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Nurs 1446 A Meds > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Fluoxetine

Class, Use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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2
Q

Citalopram

Class, Use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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3
Q

Excitalopram

Class, Use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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4
Q

Fluvoxamine

Class, use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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5
Q

Paroxetine

Class, use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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6
Q

Sertraline

Class, use, SE, Contradictions

A

SSRI

Depression:

Line treatment for major depressive disorder.

Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)

SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME

Medications potentially Serotonin Syndrome

TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng

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7
Q

Paroxetine an SSRI has 2 majors issues involved with its use.

A

Snap-back effect I’d stopped abruptly

Anticholinergic (Inhibits Acetylcholine)

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8
Q

Everything goes up is a severe SE of SSRI esp when dosage is increased or take with Contradicted medications

A

Serotonin syndrome

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9
Q

Zyprexa maybe used for…

A

Treating mild symptoms of serotonin syndrome

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10
Q

Why won’t Tylenol or Motrin help the fever associated with Serotonin syndrome?

A

Elevated temperature is due to excessive muscle activity Not Hypothalamus

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11
Q

Venalfaxine & desvenalfaxine are this type of medication

Watch for HTN

A

SNRI

Serotonin & Norepinephrine Reuptake inhibitor

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12
Q

Duloxetine SNRI has this off lable use

A

GAD, Neuropathic Pain

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13
Q

Atomoxetine (this type of med) is indicated for ADHA

A

SNRI

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14
Q

Duloxetine

A

SNRI Serotonin Norepinephrine Reuptake Inhibitor

Use

Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD

SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm

SERIOUS SIDE EFFECTS

Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients

Contradictions

MAOI
HTN
Liver or Kidney disease

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15
Q

Venalfaxine & Desvenlafaxine

A

SNRI Serotonin Norepinephrine Reuptake Inhibitor

Use

Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD

SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm

SERIOUS SIDE EFFECTS

Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients

Contradictions

MAOI
HTN
Liver or Kidney disease

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16
Q

Levomilnacipran

A

SNRI Serotonin Norepinephrine Reuptake Inhibitor

Use

Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD

SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm

SERIOUS SIDE EFFECTS

Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients

Contradictions

MAOI
HTN
Liver or Kidney disease

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17
Q

Atomoxetine

Class, use, SE & Contradictions

A

SNRI Serotonin Norepinephrine Reuptake Inhibitor

Use

Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD

SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm

SERIOUS SIDE EFFECTS

Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients

Contradictions

MAOI
HTN
Liver or Kidney disease

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18
Q

Type of Antidepressant that prevents the breakdown of neurotransmitters by enzyme Monoamine Oxidase - Increasing availability of 5-HT, NE, DA

A

MAOI

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19
Q

Used for major depression when other antidepressants have failed. Give examples

A

MAOI

Isocarboxazid
Phenelzine Sulfate
Tranylcypromine Sulfate
Selegiline

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20
Q

Isocaboxazid

Class, use, SE & Contradictions

A

MAOI

Use:

Depression when other meds didn’t work.

Anxiety

Parkinsons: Increase dopamine

Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.

Serious Side Effects

HTN Crisis with Tyramine (Cheese Effect)

Serotonin Syndrome

Contradictions

Other antidepressants

Foods containing Tyramine

Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.

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21
Q

Phenelzine

Class, use, SE, Contradictions

A

MAOI

Use:

Depression when other meds didn’t work.

Anxiety

Parkinsons: Increase dopamine

Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.

Serious Side Effects

HTN Crisis with Tyramine (Cheese Effect)

Serotonin Syndrome

Contradictions

Other antidepressants

Foods containing Tyramine

Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.

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22
Q

Tranylcypromine

Class, Use, SE & Contradictions

A

MAOI

Use:

Depression when other meds didn’t work.

Anxiety

Parkinsons: Increase dopamine

Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.

Serious Side Effects

HTN Crisis with Tyramine (Cheese Effect)

Serotonin Syndrome

Contradictions

Other antidepressants

Foods containing Tyramine

Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.

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23
Q

Selegiline

Class, use, se & Contradictions

A

MAOI

Use:

Depression when other meds didn’t work.

Anxiety

Parkinsons: Increase dopamine

Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.

Serious Side Effects

HTN Crisis with Tyramine (Cheese Effect)

Serotonin Syndrome

Contradictions

Other antidepressants

Foods containing Tyramine

Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.

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24
Q

How do MAOIs affect 5-HT, NE, DA

A

Increases them

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25
Q

SSRI have this precaution with Warfarin/ NSAIDS

A

Bleeding Risk, consult HCP

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26
Q

Amitriptyline

A

Class: Tricyclic antidepressants

Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.

SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD

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27
Q

Nortriptyline

A

Class: Tricyclic antidepressants

Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.

SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD

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28
Q

Doxepine

A

Class: Tricyclic antidepressants

Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.

SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD

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29
Q

Imipramine

A

Class: Tricyclic antidepressants

Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.

SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD

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30
Q

These medications are 5-HT & NE reuptake inhibitors

Amitriptyline
Nortriptyline
Doxepine
Imipramine

A

Tricyclic antidepressants

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31
Q

NE & D2 reuptake inhibitor

No sexual Dysfunction

Contradicted with seizures, ETOH & Benzo withdrawal

Can cause weight loss & anorexia

A

Buproprion (Wellbutrin)

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32
Q

Vilazodone SSRI & 5-HT1A receptor partial agonist

Caution with Glaucoma & Seizures due to abnormal bleeding

SE Weight gain, GI problems

Can it be used for Bipolar?

A

No may make problems worse

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33
Q

Vortioxetine (Trintellix)

Serotonergic antidepressant

Caution with (2)
Avoid use in these types of patients…

SE: May cause angioedema, abnormal bleeding, flatulence

Expensive

A

Caution: Abrupt Withdrawal & Seizure disorder

Avoid in Elderly

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34
Q

Mirtazapine (Remeron)

Tricyclic antidepressants

Antagonist of NE & 5-HT2 receptors

Smoking changes levels in blood quickly

Common SE: Weight gain, xerostomia, Constipation, Sedation

Serious SE

A

Agranulocytosis, neutropenia, torsades de pointes, Steven-Johnson syndrome

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35
Q

Trazodone

Antidepressants but given for Sleep

Caution with heart problems

Priapism (>4 hr erection)

SE xerostomia, drowsiness, blurred vision, HTN, confusion, Sexual Dysfunction

Some patients may have a paradoxical reaction. Describe…

A

Paradoxical reaction is oppsite of what you expect to happen

They will become agitated

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36
Q

Brexanolone injection (Zulresso)

Works on GABA

Expensive 34,000$

Used for….

How does it work…

A

Postpartum- Given immediately after birth

Works: Mimics hormone allopregnanolone

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37
Q

Zuranolone (Pill form for postpartum)

How long is it taken

When to expect to see improvement

A

1qDay x 14 days

Improvement in 3 days

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38
Q

Lithium
Carbamazepine
Valproate
Lamotrigine
Clonazepam

Not FDA approved

Oxcarbazepine
Gabapentin
Topiramate

This type of medication….

Works by…..

A

Mood stabilizers

Provide a balance between GABA & Glutamate

39
Q

Patients with Bipolar I & II
Poor control of anxiety & depression symptoms
Kids Behavior issues or OCD
PTSD
Treatment resistant depression
Hormone dysfunction

A

Mood stabilizer

Lithium
Carbamazepine
Valproate
Lamotrigine
Clonazepam

Not FDA approved

Oxcarbazepine
Gabapentin
Topiramate

40
Q

Check these labs before giving Lithium

Kidney function.. Serum Creatinine, GFR, BUN

Electrolytes… Which electrolyte level is a concern

Lithium levels …. Therapeutic vs Toxic levels

Thyroid….

Pregnancy…

A

Serum Creatinine:

Hold if: Creatinine >1.3 mg/dL (indicates impaired kidney function).

Glomerular Filtration Rate (GFR):

Hold if: GFR <60 mL/min/1.73 m² (suggests reduced kidney filtration).

Blood Urea Nitrogen (BUN):

Hold if: BUN >20 mg/dL, especially with high creatinine (suggests kidney dysfunction).

Electrolytes:

Hold if: Sodium <135 mEq/L (hyponatremia can increase lithium toxicity risk).

Thyroid:

TSH >4.5 mIU/L is particularly significant because it indicates hypothyroidism, which can be caused or worsened by lithium. Elevated TSH suggests that the thyroid is not producing enough thyroid hormones (T3 and T4), and this could warrant holding lithium to prevent further thyroid dysfunction.

Contradicted in preggers

41
Q

Lithium toxicity

Describe Toxicity Level and # associated with it.

Gastrointestinal Symptoms: Nausea, vomiting, diarrhea

Neurological Symptoms: Hand tremors, mild confusion, drowsiness

Muscle Symptoms: Weakness, fatigue

Describe Lithium toxicity level

Neurological Symptoms: Severe tremors, confusion, ataxia (loss of coordination), muscle twitching

Cognitive Symptoms: Slurred speech, agitation, worsening confusion

Cardiovascular Symptoms: Arrhythmias, increased heart rate

Describe Lithium Toxicity level
Neurological Symptoms: Seizures, coma, severe confusion, stupor

Renal Symptoms: Decreased urine output, kidney failure

Cardiovascular Symptoms: Hypotension, severe arrhythmias

Other Symptoms: Respiratory failure, potential death if untreated

A

Mild Toxicity (Lithium Level: 1.5–2.0 mEq/L): N/V, hand tremors, mild confusion, drowsiness, weak

Moderate Toxicity (Lithium Level: 2.0–2.5 mEq/L): Severe tremors, confusion, ataxia, muscle twitch, Slurred Speech, Worsening confusion , agitation, Arrhythmia

Severe Toxicity (Lithium Level: >2.5 mEq/L): Seizures, coma, severe confusion, decrease urine output, kidney failure, hypotension, Respitory failure

42
Q

Bradycardia
Ataxia (Jerky Movement) & acne
Tremour & hypothyroid
Teratogenic ( birth defects or abnormalities in a developing fetus )
Edema
Rash & Renal Toxicity
Leukocytosis

BATTERY

Describes side effects for …

A

Lithium

43
Q

Match the mood stabilizers

Valproate, carbamazepine, lamotrigine

Maintenance, not for acute mania, frequently used in borderline personality

Acute mania

Mixed episodes of mania & depression

A

Lamotrigine
Maintenance, not for acute mania, frequently used in borderline personality

Carbamazepine
Acute mania

Valproate
Mixed episodes of mania & depression

44
Q

Carbamazepine: Acute Mania
(Mood Stabilizer)

Therapeutic range….

SE: Anticholinergic, Orthostatic Hypotension, pruritus, HTN, ataxia, arrhythmias

Serious SE

A

Therapeutic range 4 - 12

Serious: Agranulocytosis & Steven Johnson Syndrome

45
Q

Valproate: Mixed Episodes
(Mood Stabilizer)

*boost gaba

SE: weight gain, mental dull, tremor, hair loss, libido loss, thrombocytopenia, pancreatitis, liver failure

Contradiction Pregnancy & liver issues

Therapeutic range:…..

Labs….

A

Therapeutic range 50 - 100mL

Labs

AST (Aspartate Aminotransferase):

Safe Range: 10-40 U/L

Why: Elevated AST can indicate liver damage, so levels should be within the normal range to safely start or continue valproate.

ALT (Alanine Aminotransferase):

Safe Range: 7-56 U/L
Why: ALT is more specific to the liver, and elevated levels suggest liver injury, which is a concern with valproate use.

Albumin:

Safe Range: 3.5-5.0 g/dL
Why: Albumin reflects liver function and nutritional status. Low albumin may indicate liver dysfunction or malnutrition, which can increase the risk of valproate-related side effects.

CBC (Complete Blood Count):

Safe Findings:
White Blood Cells (WBC): 4,500-11,000 cells/mcL
Platelets: 150,000-450,000/mcL
Hemoglobin: 13.8-17.2 g/dL (men), 12.1-15.1 g/dL (women)
Why: Valproate can cause thrombocytopenia (low platelets) and affect white blood cell counts, so a normal CBC is important before starting the medication.

Ammonia:

Safe Range: 15-45 µmol/L
Why: Elevated ammonia levels can indicate a risk of hyperammonemia, a possible side effect of valproate, which can lead to serious complications like encephalopathy.

46
Q

Lamotrigine (Depression in Bipolar)

Moderates release of Glutamate

SE: Dizzy, Ataxia, blurred vision, HA, Anticholinergic, Photosensitivity

Therapeutic range….

Major dangerous SE:….

A

Therapeutic range 3 - 14

Steven Johnson Syndrome. Rash first sign

47
Q

Oxcarbazepine

Not FDA approved

Mood Stabilizer

Similar to Carbamazepine

Lesser risk of Rash & Hepatotoxicity

Adverse reactions…..

A

CNS depression & hyponatremia

48
Q

Erythema multiforme

Hypersensitivity reaction to meds or infections

Symptoms

Fever
Itching
Joint aches
Skin lesions
RASH

AKA…..

A

Stevens-Johnson syndrom

Life threatening

49
Q

Avolition vs Anhedonia

A

Avolition = Lack or inability to start or complete goals

Anhedonia = lack of interest in things you once enjoyed

50
Q

Low Potency / High Dose:

Examples: (2)

Characteristics:

These drugs require higher doses to achieve the desired antipsychotic effect.

Low potency antipsychotics have weaker dopamine-blocking effects but tend to have more sedative effects and anticholinergic side effects (like dry mouth, constipation, and blurred vision).

They are more likely to cause orthostatic hypotension (a drop in blood pressure when standing up) and weight gain

High Sedation & Ach SE (Wine Coolers)

A

Chlorpromazine, Thioridazine

First gen Traditional Antipsychotics

51
Q

High Potency / Low Dose:

Examples: (2)

Characteristics:

These drugs require lower doses to be effective.

High potency antipsychotics have stronger dopamine-blocking effects, which means they are effective at lower doses.

They are more likely to cause extrapyramidal symptoms (EPS), such as tremors, rigidity, and bradykinesia (slow movements), which are movement disorders.

These drugs generally have fewer sedative and anticholinergic side effects compared to low potency antipsychotics.

A

Fluphenazine, Haloperidol

52
Q

List

Positive & Negative symptoms of Psychosis

A

Positive

Hallucinations
Delusions
Disorganized thoughts
Agitated body movements

Negative symptoms

Flat affect
Anhedonia
Avolition
Poverty of speech & thought
Neglect ADLs

53
Q

Chlorpromazine

A

1st generation antipsychotic (Blocks dopamine)

Low Potency/ High Dose

SE:

High Sedation/ Ach SE
Low EPS
Agranulocytosis
Orthostatic hypotension

54
Q

Thioridazine

A

1st generation antipsychotic (blocks dopamine)

Low Potency/ High Dose

High Sedation & Ach
Low EPS
ORTHOSTATIC HYPOTENSION

55
Q

Fluphenazine

A

1st generation antipsychotic (Blocks dopamine)

High Potency/ Low Dose

Low Sedation/ Ach SE
High EPS

56
Q

Haloperidol

A

1st generation antipsychotic (Blocks dopamine)

High Potency/ Low Dose

Low Sedation/ Ach SE
High EPS

57
Q

Trifluoperazine

A

1st generation antipsychotic (Blocks dopamine)

High Potency/ Low Dose

Low Sedation/ Ach SE
High EPS

58
Q

Perphenazine

A

1st generation antipsychotic (Blocks dopamine)

High Potency/ Low Dose

Low Sedation/ Ach SE
High EPS

59
Q

1st generation antipsychotics work well controlling which type of symptoms associated with psychosis

A

Positive

Hallucinations
Delusions
Disturbed thought process

60
Q

Risperidone

Class, Use, SE, Contradictions

Labs before starting Normal values: BMI, BP, A1c, fasting lipids

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

61
Q

Olanzapine

Labs to check

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

62
Q

Quetiapine

Class, use, SE, Contradictions

Labs to check first

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

63
Q

Ziprasidone

Class, use, SE, Contradictions

Labs to assess first

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

64
Q

Paliperidone

Class, use, SE, Contradictions

Labs to assess first

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

65
Q

Lurasidone

Class, use, SE, Contradictions

Labs to assess first

A

2nd generation atypical antipsychotics.

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Body Mass Index (BMI):

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

66
Q

Clozapine

Class, use, SE, Contradictions

Special Requirements:……

Teach:…..

A

2nd generation atypical antipsychotics.

Atypical antipsychotics

Used to prevent suicide

First line treatment

Target Postive & Negative Symptoms

SE: Lower risk for ESP
Agranulocytosis in 1%
Weight gain
Increased cholesterol

Contradicted Dementia / CVA

Maybe the labs associated with 2nd generation apply?

Special requirements

Patients must be on federal mandatory registry (REMS)

Required CBC (ANC >1500)

Teach Monitor for sore throat, fever, s/s infection Get Flu Vaccines

67
Q

Brexipipazole (Used with antidepressants, agitation in dementia)

Class, use, SE & Contradictions

A

3rd generation antipsychotic

Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)

68
Q

Cariprazine (Bipolar I disorder, MDD) WITH Antidepressants

Class, use, SE & Serious side effects

A

3rd generation antipsychotic

Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)

69
Q

Aripiprazole

Class, use, SE, Contradictions

A

3rd generation antipsychotic

Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)

70
Q

Long Acting Injectable Antipsychotics
LAIs

Distinguish 1st from 2nd generation

Fluphenazine
Aripiprazole
Olanzapine
Paliperidone
Haloperidol
Risperidone

A

1st generation
Fluphenazine
Haloperidol

2nd Generation

Aripiprazole
Olanzapine
Paliperidone
Risperidone

71
Q

This heart wave pattern is seen with Antipsychotics

Leading to which problems

A

Q-T prolongation

Arythmias, torsade de pointes, V Fib

72
Q

Movement Disorders:
Extrapyrmidal Symptoms

Dopamine DOWN & Acetylcholine UP

Dystonia: Involuntary muscle contractions causing abnormal postures or movements, often due to antipsychotic use.

Medical emergency?
Onset after ingestion of antipsychotic meds

A

Medical emergency: Yes, if muscles in throat or neck are affected

Onset: can start within 4 hrs.

73
Q

Movement Disorders:
Extrapyrmidal Symptoms

Dopamine DOWN & Acetylcholine UP

____: Restlessness of mind and body associated with antipsychotic use.

High risk suicide (According to PP)

A

Akathesia

74
Q

Movement Disorders:
Extrapyrmidal Symptoms

Dopamine DOWN & Acetylcholine UP

Slowed movements
Muscle stiffness
Shuffling walk
Flat affect
Pill rolling
Stooped posture
Reduced arm swinging

A

Pseudoparkinsonism

75
Q

EPS symptoms such as akathisia & Tardive dyskinesia will stop when antipsychotic medications are Discontinued

T or F

A

F

All EPS symptoms will stop upon discontinuation Except Tardive dyskinesia

76
Q

Neuroleptic Malignant Syndrome (NMS)

Life threatening condition from use or with drawl of Antipsychotic medication

Symptoms: ______

A

Fever
Muscle rigidity
Decreased LOC
Arythmia
Tachycardia
Diaphoresis
BP changes

77
Q

Treatment for NMS incldue:

Discontinuation of Meds

Continuation of Meds if Withdrawal is problem

Dantrolene (Muscle Relaxant)

Cool measures

Stabilize electrolyte levels

Which medications cause NMS…

A

1st generation antipsychotic

78
Q

SSRI mixed with…..

MAIO mixed with……

Can cause Serotonin Syndrome

A

SSRI St. Johns Wort

MAIO mixed with Any Antidepressants

79
Q

How long after stopping MAIO to wait before starting new Antidepressants

A

2 weeks

80
Q

SSRI

Paroxetine, Sertraline, Fluvoxamine Fluoxetine, Citalopram, Exitalopram

Most common SE

Dangerous SE

A

Usually improve 3 months

Weight Gain
Sexual Dysfunction
Insomnia

Dangerous:
Suicide high risk 18 - 24
(Report more energy without change in depression)

Serotonin Syndrome

81
Q

Sexual Dysfunction
Weight gain
Insomnia
GI Disturbances
Anxiety
Headache

Common SE with SSRIs
Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Exitalopram

Name the common SE with SNRI

A

Same as SSRI also

Increased BP
Xerostomia
Diaphoresis

Atomoxetine Levomilnacipran Venalfaxine Desvenlafaxine Duloxetine

82
Q

Atomoxetine Levomilnacipran Venalfaxine Desvenlafaxine Duloxetine

Name common and serious SE

Type of medication…

A

SNRI

Common SE

Sexual Dysfunction
Weight gain
Insomnia
GI upset
Headache
Anxiety
Increase BP
Xerostomia
Diaphoresis

Serious

Suicide
Serotonin Syndrome

83
Q

Watch for HTN with these SNRIs

A

Venalfaxine & desvenalfaxine

84
Q

2nd generation antipsychotics have SE of weight gain leading to Diabetes.

What is a normal range for.

Body Mass Index (BMI):

A

Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):

85
Q

2nd generation Antipsychotics have a SE of weight gain leading to Diabetes

What is a normal

Hemoglobin A1c (HbA1c):

A

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher

86
Q

2nd generation Antipsychotics have a SE of weight gain leading to Diabetes

What is a normal

Hemoglobin A1c (HbA1c):

A

Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher

87
Q

2nd generation Antipsychotics have a SE of weight gain leading to Diabetes

What is a normal

Fasting Lipid Panel:

Total Cholesterol:
Low-Density Lipoprotein (LDL):
High-Density Lipoprotein (HDL):
Men:
Women:
Triglycerides:

A

Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL

88
Q

Valporate - mood stable

Therapeutic range 50 - 100mL

Labs

AST (Aspartate Aminotransferase):

A

Safe Range: 10-40 U/L

Why: Elevated AST can indicate liver damage, so levels should be within the normal range to safely start or continue valproate.

89
Q

Valporate Treats Mood Disorders

Therapeutic range 50 - 100

ALT (Alanine Aminotransferase):

A

Safe Range: 7-56 U/L

Why: ALT is more specific to the liver, and elevated levels suggest liver injury, which is a concern with valproate use.

90
Q

Valporate Treats mood disorders

Therapeutic range 50 - 100

Albumin: (Safe Range)

A

Safe Range: 3.5-5.0 g/dL
Why: Albumin reflects liver function and nutritional status. Low albumin may indicate liver dysfunction or malnutrition, which can increase the risk of valproate-related side effects.

91
Q

Valporate Treats mood disorders

Therapeutic range 50 - 100

CBC (Complete Blood Count):

Safe Range

WBC
Platelets
Hemoglobin

A

Safe Findings:
White Blood Cells (WBC): 4,500-11,000
Platelets: 150,000-450,000
Hemoglobin: 13.8-17.2 g/dL (men), 12.1-15.1 g/dL (women)
Why: Valproate can cause thrombocytopenia (low platelets) and affect white blood cell counts, so a normal CBC is important before starting the medication.

92
Q

Valporate Treats mood disorders

Therapeutic range 50 - 100

Ammonia: Safe range

A

Safe Range: 15-45 µmol/L

Why: Elevated ammonia levels can indicate a risk of hyperammonemia, a possible side effect of valproate, which can lead to serious complications like encephalopathy

93
Q

Why might an MAOI be given to a Parkinsons patient?

A

To increase dopamine.

Lack of dopamine makes them shake.

94
Q

Type of medication which maybe prescribed for neuropathic pain.

A

SNRI

Nurs 1446 A Meds (2 decks)

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