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Pharm Final > Antipsychotics, Anxiolytics, and Antidepressants > Flashcards

Antipsychotics, Anxiolytics, and Antidepressants Flashcards

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1
Q

Psychosis

A

Losing contact with reality

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2
Q

Psychosis Sxs (usually has more than one)

A

Difficulty processing information/conclusion
Delusions
Hallucinations
Incoherence
Catatonia (no facial expressions)
Aggressive behavior

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3
Q

Schizophrenia

A

Chronic psychotic disorder, psychosis sxs manifest
Sxs develop in late teens to early adulthood
Results from imbalance of dopamine
Has “positive” and “negative” sxs

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4
Q

Schizophrenia Positive Sxs

A

(Exaggeration of normal function)
Incoherent speech
Hallucinations
Delusions
Paranoia

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5
Q

Schizophrenia Negative Sxs

A

(Decrease/loss of function or motivation)
Loss of speech
Poor self-care
Social withdrawal

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6
Q

General Adverse Reactions to Antipsychotics

A

Acute dystonia (muscle spasms of face, eye rolling, laryngeal spasms that can impair respiration etc.)
Akathisia (restless, can’t sit still)
Tardive dyskinesia (sticking out and rolling tongue, smacking lips, chewing motion, involuntary movement, etc.)

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7
Q

Neuroleptic Malignant Syndrome

A

Rare, potentially fatal condition associated with antipsychotic drugs

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8
Q

Neuroleptic Malignant Syndrome Sxs

A

Muscle rigidity
Acute fever
Altered mental status
Labile BP
Rhabdomyolysis, ARF, RF, coma

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9
Q

Phenothiazine (typical antipsychotic) Prototype

A

Fluphenazine (Prolixin)

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10
Q

Fluphenazine (Prolixin) Pregnancy Category

A

Pregnancy category C

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11
Q

Fluphenazine (Prolixin) Routes

A

PO/IM

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12
Q

Sxs Specific to Fluphenazine (Prolixin)

A

CNS depression (sedation, dizziness)
Anticholinergic sxs (dry mouth, urinary retention)

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13
Q

Adverse Reactions Specific to Fluphenazine (Prolixin)

A

HTN, hypotension (more common than HTN), EPS syndrome, impaired thermal regulations, convulsions

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14
Q

Contraindications Specific to Fluphenazine (Prolixin)

A

Subcortical brain damage, blood dyscrasia, renal/liver damage, coma

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15
Q

Life-threatening Reaction Specific to Fluphenazine (Prolixin)

A

Agranulocytosis

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16
Q

Drug Interactions Specific to Fluphenazine (Prolixin)

A

Increased depression with ETOH/CNS depression (Prolixin is a CNS depressant already)
Kava kava: may increase dystonia

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17
Q

Nonphenothiazine (typical antipsychotic) Prototype

A

Haloperidol (Haldol)

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18
Q

Haloperidol (Haldol) Pregnancy Category

A

Pregnancy Category C

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19
Q

Sxs Specific to Haloperidol (Haldol)

A

CNS depression (sedation), anticholinergic sxs (dry mouth and eyes, blurred vision), orthostatic hypotension

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20
Q

Adverse Reactions Specific to Haloperidol (Haldol)

A

Tachycardia, seizures, anticholinergic sxs (urinary retention)

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21
Q

Life-threatening Reaction Specific to Haloperidol (Haldol)

A

Respiratory depression, laryngospasm, neuromalignant syndrome, agranulocytosis

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22
Q

Atypical Antipsychotic Prototype

A

Risperidone (Risperdal)
Extremely sedating

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23
Q

Risperidone (Risperdal) Pregnancy Category

A

Pregnancy Category C

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24
Q

Risperidone (Risperdal) Route and Onset

A

PO unknown

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25
Atypical Antipsychotic (Non-Phenothiazine) Prototype
Aripiprazole (Abilify)
26
Sxs Specific to Aripiprazole (Abilify)
Weight gain, sexual dysfunction, CNS depression (sedation), blurred vision
27
Adverse Reactions Specific to Aripiprazole (Abilify)
Orthostatic hypotension, HTN, bradycardia, tachycardia, convulsions, EPS
28
Life-threatening Reactions Specific to Aripiprazole (Abilify)
Suicidal ideation, neuroleptic malignant syndrome
29
Contraindications Specific to Aripiprazole (Abilify)
Hypersensitivity, dehydration, ETOH intoxication, suicidal ideation
30
Drug Interactions Specific to Aripiprazole (Abilify)
Increases the effects of antihypertensives Antidiabetic agents can cause hypoglycemia Other antipsychotics increase risk of NMS and EPS syndrome CNS depressants Grapefruit juice may increase blood levels St. John's Wort may decrease blood levels
31
General Nursing Considerations for Antipsychotics
Monitor for orthostatic hypotension Make sure pt has swallowed pill Observe for EPS May take 6 weeks or longer for full clinical effect Do not discontinue abruptly Avoid CNS depressants, ETOH May be excreted in breast milk Wear medi-alert bracelet Tolerance to sedative effect develops over a few weeks
32
Anxiety Types
Primary and secondary
33
Primary Anxiety
Not caused by medical condition Treated with anxiolytics
34
Secondary Anxiety
R/T drug use or psychiatric disorders Treated with anxiolytics only if severe, untreatable, or causes disability
35
Anxiolytics
Benzodiazapines and azapirones For short term use (can cause addiction and death)
36
Benzodiazepine Prototype
Lorazepam (Ativan)
37
Lorazepam (Ativan) Pregnancy Category
Pregnancy Category D
38
Lorazepam (Ativan) Routes and Onset
PO/IM 15-30 minutes, IV 1-5 minutes PO preferred route
39
Sxs Specific to Lorazepam (Ativan)
CNS depression (drowsiness, dizziness, confusion), blurred vision, N/V/A
40
Adverse Reactions Specific to Lorazepam (Ativan)
Hypotension (more common), HTN
41
Contraindications Specific to Lorazepam (Ativan)
CNS depression, shock, coma, narrow-angle glaucoma, pregnancy, lactation Caution: hepatic or renal dysfunction, suicidal
42
Drug Interactions Specific to Lorazepam (Ativan)
Increased CNS depression when taken with ETOH, CNS depressants, or anticonvulsants Cimetidine increases lorazepam plasma levels, increases Dilantin levels, smoking decreases antianxiety effects Kava: may potentiate sedation
43
General Nursing Considerations for Anxiolytics
Do not use for more than 2-4 months (dependence/tolerance) Use lower doses for elderly and children Monitor for orthostatic hypotension Avoid activities requiring alertness (driving) Avoid ETOH and other CNS depressants May take 1-2 weeks for drug to take effect Do not stop abruptly
44
Depression
Mood changes and loss of interest in normal activities
45
Major Depression Sxs
Loss of interest in most activities Depressed mood Weight loss or gain Insomnia/hypersomnia Loss of energy/fatigue Feeling of despair Decreased ability to think/concentrate Suicidal thoughts
46
Common Causes for Depression
Genetics Social/environmental factors Biological conditions
47
Common Theory for Depression
Insufficient neurotransmitters: serotonin, norepinephrine, dopamine Low serotonin permits depression to occur Low norepinephrine causes depression
48
Herbal Supplements for Depression
St. John's wort Gingko Biloba Discontinue both 1-2 weeks before surgery due to them causing an increased risk of bleeding
49
General Info for Tricyclic Antidepressants
Clinical response 2-4 weeks Discontinue gradually to avoid withdrawal sxs such as N/V/A
50
Tricyclic Antidepressant Prototype
Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
51
Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil) Pregnancy Category
Pregnancy Category C
52
Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil) Route and Onset
PO 1-3 weeks
53
Sxs Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
CNS depression (sedation, drowsiness), anticholinergic sxs (dry mouth, urinary retention, constipation)
54
Adverse Reactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
Orthostatic hypotension, EPS syndrome
55
Life-threatening Reactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
Agranulocytosis, thrombocytopenia, leukopenia, seizures
56
Contraindications Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
Severe depression w/ suicidal tendency (gives pt enough energy to actually commit suicide) Acute MI MAOI's Cardiac dysthymias
57
Drug Interactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)
Increased CNS and respiratory depression when taken with other CNS depressants or ETOH Hypertensive crisis and death may occur with MAOI's
58
Selective Serotonin Reuptake Inhibitor (SSRI) Prototype
Fluoxetine (Prozac)
59
Fluoxetine (Prozac) Pregnancy Category
Pregnancy Category C
60
Fluoxetine (Prozac) Route and Onset
PO 2-4 weeks
61
Sxs Specific to Fluoxetine (Prozac)
HA, nervousness, restlessness, GI distress
62
Adverse Reactions Specific to Fluoxetine (Prozac)
Hyponatremia (common with all SSRI's), seizures, palpations, chest pain
63
Contraindications Specific to Fluoxetine (Prozac)
Acute MI MAOI's (increased risk of hypertensive crisis and death) Caution: severe depression w/ suicidal tendency (will have the energy to actually commit suicide), severe liver or kidney disease
64
Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) Prototype
Venlafaxine (Effexor)
65
Venlafaxine (Effexor) Sxs
Drowsiness, dizziness, nervousness
66
Venlafaxine (Effexor) Adverse Reactions
Seizures, hyponatremia
67
Venlafaxine (Effexor) Contraindications
Do NOT take with MAOI, wait 14 days after discontinuing MAOI's before starting (hypertensive crisis and death)
68
MAOI Examples
Isocarboxazid (Marplan), phenelzine sulfate (Nardil), tranylycypromine sulfate (Parnate), selegline HcL (Eldepryl) Prescribed when other antidepressants don't wok (last resort)
69
MAOI Sxs
Agitation, restlessness, insomnia, orthostatic hypotension
70
MAOI Adverse Reactions
Many adverse reactions, hypertensive crisis from food and drug interactions
71
MAOI Contraindications/Drug and Food Interactions
DO NOT TAKE WITH TCA's Do not mix with sympathomimetics or CNS stimulants (vasoconstrictors, cold medicines containing phenylephrine or pseudoephedrine) Food to avoid: cheese, bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, Italian green beans, liver, yeast, soy sauce
72
MAOI Nursing Consideration
Monitor BP for hypertensive crisis
73
General Nursing Considerations for Antidepressants
Observe for sxs of depression/suicidal ideation Monitor for orthostatic hypotension Decreased anticonvulsant effectiveness (monitor for seizures) Avoid certain foods Monitor BP for hypertensive crisis Avoid ETOH Check with MD/pharmacist before taking herbal drugs Do not do activities requiring alertness until drug stabilizes (CNS depression) Do not stop abruptly
74
Mood Stabilizer Prototype
Lithium (Eskalith, Lithane, Lithonate, Lithobid) Used for bipolar disorder
75
Lithium Pregnancy Category
Pregnancy category C
76
Lithium Route and Onset
PO 5-6 days
77
Lithium Therapeutic Drug Range
0.5-1.5 meq/L
78
Lithium Sxs
Dizziness, drowsiness, slurred speech, slow reaction time Patients will adjust after a few weeks
79
Lithium Adverse Reactions
Urinary incontinence, hyponatremia, nephrotoxicity
80
Lithium Life-threatening Reactions
Cardiac dysrhythmias and circulatory collapse
81
Lithium Contraindications
Hyponatremia (main thing), liver and renal dx, pregnancy, lactation, severe dehydration, children under 12 Caution: thyroid dx
82
Lithium Drug Interactions
Increased sodium levels with thiazide diuretics, Haldol, NSAID's, and antidepressants
83
Mood Stabilizer (Lithium) Nursing Considerations
Watch for toxicity Monitor for depression/suicidal tendencies Check blood levels immediately before next dose or 8-12 hours after last dose Monitor weight and urine output (could have a lot of fluid loss) Maintain adequate fluid intake Take with meals to decrease GI distress Full effect could take a few weeks (1-2) Compliance with med is important (pts dislike the slowness feeling)

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