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

Week 6 Part 1: Psychopharmacology Flashcards

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
Q

SNRIs

A

serotonin norepinephrine reuptake inhibitors - antidepressant

prevent reuptake of serotonin and NEP at presynaptic site

ex: Effexor, Serzone, Cymbalta, Norpramin

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26
Q

Side Effects of SNRIs

A

same as SSRIs + increased blood pressure

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27
Q

NDRI

A

NEP Dopamine Reuptake INhibitor - antidepressant

INhibits reuptake of dopamine NEP and serotonin

ex: Wellbutrin, Zyban

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28
Q

SE of NDRIs

A

agitation

anxiety

insomnia

appetite suppression

psychosis

increased seizures

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29
Q

It is very important to do what prior to giving NDRIs

A

VERIFYING PREVIOUS SEIZURE HX SINCE IT INCREASES INCIDENCE

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30
Q

NaSSA

A

alpha 2 antagonists - antidepressants

boosts NEP/Noradrenaline serotonin by blocking alpha 2 adrenergic presynaptic receptors on a serotonin receptor

ex: Remeron

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31
Q

SE of NaSSA

A

sedation (at lower doses)

dizziness

weight gain

dry mouth

constipation

change in urinary fxn

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32
Q

SARI

A

serotonin 2 antagonist/reuptake inhibitor - antidepressant

blocks serotonin 2A receptor potently and serotonin reuptake less potently

ex: Deyrel

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33
Q

SE of SARIs

A

sedation

weight gain

NV

constipation

dizziness

fatigue

incoordination!

tremor!

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34
Q

What can cause a toxic, sometimes fatal, reaction when used with an SSRI

A

MAOIs

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35
Q

SSRI use can boost the effects of what drugs

A

Tricycle antidepressants

hydantoin

clozapine

haloperidol

beta blockers

st johns worts (EVEN OTC!!!)

warfarin

etc

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36
Q

SSRI can decrease effects of ___ and ___

A

digoxin and buspirone

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37
Q

What popular psych drug can increase effects of SSRI

A

lithium

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38
Q

What can occur when SSRIs are used with other drugs that increase serotonin

A

Serotonin Syndrome - emergency!

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39
Q

S/S of Serotonin Syndrome

A

mental status change - hallucination, agitation, coma

Autonomic instability - tachycardia, hyperthermia, BP changes

Neuromuscular problems - hyperreflexia, incoordination

GI disturbance - NVD

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40
Q

Serotoning syndrome can be __ ___

A

life threatening

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41
Q

The effects of SSRIs are generally not seen for ___-___ days and it will take how long to reach full client benefit?

A

10-21 days

takes weeks longer after the first 10-21 days to reach full benefit

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42
Q

What is important to teach the patient regarding SSRI/SNRI

A

relief not immediate - will be experienced in time

skipping a dose can cause withdrawal symptoms

low to medium dose may cause sexual SE

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43
Q

Tricyclic Antidepressants

A

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

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44
Q

TCA S/S

A

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

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45
Q

The most common side effects of TCAs are

A

sedation

orthostatic Hypotension

anticholinergic SE like dry mouth, blurry vision, urinary retention and delay, confusion, constipation, and hypotension

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46
Q

the biggest s/s of TCAs is

A

early morning awakening

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47
Q

TCAs are as effective as ___, but…

A

SSRIs, but have more serious side effects and a higher lethal potential

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48
Q

If the TCA causes sedation….

A

dose should be given at bedtime

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49
Q

The more sedating the TCA…

A

the more anticholinergic properties it has

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50
Q

TCA dosage for elderly is ___ adult dose

A

1/2

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51
Q

Alcohol intake in conjunction with TCA causes ___ and ___

A

sedation and ataxia

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52
Q

Why can’t suicidal clients take TCAs

A

because of fatal cardiac and cerebral toxicity in overdoses of TCA

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53
Q

___ and ___ are effective in treating depression, but are not as safe or well tolerated as antidepressants like SSRI, SNRI, NDRI

A

MAOI and TCAs

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54
Q

2 Important OTC Anti Depressants

A

St Johns Wort

Kava

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55
Q

St Johns Wort (SJW)

A

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

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56
Q

Kava

A

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

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57
Q

MAOIs

A

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
Q

SE of MAOIs

A

dizziness

HA

insomnia

dry mouth

blurred vision

constipation

NV

peripheral edema

urinary hesitancy

muscle weakness

forgetfulness

weight gain

sexual dysfunction

59
Q

Never eat what kinds of foods when taking MAOIs

A

Tyramine Rich Foods

60
Q

Why do you never eat tyramine rich foods with MAOIs

A

it will result in hypertensive crisis

61
Q

What are some tyramine rich foods to avoid with MAOIs

A

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
Q

What other than tyramine rihc foods causes hypertensive crisis with MAOI use

A

amphetamines, methyldopa, levodopa, EP, NEP, Dopamine, vasoconstrictors, narcotic analgesics

some other antidepressants

63
Q

How long should you avoid other antidepressant use when having taken an MAOI

A

avoid use within 2 weeks of each other

64
Q

Important Nursing Considerations for MAOI use

A

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
Q

MAOIs can never be combined with ____

A

SSRIs

66
Q

Action of Antidepressants

A

increase concentration of NEP and serotonin in the body by blocking reuptake - TCA, SSRI

or

inhibiting release of MAO - MAOIs

67
Q

Mood Stabilizers (Anti Mania Drugs)

A

Lithium

Anticonvulsants

Calcium Channel Blockers

Adrenergic Blocking Agents

Atypical Antipsychotics

68
Q

Lithium

A

med for bipolar disorder - 40% effectiveness

69
Q

Action of Lithium

A

uncertain - crosses cell membranes altering sodium transport, not protein bound

70
Q

Onset of Lithium

A

5-7 days may take as long as 2 weeks

71
Q

Therapeutic Lithium Blood Levels are…

A

0.8 to 1.5 mEq/L

72
Q

SE of Lithium

A

thirst

metallic taste

increased frequency of urination

fine head and hand tremor

drowsiness

mild diarrhea

73
Q

Nursing Considerations for Lithium

A

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
Q

Lithium Toxicity S/S

A

severe diarrhea

vomiting

drowsiness

muscular weakness and lack of coord

75
Q

Lithium toxicity occurs when…

A

sodium levels are low and absorption is disrupted - excessive hear, diaphoresis, diuretic

76
Q

Lithium Toxicity signs below 1.5 mEq/L

A 
lethargy
slurred speech
muscle weakness
hand tremors
NVD
77
Q

LIthium Toxicity signs between 1.5 and 2 mEq/L

A

coarse hand tremor, mental confusion, drowsiness, lack of coord, GI distress, EKG changes

78
Q

Lithium toxicity signs between 2-2.5 mEq/L

A

ataxia, blurred vision, stupor, coma, resp failure

79
Q

What lithium level is life threatening

A

above 2.5 mEq/L

80
Q

Important Teaching Needs for Patients Taking Lithium

A
  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
  6. Serum blood tests 2x weekly for initial beginning therapy
81
Q

Higher salt concentrations do what to lithium

A

decreases absorption (and effectiveness)

82
Q

Anticonvulsant

A

Mood Stabilizer Drug

Reduces repetitive firin og action potentials in the nerves

83
Q

When are anti convulsants used as mood stabilizers

A

when patients have no responded well to lithium

84
Q

Pharmacokinetics of Anticonvulsants

A

peak serum levels in 1-4 hours

patients need education on potential drug interactions

85
Q

Carbamazepine (Tegretol)

A

anti convulsant/mood stabilizer

effective for aggressive and hostile symptoms

86
Q

Lamotrigin (Lamictal)

A

anti convulsant / mood stabilizer

decreases manic behaviors

87
Q

Oxcarbazepine (Trileptal)

A

useful in bipolar

88
Q

What requires immediate medical intervention if experienced while on anticonvulsants

A

any rash

89
Q

Carbamazepine SE

A

Dizziness

Drowsiness

Tremor

Visual Disturbances

NV

weight gain

alopecia

90
Q

There is increased risk for what when taking Carbamazepine

A

increased risk for aplastic anemia and agranulocytosis

91
Q

How to minimize carbamazepine SE

A

minimized by treating in low doses

given with food

92
Q

SE of Lamotrigine (Lamictal)

A

benign skin rash

sedation

blurred or double vision

dizziness

NV

Other GI symptoms

93
Q

In rare cases what can occur with Lamotrigine (Lamictal)

A

Stevens Johnson Syndrome - 15%

A severe life threatening rash that occurs within 2-8 weeks of treatment

Immediately discontinued if rash is noted

94
Q

Indications for Mood Stabilizer/Anti Convulsant Use?

A

prevention and treatment of manic episodes associated with bipolar disorder

95
Q

Nursing Dx potentials post anti psychotic/mood stabilizer/anti convulsant

A

risk for injury

risk for self directed or other direct violence

risk for activity intolerance

96
Q

What mood stabilizers require blood monitoring to prevent toxicity

A

lithium

depakote

tegretol

97
Q

When taking lithium, what should the client make sure to do

A

take in adequate 2-3 liters/day

eat a balanced diet with nL SODIUM INTAKE

98
Q

Mood Stabilizers should be …

A

taken with food

99
Q

Do not take mood stabilizers without docto permission, and report any ____, and do not use…

A

any bruising; not use heavy equipment if drowsy

100
Q

When it comes to mood stabilizers, clients should understand the importance of…

A

regular blood monitoring

101
Q

Anxiolytics

A

antianxiety medications used for generalized anxiety disorders, acute anxiety states, social phobia, performance anxiety, and even some short term insomnia relief

102
Q

Buspirone (Buspar)

A

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
Q

Benzodiazepines

A

anxiolytics - antianxiety meds

sedation, muscle relaxant, elevation in seizure threshold

works on GABA receptors to dampen neural overstimulation

104
Q

Examples of Benzodiazepines

A

Xanax

Ativan

Valium

Dalmane

Serax

Halcion

105
Q

Benzodiazepines are used for…

A

short term relief of anxiety or anxiety associated with depression

106
Q

SE of Benzos

A

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
Q

Important Nonbenzodiazepine antianxiety medications to know

A

buspirone (Buspar)

zolpidem (Ambien)

108
Q

Nonbenzodiazepines like Buspar and Ambien are useful in what way compared to benzodiazepines

A

effective for treating anxiety disorders without the CNS depression effects or the potential for abuse and withdrawal syndromes

109
Q

Main SE of Nonbenzodiazepine antianxiety drugs

A

dizziness

drowsiness

nausea

110
Q

Indications for Anti Anxiety Medications

A

short term management of various anxiety states and treatment of insomnia

111
Q

Action of most anti anxiety meds

A

depression of the CNS

112
Q

Contraindications and Precautions for Anti Anxiety Medications

A

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
Q

What interactions change anti anxiety med effects

A
  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
Q

Indications for antipsychotic med use

A

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
Q

Action of Antipsychotic meds

A

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
Q

Antipsychotic big benefit and negative when released

A

huge breakthrough but SE are significant with some irreversible

117
Q

Nursing Diagnoses related to antipsychotic meds

A

risk for injury

disturbed sleep pattern

risk for activity intolerance

risk for acute confusion

118
Q

Antipsychotic medications target symptoms of what

A

schizophrenia

mania

autism

symptoms of psychosis such as hallucination, delusion, bizarre behavior, disorganized thinking, agitation psychosis

119
Q

Antipsyhotic meds mostly target what

A

the NT dopamine

120
Q

Examples of Typical and Atypical Antipsychotic meds

A

typical: Prolixin, Navane, Loxitane, Haldol
atypical: Clozeril, Abilify, Geodon, Zyprexa

121
Q

What is the big difference between typical and atypical antipsychotic meds

A

atypical meds have far fewer side effects

122
Q

SE of Typical/Traditional Antipsychotic Meds

A

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
Q

SE of Atypical Antipsychotic Medications

A

sedation

weight gain

insomnia

agitation

minimal anticholinergic effects

MUCH LESS RISK OF DEVELOPING EPS AND/OR TARDIVE DYSKINISA

124
Q

___ is an atypical antipsychotic with greater sedation, anticholinergic, and orthostatic hypotension effects than others

A

Clozaril

125
Q

The importance of regular administration of antipsychotic medications is to …

A

provide treatment and prevent exacerbations of psychosis

126
Q

While taking clozaril, what must a patient have done

A

They may need to have blood count monitored frequently because of the drugs potential for bone marrow toxicity (leads to low WBC)

127
Q

Acute and Chronic Extrapyramidal Syndromes that can be Medication Related Movement Disorders

A

Dystonia, Pseudoparkinsonism, Akathisia - Acute

Tardive Dyskinisia - Chronic

128
Q

Dystonia

A

involuntary muscle spasms

abnormal postures

oculogyric crisis

torticollis

acute movement disorder related to medication use

129
Q

Pseudoparkinsonism

A

rigidity, akinesia (swlo movement)

tremor

masklike face

loss of spontaneous movements

acute movement disorder related to medication use

130
Q

Akathisia

A

inability to sit still

restlessness

acute movement disorder related to medication use

131
Q

Medication Related Movement Disorders sometimes occur as a result of using what type of medicine

A

anti psychotics

132
Q

What is the etiology of medication related movement disorders

A

related to dopamine in nigrostrial pathway that increases cholinergic activity

133
Q

Tx for Acute Medication Related Movement Disorders

A

Anticholinergic medication for dystonia and parkinsonism (Artane and Congentin)

Akathisia does not usually respond to anticholinergic meds, but beta blockers have best success

134
Q

Tardive Dyskinesia

A

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
Q

When do symptoms begin for medication related tardive dyskinesia and are they reversible?

A

potentially irreversible

begin 6 months after start of antipsychotic use or when they are withdrawn

136
Q

Etiology of Tardive Dyskinesia

A

cause unclear

137
Q

Tx for Tardive Dyskinesia

A

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
Q

Nursing Diagnoses for Anti Psychotics and Medication Related Movement Disorders

A

risk for other directed violence

risk for injury

risk for activity intolerance

noncompliance

139
Q

The most common reason for psych medication noncompliance is…

A

side effects!

140
Q

Compliance to psych med regimens can be improved through…

A

education

141
Q

Psychiatric nurses should actively…

A

address compliance concerns

NURS363 - Practice of Nursing IV (15 decks)

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