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Pharmocology RN212 > Chap 16 Psychotherapeutic Drugs > Flashcards

Chap 16 Psychotherapeutic Drugs Flashcards

1
Q

Biochemical Imbalance Theory

A

imbalance of neurotransmitters
Dopamine and epinephrine
Serotonin and histamine
Gamma-aminobutyric acid and acetylcholine

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2
Q

Anxiety

A

Unpleasant state of fear

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3
Q

Affective Disorders (Mood Disorders)

A

Changes in mood from mania to depression

Bipolar disorder is an example

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4
Q

Psychosis

A

Severe emotional disorder that impairs mental fxn to the point they cannot participate in activities of daily living

Hallmark:Loss of contact with reality

Depressive and drug-induced psychosis

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5
Q

Anxiolytic Drugs

A

Benzodiazepines
Depress activity in the brainstem and limbic system.

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6
Q

Benzodiazepines/Adverse Effects/Overdose/Interactions

A

Largest and most commonly prescribed anxiolytic

Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)

Adverse Effects
Decreased CNS activity, sedation
Hypotension
Drowsiness, loss of coordination, dizziness, headaches
Nausea, vomiting, dry mouth, constipation

Overdose
dangerous with alcohol
Flumazenil (Romazicon) may be used to reverse benzodiazepines’ effects.

Interactions
Alcohol and CNS depressants can result in additive CNS depression and even death.
More likely to occur in patients with renal or hepatic compromise

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7
Q

Alprazolam (Xanax)

A

Most used as an anxiolytic

Adverse effects: confusion, ataxia, headache, and others

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8
Q

Diazepam (Valium)

A

Indications: relief of anxiety
Avoid in patients with hepatic dysfunction
Adverse effects: headache, confusion, slurred speech, and others

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9
Q

Lorazepam (Ativan)

A

Used to treat or prevent alcohol withdrawal

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10
Q

Buspirone (Buspar)

A

Lacks sedative properties and dependency potential as other benzodiazepines

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11
Q

Mood-Stabilizing Drugs

A

Lithium carbonate
Drugs used in combination with lithium
Benzodiazepines
Antipsychotic drugs
Antiepileptic drugs
Dopamine receptor agonists

New agent: cariprazine (Vraylar)

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12
Q

Lithium Level Range/Adverse Effects

A

treatment of mania

Narrow therapeutic range: 1-1.5 mEq/L; maintenance serum lvls should range between 0.6 and 1.2 mEq/L.

exceeding 1.5-2.5 mEq/L produce toxicity, GI discomfort, tremor, confusion, somnolence, seizures, and possibly death.

Keeping the sodium level normal range (135-145 mEq/L) helps therapeutic lithium levels.

Adverse effects
Most serious adverse effect is cardiac dysrhythmia.
Long-term treatment may cause hypothyroidism

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13
Q

Antidepressants

A

Requires at least 6 weeks of therapy
Higher risk of suicide

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14
Q

Tricyclic Antidepressants (TCA)

A

largely been replaced by SSRIs as first-line antidepressant drugs

Amitriptyline (Elavil)

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15
Q

Tricyclic Antidepressants:
Indications/Overdose

A

Depression
Childhood enuresis (imipramine)
Adjunctive analgesics for chronic pain conditions

Overdose
CNS and cardiovascular systems are 
mainly affected.
dysrhythmias

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16
Q

Amitriptyline (Elavil)

A

Commonly used to treat insomnia and neuropathic pain

17
Q

Monoamine Oxidase Inhibitors (MAOIs)

A

Disadvantage: potential to cause hypertensive crisis when taken with tyramine

18
Q

MAOIs and Tyramine

A

Ingestion of foods or drinks with tyramine leads to hypertensive crisis

Avoid foods that contain tyramine!
Aged, mature cheeses (cheddar, bleu, Swiss)
Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)

THE CHACOOTURIE BOARD

18
Q

SSRIs

A

fluoxetine,
sertraline,
mirtazapine

19
Q

Bupropion

A

also indicated as an aid in smoking cessation

Zyban: approved for smoking cessation treatment

20
Q

Second-Generation
Antidepressants Adverse Effects

A

insomnia (partly caused by reduced rapid eye movement sleep),
weight gain, and
sexual dysfunction

21
Q

Serotonin Syndrome

A

More severe symptoms
Hyperthermia
Seizures
Rhabdomyolysis
Cardiac dysrhythmias

22
Q

Fluoxetine (Prozac)

A

Prototypical SSRI
Indications: depression, bulimia, OCD, panic disorder
Contraindications: known drug allergy and concurrent MAOI therapy
Interactions: warfarin
Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

23
Q

Duloxetine (Cymbalta)

A

Indications:
depression,
GAD, and
pain resulting from diabetic peripheral neuropathy or fibromyalgia

24
Q

Mirtazapine (Remeron)

A

Sedation often occurs
Dose at bedtime

appetite stimulant

25
Q

Antipsychotics Used to Treat/Adverse Effects

A

Drug-induced psychoses,
schizophrenia

Adverse Effects
Agranulocytosis and
hemolytic anemia
Extrapyramidal symptoms (EPS)
Involuntary muscle symptoms similar to Parkinson’s disease
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)

Tardive dyskinesia
Involuntary contractions of oral and facial muscles

26
Q

+/- Symptoms of Schizophrenia

A

Positive symptoms: hallucinations, delusions, and conceptual disorganization

Negative symptoms: apathy, social withdrawal, blunted affect, poverty of speech, and catatonia

27
Q

Haloperidol (Haldol) Indications

A

Indications: long-term treatment of psychosis

28
Q

Quetiapine (Seroquel)

A

Atypical Antipsychotic

29
Q

Clozapine (Clozaril) Adverse effects

A

Adverse effects: blood dyscrasias
Monitor WBC counts frequently

30
Q

Risperidone (Risperdal)

A

Indication: schizophrenia, including negative symptoms

Adverse effects: minimal EPS at therapeutic dosages of 1 to 6 mg/day

Risperdal Consta: long-acting injectable form; lasts approx 2 weeks

Invega Sustenna: long-acting injection; lasts 1month

31
Q

Psychotherapeutic Drugs: 
Nursing Implications

A

Obtain liver and renal function tests.

Complete Suicide Assessment Scale

Assess level of consciousness, mental alertness, and potential for injury to self and others.

Advise patients to avoid abrupt withdrawal.

Advise change positions slowly avoid postural hypotension and possible injury.

small amounts of meds should dispensed a time to minimize risk of suicide attempts.

Simultaneous use these drugs w/ alcohol or other CNS depressants can be fatal.

32
Q

Antidepressants

A

inform patients that it may take several weeks to see therapeutic effects.

assess for suicidal tendencies

Assist older adult with ambulation, falls may occur because of drowsiness or postural hypotension.

With MAOIs, instruct patients and family regarding tyramine-containing foods and signs and symptoms of hypertensive crisis.

Antipsychotics—phenothiazines
Instruct patients to wear sunscreen because of photosensitivity.
avoid taking antacids or antidiarrheal preparations within 1 hour of a dose.
Inform patients to avoid alcohol and other CNS depressants with these medications.
-drugs may cause drowsiness, dizziness, or fainting;
change positions slowly.

33
Q

therapeutic effects

A

Monitor mental alertness,
cognition,
affect,
mood,
ability to carry out activities of daily living,
appetite, and
sleep patterns.
Monitor potential for self-injury

34
Q

therapeutic effects For anxiolytics

A

Improved mental alertness, cognition, and mood
Fewer anxiety and panic attacks
Improved sleep patterns and appetite
Less tension and irritability; fewer feelings of fear, impending doom, and stress
More interest in self and others

35
Q

therapeutic effects For antidepressants

A

Improved sleep patterns and nutrition
Increased feelings of self-esteem
Decreased feelings of hopelessness
Increased interest in self and appearance
Increased interest in daily activities
Fewer depressive manifestations or suicidal thoughts or ideations

36
Q

therapeutic effects For antipsychotics

A

Improved mood and affect
Alleviation of psychotic symptoms and episodes
Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope
For lithium
Less mania
Therapeutic lithium levels of 0.6 to 1.2 mEq/L

Pharmocology RN212 (20 decks)

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