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NURS363 - Practice of Nursing IV > Week 6 Part 1: Psychopharmacology > Flashcards

Week 6 Part 1: Psychopharmacology Flashcards

(141 cards)

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1
Q

What is the predominant goal for medication getting to the public

A

Safety

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2
Q

Before 1950s what drugs were usually used for psychiatric illnesses? What has it expanded to since then?

A

1950s - Sedatives and Amphetamines

Now - antipsychotics, antidepressants, anti anxiety meds

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3
Q

Psychotropic medications are intended to be utilized…

A

with adjunct therapies - individual and group psychotherapy

combo therapies and meds lead to best results

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4
Q

___ have become the dominant treatment of psychiatric disorders

A

medications

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5
Q

What is the purposes of psychotropic drugs

A

relieve or reduce symptoms of dysfunctional thoughts, moods, or actions, mental illness or disorder

improve client functioning

increase clients adhered or compliance to other therapies

increase productivity and independence - the end goal!

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6
Q

Reasons for Nonadherence to Psychotropic Med Regimen

A

Expensive - Unaffordable

Unpleasant or distressing SE

Stopping because they feel they no longer need them

May not believe they have an illness warranting the meds

Stigma

denial or fears about medication usage from mental illness like paranoia

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7
Q

Pharmocodynamnics

A

study of mechanisms of acton and biochemical and physiologic effects of drugs

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8
Q

What is the main basic principle of psychopharmacology

A

mental illness symptoms result from chemical imbalances within the nervous system (CNS - brain and spinal cord)

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9
Q

Neurotransmission

A

process in which the interactive systems help the brain navigate the internal and external stimuli and allows the brain to create consciousness awareness of sensory perceptions

the brain decides how to respond to the stimuli, stores the memories of the response, and then subsequent responses are usually behavioral with some accompanied emotions

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10
Q

Any disruption in neurotransmission…

A

can affect cognition or the ability to accurately perceieve, or process incoming information or stimuli

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11
Q

4 Sites of Pharmacodynamic Action

A

Receptors

Ion Channels

Enzymes

Carrier Proteins: Uptake Receptors

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12
Q

Where are neurotransmitters stored and release

A

in the axon terminals of the presynaptic neuron

electrical impulses through the neuron wil; stimulate NT release into the synaptic cleft which determines whether another electrical impulse is generated

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13
Q

Reuptake

A

the process of NT inactivation by which the NT is reabsorbed into the presynaptic neuron form which it had been released

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14
Q

The funamental action of psychotropic medications is to…

A

alter either the transmission or reception of nerve impulses resulting in the increasing or slowing of nervous system functions

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15
Q

3 types of Psychotropic Meds

A
  1. Antidepressants
  2. Antipsychotics
  3. Benzodiazepines (Anti-Anxiety)
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16
Q

Antidepressants

A

class of psychotropic drugs that block reuptake of NT

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17
Q

Antipsychotics

A

class of psychotropic drugs that block dopamine and other receptors

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18
Q

Benzodiazepines

A

class of anti anxiety drugs

facilitates transmission of GABA to decrease excitability

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19
Q

How long does relief of symptoms take with antidepressants

A

initial improvement for some in 7 days but takes several weeks to get complete relief

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20
Q

Why should antidepressants never be discontinued abruptly

A

uncomfortable symptoms such as depression and anxiety from withdrawal, which are often worse than the original depression leading to a vicious cycle

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21
Q

Why is there an increased risk of suicidal behavior sometimes associated with anti depressants

A

increased in children and adolescents

but risk for suicide increases because they feel better and gain energy before they are fully relieved of depression

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22
Q

Types of Antidepressants

A

SSRI

SNRI

NDRI

NaSSA

SARI

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23
Q

SSRIs

A

selective serotonin reuptake inhibitors - antidepressant

inhibit serotonin reuptake by blocking presynaptic neuron increasing serotonin concentration

ex: Prozac, Selexa, Lexapro, Zoloft, Paxil, Luvox

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24
Q

SE of SSRIs

A

HA

anxiety

insomnia

transient nausea and vomiting

diarrhea

sedation

sexual dysfunction

diastolic HTN

increased perspiration

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25
SNRIs
serotonin norepinephrine reuptake inhibitors - antidepressant prevent reuptake of serotonin and NEP at presynaptic site ex: Effexor, Serzone, Cymbalta, Norpramin
26
Side Effects of SNRIs
same as SSRIs + increased blood pressure
27
NDRI
NEP Dopamine Reuptake INhibitor - antidepressant INhibits reuptake of dopamine NEP and serotonin ex: Wellbutrin, Zyban
28
SE of NDRIs
agitation anxiety insomnia appetite suppression psychosis increased seizures
29
It is very important to do what prior to giving NDRIs
VERIFYING PREVIOUS SEIZURE HX SINCE IT INCREASES INCIDENCE
30
NaSSA
alpha 2 antagonists - antidepressants boosts NEP/Noradrenaline serotonin by blocking alpha 2 adrenergic presynaptic receptors on a serotonin receptor ex: Remeron
31
SE of NaSSA
sedation (at lower doses) dizziness weight gain dry mouth constipation change in urinary fxn
32
SARI
serotonin 2 antagonist/reuptake inhibitor - antidepressant blocks serotonin 2A receptor potently and serotonin reuptake less potently ex: Deyrel
33
SE of SARIs
sedation weight gain NV constipation dizziness fatigue incoordination! tremor!
34
What can cause a toxic, sometimes fatal, reaction when used with an SSRI
MAOIs
35
SSRI use can boost the effects of what drugs
Tricycle antidepressants hydantoin clozapine haloperidol beta blockers st johns worts (EVEN OTC!!!) warfarin etc
36
SSRI can decrease effects of ___ and ___
digoxin and buspirone
37
What popular psych drug can increase effects of SSRI
lithium
38
What can occur when SSRIs are used with other drugs that increase serotonin
Serotonin Syndrome - emergency!
39
S/S of Serotonin Syndrome
mental status change - hallucination, agitation, coma Autonomic instability - tachycardia, hyperthermia, BP changes Neuromuscular problems - hyperreflexia, incoordination GI disturbance - NVD
40
Serotoning syndrome can be __ ___
life threatening
41
The effects of SSRIs are generally not seen for ___-___ days and it will take how long to reach full client benefit?
10-21 days takes weeks longer after the first 10-21 days to reach full benefit
42
What is important to teach the patient regarding SSRI/SNRI
relief not immediate - will be experienced in time skipping a dose can cause withdrawal symptoms low to medium dose may cause sexual SE
43
Tricyclic Antidepressants
TCAs Made in 60s - first drug to treat major depression blocks NEP and serotonin and AcH - works on a lot of NT systems and serotoning reuptake ex: Elavil, Tofranil, Asendin, Norpramin, Vivactil
44
TCA S/S
Early Morning Wakening, Anxiety, Weight Loss Panic, Compulsive Disorders - for those responding well Blocking NEP, Serotonin and AcH has cholinergic effects = dry mouth, blurred vision, Urinary retention, delayed micturation, confusion, constipation, hypotension others: tremors, restlessness, insomnia, NV, confusion, pedal edema, HA, seizures, blood dyscrasia
45
The most common side effects of TCAs are
sedation orthostatic Hypotension anticholinergic SE like dry mouth, blurry vision, urinary retention and delay, confusion, constipation, and hypotension
46
the biggest s/s of TCAs is
early morning awakening
47
TCAs are as effective as ___, but...
SSRIs, but have more serious side effects and a higher lethal potential
48
If the TCA causes sedation....
dose should be given at bedtime
49
The more sedating the TCA...
the more anticholinergic properties it has
50
TCA dosage for elderly is ___ adult dose
1/2
51
Alcohol intake in conjunction with TCA causes ___ and ___
sedation and ataxia
52
Why can't suicidal clients take TCAs
because of fatal cardiac and cerebral toxicity in overdoses of TCA
53
___ and ___ are effective in treating depression, but are not as safe or well tolerated as antidepressants like SSRI, SNRI, NDRI
MAOI and TCAs
54
2 Important OTC Anti Depressants
St Johns Wort Kava
55
St Johns Wort (SJW)
used for depression, pain anxiety, insomnia, and premenstrual syndrome modulates serotonin, dopamine, and NEP Risk of developing serotonin syndrome when taken with other serotonergic drugs
56
Kava
used for anxiety reduction interacts with dopaminergic transmission, inhibits MAO-B enzyme system and modulates GABA receptors risk for severe liver injury, thrombocytopenia, leukopenia, and hearing impairment
57
MAOIs
Antidepressant Monoamine oxidase inhibitors Inhibits MAO, an enzyme that breaks down serotoning, NEP, and others - by inhibiting this enzyme serotonin and NEP activity is increased in the synapse
58
SE of MAOIs
dizziness HA insomnia dry mouth blurred vision constipation NV peripheral edema urinary hesitancy muscle weakness forgetfulness weight gain sexual dysfunction
59
Never eat what kinds of foods when taking MAOIs
Tyramine Rich Foods
60
Why do you never eat tyramine rich foods with MAOIs
it will result in hypertensive crisis
61
What are some tyramine rich foods to avoid with MAOIs
Cheeses Herbal Extracts (Palmetto, Ginseng) Fruits (avoacdos, overripe and dried fruit, egg plant, grapes, figs, organes, pineapple, plum, prune, raisin) Process foods (yeast extract, sauerkraut, shrimp paste, pickled meats and vegis) Meat and Fish (liver, game birds, meat by products) Soy Chocolate (in hihg quantities it causes HA NV)
62
What other than tyramine rihc foods causes hypertensive crisis with MAOI use
amphetamines, methyldopa, levodopa, EP, NEP, Dopamine, vasoconstrictors, narcotic analgesics some other antidepressants
63
How long should you avoid other antidepressant use when having taken an MAOI
avoid use within 2 weeks of each other
64
Important Nursing Considerations for MAOI use
extensive instruction about foods and medications to avoid with MAOI use like cheese, cold and decongestant medication and nasal sprays severe HA, excess perspiration, lightheaded, vomiting, increased HR - MAOI hyptensive crisis liekly hold meds and contact physician + ER
65
MAOIs can never be combined with ____
SSRIs
66
Action of Antidepressants
increase concentration of NEP and serotonin in the body by blocking reuptake - TCA, SSRI or inhibiting release of MAO - MAOIs
67
Mood Stabilizers (Anti Mania Drugs)
Lithium Anticonvulsants Calcium Channel Blockers Adrenergic Blocking Agents Atypical Antipsychotics
68
Lithium
med for bipolar disorder - 40% effectiveness
69
Action of Lithium
uncertain - crosses cell membranes altering sodium transport, not protein bound
70
Onset of Lithium
5-7 days may take as long as 2 weeks
71
Therapeutic Lithium Blood Levels are...
0.8 to 1.5 mEq/L
72
SE of Lithium
thirst metallic taste increased frequency of urination fine head and hand tremor drowsiness mild diarrhea
73
Nursing Considerations for Lithium
Lithium Toxicity - monitor blood levels Monitor Creatinine concen, thyroid hormones and CBC every 6 months Kidney damage risk thryoid function alteration after 6-18 months including potentia dry skin, bradycardia, constipation, hair loss, and cold intolerance
74
Lithium Toxicity S/S
severe diarrhea vomiting drowsiness muscular weakness and lack of coord
75
Lithium toxicity occurs when...
sodium levels are low and absorption is disrupted - excessive hear, diaphoresis, diuretic
76
Lithium Toxicity signs below 1.5 mEq/L
``` lethargy slurred speech muscle weakness hand tremors NVD ```
77
LIthium Toxicity signs between 1.5 and 2 mEq/L
coarse hand tremor, mental confusion, drowsiness, lack of coord, GI distress, EKG changes
78
Lithium toxicity signs between 2-2.5 mEq/L
ataxia, blurred vision, stupor, coma, resp failure
79
What lithium level is life threatening
above 2.5 mEq/L
80
Important Teaching Needs for Patients Taking Lithium
1. Several weeks for full benefit - if a dose is missed DO NOT DOUBLE UP 2. Do not change salt intake consumption 3. Do not take pain meds, alcohol, sleeping pills as this will enhance sedation effects 4. Weight increase common 5. Avoid caffeine - impacts effectiveness 5. Serum blood tests 2x weekly for initial beginning therapy
81
Higher salt concentrations do what to lithium
decreases absorption (and effectiveness)
82
Anticonvulsant
Mood Stabilizer Drug Reduces repetitive firin og action potentials in the nerves
83
When are anti convulsants used as mood stabilizers
when patients have no responded well to lithium
84
Pharmacokinetics of Anticonvulsants
peak serum levels in 1-4 hours patients need education on potential drug interactions
85
Carbamazepine (Tegretol)
anti convulsant/mood stabilizer effective for aggressive and hostile symptoms
86
Lamotrigin (Lamictal)
anti convulsant / mood stabilizer decreases manic behaviors
87
Oxcarbazepine (Trileptal)
useful in bipolar
88
What requires immediate medical intervention if experienced while on anticonvulsants
any rash
89
Carbamazepine SE
Dizziness Drowsiness Tremor Visual Disturbances NV weight gain alopecia
90
There is increased risk for what when taking Carbamazepine
increased risk for aplastic anemia and agranulocytosis
91
How to minimize carbamazepine SE
minimized by treating in low doses given with food
92
SE of Lamotrigine (Lamictal)
benign skin rash sedation blurred or double vision dizziness NV Other GI symptoms
93
In rare cases what can occur with Lamotrigine (Lamictal)
Stevens Johnson Syndrome - 15% A severe life threatening rash that occurs within 2-8 weeks of treatment Immediately discontinued if rash is noted
94
Indications for Mood Stabilizer/Anti Convulsant Use?
prevention and treatment of manic episodes associated with bipolar disorder
95
Nursing Dx potentials post anti psychotic/mood stabilizer/anti convulsant
risk for injury risk for self directed or other direct violence risk for activity intolerance
96
What mood stabilizers require blood monitoring to prevent toxicity
lithium depakote tegretol
97
When taking lithium, what should the client make sure to do
take in adequate 2-3 liters/day eat a balanced diet with nL SODIUM INTAKE
98
Mood Stabilizers should be ...
taken with food
99
Do not take mood stabilizers without docto permission, and report any ____, and do not use...
any bruising; not use heavy equipment if drowsy
100
When it comes to mood stabilizers, clients should understand the importance of...
regular blood monitoring
101
Anxiolytics
antianxiety medications used for generalized anxiety disorders, acute anxiety states, social phobia, performance anxiety, and even some short term insomnia relief
102
Buspirone (Buspar)
Anti Anxiety medication binds to serotonin receptor via unknown mechanism of action NOT an anticonvulsant, sedative or muscle relaxant contraindicated in renal and liver impairment and in lactating women
103
Benzodiazepines
anxiolytics - antianxiety meds sedation, muscle relaxant, elevation in seizure threshold works on GABA receptors to dampen neural overstimulation
104
Examples of Benzodiazepines
Xanax Ativan Valium Dalmane Serax Halcion
105
Benzodiazepines are used for...
short term relief of anxiety or anxiety associated with depression
106
SE of Benzos
drowsiness intellectual impairment memory impairment ataxia reduced motor coordination sedation hangover effects tolerance development alcohol potentiating CNS depression abrup discontinuation may result in targe symptom recurrence (rebound)
107
Important Nonbenzodiazepine antianxiety medications to know
buspirone (Buspar) zolpidem (Ambien)
108
Nonbenzodiazepines like Buspar and Ambien are useful in what way compared to benzodiazepines
effective for treating anxiety disorders without the CNS depression effects or the potential for abuse and withdrawal syndromes
109
Main SE of Nonbenzodiazepine antianxiety drugs
dizziness drowsiness nausea
110
Indications for Anti Anxiety Medications
short term management of various anxiety states and treatment of insomnia
111
Action of most anti anxiety meds
depression of the CNS
112
Contraindications and Precautions for Anti Anxiety Medications
those with known hypersensitivity caution in those with hepatic dysfunction or severe renal impairment, those that are suicidal and those that have been addicted to drugs before
113
What interactions change anti anxiety med effects
1. Additive CNS depression with alcohol, anti histamines, antidepressants, phenothiazine, or other CNS depressent drugs 2. Barbituates decrease effectiveness of drugs metabolized by the liver 3. Adverse effect when taken with MAOI
114
Indications for antipsychotic med use
treatment of acute and chronic psychoses selected agents are also used as antiemetics in the treatment of intractable hiccoughs and for control of tics and vocal utterances in tourettes
115
Action of Antipsychotic meds
unknown though to block post synaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla newer antipsychotics may block action on receptors specific to dopamine, serotonin and other NTs
116
Antipsychotic big benefit and negative when released
huge breakthrough but SE are significant with some irreversible
117
Nursing Diagnoses related to antipsychotic meds
risk for injury disturbed sleep pattern risk for activity intolerance risk for acute confusion
118
Antipsychotic medications target symptoms of what
schizophrenia mania autism symptoms of psychosis such as hallucination, delusion, bizarre behavior, disorganized thinking, agitation psychosis
119
Antipsyhotic meds mostly target what
the NT dopamine
120
Examples of Typical and Atypical Antipsychotic meds
typical: Prolixin, Navane, Loxitane, Haldol atypical: Clozeril, Abilify, Geodon, Zyprexa
121
What is the big difference between typical and atypical antipsychotic meds
atypical meds have far fewer side effects
122
SE of Typical/Traditional Antipsychotic Meds
Cardiovascular / Orthostatic Hypotension - HIGH FALL RISK Anticholinergic effects weight gain diabetes sexual side effects blood dyscrasias neuroleptic malignant syndrome photosensitivity lowered seizure threshold medication related movement disorders
123
SE of Atypical Antipsychotic Medications
sedation weight gain insomnia agitation minimal anticholinergic effects MUCH LESS RISK OF DEVELOPING EPS AND/OR TARDIVE DYSKINISA
124
___ is an atypical antipsychotic with greater sedation, anticholinergic, and orthostatic hypotension effects than others
Clozaril
125
The importance of regular administration of antipsychotic medications is to ...
provide treatment and prevent exacerbations of psychosis
126
While taking clozaril, what must a patient have done
They may need to have blood count monitored frequently because of the drugs potential for bone marrow toxicity (leads to low WBC)
127
Acute and Chronic Extrapyramidal Syndromes that can be Medication Related Movement Disorders
Dystonia, Pseudoparkinsonism, Akathisia - Acute Tardive Dyskinisia - Chronic
128
Dystonia
involuntary muscle spasms abnormal postures oculogyric crisis torticollis acute movement disorder related to medication use
129
Pseudoparkinsonism
rigidity, akinesia (swlo movement) tremor masklike face loss of spontaneous movements acute movement disorder related to medication use
130
Akathisia
inability to sit still restlessness acute movement disorder related to medication use
131
Medication Related Movement Disorders sometimes occur as a result of using what type of medicine
anti psychotics
132
What is the etiology of medication related movement disorders
related to dopamine in nigrostrial pathway that increases cholinergic activity
133
Tx for Acute Medication Related Movement Disorders
Anticholinergic medication for dystonia and parkinsonism (Artane and Congentin) Akathisia does not usually respond to anticholinergic meds, but beta blockers have best success
134
Tardive Dyskinesia
irregular, reptitive, involuntary movement sof mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips and rapid eye blinking abnormal finger movements are common a chronic medication related movement disorder syndrome
135
When do symptoms begin for medication related tardive dyskinesia and are they reversible?
potentially irreversible begin 6 months after start of antipsychotic use or when they are withdrawn
136
Etiology of Tardive Dyskinesia
cause unclear
137
Tx for Tardive Dyskinesia
prevention by using atypical antipsychotics, using lowest possible dose, minimizine use of PRN, closely monitoring those in high risk groups standardized assessments to monitor at a minimium of 3 to 6 month intervals
138
Nursing Diagnoses for Anti Psychotics and Medication Related Movement Disorders
risk for other directed violence risk for injury risk for activity intolerance noncompliance
139
The most common reason for psych medication noncompliance is...
side effects!
140
Compliance to psych med regimens can be improved through...
education
141
Psychiatric nurses should actively...
address compliance concerns

NURS363 - Practice of Nursing IV (17 decks)

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