?

A

Monoamine Oxidase inhibitor: Inhibits the enzyme that degrads NE, Dopamine & 5HT

92
Q

What are some examples of MAOIs

A
  1. isocarboxazid
  2. Phenelzine
  3. Tranylcypromine
  4. Selegiline (comes in transdermal patch form for treatment of depression)
93
Q

Why are TCAs more lethal in overdose?

A

Due to the solubility of the drug… it is more rapdily absorbed

94
Q

What are side effects of MAOI’s

A
  1. Muscle cramps
  2. Weight gain
  3. Sexual dysfunction
  4. Anticholinergic effect
    5. Serious food/drug interactions with tyramine
95
Q

True or false: TCA’s are a 1st line drug for treatment of depression?

A

False- Usually never given as a 1st line of treatment. Often given in very small dosages to reduce the chance of OD

96
Q

Patient teaching for MAOI usage includes?

A
  1. Lethal in overdose
  2. Tyramine free diet avoid
    • aged cheeses & meats
    • food with yeast
    • soy
    • beer and wine
    • avacados & bananas
  3. Continue dietary restrictions for at least 2 weeks after drug discontinues
  4. Before taking any other medication notify physician
  5. Use caution when driving
97
Q

Why is there a concern of a hypertensive crisis when using MAOI

A

A MAOI keeps mono amines from being broke down and metabolized. So when the oxidase is inhibited you get a build up of tyramine which is a vassopresser and it will continue to build up and leaad to a hypertensive crisis and ciculatory collapse

98
Q

What are s/s of HTN crisis?

A
  1. N/V
  2. chills
  3. sweating
  4. fever
  5. severe htn
  6. restlessness
  7. nuchal rigiditidy (reportable by pt)
  8. dilated pupils
  9. occipital headache
  10. motor agitation
  11. severe nose bleeds
99
Q

What are 2 examples of a SNRI?

A

Venlafaxine (effexor)
Duloxetine (cymbalta)

100
Q

What is the MOA of SNRIs

A

Increases serotonin and norepinephrine

101
Q

What are the side effects of SNRIs

A
  1. include fewer anticholinergic effects
102
Q

What is an example of SNDIs? Serotonin-norepinephrine disinhibitors)

A

Mirtazapine (remeron)

103
Q

What is the MOA of SNDI?

A

Increase serotonin and norepinephrine (combined with SSRIs to augment efficacy or counteract serotonergic side effects)

usually given in adjunct

104
Q

What are examples of 1st generation/concentional antipsychotics?

A
  1. Cholromazine
  2. Haloperidol (long-acting form)
  3. trifluperazine
  4. fluphenazine
  5. loxapine perphenazine
    6.** thiroidazine**
105
Q

What are examples of 2nd generation antipsychotic?

A
  1. Clozapine
  2. amisulpride
  3. aripiprazole
  4. asenapine
  5. loperidone
  6. Olanzapine (short and long acting forms)
  7. Paliperidone (long and very long acting forms)
  8. Risperidone (sort and long acting)
  9. cariprazine
  10. brexipiprazole
  11. ziprasidone
  12. serindole
  13. quietapine
  14. lumaterperone
106
Q

What is the MOA of 1st generation/conventional antipsychotic drugs?

A

Dopamine receptor antagonist= strong dopamine blockade (causes lots of side effects)
Also blocks to lesser degree acetylcholine,histamine & NE
Control of postive symptoms (hullcinations, delsuions, agression)

107
Q

What are considered postive symptoms when talking about antipsychotic medications?

A

Symptoms that have been added that shouldn’t be there like hullucinations, delsuions, agression…

108
Q

What are considered negative symptoms when discussiong antipsychotic drugs?

A

Symptoms that should be there but arent… like ADLs, bathing, talking, etc.

109
Q

What is the MOA of 2nd generational/atypical antipsychotic drugs?

A
  1. Serotonin-dopamine antagonists= less blockage of dopamine plus strong 5HT receptor antagonist
  2. Also blocks to lesser degree acetycholine, histamine & NE
  3. Control of both postive & negative symptoms
110
Q

What are s/e of 1st generation antipsychotic meds… Remember think neuro symptoms

A
  1. anticolinergic effects
  2. weight gain
  3. sexual and/or reproductive organ issues
  4. increased prolactin levels
  5. seizures
  6. sedation
  7. tachy and or/prolonged QT intervals
  8. orthostatic hypotension
  9. EPS/tradive dyskinesia
111
Q

What are s/e of 2nd generational/atypical antipsychotic… Remember think metabolic symptoms

A
  1. Less anticholinergic effects
  2. weight gain
  3. T2DM
  4. dylipidemia
  5. anxiety
  6. headach
  7. sedation
112
Q

What are “other considerations” of 1st generation/conventional antipsychoitcs?

A
  1. More likelihood of EPS
  2. More anticholinergic effects
  3. Control of postive symptoms
    • Violence & agression
  4. Reserved for those who have been on and can tolerate
  5. Tourette’s disorder
  6. Extreme nausea in some siutaitons
113
Q

What are some 2nd generation/atypical antipsychotics considerations?

A
  1. Less likelihood of EPS
  2. Fewer anticholinergic effects
  3. control of postive & negative symptoms of schizophrenia
  4. 1st choice for inital therapy
  5. breakthrough pyschosis for concetionals
  6. greater risk of metabolic syndrome
  7. psychois r/t levadopa use
114
Q

If we have a patient who is acutely violent and agreessive which antipsychotic would be our 1st choice?

115
Q

Which generation of antipsychotic drug is at most risk of developing metabolic syndrome?

A

2nd generation

116
Q

What is our patient teaching for 1st generation/conventional antipsychotic drug?

A
  1. Limit sun exposure, use sunscreen, wear sunglasses
  2. prevention of constipation
  3. instruct to change position slowly
  4. Encourage use of sugar-free liquids and candies for dry mouth
  5. may take 2-4 weeks (if not months) for full effect/reduction of symptoms
117
Q

What is our patient education for 2nd generation/atypical antipsychotic medications

A
  1. importance of adhering to medication regimen
  2. monitor weight gain,
  3. observe for signs of diabetes melitus
  4. encourage use of sugar-free liquids and candies for dry mouth
  5. Observe for signs of infection
  6. report any change to physcian
118
Q

What is EPS?

A

Extrapyramidal is part of the nervous system that works on your involuntary movements

119
Q

What are EPS side effects?

A
  1. Acute dystonia
  2. Akathesia
  3. Pseudoparkinsonism
  4. Tardive dyskenesia
120
Q

What are signs of Acute dystonia?

A
  1. facial grimacing
  2. involuntary upward eye movement
  3. Muscle spasms of the tongue, face, neck and back (back muscle spasms cause trunk to arch forward)
  4. Laryngeal spasms
121
Q

What are s/s of pseudoparkinsonism?

A
  1. Stopped posture
  2. shuffling gait
  3. rigidity
  4. bradykinesia
  5. tremors at rest
  6. pill-rolling motion of the hand
122
Q

What are s/s of akathesia?

A
  1. restless
  2. trouble standing still
  3. paces the floor
  4. feet in constant motion, rocking back and forth
123
Q

What are different types of dystonia?

A
  1. Oculogyric
  2. opisthotonos
  3. Torticollis spasmodica
124
Q

What should we know about tardive dyskinesia?

A
  1. Considered late EPS
  2. Permanent involuntary movement
  3. May occur months to years after onset of therapy
  4. Anitpsychotic can mask early symptoms
  5. Affects 20-30% of long-term concentional antipsychotics
125
Q

What are 2 drugs that have been introduced and approved to treat TD?

A
  1. Valvenazine
  2. Deutetravenazine
126
Q

What is NMS (Neuroleptic malignant syndrome)

A

rare but serious reaction to certain medications used to treat mental health conditions. It is believed to be caused by an imbalance in the brains dopamine system.

127
Q

What are symptoms of NMS?

A
  1. Tachycardia/tachypnea
  2. Muscle rigidity (elevated CPK)
  3. Drooling
  4. Sudden high fever
  5. diaphoresis
  6. labile bps
  7. decreased LOC up to coma
128
Q

How do we treat NMS?

A
  1. Emergency care- potential transfer to ICU
  2. Stop- antipsychotic medication
  3. Increase- FLuid intake (iv fluids)
  4. Administer medications- Dantrolene or bromocriptine, antipyretics, sedation
  5. Treat fever- antipyretics, cooling blankets, cooled iv fluids
  6. Treat- bp & dysrhythmias
  7. Consider intubation
129
Q

What are some examples of benzodiazepines?

A
  1. Alprazolam
  2. oxazepam
  3. triazolam
  4. lorazepam
  5. diazepam
  6. clonazepam
  7. chlordiazepoxide
130
Q

What is the BBW for benzodiazepine?

A
  1. Risk from concomitant use w/opiods- use of benzodiazepines and opiods may result in profound sedation, resp. depression, coma, and death
131
Q

What should we know about benzodiazepines

A
  1. Depresses neurotransmission in limbic and cortical areas of the brain
  2. Useful in short term anxiety/acute anxiety
  3. dependance & tolerance may develope
132
Q

Frequent use of benzodiazepine is linked with?

A
  1. Rebound anxiety
  2. dementia
  3. increased fall risk
  4. higher mortality
133
Q

Benzodiazepines should not be combined with what type of medicaiton?

A
  1. Opiod medications
134
Q

Which two EPS signs are irreversible?

A
  1. Tardive dyskinsia
  2. Psudoparkinsonism
135
Q

If left untreated acute dystonia can turn into…

A

tardive dyskinesia

136
Q

What is the MOA of benzodiazepine?

A
  1. Promote the activity of the GABA by binding to a specific receptor on the GABA receptor complex; slows neuronal transmission
137
Q

What is the earlist sign of acute dystonia?

A

Stiffness of the neck

138
Q

What are the side effects of benzodiazepines?

A
  1. sedation
  2. dizziness
  3. fatigue
  4. impaired driving
  5. impaired cognitive function
  6. CNS depression
139
Q

What is our patient teaching for benzos

A
  1. avoid alchohol- benzos potentiate effects of alcohol
  2. Caution during driving- due to slower reflexes and response time
  3. Never discontinue abruptly- withdrawal can be fatal
  4. Medication treats the symptoms- does not cure underlying problem
  5. Takes as directed- Highly addictive
140
Q

What are benzo withdrawal symptoms after short term use?

A
  1. Anxiety
  2. insomnia
  3. sweating
  4. tremors
  5. dizziness
141
Q

What are benzo withdraw syndrome after long term use

A
  1. panic
  2. paranoia
  3. delirium
  4. HTN
  5. muscle tiwtches
  6. Seizures
142
Q

What is the MOA of a buspirone (BUSPAR)?

A
  1. Stimulates serotonin type 1A receptors on nervers, altering the chemical messages that nerves recieve
143
Q

What is the side effects of buspirone?

A
  1. Dizziness
  2. nausea
  3. headache
  4. nervousness
  5. lightheadedness
  6. excitement
144
Q

What is our patient teaching for buspirone (buspar)?

A
  1. Take 2-4 weeks to reach therapeutic response
  2. Do not take buspirone if you have taken an MAO inhibitor in the past 14 days
  3. Non-addicting
145
Q

Risk factors for acute drug indused dystonia includes

A
  1. Male
  2. young
  3. use of cocaine (cocaine effects dopamine)
  4. hx of acute dysonia
146
Q

Hadol should always be given with… to prevent what

A

Anticholergic

147
Q

What is the MOA of hydroxyzine pamoate?

A

1st generation antihistamine-blocks histamine

148
Q

What are the side effects of hydroxyzine pamoate (vistaril)?

A
  1. Drowsiness
  2. Headache
  3. Dry mouth
149
Q

What is our patient teaching for hydroxyzine pamoate?

A
  1. Takes 20-30 mins to take effects
  2. Dont take with other cns depressants
  3. non addicting
150
Q

Overview for benziodiazapines

A
  1. Rapid onset
  2. sedating
  3. dependance & withdrawl
  4. tolerance varies with increased age
  5. may be used prn
  6. used for man anxiety disorders
151
Q

Overview for buspirone (buspar)

A
  1. Delayed onset
  2. non-sedating
  3. no dependance or withdrawl
  4. no pharmacokinetic change with age
  5. not suitable for PRN use
  6. FDA or GAD only (effective in other anxiety disorders)
152
Q

True or false: Benzo are not addictive

A

False- very addictive

153
Q

Overview of hydroxyzine pamoate (vistaril)

A
  1. Rapid onset
  2. sedating
  3. no dependence or withdrawl
  4. may be used PRN
  5. Used for many anxiety disorder
154
Q

What other meds can be used for anxiety?

A
  1. Antidepressants (anxiety often linked to depression)
  2. Antihistamines
  3. Anticonvulsants
  4. Antipsychotics
  5. Beta blockers
  6. Herbal
    • Kava-kava- NOPE r/t psychosis & liver damage
    • Valerian root NOPE r/t ineffective, potentiates CNS depressants
    • Melatonin- Maybe, but can cause vivid/bizarre dreams

Remember that anxiety can be acute or can be part of chronic aniety disorder… tx is individualized.

155
Q

What are two different mood stabilizers?

A

Lithium
Anticonvulsants

156
Q

What are exmaples different types of mood stablilizes?

A
  1. balproic acid (depakote)
  2. Lamotrigine (lamictal)
  3. Carbamazepine (tegretol)
  4. Oxycarbazepine (trileptal)
  5. Gabapentin (neurontin)
  6. Topiramate (Topomax)
157
Q

What is the MOA lithium?

A

Unknown- but believed to inhibit release of dopamine & norepinephrine, hasten the destruction of catecholamines serotonin receptor blockade & decrease sensitivity of postsynaptic receptors

158
Q

What are side effects of lithium?

A
  1. fine hand tremor
  2. polyuria
  3. mild thirst
  4. mild nausea
  5. weight gain
  6. sedation
  7. acne
  8. cognitive problems
  9. delayed sexual response
  10. hair loss
159
Q

What is the acute range of lithium?

A

05.5-1.2 mEq/l

160
Q

What is the maintenance range of lithium?

A

0.6-1.0 mEq/L

161
Q

What is the toxic level of lithium

A

> 1.5 mEq/L

162
Q

What are early signs of lithium toxicity?

A

<1.5mEq/L
1. N/V/D
2. thirst
3. polyuria
4. Slurred speech
5. Muscle weakness

163
Q

True or false: Lithium levels increase/decrease depending on fluid levels?

164
Q

What are advanced signs of lithium toxicity?

A

1.5-2.0 mEq/L
1. Coarse tremors
2. confusion
3. EEG changes
4. Incoordination
5. Worsening GI Upset
6. Hyperirritability in muscles

165
Q

What are severe signs of lithium toxcity?

A

2.0-2.5 mEq/L
1. Clonic movements
2. Copious dilute urine
3. Seizures
4. Stupor
5. Severe hypotension
6. Ataxia
7. Tinnitus

166
Q

What are signs of a lethal lithium toxicity?

A

> 2.5mEq/L
1. Coma
2. Dysrhythmias
3. Ciculatory collapse
4. Oliguria
5. protienuria
6. Death

167
Q

What is our patient teaching for lithium?

A
  1. Effects begin in 5-7 days
  2. Do not take if pregnant
  3. Symptoms of toxcity
  4. Take with food to decrease GI upset
  5. Be mindful of fluid and sodium intake- think about the water/sodium balance and how it affects water
  6. WIll require monitoring of blood levels
168
Q

What is the MOA of anticonvulsants for mood stabilization?

A
  1. Potentiates the inhibitory effects of GABA; inhibits glutamate supressing CNS excitement; & slows ca+, & Na+ movement back into the neuron extending the time it takes the neuron to return to active state
169
Q

What are adverse effects of valporic acid (depakote)?

A
  1. Blood dyscrasias
  2. Hepatoxicity
  3. Pancreatitis
170
Q

What are adverse effects of carbamazepine (tegretol)

A
  1. Agranulocytosis (SORE THROAT)
  2. Aplastic anemia
171
Q

What is our anticonvulsant patient teaching?

A
  1. Report pregnancy
  2. Monitor blood levels as prescribed
  3. Do not stop abruptly
  4. Take as prescribed
  5. WIll require monitoring of blood levels
172
Q

What are the principles for psychoparmacology?

A
  1. Targets symptoms
  2. adequate dosage for sufficient time
  3. Lowest dose needed for maintenance
  4. Lower doeses for the elderly (they metabolize things different)
  5. Tapering rather than abrupt cessation
  6. follow up care
  7. simplify the medication regimen
  8. Informed consent required in psych units in Texas
  9. Conisder genetic implications

Module 6 (19 decks)

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