Unit 3: Neurological system part 2 Flashcards
What is the physiologic action of Anxiolytic Meds?
Enhance the inhibitory effects of GABA in the CNS.
What are the two types of sedative drugs that treat anxiety disorders?
Benzodiazepines and non-benzodiazepines
What is the prototype for benzodiazepines for anxiety?
alprazolam (Xanax)
What are some serious side effects of Benzodiazepines like alprazolam?
Sedation, respiratory depression, amnesia, dependence, and withdrawal.
What is the prototype for non-benzodiazepines (atypical anxiolytics)?
buspirone (BuSpar)
Are atypical anxiolytic medications like buspirone scheduled or prn?
Scheduled
What do we prescribe buspirone for?
anxiety, panic disorder, OCD, and PTSD
What are some adverse effects of buspirone?
Paradoxical anxiety, blurred vision, headache, and nausea
What do Tricyclic antidepressants do?
Reduce depression and anxiety, and improves mood and activity, appetite, and sleep. Treat neuropathy, fibromyalgia, and chronic pain.
What is the prototype for Tricyclic antidepressants?
amitriptyline
What is the pharmacologic action of tricyclic antidepressants?
Block reuptake of neurotransmitters, serotonin and norepinephrine
What are some side/adverse effects of tricyclic antidepressants?
Sedation, sweating, seizures, anticholinergic side effects, orthostatic hypotension, and overdose. (Overdose is the most dangerous adverse effect because it is life-threatening!)
Is there an antidote for tricyclic antidepressants? If so, what is it?
No there is not. They use activated charcoal to decrease drug absorption but there is no antidote.
What are the uses of Monoamine Oxidase Inhibitors (MAOIs)?
Depression that has not responded to other classes of antidepressants and depression associated with bipolar disorder.
What is the prototype of MAOIs?
phenelzine (Nardil)
What is a major side effect of MAOIs?
Hypertensive crisis with tyramine containing foods
What kinds of foods contain tyramine?
Aged cheeses, smoked, pickled, or aged meats, fish, poultry, tap beer, red wines, fava beans, soybeans, or tofu.
What is St. John’s wort?
A holistic herbal anti-depressant used for depression, anxiety, sleep disorders, and nervousness.
What does St. John’s Wort have negative interactions with?
MAOI’s and SSRI’s
What is Ginseng?
A holistic herbal anti-depressant used for stress reduction, and improvement of physical endurance and concentration.
What symptoms can Ginseng cause?
Elevated BP, chest pain, palpitations, anxiety insomnia, headache, GI symptoms
What does Ginseng have interactions with?
Anticoagulants, immunosuppressants, anticonvulsants, and antidiabetic drugs.
What are second-generation anti-depressants?
SSRIs, SNRIs, and atypical antidepressants.
What line of drugs for depression are SSRIs and SNRIs?
First-line drugs for depression
What is the mechanism of action for SSRIs and SNRIs?
SSRIs: inhibit serotonin reuptake
SNRIs: block reuptake of norepinephrine and serotonin.
What are two pieces of patient education for SSRIs and SNRIs?
- Sexual dysfunction can occur
- Can take up to 4-6 weeks before full therapeutic effects
What is the prototype for SSRIs?
fluoxetine (Prozac)
What is the prototype for SNRIs?
venlafaxine (Effexor)
What is the pharmacologic action of SSRIs and SNRIs?
Maintains neurotransmitters in synaptic space
What are the indications for 2nd generation antidepressants?
Major depression, bipolar disorder, bulimia nervosa, OCD, panic disorder, and premenstrual dysphoric disorder.
What are some contraindications for 2nd generation antidepressants?
Allergies to MAOIs or this drug/its ingredients, and Pregnancy (category C)
What are some adverse effects of 2nd generation antidepressants?
Anxiety, insomnia, sexual dysfunction, weight gain, nausea, increased risk for suicide, and serotonin syndrome.
What are some common symptoms of serotonin syndrome?
Delirium, agitation, sweating, coarse tremors, hyperthermia, seizures, rhabdomylosis, etc.
What kind of interactions are there in 2nd generation antidepressants?
MAOIs, TCAs, St. John’s Wort, Blood thinners; NSAIDs, and anticoagulants.
What is the prototype for atypical antidepressants?
bupropion (Wellbutrin)
What is bupropion’s major use and off-label use?
Major: anti-depression
Off label: Smoking cessesion
What kinds of medications manage Bipolar Disorder?
Mood stabilizers/antipsychotics
What is the prototype medication for treating bipolar disorder?
lithium carbonate
What does lithium carbonate do?
It is a mood stabilizer. It changes the transport of sodium ions in nerve cells and alters the metabolism of catecholamines (fight or flight hormones) to decrease mania.
What are the therapeutic uses of lithium carbonate?
Bipolar disorder treatment. Controls episodes of acute mania and stabilizes by preventing the return of mania or depression.
What are the side/adverse effects of lithium carbonate?
GI effects, fine hand tremors (coarse hand tremors are a sign of toxicity), weight gain, polyuria, kidney toxicity, and electrolyte imbalances.
What is the therapeutic range of lithium?
0.6 - 1.2 mEq/L (over 1.5 is toxic, over 2.5 is emergent)
What do you do for someone who has a toxicity level of 2.0 to 2.5 mEq/L of lithium?
Gastric lavage (stomach pumping)
What interactions does lithium have?
Diuretics, NSAIDs, and anticholinergics
What is the prototype medication for anti-epileptic drugs used for Bipolar disorder?
Valproic acid (Depakote)
How do anti-epileptic drugs like Valproic acid treat bipolar disorder?
They suppress CNS excitation.
What are the therapeutic uses of Valproic acid?
All seizure types, mania and bipolar disorder, and migraine headaches.
What are the positive (present) symptoms of schizophrenia?
Agitation, bizarre behavior, delusions, hallucinations, flight of ideas, illogical thinking patterns, and tangential speech patterns.
What are the negative symptoms of schizophrenia?
Social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation, decreased pleasure in activities
What are conventional antipsychotics (first generation) used for?
Schizophrenia-positive symptoms, bipolar disorder during acute manic phases, nausea and vomiting, and intractable hiccups.
What is the prototype of conventional antipsychotics?
chlorpromazine (Thorazine) Was the most commonly prescribed at one time but is now rarely used. Called a “chemical lobotomy”
What are the adverse effects of antipsychotic drugs like chlorpromazine?
anticholinergic effects, extrapyramidal side effects, sexual dysfunction, neuroleptic syndrome, and photosensitivity
What are Extrapyramidal side effects (EPS)?
Akathisia, pseudo-parkinsonism, acute dystonia, and tardive dyskinesia
What is Akathisia?
An adverse effect of antipsychotic drugs that causes Restlessness, trouble standing still, pacing the floor, feet in constant motion, and rocking back and forth. Cannot stand still or sit still, continual pacing, agitation.
Occurs within 2 months of beginning meds
Treatment: Beta-blocker, benzodiazepine, or anticholinergic.
What is psudo-parkinsonism?
An adverse effect of antipsychotic drugs that causes bradykinesia, rigidity, shuffling gait, drooling, tremors, stooped posture, and pill-rolling motion of the hand.
Occurs within 1 month of beginning meds
Treatment: anticholinergic agents like benztropine or diphenhydramine.
D/C to determine if still needed; if s/s return, give meds as prescribed.
What is acute dystonia?
An adverse effect of antipsychotic drugs that causes Severe, painful spasms of the tongue, neck, face, and back. Involuntary upward eye movement, laryngeal spasms. “Candy cane” arched position
Just hours or days after the first dose
Treatment: anticholinergic agents like diphenhydramine. Crisis situation and requires rapid treatment.
What is Tardive dyskinesia (TD)?
An adverse effect of antipsychotic drugs that cause involuntary movements of the tongue and face. Writhing movements of the tongue, extremities, and trunk. Lip smacking, sucking movements of the lips, chewing motion, rolling the tongue.
Occur months to years after starting meds.
Treatment: Notify the provider immediately, OR stop the dose; can be permanent.
What is Neuroleptic malignant syndrome (NMS)?
A potentially life-threatening syndrome caused by antipsychotic drugs. It causes High fever, unstable BP, dysrhythmias, muscle rigidity, diaphoresis, drooling, and change in loc developing into a coma.
Treatment: STOP the meds, treat s/s, and change to atypical antipsychotics.
What line of defense and generation are atypical antipsychotics?
1st line of defense!! But second generation
What are atypical antipsychotics used for?
Schizophrenia, bipolar disorder, and irritability in patients with autism
What is the prototype for atypical antipsychotics?
risperidone (Risperdal)
What is the expected pharmacological action of atypical antipsychotics like risperidone?
Block dopamine receptors and serotonin
What is the difference between first and second-generation antipsychotics?
First gen: Dopamine antagonists. Higher risk of developing EPS.
Second-gen: Dopamine-serotonin antagonists. Lower risk of developing EPS but higher risk of metabolic side effects.
What are some adverse effects of atypical antipsychotics?
- Insulin resistance + weight gain = metabolic syndrome - diabetes.
- Changes in serum lipid levels ^ cholesterol
- Mild EPS with high doses of risperidone
- Orthostatic hypertension
- Anticholinergic effects
- CNS effects: sedation, insomnia, dizziness
- Elevated prolactin levels (grow breasts no menstruation)
- Sexual dysfunction
What are some contraindications of atypical antipsychotic drugs like risperidone?
- Pregnancy risk category c
- Patients with dementia
What are some interactions of atypical antipsychotics like risperidone?
Anti-parkinson’s drugs increase symptoms
Anti-seizure decreases the effects of risperidone
What is a glaucoma?
Increased pressure in the eye and on the optic nerve.
What is a glaucoma caused by?
Excessive production of aqueous humor
Aqueous humor does not go back into the circulatory system leading to pressure in the eye.
What are the prototype drugs to treat glaucoma?
betaxolol (Betoptic) and timolol (Timpotic)
What are betaxolol and timolol?
Beta adrenergic blockers
What other drugs treat glaucoma?
Cholinergic agonists (pilocarpine) and cholinesterase inhibitors (echothiophate)
What is the primary action of timolol?
Treat open-angle glaucoma by decreasing aqueous humor production which decreases intraocular pressure.
What are the side effects of timolol?
Temporary stinging of the eye
Cardiac or respiratory effects (bradycardia, hypotension, and bronchospasm) if absorbed into the system. (Hold pressure on lacrimal ducts to prevent this.)
What are some precautions for timolol?
- Liver or renal disorders
- Older adults
