Mental Health Pharm Exam 2 Flashcards
(124 cards)
1
Q
Instead of saying “committed suicide” one should say
A
Killed themselves, took their own life died as a result of blah blah
2
Q
Depression is characterized by
A
sad or despondent mood out of proportion to actual life events
3
Q
Depression increases risk of
A
suicide
4
Q
Bigogenic Amine Theory
A
Deficiency of biogenic amines in key areas of the brain
Depression is associated with abnormally low levels of norepinephrine, serotonin, and dopamine
pretty solid theory since the meds work
5
Q
suicide is the ____ leading cause of death in the US as of 2020
A
11th
6
Q
All antidepressants come with a black box warning stating … and why
A
increased in suicide ideations or behavior.
Gives them more energy to do it
7
Q
The nurse should educate a patient when starting antidepressants about what in the first few weeks?
A
May give them only a weeks worth of medications educate that this is a side effect
8
Q
Standard reason meds are primary standard treatment of depression
A
enhance, elevate, or stabilize moods
9
Q
What are the 4 antidepressant groups for depression
A
Selective serotonin reuptake inhibitors (SSRIs)
Atypical antidepressants
Tricyclic antidepressants (TCA)
Monoamine oxidate inhibitors (MAOIs)
10
Q
when starting antidepressants the nurse should educate
A
1 it takes several weeks to work
2 therapy usually begins at SSRI with a low dose
3 If little to no improvement in 4 weeks second med is added
4 If you want to get off a minimum of 6 months after depression have resolved to prevent withdrawl and rebound depression
11
Q
Selective serotonin reuptake inhibitors med to memorize
A
fluoxetine (prozac)
12
Q
How does SSRI work
A
stops serotonin from being destroyed with increases it in the brain
13
Q
Adverse effects of SSRI
A
- N/V in the beginning but usually get over it
Dry mouth and diarrhea - CNS stimulation: headache, dizzy, insomnia (really BAD)
- Sexual dysfunction (70%) decrease libito and inability to orgasm
- weight gain >20 lbs
Bruxism (TEETH GRINDING ugggggghhhhhhhh)
-increase in suicide and seritonin syndrom
-withdraw syndrome
14
Q
Therapeutic Use for SSRI
A
OCD, bulimia, ptsd, bipolar, social phobias, panic disorders
15
Q
Contraindications to SSRI
A
MAOI or TCA and hypersensitivity
16
Q
Food and Drug interactions with SSRI
A
MAOI and TCA risk of serotonin syndrome
Elevate lithium
nyquil
St. Johns wart (serotonin syndrome)
Grapefruit juice
17
Q
SSRI makes you sleepy when should you take it?
A
at night… duh
18
Q
Serotonin syndrome (SES)
A
Too much serotonin in body
19
Q
When does SES usually happen
A
2-72 hours after starting treatment
20
Q
Symptoms of Serotonin syndrome
A
confusion, ams, agitation, halluciantions, seizures, tachycardia, sweating, ataxia, tremors, fever, hyperreflexia, coma, death
21
Q
treatment for SES
A
stop taking the fucking meds
22
Q
ATYPICAL ANTIDEPRESSANTS:
SNRI- Serotonin Norepinephrine reuptake inhibitors do what
A
Blocks seritonin and norepinephrine from being taken away and keeps it in the brain
23
Q
Venlafaxine is started at what dose
A
a very low dose (not even therapeutic)
24
Q
Adverse effects
A
N/V obviously
CNS stimulation: like amphetamines’
Tachycardia
Sexual disfunction
Recital vaginal or uterine hemorrhage
Suicide and serotonin syndrome
Mild to moderate withdrawl dyndrome so taper over 2-4 weeks
25
Depressed and ADHD can you take SNRI?
26
what is withdrawal syndrome
Headache, nausea, visual disturbances, anxiety, dizziness, tremors
27
Drug/Food interactions for atypical antidepressant: venlafaxine
SSRI, MAOIs, TCA (serotonin syndrome)
CNS depressant/ alcohol
28
Atypical antidepressants: bupropion (Wellbutrin)
Primarily a dopamine reuptake inhibitor
??may also block reuptake of norepi they think
29
Bupropion aka Welbutrin benefits
Supressess appetite
Does not cause weight gain (don't give to eating disorders)
increases sexual desire and pleasure
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Bupropion aka Welbutrin use
depression
SAD
Smoking cessation
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bupropion aka welbutrin
Agitation, insomnia, tremor, seizure, psychosis, tachycaardia, N/V weight loss
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Welbutrin or bupropion Contraindications
allergy, seizure or hx of anorexia
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Drug interactions with welbutrin
MAOI
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Tricyclic Antidepressant is a ___ line medication
second line medicaations for when 1st line and atypical medications are not working
35
Therapeutic indications for TCA
Depressive stage of bipolar, depression, insomnia, ADHD, Neuropathic pain and fibromialgia, panic, OCD, Nocturnal Enuresis (bed wetting)
36
Tricyclic antidepressants MOA
Reduce neuronal reuptake of serotonin of norepi and keep it in the brain
37
Prototype of TCA
Imipramine
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Adverse effects of TCA
Anticholinergic effect (Dry mouth, constipation, anorexia, decreased salivation, urinary retention, blurred vision)
Yawngasm hahahhahahhahahhaha
loss of libido, high risk of overdose withdrawl syndrome
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Contraindications
Seizure, kids <12, allergies
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Food and drug interactions with TCA
St. Johns wort Serotonin syndrome
CNS depressants alcohol ( sedation
MAOI (hypertensive crisss)
Cimetidine, fluoxetine, and ranitidine (increase in TCA levels)
41
Monoamine oxidase inhibitor (MAOIs) MOA
MOA(a) and MOA(b)
1 inactctivates norepi and seritonin
2 dopamine
Irreversibly inhibits the actions of monoamine oxidase a and b (enzymes that inactivate monoamines)
42
MAOI is given
atypical depresssion, depression associated bipolar disoreder migraine if other meds didnt work
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MAOI prototype
Phenelzine (FIDDLEZINE)
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Contraindications for MAOI
schezophrenia, CV disease, hepatic or renal impairment
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Monoamine oxidase inhibitor adverse effect
Hypertensive crisis (from eating tyramine breakdown)
liver toxicity
incontinence and urinary retention
46
tyramine is
regulates blood pressure
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What food contains tyramine
have a lot: aged cheese, red wine, smoked or pickled meats sausage and soy sauce
have a little: meat extracts (bouillon), light beer avocados
Basically dairy, alcohol, lunch meat, avacados and soy sauce
48
Nursing education with MAOIs
list of food to not drink (tyramine
St. John's wort (serotonin syndrome)
Need to check with prescriber before taking any other medications
49
Treatment for hypertensive crisis
Phentolamine or SL nifedipine
50
4 primary medications for anxiety
benzos ("short term")
nonbenzodiazepines
barbiturate's (watch for respiratory depression)
antidepressants
51
Prototype of bezo for anxiety
lorazepam
alprazolam
52
Benzodiazepines MOA
Intensifies the effect of GABA (GABA is the primary inhibitory neurotransmitter)
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Antidote for Benzo
flumazenil
54
Pharmacologic effects of Benzodiazepines
CNS (reduce anxiety and promote slep
Weak resp depression
Death from od unlikely
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Benzo classification
antianxiety, sedative, hypnotic, antiseizure drug
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adverse effects of benzos
anterior grade amnesia (trouble recalling events while on it)
paradoxical CNS excitation
CNS DEPRESSION (sleep driving apparently)
IV give slow so not cardiac arrest,
tolerance and withdrawal syndrome
57
Non Benzodiazepine anxiolytics
Valporic acid: treats anxiety in bipolar
beta blockers and clonidine: dont cure anxiety
antihistamines: drowsiness and may calm people down
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Non benzo anxiety medication prototype
BUSPIRONE or BUSPAR do not confuse with bupropion (the depression one)
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Buspirone
not CNS depressant
no abuse potential
no increased effects of central nervous systemp depressants
Anxiolytic defelop slow
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Buspirone MOA
they dont know
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Adverse effects of buspirone (non benzo anxiolytics
not back heaache
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drug and food interactions with buspirone
- erythromycin and ketoconazole
- grapefruit juice
- no withdrawl from it
63
Insomnia
a sleep disorder defined by the inability to fall asleep, frequent awakenings, or difficulty staying asleep
64
Insomnia CAM treatment options
melatonin MAY improve sleep
Valerian and kava root have shown efficacy in promoting relaxation
65
Hypnotic vs sedation
hypnotic: used to help people fall asleep by causing sedation vs sedation which is the loss of awareness and reaction to environmental stimuli
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Benzos for sleep disorders
Relieve insomnia decrease repeated awakenings through the night
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Benzo prototype
Temazepam
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Benzo doses for anxiety vs sleep
higher for insomnia so they can sleep. Use 30 minutes before bed and ensure 8 hours of sleepso they arent groggy
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nursing interventions for Benzos for sleep disorders
- Monitor people while they sleep incase they get up ---> fall risk
- Paradoxical reaction (CNS excitation common in old and young populations)
- tolerance
- make sure they know no to use alcohol or other CNS depressants
70
Non benzodiazepine: zolpidem
sedative-hypnotic
non benzo, anxiolytic with miscellaneous CNS depressant
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Therapeutic uses for for nonbenzodiazepine: zolpidem
short term for insomnia (7-10 days)
just prior to sleep because of rapid onset
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MOA of zolpidem
enhances the action of GABA
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Route of Zolpidem
PO and oral spray
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Adverse effects of zolpidem
- females cannot have the max dose because of he hangover groggy feeling the next day
- Amnesia daytime drowsiness, old = confusion, sleep activities
- can be used and lead to dependency
75
Contratindications of zolpidem (non benzo for insomnia
hypersensitivity
76
Drug interactions with zolpidem (non benzo for insomnia)
take on an empty stomach
ssri = worseningdepression
alcohol and cns depresions
77
Bipolar disorder
involves extremes of depresion alternating wth hyperactivity and excitement
3.7% people in the US have it
78
Non pharmacologic for bipolar
Education of patient and family
psychotherapy - individual group and family
Electroconvulsive therapy: very effective at treating acute mania and depressive episodes
79
conversion side effect
Memory loss
80
Pharmacologic drugs for bipolar disorders
Mood stabilizers
antipsychotics
antidepressants: used in depression phase
81
Mood stabilizers for bipolar work by
moderate extreme shifts in emotion and relieve symptoms of mania and depression during acute episodes
and prevent recurrence of manic and depressive episodes
82
medications used as mood stabilizers
: lithium, valproic acid/divalproex, carbamazepine and lamotrigine
83
Lithium as mood stabilizer in bipolar
need to take several times a day, need to have lab draws for thyroid (hypothyroidism) and lithium levels and takes a couple weeks to start working.
Sodium transport in muscles and inhibits release of norepi and dopamine but otherwise doctors don t know how it works
84
Serum manic and maintenance level lithium level
Initial therapeutic level if having mania 1-1.5
maintenance level 0.6 - 1.2 mEq/L
85
Dont reduce sodium in lithium t/f
true
86
Lithium adverse effects
gi early on
goiter an dhypothyroidisms
most are associated are directly related to serum levels of drug
87
drug food interaction
NSAID increase lithium up to 60%
diuretics
caffine
88
nursing monitoring with lithium
Lithium toxicity
hydration
kidney function
hypothyroidsim
increasing tremor (they getting toxic)
89
Schizophrenia
Most common psychotic disorder with peak incidence in men 15-24 and women 25-34 years
Characterized by abnormal though and thought process disordered communication, withdrawal from people and outside enviroment inability to preform adls, and high risk for suicide
90
schizophrenias primary goal
function as independently as possible and accomplish ADLs with minimum assistance
91
Initial treatment for schizophrenia
- High initial dose for aggressive treatments
- Usually given po but some can be IV )depo - long acting injections with meds)
- Acute symptoms usually resolve in 3-7 days and they can be switched to maintenance therapy
92
Maintenance treatment
cate up to 6-8 weeks for improvement
most commonly require lifelong treatment
abrupt cessation can cause withdrawal
93
Promoting medication adherence for schizophrenia
promoting compliance and that meds are taken
encourage family members to oversee meds
therapeutic relationship
Assure patients that antipsychotic drug use does not lead to addiction
94
Antipsychotic Drugs
All have a blackbox warning should not be used to treat dementia in older adults because it increases death ... but they fucking do like seroquel to sleep
They are used for a diverse spectrum schizophrenia, turrets etc
95
2 major groups of antipsychotic drugs
1 gen (typicals) started in 1950s block receptors for dopamine in CNS. Cause serious movement disorders (extrapyramidal symptoms)
96
1 gen (typicals)
started in 1950s block receptors for dopamine in CNS. Cause serious movement disorders (extrapyramidal symptoms) work by blocking dopamine
97
2nd gen atypical antipsychotics (SGA)
work by blocking serotonin
98
What are EPS extrapyramidal symptoms
Movement disorders
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Posative symptoms in schizophrenia
heightened reality: hallucinations
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negative symptoms in schizophrenia
losing normal function: lack of motivation, inability to care for self, poverty of speech (not speaking)
101
1st generation typical antipsychotics MOA
dopamine blocker
102
Adverse effects of 1st gen
EPS
Neuroleptic malignant syndrome
103
Types of EPS 4 and treatment
Acute dystonia - painful spasms of neck and body
* anticholinergic (Benadryl and benztropine)
parkinsonism- movement issues that mimic Parkinson's
* anticholinergic and amantadine (Parkinson's treatment)
Akathisia (ants in pants)- inability to relax could be rocking, crossing and uncrossing arms. It is the most common
* Benzos and beta blockers
Tardive dyskinesia - involuntary twisting, writhing movements of tongue and they have no idea
* no treatment available other than decreasing or discontinuing but it is sometimes permanent
104
neuroleptic malignant syndrome
HIgh fever, rigidity, autonomic instability, confusion, (autonomic instability like dysrhythmias and fluctuations in BP) confusion seizures and coma.
Its likey hypermalignant syndrome but from the brain
105
prior to starting 1st gen
they should have a baseline ECG
106
1st generation med prototype
chlorpromazine
107
Chlorpromazine
blocks postsynaptic dopamine receptors
108
1st gen chlorpromazine drug interactions
CNS depressants/ alcohol
anticholinergic
109
Atypical 2nd generation antipsychotics therapeutic effect
negative symptoms associated with schizophrenia
acute mania with bipolar
irritability in pediatric autism pts
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Prototype of 2nd gen antipsychotics atypical
risperidone
111
narcolepsy and ADHD
Narcolepsy daytime sleepiness and sudden periods of loss of wakefullness with sleep attacks where they fall asleep at inappropriate times
ADD - various conditions charaterized by an inability to concentrate on one activity for longer than a few minutes and a state of hyperkinesis
112
3 types of CNS stimulant drugs used
1 amphetamines
2. methylphenidate
3.
113
amphetamines MOA
release Norepi and dopaamine in brain and peripheral nervous system
improves mood
increases focus and attention
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amphetamine prototype
Adderall
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nursing evaluation for children that are on amphetamine
make sure they are eating before meals and grazing and monitoring their height, encourage drug holidays to promote growth. Fun fact Vitamin c decreases effects
116
Methylphenidate
same as ampetamines works faster then amphetamines' but amphetamines work longer
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Non amphetamines for narcolepsy and ADHD therapeutic effects/use
promotes wakefulness in narcolepsy, shift-work sleepiness, and obstructive sleep apnea
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MOA of non amphetamines
no idea maybe related to the drug blocking reuptate of norepi
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prototype for non amphetamines
modafinil (daffodil)
120
Drug interactions for modafinil
Oral contraceptives
121
Cyclobenzaprine what is it? side effects? And how to discontinue
- Used for muscle spasms
Anticholinergic medication
Side effects: Dry mouth, Urinary retention
- taper off medication to prevent abstinence syndrome or rebound insomnia
122
What’s the best finding for a pain medications effectiveness
Their description on the pain is the most accurate assessment of pain
123
After administering Cefazolin, a patient is experiencing anxiety hypotension and dyspnea. What is happening and what do you do?
Epi for the anaphylaxis is first line
Benadryl is the second line medication
Albuterol and prednisone are next
124
Oxybutynin is used for what and what are adverse effects?
Anticholinergic that inhibits parasympathetic used for overactive bladder
- Side effects dry mouth
- Dry eyes (eye pain, halos) pupil dilation
- Blurred vision (increased intraoccular pressure)
- Prolongation of QT interval palpitation, hypertension, and tachycardia
