Psychotherapeutic Drugs Flashcards

Question

Tricyclic Antidepressants: Mechanism of Action

Answer 1

Block reuptake of neurotransmitters, causing accumulation at the nerve endings It is thought that these drugs may help regulate malfunctioning neurons.

Answer 2

Neuropathic pain, insomnia Childhood enuresis (imipramine) Obsessive compulsive disorders (OCDs) (clomipramine) Sometimes, anorexia

Answer 3

Sedation Impotence Orthostatic hypotension

Answer 4

Lethal; 70 to 80% die before reaching the hospital. CNS and cardiovascular systems are mainly affected. Death results from seizures or dysrhythmias.

Answer 5

No specific antidote Decrease drug absorption with activated charcoal. Speed elimination by alkalinizing urine. Manage seizures and dysrhythmias. Provide basic life support.

Answer 6

Oldest and most widely used of all the tricyclic antidepressants Original indication: depression Commonly used to treat insomnia and neuropathic pain Contraindications: known drug allergy, pregnancy, and recent myocardial infarction. Adverse effects: dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias

Answer 7

Nonselective: phenelzine sulphate and tranylcypromine sulphate Selective: selegiline hydrochloride Rarely used for depression Used for Parkinson’s disease Disadvantage: potential to cause hypertensive crisis when taken with tyramine

Answer 8

Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death Patients must avoid foods that contain tyramine!

Answer 9

Aged, mature cheeses (cheddar, blue, Swiss) Smoked, pickled, and aged meats, fish, and poultry (herring, sausage, corned beef, salami, pepperoni, paté) Yeast extracts Red wines (e.g., Chianti, burgundy, sherry, vermouth) Italian broad beans (fava beans)

Answer 10

bupropion (Wellbutrin®) SNRI – duloxetine hydrochloride (Cymbalta) SSRIs --fluoxetine (Prozac®)

Answer 11

Depression BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, the neurologic disorder myoclonus, and various substance misuse problems such as alcoholism

Answer 12

Adverse effects: insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction Watch for excessive effects of serotonin on the CNS – Serotonin Syndrome

Answer 13

Indications: depression, generalized anxiety disorder (GAD), and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis Adverse effects: dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity. Drug interactions: SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury) Can worsen uncontrolled angle-closure glaucoma

Answer 14

Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy Zyban®: approved for smoking cessation treatment and was the first nicotine-free prescription medication used to treat nicotine dependence

Answer 15

Prototypical SSRI Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder Contraindications: known drug allergy and concurrent MAOI therapy Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

Answer 16

Promotes the presynaptic release of serotonin and norepinephrine in the brain Sedation Indications: depression (including that associated with BPD), sexual adverse effects in male patients receiving SSRI therapy (reduction), and an appetite stimulant Contraindications: drug allergy and MAOIs Adverse effects: drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia Drug interactions: additive CNS depressant effects with alcohol and cytochrome P-450 (CYP) inhibitors

Answer 17

Drugs used to treat serious mental illness -Drug-induced psychoses, schizophrenia, and autism -Also used to treat extreme mania (as an adjunct to lithium), BPD, depression that is resistant to other therapy, certain movement disorders (e.g., Tourette’s syndrome), and certain other medical conditions (e.g., nausea, intractable hiccups)

Answer 18

Conventional, or first-generation antipsychotics: phenothiazines – haloperidol Second-generation antipsychotics Atypical antipsychotics – clozapine, resperidone

Answer 19

Conventional, or first-generation antipsychotics: phenothiazines – haloperidol Second-generation antipsychotics Atypical antipsychotics – clozapine, resperidone

Answer 20

Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function Dopamine levels in the CNS are decreased. Result: tranquilizing effect in psychotic patients

Answer 21

Positive symptoms: hallucinations, delusions, and conceptual disorganization

Answer 22

Negative symptoms: apathy, social withdrawal, blunted affect, poverty of speech, and catatonia

Answer 23

All antipsychotics show efficacy in improving the positive symptoms of schizophrenia. Conventional drugs are less effective in managing negative symptoms. Atypical antipsychotics have greater efficacy in treating both positive and negative symptoms.

Answer 24

Psychotic illness, most commonly schizophrenia Anxiety and mood disorders prochlorperazine (antiemetics)

Answer 25

Agranulocytosis and hemolytic anemia CNS effects: Drowsiness Neuroleptic malignant syndrome (NMS) Extrapyramidal symptoms (EPS): pseudoparkinsonism-akathisia, acute dystonia treated with benztropine (Kynesia®) and trihexyphenidyl hydrochloride Tardive dyskinesia NMS: Potentially life threatening High fever, unstable blood pressure, myoglobinemia EPS: Involuntary muscle symptoms similar to those of Parkinson’s disease Akathisia (distressing muscle restlessness) Acute dystonia (painful muscle spasms)

Answer 26

Treated with benztropine (Cogentin®) and trihexyphenidyl (Artane®)

Answer 27

Involuntary contractions of oral and facial muscles Choreoathetosis (wavelike movements of extremities) Occurs with continuous long-term antipsychotic therapy

Answer 28

Tardive dyskinesia Insulin resistance Weight gain Changes in serum lipid levels Cardiometabolic syndrome

Answer 29

Indications: long-term treatment of psychosis Contraindications: hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken Oral, intramuscular Useful in treating patients with schizophrenia who were nonadherent to their drug regimen

Answer 30

clozapine (Clozaril®) risperidone (Risperdal®)

Answer 31

Block specific dopamine receptors: dopamine-2 (D2) receptors Also block specific serotonin receptors: serotonin-2 (5-HT2) receptors --This is responsible for their improved efficacy and safety profiles.

Answer 32

Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain Associated with minor or no EPS Adverse effects: blood dyscrasias

Answer 33

Indication: schizophrenia (including negative symptoms) Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day. Oral and long-acting injectable forms

Answer 34

Used for depression, anxiety, sleep disorders, nervousness May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity Severe interactions if taken with MAOIs and SSRIs; many other drug interactions Food–drug interaction with tyramine-containing foods

Answer 35

Before beginning therapy, assess the physical and emotional status of patients. Obtain baseline vital signs, including postural blood pressure readings. Obtain liver and renal function tests. Assess for possible contraindications to therapy, cautious use, and potential drug interactions. Assess for level of consciousness, mental alertness, and potential for injury to self and others. Check the patient’s mouth to make sure oral doses are swallowed. Provide the patient with simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected. Advise patients to avoid abrupt withdrawal. Advise patients to change positions slowly to avoid postural hypotension and possible injury. The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills. Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal.

Answer 36

Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts.

Answer 37

With older adult patients, monitor closely for oversedation and profound CNS depression.

Answer 38

Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants. Inform patients that it may take several weeks to see therapeutic effects. Monitor patients closely during this time, assess for suicidal tendencies, and provide support. Assist older adult and weakened patients with ambulation and other activities because falls may occur due to drowsiness or postural hypotension. To avoid interactions with anaesthetic drugs, tricyclics may need to be weaned and discontinued before a patient undergoes surgery. Monitor for adverse effects and discuss with patients. Caffeine and cigarette smoking may decrease the effectiveness of medication therapy. When MAOIs are given, teach the patient and family about tyramine-containing foods and the signs and symptoms of hypertensive crisis.

Answer 39

Instruct patients to wear sunscreen because of photosensitivity. Tell patients to avoid taking antacids within 1 hour of a dose. Inform patients to avoid alcohol and other CNS depressants with these medications.

Answer 40

Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups. Report these symptoms to the physician Oral forms may be taken with meals to decrease GI upset. May cause drowsiness, dizziness, or fainting. Instruct patients to change positions slowly.

Answer 41

Monitor mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns. Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement.

Answer 42

Improved mental alertness, cognition, and mood Fewer anxiety and panic attacks Improved sleep patterns and appetite Less tension and irritability; fewer feelings of fear, impending doom, and stress More interest in self and others

Answer 43

Improved sleep patterns and nutrition Increased feelings of self-esteem Decreased feelings of hopelessness Increased interest in self and appearance Increased interest in daily activities Fewer depressive manifestations or suicidal thoughts or ideations

Answer 44

Improved mood and affect Alleviation of psychotic symptoms and episodes Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope

Answer 45

Less mania Therapeutic lithium levels of 0.6 to 1.2 mmol/L

Psychotherapeutic Drugs Flashcards

(69 cards)