Chapter 11 Flashcards by Brina Quintanilla Reyes

The following flashcards are going to be a mixture of study guide information and the powerpoint information that was provided

How well did you know this?

Not at all

Perfectly

Before anything we always need to understand Maslow hierarchy, which are ?

physiological needs
security and safety
love and belonging
self-esteem
self actualization

How well did you know this?

Not at all

Perfectly

notes to read outloud
- Psychiatric medications are designated in certain conditions for specific symptoms.

same symptoms may be present with different diagnoses.
all medications have desirable and undesirable effects.
nurses must understand these concepts to help ensure patient safety

How well did you know this?

Not at all

Perfectly

notes to read outloud
target symptoms
- specific, measurable, expected to improve with treatment

monitor and document effect of medication on target symptoms
medications will affect more than just target symptoms resulting in wanted and unwanted side effects or adverse reactions
nurse must document and report any side effects and/or adverse reactions

How well did you know this?

Not at all

Perfectly

notes to read out loud
drug regulation and use
- FDA responsible for ensuring safety, efficacy, and security of drugs

includes 4 phases of testing before approving new medication
nurse must know labeling content before administering a medication
muse be aware of any boxed warning and be alert for any appearance of the adverse reactions

How well did you know this?

Not at all

Perfectly

notes to read out loud
psychopharmacology
- small amount of medication can have profound effect on individual

each nurse must understand the basics to be able to provide the best clinical care possible
pharmacodynamics
Clincal concepts
pharmacokinetics

How well did you know this?

Not at all

Perfectly

something important to note that when a patient is receiving any medication, the medication is going to act on your receptors, mainly 2 types. what are the 2 types?

agonists
antagonist

How well did you know this?

Not at all

Perfectly

what is agonists vs antagonists receptors ?

agonist
- same response

antagonists
- block response

How well did you know this?

Not at all

Perfectly

within the receptors, we have selectivity, affinity and intrinsic activity.

tell me what each of these mean

selectivity
- specific drug for specific receptor

affinity
- degree of attraction or strength of bond between drug and biologic target

intrinsic activity
- ability to produce response after attaching to receptor

How well did you know this?

Not at all

Perfectly

we understand that medications are a very important part of psychiatric-mental health nursing care.
- psychotropic medications work on different and various receptors in the brain as we mentioned before.
- they can inhibit the reuptake of the neurotransmitter or block the receptor

with this information, what can be ruled out if change in receptors, loss of receptors, exhaustion of neurotransmitter supply, increased metabolism of the drug or physiologic adaptation can cause what ?

explain this

decreased in medication effects

because our body either adapts/tolerance to the medication and or we simply dont work well with the medication

How well did you know this?

Not at all

Perfectly

this flashcard is going to be asking about the defiention of each term.

Efficacy
Potency
Desensitization
Tolerance
Toxicity
Therapeutic index

ability to produce response
dose needed for effect
rapid decrease in drug effects
gradual decrease in drug action
drug concentration harmful to body
ratio to maximum nontoxic dose to minimum effective dose

How well did you know this?

Not at all

Perfectly

Each route of administration has its advantages and disadvantages.
What are some examples of administration?
What is the best?

Oral, IV, IM, Topical

IV - fastest route

How well did you know this?

Not at all

Perfectly

read out loud notes
pharmacokinetics
- first pass effect
- bioavailability

distribution
- size of the organ
- blood flow to the organ
- solubility of the drug
blood brain barrier
placenta
- plasma protein binding
- anatomic barriers

metabolism
- biotransformation
- cytochrome

excretion
- clearance
- half life
- can vary significantly to any individual ; must be alert to fluctuations and adjust dose and or schedule accordingly

How well did you know this?

Not at all

Perfectly

The cytochrome P450 (CYP450) system plays a major role in drug ____?

metabolism

How well did you know this?

Not at all

Perfectly

CYP450 is usually prescribed for what two types of medications?

antipsychotic
antidepressants

How well did you know this?

Not at all

Perfectly

Several factors can affect the distribution, such as ?
dont overthink it

age
genetics
allergies

How well did you know this?

Not at all

Perfectly

what are the 4 phases of drug treatment and nurses role ?

initiation
stabilization
maintenance
discontinuation

How well did you know this?

Not at all

Perfectly

tell me what is going on with each phase

initiation
stabilization
maintenance
discontinuation

psychiatric evaluation
cultural beliefs & practices
physical examination
monitor patients respond to med

adjust or titrate medication dosage
patient education
patient care plan
therapeutic drug monitoring

target symptoms have improved
patient education
assist patient in process

some medications will be gradually tapered in dose to prevent recurrence or withdrawal
- some mediation will be needed for life

How well did you know this?

Not at all

Perfectly

what does pharmacokinetics means?

including what 4 things

how the human body processes the drug, including absorption, distribution, metabolism, excretion

How well did you know this?

Not at all

Perfectly

what does bioavailability mean ?

describes the amount of the drug that actually reaches circulation throughout the body

How well did you know this?

Not at all

Perfectly

how does age affect drug absorption, distribution, metabolism and excretion?

gastric, renal, liver, parasympathetic functions/system are usually decreased with older ages

How well did you know this?

Not at all

Perfectly

how does pharmacogenetics affect absorption, distribution, metabolism, and excretion?

genetic makeup can affect response to medication

(variations among ethnic groups)

How well did you know this?

Not at all

Perfectly

what does ethnopsychopharamacology mean ?

and how does it affect absorption, distribution, metabolism, and excretion ?

cultural variations and differences influencing effectiveness

example ; asian descent produce higher concentration of acetaldehyde with alcohol use than do those of European descent

some cultures may not want to take the medications, and genetic makeup can mess up the actual helpfulness of the med

How well did you know this?

Not at all

Perfectly

with medication use, it comes with side effects. its a no brainer that no matter how clean the medication can be, some patients will have side effects and some not. But not all side effects need to be treated with more medications, so as a nurse its important to what ?

know how/when to intervene when side effects need to be treated.

so like if dry mouth is an issue, tell them to drink more water, instead of giving them like a med for it

How well did you know this?

Not at all

Perfectly

in the lecture 7 powerpoint, it talks about lipid-soluble with variable lipohilicity high protein bond metabolized primary in the liver can you tell what these means?

it means the solubility of the drug in fatty or oily solutions - so pretty much most medications are lipid soluble its a drug ability to leave the bloodstream and enter the tissues most drugs will be metabolized in the liver

now we are going to talking about antipsychotic medications what are the two types ?

typical (conventional) atypical

what are indications for patients to be on antipsychotic medications?

thought disorders, mania(bipolar), mood lability, impulse control, sleep schizophrenia mania autism symptoms of psychosis, hallucinations, delusions, bizarre behavior, disorganized thinking and agitation

how does antipsychotic work/act ?

act primarily by blocking dopamine or serotonin post-synaptically

older typical antipsychotic drugs work on ____symptoms are inexpensive but produce more ____ compared to new atypical antipsychotic drugs

positive side effects

newer atypical antipsychotic drugs work on ___and __symptoms ?

postitive negative

so typical works on ___ atypical works on __,__-

positive symptoms positive & negative symptoms

what are first generation/typical examples of medications of antipsychotics ?

chlorpromazine (thorazine) fluphenazeine(prolifxin) haloperidol(haldol)

what are major side effects that we need to understand and know for the test for antipsychotics?(5)

weight gain diabetes blood disorders (neutropenia, agranulocytosis) NMS (neuroleptic malignant syndrome) medication related movement disorders

what are second generation/atypical examples of medications for antipsychotics?

Clozapine^ (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Aripiprazole (Abilify), Paliperidone (Invega)

what are 2 examples of blood disorders patient who are taking anti-psychotics may get?

neutropenia agranulocytosis

what does neuroleptic malignant syndrome that patients may get as a side effect from antipsychotics? what is an anagram to help remember the hallmark features of NMS ( and tell me what it is ) what is the medication we use to treat this ?

a life threatening, neurologic disorder caused by an adverser reaction to antipsychotic drug, causing a fever, altered mental status, muscle rigidity, and autonomic dysfunction FEVER fever, encephalopathy, vital signs unstable, elevated enzymes (CPK) and rigidity of muscles dopaminergic medications (bromocriptine and amantadine)

what are the 3 most common side effects patients who are taking first generation/typical antipsychotics?

extrapyramidal symptoms (can't sit still, eye spams, tardive dyskinesia (facial movements happen involuntarily/uncontroablle) QT prolongation ( heart issue)

what is tardive dyskinesia ?

unable to control facial movements

most common symptom that happens in second generation/atypical antipsychotic medication ?

metabolic syndrome

what is metabolic syndrome ?

a collection of conditions that often occur together and increase your risk of diabetes, stroke and heart disease high blood pressure high blood triglycerides insulin resistance obesity

however overall most common symptom reported overall, is what?

orthostatic hypotension

you can get something called medication related movement disorders, so as the name implies, the medication your taking (antipsychotic) is causing a movement disorder. what are the 3 disorders? typically often associated with what type of antipsychotic? these 3 are acute ! what is the 1 chronic called ? dont over think this, we just talked about the 3 most common typical side effects patients will experience

dystonia pseudoparkinsonism akathisia typical/first tardive dyskninesia

now onto mood stabilizers (anti-manic medications ) what is the gold standard for mood stabilizer medication? but we also going to be talking about what?

lithium anticonvulsants

what are mood stabilizer or antimanic medications used for ?

control wide variations in mood related to mania ( but these agents may also be used to treat patients with other disorders )

lithium therapeutic index range is ? monitor for toxicity - what are the side effects^(5)

0.8-1.4 severe diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination

when patients are on lithium, we are mainly look at ___&___?

thyroid and kidney

why are some things we are going to look at or for when monitoring renal and thyroid function in a patient who is taking lithium?

creatinine concentrations thyroid honors, dry skin, bradycardia, hair loss, cold intolerance

why are we looking at renal function and thyroid function ?

renal function - kidney damage can occur thyroid function because It can be altered after 6-18 months while on medications

now onto the anticonvulsants part of the mood stabilizers, what are the 3 medications we need to know for this? We need to know these ! CVS more like ???

carbamazepine valproate lamotrigine

carbamazepine notes side effects dizziness, drowsiness, tremor, visual disturbance, nausea, vomititng adverse aplastic anemia, severe rash, SIASH minimize side effects by giving small lose and nausea reduced when given with food

valproate (depakote) has a very _____ and can affect your ____

narrow therapeutic index uric acid cycle

lamotrigine (lamitcal) we need to give it how ? severe side effect is what ? and describe the symptoms of it^

slow dose titration/skin monitoring Steven Johnson syndrome - blistering or painful rash that is centrally located (lips, mouth, mucousa)

now onto the antianxiety and sedative-hypotonic medications mainly these are what ?

benzodiazepines and nonbenzodiazepines

how does benzodiazepines work ? how does nonbenzodiazepines work?

enhancing the effect of gaba (buspirons)acts on serotonin

typically benzodiazepines are short term use of anxiety, panic and alcohol withdrawal, however when using this, we have to be careful and warn patients that this medication is highly what?

high dependence tolerance addiction risk

what is the mechanism of action for benzodiapenies ?

GABA agonist

what are the main side effects to remember for benzodiazepines? (3)

drowsiness sedation hangover effects

its important to just know that we have an additional medication that can also be classified as a benzodiazepines usage, which is Called? its a antihistamine

Hydroxyzine (vistrail)

since we know the benzodiazepines is high addictive, we tell patients to only take it when ? however with buspirone, they must take it regularly, usually ___x per day

as needed (PRN) 2-3x per day

what are stimulants and wakefulness promoting agents usually used for ? treating 2 things

treating symptoms related to ADHD and narcolepsy

now onto the topic of antidepressants what are antidepressants used for ?

treating depression, eating disorder, other mental disorders, anxiety

notes the exact mechanism on how antidepressants work is unknown, however initial improvement with some antidepressants can be seen within 7 days of the medication and complete relief of symptoms possibly taking several weeks its important to note that slow tapering is necessary since antidepressants are that are stopped abruptly can cause uncomfortable symptoms antidepressants are also metabolized in the liver

when taking any form of antidepressant, it has a boxed warning, meaning what?

increased risk of suicidal behavior in children and adolescents!!

not only is there a boxed warning for antidepressants, you are at risk of developing what syndrome? and describe to me what it is ? what are some common symptoms ^ how do you treat it ?

serotonin syndrome overactivity of serotonin or an impairment of the serotonin metabolism ; life threatening condition - mental status changes - autonomic instability - neuromuscular problems ; hyperreflexia, incoordination, nausea, vomiting, diarrhea, discontinuation of the medication

what are the 6 antidepressants groups we are going to talk about ?

SSRI SNRI NDRI A2-Antagonist Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs)

what are some examples of SSRI medications? You need to know these (6)

Fluoxetine (Prozac) Citalopram (Celexa) Sertraline (Zoloft) Paroxetine (Paxil) Escitalopram (Lexapro) Fluvoxamine (Luvox)

we usually like to start low and slow on the dose of SSRI due to the risk of serotonin syndrome and the increased sucidial thoughts (black box warning) not only that, we are also avoiding common side effects like?

GI upset, akithesia, sexual side effects, headache, dry mouth biggest one to know is sexual dysfunction

in the small little diagram, it mentions to never take SSRI with what ?

MAOI

What are your 3 SNRI medications ? ECP!!

Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxeine (Pristiq)

what are your common side effects with SNRI?

headache anxiety gi upset sexual side effects potential impact on BP

what are your two serious side effects with SNRI?

serotonin syndrome increased suicidal thoughts (black box warning)

what is the action of mechanism for NDRI?

inhibition of norepinephrine, serotonin and dopamine

what is the medication name for NDRI?

bupropion(Wellbutrin)

what are the indications to start using an NDRI?

depression, smoking cessation ADHD

what is NDRI contraindication with ? (2 things )

eating disorders seizure disorders

im not going to go too in depth but for the a2 antagonist, what is the medication we need to know?

Remeron

Tricyclic antidepressants action on variety of neurotransmitter systems, including norepinephrine and serotonin reuptake systems TCAs are as effective as SSRI, however they are what ? - which is why we only give it ??

they have more serious side effects and a higher lethal potential we only give it once/daily single dose

what are some examples of TCA medications ?

amitriptyline clomipramine doxepin desipramine

patients who take TCA have a higher risk of what ?

cardio toxicity/suicide

what is the action of MAOI?

inhibition of Mao -> increased serotonin and norepinephrine activity in the synapse

what are some examples of MAOIS? think of the anagram to remember NO POPULAR MEDS EVER

phenelzine (nardil) tranylcypromine (parnate) isocarboxazid (marplan) selegiline (emsam)

what are some side effects with MAOI?

severe headache sweating palpitations nausea/vomiting increase bp and hr

EVERY MAOI HAS SEVERE INTERACTIONS WITH WHAT 3 THINGS ?

tyramine sympathomimetic agents OTC cold medicines

what foods contain tyramine that we tell patients taking maoi to avoid ? reason why we need to avoid this is because tyramine causes hypertensive crisis

cheese, milk, chianti wine, preserved meats, avocados

what are 2 serious side effects we need to worry about with maoi?

hypertensive crisis - CAUSED BY TYRAMINE RICH FOODS AND MEDICATIONS serotonin syndrome

REMEMBER WITH MAOI, WE WANT NO AGED OR FERMENTED FOOD!

Chapter 11 Flashcards

psychopharmacology, dietary supplements, and biologic interventions (86 cards)