Drugs For Psych Flashcards
(27 cards)
Situational depression
Related to circumstances such as illness, divorce, loss of job, death, etc
Substance abuse, meds
Biological factors of depression
Imbalances of neurotransmitters, genetic,hormonal, secondary to another condition such as traumatic brain injury or stroke
Common symptoms
Emotions: hopelessness, sadness, guilt, anger, mood swings
Behaviors: crying, withdrawn, changes in appearances
Thoughts: down on yourself, confusion, death/suicidal thoughts
Physical: fatigue, lack of energy, sleeping, weight gain/loss, substance abuse
Treatment of Depression
Assess causative factors or other disease processes that mimic depression
Psychotherapy
Pharmacotherapy
When depression is unresponsive to other therapies and becomes life threatening: electroconvulsive therapy (ECT), repetitive transcribing magnetic stimulation (sTMS), Vagus nerve stimulation (surgical implant)
Antidepressants
Reduce depressive symptoms by correcting chemical imbalances (norepinephrine, dopamine, serotonin)
Antidepressants also used to treat anxiety, phobias, OCD, and neuropathic pain
Improvement in Sx usually occurs within first 2 weeks, may take 6-8 week for full effect
Black box warning fur to increased risk of suicidal thinking and behaviors in children and young adults
DO NOT take St.Johns Wort with ANY antidepressant (increases availability of serotonin)
Neurotransmitters with Depression
Norepinephrine
Serotonin
Dopamine
Pharm for Depression
Antidepressssants SSRI SNRI TCAS MAOI ADD INFO
Selective Serotonin Reuptake Inhibitors
SSRI
First line treatment of depression
Slow reuptake of serotonin into presynaptic nerve terminals (increases levels of serotonin enhance mood)
Safe than other classes (less sedation, fewer sympathomemtic and anticholinergic effects + low toxicity with overdoes)
Monitor for serotonin syndrome
EX: citalopram (Celexa), escialtopram (Lexapro), fluoxetine (Prozac)m sertralin(Zoran)
Serotonin Symdrome
Too much serotonin (over abundance of anticholinergic effects)
Results in: tachycardia, agitation, hypertension, dilated pupils, hyperactive reflexes, clonus (repetitive involuntary muscles)
Can have seizures, fever and muscle rigidity
Sertraline (Zoloft)
THera: Antidepressant
Pharm: SSRI
Indications: Depression, anxiety, OCD, panic disorders
MOA: Inhibits the reuptake of serotonin
Adverse: Insomnia, headache, dizziness, fatigue, dry mouth, sexual dysfunction
Implications: Many drug-drug interactions (digoxin, warfarin, diazepam, aspirin, NSAIDS), avoid use with alcohol, monitor suicidal ideation, avoid abrupt discontinuation and DO NOT give with MAOI. Can have a lot of ethnic variation with SSRIs
Serotonin and Norepinepherine Reuptake Inhibitors
SNRIs
Inhibit reabosroption of serotonin and norepinepherine, may also affect levels of dopamine
Safety and side effect provide same as for SSRI’s with addition of HTN
EX: vanlafaxine (Effexor), duloxetine(Cymbalta)
Tricyclics ANtidpressants
TCAS
Inhibit reuptake of serotonin and norepinepherine
Less commonly used than SSRI and SNRI due. To adverse effects and toxicity
Adverse effects include orthostatic hypotension, sedation, anticholinergic effects (fight/flight)
Avoid used of alcohol, take at bedtime
ADD EXAMPLES
Monoamine Oxidase Inhibitors
MAOIs
MAO is. mitochondrial enzyme found in nerve and other tissues that breaks down norepinepherine serotonin and dopamine. When MAO is inhibited
Oldest class of.drugs Adverse effects include orthostatic hypotensions, insomniac, headache, diarrhea, sexual ysfunction As effective as others but has high drug-drug and drug-food interactions and risk. Of hepatotoxicitiy
MAOI food. Interactions
Reacts with foods containing tyramine (degraded my MAO. So inhibiting the MAO enzyme leads to high levels of. Thiamine in the blood))
Tyramine is similar to norepinephrine… ADD
AVOID: Cheese, wine, soy, bananas, beer
Drugs to avoid with MAOI
Sympaphtomemeitcs Option. Analgesics Amphetamine Dextromethorphan CNS Depressants.
Bipolar disorder
Alternate between periods of depression and over excitement
Excess. Of excitatory neruotranmittters (norepinephrine). Or deficiency of inhibitory neurotransmitters (GABA)
Treatment depends on current symptoms
Ex: lithium, anticonvulsives,, antipsychotics, benzodiazepine
Lithium Carbonate
Eskalith
Thera: Antimanic
MOA: Exact MOA unknow, affects synth
Adverse: Metallic taste, treaters, polyuria, polydipsia, diarrhea, fatigue, weight. gain
Implications: monitor serum. Drug level (narrow therapeutic range, patients widely vary), alcohol and diuretics increase risk of dehydration (increased risk of toxicity, take with food to decrease N//V, consistent salt. Intake, there effects take 7–10 days, contraindicated in pregnancy
Black box: Monitor serum levels for toxicity
Signs of toxicity: Ulsteady gait, vomiting, diarrhea, drowsiness, tremor, muscle. Weakened,, blurred vision, large volume diuresis
ADD/ADHD
Inattention and distrachibility,, without with hyperactivity
Thought to be related. To deficit or dysfunction. Of dopamine and norepinephrine
Harm
CNS Stimulants:: heighten alertness, increase focus, Schedule II, may cause paradoxical hyperactivity. Ex: Ritalin, adderall
Non–CNS Stimulants: norepinephrine. Reuptake inhibitors, newer alternative to CNS stimulant, no abuse potential. Ex: Straterra
ADD
methylphenidate (Ritalin)
THera: ADHD drugs
Pharm: CNS stimulant
Indications: ADHD, narcolepsy
MOA: Activates. Reticular activating system (increasing alertness). Blocks uptake of norepinephrine and dopamine
Adverse: HTN, tachycardia,, hepatotoxicity, decreased appetitive s, anxiety
Implications: symptoms typically improve within a few weeks. Schedule II drug, periodic drug free breaks are reommencded to reduce dependence
Black Box:
Psychoses
Severe mental disorders where’re is a. Loss of contact with reality
Delusions, hallucinations, disorganized behaviors, paranoia, difficulty relating to others.
Pharm for Psychoses
Offer symptom relief, not a. Cure
Goal. Is for client to maintain social relationships, care for, hold a job
Long term or life long therapy is requires
Compliance is an issues (adverse. Effect, feel well/denial of problem, replaces rates 60-80%%)
Conventional/Typical ANtpsychotics
First generation
Thought to block dopamine receptor sites reducing positive symptoms (hallucinations, Deion’s, disorganized thoughts/speech)
Many adverse effects
Black box: older adults with dementia related. Psycho did are at risk of death. Typically on BEERS list
EX; Phenothiazine: chlorpromazine (Thorazine)), prochlorperazine (Copazine)
Nonephenothizines: Haladol
Extrapyramidal Symptoms (EPS)
Include dystopia, akathisia, anticholinergic effects,sedative effects, sexual dysfunction, hypotension, Parkinsonism (shuffling gait,tremor, stooped posture), and tardive dyskensia (bizarre tongue and face movements)
May give benztropine. (Cogentin) an anticholinergic to treat EPS
Atypical Antipsychotices
Second Gen
Thought to block dopami, serotonin and alpha 1 receptor sites
Broader spectrum of action than first generation
Less incidence of EPS
May cause neutropenia (decrease neutrophils), weight gain, type 2 diabetes
EX; clozapine (Clozaril), asenapine, danzapine,
Risperidone,
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