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Flashcards in Drugs For Psych Deck (27):
1

Situational depression

Related to circumstances such as illness, divorce, loss of job, death, etc
Substance abuse, meds

2

Biological factors of depression

Imbalances of neurotransmitters, genetic,hormonal, secondary to another condition such as traumatic brain injury or stroke

3

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Behaviors: crying, withdrawn, changes in appearances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

4

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)

5

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)

6

Neurotransmitters with Depression

Norepinephrine
Serotonin
Dopamine

7

Pharm for Depression

Antidepressssants
SSRI
SNRI
TCAS
MAOI
ADD INFO

8

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)

9

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

10

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

11

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)

12

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

13

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

14

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


15

Drugs to avoid with MAOI

Sympaphtomemeitcs
Option. Analgesics
Amphetamine
Dextromethorphan
CNS Depressants.

16

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

17

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

18

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

19

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:

20

Psychoses

Severe mental disorders where're is a. Loss of contact with reality

Delusions, hallucinations, disorganized behaviors, paranoia, difficulty relating to others.

21

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%%)

22

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

23

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

24

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,
END in -PINE or -DONE

ADD INFO

25

Dopamine-Serotonine System Satbilizers.
((Third Gen))

Dopamine partial. Agonists
Lower. Incidence of EPS, less weight gain


EX: Abilify

ADD INOF

26

Long term. Metabolic effect associated with Antipsychotics

Weight gain, obesity
Hyperlipidemia
Insulin resistance, diabetes

Antipsychotics should be used with caution in older adults.

(Increased prolactin especially with riparidone use - infertility, amenorrhea, lactation even in men)

27

Client education with antipsychotics

Report tremors, muscle spasms,, involuntary repeatitive movements, decreased muscle tone or increased restlessness
Consult a healthcare provider
Avoid taking antiacids b/c may. Decrease absorption of antipsychotic
Avoid alcohol