Psych Meds

Question 1

Examples of Typical/Conventional Antipsychotic Drugs

Answer 1

haloperidol (Haldol)

• one of the most common, very cheap, causes more EPSEs than others, if pt is non-compliant give deconoate haloperidol IM every 4 weeks

chlorpromazine (Thorazine)

• usually give when pt starts acting out for 1 - 3 doses, not typically a long term med

fluphenazine (Prolixin)

• good for noncompliant (deconoate-IM every 7 to 28 days)

perphenazine (Trilafon)

Question 2

Side Effects of Antipsychotic drugs

Answer 2

Anticholinergic Side effects (everything dries out)

• dry mouth, blurred vision, dry eyes, constipation, urinary retention, nasal congestion

Other side effects

1. Increased blood prolactin level (gynecomastia, galactorrhea, amenorrhea)
2. Alteration in sexual functioning-decreased libido
3. Weight gain
4. Sedation
5. GI, nausea, heart burn, diarrhea
6. Reduction of seizure threshold
7. Orthostatic hypotension
8. Photosensitivity
9. Agranulocytosis (lowered WBC - observe for signs of infection)
10. Cardiac - baseline ECG/potassium level prior to TX

Question 3

Atypical Antipsychotic Drugs

Answer 3

Dopamine and serotonin antagonist

• improve + & - symptoms of schizophrenia
• rarely cause EPS or tardive dyskinesia effects (except when giving high doses such as when 1st admitted)
• disadvantage: cost

Question 4

Examples of Atypical Antipsychotics

Answer 4

1. respiradone (Resperdal)
2. olanzapine (Zyprexa, Zydis)
3. quetiapine (Seroquel)
4. ziprasidone (Geodon)
5. paliperidone (Invega)
6. clozapine (Clozaril)
7. lurasidone (Latuda)
8. aripiprazole (Abilify)

DON’T give atypical med to elderly clients w/ dementia and psychosis b/c it increases the risk of ACVA (stroke)-black boxed now

Question 5

risperidone (Risperdal)

Answer 5

• atypical
• few anticholinergic side effects
• elevated prolactin level
• EPSEs at higher dose
• Increased appetite
• Least sedating
• often 1st line of TX
• Resperidone Consta-long acting IM - every 2 weeks
• DON’T give atypical med to elderly clients w/ dementia and psychosis b/c it increases the risk of ACVA (stroke)-black boxed now

Question 6

olanzapine (Zyprexa, Zydis)

Answer 6

• atypical
• most anticholinergic effects
• sedation
• hyperglycemia or diabetes
• Weight gain therefore more prone to DM and HTN
  
  • 70/80% will go back to normal BG
  • baseline fasting BG prior to 1st admin,
  • if already diabetic, don’t want to give
• proven effective in treating mania
• olanzapine pamoate - IM every 2 to 4 weeks depending on dosage

Question 7

quetiapine (Seroquel)

Answer 7

• atypical
• monitor AST/ALT and LDH (liver function)
  
  • can cause liver impairment
  • don’t give if already impaired
• low risk of EPS
• moderate risk diabetes and weight gain
• often ordered for elderly but shouldn’t be
• if pt overdoses, causes heart block which leads to dec BP, potassium which leads to cardiac arrest

Question 8

ziprasidone (Geodon)

Answer 8

• atypical
• few EPS and anticholinergic side effects
• should not be given to patients with current or past cardiac history
  
  • lengthens QT interval (risk for torsades de point…ventricular tachycardia)
• less weight gain

Question 9

paliperidone (Invega)

Answer 9

• atypical
• chemically similar to risperidone (Risperdal)
• Administered in ext. release tabs - take once daily
• adverse SE - EPS, QT prolongation, orthostatic hypotension, syncope, hyperprolactinema, hyperglycemia
• paliperidone (Invega Sustenna) IM - every 4 weeks

Question 10

clozapine (Clozaril)

Answer 10

• first atypical - used to be 1st choice but found clients developed agranulocytosis - have to run a CBC every week - now a 2nd line choice
• if WBC dropping, check for infection
• Weight Gain!!!
• Myocarditis - low risk

Question 11

lurasidone (Latuda)

Answer 11

• atypical
• treatment of schizophrenia.
• Recently approved for depressive tendencies of bipolar

Question 12

arirpiprazole (Abilify)

Answer 12

• atypical
• most common SE: HA, insomnia, anxiety, nausea, vomiting, constipation, akathisia
• EPSEs rarely occur
• no increase in prolactin levels
• risk for hyperglycemia
• Weight gain - inc DM risk
• Avoid alcohol
• Monitor suicidal ideation (coming down off mania, sometimes come too far)
• Monitor for cardiovascular disease

Question 13

4 major classes of Antidepressants

Answer 13

1. SSRIs (Selective Serotonin Reuptake Inhibitors)
2. Trycyclics
3. Atypcial antidepressants or Novel Antidepressants including SNRIs (Serotonin Norepinepherine Reuptake Inhibitors)
4. MAOIs (Monoamine Oxidase Inhibitors)

Question 14

SSRIs

Answer 14

• Selective Serotoning Reuptake Inhibitors
  
  • Drug of choice in treatment of depression
  • block the reuptake of serotonin…make it more available at the synaps
  • safe, overdose can usually be reversed
  • anticholinergic effects less common
  • less sedation
  • cardiotoxicitiy not observed
• Major side effects
  
  • sexual dysfunction (buspirone, bupropion, sildenafil are good at managing this SE)
  • GI symptoms (n/v/d): usually subside in a couple weeks
  • HA, anxiety, akathisia, insomnia, weight gain

Question 15

Serotonin Syndrome

Answer 15

• Potentially fatal, symptoms suggestive of NMS
  
  • most frequent symtpoms - mental status change, restlessness, or agitation
• MAOI’s and SSRI’s should NOT be given together
• Period of 14 days ( 2 - 4 weeks) required between stopping MAOIs and starting SSRI

Question 16

Examples of SSRIs

Answer 16

• fluoxetine (Prozac)
  
  • good for kids, longest half life -> less withdrawal symptoms if discont.
  • problem…pt’s more prone to suicide
  • pt’s with panic disorders or PTSD also benefit from prozac
• sertraline (Zoloft)
  
  • very common-
  • most diarrhea, sometimes stabalizes
  • also sexual dysfunction is a biggie
• paroxetine (Paxil)
  
  • most anticholinergic-causes significant sedation
  • effective in TX of panic disorders
• citalopram (Celexa)
• escitalopram (Lexapro)

Question 17

Trycyclic antidepressants

Answer 17

• inhibit the reputake of both norephinephrine and serotoning
• Side effects
  
  • most common: orthostatic hypotension
  • can cause tachycardia and disarrythmias that can lead to an MI
  • lowers seizure threshhold
  • lethal in overdose…weekly suicidal assessments
  • need to avoid OTC drug
  • immediately report eye pain.
  • Most serios adverse effect occurs wehn TCAs accumulate in cardiace tissue. Contraindicated in recovery phase of an MI, heat block, or history of arrhythmias
  • anticholinergic
  • insomnia, agitation, sexual dysfunction, weight gain, tremors, delirium or mania, and sedation

Question 18

Examples of Tricyclics

Answer 18

amitriptyline (Elavil)

• most cardiotoxic, sedating, and highly anticholinergic
• not a 1st line choice in older client

imipramine (Tofranil)

• used mostly in panic disorders

Question 19

Atypical Antidepressants of Novel Antidepressants

&

Examples of

Answer 19

• First line agents
• contraindicated in patients with seizuer disorders - lowers the seizure threshold
• Examples:
  
  • bupropion (Wellbutrin, Zyban) - excellent for depression and sexual SE
    
    • Zyban used to stop smoking
    • lowers seizure threshhold, 4 - 5 times more likely than any other antidepressent to cause a seizure (contraindicated in pts with a seizure disorder
    • Will cause weight loss
    • often given as part of a combination
    • selective dopamine inhibitior
    • effect replacment of or addition to SSRIs for sex-related problems
  • trazadone
    
    • almost no anticholinergic effects or cardiac effects
    • often used for sleep b/c caueses lots of sedation
  • SNRIs (serotonin norepinepherine reuptake inhibitor
    
    • devenlafaxine (Pristiq)
      
      • used to treat MDD
      • should not be taken together with venlafaxine or if allergic to venlafaxine
    • venlafaxine (Effexor)
      
      • monitor BP and electrolytes -cause hyponatremia
        
        • do a baseline BP-if already HTN, go to a different drug
      • few anticholinergic side effects
    • duloxetine (Cymbalta)
      
      • should not give to hepatic insuff. or end stage renal disease

Question 20

MAOIs

(Monoamine Oxidase Inhibitors)

Answer 20

• block monoamine oxidase, a major enzyme that inactivates norepinephrine, serotonin, and dopamine. Thus increasing the availability of those neurotransmitters
• rarely given
• we need monoamine oxidase to prevent our BP from going up, this drug blocks it thus causing hypertensive crisis when foods high in tyramine are consumed
  
  • sudden elevation in BP (explosive occipital HA) in response to high levels of tyramine
• must read labels before consuming OTC meds and food
• Side effects
  
  • CNS: agitation, acute anxiety attacks, restlessness insomni, and euphoria
  • Hypotension
  • anticholinergic side effects
  • hepatic and hematological dysfunction rare, but possible
  • blood count and liver function tests done before therapy begins
  • Hypertensive Crisis:
    
    • Warning Signs…Inc BP, palpitations, HA
    • Symptoms: Sudden elevation of BP, explosive occipital HA, head and face flushed, palpitations, chest pain, sweating, fever, n/v, dilated pupils, photophobia

Question 21

MAOIs…things to avoid

Answer 21

• Tyramine rich foods
• OTC meds
• TCA
• Narcotics
• Antihypertensives
• Sedatives
• General anesthesia
• Stimulants
• MAOIs contraindicated with hx of stroke or CV disease

Question 22

Examples of MAOIs

Answer 22

1. phenelzine (Nardil) - most effective MAOI and most sedative. Used for treatment of atypical depression
   * contraindicated in CVD, heart failure, CVA, hepatic and renal dysfunction, and paranoid schizophrenia
2. tranylcypromine (Parnate)

Question 23

Lithium

Answer 23

• mood stabilizer
• during an acute manic epidsode, may pair with antispsychotic
• excreted by kidneys t/f check creatinine, GFR, BUN, Na/K
• monitor thyroid
• don’t start if pregnant
• assess levelst to ensure not entering toxicity
• maintenance therapeutic level: 0.6 - 1.2 mEq/L
• Blood levels over 1.5 mEq/L considered toxic

Question 24

Lithium Toxicity

Answer 24

• Toxicity symptoms: d/v, drowsiness, muscular weakness, polyuria, lack of coordination, slurred speech, coma, death
• Side Effects: dry mouth, nausea, thirst. Drowsiness, dizziness, mild hand tremor, polyuria, dehydration, weight gain, hypotension & arrhythmias
• Contraindicated: CV disease, pregnancy, renal disease

Question 25

Examples of Antimanic Drugs (Anticonvulsants)

Answer 25

1. divalproex (Depakote)/ valproic acid (Depakene) 2. lamotrigine (Lamictal) 3. carbamazapine (Tegretol) 4. gabapentin (Neurontin) 5. oxcarbazepine (Trileptal) **_Risk of suicide with all antiepileptic drugs_** May also used in combination with lithium

Question 26

divalproex (Depakote) / valproic acid (Depakene)

Answer 26

* effective in treating both manic and depressed phases of bipolar and schizoaffective * Side effects: GI (n/v/d, anorexia), tremor, sedation, dizziness, weight gain, thrombycytopenia, hepatotoxicity * **_Prior to administering_**: CBC, liver function studies, amylase, pregnancy test, Valproic acid levels * lethal in overdose * thrombocytopenia-increase bruising, anemia, petichiae, bleeding * can cause dose related thrombocytopenia --\> monitor PLT

Question 27

lamotrigine (Lamictal)

Answer 27

* stabilizes manic/mixed epidsodes and depression * not recommended if pregnant * **_Stevens-Johnson_** syndrome

Question 28

carbamazapine (Tegretol)

Answer 28

* good for rapid cycling bipolar episodes * serious side effects: agranulocytosis, aplastic anemia * weekly CBC (monitor WBC and platelet) * lethal in overdose * increased in popularity b/c of increased PTSD

Question 29

ADHD medications (Stimulants)

Answer 29

* Stimulants: * Examples * methylphenidate (Ritalin, Ritalin SR & ER, Concerta) * amphetamine/dextroamphetamine (Adderall, Adderall XR) * lisdexamfetamine (Vyvanse) * if taken after 4 pm may cause insomnia and restlessness * decrease appetitie * Side Effects: * insomnia and restlessness * weightloss (admin. before or after meals, monitor weight) * Cardiac: dysrhythmias, chest pain, HTN (do cardiac assessment) * HA, nervousness, irritability, dizziness, nausea, abd. pain, blurred vision, tremor, seizures, mania * do periodic growth measurements and cardiac assessments

Question 30

ADHD Medications (Nonstimulants)

Answer 30

* atomoxetine (Strattera) * takes 6-8 weeks until effedtive * Side effects: weight loss, appetite and growth supression, n/v, **_suicidal ideation, hepatotoxicity_** * guanfacine (Intuniv) * most common side effects: fatigue, trouble sleeping, **_low BP_**, nausea

Question 31

Antianxiety Agents (Benzodiazepines)

Answer 31

* used to treat anxiety and insomnie * rapid onset (1 week or less) * Benzos: * major class of antianxiety drugs * most widely prescribed drugs * Action: produces calming effect by potentiating the effects of GABA (the valium of our body) * Disadvantages: congnitive impairment, dec coordination, **_potential drug abuse_**, withdrawal symptoms * potential for physical/psychological dependence * must be tapered off (2 - 6 weeks) * potentiates the effects of alchohol

Question 32

Benzos (Side effects and withdrawal symptoms)

Answer 32

* Side effects: * CNS: drowsiness, fatigue, dec coordination, mentail impairment and slowing of reflexes * less frequent: confusion, depression, HA * PNS: occasional constipation, double vision, hypotension, incontinence, urinary retention * Teach client: not for minor stressors of life * Monitor OTC drugs, can potentiate effects of benzos * Withdrawal * begins the 1st week after the drug is discontinued * taper off gradually over 2 - 6 weeks * Side Effects: agitation, irritability, nausea, vomiting, nervousness, sweating, muscular cramps, anorexia, dizziness, hallucinations, insomnia

Question 33

Examples of Antianxiety Agents (with their general uses)

Answer 33

* diazepam (Valium): anxiety disorders, preop * alprazolam (Xanax): generalized anxiety disorders * clonazepam (Klonopin): anticonvulsant, panic disorders * occasionally given as anticonvulsant or mood stabilizer * lorazepam (Ativan): Sedation and relieves anxiety

Question 34

NonBenzo Antianxiety Med

Answer 34

* buspirone (BuSpar) * no addictive potential * does not produce sedation or euphoria * not effective in drug or alcohol withdrawal * slow onset * does not produce physical dependence * **_does not produce muscle relaxation_** * effective in reducing symptoms of worry, apprehension, difficulties with concentration, and cognition * side effects: dizziness, nausea, HA, nervousness, light-headedness