Antipsychotics, antimanic, antiseizure Drugs Flashcards
(89 cards)
1
Q
chlopromazine/Thorazine
A
antipsychotic, phenothiazine, typical, low potency, older conventional antipsychotic
2
Q
thioridazine/Mellaril
A
antipsychotic, phenothiazine, typical, low potency, older conventional antipsychotic
3
Q
haloperidol/Haldol
A
antipsychotic, nonphenothiazine, typical, high potency, older conventional antipsychotic
4
Q
olanzapine/Zyprexa
A
antipsychotic, atypical, newer Atypical antipsychotics
5
Q
quetiapine/Seroquel
A
antipsychotic, atypical, newer Atypical antipsychotics
6
Q
risperidone/Risperdal
A
antipsychotic, atypical, high potency, newer Atypical antipsychotics
7
Q
aripiprazole/Abilify
A
antipsychotic, atypical, newer Atypical antipsychotics
8
Q
clozapine/Clozaril
A
antipsychotic, atypical, low potency, newer Atypical antipsychotics
9
Q
benzotropine/Cogentin
A
Benzodiazepine?
10
Q
phenytoin/Dilantin
A
Hydantoin
11
Q
fosphenytoin/Cerebyx
A
Hydantoin
12
Q
phenobarbital/Luminal
A
Barbitiate. Suppresses abnormal neuron discharges without significant sedation. Few adverse effects. Takes several weeks for optimal effect though.
13
Q
ethosuximide/Zarontin
A
Succinimide
14
Q
gabapentin/Neurontin
A
Miscellaneous Drug
15
Q
carbamazepine/Tegretol
A
Miscellaneous Drug
16
Q
valproic acid/Depakene
A
Miscellaneous Drug
17
Q
clonazepam/Klonopin
A
Benzodiazepine
18
Q
diazepam/Valium/Diastat
A
Benzodiazepine, used for status epilepticus.
19
Q
chlorazepate/Tranxene
A
Benzodiazepine
20
Q
lithium/Eskalith
A
Antimanic
21
Q
Barbituates
A
CNS depression; raise the seizure threshold.
22
Q
Benzodiazepines
A
Generally not used alone but as an add on for short term use. PRN
23
Q
Hydantoins
A
Uses: partial and tonic-clonic seizures
Action: Stabilizes hyperexcitability in motor part of brain.
24
Q
Succinimides
A
These drugs are generally used for absence seizures but are less preferred than other types due to adverse effects.
Adverse reactions: GI disturbances, nystagmus, fetal abnormalities and HEMATOLOGIC CHANGES.
25
Oxazolidinediones
These drugs are generally used for absence seizures but are less preferred than other types due to adverse effects.
Adverse reactions: GI disturbances, nystagmus, fetal abnormalities and HEMATOLOGIC CHANGES.
26
Miscellaneous drugs
Many of these drugs are similar to Hydantoins and may cause hematologic toxicity. - Widely used for various types of seizures as well as mania associated with bipolar disorder and certain pain disorders (migraines, fibromyalgia, neuropathic pain associated with diabetes or shingles)
27
Antiseizure drugs are used...
to reduce the number and/or severity of seizures while minimizing the adverse effects or toxicity
28
Antiseizure drugs are used to reduce the number and/or severity of seizures while...
minimizing adverse effects or toxicity
29
Discontinued or missed antiseizure dose may...
result in reoccurrence of seizures
30
Many of the miscellaneous antiseizure drugs are used to control...
psychosis with dementia and bipolar disorder as well as mood stabilization with bipolar such as neuropathic pain
31
Antiseizure drugs may also be used to treat...
pain disorders such as neuropathic pain
32
Benzodiazepines may be used to
Prevent seizureswith some drugs uses to treat status epilepticus
33
Benzodiazepines are not usually use ___ in the treatment of seizures.
alone
34
Benzodiazepines may also be used to treat the ___ phase of ___
to treat the manic phase of bipolar disorder.
35
Decreased effectiveness of birth control can occur with the use of some
Antiseizure medications. Many of the drugs are pregnancy category C or D.
36
Instruct patients to take Antiseizure medication with food to prevent GI upset
...
37
Avoid activities such as driving, due to possible
sedation efffects
38
Patients also need to be observed for risk of falls because of
sedation effect
39
Barbituates and Benzodiazepines and some Miscellaneous drugs can cause
CNS depression
40
Barbituates and Benzodiazepines have a
high risk for dependence and tolerance and many undesirable side effects.
41
A greater CNS depressant effect occurs when Barbituates and Benzodiazepines are used with
other CNS depressants or alcohol
42
Barbituates and Benzodiazepines: the most common GI disturbances are
constipations, nausea, and vomiting
43
Severe CNS depression can lead to
respiratory depression, hypoventilation, hypoxia, cardiac arrest, brain damage, or death.
44
Exception: the Barbituate phenobarbital/Luminal
does not cause significant sedation.
45
Anyone with impaired organ function may
have increased risk for toxicity with barbiturates and benzodiazepines
46
Elderly patients may experience a
paradoxical effect of excitability with barbiturates.
47
Status epilepticus treatment
IV diazepam/Valium or rectal gel diazepam/Diastat, which only lasts a short duration thus administration of another longer acting medication is needed to.
48
Hydantoins are the
most commonly used medications as they don't cause sedation and have a lower risk for drug toxicity and dependence.
49
Hydantoins have ___ and require ___
Have a narrow therapeutic index and require monitoring of the serum blood level.
50
Hydantoins: adverse reactions include
GINGIVAL HYPERPLASIA, nausea, vomiting, nystagmus, slurred speech, liver toxicity and HEMATOLOGIC TOXICITY
51
Symptoms of hematologic toxicity
sore throat, fever, easy bruising/bleeding, and swollen glands.
52
Hydantoins: Blood work should include
CBC and if the WBC is low (normal range 4,500-10,000) then the physician should be contacted.
53
Succinimides and Oxazolidinediones are not commonly used due to the increase risk of...
severe adverse reactions such as hematologic toxicity and fetal abnormalities.
54
Miscellaneous Antiseizure Drugs are often prescribed for
psychosis, bipolar disorder and pain disorders as well as for seizures
55
Miscellaneous Antiseizure Drugs are thought to
have a lesser risk for side effects than other drugs
56
Low Potency (what is meant)
high in causing sedation and negative cardiovascular effects, high in anticholinergic side effects, low in causing TD or EPS
57
High Potency (what is meant)
low in causing sedation, negative cardiovascular effects, and anticholinergic effects BUT high in causing TD or EPS
58
Generation: older/Conventional drugs/1st generation
Less selective in blocking certain dopamine receptors= more unwanted significant adverse effects.
59
Generation: newer/Atypical drugs/2nd generation
Less incidence of causing the more undesirable adverse effects= often preferred over 1st generation drugs.
60
Antipsychotics treat
acute and chronic psychoses, schizophrenia, schizoaffective disorder, and bipolar disorder
61
Conventional drugs (older 1st generation on invented drugs around 1950's) have
more unwanted side effects so not often the first choice
62
Atypical drugs (newer 2nd generation of invented drugs since 1990's
overall have less incidence of the undesirable side effects or adverse reactions so often chosen first.
63
Antipsychotic drugs are often chosen (prescribed) based on
a drugs side effect profile. This is because some patients have conditions which make certain antipsychotics not a good choice for them.
64
Antipsychotics: adverse effects
tardive dyskinesia-TD, extrapyramidal symptoms-EPS (akathisia, dystonia, and parkinsonism), and neuroleptic malignant syndrome - NMS
65
Tardive Dyskinesia (TD)
Syndrome of potentially irreversible involuntary unusual, purposeless dyskinetic movements. - Rhythmic involuntary movements of the tongue, face, mouth, jaw, or extremities. Long-term blocking of dopamine receptors cause increase in receptors in part of the brain that controls muscle coordination. This leads to spontaneous and random muscle movements.
66
Extrapyramidal symptoms (EPS)
Brain controls motor activity: If an antipsychotic drug blocks too many dopamine receptors, a patient may have difficulty controlling movements.
Akathisia (most common): inability to rest or relax. Pacing, trouble sitting still, insomnia.
Dystonia: severe muscle spasms, particularly of the tongue, face, neck, or back. Facial grimacing, twisting of the neck.
Parkinson-like symptoms: tremor, rigidity, stooped posture, shuffling gait, bradykinesia, mask like expression
67
Neuroleptic Malignant Syndrome (NMS)
Potentially fatal; rare - once it starts, progresses rapidly - requires tx and abrupt discontinuation of drug; recovery takes 7-10 days. - Symptoms: sudden onset fever, muscular rigidity, tachycardia, dyspnea, incontinence, high serum creatinine, unstable BP, leukocytosis
68
Other adverse effects of Antipsychotics include:
Anticholinergic effects, Weight gain, postural hypotension, sedation, headache, and photosensitivity
69
Anticholinergic side effects
dry mouth, constipation, blurred vision, urinary retention, postural hypotension, tachycardia
70
When a patient shows signs of EPS
the med should be discontinues, the dosage lowered or medications such as benzotropine/Cogentin can be prescribed to minimize EPS
71
TD can occur...
months or years after long term use of an Antipsychotic. It is potentially irreversible. The antipsychotic should be discontinued (tapered), There is no known treatment to cure TD,
72
NMS
is potentially fatal. Know the symptoms.
73
Haldol is associated with
NMS. Antipsychotic drug must be discontinued.
74
Antipsychotic drugs generally
have a wide safety margin and deaths are NOT common and antipsychotic drugs do not cause dependence.
75
Teaching needed for antipsychotic drugs:
caffeine and cigarette smoking may decrease the effectiveness of antipsychotic medications, diet and exercise instruction to prevent weight gain, high fiber foods for constipation and oral hygiene/hard candy for dry mouth, protect against sun sensitivity, report urinary retention, and blurred vision. Watch for orthostatic hypotension (risk for falls) and avoid alcohol.
76
clozapine/Clozaril is used only for schizophrenia that is....
not responsive to other antipsychotics and that specific monitoring of the WBC is required with its use as it can cause leukopenia and agranulocytosis (a low WBC count and low neutrophil count).
77
Antimanics also called
mood stabilizers
78
lithium/Eskalith is used for treatment of
mania with bipolar disorders as well as a preventative or to manage bipolar disorder.
79
Miscellaneous antiseizure drugs (primarily volproic acid/Depakene and carbamazepine/Tegretol) and many of the newer/Atypical antipsychotic drugs are used
in the treatment of bipolar disorder to stabilize bood.
80
B: Benzodiazepines may be used during
A: Antidepressants may be used during
C: CAUTION
B: periods of mania.
A: major depressive episode for bipolar disorder.
C: CAUTION these drugs may swing the patient to become either manic or depressive.
81
lithium/Eskalith is the mainstay drug for __ to __
Bipolar disorder to prevent mania and to treat acute mania
82
lithium is a ___ and it ___
salt and it competes with the sodium in the body,
83
lithium: Adverse effects
fatigue, fine hand tremors, dysrhythmias, hypotension, increased thirst, increased urination, and dry mouth
84
lithium/Eskalith has a very ___ therapeutic range, and monitor ___. Therapeutic range and toxic level.
very low therapeutic range and serum blood levels should be monitored. Therapeutic range: 0.6-1.2 mEq/L and the toxic levels are above 2.0 mEq/L
85
If the bodies sodium level is decreased ( excretion, diuretics, caffeine, diarrhea, vomiting, fever, and sweating) lithium is reabsorbed by the ___ and this increases the risk for ___, as the serum blood level will be ___
reabsorbed by the kidneys, and this increases the risk for toxicity, as the serum blood level will be high
86
Increased intake of sodium may ___ the therapeutic effect of lithium and the serum blood level will be ___.
Intake of sodium may reduce the therapeutic effect of lithium and the serum blood level will be low. Therefore, a regular sodium intake is needed.
87
Do not give lithium/Eskalith with
haloperidol/Haldol as brain damage may result.
88
Pregnancy category for lithium/Eskalith is
D. This means the benefit to the patient may outweigh the risk to fetus.
89
lithium/Eskalith should be taken with ___ to prevent GI upset and ___ should be avoided. Alcohol should be ___. Pts should avoid activities that lead to ___. Pts should have oral fluid intake of ___/day to minimize ___
lithium/Eskalith should be taken with food to prevent GI upset and antacids should be avoided. Alcohol should also be avoided due to an increased action of lithium. Patients should avoid activities that lead to excessive sweating or urination, have regular lab tests for monitoring serum blood levels and consume a consistent regular salt intake. Pts should have an oral fluid intake of 3000ml/day to minimize risk of toxicity.
