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Mental Health > Pharm for Bipolar & psychotic disorders > Flashcards

Pharm for Bipolar & psychotic disorders Flashcards

1
Q

Lithium mechanism of action

A

Thought to potentiate serotonergic neurotransmission

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2
Q

Lithiums therapeutic range

A

0.6-1.2mEq/L

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3
Q

What should be monitored with Lithium?

A

Sodium levels…inverse corolation between lithium and sodium levels….it’s given in a salt form.

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4
Q

Lithium Side Effects

A 
Nausea
Loose Stools
Tremor
Polyuria
Weight gain
Cognitive Impairment such as: Apathy, decreased creativity, changes in verbal learning, memory and concentration
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5
Q

What happens in Lithium Toxicity general

A

-Nausea, vomiting, diarrhea
-Sluggishness, ataxia, confusion, tremors, myoclonic jerks
Severe- seizures, nonconvulsive status epilepticus, encephalopathy, death
-ECG changes
Prolonged QTc intervals
Bradycardia

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6
Q

Lithium toxicity symptoms at 1.5-2 mEq/L

A

GI- Nausea, vomiting, diarrhea

Mental confusion, poor coordination, course tremors

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7
Q

Lithium toxicity symptoms at 2-2.5 mEq/L

A

Sluggishness, ataxia, blurred vision, seizures

Severe hypotension  Coma, Death

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8
Q

Lithium toxicity symptoms at > 2.5 mEq/L

A

Coma, Death

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9
Q

Lithium interactions

A 
The following Increase Lithium level:
Thiazide Diuretics
NSAIDS (except aspirin)
ACE Inhibitors
Calcium Channel Blockers
Tetracyclines
The following Decrease Lithium Level:
Potassium-sparing diuretics
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10
Q

Things that increase lithium toxicity

A

Dehydration (Sodium imbalance)

Major Renal or Cardiovascular disease

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11
Q

What should be monitored with Lithium

A

Plasma lithium levels need to be between 0.4-1.0

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12
Q

How long does it take for lithium to start working?

A

7-14 days

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13
Q

Patient teaching

A

Take with food to minimize GI upset

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14
Q

First-generation Antipsychotics (FGAs)

A

-“Conventional Antipsychotics”
-More effective at treating Positive symptoms
-Cause serious movement disorders (EPS)
-less expensive
Less adverse effects

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15
Q

Second-generation Antipsychotics (SGAs)

A
  • “Atypical Antipsychotics”
  • Equal efficacy to FGA’s
  • Fewer adverse effects of EPS
  • More Metabolic effects-weight gain & glucose intollerance
  • More expensive
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16
Q

First-generation Antipsychotics examples

A 
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Thiothixene (Navane)
Molindone (Moban)
Loxapine (Loxitane
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17
Q

How do First-generation Antipsychotics work

A 
Block dopamine (D²)
Also block acetylcholine, histamine and norepinephrine
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18
Q

Extrapyramidal effects: Acute Dystonia

A

Painful severe spasms of tongue, face, neck or back
Usually in first few hours to days
Requires rapid treatment
Benzotropine, Diphenhydramine IV

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19
Q

Extrapyramidal effects: Parkinsonism

A

Bradykinesia
Mask-like face, drooling
Rigidity, shuffling gait, stooped posture
Treat with Antiparkinsonian drugs: Benzotropine

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20
Q

Extrapyramidal effects: Akathisia

A

Uncontrollable need to be in motion
Pacing or squirming
Unable to sit or stand still

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21
Q

Extrapyramidal effects: Tardive Dyskinesia

A

Long-term treatment- Late symptom
Involuntary movements of tongue, face
Lip-smacking, tongue thrusting/flicking
Choreoathetosis- wavelike extremity movements
Treatment: Drug dose reduction, irreversible

22
Q

FGA’s:Adverse Effects Neuroleptic Malegnant Syndrome

A
  • -It’s Rare
  • -Potentially life threatening
  • -Sudden high fever, unstable BP, dysrhythmias, muscle rigidity
  • -Change in level of consciousness
  • -Discontinue Medication, supportive care
23
Q

FGA’s:Adverse Effects Anticholinergic

A
  • -Dry mouth
  • -Blurred vision, photophobia
  • -Urinary hesitancy, constipation
  • -Tachycardia
24
Q

FGA’s:Adverse Effects Cardiovascular

A

FGA’s:Adverse Effects Cardiovascular

25
Q

FGA’s: Adverse Effects Dermatologic

A

Photosensitivity, contact dermatitis

26
Q

FGA’s: Adverse Effects Hematologic

A

Agranulocytosis

27
Q

FGA’s: Adverse Effects Metabolic

A
  • Increased prolactin levels causes Galactorrhea
  • Irregular menses
  • Weight gain
28
Q

FGA’s: Adverse Effects Sexual Dysfunction

A

Decreased libido, inability to achieve orgasm

29
Q

FGA’s: Interactions

A 
Anticholinergics
CNS Depressants
--Alcohol, Opioids, Antihistamines
Dopamine Receptor Agonists- Levodopa
--Counteract therapeutic effects
30
Q

FGA’s Contraindications

A 
Allergy
CNS Depression
Parkinson’s Disease
Liver or kidney disease
Uncontrolled seizures
Dementia in Elderly patients
31
Q

Second Generation Antipsychotics (SGA’s) Mechanism of Action

A

Block serotonin and dopamine receptors

Also block acetylcholine, histamine and norepinephrine

32
Q

Examples of SGA’s

A 
Risperidone (Risperdal)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
33
Q

SGA’s Adverse Effects Metabolic

A

Weight gain
Diabetes
Dyslipidemia

34
Q

Other SGA’s Adverse Effects

A

Orthostatic hypotension
Anticholinergic effects
Dizziness, sedation, sleep disruption
Agranulocytosis (Clozapine)

35
Q

SGA’s Interactions

A 
CNS Depressants (Alcohol)
Myelosuppressive Drugs
36
Q

SGA’s Contraindications

A

Immunosuppressed patients
Dementia
Seizures
Diabetes Mellitus

37
Q

Antiepileptics examples

A

Valproic Acid / Valproate(Depakene, Depakote, Depacon)

38
Q

Antiepileptics Mechanism of Action

A

Causes increased availability of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter(more GABA, more inhibition, less brain activity)

39
Q

Antiepilieptics Side Effects

A

Hepatotoxicity & Pancreatitis

Drowsiness, nausea, vomiting, tremor, weight gain

40
Q

Antiepileptic Contraindications

A

Drug Allergy
Liver Impairment
Urea cycle Disorders

41
Q

Valproic Acid Interactions

A

Many! Highly Protein Bound

42
Q

Valproic Acid Nursing Implications

A

Assess baseline liver function & amylase levels
Teach to watch for signs of Pancreatitis & Hepatotoxicity
–Anorexia, nausea, vomiting, abdominal pain, jaundice
Take medications with food to minimize GI symptoms

43
Q

Carbamazepine (Tegretol) Mechanism of Actin

A
  • Related to Tricyclic Antidepressants
  • Slow sodium influx which reduce neural discharge( slows down the sodium during an action potential, slows down brain activity)
44
Q

Carbamazepine (Tegretol) Therapeutic Levels

A

4-12 mcg/ml

45
Q

Carbamazepine (Tegretol) Side Effects

A

Nystagmus, ataxia, double vision
Nausea, Headache, Dizziness, Drowsiness
Leukopenia, anemia, thrombocytopenia
Birth defects (Pregnancy Category D)

46
Q

Carbamazepine (Tegretol) Contraindications

A

Drug Allergy
Bone Marrow Depression
Myoclonic or Absence Seizures (Worsens)

47
Q

Carbamazepine (Tegretol) Warnings

A

Autoinduction

Occurs in first 2 months of use

48
Q

Carbamazepine (Tegretol):Monitoring & Teaching

A

CBC baseline & throughout treatment
Test baseline vision
Administer with meals to minimize GI effects
No Grapefruit juice
Increases drug levels leading to toxicity

49
Q

Lamotrigine (Lamictal) Mechanism of Action

A

Inhibits release of glutamate (an excitatory amino acid)

Inhibits sodium channels stabilizes neuronal membranes

50
Q

Lamotrigine (Lamictal) Side effects

A

Double/blurred vision, Dizziness, headache
Nausea/vomiting
Stevens-Johnson Syndrome (rare)

Mental Health (5 decks)

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