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PsychoPharmacology Flashcards

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1
Q

CLASSES OF PSYCHOACTIVE DRUGS

A
  1. antidepressants
  2. antipsychotics
  3. antiparkinsonian
  4. antianxiety
  5. antimanics (mood stabilizers)
  6. CNS stimulants
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2
Q

ANTIDEPRESSANTS ACTION

A

elevate serotonin and or norepinephrine levels

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3
Q

ANTIDEPRESSANTS INDICATIONS

A
  • DEPRESSION
  • ANXIETY DISORDERS
  • OCD
  • PTSD
  • PANIC DISORDER
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4
Q

SELECTIVE SEROTOINI RE-UPTAKE INHIBITORS (SSRI) ANTIDEPRESSANTS

A
  • fluoxetine (Prozac)
  • paroxetine
  • citalopram (celexa)
  • sertraline(Zoloft)
  • escitalopram (Lexapro)
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5
Q

SSRI SIDE EFFECTS

A
  • may report GI symptoms
  • change in appetitie /weight loss
  • headache
  • sexual dysfunction

may give person enough energy to act on thoughts of suicide

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6
Q

SERIOUS SIDE EFFECTS OF SSRI

A

-serotogenic syndrome caused by:
mixing MAOI’s and SSRI’s
overdose of SSRI’s
taking two antidepressants at once

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7
Q

SYMPTOMS OF SEROTONERGIC SYNDROME

A 
agitation 
sweating 
fever
rigidity 
tachycardia
hypotension 
hyperreflexia
in extreme conditions coma/death
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8
Q

SEROTONIN AND NOREPINEPHRINE RE-UPTAKE INHIBITORS SNRI’S

A

VENLAFAXINE (EFFEXOR) - WATCH BP
DESVENLAFAXINE
DULOXETINE (CYMBALTA)

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9
Q

TRICYCLIC ANTIDEPRESSANTS

A

-increase levels of serotonin and norepinephrine

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10
Q

NAMES OF TRICYCLIC ANTIDEPRESSANTS

A 
amitriptyline 
imipramine
doxepin 
desipramine
nortriptyline
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11
Q

TRICYCLIC Antidepressants side effects

A

-blurred vision
-dry mouth
constipation
urinary retention

-ORTHOSTATIC HYPOTENSION
-EKG CHANGES DUE TO TOXICITY
SEDATION DUE TO HISTAMINE RECEPTOR
-MEMORY AND CONCENTRATION DISTURBANCES
- HEADACHES
-FATIGUE
- IMPOTENCE

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12
Q

MONOAMINE OXIDASE INHIBITORS MOAI’S

A
  • inhibit the breakdown of monoamines specifically serotonin and norepinephrine by inhibiting the catabolic enzyme
  • also inhibits the metabolism of tyramine (potent vasopressor)
  • foods containing tyramine may stimulate hypertensive events ,possibly hypertensive crisis
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13
Q

MAO INHIBITORS

A
  • tranylcypromine
  • pheneizine
  • isocarboxzid
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14
Q

RESTRICTED FOODS for MAOI

A 
-aged cheeses 
aged and cured meats 
dried or pickled fish 
liver
bananas
broad bean pods
sauerkraut 
soy sauce and other soy condiments 
draft beer
vitamins with yeast
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15
Q

ANTIPSYCHOTICS INDICATION AND ACTION

A

indication - treatment of acute and chronic psychosis

action - dopamine antagonist , blocks dopamine

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16
Q

ATYPICAL ANTIPSYCHOTICS

A

now also known as second generation antipsychotics

most often prescribed currently due to side effect profile

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17
Q

COMMONLY USED ANTIPSYCHOTICS ATYPICALS (Second generation)

A 
clozapine
risperidone
olanzapine 
quetiapine
ziprasidone
aripiprazole
lurasidone
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18
Q

ATYPICAL/SGA

A
  • aruguably the most effective for positive and negative symptoms
  • first atypical very effective but some serious adverse reactions
  • bone marrow suppression can cause leukopenia need weekly CBC with Diff every week for 1st 6months then every 2 weeks
  • increased risk of seizures
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19
Q

ATYPICAL/SGA

A
  • aruguably the most effective for positive and negative symptoms
  • first atypical very effective but some serious adverse reactions
  • bone marrow suppression can cause leukopenia need weekly CBC with Diff every week for 1st 6months then every 2 weeks
  • increased risk of seizures
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20
Q

INTERDICIPLINARY COLLABORATION

A
  • clozapine monitoring
  • physician enrolls patient in registry, orders lab work
  • nurse faxes lab work to pharmacy /physician as needed , monitors for symptoms of immunosuppression and delivers med
  • pharmacist does not dispense medication until new lab values are received
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21
Q

COMMON SIDE EFFECTS ATYPICALS/SGA

A

clozaril and zyprexa- sedation, constipation, orthostatis ,low EPS

zyprexa- may cause appetite increase and is contraindicated with diabetes

Risperdal- sedation, orthostasis moderate EPS, ANTICHOLENERGIC -LOW CAN CAUSE ELEVATED PROLACTIN LEVELS

aeroquel- orthostais , somnolence, wt gain

Geodon- nausea, somnolence, increased QTC , EKG changes

Ability- nausea , H/A , somnolence/ insomnia

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22
Q

METABOLIC EFFECTS OF CLOZAPINE

A

WEIGHT GAIN
TYPE 2 DIABETES
DYSLIPIDEMIA
MYOCARDITIS , PERICARDITIS

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23
Q

metabolic effects of olanzapine

Study These Flashcards
A

WEIGHT GAIN
TYPE 2 DIABETES
DISLIPIDEMIA

24
Q

METABOLIC EFFECTS OF QUETIAPINE

Study These Flashcards
A

WEIGHT GAIN
TYPE 2 DIABETES
QT PROLOGATION

25
METABOLIC EFFECTS OF RISPERDONE
WEIGHT GAIN TYPE 2 DIABETES QT PROLONGATION
26
ZIPRASIDONE
QT PROLOGATION
27
FIRST GENERATION TYPICAL ANTIPSYCHOTICS
- effective only for positive symptoms of schizophrenia (hallucinations, delusions,etc) - may mask or worsen negative symptoms ( blunt affect, apathy,social withdrawl) - classified as to potency : low, mid,high (affects S/E profile)
28
COMMONLY USED ANTIPSYCHOTICS
``` haloperidol fluphenazine trifluoperazine thiothixene loxapine perphenazine thioridazine chlorpromazine ```
29
SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS
ANTICHOLINERGIC - BLURRED VISION - CONSTIPATION - DRY MOUTH - URINARY RETENTION - CONSTIPATION
30
GENERAL SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS
``` common/early -sedation - postural hypotension - dizziness - lightheadedness -decreased sweating potentiation of CNS depressants ```
31
EXTRAPYRAMIDAL SIDE EFFECTS
AKATHISIA -RESTLESSNESS DYSTONIAS PARKINSONIAN SYMPTOMS
32
TARDATIVE DYSKINESIA
- may be irreversible - may be prevented by use of low doses . Vitamin E,valproate, clonidine clozapine cholinergic drugs - GABAMINERGIC drug (benzos) may be useful in treating - discontinue the drug may lessen or reverse symptoms - AIMS Test ( standardized exam)
33
NEUROLEPTIC MALIGNANT SYNDROME
-an idiosyncratic reaction to an antipsychotic drug - potentially fatal - all psychotropics of high potency antipsychotic drugs have increased risk - poor nutrition , dehydration , and concurrent medical illness
34
MAJOR SYMPTOMS OF NEUROLEPTIC MALIGNANT SYNDROME
``` rigidity high fever elevated level of enzymes (cpk) diaphoresis pallor delirium autonomic instability ( unstable BP) ```
35
TREATMENT OF NMS
immediate discontinuation of all antipsychotic medications supportive medical care -rehydration and hypothermic measure
36
DEPOT THERAPY
- Haldol and proxlixin - respirdone now available - injectable , oil based form - long half life they are active for 2-4 weeks due to slow release from muscle tissue - called depot due to cyclical nature of treatment
37
MEDICATIONS USED FOR EPS
MEDICATIONS USED FOR ACUTE DYSTONIA MOST COMMNLY INCLUDE - BENZTROPINE - DIPHENHYDRAMINE - LORAZEPAM
38
ANTIMANICS MOODS STABILIZERS
-indicated for bipolar (chronic manic episodes) LITHIUM ACTION: stabilizes the activity of electrolytes at the cell membrane and reduces cell excitability INDICATION: prevention of manic episodes - for many years drug of choice - eliminated by the kidneys in riginal form - need to ensure good kidney function
39
NEED FOR LITHIUM AND SODIUM BALANCE
- lithium has a chemical structure that is similar to sodium - may compete at some sites - If sodium intake is decreased , lithium is reabsorbed by the kidneys - this leads to an increased risk of lithium toxicity - lithium has narrow therapeutic window
40
LITHIUM
- can be nephrotoxic/ thyrotoxic - need to minitor serum levels as well as periodic kidney / thyroid studies - narrow therapeutic window - between 0.5-1.5
41
SIDE EFFECTS OF LITHIUM
``` tremors polydipsia polyuria dry mouth GI upset pulse irregularities weight gain ```
42
ADVERSE EFFECTS
electrolyte imbalance sodium balance importanat side effects worsen as levek rises more severe symptoms usually symptoms correlated to levels from 2-3
43
LITHIUM TOXICITY
``` vomiting diarrhea lethargy ataxia slurred speech blurred vision confusion seizures coma death ```
44
ATYPICAL ANTIPSYCHOTICS
indicated for bipolar 1 (acuta manic episodes) - risperidone - ziprasidone - olanzapine - aripiprazole - quetiapine
45
ANTICONVULSANTS
``` valporic acid gabapentin topiramate lamotrigine carbamazepine ```
46
HOW ANTICONVULSANTS WORK
These anticonvulsants have shown varied levels of effectiveness in management of bipolar illness and some are indicated for acute manic episodes as well as maintanenece therapy may raise the threshold at which neurobiological messages can trigger mood changes
47
ANTINXIETY AGENTS PRIMARY CLAS (BENZODIAZEPINES
ACTION - inhibit CNS excitability by binding to the receptor complex enhance the activity of GABA at the GABAa receptor
48
BENZODIAZEPINES INDICATIONS
``` anxiety agitation insomnia tension panic disorder seizures dystonias muscle spasms agoraphobia ```
49
BENZODIAZEPINES
``` LORAZEPAM ALPRAZOLAM CLONAZEPAM DIAZEPAM CHLORDIAZEPAM ```
50
SIDE EFFECTS OF BENZOS
``` drowsiness fatigue decreased concentration confusion decreased coordination disorientation ```
51
BENZO NOTES
major drawback is tolerance and dependence synergistic effects when combined with ETOH not to be used for sleep
52
OTHER AXIETY AGENTS
SSRI'S BUSPIRONE PROPRANOLOL HYDROXYINE
53
ANTI-AGRESSION AGENTS
- antiaxiety agents -tegretol -lithium -beta blockers( Inderal, Lopressor) -lithium -antipsychotics others -trazodone -Prozac -klonopin -combinations
54
AUGMENTATION
- a variety of medications can be used along with the primary pharmacological agent that may serve to boost its effect - commonly used: lithium, antianxiety, desyrel, antipsychotics, anticonvulsants
55
COMMON NURSING INTERVENTIONS
- document first dose response to new medication - monitor subsequent response to treatment - collaborate to ensure that long term monitoring completed as needed
56
PATIENT EDUCATION
- patients more likely to continue treatment if given these five instructions 1. take antidepressant daily 2. antidepressants must be taken for at least 2-4 weeks to see a noticeable effect 3. continue to take the antidepressant even if you feel better 4. do not stop taking without checking with your doctor first 5. follow instructions to contact your healthcare provider when questions arise about antidepressants
57
PREVENTING NONCOMPLIANCE : SCHIZPHRENIA
- discuss adherence in nonthreatening nonjudgmental way - remember that persuasion is better than coercion - focus on any passible day to day benefit of the drug - match idea of taking drug with achieving life goals

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