UNIT 2-Psychopharmacology Flashcards
1
Q
What is a psychotrophic drug?
A
Drugs that affect the persons behavior, cognition, emotional state
2
Q
What is efficacy?
A
The ability to produce a desired or intended result
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.
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
5
Q
The brain monitors….
A
Changes in the external world & composition of body fluids
6
Q
The brain regulates?
A
- Contractions of muscles
- internal organs
- basic drives (hunger, thirst, sex, agression, self-protection)
- Mood & emotions
- Sleep cycles
7
Q
The brain mediates?
A
- Conscious sensation
8
Q
The brain stores and retrieves
A
memories
9
Q
The brain performs
A
intellectual function
10
Q
The brain produces & interprets
A
language
11
Q
The brain processes
A
visual & auditory data
12
Q
The frontal lobe of the brain…
A
- Though processes: such as descision making, judgement, motivation, insight, social judgement, develope and carry out plans, many executive functions originate here including personality development
13
Q
Temporal lobe of the brain…
A
- Language comprehension stores sounds into memory, connects with limbic system (emotional brain)
14
Q
The parietal lobe of the brain….
A
- Recieves & identifies sensory information, concept formation, abstraction, preoprioception with body awareness, reading and math skills, right and left orientation.
15
Q
The cerebellum of the brain…
A
Regulates skeletal musce (coordination & contraction) & maintains equilibruim
16
Q
The midbrain of the brain…
A
- Pupillary reflex & eye movement
17
Q
The pons of the brain…
A
Processing station in auditory pathway
18
Q
The medulla oblongata
A
Reflex center control (balance, hr/rr/and depth, coughing, sneezing, swallowing vomiting, maintains blood pressure
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
20
Q
The purpose of psychoactive medications is too…
A
manage problem symptoms and behaviors
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
22
Q
What are neurons?
A
Interconnected nerve cells
23
Q
What are neurotransmitters?
A
- Chemical messengers between neurons which trigger a response from one neuron to another
24
Q
What is a neurotransmission?
A
Conduction an electrical impulse from one end of the neuron to another
25
True or false: Alot of the medications used in psycopharmacology affect the quality of the neurotransmitters or how they are moved around?
true
26
What is a synaptic transmission?
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
27
What are inhibitory neurotransmitters?
inhibits action in the post-synaptic cell
28
What are the excitatory neurotransmitter?
1. Promotes action in post-synaptic cell
29
What happens if you have too many neurotransmitters in the synapse and they arent able to be picked up by the next cell?
They can't be just left out there.... after some time in the synapse the sender will reuptake the neurotransmitters.
30
What are the classess of neurotransmitters?
Monoamines
Amino acids
Cholinergics
Peptides
31
What are 4 examples of a monamine neurotransmitter?
| think "Dan Needs Serious Help"
1. Dopamine (DA)
2. Norepinephrine (NE)
3. Serotonin (5HT)
4. Histomine (H)
32
What are 2 examples of amino acids neurotransmitter?
1. GABA y-aminobutyric acid
2. Glutamate (NMDA/AMPA)
33
What is an example of a cholinergic neurotransmitter?
Acetylcholine (Ach)
34
What are 3 different types of peptides neurotransmitter?
1. Substance P (SP)
2. Somatostatin (SRIF)
3. Neutotensin (NT)
35
What is dopamine?
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
36
What is the function of Dopamine (DA)
1. Fine muscle movement
2. Decsion-making
3. Release of hormones (sex, thyroid & adrenal)
4. Intergration of emtions and thoughts
37
An increase in dopamine can cause?
1. Schizophrenia
2. Mania
3. Psychosis
38
A deficency in dopamine can cause?
1. Parkinson's
2. depression
39
What is Norepinephrine?
Aneuro transmitter released from the noadrenegic neurons
40
What are the functions of NE
1. Mood
2. Attention
3. Arousal
4. SNS stimulation
This stimulation of our sympathatic nervous system
41
An excess in NE can result in?
1. mania
2. anxiety
3. psychosis
4. hightened arousal state
42
A deficency of NE can cause?
1. depression
2. lowered arousal state
43
What are the functions of serotonin (5HT)
Helps with
1. Sleep regulation
2. hunger
3. mood
4. pain perception
5. libiddo
6. agression
7. hormonal activity
44
What does a excessive amount of serotonin (5HT) cause?
Anixety
45
What does a deficeincy of serotonin (5HT) cause?
Depression
46
What is serotonin (5-ht)
Found in the brain and spinal cord, helps regulate mood, arousal, attention, behavior and body temp
47
What is histamine (H)?
Neurotransmitter
48
What is the function of histomine (H)
1. Alertness
2. Gastric secretion stimulation
3. Inflammation response
49
What will excessive histamine cause?
1. sleep distrubances
2. Anxiety
50
What will a deficency of histimine cause?
1. Sedation
2. Seizures
51
What are two amino acids?
GABA & Glutamate
52
What is the function of Y-aminobutyric acid (GABA)?
1. Decreases anxiety
2. Decreases excitement
3. Decreases agression
4. Anitconvulsant
53
What can an excesses of GABA cause?
Reduction of anxiety
54
What can a defeciency of a GABA cause?
1. Mania
2. Anxiety
3. Psychosis
55
What is the function of glutamate?
1. Memory
2. Emotions
3. Cognition
56
What happens if you have an excess of glutamate?
1.Increased perception of pain
2.Anxiety
3.Restlessness
57
What happens if you have defeciency in glutamate?
1. low energy
2. difficulty concentrating
3. Insomnia
4. Psychois
58
What is an example of a cholinergics?
Acetylcholine
59
What is acetylcholines functions?
1. Learning
2. Memory
3. Mood regulation
4. Sexual and agressive behavior
5. PNS stimulant
60
An excess amount of acetylcholine can cause?
Depression
61
What can a deficency of acetylcholine cause?
1. Alzheimer's
2. Parkinson's
3. Huntingtons chorea
62
SLUDGE (dont ask this card)
s-salivation
L-lacramation
U- urination increase
D-defication increase
E- emisis
Basically juicy with a cholinergic
63
What are 4 types of antidepressants
1. TCA
2. MAOIs
3. SSRIs
4. SNRIs
64
What are 2 types of mood stabilizers?
1. Lithium
2. Anticonvulsants
65
What are 2 types of antipsychotics?
1. 1st generation- typical (conventional)
2. 2nd generation-atypical (unconventional)
66
What are 4 types of anxiolytics?
1. Benzodiazapine
2. Antihistamines
3. Anticonvulsants
4. Beta Blockers
67
What is the treatment purpose of an antidepressants?
1. Major depression
2. Panic disorder
3. Some anxiety disorders
4. Bipolor depression
5. Psychotic depression
68
What are the different classess of antidepressants? list 8
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
69
what is the drug of choice typically for major depression and panic disorder?
Antidepressant- SSRIs
70
What is the expected outcome of taking an antidepressant?
1. mood improvement
2. decreased depression and anxiety levels
71
What is the function of SSRIs?
Inhibit the reuptake of serotonin, making it stay longer in the synapse.
72
What are examples of SSRI'S
8
**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
What is the function of SNRIs?
block the reuptake of both serotonin and neorepinephrine, but remains controversial whether the dual action results in greater effcacy than SSRI
74
What is the function of SNDIs
increase norepinephrine and serotonin transmission by blocking presynaptic a2- non adrenergic receptors.
75
What is the function of a NDRI?
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
What are some side effects of SSRIs?
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
# ```
Patient teaching for SSRIs include?
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
What are symptoms of discontinuation syndrome?
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
What is the black box warning for SSRIs?
Increased risk of suicide
80
Why might a doctor have a patient stop taking SSRI before a procedure?
can effect the way they clot
81
using SHIVERS what are the symptoms of serotonin syndrome (toxicity)?
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
True or false: Discontinuation syndrome will happen to someone who stops taking SSRIs after taking them for the 1st time for 1 week?
False- happens to people who have been on SSRIs for extended periods of time.
83
Nursing interventions for serotonin syndrome?
What drug might we give?
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
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.
True- we will monitor patients extremely close because it can affect anyone even if they have never been suicidal
85
What are some examples of TCA (Tricyclic antidepressants)
(Mine/line)
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
What is the MOA of TCA?
1. Inhibits the reuptake of serotonin (5HT) & norepinephrine (NE) * blocks the cholinergic receptors
87
What are the side effects of TCAs?
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
True or false- lexapro causes bad discontinuation syndrome
True
89
Are TCA's high or low in lipid solubility?
high
90
What is our patient teaching for TCA's?
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
What is a MAOI and what is its MOA?
Monoamine Oxidase inhibitor: Inhibits the enzyme that degrads NE, Dopamine & 5HT
92
What are some examples of MAOIs
1. isocarboxazid
2. Phenelzine
3. Tranylcypromine
4. Selegiline (comes in transdermal patch form for treatment of depression)
93
Why are TCAs more lethal in overdose?
Due to the solubility of the drug... it is more rapdily absorbed
94
What are side effects of MAOI's
1. Muscle cramps
2. Weight gain
3. Sexual dysfunction
4. Anticholinergic effect
**5. Serious food/drug interactions with tyramine**
95
True or false: TCA's are a 1st line drug for treatment of depression?
False- Usually never given as a 1st line of treatment. Often given in very small dosages to reduce the chance of OD
96
Patient teaching for MAOI usage includes?
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
Why is there a concern of a hypertensive crisis when using MAOI
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
What are s/s of HTN crisis?
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
What are 2 examples of a SNRI?
Venlafaxine (effexor)
Duloxetine (cymbalta)
100
What is the MOA of SNRIs
Increases serotonin and norepinephrine
101
What are the side effects of SNRIs
1. include fewer anticholinergic effects
102
What is an example of SNDIs? Serotonin-norepinephrine disinhibitors)
Mirtazapine (remeron)
103
What is the MOA of SNDI?
Increase serotonin and norepinephrine (combined with SSRIs to augment efficacy or counteract serotonergic side effects)
usually given in adjunct
104
What are examples of 1st generation/concentional antipsychotics?
1. Cholromazine
2. **Haloperidol** (long-acting form)
3. trifluperazine
4. fluphenazine
5. loxapine perphenazine
6.** thiroidazine**
105
What are examples of 2nd generation antipsychotic?
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
What is the MOA of 1st generation/conventional antipsychotic drugs?
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
What are considered postive symptoms when talking about antipsychotic medications?
Symptoms that have been added that shouldn't be there like hullucinations, delsuions, agression...
108
What are considered negative symptoms when discussiong antipsychotic drugs?
Symptoms that should be there but arent... like ADLs, bathing, talking, etc.
109
What is the MOA of 2nd generational/atypical antipsychotic drugs?
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
What are s/e of 1st generation antipsychotic meds... Remember think neuro symptoms
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
What are s/e of 2nd generational/atypical antipsychotic... Remember think metabolic symptoms
1. Less anticholinergic effects
2. weight gain
3. T2DM
4. dylipidemia
5. anxiety
6. headach
7. sedation
112
What are "other considerations" of 1st generation/conventional antipsychoitcs?
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
What are some 2nd generation/atypical antipsychotics considerations?
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
If we have a patient who is acutely violent and agreessive which antipsychotic would be our 1st choice?
1st gen
115
Which generation of antipsychotic drug is at most risk of developing metabolic syndrome?
2nd generation
116
What is our patient teaching for 1st generation/conventional antipsychotic drug?
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
What is our patient education for 2nd generation/atypical antipsychotic medications
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
What is EPS?
Extrapyramidal is part of the nervous system that works on your involuntary movements
119
What are EPS side effects?
1. Acute dystonia
2. Akathesia
3. Pseudoparkinsonism
4. Tardive dyskenesia
120
What are signs of Acute dystonia?
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
What are s/s of pseudoparkinsonism?
1. Stopped posture
2. shuffling gait
3. rigidity
4. bradykinesia
5. tremors at rest
6. pill-rolling motion of the hand
122
What are s/s of akathesia?
1. restless
2. trouble standing still
3. paces the floor
4. feet in constant motion, rocking back and forth
123
What are different types of dystonia?
1. Oculogyric
2. opisthotonos
3. Torticollis spasmodica
124
What should we know about tardive dyskinesia?
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
What are 2 drugs that have been introduced and approved to treat TD?
1. Valvenazine
2. Deutetravenazine
126
What is NMS (Neuroleptic malignant syndrome)
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
What are symptoms of NMS?
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
How do we treat NMS?
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
What are some examples of benzodiazepines?
1. Alprazolam
2. oxazepam
3. triazolam
4. lorazepam
5. diazepam
6. clonazepam
7. chlordiazepoxide
130
What is the BBW for benzodiazepine?
1. Risk from concomitant use w/opiods- use of benzodiazepines and opiods may result in profound sedation, resp. depression, coma, and death
131
What should we know about benzodiazepines
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
Frequent use of benzodiazepine is linked with?
1. Rebound anxiety
2. dementia
3. increased fall risk
4. higher mortality
133
Benzodiazepines should not be combined with what type of medicaiton?
1. Opiod medications
134
Which two EPS signs are irreversible?
1. Tardive dyskinsia
2. Psudoparkinsonism
135
If left untreated acute dystonia can turn into...
tardive dyskinesia
136
What is the MOA of benzodiazepine?
1. Promote the activity of the GABA by binding to a specific receptor on the GABA receptor complex; slows neuronal transmission
137
What is the earlist sign of acute dystonia?
Stiffness of the neck
138
What are the side effects of benzodiazepines?
1. sedation
2. dizziness
3. fatigue
4. impaired driving
5. impaired cognitive function
6. CNS depression
139
What is our patient teaching for benzos
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
What are benzo withdrawal symptoms after short term use?
1. Anxiety
2. insomnia
3. sweating
4. tremors
5. dizziness
141
What are benzo withdraw syndrome after long term use
1. panic
2. paranoia
3. delirium
4. HTN
5. muscle tiwtches
6. Seizures
142
What is the MOA of a buspirone (BUSPAR)?
1. Stimulates serotonin type 1A receptors on nervers, altering the chemical messages that nerves recieve
143
What is the side effects of buspirone?
1. Dizziness
2. nausea
3. headache
4. nervousness
5. lightheadedness
6. excitement
144
What is our patient teaching for buspirone (buspar)?
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
Risk factors for acute drug indused dystonia includes
1. Male
2. young
3. use of cocaine (cocaine effects dopamine)
4. hx of acute dysonia
146
Hadol should always be given with... to prevent what
Anticholergic
147
What is the MOA of hydroxyzine pamoate?
1st generation antihistamine-blocks histamine
148
What are the side effects of hydroxyzine pamoate (vistaril)?
1. Drowsiness
2. Headache
3. Dry mouth
149
What is our patient teaching for hydroxyzine pamoate?
1. Takes 20-30 mins to take effects
2. Dont take with other cns depressants
3. non addicting
150
Overview for benziodiazapines
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
Overview for buspirone (buspar)
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
True or false: Benzo are not addictive
False- very addictive
153
Overview of hydroxyzine pamoate (vistaril)
1. Rapid onset
2. sedating
3. no dependence or withdrawl
4. may be used PRN
5. Used for many anxiety disorder
154
What other meds can be used for anxiety?
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
What are two different mood stabilizers?
Lithium
Anticonvulsants
156
What are exmaples different types of mood stablilizes?
1. balproic acid (depakote)
2. Lamotrigine (lamictal)
3. Carbamazepine (tegretol)
4. Oxycarbazepine (trileptal)
5. Gabapentin (neurontin)
6. Topiramate (Topomax)
157
What is the MOA lithium?
Unknown- but believed to inhibit release of dopamine & norepinephrine, hasten the destruction of catecholamines serotonin receptor blockade & decrease sensitivity of postsynaptic receptors
158
What are side effects of lithium?
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
What is the acute range of lithium?
05.5-1.2 mEq/l
160
What is the maintenance range of lithium?
0.6-1.0 mEq/L
161
What is the toxic level of lithium
>1.5 mEq/L
162
What are early signs of lithium toxicity?
<1.5mEq/L
1. N/V/D
2. thirst
3. polyuria
4. Slurred speech
5. Muscle weakness
163
True or false: Lithium levels increase/decrease depending on fluid levels?
True
164
What are advanced signs of lithium toxicity?
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
What are severe signs of lithium toxcity?
2.0-2.5 mEq/L
1. Clonic movements
2. Copious dilute urine
3. Seizures
4. Stupor
5. Severe hypotension
6. Ataxia
7. Tinnitus
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What are signs of a lethal lithium toxicity?
>2.5mEq/L
1. Coma
2. Dysrhythmias
3. Ciculatory collapse
4. Oliguria
5. protienuria
6. Death
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What is our patient teaching for lithium?
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
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What is the MOA of anticonvulsants for mood stabilization?
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
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What are adverse effects of valporic acid (depakote)?
1. Blood dyscrasias
2. Hepatoxicity
3. Pancreatitis
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What are adverse effects of carbamazepine (tegretol)
1. Agranulocytosis (SORE THROAT)
2. Aplastic anemia
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What is our anticonvulsant patient teaching?
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
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What are the principles for psychoparmacology?
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
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