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Pharmacotherapeutics > Psychiatric Drugs > Flashcards

Psychiatric Drugs Flashcards

1
Q

Anti-pychotics

A

-Treats psychotic disorders, particularly schizophrenia

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2
Q

Antiolytics

A
  • Treats anxiety disorders, insomnia, nausea and vomiting in cancer therapy
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3
Q

Antidepressants

A

Treat depression-reactive, major and bipolar disorders

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4
Q

Mood Stabilizers

A

Are antidepressants and treat bipolar disorders

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5
Q

How are moods and emotions communicated throughout the central nervous system

A
  • Chemical neurotransmitters
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6
Q

How does an impulse travel?

A
  • Travels through the presynaptic neuron across the synaptic cleft and binds to a receptor on a post synaptic neuron
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7
Q

Dopamine

A
  • Cognition, emotional responses, motivation, movement, attention
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8
Q

Serotonin

A
  • Role in mood, sleep rhythms and arousal
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9
Q

Norepinephrine

A
  • Controls arousal, vigilance, mood, anxiety, fight or flight
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10
Q

Gamma-aminobutyric acid GABA

A
  • Regulates anexity
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11
Q

Psychosis

A
  • Losing contact with reality, manifested in mental or psychiatric disorders.
  • Thought to be due to an imbalance of neurotransmitter dopamine in the brain
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12
Q

Symptoms of psychosis

A
  1. Difficulty in processing information
  2. Delusions
  3. Hallucinations
  4. Catatonia
  5. Aggressive/violent behavior
  6. Incoherence
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13
Q

Delusion

A

A false belief in which one’s own thoughts, feelings, or fears cannot be distinguished from reality.
- Present in form of delusions of control, grandeur, persecution

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14
Q

Hallucinations

A
  • A false perception having no relation to reality

- Could be visual, auditory, tactile, gustatory or olfactory

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15
Q

Schizophrenia- what kind of disease is it?

What are the categories for symptoms?

A

Chronic disease (major category of psychosis) has Positive and Negative symptoms

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16
Q

Positive Symptoms

A
  • Exaggeration of normal function
  • Additive
  • Agitation, hallucinations
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17
Q

Negative Symptoms

A
  • Diminished
  • Decreased loss of function
  • Social withdrawal or loss of speech
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18
Q

Antipsychotics- how do they work?

- What are the categories?

A
  • Block dopamine receptors

- Typical aka traditional or Atypical aka second generation

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19
Q

Typical (traditional) First Generation Antipsychotics

A

Phenothiazines

Nonphenothiaznes

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20
Q

Antipsychotics block what?

A
  • D2 receptors
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21
Q

Typical (Phenothiazines)- detailed action?

A

They are anti-psychotics that have a strong affinity for the D2 and they have an increased incidence of extra pyramidal symptoms????

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22
Q

Atypical Antipsychotics Action

A

They have weak affinity for the D2 receptors and decreased incidence of EPS

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23
Q

Symptoms of pseudo-parkinsomism

A
  • Stooped posture
  • Shuffling gait
  • Fidgety
  • Pill rolling
  • Tremors at rest
  • Bradykinesia
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24
Q

Akthisia symptoms

A
  • Restless
  • Trouble standing still
  • Paces the floor
  • Feet in constant motion, rocking back and forth
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25
Q

Acute Dystonia Symptoms

A
  • Facial grimacing
  • Involuntary upward eye movement
  • Muscle spams of the tongue, face, neck and back (back muscle spasms cause trunk to arch forward)
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26
Q

Tardive Dyskinesia Symptoms

A
  • Protrusion and rolling of the tongue
  • Sucking and smacking movements of the lips
  • Chewing motion
  • Facial dyskinesia
  • Involuntary movements of the body and extremities
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27
Q

Adverse Reactions of Antipsychotics

A
  • Reactions common early in treatment
  • Acute Dystonia
  • Akathisia
28
Q

Acute Dystonia - adverse reactions

A
  • Occurs within a week of taking the medications
  • Treat with anticholinergic or anti-parkinsonism drugs
  • ex. cogentin or benztropine or benzodiazepines or ativan
29
Q

Akathia

A
  • Can occur early in treatment

- Treat with benzodiapines and Lorazepam (Ativan) ot beta blockers and propanolol (Inderal)

30
Q

Tardive Dyskinesia - What is it?
How do we treat it?
When does it manifest?
What factors influence it?

A
  • Typically more than a year
  • A very serious adverse reaction and the drug should be stopped
  • The reaction is more frq and serve in older adults
  • Depends on the dose and the duration
  • Treatments: high doses Vitamin E may be helpful or other benzodiazapines like Ca channel blockers or beta blockers
31
Q

Neuroleptic Malignant Syndrome (NMS)- Symptoms

A
  • Sudden high fever
  • Muscle rigidity
  • Altered mental status
  • BP fluctuations- tachycardia and dysrthymia
  • Seizures
  • Rhabdomyolysis ( skeletal muscle destruction)
  • Acute Renal Failure due to the skeletal muscle destruction
  • Coma
  • Respiratory fail
32
Q

Treatments for NMS

A
  • Immediate withdrawal of antipsychotics
  • Hydration
  • Antipyretics
  • Muscle relaxants
  • Benzodiazephine
33
Q

How do the three groups of phenothiazine differ?

A
  • Mostly due to side effects
34
Q

What are the three groups of phenothiazines?

A
  • Aliphatic: Chlorpromazine- Thorazine
  • Piperazine: Fluphenazine- Prolixin
  • Piperidine: Thioridazine- Mellarli
35
Q

Side Effects of Aliphatic: Chlorpromazine- Thorazine

A
  • Strong sedative effect
  • Lowers BP
  • Moderate EPS
36
Q

Side Effects of Piperazine: Fluphenazine- Proli

A
  • Low sedative effect
  • Strong antiemetic effect ( dec the urge to vomit)
  • Little effect on BP
  • Greater EPS than other phenothiazines
37
Q

Side Effects Piperidine: Thioridazine- Mellarli

A
  • Few EPS

- Can cause life threatening dysrhythmia

38
Q

Haloperidol (Haldol)

A
  • Type of nonphenothoazine
  • Freq used
  • Similar to phenothiazines
  • Potent antipsychotic so smaller dosage is used
  • Prolonged QTc so leads to arrhythmias
39
Q

What are the advantages of atypical antipsychotics

A
  • Treats both positive and negative symptoms

- Less likely to cause EPS or tardive dyskinesia

40
Q

What is the mechanism of function for atypical antipyschotics

A
  • The block serotonin and dopaminergic D4 receptors
41
Q

Risperidone (Risperdal) uses

A
  • Atypical antipsychotic

- Used to manage psychosis and schizophrenia

42
Q

Risperidone (Risperdal) Side Effects

A
  • Sedation
  • H/A
  • Photosensitivity
  • EPS
  • Seizures
  • Dry mouth
  • Weight gain
  • Tachycardia
  • Orthostatic hypotension
  • Urinary retention
  • Sexual dysfunction
43
Q

What assessment do you do for people receiving antipsychotics

A
  • Vital Signs and weight
  • Drug hx- check for allergies and may need to increase anticonvulsant dose
  • Mental status, cardiac, eye and respiratory
44
Q

What nursing diagnosis can we give someone who is psychotic?

A
  • Disturbed thought processes related to delusions
  • Disturbed sensory- perceptual responses related to biochemical imbalances (hallucinations)
  • Non-compliance related to loss of motivation
45
Q

What is in the planning phase for the psychotic patient?

A

Patient’s condition (psychosis) will improve with psychotherapy and drugs

46
Q

Interventions for psychosis

A
  • BC orthostatic hypotension is typical so check vital signs
  • monitor for adherence
  • check for EPS
  • assess for neuroleptic malignant syndrome
  • monitor WBC
  • let PT know that it may take 3-6 weeks for the meds to take effect
  • warn them not to use alcohol, narcotics, or other CNS depressants
  • tell them not to suddenly discon.
47
Q

Anxiolytics

A

used to treat anxiety and insomnia

48
Q

Types of anexity

A

1- not caused by a medical or drug

2- related to drug use, medical/psych disorders

49
Q

For which anexity are anxiolytics not given?

A

type 2

50
Q

How is long term use of aniolytics?

A
  • discouraged
  • tolerance builds in weeks or months
  • non pharm measures should be used b4 this med
51
Q

Benzodiazephines - what are the users?

A
  • Anticonvulsants
  • Sedative- hypnotics
  • Pre-op drugs
  • Anxiolytics
52
Q

Examples of Benzodiazephines

A

Lorazepam- ativan

diazepam- valium

53
Q

Lorazepam- ativan

-Actions?

A
  • inc the GABA effects
  • binds to specific benzodiazephine receptor
  • postsynaptic receptor becomes more sensitive to GABA
  • inhibits rapid neurotransmitters
  • decreases signs and symptoms of anexity
54
Q

Pharmacokinetics of lorazepam

A
  • rapid absorption
  • high PB 91%
  • half life- 12-14 hours
  • excreted in urine
55
Q

Lorazepam- Ativan: Side Effects

A 
weakness
confusion 
blurred vision
N/V
anorexia
sleep disturbances
restlessness
hallucainations 
anorexia
56
Q

Ativan aka lorazepam adverse effects

A

hypertension
hypotension
- cannot discontinue abruptly: withdrawal symptoms= agitation, muscle tremors, cramps, nausea, sweating, drug is tapered over time

57
Q

Depression:

A

mood disorder:
depressed mood, despair, insomnia, loss of interest in normal activities, fatigue, dec ability to think, suicidal thoughts

58
Q

pathophysiology of depression

A

insufficient amount of monamine neurotransmitters such as serotonin, dopamine, norepinephrine

59
Q

etiology of depression

A

genetic predisposition

social and environmental factors

60
Q

3 types of depression

A

bipolar affective disorder
reactive
major

61
Q

reactive depression

A

sudden onset after precipitating event

may last for months

62
Q

major depression

A

loss of interest in life
inability to complete tasks
deep depression

63
Q

bipolar affective disorder

A

mood swings between manic and depressive aka euphoric and dysphoria

64
Q

herbal supplements for depression

A

St. John’s Wart-dec the reuptake of serotonin, norepinephrine and dopamine

65
Q

Gingko Biloba

A
  • use of this substance needs to be discontinued 1-2 weeks before surgery
  • the patient should check with the health care provider regarding herbal treatments
66
Q

4 types of antidepressants

A
  1. Tricyclics (TCA)
  2. Selective serotonin reuptake inhibitors (SSRI)
  3. Atypical antidepressants
  4. Monoamine oxidase inhibitors (MAOIS)
67
Q

Tricyclics

A

ex. Elavil aka amitriptyline
blocks uptake/reuptake (removal of) norepinephrine and serotonin
effective and less expensive than SSRI
elevate mood, inc intrerest and dec insomnia
usually given at night to dec problems

Pharmacotherapeutics (2 decks)

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