psych_parm.txt

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digver
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150970
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psych_parm.txt
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2012-04-29 17:46:17
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pharm psych
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psych pharm
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  1. (6) psychopharmacology classes
    • antipsychotics
    • antidepressants
    • anxiolytics (antianxiety)
    • cognitive enhancers
    • mood stabilizers
    • stimulants
  2. What is the use and action of antipsychotic drugs?
    • Use: treatment of psychotic symptoms
    • Action: block dopamine receptors
  3. (3) types of neuroleptic or antipsychotic Drugs
    • Conventional or typical
    • Atypical or noval
    • New generation (dopamine system stabilizers)
  4. (7) Traditional or Typical Antipsychotics
    • chlorpromazine (Thorazine)
    • fluphenazine (Prolixin)
    • haloperidol (Haldol)
    • loxapine (Loxitane)
    • mesoridazine (Serentil)
    • thioridazine (Mellaril)
    • thiothixene (Navane)
  5. (3) High Potency Neuroleptics
    • haloperidol (Haldol)
    • fluphenazine (Prolixin)
    • thiothixene (Navane)
  6. Properties of High Potency Neuroleptics
    • Low Sedation
    • Low Anticholinergic Effects
    • High Extrapyramidal Symptoms
  7. (3) Low Potency Neuroleptics
    • chlorpromazine (Thorazine)
    • mesoridazine (Serentil)
    • thioridazine (Mellaril)
  8. Properties of Low Potency Neuroleptics
    • High Sedation
    • High Anticholinergic Effects
    • Low Extrapyramidal Side Effects
  9. (6) Atypical or Noval Antipsychotics?
    • Clozapine (Clozaril)
    • Risperidone (Risperdal)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Ziprasidone(Geodon)
    • Asenapine (Saphris)
  10. Extrapyramidal syndrome (EPS):
    • torticollis (head is tilted to one side)
    • acute dystonia
    • ___ oculogyric crisis (upward deviation of the eyes)
    • pseudoparkinsonism (stooped posture, mask-like faces, shuffling gait)
    • akinesia (inability to initiate movement)
    • akathisia (inability to remain motionless)
    • ___ restlessness, anxiety, agitation
    • Tardive dyskinesia: involuntary asymmetrical movements of the muscles)
  11. What is the cause of EPS, treatment?
    • Typicallly caused by dopamine antagonists
    • Tx: diphenhydramine
    • ___ anticholinergic drugs
  12. Tardive Dyskinesia
    • Involuntary Muscle Spasms
    • Periorbital Movements
    • Tongue Protruding
    • Rocking
    • Abnormal Involuntary Movement Scale (AIMS)
  13. Neuroleptic Malignant Syndrome
    • Acute Decrease in Brain Dopamine
    • Severe Muscle Rigidity
    • Hperpyrexia
    • Autonomic Dysfuction
    • Delirium
    • Risk Factors include: Female, Rapid Titration, Mood Disorder
    • Fatal in 10% Cases
  14. Antipsychotics: Side Effects
    • Other side effects:
    • Increased prolactin levels
    • Weight gain (atypical agents, except ziprasidone)
    • Prolonged QT interval (thioridazine, ziprasidone, mesoridazine)
    • Agranulocytosis (clozapine)
  15. Antipsychotics: Client Teaching
    • Adherence to regimen
    • Side effects, management
    • Thirst/dry mouth (sugar-free candy, liquids)
    • Constipation (dietary fiber, stool softeners)
    • Sedation (safety measures)
    • Actions for missed dose (dose if within 4 hours of usual time)
    • CBC, with clozapine
  16. (4) uses for antidepressants
    • major depressive illness
    • anxiety disorders
    • depressed phase of bipolar disorder
    • psychotic depression
  17. (4) classes of antidepressants
    • Tricyclic antidepressants (TCAs)
    • Selective serotonin reuptake inhibitors (SSRIs)
    • Mono-animase oxidiserinhibitors (MAOIs)
  18. (3) Tricyclic Antidepressants
    • amitriptyline (Elavil)
    • desipramine (Norpramin, Pertofrane)
    • mirtrazipine (Remeron)
    • nortriptyline (Aventyl, Pamelor)
  19. (5) SSRIs (selective serotonin reuptake inhibitors)
    • citalopram (Celexa)
    • escitalopram (Lexapro)
    • fluoxetine (Prozac)
    • paroxetine (Paxil)
    • sertraline (Zoloft)
    • Vilazodone (Viibryd)
  20. (3) SNRIs (Serotinin/Norepinephrine Reuptake Inhibitors)
    • desvenlafaxine (Pristiq)
    • duloxetine (Cymbalta)
    • venlafaxine (Effexor)
  21. (4) MAOIs
    • isocarboxazid (Marplan)
    • phenelzine (Nardil)
    • selegiline (Emsam, Eldepryl, Zelapar)
    • tranylcypromine (Parnate)
  22. (1) Non-specific antidepressants
    bupropion (Wellbutrin)
  23. Action of Phenylpiperazine antidepressants
    SSRI and/or serotonin receptor blockers
  24. (2) Phenylpiperazine antidepressants
    • nefazodone (Serzone)
    • trazodone (Desyrel,Oleptro)
  25. (6) Side Effects of SSRIs
    • anxiety
    • agitation
    • akathisia
    • nausea
    • insomnia
    • sexual dysfunction
    • Weight gain
  26. (6) side effects of TCAs
    • Anticholinergic effects
    • Orthostatic hypotension
    • sedation
    • weight gain
    • tachycardia
    • sexual dysfunction
  27. (6) side Effects of MAOIs
    • daytime sedation
    • insomnia
    • weight gain
    • dry mouth
    • orthostatic hypotension
    • sexual dysfunction
    • Hypertensive crisis (with foods containing tyramine)
  28. Antidepressant Drug Interactions
    • MAOI + SSRI or SSRI alone
    • ___ Serotonin syndrome
  29. Serotonin syndrome
    • agitation
    • sweating, fever
    • tachycardia, hypotension
    • rigidity
    • hyperreflexia
    • !extreme reactions!
    • !! coma
    • !! death
  30. Antidepressants: Client Teaching
    • Time of dosage
    • ___ SSRI first thing in morning
    • ___ TCAs at night
    • Actions for missed dose
    • ___ SSRI up to 8 hours after missed dose
    • ___ TCA within 3 hours of missed dose
    • Safety measures
    • Dietary restrictions if taking MAOI
  31. (3) Mood Stabilizers
    • lithium carbonate (Lithium)
    • carbamazepine (Tegretol)
    • divalproex sodium (Depakote)
    • gabapentin (Neurontin)
  32. Mood-Stabilizing Drugs
    • Lithium
    • some anticonvulsants
    • ___ carbamazepine
    • ___ valproic acid
    • ___ gabapentin
    • ___ topiramate
    • ___ oxcarbazepine
    • ___ lamotrigine
  33. Side Effects Lithium
    • Nausea, diarrhea
    • anorexia
    • fine hand tremor
    • polydipsia, polyuria
    • metallic taste
    • fatigue, lethargy
    • Toxicity
    • ___ Severe diarrhea
    • ___ vomiting
    • ___ drowsiness
    • ___ muscle weakness
    • ___ lack of coordination
    • later in therapy
    • ___ weight gain
    • ___ acne
  34. Side effects of carbamazepine and valproic acid
    drowsiness, sedation, dry mouth, blurred vision
  35. Mood-Stabilizing Drugs: Side Effects
    • Carbamazepine (Tegratol): rash, orthostatic hypotension
    • Valproic acid (Depakote): weight gain, alopecia, hand tremor
    • Topiramate (Topamax): dizziness, sedation, weight loss
  36. Mood-Stabilizing Drugs: Client Teaching
    • Periodic monitoring of blood levels
    • 12 hours after last dose taken
    • Drug with meals
    • Safety measures
  37. Anti-Anxiety Agents
    • Benzodiadepines
    • Valium
    • Xanex
    • Serax
    • Restoril
  38. Antianxiety Drugs
    • Use: treatment of anxiety and anxiety disorders, insomnia, OCD, depression, post-traumatic stress disorder, alcohol withdrawal
    • Benzodiazepines, buspirone
    • Mechanism of action
    • Mediation of GABA (benzodiazepines)
    • Partial agonist activity at serotonin receptors (buspirone)
  39. Antianxiety Drugs: Side Effects
    • Benzodiazepines
    • Physical, psychological dependence
    • CNS depression
    • Hangover effect
    • Tolerance
    • Buspirone
    • Dizziness, sedation, nausea, headache
  40. Antianxiety Drugs: Client Teaching
    • Safety measures
    • Avoidance of alcohol
    • Avoidance of abrupt discontinuation
  41. Cognitive Enhancers
    • Aricept
    • Reminyl
    • Exelon
    • Namenda
  42. Stimulant Medications
    • Ritalin (methylphenidate)
    • Cylert (pemoline)
    • Strattera (atomoxetine)
    • Adderall (dextroamphetamine)
    • Dexadrine (Dextroamphetamine sulfate)
  43. Stimulants
    • Mechanism of action
    • Cause release of norepinephrine, dopamine, serotonin presynaptically
    • Direct agonist effects postsynaptically
    • Block reuptake of neurotransmitters
  44. Stimulants: Side Effects and Client Teaching
    • Side effects
    • Anorexia, weight loss, nausea, irritability
    • Growth, weight suppression
    • Client teaching
    • Dose after meals
    • Avoidance of caffeine, sugar, chocolate
    • Drug holidays
    • Proper storage out of reach of children
  45. Disulfiram (Antabuse)
    • Use: aversion therapy for alcoholism
    • Mechanism of action: inhibition of enzyme involved with alcohol metabolism
    • Adverse reaction with alcohol ingestion
    • Side effects: fatigue, drowsiness, halitosis, tremor, impotence
  46. Disulfiram (Antabuse)
    • Drug interactions with phenytoin, isoniazid, warfarin, barbiturates, long-acting benzodiazepines
    • Client teaching: avoidance of alcohol, including common products that may contain it
    • Shaving cream, deodorant, OTC cough preparations
  47. African American cultuaral considerations for psychoparmacology
    • Lithium lower dose needed for same effect as whites
    • TCA - more rapid response than whites
    • ___ - greater risk for side effects
  48. Asian cultuaral considerations for psychoparmacology
    • TCA - slower metabolism
    • Lithium lower dose needed for same effect as whites
  49. Hispanic cultuaral considerations for psychoparmacology
    antidepressants - lower dose needed for same effect as whites

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