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Module 6 (Psych Mental Health) > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

Differentiate between the different drug classes; recognize the drug names to the class (214 cards)

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1
Q

Psychotropic drugs

A

drugs that affect the person’s behavior, emotional state

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2
Q

Efficacy

A

maximal aptitude the drug can achieve

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3
Q

Potency

A

amount of drug required for therapeutic effect

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4
Q

Half-life

A

time it takes for the amount of a drug’s active substance in your body to reduce by half
- 5 half-life for clearing the syste

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5
Q

Reuptake

A

neurotransmitters behavior synapses pulled in

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6
Q

Approved use

A

FDA approval for certain diseases

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7
Q

Lipid solubility

A

ability to pass through the lipid walls (chemically) High – MEANS PASS THROUGH WITHOUT PERMISSION (higher chance of overdose)

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8
Q

Off-label use

A

reason used other than intended by FDA

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9
Q

Black box warning

A

strongest warning

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10
Q

Rebound effect

A

stop taking the drugs and withdrawal causes more intense symptoms

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11
Q

Withdrawal

A

= s/s noticed after not taking the substance

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12
Q

Akathisia

A

feel uneasy
inner restlessness or more intense symptoms

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13
Q

The brain monitors

A

changes in the external world (stimuli)
composition of body fluids

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14
Q

The brain regulates

A

contractions of muscles
internal organs
basic drives (hunger, thirst, sex, aggression, self-protection)
mood & emotions
sleep cycles
homeostasis

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15
Q

the brain mediates

A

conscious sedation

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16
Q

the brain produces and interprets

A

language and intellectual functions

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17
Q

the brain stores

A

memories

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18
Q

The cerebellum frontal lobe controls what functions

A

Thought processes
decision-making,
judgment,
motivation,
insight,
social judgment,
plans
personality development

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19
Q

The cerebellum temporal lobe controls what functions

A

Language comprehension, stores sounds into memory, connects with limbic system (the emotional brain)

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20
Q

The cerebellum occipital lobe controls what functions

A

Interprets visual images, visual associations, visual memories, involved with language formation

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21
Q

The cerebellum parietal lobe controls what functions

A

Receives & identifies sensory information, concept formation and abstraction, proprioception with body awareness, reading and math skills, right and left orientation

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22
Q

Proprioception

A

awareness of space

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23
Q

Cerebellum

A

Regulates skeletal muscle (coordination & contraction), & maintains equilibrium

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24
Q

Brainstem

A

midbrain
pons
medulla oblongata

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25
Midbrain
Pupillary reflex & eye movement
26
Pons
Processing station in auditory pathways
27
Medulla Oblongata
Reflex center control (balance, heart rate, resp rate and depth, coughing, sneezing, swallowing & vomiting, maintains blood pressure)
28
Psychoactive Medications affect what in the body
thinking behavior emotions perceptions
29
Neurons:
Interconnected nerve cells
30
Neurotransmitters:
Chemical messengers between neurons which triggers a response from one neuron to another
31
Neurotransmission:
Conduction of an electrical impulse from one end of the neuron to the other
32
Synaptic Transmission:
When the electrical impulse reaches the end of a neuron, the neurotransmitter is released at the axon terminal & diffuses across the synapse to the postsynaptic neuron
33
Inhibitory neurotransmitters:
**inhibits** action in the post-synaptic cell
34
Excitatory neurotransmitters:
Promotes action in the post-synaptic cell
35
Deficient neurotransmitter
the message is not thoroughly delivered as there are too many receptors for the too little messages
36
Deficient receptor
damage quality of the transmission sender reuptakes when clogged - no other messages can get though while clogged
37
Monoamines types
dopamine norepinephrine serotonin histamine
38
Amino acids
y-Aminobutyir Acid (GABA) Glutamate
39
Cholinergics
acetylcholine
40
Peptides
substance P somatostatin neurotensin
41
Dopamine affects
fine muscle mvmt decision-making release of sex hormones (sex, thyroid, adrenal) integration of emotions/thoughts
42
If you have too much dopamine, what diseases could occur +
Schizophrenia psychosis mania
43
If you have too little dopamine, what diseases could occur -
Parkinson' depression
44
Norepinephrine affects
mood attention arousal SNS stimulation (fight or flight)
45
If you have too much norepinephrine, what diseases could occur +
mania anxiety psychosis heightened arousal state
46
If you have too little norepinephrine, what diseases could occur -
depression lowered arousal state
47
Serotonin affects
Sleep regulation  Hunger Mood Pain perception Libido Aggression Hormonal activity
48
If you have too much serotonin, what diseases could occur +
anxiety
49
If you have too little serotonin, what diseases could occur -
depression
50
histamine affects
Alertness Gastric secretion stimulation Inflammation response
51
If you have too much histamine, what diseases could occur +
sleep disturbances anxiety
52
If you have too little histamine, what diseases could occur -
sedation seizures
53
ϒ -Aminobutyric acid: (GABA) affects
Decreases anxiety Decreases excitement Decreases Aggression Anticonvulsant
54
If you have too much ϒ -Aminobutyric acid: (GABA), what diseases could occur +
reduction of anxiety
55
If you have too little ϒ -Aminobutyric acid: (GABA), what diseases could occur -
mania anxiety psychosis
56
Glutamate affects
Memory Emotions Cognition
57
If you have too much glutamate, what diseases could occur +
Increased perception of pain Anxiety Restlessness
58
If you have too little glutamate, what diseases could occur -
Low energy Difficulty concentrating Insomnia Psychosis
59
Acetylcholine (ACh) affects
Learning Memory Mood regulation Sexual and aggressive behavior PNS stimulant
60
If you have too much ACh, what diseases could occur +
depression
61
If you have too little ACh, what diseases could occur -
alzheimer's parkinson's huntington's chorea
62
ACh does what to blood vessels
dilates
63
What are the s/s of a cholinergic (ACh) crisis (too much)?
INCREASE of Salivation Lacrimation (tears) Urine excess/leakage Defecation GI upset Emesis and vomiting
64
Antidepressant medication
TCAs MAOIs SSRIs SNRIs
65
Mood stabilizers
Lithium Anticonvulsants
66
Antipsychotics
1st (Typical) and 2nd (Atypical generations
67
Anxiolytics
benzodiazepines antihistamines anticonvulsants beta blockers
68
Tx purpose for antidepressants
Major Depression Panic disorder Some anxiety disorders Bipolar depression Psychotic depression - mood improvement and decrease depression and anxiety
69
SSRIs (Selective Serotonin **Reuptake** Inhibitors)  - pathos
More likely to see discontinuation syndrome in SSRIs with shorter half-life, such as paroxetine sit in the synapse in the space to continune down the chain
70
SNRIs (Serotonin Norepinephrine Reuptake Inhibitors)
– venlafaxine, duloxetine, desvenlafaxine – also treat anxiety and neuropathic pain **inhibits the reuptake of both serotonin and norepinephrine**
71
SNDIs (Serotonin Norepinephrine Disinhibitors) –
mirtazapine – often combined with SSRIs to enhance antidepressant effects or to reduce SSRI side effects of nausea, anxiety, insomnia
72
NDRIs (Norepinephrine Dopamine Reuptake Inhibitors)
– buproprion – also prescribed for smoking cessation
73
SARIs (Serotonin Antagonist/Reuptake Inhibitors) – trazodone – at high doses for antidepressant effects, lower doses for hypnotic effects; can cause priapism
– at high doses for antidepressant effects, lower doses for hypnotic effects; can cause priapism
74
NRIs (Selective Norepinephrine Reuptake Inhibitors) – atomoxetine
– used to treat **ADHD when stimulants cannot be tolerated**
75
MAOIs (Monoamine Oxidase Inhibitors)
– **tyramine-restrict**ed diet inhibits the metabolism of the monoamine
76
TCA are lethal in
overdose
77
SSRI medication names
**fluoxetine (Prozac)** fluvoxamine (Luvox) paroxetine (Paxil) **sertraline (Zoloft)** citalopram (Celexa) **escitalopram (Lexapro)** vilazodone (Viibrid) vortioxetine (Trintellix)
78
SSRIs do what in the body
Inhibit reuptake of serotonin (5HT) making it available **longer in the synapse**
79
SSRI side effects
Tremors Anxiety/agitation Nausea Dry mouth (sips of water or candy) Headache Diarrhea Insomnia, drowsiness Hyponatremia Sexual dysfunction Bruxism (especially with paroxetine) – grinding in the teeth
80
SSRI patient teachings
with morning food no alcohol or **antihistamines** adherence to regimen Medication should **not be discontinued abruptly**
81
Why should you not abruptly D/C SSRIs
prevent withdrawal/discontinuation syndrome - continently for a long time
82
SSRIs take how long to be therapeutic
1-3 weeks - notice and efficiency
83
Let the physician know immediately when a pt on SSRIs starts having
suicidal thoughts increases (opposite effect)
84
If SSRIs are taken with other serotonin-blocking agents may cause (SSRIs, MAOIs, lithium, triptan, buspirone, tramadol, & OTC cold/cough meds)
serotonin toxicity
85
SSRIs are used cautiosly with what
CYP450 enzyme inhibitors or inducers (Example: ketoconazole or rifampin) – ability to metabolize
86
Withdrawal/Discontinuation syndrome s/s for SSRIs
anxiety, insomnia or vivid dreams, headaches, dizziness, tiredness, irritability, flu-like symptoms, including achy muscles and chills, nausea electric shock sensations, and return of depression symptoms 
87
Black Box Warning for SSRIs
increased risk of suicide
88
Serotonin Syndrome Interventions
D/C SSRI maintain safety (environment) Monitor physical/mental Administer **Serotonin receptor blockade Zofran for nausea Dantrolene or diazepam for muscle rigidity Cyproheptadine (histamine 1 receptor antagonist)** Provide reassurance
89
Serotonin Syndrome S/S mnemonic
SHIVERS
90
Serotonin Syndrome S/S
Shivering Hyperreflexia and myoclonus (rhabdomyolysis) increase temp VS instability (tachy and labile BP) Encephalopathy (agitation. delirium. and confusion) restless and incoordination sweating
91
Labile BP
change quickly and spontaneously out of the normal but not too high
92
Tricyclic antidepressant medication names
imipramine * amitriptyline doxepin desipramine nortriptyline clomipramine *  maprotiline protriptyline trimipramine amoxapine       
93
What TCAs are acceptable for 8+ y/o
imipramine clomipramine
94
TCA patho
Inhibits reuptake of serotonin (5-HT) & norepinephrine (NE) & blocks cholinergic receptors
95
TCA side effects
Sedation **Mydriasis – dilation pupils** Weight gain Sweating **Toxicity** Sexual dysfunction **Decreased seizure threshold** Orthostatic hypotension Anticholinergic effects
96
DO NOT GIVE TCA to a petient prone to
seizures suicidal
97
TCA pt teachings
avoid alcohol **lethal in overdose** take at night - sedation caution while driving adherence
98
TCA absoption
HIgh lipid soluble - quick absorption = lethal in overdose
99
TCA effective at
4-8 weeks
100
The nurse should question a TCA prescription when
given in large quantity as it can lead to overdose
101
MAOIs patho
Inhibits enzyme that degrades NE, dopamine, & 5-HT
102
MAOI medication names
**Isocarboxazid** phenelzine tranylcypromine selegiline (comes in transdermal patch form for treatment of depression)
103
MAOI side effects
Muscle cramps Weight gain Sexual dysfunction Anticholinergic effects - dries out **Serious food/drug interactions (tyramine)**
104
MAOI pt teachings
lethal in overdose **Tyramine free diet** Continue diet for 2 weeks after d/c of drug
105
HOw long should you contune the tyramine-free diet when the MAOIs is D/C?
2 WEEKS MINIMUM
106
Tyramine-free diet - avoid these foods
Aged cheeses &meats Foods with yeast Soy Beer & wine Avocados & bananas
107
Build up of tyramine in the nerve cells can lead to
vasopressor = HTN= circulatory collapse
108
HTN Crisis S/s
N/V chills sweating fever severe HTN restlessness' **nuchal rigidity** dilated pupils occiptal HA suddenly motor agitation severe nosebleeds
109
SNRI medication types
venlafaxine (Effexor) duloxetine (Cymbalta)
110
SNRI patho
Increase serotonin and norepinephrine
111
SNRI side effects
Include fewer anticholinergic effects
112
SNDI medication types
mirtazapine (Remeron)
113
SNDI patho
Increase serotonin and norepinephrine (Combined with SSRIs to augment efficacy or counteract serotonergic side effects)
114
SNDI needs to be given with
food
115
1st Generation /Conventional antipsychotics med names
**Chlorpromazine** **haloperidol (long-acting form)** trifluoperazine  **Fluphenazine** loxapine perphenazine **Thioridazine**
116
2nd Generation /Atypical antipsychotics medication names
clozapine                  cariprazine   amisulpride              brexpiprazole aripiprazole              ziprasidone asenapine                  sertindole loperidone                quetiapine  lurasidone                lumateperone olanzapine (short-and long-acting forms) paliperidone  (long-and very-long-acting forms) risperidone (short-and long-acting forms)
117
1st Generation /Conventional antipsychotics patho
Dopamine receptor antagonist = **Strong dopamine blockade – no control on neg** Also blocks to lesser degree acetylcholine, histamine & NE
118
1st Generation /Conventional antipsychotics control of what type of symptoms?
postive not negative
119
positive symptoms mean
+ something added that should not be there
120
negative symptoms mean
- something that is not there anymore
121
2nd Generation /Atypical antipsychotics patho
Serotonin-dopamine antagonists = Less blockade of dopamine plus strong 5HT receptor antagonist Also blocks to lesser degree acetylcholine, histamine & NE
122
2nd Generation /Atypical antipsychotics control what type of symptoms
positive and negative
123
1st Generation /Conventional antipsychotics side effects
NEURO Anticholinergic effects Weight gain Sexual and/or reproductive organ issues Increased prolactin levels (both genders) Seizures Sedation **Tachycardia and/or prolonged QT interval** Women more common on QT **Orthostatic hypotension EPS/Tardive Dyskinesia**
124
2nd Generation /Atypical antipsychotics SIDE EFFECTS
METABOLIC Less anticholinergic effects Weight gain Type II Diabetes Mellitus Dyslipidemia Anxiety Headache Sedation
125
1st generation antipsychotics need what procedure done
EKG
126
Which antipsychotic generation is more likely to have EPS?
1st generation
127
Which antipsychotic generation has fewer anticholinergic effects?
2nd gen
128
Which antipsychotic generation is the 1st choice of initial therapy?
2nd gen - 1st gen reserved for who have been on and tolerate
129
Which antipsychotic generation is used to treat Tourette's disorder?
1st gen
130
Which antipsychotic generation is used for breakthrough psychosis and r/t levodopa use?
2nd gen
131
Which antipsychotic generation has the greater risk of metabolic syndrome?
2nd gen
132
Which antipsychotic generation can be used for extreme nausea in some situations (chemo)?
1st gen
133
1st gen antipsychotics pt teachings
limit sunlight, need sunscreen and sunglasses prevent constipation reposition frequently **sugar-free liquids and candies for dry mouth**
134
1st generation antipsychotics might take up to __________ for effectiveness
2-4 weeks
135
2nd gen antipsychotics pt teachings
regimen **monitor wt gain and exercise** observe for s/s of DM, INFECTION **sugar-free liquids and candies for dry mouth** REPORT ANY CHANGES TO HCP
136
EPS stands for
Extrapyramidal Side Effects
137
EPS consists of
acute dystonia akathesia pseudoparkinsonism tardive dyskenesia
138
Acute dystonia s/s
**stiff neck** facial grimacing **invol upward eye mvmt** muscle spasms of tongue, face, neck, and back - arching forward laryngeal spasms
139
Tardive dyskinesia s/s
snake-like eye and tongue involuntary mvmt of the body protrusion and rolling tongue sucking/smacking mvmts of the lips chewing motions facial dyskinesia
140
Can tardive dyskinesia be reversed
yes if caught early on but usually permanent
141
Psuedoparkinsonsism
stooped posture shuffling gait rigidity slow mvmt tremors at rest **pill-rolling hand motion**
142
Psuedoparkinsonsism is treated the same way as
parkinsons
143
Akathesia
restless trouble standing still paces constant motion, rocking back and forth **reversible**
144
Dystonia is shown through
oculogyric crisis (eyes roll to the top of the head) opisthotonos (backward arch) torticollis spasmodic (stiff neck in bad position making it hard and painful to turn
145
Dystonia is caused by
starting the antipsychotic or increasing the dose to rapidly - drug-induced if they have a hx of acute dystonia, young, male, **cocaine use**
146
Tx for dystonia
Haldol with anticholinergic
147
Tx for EPS
reduce or stop cause antihistamine or anticholinergic
148
Tardive dyskinesia is considered _____ EPS
late
149
Tardive dyskinesia how long after tx
months to years
150
Antipsychotics can mask ________ _____________ of tardive dyskinesia
early s/s
151
20-30% of Older patients on long-term 1st gen antipsychotics can get
tardive dyskinesia
152
What 2 drugs were introduced to treat Tardive dyskinesia?
Valbenazine Deutetrabenazine
153
NMS
Neuroleptic Malignant Syndrome
154
Neuroleptic Malignant Syndrome s/s
tachycardia/tachypnea muscle rigidity drooling sudden high fever diaphoresis labile BPs decreased LOC to coma
155
NMS is a
emergency
156
Tx for NMS
ICU STOP antipsychotics Increase fluid with IV Administer antipyrietics,sedation, and **DANTROLENE/BROMOCRIPTINE** Tx fever, BP, and dysrhythmias
157
When a patient has NMS, you should treat the fever with
antipyretics **cooling blankets and IV fluids**
158
In tx for NMS, what should be considered if they are a good candidate?
intubation
159
Benzodiazepines
alprazolam oxazepam triazolam **lorazepam** **diazepam** clonazepam chlordiazepoxide **PAM and LAM driving in their BENZ**
160
Benzodiazepines do what to the body
Depresses neurotransmission in limbic and cortical areas of the brain - promote GABA in the receptor complex **slows transmissions**
161
Benzodiazepines are used for
short-term anxiety/acute anxiety
162
Benzodiazepines patient may develop a
Dependence & tolerance
163
Benzodiazepines frequent uses are linked to
rebound anxiety Dementia increased fall risk: hypersexual, agitated, and high metabolisms higher mortality
164
Benzodiazepines should NOT be combined with
opioid medications
165
Benzodiazepines side effects
Sedation Dizziness Fatigue **Impaired driving** Impaired cognitive function CNS depression
166
Benzodiazepines pt teachings
avoid alcohol (potentiates effects) caution whikle driving due to slow reflexes and responses **NEVER D/C apruptly** - fatal withdrawal does not care underlying illness **highly addictive - long-term**
167
Benzodiazepines Withdrawal Syndrome - short-term
Anxiety Insomnia Sweating Tremors Dizziness
168
Benzodiazepines Withdrawal Syndrome - long-term
Panic Paranoia Delirium HTN Muscle twitches Seizures
169
Buspirone (Buspar) patho
Stimulates serotonin type 1A receptors on nerves, altering the chemical messages that nerves receive  **rescue for anxiety attacks**
170
Buspirone (Buspar) side effects
Dizziness Nausea Headache Nervousness Lightheadedness Excitement
171
Buspirone (Buspar) pt teachings - DO NOT TAKE IF
Do not use buspirone if you have taken an MAO inhibitor in the past 14 days. - non-addictive
172
Buspirone (Buspar) effectiveness
2-4 weeks
173
Hydroxyzine pamoate (Vistaril) patho
1st generation antihistamine – blocks histamine
174
Hydroxyzine pamoate (Vistaril) side effects
drowsiness headache dry mouth
175
Hydroxyzine pamoate (Vistaril) pt teachings
Don’t take with other CNS depressants Non-addicting
176
Hydroxyzine pamoate (Vistaril) effectiveness
20-30 minutes
177
Hydroxyzine pamoate (Vistaril) if used for a long time can cause
cardiac dyskinesia
178
Benzodiazepines onset sedating? dependence and withdrawal? PRN?
Rapid onset Sedating Dependence & withdrawal Tolerance varies with increased age May be used prn
179
Buspirone onset sedating? dependence and withdrawal? PRN?
Delayed onset Non-sedating No dependence or withdrawal No pharmacokinetic change with age Not suitable for prn use
180
Hydroxyzine pamoate onset sedating? dependence and withdrawal? PRN?
Rapid onset Sedating No dependence or withdrawal May be used PRN
181
What other medications can be used for anxiety
Antidepressants (Anxiety often linked to depression) Antihistamines Anticonvulsants Antipsychotics Beta blockers
182
What herbal medications can be used for anxiety
Kava Kava Valerian Root Melatonin
183
KAVA KAVA is not used for pts with
psychosis and liver damage
184
VALERIAN ROOT is not used for pts with
aductive use of CNS depressants as it potentiate and becomes ineffective
185
Melatonin can cause the pt to experience
vivid/bizarre dreams
186
With anxiety, tx is base on
individualized
187
Anticonvulsant med names
valproic acid (Depakote) lamotrigine (Lamictal) carbamazepine (Tegretol) oxcarbazepine (Trileptal) gabapentin (Neurontin) topiramate (Topomax)
188
Lithium patho
Unknown (but believed to inhibit release of dopamine & norepinephrine, hasten the destruction of catecholamines, serotonin receptor blockade & decrease sensitivity of postsynaptic receptors)
189
Lithium side effects
**NEURO EXPECTED** - no vomiting Fine hand tremor Polyuria **Mild** thirst Mild nausea Weight gain Sedation Acne Cognitive problems Delayed sexual response Hair loss
190
Lithium's therapeutic index
NARROW
191
Lithium normal lab values for maintenance
0.6-1.0
192
Lithium normal lab values for acute use
0.5-1.2
193
Lithium normal lab values for TOXIC
> 1.5
194
With lithium, the blood draws consist of
peak and trough before each dose and regular lab level
195
Early Lithium Toxicity lab level
<1.5
196
Early Lithium Toxicity s/s
Nausea **Vomiting** **Diarrhea** Thirst **Polyuria** Slurred speech Muscle weakness
197
Advanced Lithium Toxicity lab values
1.5-2
198
Advanced Lithium Toxicity s/s
**Coarse Tremors** Confusion EEG changes Incoordination Worsening GI upset Hyperirritability in muscles
199
Severe Lithium Toxicity lab
2-2.5
200
Severe Lithium Toxicity s/s
Clonic movements **Copious dilute** urine Seizures Stupor **Severe hypotension** **Ataxia Tinnitus**
201
Lethal Lithium Toxicity labs
>2.5
202
Lethal Lithium Toxicity s/s
Coma Dysrhythmias **Circulatory collapse** Oliguria Proteinuria Death
203
Lithium can make it potentiate the severity of itself by
causing vomiting, diarrhea, and polyuria - increases the concentration of lithium in the body
204
If the nurse notices the patient on Lithium vomiting or diarrhea, what should they do
D/C lithium STAT lithium levels
205
If the patient has a dose of furosemide next but they are on lithium, what should the nurse do
question the diuretic and call the doctor to confirm
206
Lithium pt teaching effetiveness
5.7 days -max at 2-3 weeks
207
Lithium pt teaching
NOT for pregnant women **expected vs toxicity s/s** With food to lower GI upset I&Os **frequent and early blood draws**
208
Anticonvulsants for mood stabilizers patho
Potentiates the inhibitory effects of GABA; inhibits glutamate suppressing CNS excitement; & slows Ca+ & Na+ movement back into the neuron extending the time it takes the neuron to return to active state
209
Valproic acid (Depakote) adverse effects
Blood dyscrasias Hepatoxicity Pancreatitis - immune depressants
210
Carbamazepine (Tegretol) adverse effects
Agranulocytosis – teach to report a sore throat** Aplastic anemia - immunodepressants
211
A patient on carbamazepine has a sore throat, what should the nurse do?
report to the HCP
212
Anticonvulsant pt teachings
Report pregnancy Monitor blood levels as prescribed **Do not stop abruptly or if pregnant* Take as prescribed Will **require monitoring**
213
Psychopharmacological principles
target s/s adequate doages for sufficient timing **lowest dose for maintenance** lower doses for the elderly -taper than abrupt -follow-up -simplify - informed consent required
214
Agranulocytosis tx
monitor WBCs (extreme low) Cloraepine protocol for any signs of infection

Module 6 (Psych Mental Health) (12 decks)

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