Chap 16 Psychotherapeutic Drugs

Question 1

Biochemical Imbalance Theory

Answer 1

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

Question 2

Anxiety

Answer 2

Unpleasant state of fear

Question 3

Affective Disorders (Mood Disorders)

Answer 3

Changes in mood from mania to depression

Bipolar disorder is an example

Question 4

Psychosis

Answer 4

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

Question 5

Anxiolytic Drugs

Answer 5

Benzodiazepines
Depress activity in the brainstem and limbic system.

Question 6

Benzodiazepines/Adverse Effects/Overdose/Interactions

Answer 6

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

Question 7

Alprazolam (Xanax)

Answer 7

Most used as an anxiolytic

Adverse effects: confusion, ataxia, headache, and others

Question 8

Diazepam (Valium)

Answer 8

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

Question 9

Lorazepam (Ativan)

Answer 9

Used to treat or prevent alcohol withdrawal

Question 10

Buspirone (Buspar)

Answer 10

Lacks sedative properties and dependency potential as other benzodiazepines

Question 11

Mood-Stabilizing Drugs

Answer 11

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

New agent: cariprazine (Vraylar)

Question 12

Lithium Level Range/Adverse Effects

Answer 12

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

Question 13

Antidepressants

Answer 13

Requires at least 6 weeks of therapy
Higher risk of suicide

Question 14

Tricyclic Antidepressants (TCA)

Answer 14

largely been replaced by SSRIs as first-line antidepressant drugs

Amitriptyline (Elavil)

Question 15

Tricyclic Antidepressants:
Indications/Overdose

Answer 15

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

Overdose
CNS and cardiovascular systems are 
mainly affected.
dysrhythmias

Question 16

Amitriptyline (Elavil)

Answer 16

Commonly used to treat insomnia and neuropathic pain

Question 17

Monoamine Oxidase Inhibitors (MAOIs)

Answer 17

Disadvantage: potential to cause hypertensive crisis when taken with tyramine

Question 18

MAOIs and Tyramine

Answer 18

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

Question 18

SSRIs

Answer 18

fluoxetine,
sertraline,
mirtazapine

Question 19

Bupropion

Answer 19

also indicated as an aid in smoking cessation

Zyban: approved for smoking cessation treatment

Question 20

Second-Generation
Antidepressants Adverse Effects

Answer 20

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

Question 21

Serotonin Syndrome

Answer 21

More severe symptoms
Hyperthermia
Seizures
Rhabdomyolysis
Cardiac dysrhythmias

Question 22

Fluoxetine (Prozac)

Answer 22

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

Question 23

Duloxetine (Cymbalta)

Answer 23

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

Question 24

Mirtazapine (Remeron)

Answer 24

Sedation often occurs Dose at bedtime appetite stimulant

Question 25

Antipsychotics Used to Treat/Adverse Effects

Answer 25

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

Question 26

+/- Symptoms of Schizophrenia

Answer 26

Positive symptoms: hallucinations, delusions, and conceptual disorganization Negative symptoms: apathy, social withdrawal, blunted affect, poverty of speech, and catatonia

Question 27

Haloperidol (Haldol) Indications

Answer 27

Indications: long-term treatment of psychosis

Question 28

Quetiapine (Seroquel)

Answer 28

Atypical Antipsychotic

Question 29

Clozapine (Clozaril) Adverse effects

Answer 29

Adverse effects: blood dyscrasias Monitor WBC counts frequently

Question 30

Risperidone (Risperdal)

Answer 30

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

Question 31

Psychotherapeutic Drugs: 
Nursing Implications

Answer 31

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.

Question 32

Antidepressants

Answer 32

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.

Question 33

therapeutic effects

Answer 33

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

Question 34

therapeutic effects For anxiolytics

Answer 34

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

Question 35

therapeutic effects For antidepressants

Answer 35

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

Question 36

therapeutic effects For antipsychotics

Answer 36

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