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NUR 334: Pharmacology > Exam 2: Module 3 - Psychotropic Medications > Flashcards

Exam 2: Module 3 - Psychotropic Medications Flashcards

1
Q

Serotonin Syndrome symptoms

A

o tremors
o fever
o altered mental state (AMS)
o hypertension

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2
Q

Selective Serotonin Reuptake Inhibitors (SSRI) Drugs

A

o Sertraline
o Fluoxetine
o Escitalopram
o Citalopram
o Paroxetine

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3
Q

first line for depression and anxiety

A

SSRI

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4
Q

when should a patient take SSRI medications due to the SE/AE of insomnia?

A

morning/A.M.

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5
Q

SSRI
MOA, indication, SE/AE, BBW

A

MOA: inhibits/block the reuptake of serotonin elevating patients serotonin levels

indications: depression and anxiety

SE/AE: insomnia and sexual dysfunction

BBW: risk for suicdie

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6
Q

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) drugs

A

o Dulaxotine
o Venlafaxine

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7
Q

SNRI
MOA, indication, SE/AE, BBW

A

MOA: inhibit/block reuptake of serotonin and norepinephrine

indications: anxiety, depression, MIGRAINE PREVENTION, FIBROMYALGIA

SE/AE: sexual dysfunction, insomnia, HTN, ORTHOSTATIC HYPOTENSION, HEPATOTOXICITY

BBW: risk for suicide

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8
Q

Tricyclic Antidepressants (TCA) drugs

A

o Amitriptyline
o Imipramine
o Nortriptyline
o Doxepin

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9
Q

TCA
MOA, indication, SE/AE, BBW

A

MOA: inhibit/block reuptake of serotonin and norepinephrine (same as SNRI)

indication: depression

off label use: fibromyalgia, IBS, migraines, anxiety and withdrawal syndrome

SE/AE: anticholinergic effects, ECG changes, CNS depression, orthostatic hypotension, sedation, weight gain

BBW: risk for suicide

o NOT FIRST LINE TREATMENT FOR DEPRESSION
o DOXEPIN IS USED FOR BOTH DEPRESSION AND INSOMNIA

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10
Q

Monoamine Oxidase Inhibitors (MAOI) drugs

A

o Phenelzine

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11
Q

MAOI
MOA, indication, BBW, SE/AE

A

MOA: MAO is responsible for getting rid of norepinephrine, dopamine, epinephrine and serotonin in the body so MAOI blocks this action which increases the neurotransmitter levels in the body

indication: depression

off label: anxiety

SE/AE: orthostatic hypotension, hypertension when interacting with tyramine, insomnia, anticholinergic effects

o DO NOT CONSUME FOODS CONTAINING TYRAMINE
O NOT FIRST LINE TX FOR DEPRESSION

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12
Q

Bupropion
MOA, indication, SE/AE, BBW

A

MOA: unknown - inhibits/blocks uptake of norepinephrine and dopamine

indications: depression and smoking cessation

off label : ADHD, bipolar d/o

SE/AE: risk for seizures (highest with high doses or rapid titration) and insomnia

BBW: risk for suicide and neuropsychiatric events

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13
Q

drug used for smoking cessation

A

Zyban

  • bupropion drug
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14
Q

Benzodiazepines drugs

A

o Lorazepam
o Diazepam
o Alprazolam

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15
Q

Benzos
MOA, indications, SE/A, BBW

A

MOA: GABA agonist, GABA being an inhibitory neurotransmitter so Benzos slows down cerebral functions

indications: seizure disorder, insomnia, anxiety, sedation, muscle relaxant, ETOH withdrawal

SE/AE: muscle weakness, hypotension, sedation, respiratory depression

BBW: do not mix with CNS depressants - can cause respiratory depression and addiction and dependency

o CONTROLLED SUBSTANCE (SCHEDULE IV)
o FIRST LINE FOR CESSATION OF ACUTE GENERALIZED SEIZURE
o DO NOT TAKE WITH ETOH OR OTHER CNS DEPRESSANTS

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16
Q

reversal agent for benzodiazepine OD

A

Flumazenil

17
Q

another drug used for anxiety that can help test anxiety and other situational anxiety that presents with physical manifestations such as tachycardia, palpitations, and hypertension.

  • slows down cardiovascular system
A

Propranolol

18
Q

Mood Stabilizer Drug

A

o Lithium

19
Q

Mood Stabilizer (Lithium)
MOA, Indication, SE/AE, BBW

A

MOA: unknown - alters ion transport (sodium levels)

indication: bipolar disorder

off label: depression

SE/AE: adverse cardiac, renal, CNS effects, nephrogenic diabetes insipidus (DI), polyuria

BBW: narrow therapeutic index

Lab Values: therapeutic response 0.4 - 1.2 mEq/L (narrow therapeutic index), toxic above 1.5 mEq/L

o MONITOR LITHIUM LEVELS - REQUIRES REGULAR LAB MONITORING
o ENCOURAGE PATIENTS TO INCREASE FLUID INTAKE DUE TO INTERFERING WITH ADH AND SE OF POLYURIA - COULD BECOME THIRSTY AND DEHYDRATED

20
Q

Valproate Drug

A

o Valproic Acid

21
Q

Valproate (Valproic Acid)
MOA, indications, BBW

A

MOA: prolong sodium channel inactivation and is also a GABA agonist

indications: seizure disorder, migraines, bipolar disorder

BBW:
o Hepatoxicity (monitor AST/ALT, skin discoloration - like jaundice)
o Highly teratogenic - least preferred for females of childbearing age
o pancreatitis

22
Q

Lamotrigine
MOA, indications, BBW

A

MOA: prolong sodium channel inactivation, blocks specific calcium channels, blocks glutamate (in the brain)

indications: seizure disorder and bipolar disorder

BBW: SJS/TEN (stevens-johnson’s syndrome and toxic epidermal necrolysis) - fatal skin diseases

23
Q

what is a fourth option for bipolar disorder

A

antipsychotics

24
Q

CNS Stimulants Drugs

A

o Methylphenidate*
o Amphetamine
o Dextroamphetamine

25
Q

CNS Stimulants
MOA, indications, BBW, SE/AE

A

MOA: CNS stimulants. these drugs cause RELEASE of norepinephrine and dopamine

indications: ADHD and narcolepsy

SE/AE: weight loss and insomnia

BBW: linked to abuse and dependency due to SE/AE of weight loss and insomnia

o CONTROLLED SUBSTANCE (SCHEDULE II)
o FIRST LINE TREATMENT FOR ADHD

26
Q

Benzodiazepine Receptor Agonist (BZRA) drugs

A

o Zolpidem*
o Eszopiclone

27
Q

BZRA
MOA, indication, BBW

A

MOA: same as benzodiazepines - GABA agonist which means it slows own cerebral functions

indications: insomnia

BBW: risk of abuse and dependency

o SHOULD NOT BE USED FOR LONG-TERM MANAGEMENT
o CONTROLLED SUBSTANCE (SCHEDULE IV)

28
Q

Melatonin Receptor Agonist drug

A

o Ramelteon

29
Q

Melatonin Receptor Agonist (Ramelteon)
MOA, indication

A

MOA: activates melatonin receptors which control circadian rhythm and sleep-wakefulness

indication: insomnia

o NOT A CONTROLLED SUBSTANCE
o RELATIVELY SAFE FOR LONG TERM USE
o 8-10x STRONGER THAN OTC MELATONIN

30
Q

First Generation Antipsychotics Drugs
(phenothiazine and non-phenothiazine)

A

o Chlorpromazine (phenothiazine)
o Fluphenazine (phenothiazine)
o Haloperidol (non-phenothiazine)

31
Q

First Generation Antipsychotics
MOA, indication, SE/AE, BBW

A

MOA: blocks dopamine 2 receptors

indication: schizophrenia

off label: bipolar and nausea

SE/AE: drowsiness, anticholinergic effects, sexual dysfunction, orthostatic hypotension

o associated with EPS and NMS (more with pheno than non-pheno drugs)

BBW: not to be used for dementia related psychosis

o ANTIPSYCHOTICS HAVE A HIGH INCIDENCE OF MEDICATION NONCOMPLIANCE

32
Q

What is EPS?

A

Extrapyramidal Symptoms
o acute dystonia (involuntary muscle contractions)
o parkinsonism (tremors/ridgity)
o akathisia (restlessness)
o tardive dyskinesia (involuntary, repetitive, purposeless movements)

33
Q

what is used to treat EPS?

A

o Benztropine

34
Q

What is NMS?

A

Neuroleptic Malignant Syndrome

rare but potentially fatal reaction that presents with:
o rigidity
o high fever

35
Q

what is used to treat NMS?

A

o Dantrolene

36
Q

Second Generation Antipsychotics Drugs
(Atypical Antipsychotics)

A

o Aripiprazole
o Lurasidone
o Olanzapine
o Quetiapine
o Risperidone
o Ziprasidone

37
Q

Second Generation Antipsychotics
MOA, indications, SE/AE, BBW

A

MOA: blocking dopamine 2 AND serotonin receptors

indications: bipolar disorder (possible 1st line option), depression, and schizophrenia

off label: delusional disorder and OCD

SE/AE: metabolic effects (weight gain, DM, dyslipidemia), EPS, and orthostatic hypotension

o less likely to have EPS than first generation

BBW: not to be used for dementia related psychosis

o ANTIPSYCHOTICS HAVE A HIGH INCIDENCE OF MEDICATION NONCOMPLIANCE

38
Q

What 1st and 2nd gen antipsychotics is used for acute psychosis?

A

o Haloperidol (1st gen)
o Ziprasidone (2nd gen)

NUR 334: Pharmacology (13 decks)

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