Chapter 2: Neurobiologic Theories and Psychopharmacology Flashcards
(263 cards)
1
Q
What does the pineal gland influence?
A
Its an endocrine gland that influences activities of the pituitary gland, islets, parathyroids, adrenals, and gonads
2
Q
What does the left hemisphere control?
A
Controls right side of body and is center for logical reasoning and analytic functions like reading, writing, and math
3
Q
What does the right hemisphere control?
A
Left side of body. Center for creative thinking, intuition and artistic abilities
4
Q
Cerebral hemisphere is divided how?
A
Frontal, parietal, temporal, and occipital
5
Q
Front lobe conrols what?
A
Organization of thought, body movement, memories, emotions, and moral behavior
6
Q
Disorders of the Frontal Lobe is associated with what disease?
A
Schizophrenia, ADHD, and DEmentia
7
Q
What does the Parietal Lobe interpret?
A
Sensations of taste and touch and assist with spacial orientation
8
Q
What does the Temporal Lobe do?
A
Centers for senses of smell and hearing and for memory and emotional expression
9
Q
Occipital Lobes do what?
A
Assist in coordinating language generation and visual interpretation, such as depth perception
10
Q
What does the cerebellum do?
A
Center for coordination of mvoements and postural adjustments . Receives information from all over the body
11
Q
Lack of Dopamine in Cerebellum associated with what?
A
Lack of smooth coordinated movemenets in diseases like parkinsons and dementia
12
Q
Brainstem includes what
A
midbrain, pons, and medulla oblongata
13
Q
What does the medulla control?
A
Contains vital centers for respiration and cardiovascular functions
14
Q
What does the pons do?
A
Serves as a primary motor pathway
15
Q
What does the medulla oblongata do?
A
Contains retricular activating system (influences motor activity, sleep, consciousness, awareness) and extrapyramidal system (relays information about movement and coordination from brain to spinal nerves)
16
Q
What does the limbic system include?
A
Thalamus, Hypothalamus, Hyppocampus, and Amygdala
17
Q
What does the Thalamus do?
A
Regulates activity, sensation and emotion
18
Q
Hypothalamus does what?
A
Temperature regulation, appetite control, endocrine function, sexual drive, and impulse behavior with anger and rage
19
Q
What do the Hypocampus and amygdala do?
A
Involved in emotional arousal and memory
20
Q
Disturbances in the limbic system are associated with what mental illnesses?
A
Memory loss with dementia and poorly controlled emotions and impulses seen with psychotic or manic behavior
21
Q
What is a synapse?
A
Gap between the cells . Electrochemical messages cross here by way of special chemical messengers
22
Q
What are neurotransmitters?
A
Chemical substances manufactured in neuron that aid in transmission of information throughout body
23
Q
Where do Neurotransmitters fit?
A
Fit into specific receptor cels embedded in the membrane of the dendrite
24
Q
Dopamine MOA
A
Excitatory
25
Dopamine Physiologic Effects?
Controls complex movements, motivation, cognition: regulates emotional response
26
Norepinephrine MOA
Excitatory
27
Norepinephrine Physiologic Effects
Causes change in attention, learning and memory ,sleep and wakefulness, mood
28
Epinephrine MOA
Excitatory
29
Epinephrine Physiologic Effects
Controls fight or flight response
30
Serotonin MOA
Inhibitory
31
SErotonin Physiologic Effects
Controls food intake, sleep and wakefulness, temp, pain, sexual behaviors, emotions
32
Histamine MOA
Neuromodulator
33
Histmaine Physiologic Effects
Controls alertness, gastric secretions, cardiac stimulation, peripheral allergies
34
Acetylcholine MOA
Excitatory or Inhibitory
35
Acetylcholine Physiologic Effects
Controls sleep and wakefullness cycle, signals muscles to become alert
36
Neuropeptides MOA
NEuromodulators
37
NEuropeptides Physiologic Effects
Enhance, prolong, inhibit, or limit efects of neurotransmitters
38
GLutamate MOA
Excitatory
39
Glutamate Physiologic Effects
REsults in neurotoxicity if levels too high
40
Y-Aminobutyric Acid MOA
Inhibitory
41
Y-Aminobutyric Acid Physiologic Effects
Modulates other neurotransmitters
42
What does Dopamine control?
COmplex movements, motivation, cognition, and regulation of emotional responses
43
Dopamine is implicted in what disorders?
Schizophrennia and movement disorders like Parkinsons
44
Antipsychotic medications work how?
By blocking dopamine receptors and reducing dopamine activity
45
What is the mostprevelent neurotransmitter in the nervous sytem?
Norepinephrine
46
What does Norepinephrine do?
Plays role in attention, leanring and memory, sleep and wakefulness and mood regulation
47
Excess Norepinephrine associated with
several anxiety disorders
48
Deficit of Norepinephrine and Epinephrine may contribute to what?
Memory loss, social withdrawal, and depression
49
How do some antidepressants work with Norepinephrine and Epinephrine?
BLock reuptake of norepinephrine while others inhibit MAO from metabolizing it
50
What does Epinephrine control?
Fight or lfight response in peripheral nervous sytem
51
What does Serotonin control?
Control of food intake, sleep and wakefulness temp regulation, pain control, sexual behavior and regulates emotions
52
SErotonin is associates with what illness?
Anxiety, mood disorders, schizophrenia
53
SErotonin has been foudnt ocontribute to what seen in schizophrenia?
Delusions, Hallucinations, and Withdrawn behavior
54
How to Antidepressants affect SErotonin?
Block serotonin reuptake, staying longer in synapse and improving mood
55
Some psychotropic drugs block histamine, resulting in
weight gain, sedation, and hypotension
56
Where is Acetylcholine found?
Brain, spinal cord, and peripheral nervous sytem.. Particularly at neuromuscular junction of skeletal muscle
57
Where can Acetylcholine be synthesized from?
Found in red meat and vegetables and found to affect the sleep-wake cycle and signal muscles to become active
58
What illness are due to acetylcholine?
Alzhemier and Myasthenia Gravis
59
When can GLutamate be implicated in the brain?
Stroke, hypoglycemia, sustained hypoxia and Huntington or Alzheimer disease
60
Drugs that increase GABA are and do what?
Benzodiazepines and treat anxiety and induce sleep
61
What can a CT diagnose?
Primary tumors, metasteses and effusions and to determine size of ventricles (Thsoe with Schizo have enlarged ones)
62
What is SORL1?
Its a variation in a gene in those with Alzheimers
63
What are Twin Studies?
Used to compare rate of certin mental illness or traits in monozygotic (identical) and dizygotic (fraternal) twins
64
What are adoption studies?
Used to determine a trait among biologic veruss adoptive family members
65
What are family studies?
Used to ocmpared whether a treat is more common amove first-degree relatives than more distant relatives
66
What is Psychoimmunology?
Examines effect of psychosocial stressors on the body's immune system . such as someone with an compromised immune system
67
What is Efficacy?
Refers to maximal therapeutic effect that a drug can achieve
68
What is Potency?
Amount of drug needed to achieve maximum effect
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What are antipsychotic drugs used to treat?
Symptoms of psychosis, such as delusions and hallucinations seen in schizo, schizoaffective disorders, and manic phaase of bipolar
70
Antipsychotics: Off lab use includes
treatment of anxiety and insomnia, aggressive behavior, and delusions and hallucinations with alzheimers
71
Antipsychotics: How do these drugs work?
By blocking receptors of the neurotransmitter dopamine
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Antipsychotics: These are the primary medical treamtent for what illness?
Schizophrenia and also used in acute mania, psychotic depression and drug-induced psychosis
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Antipsychotics: How does this affect Alzhemiers?
Use a low dose for those with psychotic symptoms
74
Antipsychotics: Benefit for second-generation?
Can increase mortality rates in elderly clients with dementia-related psychosis
75
Antipsychotics: Short term therapy may be used for what?
transient psychotic symptoms such as those with borderline personality disorder
76
Antipsychotics: Major action of this drug?
Block receptors for the neurotransmitter.
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Antipsychotics: What are dopamine receptors classified into?
D1, D2, D3, D4, D5
78
Antipsychotics: Which dopamine receptors are associated with illness?
D2, D3, D4
79
Antipsychotics: First generation drugs are potent antagonists of what?
D2, D3, and D4 but produce many side effects due to D2
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Antipsychotics: Newer, second-generation drugs like Clozapien (Clozaril) are weak blockers of what?
D2, resulting in lower side efects
81
Antipsychotics: What else do second generation drugs inhibit?
Inhibit the reuptke of serotonin, as do some antidepressants, increasing their effectiveness in treating depressive aspects of schizophrenia
82
Antipsychotics: What are the newest second gen drugs?
Paliperidone (Invega), Iloperidone (Fanapt), Asenapine (Saphris) and Lurasidone (Latuda)
83
Antipsychotics: What is the difference between Paliperidone (Invega) and Risperidone (Risperdal)?
Extended relase, meaning you only take one time a day
84
Antipsychotics: How is Asenapine (Saphris) taken?
Sublingually, avoid food or drink 10-15 minutes after med dissolves
85
Antipsychotics: What do third generation drugs do?
Dopamine system stabilizers. Thought ot stabilize dopamine output . Increase when low and decrease when high
86
Antipsychotics: What are the third generation drugs?
Aripiprazole (Abilify)
Cariprazine (Vraylar)
Brexpiprazle (Rexulti)
87
Antipsychotics: What are the third generation drugs used for?
Schizo, Manic Episodes, and Adjunct Medication in both bipolar and depression
88
Antipsychotics: SIde effects of third generation drugs?
Weight gain, akathisia, headache, anxiety, and nausea
89
Antipsychotics: What is Depot injection?
A time release form of intramuscular medication for maintenance therapy
90
Antipsychotics: Decanoate Fluphenazine (Prolixin) duration?
7-28 days
91
Antipsychotics: Decanoate Haloperidol (Haldol) duration?
4 weeks
92
Antipsychotics: Once patient condition is stablized with oral condiiton , administration by depot injection required how often?
2-4 weeks to maintian therapeutic effect
93
Antipsychotics: How do Risperidone (Riseperdal Consta), Paliperidone (Invega Sustenna) and Olanzapine Pamoate (Zyprexa RElprevv) second gen drugs work?
Encapsulate active medicationinto polymer based microspheres tht degrade slowly in the body
94
Antipsychotics: How often is Risperdal Consta given?
25 mgevery 2 weeks
95
Antipsychotics: How often is Invega Sustenna given?
117 mg every 4 weeks
96
Antipsychotics: How often is Zyprexa Relprevv given?
210 mg every 2 weeks or 405 mg every 4 weeks. May cause postinjection delirium/sedation syndrome
97
Antipsychotics: Signs of postinjection dlirium/sedation syndrome?
Sedation, confusion, disorientation, agitation and cogntiive impairment that leads to ataxia, convulsions, weakness, and hypertension. Must be observed for 3 hours after injection
98
Antipsychotics: What are Extrapyramidal symptoms (EPS)?
Serious neurologic symptoms and side effects of antipsychotic drugs
99
Antipsychotics: EPS of this drug?
Acute Dystonia, Pseudoparkinsonism and Akathisia
100
Antipsychotics: What is responsible for the development of EPS?
Blockade of D2 reeptors
101
Antipsychotics: Which drug rarely causes EPS?
Ziprasidone (GEodon)
102
Antipsychotics: Geodon is contraindicated in those with?
History of QT prolongation
103
Antipsychotics: How to treat EPS?
lowering the dose, change to a different drug, or administer anticholinergic meds
104
Antipsychotics: What is Acute Dystonia?
Acute muscular rigidity and cramping, a stiff or thick tongue, and laryngospasm and respiratory difficulties
105
Antipsychotics: When is Dystonia most likely to occur?
In the first week of treatment, those <40 and in males and those receiving haloperidol and thiothixene
106
Antipsychotics: Spasms or stiffness is muscle groups can produce what?
Torticollis (twisted head and neck), Opisthotonus (tightness in entire body with the head back and an arched neck) or oculogyric crisis (eyes rolled back in locked position)
107
Antipsychotics: Treatment for Actue Dystonia includes what?
Anticholinergic drugs like intramuscular benztropine mestylate (Cogentin) or IM/IV Benadryl
108
Antipsychotics: What is Pseudoparkinsonism?
Drug induced parkinsonism
109
Antipsychotics: Symptoms of one with Psuedoparkinsonism?
Stiff, stooped posture
Masklike Facies
Decreased Arm Swing
Shuffling, Festinating Gait
Cogwhell Rigidity
Drooling, Tremor, Bradycardia, Pill-Rolling movemenets of thumb
110
Antipsychotics: How is Pseudoparkinsonism treated?
Changing to an antipsychotic medication that has lower EPS or adding oral anticholinergic agent or amatadine )dopamine agonist)
111
Antipsychotics: How does a client report Akathisia?
An intense need to move about. Restless or anxious and agitated.
112
Antipsychotics: How ccan Akathisia be treated?
By a change in antipsychotic meds or by addition of an oral agent such as beta blocker, anticholinergic, or benzodiazepine
113
Antipsychotics and NMS: What is Neuroleptic Maligant Syndrome (NMS)?
Potentially fatal idiosyncratic reaction to antipsychotic drug.
114
Antipsychotics and NMS: Symptoms of this?
Rigidity, high fever, autonomic instability such as unstable BP diaphoresis and pallar, delirium, and elevated levels of enzymes
115
Antipsychotics and NMS: When does this most often occur?
During the first 2 weeks of therapy or after an increase in dosage
116
Antipsychotics and NMS: What else can increase the risk for this?
Dehydration, poor nutrition and concurrent medical illness
117
Antipsychotics and NMS: Treatment for this?
Discontinuance of all antipsychotic medsd and institution of supporitive medical care to treat dehydration and hyperthermia
118
Antipsychotics and TD: What is this?
Tardive Dyskinesia. A syndrome of permanent involuntary movements due to long-term use
119
Antipsychotics and TD: Symptms of this?
involuntary movements of the tongue, facial and neck muscles, upper and lower extremities. Tongue thrusting and lip smacking are characteristic of this . It is irreversible
120
Antipsychotics and TD: First drugs to treat TD?
Valbenazine (Ingrezza) and Deutetrabenazine (Austedo, TEVA)
121
Antipsychotics and TD: How do Valbenazine and Deutetrabenazine work?
VMAT2 Inhibitors. Decrease activity of monoamines like dopamine, serotonin and norepinephrine therefore decreasing abnromal movements associated with this
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Antipsychotics and TD: Valbenazine dosage?
40-80 mg daily
123
Antipsychotics and TD: Deutetrabenazine dosage?
12-48 mg daily.
124
Antipsychotics and TD: What side effects do Valbenzine and Deutetrabenazine cause?
Somnolence, QT prolongation, Akathisia, and restlessness
125
Antipsychotics and TD: When specific side effects can Valbenzine cause?
nausea, vomiting, headache, and balance disturbances
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Antipsychotics and TD: What specific side effects can deutetrabenazine cause?
NMS and depression and suicidality in patients with huntington
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Antipsychotics and TD: How toprevent TD when administering drugs?
Keep maintenance dosage as low as possible, change meds, and monitor the client periodically for inital signs
128
Antipsychotics and Anticholinergic SE: When does this occur?
With use of antipsychotics
129
Antipsychotics and Anticholinergic SE: Side effects of this?
```
Orthostatic Hypotension
Dry mouth
Constipation
Urinary Hesitance
Blurred Near Vision
Dry Eyes
Photophobia
Decrease Memory
```
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Antipsychotics and Anticholinergic SE: When do the side effects decrease?
Within 3-4 weeks
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Antipsychotics and Anticholinergic SE: Client taking this to treat EPS may have what side effects?
Increase Anticholinergic SE
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Antipsychotics and SE: What does this do to prlactin?
Increase it. Cause breast enlaargement and tenderness in men and women, diminished libido, erictile dysfunction and menstural irregulatories
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Antipsychotics and SE: Weight gain significant with what drugs?
Clozapine (Clozaril) and Olanzapine (Zyprexa)
134
Antipsychotics and SE: What is Metabolic syndrome?
When a patient has three or more of the following:
Obesity (Excess Weight)
Increased BP
High Blood Sugar
High Cholesterol
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Antipsychotics and SE: Those with Schizo have an increase RF what?
Obesity. Should be involved in education program to control weight and decrease BMI
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Antipsychotics and SE: Thioridazine and Mesoridazine are used to treat...
psychosis
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Antipsychotics and SE: Droperidol is most often used as an adjunct with
anesthesia or to produce sedation
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Antipsychotics and SE: Clozapine produces fewer traditional side effects than do m ost antipsychotics drugs but has potentially fatal side efect of
agranulocytosis
139
Antipsychotics and SE: What is Agranulocytosis characterized by?
Fever, Malaise, Ulcerative Sore Throat, and Leukopenia
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Antipsychotics and SE: When can Agranulocytosis begin?
24 weeks after initation of therapy . Need weekly WBCs drawn for first 6 months
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Antipsychotics and SE: What range do you want your WBCs to be in for someone taking Clozapine?
WBC at 3500 and ANC at 2,000. Monitor every 2 weeks for 6 months and then every 4 weeks
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Antipsychotics and SE: What can ease dry mouth?
Drinking sugar free fluids and eating sugar-free hard candy
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Antipsychotics and SE: What to do if client misses dose?
Can take missed dose if it is 3-4 hours late. If longer, client can omit the forgotten dose.
144
Antidepressants: Primarily used to treat
major depressive illness, anxiety disorders, depressed phase of bipolar, and psychotic depresion
145
Antidepressants: off-label uses inlcude
tx of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, pain disorder, eating disorder
146
Antidepressants: They interact with whattwo neurotransmitters?
Serotonin and norepinephrine, that regulate mood, arousal, attention, sensory processiving and appetite
147
Antidepressants: Four groups of antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRI)
MAO Inhibitors (MAOIs)
Tryclic and related Cyclic Antidepreassants
Other Antidepressants
148
Antidepressants: Problems with first generation drugs?
Varying degrees of sedation, orthostatic hypotension , and anticholinergic side efects
149
Antidepressants: Problems with MAOIs?
Life-threatening SE, hypertensive crisis may occur if food with tyramine ingested . Cannot be given with other MAOIs or depressants.
150
Antidepressants: What is the first choice in treating depression?
Fluxetine (Prozac) in 1987. Its an SSRI
151
Antidepressants: What is effective in treating OCD?
SSRIs and Clomipramine
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Antidepressants: What is the only drug that can be given once a week after client stabilized on Fluoxetine?
Prozac Weekly. Contains 90 mg with an enteric coating
153
Antidepressants: What are the drugs of choice for someone with suicidial idealiations?
SSRIs, Venlafaxine, Nefazodone, and Bupropion. No risk of overdose when compared to cyclic compounds and MAOIs
154
Antidepressants: SSRIs only effective for what type of depression
mild to moderate
155
Antidepressants: Major interaction occurs how?
With the monamine neurotransmitter system in the brain: Norepinephrine and Serotonin . Help regulate arousal, vigilance, attention, mood, sensory processing, and appetite.
156
Antidepressants: What happens to Norepinephrine, SErotonin and Dopamine in the synapse?
Removed from synapse after release by reuptake. After reuptake, these three neurotransmitter are reloaded for subsequent release or metabolize dby enzyme MAO
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Antidepressants: What do SSRIs block?
Reuptake of serotonin
158
Antidepressants: What do cyclic antidepressants and venlafaxine block?
The reuptake of norepinephrine primarily and block serotonin to some degree.
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Antidepressants: Cyclic compounds take how long to become effective?
4-6 weeks
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Antidepressants: MAOIs tkke how long to become effective?
2-4 weks
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Antidepressants: SSRIS take how long to become effective?
2-3 weeks
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Antidepressants and SSRI SE: Side effets may lead to
Anxiety, Agitation, Akathisia (Motor Restlessness), Nausea, Insomnia, and Sexual Dysfunction. weight gain too
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Antidepressants and SSRI SE: How is Akathisia treated?
With Beta-blocker, such as propranolol (Ideral) or benzodiazepine)
164
Antidepressants and SSRI SE: Les common SE of this?
Sedation, Sweating, Diarrhea, Hand Tremor, And Headaches
165
Antidepressants and Cyclic SE: How do these work?
Block cholinergic receptors, resulting in anticholinergic effecs like dry mouth, constipation, urinary retnetion, dry nasal, blurred near vision
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Antidepressants and Cyclic SE: More severe SE include
agitation, delirium, and ileus.
167
Antidepressants and Cyclic SE: Normal SE?
Orthostatic hypotension, Sedation, Weight Gain, Tachycardia
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Antidepressants and MAOIs SE: Most common SE include
Daytime sedation, Insomnoia, Weight Gain, Dry Mouth, Orthostatic Hypotension, Adn Sexual dysfunction
169
Antidepressants and MAOIs SE: Most important concern to watch for is
potential for hypertensive crisis if client ingests food with tyramine.
170
Antidepressants and MAOIs SE: Hypertensive Crisis SE?
Hypertension, Hyperpyrexia, Tachycardia, Diaphoresis , Cardiac Dysrhythmias
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Antidepressants and MAOIs SE: Drugs that may cause fatal interaction with MAOIs include
SSRIs, certain cyclic compounds, buspirone , dextromethorphan, and opiate derivatives
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Antidepressants and Other Antidepressants SE: What drugs are included here?
Nefazodone, Trazodone, and Mirtazapine
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Antidepressants and Other Antidepressants SE: What do Nefazodone, Trazodone and Mirtazapien cause?
Sedation
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Antidepressants and Other Antidepressants SE: What do Nefazodone and Trazodone cause?
Headache
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Antidepressants and Other Antidepressants SE: What can Nefazodone cause?
Dry mouth and nausea
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Antidepressants and Other Antidepressants SE: What can Bupropion, Venlafaxine and Desvenlafaxine cause?
loss of appetite, nausea, agitation, and insomnia
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Antidepressants and Other Antidepressants SE: What can Venlafaxine cause?
Dizziness, sweating or sedation
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Antidepressants and Other Antidepressants SE: Nefazodone can cause what life threatening issue?
Liver damage
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Antidepressants and Other Antidepressants SE: Bupropion can cause what major issue?
Seizures at a rate 4x other antidepressants
180
Antidepressants and Drug Interactions: What is Serotonin Syndrome?
Can result from taking an MAOI and a SSRI at the same time
181
Antidepressants and Drug Interactions: Symptoms of Serotonin Syndrome?
Agitation, Sweating, Fever, Tachycardia, Hypotension, Rigidity, Hyperreflexia and even coma/death
182
Antidepressants and Client Teaching: Whens hould clients take SSRI
in the morning
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Antidepressants and Client Teaching: which drug causes most sedation?
paroxetine
184
Antidepressants and Client Teaching: What happens if patient forgets SSRI dose?
can take up to 8 hours after missed dose
185
Antidepressants and Client Teaching: When should client take cyclic compound?
At night .
186
Antidepressants and Client Teaching: What happens if client misses cyclic dose?
Take within 3 hours or omit dose for that day
187
Antidepressants and Client Teaching: Those taking MAOI ned to be aware of what?
Hyperadrenergic crisis can ocur if diet restrictions arent observed
188
Mood-Stabilizing Drugs: Used to treat what?
Bipolar disorder by stabilzing the clients mood, preventing or minimizing the highs and lows a dn treating acute episodes of mania
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Mood-Stabilizing Drugs: What is the most established mood stabilizer?
Lithium
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Mood-Stabilizing Drugs: What are some effective modo stabilizers?
Carbamazepine (Tegretol) and Valproic ACid (Depakote, DEpakene)
191
Mood-Stabilizing Drugs: What is occasionaly used to treat acute mania?
Clonazepam (Klonopin)
192
Mood-Stabilizing Drugs: What is a warning about Lamotrigine?
Can cause serious rashes requiring hospitalization including Stevens-Johnson Syndrome
193
Mood-Stabilizing Drugs and MOA: How does Lithium work?
Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine and acetylcholine and dopamine. Also reduces release of norepinephrine through competition with calcium.
194
Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Topiramate work?
Increases levels of GABA
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Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Carbamazepien work?
Stabilize mood by inhibiting kindling process. Is a snowball effect where minor seizures start to build up.
196
Mood-Stabilizing Drugs and Dosage: Lithium is available in what form
tablet, capsule, liquid, and sustained-release forms
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Mood-Stabilizing Drugs and Dosage: How is Lithium dosage determined?
Monitoring serum lithium levels .
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Mood-Stabilizing Drugs and Dosage: Lithium dose ranges form what ot what?
900 - 3600 mg.
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Mood-Stabilizing Drugs and Dosage: Serum Litium level should be at what level?
1 mEq/L
200
Mood-Stabilizing Drugs and Dosage: Serum Lithium levels less than 0.5 are rarely
therapeutic
201
Mood-Stabilizing Drugs and Dosage: Serum Lithium levels more than 1.5 are
considered toxic
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Mood-Stabilizing Drugs and Dosage: How is Carbamazepien available?
In liquid, tablet, and chewable tablet forms
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Mood-Stabilizing Drugs and Dosage: Carbamazepien dosage range from
800-1200 / day. Extreme dosage is 200-2,000 mg/day
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Mood-Stabilizing Drugs and Dosage: How is Vlproic Acid available?
Liquid, tablet, and capsule forms and as prinkles
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Mood-Stabilizing Drugs and Dosage: Valproic Acid range"?
1,000 to 1,500 . Extreme dose is 750-300
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Mood-Stabilizing Drugs and Side Effects: Common side effects of Lithium include
mild nausea/diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic tase in mouth, and fatigue. Weight gain and acne occur later
207
Mood-Stabilizing Drugs and Side Effects: Toxic effects of lithium include
diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination. If untreated, lead to renal failure
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Mood-Stabilizing Drugs and Side Effects: What does a Lithium level of 3 indicate?
Dialysis may be needed
209
Mood-Stabilizing Drugs and Side Effects: SE of Carbamazepien and Valproic Acid include
drowsiness, sedation, dry mouth and blurred vision
210
Mood-Stabilizing Drugs and Side Effects: What may Carbamazepine specifically cause?
Rashes and orthostatic hypotension
211
Mood-Stabilizing Drugs and Side Effects: What may Valproic Acid specically cause?
Weight gain, alopecia and hand tremor
212
Mood-Stabilizing Drugs and Side Effects: What may Topiramate cause?
Dizziness, sedation, weight loss, and increase incidence of renal calculi
213
Mood-Stabilizing Drugs and Side Effects: What dangerous SE can Valproic Acid cause?
Hepatic Failure. Liver function tests should be performed often
214
Mood-Stabilizing Drugs and Side Effects: What dangerous SE can occur with Carbamazepine?
Aplastic Anemia and Agranulocytosis at a rate 5-8x higher than normal population
215
Mood-Stabilizing Drugs and Client Teaching: What is important for someone taking Lithium or Anticonvulsants?
Monitor blood levels periodically. Time of last dose must be accurate so labs can be checked 12 hours after lat dose.
216
Antianxiety Drugs (Anxiolytics) : USed to treat what?
Anxiety, and anxiety disorders, insomnia, OCD , depression, posttraumatic stress disorder and alcohol withdrawal
217
Antianxiety Drugs (Anxiolytics) : What has been proven to be most effective in relieving anxiety?
Benzodiazepines
218
Antianxiety Drugs (Anxiolytics) : Why may Benzodiazepines also be prescribed?
Anticonvulsant and Muscle relaxant effects
219
Antianxiety Drugs (Anxiolytics) : What is Buspirone?
Nonbenzodiazepien and often used for relief of anxiety
220
Antianxiety Drugs (Anxiolytics) and MOA: How do Benzodiazepines work?
Medicate actions of GABA. Binds to specific site on Gaba
221
Antianxiety Drugs (Anxiolytics) and MOA: How does Buspirone work?
Acts as a partial agonist at serotonin receptors which decreases serotonin turnover
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Antianxiety Drugs (Anxiolytics) and MOA: What is most often prescribed for sleep rather thn releif of anxiety?
Temazepam (Restoril)
Triazolam (Halcion)
Flurazepam (Dalmane)
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Antianxiety Drugs (Anxiolytics) and MOA: What is often prescribed to manage alcohol withdrawal and to relieve anxiety?
Diazepam (Valium)
| Chlordiazepoxide (Librium)
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Antianxiety Drugs (Anxiolytics) and SE: Main problem with Benzodiazepines?
How it causes physical dependence. Buspirone does not cause thi s
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Antianxiety Drugs (Anxiolytics) and SE: SE seen with Benzodiazepines include?
CNS depression such as drowsiness, sedation, poor coordination and impaired memory or clouded sensorium
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Antianxiety Drugs (Anxiolytics) and SE: Common SE from Buspirone include
Dizziness, sedation, nausea, and headache
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Antianxiety Drugs (Anxiolytics) and client Teaching: Clients need to know what?
Are aimed at relieving symptoms such as anxiety or insomnia but do not treat the underlying problem
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Antianxiety Drugs (Anxiolytics) and client Teaching: Benzodiazepines strongly potentiate the efects of
alcohol. One drink feels like three.
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Antianxiety Drugs (Anxiolytics) and client Teaching: How should they discontinue this?
Withdrawal can be fatal. Never discontinnue abruptly.
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Stimulants: What were they first used for?
Amphetamines and other drugs were used to treat psychiatric disorders in the 1930s.
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Stimulants: Dextroamphetamine (Dexedrine) has been abused how?
To produce a high or to remain awake for long periods.
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Stimulants: The primary use for stimulants today is
for ADHD, residual attention-deficit disorder in adults, and narcolepsy
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Stimulants: Primary drugs to treat ADHD?
Methyphenidate (Ritalin)
Amphetamine (Addrerall)
Dextroamphetamine (Dexedrine)
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Stimulants: Wh is Pemoline (Cylert) infrequently used?
Because potential for liver problems
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Stimulants: What was the first nonstimulation medication specifally designed to treat ADHD?
Atomoxetine (Strettera) a SSRI
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Stimulants: What is a Warning about Methyphenidate?
Use in caution with emotionally unstable clients such as those with drug or alcohol dependnce
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Stimulants: Warning about Pemoline?
Can cause life-threatening liver failure
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Stimulants and MOA: Amphetamines and Methyphenidate work how?
Act by causing release of enurotransmitters (norepinephrine, dopamine, and serotonin) from presynaptic nerve terminals as opposed to having direct agonist effects of postsynaptic receptors. They also block reuptake of these
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Stimulants and MOA: How does Pemoline work?
Affects dopamine and therefore has less effects on the sympathetic nervous sytem
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Stimulants and MOA: How does Atomoxetine work?
Blocks the reuptake of norepinephrine into neurons, thereby leaving more of the neurotransmitter int he synapse to help convey electrical impulses
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Stimulants and Dosage: Dextroamphetamine and MEthylphenidate can be given in what dose?
Dose up to 20-200 mg/day. Higher doses may be needed if Nacrolepsy develops
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Stimulants and SE: Most common side effects re
anorexia, weight loss, nausea, and irritability . Should avoid caffeine, sugar and chocolate
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Stimulants and SE: Less common SE include
dizziness, dry mouth, blurred vision, and palpitations
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Stimulants and SE: Most common long term problems is
growth and weight suppression occurs in some children
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Stimulants and SE: What can Atomoxetine cause?
Decreased appetite, nausea, vomiting, fatigue, or upset stomach
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Stimulants and Client Teaching: What should be taught?
Take after meals.
| Caffeine-Free Beverage important. Avoid chocolate and excessive sugar
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Disulfiram (Antabuse): What is this?
It is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body
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Disulfiram (Antabuse): Symptoms after someone ingests alcohol?
10 minutes later.. facial and body flushing, throbbing headache, sweating, dry mouth, n/v, dizziness
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Disulfiram (Antabuse): How logn do symptoms last?
30 minutes to 2 hours
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Disulfiram (Antabuse): What does Disulfiram inhibit?
The enzyme aldehyde dehydrogenase, which is involved in metabolism of ethanol
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Disulfiram (Antabuse): What products may contain alcohol?
Shaving cream, aftershave lotion, cologne, deodorant and OTC meds
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Disulfiram (Antabuse): Other side effects from this?
Fatigue, drowsiness, halitosis, tremor, and impotence
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Disulfiram (Antabuse): This can interfere with other drugs being taken such as
Phenytoin (Dilantin)
Isoniazid
Warfarin (Coumadin)
Barbiturates
Benzodiazepines such as diazepam and chlordidazepoxide
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Disulfiram (Antabuse): What is Acamprosate (Campral)
Prescribed for those recovering from alcohol abuse. Reduces physical and emotional discomfort
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Disulfiram (Antabuse): Acamprosate (Campral) dosage?
2 tabs 33 mg each 3x per day
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Disulfiram (Antabuse): SE of Acamprosate?
Mild and include diarrhea, nausea, flatulence, and pruritus
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Cultural Considerations: African American respond quickly to what drugs?
Antipsychotic and tricyclic antidepressants and have a greater risk for developing side effects
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Cultural Considerations: How do Asians handle their drugs?
Metabolized antipsychotics and tricyclic antidepressants more slowly than white people
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Cultural Considerations: What is St. Johns wort sued for?
To treat depression
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Cultural Considerations: What is Kava used for?
Treat anxiety and can potentiate effects of alcohol, benzodiazepines and other sedative-hypnotic agents
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Cultural Considerations: What is Valerian used for?
Helps produce sleep and is sometimes used to relieve stress and anxiety
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Cultural Considerations: What is Ginkgo Biloba used for
Primairly used to improve memory but is also taken for fatigue, anxiety, and depression
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What factors must be considered in the selection of medications to treat mental disorders?
The Efficacy, potency, half-life of drug. Age and Race of Client. Other Meds client taking and side effects of the drugs
