Mental Health Drugs Flashcards
(111 cards)
1
Q
what is the function of GABA?
A
inhibitory neurotransmitter “sleep hormone”
2
Q
what is the role of serotonin and norepinephrine?
A
contributes to sleep, mood, appetite, attentiveness, and emotions
3
Q
what is the role of dopamine?
A
modulates mood, behavior, and emotion
4
Q
what is the purpose of anxiolytics?
A
decrese ANXIETY and suppress CNS
5
Q
what is the purpose of hypnotics?
A
SLEEP - the goal is to initiate and extend sleep, improve REM sleep
6
Q
what do sedatives help with?
A
help pt sleep, but not restorative sleep
7
Q
what tends to come with anxiety?
A
insomnia
8
Q
what is the action of benzodiazepines?
A
increase the actions of GABA (sleep hormone)
9
Q
what is the use of benzodiazepines?
A
- 1st choice for anxiety
- short term treatment for sleep (not restorative sleep)
10
Q
what is the common ending for benzodiazepines?
A
-lam or -pam
11
Q
do benzodiazepines help with restorative sleep?
A
no - helps with sleep but not restorative sleep
12
Q
what side effects are seen with benzodiazepines?
A
- daytime sedation (not getting enough restorative sleep)
- dizziness and ataxia (impaired coordination)
- anterograde amnesia (decreased memory after dose)
- rebound insomnia
- respiratory depression
- fatigue, muscle weakness, dry mouth, nausea, and vomiting
13
Q
what benzodiazepine is used for alcohol withdrawal?
A
lorazepam (Ativan)
14
Q
what are some examples of benzodiazepines?
A
- diazepam (Valium)
- chlordiazepoxide (Librium)
- flurazepam (Dalmane)
- alprazolam (Xanax)
- lorazepam (Ativan)
- temazepam (Restoril)
15
Q
what route are benzodiazepines given?
A
all are PO
- ativan can be given IV but causes a risk of hypotension, cardiac arrest, and respiratory arrest, life-threatening reaction in 2% of patients
16
Q
what is the antidote for benzodiazepines?
A
flumazenil (Romazicon)
17
Q
what should never be used with benzodiazepines?
A
alcohol/ethanol because they are both respiratory depressants
18
Q
what are the symptoms of benzodiazepines overdose?
A
- respiratory depression
- hypotension
- depression
- confusion
- lethargy
19
Q
there is a high risk of what with benzodiazepines?
A
abuse
20
Q
what is the treatment for benzodiazepines overdose?
A
- airway management
- gastric lavage
- flumazenil (Romazicon)
21
Q
what is the action of benzodiazepine-like drugs?
A
bind to GABA receptor sites (sleep hormone)
22
Q
what is the use for benzodiazepine-like drugs?
A
insomnia (not anxiety)
23
Q
what are examples of benzodiazepine-like drugs?
A
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
24
Q
what is the duration of zolpidem (Ambien)? what is the onset like?
A
- duration is 6-8 hours
- rapid onset
25
what is the purpose of zaleplon (Sonata)? what is duration like?
- helps fall asleep, but not stay asleep
| - short-acting
26
what is the use like for eszopiclone (Lunesta)? what is the onset like? what is the downside?
- no limits on the length of use
- rapid onset
- bitter aftertaste
27
what is the use for melatonin agonist ramelteon (rozerem)?
chronic insomnia
28
what is the onset like for melatonin agonist ramelteon (rozerem)?
rapid onset
29
what is the action of melatonin agonist ramelteon (rozerem)?
a newer medication that activates the receptors for melatonin
30
what is the use for melatonin?
- insomnia
| - jet lag
31
what is the component in melatonin
tryptophan (turkey)
32
what gland is melatonin associated with?
pineal gland
33
what does melatonin help with the release of?
sleep-wake cycle
| - released while sleeping
34
what is the action of barbiturates?
- enhance actions of GABA
- directly mimic GABA receptors
(sleep hormone)
35
what is the negative of barbiturates?
cause tolerance/dependence
| - high potential for abuse
36
what would barbiturates be used for?
- seizures (epilepsy)
| - surgery (general anesthesia)
37
what is the common ending for barbiturates?
-tal
38
what are some examples of barbiturates?
- phenobarbital (luminal)
- secobarbital (seconal)
- thiopental (pentothal)
39
what are the side effects of barbiturates?
- CNS: drowsiness, lethargy
- powerful respiratory depressant
- CV: bradycardia, hypotension
40
what kind of patient should not be prescribed barbiturates?
a depressed patient because of increased risk of suicide with barbiturate overdose
41
what should nurses know about barbiturates?
- short term use (except in seizure patients)
- discontinue ASAP
- not for pain control
- infrequent use because it is dangerous
42
what are the symptoms of barbiturate overdose?
- respiratory depression
- coma
- pinpoint pupils
43
what is the antidote for barbiturates?
there is no antidote (makes overdose even worse)
44
what are the different types of antidepressants?
TCA's, SSRI's, MAOI's, SNRIS
45
what is the action of tricyclic antidepressants (TCAs)?
block the uptake of norepinephrine and serotonin/5-HT (sleep, mood, appetite, attentiveness, and emotions)
46
what are tricyclic antidepressants (TCAs) used for?
- depression
- bipolar
- OCD
- insomnia
- ADHD
47
what are some examples of tricyclic antidepressants (TCAs)?
- amitriptyline
| - imipramine
48
what are the side effects of tricyclic antidepressants (TCAs)?
- orthostatic hypotension
- anticholinergic
- sedation
- dysrhythmias
- seizures
- hypomania
49
what is a negative of tricyclic antidepressants (TCAs)?
overdose can lead to death
50
what is the action of selective serotonin reuptake inhibitors (SSRIs)?
inhibit the reuptake of serotonin (creates a higher concentration of serotonin)
51
what are selective serotonin reuptake inhibitors (SSRIs) used for?
- DEPRESSION
- anxiety
- OCD
- panic
- ptsd
- bulimia nervosa
- bipolar (adjunct therapy)
52
what are some examples of selective serotonin reuptake inhibitors (SSRIs)?
- Prozac
- Celexa
- Lexapro
- Luvox (OCD)
- Paxil
- Zoloft
53
what is the most commonly prescribed selective serotonin reuptake inhibitor (SSRI)? explain more about it...
Prozac
- takes 1-3 weeks to be effective
- half-life is 7-15 days so pt would need a washout period before starting a new drug
- washout period is 5 weeks for MAOIs
54
what are some side effects of selective serotonin reuptake inhibitors (SSRIs)?
- serotonin syndrome
- withdrawal syndrome
- neonatal effects when used late in pregnancy
- sexual dysfunction (70% decrease sex drive)
- weight gain, nausea, headache,
- increased suicide ideation
- hyponatremia
- GI issues (improves with food and time)
55
what is serotonin syndrome? how do you treat it? what are the signs and symptoms?
- too much serotonin
- treatment: stop drug
- agitation, confusion, hallucinations, hyperreflexia, tremor, and fever
56
what happens with selective serotonin reuptake inhibitors (SSRIs) use in late pregnancy?
the baby goes through withdrawal and will have extreme crying
57
what are the drug interactions for selective serotonin reuptake inhibitors (SSRIs)?
- monoamine oxidase inhibitors (MAOIs - would cause serotonin syndrome and would need a five-week wash out before)
- warfarin
- tricyclic antidepressants and lithium
58
what are the signs and symptoms of depression? what are the qualifications?
symptoms must be present most of the day, nearly every day for at least 2 weeks
- depressed mood
- loss of interest
- feeling worthless/sad
- weight loss/gain
59
why does the risk of suicide increase during early treatment with antidepressents? what should patients be observed for?
pts have a sudden burst of "energy" to potentially commit suicide
- watch for suicide ideation, worsening mood, changes in behavior such as mania
- patients and families should be educated on this
60
how do you address suicide with a patient?
clear and direct to receive a clear and direct response
61
how does a doctor choose selective serotonin reuptake inhibitors (SSRIs), select dosing, and know when to increase?
- doctor has a personal preference
- dosing is based on age and weight
- after a period of time the doctor will increase based on age and weight
62
what are monoamine oxidase inhibitors (MAOIs)? why would they be used?
2nd or 3rd choice antidepressants
| - more dangerous and would only be used if a patient isn't responding to another drug
63
what are the uses for monoamine oxidase inhibitors (MAOIs)?
- depression
- anxiety
- panic
- OCD
- bulimia nervosa
64
what is the action of monoamine oxidase inhibitors (MAOIs)?
prevent the breakdown of tyramine
| - tyramine promotes the release of norepinephrine causing severe vasoconstriction
65
what do monoamine oxidase inhibitors (MAOIs) react badly with?
tyramine - foods that are high in tyramine:
- avocado
- soybean paste
- bean curd
- cheeses
- beer
- wine
- smoked meats and sausages
66
what is a potentially dangerous side effect of monoamine oxidase inhibitors (MAOIs)? how would you treat it?
hypertensive crisis from tyramine
- IV phentolamine
- IV labetalol
- SUBLINGUAL NIFEDIPINE
67
what are some side effects of monoamine oxidase inhibitors (MAOIs)?
- headache
- orthostatic hypotension
- tachycardia
- palpitations
- N/V
- confusion
- profuse sweating
68
what are some examples of monoamine oxidase inhibitors (MAOIs)?
- phenelzine (Nardil)
| - selegine (emsam)
69
what is bupropion (Wellbutrin)?
an atypical antidepressant
70
what is the action of bupropion (Wellbutrin)?
blocks the uptake of dopamine and norepinephrine
| - does not affect serotonin
71
what is bupropion (Wellbutrin) used for?
- smoking cessation
- ADHD
- depression
- seasonal affective disorder
72
how long does it take for bupropion (Wellbutrin) to work?
1-3 weeks
73
what are two benefits that bupropion (Wellbutrin) has, that many antidepressants don't?
- increases sexual desire
| - doesn't cause weight gain (suppresses appetite)
74
what are some adverse effects of bupropion (Wellbutrin)?
- seizures (don't take with history of seizures)
- increased agitation
- weight loss
- hand tremors
75
what is the action of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
block reuptake of 5-HT & NE
76
what are the uses for serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- major depression
- generalized anxiety disorder
- social anxiety disorders
77
what is one abnormal use of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
specifically, Cymbalta helps with fibromyalgia
78
what are 3 examples of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- venlafaxine (effexor)
- duloxetine (cymbalta)
- desvenlafaxine (Pristiq)
79
what are some side effects of serotonin/norepinephrine reuptake inhibitors (SNRIs)?
- nausea
- headache
- sexual dysfunction
80
what is mirtazapine (Remeron)?
an antidepressant without a category (effects serotonin)
81
what is the use of mirtazapine (Remeron)?
sleep issues and eating disorders (causes weight gain)
82
what is trazodone (Desyrel)?
an antidepressant without a category (effects serotonin)
83
what is trazodone (Desyrel) used for?
depression-related insomnia (adjunct therapy, sedative effect)
84
what is the action of conventional antipsychotics 1st generation?
- block a variety of receptors within and outside of the CNS
| - decrease levels of dopamine to suppress undesirable behaviors
85
what are the uses of conventional antipsychotics 1st generation?
- schizophrenia
- bipolar disorder (manic depressive illness)
- Tourette's syndrome
- prevention of emesis
86
what are the drug interactions of conventional antipsychotics 1st generation?
- anticholinergic drugs
- CNS depressants
- levodopa (antiparkinsons and direct dopamine receptor agonists)
87
what are the adverse effects of conventional antipsychotics 1st generation?
extrapyramidal symptoms (EPS)
- acute dystonia - onset within hours and if it is not treated it will turn into tardive dyskinesia
- parkinsonism onset - 5-30 days
- tardive dyskinesia - with long-term use, no treatment
88
how would you treat acute dystonia related to conventional antipsychotics 1st generation?
with diphenhydramine
89
what is a neuroleptic malignant syndrome?
rare but serious disease seen with conventional antipsychotics 1st generation
- risk of death without treatment
- sweating, rigidity, sudden high fever, automatic instability
90
what is an example of a low potency conventional antipsychotic 1st generation? what is used for? what are the side effects?
chlorpromazine (Thorazine)
- used for schizophrenia, manic phase of bipolar, hiccups
- side effects are sedation, hypotension, and anticholinergic
91
what is an example of a medium potency conventional antipsychotic 1st generation? what is used for?
loxapine (Loxitane)
| - schizophrenia (acute agitation) and bipolar disorder
92
what is an example of a high potency conventional antipsychotic 1st generation? what is used for? what are the side effects?
haloperidol (Haldol)
- used for Tourette's syndrome and agitation
- side effects are early EPS and prolonged QT intervals causing serious dysrhythmias
93
what does low and high potency related to conventional antipsychotic 1st generation mean?
low potency - means they would need a really high dose to be effective like 600mg
high potency - means a small dose would be effective like 4mg
94
what are examples of 2nd generation agents: atypical antipsychotic agents
- clozapine
- risperdal
- zyprexa
- abilify
- lithium carbonate
- depot preparation
95
what is a benefit of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?
- fewer EPS (extrapyramidal side effects, commonly referred to as drug-induced movement disorders)
96
what is a negative of 2nd generation agents: atypical antipsychotic agents compared to 1st generation?
increased metabolic problems
- increased cholesterol
- increased blood sugar
- increased weight gain
97
what is the action of clozapine?
blocks receptors of dopamine and serotonin
98
what are the uses for clozapine?
- schizophrenia
- levodopa-induced psychosis ( a side effect of a treatment for Parkinson's disease - can alleviate the symptoms of PD without making them worse)
99
what are the adverse effects of clozapine?
- agranulocytosis (drop in WBC)
- seizures
- diabetes (not often used in diabetics)
- weight gain
- myocarditis
- effects in elderly patients with dementia
100
what is risperidone (Risperdal) used for?
- schizophrenia (PO or IM for long term therapy)
- bipolar disorder
- autism
- Alzheimer's disease
101
what is olanzapine (Zyprexa) used for?
- schizophrenia
- bipolar
- off label use: nausea and vomiting caused by chemo
102
what are the adverse effects of olanzapine (Zyprexa)?
- low risk of EPS
- high risk of metabolic issues
- weight gain
103
what is the action of aripiprazole (Abilify)?
blocks multiple receptors
104
what is the benefit of aripiprazole (Abilify)?
generally well tolerated
105
what is aripiprazole (Abilify) used for?
- major depressive disorder
- bipolar disorder
- schizophrenia
106
what is lithium carbonate (Lithobid) used for?
bipolar disorder (prevent manic episodes)
107
what is the dosing like with carbonate (Lithobid)?
- begin with low doses and increase slowly
- doses will vary with patients
- monitor serum level (lithium toxicity)
108
what are depot antipsychotic preparations?
long-acting injectables used for long term maintenance for schizophrenia
109
what are the side effects of depot antipsychotic preparations?
no long term risks
110
what is the benefit of depot antipsychotic preparations?
IM injection every 4 weeks
| - good for patients who forget to take meds
111
what are the three depot antipsychotic preparations available?
- haloperidol decanoate (haldol decanoate)
- fluphenazine decanoate (prolixin decanoate)
- risperidone microspheres (risperdal consta)
