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Flashcards in Final Exam Deck (30):
1

FIRST GENERATION DRUGS

FIRST GENERATION DRUGS

Chlorpromazine (Thorazine)

Haloperidol (Haldol)     For take-downs the dose is 5mg

Perphenazine (generic only) 

Fluphenazine (generic only) 

Prolixin 

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ANTIPSYCHOTIC MEDS

 

used to treat

  • schizophrenia and
  • schizophrenia-related disorders

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FIRST GENERATION DRUG 

SIDE EFFECTS

  • Extrapyramidal symptoms (EPS) such as: rigidity, persistent muscle spasms, tremors, restlessness . (This can also happen with second generation anti-psychotics).
  • Tardive dyskinesia (TD). TD causes muscle movements a person can’t control . The movements commonly happen around the mouth.  TD can range from mild to severe, and in some people the problem cannot be cured . Sometimes people with TD recover partially or fully after they stop taking the medication .  

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SECOND GENERATION DRUGS 

SIDE EFFECTS

  • cause “metabolic syndrome”: major weight gain and changes in a person’s metabolism . This may increase a person’s risk of getting diabetes and high cholesterol.  A person’s weight, glucose levels, prolactin levels and lipid levels should be monitored regularly.

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Clozapine (Clozaril)

300-450 mg Daily

  • can cause agranulocytosis.
  • must get their white blood cell counts (ANC in particular) checked every week or two.  
  • must be in a Clozapine Registry in order to receive the medication.
  • potentially helpful for people who do not respond to other antipsychotic medications, esp. young men with suicidal ideation 
  • MEDICATION OF LAST RESORT FOR ANTIPSYCHOTIC

  • Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, antipsychotics are used as adjuncts to mood stabilizers .

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SECOND GENERATION DRUGS 

  • Clozapine (Clozaril)                300-450mg daily
  • Risperidone (Risperidone)  1-4mg daily (up to 8mg max daily dose)
  • Olanzapine (Zyprexa)                 10-20mg daily
  • Quetiapine (Seroquel)                100-800mg daily
  • Ziprasidone (Geodon)                 40-200mg daily
  • Aripiprazole (Abilify)                 10-15mg daily

 

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FDA issued a Public Health Advisory for all antipsychotic medications

The FDA determined that death rates are higher for elderly people with dementia when taking this medication.

 

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Tips on Drugs

If you get an order that DOES NOT MAKE SENSE, challenge the order! 

    You have to know:

    1. What you are doing

    2. Why you are doing this

    3. The right dose

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“Positive symptoms” of schizophrenia

Positive is too much of something

  • a feeling of agitation and having hallucinations or delusions
  • usually diminish within 1-3 weeks.  

 

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“Negative symptoms” 

of schizophrenia

Negative is too little of something

  • example: doesn't want to shower
  • withdrawal and lack of self-care should also improve on SGAs
  • Hard to treat

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“Take down” meds or “B-52’s”

combination of :

  • Haldol 5mg
  • Ativan 2 mg
  • benztropine 1mg, (sometimes Benadryl is used instead of benztropine).

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ANTIDEPRESSANTS TREAT 

DEPRESSION 

  • depression commonly treated with antidepressant medications.
  • Antidepressants work to increase circulation of one or more of these monoamine neurotransmitters the brains:
  • serotonin
  • norepinephrine
  • dopamine
  • takes three or four weeks until the medicine takes effect 
  • Some people (6-18 months),
  • some people (possibly lifetime)   
  • DON'T STOP antidepressants suddenly! Can cause flu-like symptoms called discontinuation syndrome. Decrease slowly the dose . People don’t get addicted, or “hooked,” on the medications, but stopping them abruptly can cause withdrawal symptoms .  

 

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SSRI (antidepressant)

SELECTIVE SEROTONIN 

REUPTAKE INHIBITORS

Fluoxetine (Prozac)              20-60mg daily

Citalopram (Celexa)             20-40mg daily

Sertraline (Zoloft)                 25-150mg daily

Paroxetine CR (Paxil CR)      25-50mg daily

Escitalopram (Lexapro)        10-20mg daily

 

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SNRI (antidepressant)

SEROTONIN AND NOREPINEPHRINE 

REUPTAKE INHIBITOR

Venlafaxine XR (Effexor XR)       75-300mg/day

Duloxetine (Cymbalta)                 30-60mg daily

Desvenlafaxine (Pristiq)              50-100mg daily

 

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NDRI (antidepressant)

NOREPINEPHRINE AND DOPAMINE 

REUPTAKE INHIBITOR 

Bupropion XL (Wellbutrin XL)        150-300mg/day

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TRICYCLICS (antidepressant)

amitriptyline, desipramine, doxepin  (these are usually used for sleep and pain augmentation)

 

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SARI (antidepressant)

trazodone (good for sleep)

  • one side effect for men is a sustained erection for more than 4 hours

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MAOIs (antidepressant) 

MONOAMINE OXIDASE INHIBITORS

Foods and medicines that contain high levels of tyramine are dangerous for people taking MAOIs . Tyramine is found in some wines, and pickles, smoked meats & cheeses, draft beers. Mixing MAOIs with other antidepressants or  tyramine foods can cause a hypertensive crisis which can lead to stroke 

(EMSAM)

Selegiline             

Nardil

Parnate

Marplan

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SSRIs and SNRIs 

SIDE EFFECTS

  • Headache and mild nausea 
  • Drowsiness OR jitteriness
  • If sleepiness is a problem, give dose in a.m. 
  • Reduced sex drive, and problems having and enjoying sex .
  • Suicidal risk is increased at the beginning of treatment, typically within the first 8-12 weeks.

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TRICYCLIC ANTIDEPRESSANT 

SIDE EFFECTS

  • anticholinergic side effects, including: dry mouth, constipation, urinary retention, blurred vision, drowsiness. 
  • Sexual problems, which can affect both men and women and may include decreased libido and anorgasmia.  
  • Suicidal risk is increased at the beginning of treatment, typically within the first 8-12 weeks.

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MOOD STABILIZERS

  • Bipolar disorder is commonly treated with mood stabilizers .
  • sometimes antipsychotics and antidepressants are used along with a mood stabilizer. 
  • Patients must get blood levels drawn to make sure they are in the therapeutic range (which is wider than lithium). 
  •  Doses of lithium and the anti-epileptic drugs are increased SLOWLY because of risk of SJS: (itching, rash on body or mucous membranes, swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs)
  •  

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LITHIUM

  • Therapeutic blood level: 0.6-1.2 (or 1.5)
  • Average dose: 900-1200mg/day
  • Lithium toxicity: loss of coordination, excessive thirst, frequent urination, blackouts, seizures, slurred speech, fast (or, slow, irregular, or pounding) heartbeat, hallucinations, changes in vision 
  • make sure the kidneys and the thyroid are working normally
  • maintain fluid and electrolyte balance

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ANTICONVULSANT MEDS 

AS USED FOR MOOD STABILIZERS 

Originally developed to treat seizures, but they were found to help control mood as well.  Weight gain can occur:

  • valproic acid, also called divalproex sodium (Depakote) 
  • carbamazepine (Tegretol)
  • lamotrigine (Lamictal) 
  • oxcarbazepine (Trileptal) 

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ANXIETY MEDICATION

SSRI antidepressants are the first choice for treatment of chronic anxiety: PTSD, OCD, panic disorder, social phobia and generalized anxiety disorder.

  • Beta blocker antihypertensive meds (Inderal) and some antihistamines (Vistaril) can be used for situational anxiety.
  • Beta-blockers not recommended for people with asthma or diabetes because they may worsen symptoms

Buspar: Possible side effects from buspirone (BuSpar) include: Dizziness Headaches Nausea Nervousness Lightheadedness Excitement Trouble sleeping. Can take 2 weeks to work.

Benzodiazepines ( increase GABA in the brain) are addictive and should not be used for outpatient anxiety.  Sudden stop of benzodiazepines is bad! May get withdrawal symptoms, or their anxiety may return. Taper off slowly. 

Withdrawal can be life-threatening.

 

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BENZODIAZEPINE 

SIDE EFFECTS

  • drowsiness and dizziness 
  • Upset stomach, Blurred vision, Headache 
  • Confusion, Grogginess
  • Respiratory arrest when combined with alcohol
  • Tolerance, withdrawal, addiction (which can be life-long)

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MEDICATION FOR ADHD

"STIMULANTS"

 

  • Methylphenidate (Ritalin, Metadate, Concerta, Daytrana) 
  • Amphetamine (Adderall) 
  • Dextroamphetamine (Dexedrine, Dextrostat)
  • Lisdexamfetamine (Vyvanse)

SE: decreased appetite, headaches, stomach aches and labile emotion, esp. in younger children.  Insomnia can occur, but this is often seen with ADHD even if the patient is not medicated.

Less common side effects:  Repetitive movements or sounds called tics . These tics may or may not be noticeable .  Decreasing dosage may make tics go away . Some children also may appear to have a personality change, such as appearing “flat” or without emotion . This usually means the dose is too high.

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MEDICATION FOR ADHD 

"SNRI" 

 

atomoxetine (Strattera) Same side effects as for other SNRIs

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MEDICATION FOR ADHD

Anti-hypertensive agents

clonidine 

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MEDICATIONS FOR INSOMNIA

 

  1. The “Z” drugs:  Ambien (sleep text-eat-sex), Lunesta, Sonata (they are the “non-benzo” drugs that act on GABA receptors in the brain)  
  2. Seroquel – SGA- 25-50mg
  3. Remeron- antidepressant (7.5-15mg)
  4. Trazodone (50-100mg)
  5. Prazosin – the “nightmare” drug
  6. Benzos should not be used
  7. Some tricyclic anti-depressants

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Herbal medicines used to treat depression:

You cannot SAFELY recommend any herbal preparations to your patients.