Psychopharmacology Flashcards
(44 cards)
Signs and Symptoms of Serotonin Syndrome
Mild: Nervousness, insomnia, nausea/diarrhea, tremor, big pupils
Moderate: hyperreflexia, sweating, agitation/restlessness, inducible clonus, side-to-side eye movements
Severe: fever >38.5C/101.3F, confusion/delirium, sustained clonus/rigidity, rhabdomyolysis, Death
Nursing Interventions of Neuroleptic Malignant Syndrome?
life threatening, sent out for clearance…
What are the risks of the following drug interaction:
-SSRIs (i.e. fluoxetine) and warfarin
• MAOIs (phenelzine, tranylcypromine) and tyramine
• Lithium and NSAIDs
• Lorazepam and sertraline
• Serotonin modulators enhance effects of other serotonin modulators
- bleeding
- hypertensive crisis
- lithium toxicity
- sedation?
- serotonin syndrome
Examples of Selective Serotonin Reuptake Inhibitors (SSRIs)
- citalopram (Celexa)
- escitalopram (Cipralex) *
- fluoxetine (Prozac)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- sertraline (Zoloft) *
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran (Fetzima)
- venlafaxine (Effexor) *
Tricyclic Antidepressants (TCAs)
- amitriptyline (Elavil)
- clomipramine (Anafranil)
- desipramine (Norpramin)
- doxepin (Sinequan )
- imipramine (Tofranil)
- nortriptyline (Aventyl)
Monoamine Oxidase Inhibitors (MAOIs)
- moclobemide (Manerix) – reversible inhibitor of MAO
- phenelzine (Nardil) – irreversible inhibitor of MAO
- tranylcypromine (Parnate) – irreversible inhibitor of MAO
Mood Stabilizers
- Lithium (Carbolith, Lithmax )
- carbamazepine (Tegretol)
- divalproex (Epival)
- gabapentin (Neurontin)
- lamotrigine (Lamictal)
- valproic acid (Depakene)
What is first line treatment for acute mania, acute depression and maintenance treatment in Bipolar Disorder?
Lithium
Quetiapine
1st line in acute mania, acute depression and maintenance therapy
• Quetiapine, aripiprazole, risperidone, asenapine - used in combination with mood
stabilizers for faster onset in the management of acute mania
• Treat concomitant psychotic symptoms and rapidly help with agitation
First line treatment for most anxiety disorders?
antidepressants
Types of anxiolitics?
buspirone
benzodiazepine
What are signs and symptoms of discontinuation syndrome?
F lu-like symptoms I nsomnia N ausea I mbalance S H yperarousal
Common Side effects of SSRIs?
GI upset, dry mouth, insomnia, somnolence, headache, sexual dysfunction, sweating, agitation, anorexia, increased bleeding risk (with drug interactions), SIADH with hyponatremia, glaucoma, falls risk
(paroxetine is most anticholinergic and caution: discontinuation syndrome)
Common Side effects of SNRIs
Similar to above; sleep disturbances, nausea, agitation, as dose increases: increased BP&HR, caution: discontinuation syndrome especially with venlafaxine)
Common Side effects of NDRI, ex. bupropion (Wellbutrin) - Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Insomnia, tremor, sweating, anxiety, decreased appetite, increased risk of seizure
Common Side effects of SARI, ex. trazodone (Desyrel) - Serotonin Antagonist Reuptake Inhibitor (SARI)
Sedation, dizzy, falls/fracture risk; decrease BP (alpha blockade)
Common Side effects of NaSSA, ex. mirtazapine (Remeron)* - Noradrenergic and Specific Serotonin Antidepressant?
Sedation, increased weight, edema, anticholinergic → dry mouth
Common Side effects of TCAs?
Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention →nortriptyline generally better tolerated), sedation, increase weight, sexual dysfunction, confusion, increase HR, decrease BP, falls risk, cardiac arrhythmias, potentially fatal in overdose
Common Side effects of MAOIs?
Decreased BP, drowsiness, anticholinergic effects, weight gain, sexual dysfunction (less with moclobemide), drug-food interactions (tyramine) → hypertensive crisis
Common side effects of lithium?
- N/V/D
- polyuria, polydipsia
- fatigue
- weight gain
- hand tremor
- alopecia
- acne, psoriasis
- hypothyroidism
- hyperparathyroidism, increased calcium
- increased potassium
- increased SCr, renal impairment
- cardiac effects
- leukocytosis
What and when to monitor when taking lithium?
- SCr
- CBC
- weight
- TSH
- ECG
- lytes
- Ca++
- 12-hour post dose serum levels (5 days after initiating therapy or change in therapy)
What are signs and symptoms of mild, moderate and severe lithium toxicity?
➢ Mild: GI upset (diarrhea, vomiting), confusion, agitation,
muscle weakness, fatigue, fine hand tremor, slurred speech
➢ Moderate: lethargy, nystagmus, course hand tremors, fluctuating LOC
➢ Severe: seizures, organ failure, coma, death
What factors effect lithium concentration?
- hydration status
- salt intake
- renal function
- drug interactions
Common side effects of carbamazepine (Tegretol)?
N/V, drowsiness, blurred vision, menstrual irregularities Rare: aplastic anemia, severe skin reactions (esp. in Asian population)
LOTS of drug interactions!
