W5 - Psychopharmocology, ECT, rTMS Flashcards
Psychopharmacology:
MUST KNOW the impt side effects & wht to do in the case of the side effects
What are the types of antipsychotics and names of 2 drugs from each group?
1st gen typical antipsychotics:
- improves POSITIVE symptoms
- LOW POTENCY: chlorpromazine
- haloperidol
- stelazine
- IM piportil
- IM clopizol
- IM modecate
- IM fluanxol
2nd gen atypical antipsychotics:
- improves positive & NEGATIVE symptoms
1. clozapine
2. risperidone
3. olanzapine
4. quetiapine
5. aripirazole
MUST KNOW FOR FINALS!!!!
1. nursing interventions
2. different classes of meds
MUST KNOW FOR FINALS!!!!
1. nursing interventions
2. different classes of meds
Potency, side effects & monitoring for patients taking 1st gen antipsychotics?
- Low potency
- needs higher dose to reach optimal strength
- SIDE EFFECTS MUST KNOW - anticholinergic effects: high sedation, postural hypotension, dizziness, blurred vision, dry mouth, difficulty urinating/urinary retention
- eg: chlorpromazine
MONITORING:
- fall risk bcs of dizziness, blurred vision
- suck on ice instead of drinking too much water to prevent water toxicity
- postural BP monitoring
- High potency
- less sedation & anticholinergic effects
- eg: haloperidol, stelazine, IM modecate
SIDE EFFECTS: MOST extrapyramidal side effects (EPSE):
A. Acute dystonia: roll up their eyes, can only see the whites of their eyes
B. Akathisia: cannot sit still
C. Dystonia: move like toy soldier very stiff
D. Tardive dyskinesia:
- tongue protrusion, rapid chewing like a rabbit, repetitive, involuntary, purposeless movements,
- rapid movements of arms, legs, trunk, impaired movement of fingers
- irreversible neurological syndrome
- caused by long term neurological syndrome
E. Parkinsonism: abnormal gait, fine tremors
F. MOST SEVERE FORM OF EPSE - neuroleptic malignant syndrome!!!!!
- MUST be sent to ICU
- hyperprexia fever 41deg
- unstable BP
- rigid muscles
- altered consciousness
- elevated blood creatinine phosphokinase
- profuse diaphoresis
- urinary incontinence
- acute renal failure
Treatment of EPSE? (3)
- acute start of symptoms: take IM congentin
- tablet artane
- diphenhydramine (cough syrup)
Treatment of neuroleptic malignant syndrome? (3)
- Symptomatic relief of hyperpyrexia
- Dantrolene: decrease muscle rigidity
- Bromocriptine: Active Dopamine agonist
How do 2nd gen atypical antipsychotics help patients?
- improves positive &
- more effective for negative symptoms like: (idt need to know)
asocial behaviour, amotivation, avolitional attitude, attention deficit, alogia (restricted thoughts & speech), anhedonia
why are 2nd gen atypical antipsychotics better than 1st gen typical?
- less risk of Neuroleptic Malignant Syndrome (NMS) and extrapyramidal side effects (EPSE)
Side effects of 2nd gen atypical antipsychotics? (5)
- majority are dose-related: high dose -> side effects
- high dose -> can cause EPSE
- clozapine: agranulocytosis (severely low WBC levels)
- olanzapine: weight gain, type 2 DM, dyslipidemia
Classes of antidepressants and names? (4)
1st line treatment: SSRIs
- fluoxetine, setraline hydrochloride
- Tricyclics (TCAs)
- amitriptylline, clomipramine, imipramine - Monoamine Oxidase Inhibitors (MAOIs)
- atypical antidepressants
- used if not responding to TCAs, SSRIs & ECT
- isocardoxaid, phenelzine
SNRIs less used
How do antidepressants help patients?
SSRI
- 1st LINE for depression
- helps with mood disturbances, altered cognition, anxiety, aggression
TCA
- treat depression
- not used often for depressive episodes
MAOI
- used ONLY if not responding to TCAs, SSRIs & ECT
- atypical antidepressants
MUST KNOW:
- ALL ANTIDEPRESSANTS takes at least 2-3 wks to take action
Side effects of SSRIs? (5)
- nausea, vomiting, diarrhoea -> weight loss
- tremors
- insomnia - served in the morning
- headache
- low libido
Side effects of TCAs? (3)
- anticholinergic effects: dizziness, blurred vision, dry mouth, urinary retention, constipation, increased ocular pressure
- tachycardia
- weight gain
Side effects of MAOIs and solution? (4)
- anticholinergic effects: dizziness, headache, blurred vision, vertigo, dry mouth, nausea, vomiting, orthostatic hypotension
- abnormal heart rate
- causes multiple drug-food interactions -> pts cannot eat alot of foods -> not usually given
- HYPERTENSIVE CRISIS:
- increased BP, palpitations
- stiff neck, radiating headache
- diaphoresis
- pupil dilation
- intracranial bleeding -> late signs: confusion, convulsion, coma
SOLUTION?
IV Pentolamine 5-10mg
Foods to avoid with MAOIs?
- aged cheese, avocados, bananas, beers, coffee, wine, chocolates, pickled food, soya & by-products: miso, soya sauce, raisins, yoghurts
What are the different types of mood stabilisers and its effects? (3+1)
- Lithium
- acceptable dose: 0.8-1.2 mEq/L - Carbamazepine - anticonvulsant
- Sodium valporate - anticonvulsant
- Mood stabilisers: reduce mood swings, manic and aggression
Side effects of lithium?
- slurred speech, hand tremors, poor memory, mental slowness
- severe nausea, polyuria, thirst
- risk of hypothyroidism
- ECG changes
- leucocytosis - high WBC can cause organ damage
TOXIC EFFECTS SEEN:
>1.5 mEq/L
- marked tremor, nausea, muscle weakness, diarrhoea, blurred vision
LIFE THREATENING:
>2.0 mEq/L
- neurotoxicity, delirium
- encephalopathy: cause brain dysfunction
Side effects of Carbamazepine
- dizziness, headache, confusion, sedation
2, dry mouth, nausea, constipation - stevens-johnson syndrome
- usually reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters.
Side effects of Sodium valproate?
- sedation, tremors, headache, visual disturbances, tinnitus (ringing in ears), agitation
- nausea, diarrhoea, cramps, heartbun
What are anxiolytics and hypnotics used for?
What are the concerns of using these drugs?
Anxiolytics:
- reduce anxiety
Hypnotics:
- treat insomnia and other sleep disorders
Concerns:
- rebound insomnia (cant sleep after stopping drugs)
- withdrawal
- abuse/dependence
What are the 5 types of anxiolytics and hypnotics?
- Short acting benzodiazepine (BZP): Triazolam
- Intermediate acting BZP: lorazepam
- long acting BZP: diazepam
- novel non-BZP: busipirone
- ZDRUG: Sedating antihistamine: hydroxyzine hydrochloride / atarax - hypnotics
- need for use must be reviewed every 2-4mths to prevent overmedication & dependence
what are the 3 classes of anxiolytics and hypnotics?
- antidepressants
- usually SSRIs
- relieves insomnia & anxiety
- sedative - benzodiazepines
- for phobias, sleep disorders, alcohol & drug withdrawal - beta blockers
- used if anxiety is associated with somatic symptoms
Nursing monitoring for anxiolytics and hypnotics? (6)
- Give during bedtime to promote daytime activities unless patient does shift work
- Observe for therapeutic effects
- Observe for adverse effects: oversedation, hypotension, paradoxica excitement like hostility, confusion/hyperactivity
- Monitor adverse effects from beta blockers like hypotension, bronchospasm, bradycardia
- Know that lorazepam can be given sublingually for rapid effects
- Tell client don’t use anxiolytics with alcohol - must have 2 hr interval
- Some medications cant be stopped immediately
what are the safety precautions for atypical Antipsychotics (Clozapine)?
WBC monitoring: x1/week for 6mths
- risk of agranulocytosis
Monitoring for patients taking which drugs?
For patients taking atypical antipsychotics:
- Olanzapine, Clozapine, Quetiapine
- Significant weight gain! :(
Fit chart is required for patients taking which drugs?
- Atypical Antipsychotics:
- Clozapine: dose-related seizure risk - Anxiolytics: Clonazepam - Benzodiazepine
- Abrupt withdrawal can precipitate status epilepticus
- cannot immediately stop meds
