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semester 4 > pharmacology 2 > Flashcards

pharmacology 2 Flashcards

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1
Q

levels of anxiety

A

mild, moderate, severe and panic

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2
Q

virtually always maladaptive defense mechanisms

A

splitting and displacement

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3
Q

defense mechanisms

A

Conscious and unconscious attempts to manage anxiety

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4
Q

are defense mechanisms healthy?

A

as long as they aren’t maladaptive, yes

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5
Q

Buspirone (Buspar)

A

anxiolytic
the long term antianxiety agent of choice
lower dependency issues, can be used for long term treatment
good for worry, bad for tension
take with food to prevent nausea.
not for panic attacks, takes 2-3 weeks to reach full effect

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6
Q

drugs for short term use in panic episodes

A

Antianxiety agents, such as benzodiazepines
potential for abuse, addiction, and tolerance is high

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7
Q

Hydroxyzine (Atarax, Vistaril)

A

an antihistamine
It is used in the treatment of itchiness, insomnia, anxiety, and nausea

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8
Q

benzodiazepines

A

Alprazolam (Xanax) - for agoraphobia and panic
Clorazepate (Tranxene)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Diazepam (Valium) AND Lorazepam (Ativan) - often used for alcohol withdrawal
Oxazepam (Serax)
Temazepam (Restoril)

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9
Q

paradoxical effect to Benzodiazepines

A

around 10% of people become disinhibited rather than calm and sedated

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10
Q

complications of benzodiazepines

A

CNS depression and decreased cognitive abilities (do not drive or operate machinery until effect is known)
Respiratory depression if mixed with alcohol and other CNS depressants
Anterograde amnesia (do not make important decisions after taking medication) Ambien seems to be the worst
Abrupt discontinuation can lead to seizures, coma and death

– can often over sedate a patient –

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11
Q

benzodiazepines often used for severe alcohol withdrawal

A

Diazepam (Valium) (longer half life) and Lorazepam (Ativan) (shorter half life)

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12
Q

antidote for benzodiazepine overdose

A

Flumazenil IV

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13
Q

Citalopram (Celexa)

A

SSRI

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14
Q

Escitalopram (Lexapro)

A

SSRI

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15
Q

Fluoxetine (Prozac)

A

SSRI
like sertraline (zoloft) can be energizing initially, so that can increase anxiety. it subsides

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16
Q

Fluvoxamine (Luvox)

A

SSRI

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17
Q

Paroxetine (Paxil)

A

SSRI – helpful in GAD, more calming than the other SSRIs

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18
Q

Sertraline (Zoloft)

A

SSRI
like fluoxetine (prozac) can be energizing initially, so that can increase anxiety. it subsides

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19
Q

what is the first line choice for many anxiety disorders after busparone?

A

SSRIs

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20
Q

SSRI administration notes

A

can be energizing initially, usually subsides
4 weeks to be full effect
taper discontinuation
Generally no/low overdose potential – good for clients with a history of SI

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21
Q

SSRI side effects

A

sexual dysfunction, weight gain
Bruxism (use a mouth guard)
can increase liver/kidney issues
GI bleeding history (affects blood coagulation)
Hyponatremia risk when combined with diuretics

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22
Q

SSRI black box warning

A

rare but not reversible
Increased suicidal risk when energy improves but still suicidal - now “happy to act on their plan”
Slight increase suicides in clients 24 years old and younger compared to other age groups but the difference is not statistically significant

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23
Q

Serotonin Syndrome signs and symptoms

Study These Flashcards
A

Onset in 2-72 hours
Delirium, sudden onset of confusion, agitation
myoclonus – muscle spasms, rigidity
gI pain and diarrhea
hypertension, tachycardia, fever (with diaphoresis)
seizures, apnea, death

24
Q

increased risk for serotonin syndrome

Study These Flashcards
A

St. John’s Wort
MAOIs or TCAs
Lithium
Opioids
Copious caffeine (coffee, black tea, soft drinks with caffeine), caffeine also increases anxiety and should be avoided
Migraine medication
ECT

25
how to treat serotonin syndrome
Hold medications and notify PCP Treat symptoms: i.e., propranolol, anticonvulsants, induce paralysis Cooling blankets
26
Duloxetine (Cymbalta)
SNRI
27
Venlafaxine (Effexor)
SNRI – mixed anxiety and depression, nerve pain
28
possible meds if the client has a bipolar disorder with anxiety
Gabapentin (Neurontin), Anticonvulsants Pregabalin (Lyrica), Anticonvulsants
29
Clonidine (Catapres)
Alpha2 Agonist – panic attacks
30
Propranolol (Inderal)
Beta-blocker – social and performance anxiety
31
Prazosin (Minipress)
Alpha1 Agonist - used for nightmares in PTSD
32
Anticholinergic side effects
Extrapyramidal Side Effects: pseudoparkinsonism (examples: drooling, mask facies, shuffling, tremor …), acute dystonic reaction, akathisia, tardive dyskinesia cardiac (alpha blocks) – check orthostatic BP and pulse, may need ECG to check for Q-T interval agranulocytosis (report flu like symptoms) Neuroleptic Malignant Syndrome – rare but dangerous Metabolic Syndrome Hyperprolactinemia– even in males, can cause amenorrhea in females, lactation in all Cholestatic jaundice – rare, reversible
33
Anticholinergic side effects
Extrapyramidal Side Effects: pseudoparkinsonism (examples: drooling, mask facies, shuffling, tremor …), acute dystonic reaction, akathisia, tardive dyskinesia cardiac (alpha blocks) – check orthostatic BP and pulse, may need ECG to check for Q-T interval agranulocytosis Neuroleptic Malignant Syndrome – rare but dangerous Metabolic Syndrome Hyperprolactinemia– even in males, can cause amenorrhea in females, lactation in all Cholestatic jaundice – rare, reversible
34
anticholinergic adverse drug reactions
anticholinergic toxicity acute dystonic reaction (CONGENTIN STAT) agranulocytosis (report flu like symptoms) neuroleptic malignant syndrome cholestatic jaundice
35
what to do about dry mouth
hard sour candy (xylitol better than sugar), glycerin swaps, ice chips and water sips
36
what to do about mydriasis (dilated pupils)
Photosensitivity – limit sunlight, sunscreen, sunglasses, sun hat Blurred vision: magnifiers, may improve in 2 weeks
37
what to do about dry eyes
artificial tears
38
what to do about sexual dysfunction
artificial lubricants
39
what to do about constipation
fiber, water, exercise, monitor b.m. frequency and bowel sounds
40
what to do about urinary retention
bladder scan
41
Anticholinergic Toxicity s/s
dry, hot and red *emergency* Unstable VS No peristalsis or micturition Repetitive motor movements Seizures Delirium (increased psychosis)
42
treatment for anticholinergic toxicity
cooling, catheterize, sedation (benzodiazepines), physostigmine
43
Acute Dystonic Reaction
Opisthotonos – ‘titanic’ tetany body arching Oculogyric crisis – eyes roll upwards, backwards, and lock Laryngeal dystonia – may not be able to breath
44
acute dystonic reaction treatment
benztropine (Cogentin) IM to relax muscles and prevent muscle damage, maintain airway if needed
45
Agranulocytosis
less than 100 neutrophils (you're supposed to have 1500+) Flu like symptoms: sore throat, fever, malaise – report right away, may see these before abnormal lab test results Highest risk for clozapine
46
Neuroleptic Malignant Syndrome
can be sudden onset, but not always **high fever – “CARDINAL” symptom** diaphoresis, altered mental status **muscle rigidity** **Increased CPK** levels from muscle breakdown can die if not treated
47
neuroleptic malignant syndrome possible treatment
may include Bromocriptine for muscle rigidity and fever, dantrolene for muscle spasms
48
antipsychotic black box warning
older adults, especially those with dementia have an increased risk of death (usually related to heart failure and pneumonia)
49
typical (first generation) antipsychotics
Chlorpromazine (CPZ, Thorazine) Fluphenazine (Prolixin) Haloperidol (Haldol) – common IM against clients will for psych emergencies Loxipine (Loxitane) - lox is an old person breakfast Mesoridazine (Serentil) Molindone (Moban) Perphenazine (Trilafon) Pimozide (Orap) Thioridazine (Mellaril) Thiothixene (Navane) Trifluoperazine (Stelazine) (z/x/ i/e ne and haldol for some reason)
50
atypical (second generation) antipsychotics
Aripiprazole (Abilify) Asenapine (Saphris) Clozapine (Clozaril) Lurasidone (Latuda)* Olanzapine (Zyprexa)* Olanzapine + Samidorphan (Lybalvi) (Samidorphan is an opioid antagonist)* Paliperidone Palmate (Invega Sustena) Quetiapine (Seroquel)* Risperidone (Risperdal)* Ziprasidone (Geodon) 2016: Cariprazine (Vraylar)* - capri sun for kids (zoles, dones, and pines) *Also used to help decrease mania/hypomania in clients with a Bipolar Disorder
51
Asenapine (Saphris)
second generation anti psych - sublingual, the patient should not eat or drink for 10 minutes before and after
52
Long-Acting Injections
PERSERIS® (per-SAIR-iss) (risperidone) Inject a ‘gel pillow’ SQ, biodegrades, lasts one month - okay if there's still a bump by next dose
53
Typical/FGA quick review
Primarily treat: Positive symptoms **Have a higher risk**, compared to SGAs, for: EPSE Can make Negative symptoms worse
54
Atypical/SGA quick review
Primarily treat: Negative symptoms Have a higher risk, compared to FGAs, for: Metabolic Syndrome
55
side effects of antipsychotics
sedation, extrapyramidal side effects (pseudoparkinism, dystonic reactions), opisthotonos (arched back torso), oculogyric crisis (eyes roll upwards, backwards, and lock), laryngeal dystonia (may not be able to breathe), akathisia, hypotension, prolonged Q-T interval, being dry,
56
adverse reactions of antipsychotics
acute dystonic reactions ((STAT benztropine (Cogentin) IM, diphenhydramine (Benadryl) can help as well), cardiac arrest,
57
zoloft can give you zoomies
suzanne said to remember it can make you hyper in the first few weeks

semester 4 (11 decks)

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