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Psychopharmacology Flashcards

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1
Q

Mode of Action

A

What the drug does to the body

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2
Q

Mechanism of Action

A

How the drug works in terms of symptoms, cure of disease and the symptoms the drug does.

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3
Q

Most important neurotransmitters

A

Acetylcholine
Dopamine
Serotonin
Glutamate

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4
Q

Acetylcholine: 2 important subdivisions and important receptor

A

2 Subdivisions:
nicotinic and muscarinic cholinergic receptors
Important:
M1 postsynaptic receptor for mediating effect in memory function

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5
Q

Dopamine

A

Controls movement
Involved in pleasurable sensation, euphoria, delusions and hallucinations
Intervenes positive and negative psychotic symptoms
Release of prolactin, promotes breastmilk

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6
Q

What is the relationship between dopamine and acetylcholine?

A

Reciprocal relationship

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7
Q

Serotonin

A

Inhibitory catecholamine
Receptors start with “5-HT”
Intervenes with cognitive effects, emotions, pains, memory, anxiety, sleep-wake cycles and inhibits dopamine release.

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8
Q

Glutamate

A

Major excitatory neurotransmitter

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9
Q

Remission phase

A

Focuses on the return of baseline functions and no symptoms.

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10
Q

Maintenance phase

A

Prevents recurrence of illness

Increases pt functioning while decreasing symptoms

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11
Q

Recovery phase

A

Emphasizes individual growth and achievement despite having a mental illness.

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12
Q

Psychosis: 5 symptoms dimensions

A 
Positive 
Negative 
Cognitive Function Impairment
Aggressive and Hostile
Depressive and Anxious
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13
Q

Conventional (1st generation) vs atypical antipsychotics (2nd generation)

A

1st generation: block D2 receptors

2nd generation: lower potential for EPS (extrapyramidal effects), does not affect negative and cognitive symptoms.

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14
Q

Antipsychotic Meds Indication

A

Schizophrenia & schizoaffective disorders
Delusional disorders
Adjunct therapy for Bipolar disorder

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15
Q

Antipsychotic Meds Goal of Therapy

A

Pt needs to follow through with long term care

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16
Q

What habit affects the absorption of antipsychotic meds?

A

Cigarette smoking increases drug metabolization and pts would require higher doses.

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17
Q

Antipsychotic Meds Clinical Use and Efficacy

A

Use the lowest dose for shortest time.
Positive symptoms are relieved within hours while affective symptoms takes 2-4 weeks to be relieved.
Cognitive and Perceptual symptoms take 2-8 weeks for response.
Negative symptoms take longer to respond.
Always start with 3-4 divided dose/day and wean down to 1-2 dose/day.

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18
Q

Serum level of monitoring indications

A

No response after 6 weeks
Severe or unusual adverse reaction
Physically ill, older adults and young children

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19
Q

Extrapyramidal Effects (EPS): 4 symptoms

A

Dystonia
Pseudoparkinsonism
Akathisia
Tardive Dyskinesia

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20
Q

Dystonia: when does it normally occur, what reverses it and what does it look like.

A

Occur in the initial treatment regimen
Reversed with IM diphenhydramine ( Benadryl) or benztropine (Cogentin)
Spasms of eye, neck, back, tongue or other muscles.

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21
Q

Pseudoparkinsonism: what reverses it and what does it look like.

A

Tx: reduce antipsychotic dose or change med, or oral antiparkinsonian agent
Decreased movements. muscle rigidity, resting hand tremor, drooling and masklike face and shuffling gait.

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22
Q

Akathisia: How does it look like and Tx.

A

Restlessness. pacing, rocking and inability to sit still.

Tx: Propranolol and benzodiazepam.

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23
Q

What do you monitor if the pt takes propranolol?

A

Monitor BP

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24
Q

Tardive dyskinesia and Tx

A

Severe abnormal movements of any voluntary muscle group that occurs after a long dopamine blockade
No effective Tx.

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25
Tardive dyskinesia and EMS
When tardive dyskinesia occurs, decreasing the med dose worsens tardive dyskinesia but improves EMS. Increasing dose improves tardive dyskinesia but worsens EPS.
26
Neuroleptic Malignant Syndrome (NMS)
``` MEDICAL EMERGENCY Decreased LOC, increased muscle tone and autonomic dysfunction (hyperreflexia, labile HTN, tachycardia, tachypnea, diaphoresis, and drooling) , Fever myoglobinuria, leukocytosis elevated creatine phosphokinase levels. ```
27
Neuroleptic Malignant Syndrome (NMS) Tx:
Discontinue antipsychotic meds Hydrate with IV fluids Give Tylenol and cooling blankets for Hyperthermia IV Heparin for PE if PRN Manage arrythmias Monitor Renal Function Give IV dantrolene (Dantrium), muscle relaxant Possible dopaminergic drugs (Bromocriptine, amantadine) Wait 1-2 weeks before restarting antipsych meds
28
Cardiovascular Side Effects
Postural hypotension, esp. older adults Arrhythmias and Palpitations Changes in QT intervals - monitor with EKG.
29
Low Potency Typical Antipsychotics
``` Sedation / Drowsiness Weight gain Photosensitivity Poikilothermic Galactorrhea and Gynecomastia ```
30
Haloperidol as a short-acting typical (Conventional) Antipsychotics
Used for short term symptoms of agitation. Given IV and IM Caution with elderly pts
31
Fluphenazine Deconate Injection
Long-Acting Injectible Typical Antipsychotics Given IM or subQ Feel effects within 48-96 hours
32
Haloperidol Decanoate Injection
Long-Acting Injectible Typical Antipsychotics Deep IM Given every 4 weeks
33
Clozapine: Drug Class, Mechanism of Action, Clinical Use
Atypical Antipsychotics Not a first-line therapy due to agranulocytosis High receptor affinity for D4 and 5-HT2 Used for refractory illness
34
Clozapine: Risks and Side Effect
``` Risk for Agranulocytosis- decrease or lack of agranulocytic WBCs. Side Effects: Sedation, Anticholinergic effects, orthostatic hypotension, weight gain, hypersalivation and risk for seizures. ```
35
Anticholinergic effects
``` Dry mouth Blurry vision Constipation Urinary retention Ejaculatory inhibition ```
36
Risperidone: Drug Class, Receptor, Clinical Use, Side Effects
Atypical Antipsychotics Blocks dopamine (D2) receptors Treats both positive and negative symptoms Used for older pts and has few anticholinergic effects Side Effects: insomnia, hypotension, agitation, headache and hyperthermia
37
Olanzapine: Drug Class, Receptor, Clinical Use, Side Effects
Atypical Antipsychotics Greater D2 blocker and weaker D4 and a-adrenergic blockade Treats both positive and negative symptoms of schizophrenia, monotherapy for bipolar Side Effects: Sedation, anticholinergic effects, weight gain, adult onset DM, risk for seizures and hyperprolactinemia
38
Quetiapine: Drug Class, Receptor, Clinical Use, Safety
Atypical Antipsychotics Multiple receptors Treatment of schizophrenia Monitor cholesterol and triglycerides for elevation
39
Ziprasidone: Drug Class, Receptor, Clinical Use
Atypical Antipsychotics 5HT and D2 antagonist, protects against EPS and inhibits norepinephrine reuptake Treatment of acute agitation of schizophrenia
40
Ziprasidone: Contraindication, Side Effects
Contraindicated pts with heart problems Increased risk of death with dementia-related psychosis Take with food Side Effects: GI discomfort, drowsiness, EPS, akathisia, dizziness, dystonia, hypertonia, tachycardia and postural hypotension, rash, fungal dermatitis, and abnormal vision and upper respiratory function.
41
Antidepressants: Indications
``` Major Depression Anxiety OCD Panic Bulimia Anorexia PTSD Bipolar Social Phobia IBS Enuresis Neuropathic pain Migraine headache ADHD Smoking cessation Autism ```
42
Downregulation of Antidepressants
Increased neurotransmitter in synapse but less neurotransmitter in synapse
43
Major Classes of Antidepressants
Selective Serotonin Reuptake Inhibitor (SSRIs) Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOIs)
44
Selective Serotonin Reuptake Inhibitor (SSRIs): Receptor and efficacy
First-line treatment of antidepressants Inhibiting reuptake of 5HT Efficacy depends on pt's tolerance to adverse effects and cost
45
Serotonin Syndrome
``` Life threatening due to interactions with other drugs Confusion Hypomania Restlessness Myoclonus Hyperreflexia Diaphoresis Shivering Tremor Diarrhea ```
46
Serotonin Syndrome Tx
Discontinue med that increases serotonin | Suppoertive measures
47
Selective Serotonin Reuptake Inhibitor (SSRIs): Side Effects
``` Side effects are most severe beginning of tx GI upset Insomnia restlessness irritability headache Sexual dysfunction EPS Not lethal with overdose ```
48
Tricyclic Antidepressants (TCAs): Receptor, Side Effects
Second-line therapy Blocks reuptake of 5-HT and norepinephrine Anticholinergic side effects, Orthostatic hypotension
49
Tricyclic Antidepressants (TCAs): Monitoring parameters
Take at bedtime because of sedative effect Use EKG before therapy - possible cardiotoxicity Risk of fatality with overdose Avoid with elderly pts
50
Monoamine Oxidase Inhibitors (MAOIs): Mode of Action, Efficacy
Block enzyme for degrades norepinephrine, serotonin and dopamine. Increases postsynaptic downregulation Used as last resort, resistant to TCAs Rapidly absorbed and half-life is 24 hours
51
Monoamine Oxidase Inhibitors (MAOIs): Contraindication
``` Cerebrovascular defects Cardiovascular disease Pheochromocytoma - tumor in adrenal medulla Pregnancy Older than 65yrs old ```
52
Monoamine Oxidase Inhibitors (MAOIs): Hypertensive Crisis, Symptoms and Tx
MAOIs inhibit monoamine oxidase, they decrease the breakdown of tyramine from ingested food, thus increasing the level of tyramine in the body. Excessive tyramine can elevate blood pressure and cause a hypertensive crisis Symptoms include: Headache, Stiff neck, Sweating, Nausea and vomiting, Treatment: Nifedipine, and Monitor vital signsq10-15 min
53
Monoamine Oxidase Inhibitors (MAOIs): Dietary Restrictions - Prohibited
Aged cheese, ripe avocados - Ripe figs, anchovies, bean curd - Broad beans, yeast, liver - Deli meats, pickled herring - Meat extracts, fermented foods - Chianti and sherry
54
Monoamine Oxidase Inhibitors (MAOIs): Dietary Restrictions - Moderate Use:
Cottage cheese, cream cheese - Yogurt, sour cream - Coffee, chocolate - Spinach, raisins, tomatoes, eggplant
55
Monoamine Oxidase Inhibitors (MAOIs): Restricted Use
``` Anti-asthmatics Antihypertensives Epinephrine Allergy, hay fever decongestants Cough and cold products Buspirone Meperidine SSRIs Yohimbine ```
56
Monoamine Oxidase Inhibitors (MAOIs): Side Effects and Toxicity
``` Orthostatic hypotension Edema Sexual dysfunction Weight gain Insomnia Confusion and feeling drunk is excessive dose ```
57
Monoamine Oxidase Inhibitors (MAOIs): Pt Teaching and Nursing Responsibilities
Teach pt and family about foods to avoid, - give handouts Teach pts not to take any additional medication without consulting HCP, Dentist and Pharmacist Teach pt about hypertensive crisis and toxicity Wait 5 weeks before starting MAOI after discontinuing fluoxetine. Must be tapered, do not stop abruptly
58
Other Antidepressants
Venlafaxine (Effexor) – Serotonin-norepinephrine reupdate inhibitor (SNRI) Nefazodone - Trazodone – Serotonin modulator Bupropion – Aminoketone (related to tricyclic, tetracyclic and SSNRI) Mirtazapine - Noradrenergic and specific serotonergic antidepressant Saint John's Wort
59
Time Course of Antidepressants
1st wk: decreased anxiety, improved sleep, pt unaware of changes 1-3 wk: increased activity, sex drive, and self-care abilities, improved concentration and memory and psychomotor retardation resolves 2-4wks: relief of depressed mood, less hopeless, and suicidal ideation subsides
60
Antidepressants with kids
Can increase suicidal thinking and behavior | Can happen in adults as well but monitor the kids
61
Mood Stabillizers
``` Lithium Valproate Carbamazepine Oxcarbazepine Lamotrigine Topiramate Gabapentin Tiagabine Zonisamide Levetiracetam ```
62
Lithium: Indication and Risks
Treatment for bipolar mania and depressed episodes Narrow therapeutic range Risk for toxicity in older pts Combine with valproate as first line tx
63
Lithium: Pt Teaching and Nursing Responsibilities
Monitor blood serum level to avoid adverse effects Monitor renal function, thyroid function, urinalysis, CBC with differentials, serum electrolytes, ECG and weight. Pregnancy test to women on child bearing age Teach pt the side effects of lithium and potential drug interactions Monitor fluid intake Avoid salt-restricting diet
64
Lithium: Side effects within therapeutic range
``` Fine tremor Nausea, vomiting, diarrhea Mild polydipsia, polyuria Lethargy, muscle weakness Weight gain Increased WBC Acne, alopecia Hypothyroidism ```
65
Lithium: Side effects and range of Moderate toxicity
Lithium level >1.5 mEq/L - Coarsening of tremor - Worsening GI symptoms - Confusion, slurred speech - Sedation, lethargy
66
Lithium: Side effects and range of Severe toxicity
``` Lithium level >2.5 mEq/L RISK FOR PERMANENT NEUROLOGIC IMPAIRMENT - Arrhythmias - Bradycardia - Myocarditis - Seizures - Coma - Death ```
67
Rapid cycling bipolar
4 or more mood disorder episodes within 12 months
68
Valproate: Drug class, indication and compare to lithium
Anticonvulsant med First line tx of rapid cycling bipolar Minor side effects and wider therapeutic range than lithium
69
Valproate: side Effects
``` Sedation GI distress Benign transaminase elevation Osteoporosis Tremor Hair loss Increased appetite Weight gain ```
70
Valproate: Pt teaching and nursing responsibilities
Monitor baseline liver functions and signs of hepatoxicity Severe vomit, monitor serum amylase level and evaluate for pancreatitits Take at bedtime Anticoagulation therapy, monitor for clotting function Monitor hepatic function and CBC every 6 months Teach pt side effects, risks and what to look for
71
Carbamezepine: Drug class, Indication
Anticonvulsants Tx of acute bipolar mania second-line treatment for bipolar disorder Does not reach steady state until 4 weeks after initial therapy
72
Carbamezepine: toxicity
``` Dizziness Ataxia Sedation Diplopia Stupor Coma Tx: gastric lavage and symptom management ```
73
Carbamezepine: Pt teaching and Nursing responsbilities
Effects does not show until 4 weeks after initial dose Monitor CBC and liver function test every 2 weeks Teach pts to monitor for signs and symptoms of hematologic and hepatic abnormalities Teach pt to call HCP when rash occurs
74
Oxcarbazepine
Treatment for bipolar disorder Alternate tx to carbamazepine Risks for hyponatremia esp with older adults Decreases T4 hormone in thyroid
75
Lamotrigine
Treatment for rapid cycling bipolar disorder Reduce the dose of lamotrigine by half if taken with valproate risks for steven johnson syndrome
76
Topiramate
Adjunctive therapy for seizures Treatment for binge eating, bulimia, cluster headache, Tourette's syndrome and trigeminal neuralgia Risk for acute myopia and glaucoma Caution with renal impairment pts and avoid pts with glaucoma Risk for anemia
77
Tx of Mania
Use of mood stabilizer | For agitation, benzodiazepine can be added to initial tx
78
Bipolar pt with depression
Avoid TCAs | Monitor pt because antidepressant can cause pt to have mania
79
Tx of Generalized Anxiety Disorder
Antidepressant Benzodiazepine - rapid onset Buspirone - longer onset
80
Benzodiazepine Advantages
Rapid onset
81
Benzodiazepine Disadvantages
Cognitive impairment Decreased coordination Potential Drug Abuse Withdrawal symptoms
82
Benzodiazepine Drug Names
Clonazepam Lorazepam Alprazolam
83
OCD meaning
Persistent and recurrent thoughts, images, impulses and behaviors that are distressing to the individual and impair daily function
84
OCD Tx
``` Antidepressants: SSRIs and clomipramine Cognitive Behavioral Therapy Dopamine-blocking agents: Haloperidol Busipirone Lithium Clonazepam ```
85
PTSD
Recurrent life symtoms in response to very serious life events
86
PTSD Tx:
Antidepressants: SSRIs Benzodiazepines: Clonazepam Mood stabilizers
87
Social Phobia
Most common anxiety disorder Strong persistent anxiety that results from fear of scrutiny by others, embarrassment or humiliation High incidence with alcohol abuse and depression
88
Social Phobia Tx:
``` Antidepressant: SSRIs Benzodiazepine: Clonazepam and alprazolam Gabapentin Kava Kava Valerian ```
89
Pt Education for Anxiety
Educate pt that anxiety is a treatable illness Educate about different types of medications, side effects, precautions and contraindications Encourage pt to be part of decision making Meds take several weeks to achieve maximum effects Advise pt regarding drug-drug and drug-herb interactions Encourage nonpharmacologic interventions Caution pts with mixing alcohol with drinks, avoid driving or operating machinery
90
Insomnia Medication
``` Hypnotics: benzodiazepine Nonbenzodiazepine hypnotics Trazadone - avoid alcohol Chloral Hydrate - avoid alcohol Diphenhydramine - tolerance in 2 weeks and avoid in older adults Melatonin - Avoid with other CNS drugs Barbituates Kava Kava Valerian ```
91
benzodiazepine for insomnia
Triazolam - Difficulty falling asleep Temazepam - awakens early who cannot stay asleep Flurazepam - difficulty falling asleep and staying asleep. Possible rebound insomnia
92
Nonbenzodiazepine for insomnia
Zolpidem - limit to 7-10 days and reevaluate pt Zaleplon - For middle night to early morning, dizziness and headache Eszopiclone - Rozarem
93
Trazodone insomonia
SSRI For pts undergoing drug and alcohol detox Side effects: sedation, orthostatic hypotension and priapism.
94
Aggressive and Violent Behaviors
Sedate and calm pts and prevent self-harm or harm to others | Treat chronic aggressive behaviors
95
Acute Agitation and Aggression
Antipsychotics: Haloperidol Ziprasidone Quetiapine Risperidone Olanzapine Benzodiazepines Traozodone
96
Chronic Aggression
Schizophrenia: Antipsychotics Mania: Lithium & Valproate Seizure disorder: Carbamazepine & Valproate Older adults: Trazodone

Mental Health (42 decks)

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