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Pharmacology > Ch. 10: Mental Health and Behavioral Problems > Flashcards

Ch. 10: Mental Health and Behavioral Problems Flashcards

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1
Q

Antianxiety agents/anxiolytics

A

BNZs, BNZ agonists, certain antidepressants including SSRIs/SNRIs

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2
Q

Action and uses of antianxiety drugs

A

act with GABA receptors to chance GABA effects (inhibitory), recommended for short term use, can cause anxiety with too high blood drug levels

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3
Q

Buspirone

A

reduces anxiety by affecting the serotonin and dopamine
can take 1 to 2 weeks for full effect, 3 to 6 for maximal effects
reduces the risk of dependence and sedation

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4
Q

Expected Side Effects/Adverse Reactions of antianxiety drugs

A

BNZs and BNZ agonists cause drowsiness and memory loss, dizziness, headaches, or hypotension
confusion, apnea, and seizures

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5
Q

Drug Interactions of antianxiety drugs

A 
Sodium oxybate (for narcolepsy), respiratory depression and coma
Avoid opioids or any drug that results in CNS depression
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6
Q

Do not give buspirone

A

with MAOIs, opioids, or drugs for TB

grapefruit juice increases blood levels

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7
Q

Assessment of antianxiety drugs

A

Check vitals, BP, HR, respiratory rate, and assess patient’s alertness before giving the drug

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8
Q

Assess mental status

A

before giving the drug

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9
Q

Assess patient for any history of

A

alcohol or chemical dependency

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10
Q

Planning and Implementation of antianxiety drugs

A

monitor patient for side effects of drowsiness, dizziness, increased risk for falls
report mental status changes

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11
Q

Flumazenil (Romazicon)

A

can quickly reverse effects of respiratory depression

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12
Q

Evaluation of antianxiety drugs

A

ask the patient about relief from anxiety

do not use if pregnant/breastfeeding

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13
Q

Psychosis

A

loss of control with reality

also called delirium

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14
Q

Acute vs Chronic psychosis

A

delirium vs schizophernia/bipolar

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15
Q

Dementia patients can have an increased risk for

A

stroke, cognitive impairment, and mortality

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16
Q

Positive and Negative psychosis with Schizophrenia

A

Those that add to normal behaviors, those that subtract from the normal behavior

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17
Q

Positive psychosis examples

A

hallucinations, delusions, disorganized thoughts, and speech

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18
Q

Negative psychosis examples

A

poor hygiene, difficulty with social relationships, lack of interest in activities, lack of motivation

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19
Q

Typical antipsychotics

A

1st generation, treats positive symptoms
blocks dopamine 2 D2 receptors
blocking of dopamine receptors helps treat positive symptoms of psychosis, does not affect negative symptoms

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20
Q

Schizophrenia

A

disease of overstimulation of dopamine

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21
Q

Which drug can cause pseudoparkinsonism and other extrapyrimidal symptoms?

A

typical antipsychotics

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22
Q

Phenothiazines

A

block transmission of dopamine at the dopamine receptors

also blocks ACh and alpha-adrenergic receptors

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23
Q

Nonphenothiazines

A

similar action but are chemically different from phenothiazines
side effects/adverse reactions are basically the same

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24
Q

Side effects/adverse reactions of antipsychotics

A

headache, drowsiness, nausea, constipation, and dry mouth

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25
Main adverse effects of antipsychotics
ESPs related to decrease of dopamine, pseudoparkinsonism, acute dystonia, akathisia, and tardive dyskinesia
26
Acute dystonia is managed with
anticholingeric drugs and BNZs, exhibits facial grimacing, involuntary upward eye movement, muscle spasms of face, neck, back, laryngeal spasms
27
Examples of antipsychotics
chlorpromazine (Thorazine), fluphenazine (Prolixin), halperidal (Haldol), risperidone (Risperidal), ziprasidone (Geodon), quetapine (Seroquel), aripiprazole (Abilify)
28
Akathisia
restless, trouble standing still, paces the floor, feet in constant motion
29
Tardive Dyskinesia
protrusion and rolling of the tongue, sucking and smacking of the lips, chewing motions, involuntary movements increase risk in patients with bipolar disorder
30
These drugs affect the body's ability to regulate core body temperature
can cause hypothermia in rare cases | increases risk of hypothyroidism, brain injury, or cold environmental temperature
31
Neuroleptic malignant syndrome (NMS)
hyperpyrexia, confusion changes in BP, and ESPs can lead to coma and death more often in men
32
Drug Interactions
acetaminophen, diuretics such as furosemide or hydrochlorothiazide, certain calcium channel blockers, and several antidiabetic agents
33
Assessment of antipsychotics
determine baseline level of consciousness components of the mental status exam include factors as patient's appearance, behavior, mood, affect, and thought processes
34
Monitor vital signs carefully
for significant changes: increase in temperature or severe changes in blood pressure can indicate the severe adverse effects of NMS
35
Changes in motor function such as
muscle tone, gait, or fine motor movement (ESPs) | contact healthcare provider right away
36
Most antipsychotics can be taken with food to avoid
GI upset
37
Antipsychotics can interact with
prescription drugs and herbal supplements
38
Atypical Antipsychotics (2nd generation)
many block dopamine type 2 receptors in the brain or other subtypes (serotonin)
39
Atypical Antipsychotics have a lower risk for
ESPs
40
Atypical Antipsychotics treats
negative and positive symptoms of psychosis
41
Dopamine System Stabilizers (DSS)
affect dopamine and serotonin receptors slightly differently, partial dopamine 2 agoinsts and partial 5-HT1A agonists and 5-HT2A antagonists also treats autism and tourettes
42
Side Effects/Adverse Reactions to DSS
Insomnia and drowsiness, dizziness, orthostatic hypotension, constipation and dry mouth decreased rates of ESPs
43
Risks with DSS
weight gain, hypertriglyceridemia, risk for insulin resistance, type 2 diabetes increased risk of cardiovascular disease and death
44
Dopamine System Stabilizers affects the heart by
prolonging the QT interval, can cause severe dysrhythmias
45
Clozapine can cause
agranulocytosis, decrease in WBCs
46
Drug Interactions of Dopamine System Stabilizers
Drugs that decrease dopamine, or typical antipsychotics, use with SSRIs or SNRIs, alcohol/other CNS depressants
47
With DSS drugs detemine
baseline level of consciousness, assess for history of hypertension, diabetes, cardiovascular disease, or dysrhytmias
48
Suddenly stopping antipsychotics can result in
nausea, dizziness, tremors
49
Antidepressants are used with
dysthymic disorder, major depressive disorder, bipolar disorder
50
MAOIs
tricyclic antidepressants are 1st generation, became available in the 60s
51
Atypical antidepressants
work slightly different but affect same neurotransmitters screen for thoughts of self-harm or suicide should not be stopped suddenly
52
SSRIs
inhibiting the reuptake of serotonin, increase concentration of serotonin safer than TCAs and better tolerated
53
Side Effects/Adverse Reactions of atypical antidepressants
nausea, drowsiness, insomnia, dry mouth, decreased appetite, increased sweating, and constipation decreased sex drive, decrease ability to orgasm and erectile dysfunction, increased risk for suicide
54
Risks of atypical antidepressants
bleeding, hyponatremia, and bone fracture skin reactions cause changes in the electrical conduction of the heart
55
Antidepressants should be avoided in
pregnancy, due to neonatal abstinence syndrome (withdrawal)
56
Knowledge of patient's drug use can prevent
serotonin syndrome
57
SNRIs
inhibit the reuptake of both serotonin and norepinephrine, increase concentration
58
SNRIs are also used in
depression, hot flushes, premenstrual dysphoric disorder, fibro, and chronic pain, diabetic neuropathy
59
Side effects and adverse reactions of SNRIs
nausea, dry mouth, loss of appetite, fatigue and drowsiness
60
Hyperhidrosis
increased sweating
61
SNRIs are avoided
during late pregnancy
62
Drug Interactions of tricyclic antidepressants
any drug that affects serotonin or norepinephrine and other antidepressants increase the risk for serotonin syndrome or neuroleptic malignant syndrome anticoagulants, antiplatelet drugs, and NSAIDs
63
Side Effects/Adverse Reactions of Tricyclic Antidepressants
dry mouth, drowsiness, constipation, nausea, and orthostatic hypotension weight gain/weight loss mild to severe vision problems
64
Cardiac dysrhythmias are a contraindication for
antidepressants
65
Tricyclic antidepressants can trigger a
manic episode, cause delirium in older patients with cognitive impairment, and should not be used in patients with glaucoma
66
Drug interactions with Tricyclic Antidepressants
drugs that depress the CNS, increased risk for respiratory depression, sedation, and severe hypotension interacts with a wide variety of antidysrhythmic drugs, causing serious cardiac problems use of marijuana can cause cardiac problems use of tobacco products can decrease the effectiveness of TCAs
67
MAOIs
enzymes in cells in your body break down neurotransmitters, increase the available neurotransmitters, decrease in depressive episodes used to treat severe depression that does not respond to other medications
68
Serious interactions with MAOIs can occur
with certain foods and drink (high tyramine)
69
MAOIs can also be used for
certain anxiety disorders and treating Parkinson's
70
Drug Interactions of MAOIs
severe high blood pressure from SSRIs, SNRIs, St. John's wort, and any drug with stimulant qualities Drugs that reduce BP can increase hypotensive side effects Drugs that depress the CNS Patients who are taking insulin or oral hypoglycemic drugs at risk for hypoglycemic reactions
71
Tyramine
amino acid involved in the release of norepinephrine, broken down by monoamine oxidase
72
Function of MAOIs
increase norepinephrine, thus significantly increases BP | -avoid caffeine products
73
Mood Stabilizers
Drugs used mainly to treat patients with bipolar illness. Extreme changes in mood
74
Bipolar characteristics
inability to live life, mania, rapid speech, flight of ideas, excessive activity, staying awake for hours, feelings of elation or superiority spend money recklessly or sex with multiple partners extreme depression, lose interest, sad, hopeless, suicidal
75
Actions and uses of Lithium
inhibits the synthesis, storage, release, and reuptake of monoamine neurotransmitters
76
Lithium does not cause
sedation, depression, or euphoria
77
Onset of action for mania
1 week, but may take 2 to 3 weeks for the patient to experience the full benefit
78
Lithium has a very narrow
therapeutic range, monitor blood levels regularly( 4 days after 1st day of drug therapy) adjust the pts dose accordingly
79
Side Effects/Adverse Reactions of Lithium
Mild weight gain, increased thirst, increased urine output, dry skin, mild drowsiness, nausea, vomiting, diarrhea; these can also indicate drug toxicity Hypothyroidism, renal failure, diabetes insipidus, neuroleptic malignant syndrome, serotonin syndrome
80
While taking Lithium, maintain
fluid balance to prevent drop in sodium levels | decrease caused by reduced salt intake, intensive exercise, very hot enviroments
81
Drug Interactions of Lithium
Diuretics, NSAIDs, antidepressants and antipsychotic drugs, drugs that affect the electrical conduction of the heart. Drugs that affect sodium intake or fluid balance, increased risk for toxicity
82
Contraindications of Lithium
pregnant women
83
Desired level for acute mania
0.8 to 1.2
84
Maintenance level
0.8 to 1.0
85
More than 1.5 of Lithium
toxicity
86
More than 3
organ failure or death
87
Blood levels of Lithium are measured every
6 to 12 weeks

Pharmacology (10 decks)

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