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What are positive symptoms of Schizophrenia?
- Are characterized by CNS stimulation and include agitation, delusions (imagination that someone is working w me to do something), hallucinations (perception of stimulation w/o the stimulus), insomnia, and paranoia (a fear or something).
- A-D-H-I- P = agitation-delution-hallucination-Insomnia-paranoia.
What are negative symptom in schizophrenia?
- Are characterized by lack of pleasure, lack of motivation, blunted affect (talking make a joke and they don't laugh), poverty of speech.
What is psychoses?
- Psychoses is a major emotional disorder w impairment of mental functioning.
- Hallmark: loss of contact w reality.
- Schizophrenia is a type of chronic psychosis.
what are the therapy goals in schizophrenia? How long do they take to work? what kind of medicine is it used?
- Normalize patterns of sleeping and eating.
- Increase ability to self care and socialization.
- It takes around 2 months for these therapeutic effects.
- Meds: antipsychotic meds.
What type of antipsychotics are there? describe their functionality and side effects.
- There are two types: First generation antipsychotic (FGAs) and Second generation antipsychotic (SGSs)
- First generation antipsychotic (conventional antipscychotics): block dopamine receptors in the CNS, and cause serious movement disorders or EPS -- also 10x less expensive than SGAs.
- Second generation antipsychotics (atypical antipsychotics) : Moderate blockage of dopamine, but stronger blockage of serotonin -- Produce less extrapyramidal symptoms (EPS) but produce risk of metabolic effects.
What are extrapyramidal symptoms (EPS)? which generation are the more associated with?
- EPS: acute dystonia, Parkinsonism, Akathisia, Tardive Dyskinesia.
- Acute dystonia: Abnormal muscle tone causing spasms of tongue, face, neck. EX: girl hyperextending the neck-- concern abt constricting the air way.
- Parkinsonism: ... concerns of falls.
- Akathisia: motor restlessness (moving a lot like Michael fox -- concern abt hitting others or themselves.
- Tardive Dyskinesia: Involuntary movement of mouth, tongue, trunk, extremities; chewing motions, sucking -- it is not like spasms, this are constant.
- EPS are associated more with first generation antipsychotics.
What are Depot preparations drugs for schizophrenia or psychotic pts?
What are some common interaction to watch for with conventional antipsychotic drugs?
- They are injections for ppl that don't take their meds and refuse pills.
- DI: anticholinergic drugs, CNS depressants (opioids and alcohol), levodopa and direct-receptors agonist (may counteract the antipsychotic effect)
What are some low-potency Agents antipsychotic meds? first generation.
- Chlorpromazine (thorazine) and Thioridazine (Mellaril)
- They are low potency but high sedative effect, hypotension, photosensitivity.
What are conventional antipsychotic agents classes? (first generation)
- Low-potency agents.
- Medium-potency agents.
- High-Potency agents.
- Depot preparations.
High-potency conventional drugs? side effects?
- Drugs: Haloperiodol (Haldol), Fluphenazine (prolixin), Trifluoperazine (stelazine).
- SE: Low sedative effect, low incidence of hypotension, extrapyramidal side effects (EPS)
What are some atypical antipsychotic agents? Common characteristics of this group?
- Drugs: Clozapine (clozaril) and other atypical antipsychotic (Risperidone (Risperdal), Olanzapine (zyprexa), Quetiapine (seroquel), Ziprasidone (geodon), Aripiprazole (abilify))
- C-R-Z-S-G-A (cruze sega)
- Char: Less risk of EPS that FGAs, More is of weight gain, diabetes,and dyslipidemia.
Clozapine (Clozaril) MA? TU? AE?
- MA: blocks dopamine and serotonin.
- TU: Schizophrenia.
- AE: agranulocytosis (knocks down the WBC, pt come to the hospital w a fever), seizures, diabetes, weight gain, myocarditis.
Risperidone (risperdal) MA? TU? AE?
- MA: Binds to multiple receptors.
- TU: schizophrenia.
- AE: generally infrequent and mild.
Olanzapine (zyprexa) MA? TU? AE?
- MA: blocks 5-HT2 receptros, and blocks D2 receptos.
- TU: Schizophrenia, and Bipolar disorder.
- AE: Not a lot of AE.
Quetiapine (Seroquel) preparations, dosage and administration?
Schizophrenia dosage, and Bipolar disorder dosage.
Ziprasidone (Geodon) MA? Preparation, dosage, and admin?
- MA: blocks multiple receptors D2, 5-HT2, H1.
- PDA: Schizophrenia IM. Bipolar disorder
Aripiprazole (abilify) Chrs? MA?
- Contrasts w other atypical antipsychotic agents.
- MA: block multiple receptors.
what antipsychotic drugs can be given IM?
- Haloperidol (Haldol)- 1st gen
- Fluphenazine (Prolixin) - 1st gen
- Risperidone (risperdal) - atypical
What are some common characteristics of Tricyclic antidepressants? SE? Most dangerous SE? MOA? PK? DI?
- Drugs of first choice for many patients with major depression.
- Used for depression, angry, insomnia.
- May increase risk of suicide early in treatment.
- SE: Sedation, increased appetite, take dose at bedtime, orthostatic hypotension, and anticholinergic effects.
- MDSE: Cardiac toxicity (doesn't happen often, unless they overdose)
- MOA: Blocks neuronal reuptake of tow monoamine transmitters (Norepinephrine and Serotonin)
- PK: Usually single daily dose. Long and variable half-lives.
- DI: all other antidepressant, anticholinergic agents, and CNS depressants.
What are the CM for toxicity of Tricyclic antidepressants? Treatment for those? to what type of pts should this drug be rx to?
- Dysrhythmias, tachycardia, IV blocks, complete atrioventricular block, ventricular tachycardia, ventricular fibrillation.
- Tx: Gastric lavage, ingestion of activated charcoal, etc.
- RX: to depressed pts that can't sleep. Pt. should take meds at night before going to sleep.
Selective Serotonin Reuptake Inhibitors (SSRIs) characteristics? Common drug? what type of pt should this drug be rx? MA? TU? SE? DI?
- Most prescribed antidepressant bc they DO NOT cause hypotension, sedation, or anticholinergic effects.
- Drug: Fluxetine (Prozac, Sarafem); Sertraline (zoloft), escitalopram (lexapro). Paxil.
- RX: to pts that are depressed and sleepy.
- MA: Inhibits serotonin reuptake and produces CNS excitation (like overconsumption of alcohol)
- TU: Major depression, Obsessive-compulsive disorder (OCD), Bulimia nervosa, and premestrual dysphoric disorder.
- SE: take in the am to avoid insomnia, and urinary retention (only anticholinergic effect), sexual affect,
- DI: MAOIs, warfarin, Tricyclic antidepressants and lithium.
what are S/NRIs? drugs? SE? what type of pt should this drugs be rx to? meds interactions?
- Serotonin/Norepinephrine Reuptake Inhibitors (S/NRIs)
- Drugs: Venlafaxine (effoxor), Duloxetine (cymbalta)
- SE: Diastolic HTN, hyponatremia (in elderly) -- However, if HTN is present, then HTN meds is added, the anti depression med is not taken out.
- RX: sleepy type of pt, bc we want to excite them a little.
- DI: Alcohol and MAO inhibitos, and other antidepressants.
What are MAO inhibitors? characteristics? drugs? MOA? TU? AE? what type of pt should it be RX? at what time should pt take drug? DI? what foods contain Tyramine?
- Monoamine Oxidase inhibitors (MAOIs)
- Chs: 2nd or 3th choice for the pts -- as effective as TCAs or SSRIs, but more dangerous. -- Risk of HTN crisis when eating foods rich in Tyramine.
- Drugs: Tranylcypromine sulfate (Parnate), Phenelzine sulfate (Nardil) 2 most common used, Isocarboxazid.
- MOA: inactivates MonoAmine neurotrasmitters (NE, serotonin, and Dopamine).
- TU: Depression, Bulimia Nervosa, OCD, panic attacks.
- AE: CNS stimulation (usually ppl don't take coffee), Orthostatic Hypotension, Hypertensive crisis (tyramine).
- RX: sleepy pt, pt should take drug in the morning.
- DI: Antihypertensive drugs, Meperidine, interactions secondary to inhibition of hepatic MAO, indirect-acting sympathomimetic agents (ephedrine)
- Foods: aged cheese, fermented meat (pepperoni, salami, bologna), liver, yogurt, yeast (bread), beer, wine, sour cream, pickle products (beats, tomatoes), avocados, bananas, figs, raisins.
What are the nursing Implications for MAOI's?
- Avoid tyramine foods.
- Avoid caffeine, antihistamines, and amphetamines.
- Avoid Triclyclics. (TCAs)
- Monitor vital signs.
- Wear sunblock (usually recommended for all the antidepressants)
What is Selegiline (Emsam)?
It is a transdermal MAOI. Used for depression.
What are some atypical antidepressants? Action and uses?
- Bupropion (wellbutrin): acts as stimulant and suppresses appetitte -- doesn't cause weight gain -- increases sexual desire and pleasure.
- Wellbutrin is usually a drug that is added when in other antidepressants.
What is the drug therapy for Bipolar disorder? Characteristics?
- DT: Mood stabilizers. to relieve and prevent symptoms when in manic and depressive episodes. -- use antipsychotics (manic episodes) and antidepressants (depressive episodes).
- Chs: Ppl w BPD tend to have less gray matter.
What is a common drug used for BPD? MOA? PK? AE therapeutic range? DI?
- MOA: alters synthesis and release of norepi, serotonin, and dopamine.-- Mediates intracellular responses to neurotransmitters -- can increase total gray matter in regions known to atrophy in BPD.
- PK: excreted in the kidneys -- It is affected by the levels of sodium, therefore, pts in lithium should avoid fast food, can goods, and keep a normal level of sodium.
- AE: narrow TR (0.5 to 1.5 mEq/L) KNOW THI VALUE.
- DI: Diuretics, NSAIDs, and anticholinergic drugs.
What are some common anti epileptic drugs?
- Valproic acid (depacon, depakene, depakote) --> targe 50-125 mcg/mL
- Carbamazepine (tegretol)--> 5 to 12
- Lamotrigine (Lamictal)--> indicated for long-term maintenance.
What are some common Sedative-hypnotic drugs?
- Benzodiazepine-like drugs.
Benzodiazepines most common drug? drugs? chs? Benz vs Barbiturates? AE? DI? Acute toxicity (overdose)?
- Diazepam (valium)-- Most of the drugs end in -PAM (Pam helps us go to sleep).
- drugs: Diazepam (Valium), alprazlam (xanax), lorazepam (ativan).
- Chs: safer than CNS depressants -- high potential for abuse -- fewer drug interactions.
- VS: benzos are safer, but less potent than barbiturates.
- AE: CNS depression (but not like opioids), by themselves will not cause a person to stop breathing, abuse, tolerance and physical dependence.
- DI: CNS depressants, alcohol, opioids. (need to be cautious).
- AT: oral overdose use REMAZICON (Parentally). if opioids, use narcan or nalaxon.
Drugs: zolpidem (ambien), zaleplon (sonata), eszopiclone (lunesta).
what are the classes of barbiturates? MOA? AE? TU?
- Ultrashort-acting (thiopental), short-to- intrmediate-acting (secobarbital), and long-actin (phenobarbital)
- MOA: bind to the GABA receptor-chloride channel complex.
- AE: Respiratory depression, CNS depression, cardiovascular effects, tolerance, physical dependence,
- TU: Seizures disorders, induction of anesthesia, Insomnia.
What are some common CNS stimulants and ADHD?
Amphetamines, Methylphenidate and dexmethylphenidate, methylxanthines (caffeine), Miscellaneous stimulants.
Amphetamines MOA? AE? toxicity? TU? Drugs?
- MOA: Release norepi (NE) and Dopamine (DA).
- AE: CNS stimulants , weight loss (be careful in kinds), Cardiovascular effects (increase HR, and BP), Psychosis (sitting in a class, not even moving).
- Toxicity: dysrhythmias, HTN, Dizziness, etc
- TU: ADHD, narcolepsy, Obesity (not recommended due to risk for abuse)
- Drugs: amphetamine/dextroamphetamine mixture (aderall and aderral-XR), Lisdexamfetamine (vyvanse), Methylphenidate (concerta/retalin)
Methylphenidate and dexmethylphenidate drugs? Pharmacology?
- Ritalin and Focalin.
- Pharm: Almost identical to amphetamines.
Methylxanthines derivates? drugs? MOA? PE? PK? TU? acute toxicity?
- Derivates: Xanthine.
- Drugs: Theophylline (used in asthma), Theobromine, caffeine and dietary sources (chocolate, desserts, soft drinks, cola nut).
- MOA: Reversible blockade of adenosine receptors.
- PE: CNS, Heart, Blood vessels, etc.
- PK: absorbed in the GI tract, eliminated by hepatic metabolism.
- TU: neonatal apnea, promoting wakefulness.
- AT: stimulation of the CNS, tachycardia, respiratory stimulation, sensory phenomena.
ADHD management overview? what are the 5 most important things when assessing a pt w ADHD?
- Cognitive therapy and stimulant drug.
- Could also use Tricycle antidepressants (make the person sleepy) Bupropion (wellbutrin).
- 5 things: High and weight, HR and BP, sleep.
types of anxiety disorders? drugs use?
- Generalized anxiety disorder (GAD): non-drug approach first -- Benzos, nonbenzos Buspirone (BuSpar) which is kind of a CNS stimulant. -- Paroxetine (paxil) or Escitalopram (lexapro) -- kava or melatonin.
- Panic Disorder: antidepressants (SSRIs, Tricyclic antidepressants, MAOIs) or Benzos.
- OCD: SSRI
- Social anxiety disorder (social phobia), post-dramatic stress disorder (PTSD): usually use SSRI first line and TCAs depends on the pts's response.
What is the Drug of choice for older adults?
- DOC: SSRIs.
- TACs aggravate conditions in older adults (orthostatic hypotension and anticholinergic effects)
- MAOIs cause HTN crisis (tymanine)
- Older adults have higher serum levels bc of the albumin protein.
- Lithium is more toxic in older adults.
Most important Nursing implications?
- Always assess risk of suicide.
- Monitor Vital signs and weight.
- Avoid OTCs.
- Avoid alcohol.
- Avoid driving if drowsy.