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Were neuroleptics introduced in the 1950s to cure?
No, they were introduced to relieve physical/behaviorals symptoms; do not resolve emotional problems; intended to be used as an adjunct to individual or group psychotherapy
What are the categories of psychopharm?
- anti-manic (mood stabilizers
- CNS stimulant
What is pharmacodynamics? Pharmacokinetics?
- codynamics: what the drug does to the body
- cokinetics: what the body does to the drug (ADME)
What are neurotransmitters?
- chemicals (pre synaptic)
- there are receptors for each,
- reuptake, MAO
What do the different neurotransmitters do?
- Dopamine: fluid movements, it is increased in schizos and mania, and decreased in depression and parkinsons
- Norepinephrine: Increased in mania, anxiety, schizo; and decreased in depression
- Serotonin: increased in anxiety states; decreased in depression
- GABA: increased in reduced anxiety; decreased in anxiety disorders, schizos
- Acetylcholine: Increased in depression; decreased in Parkinson's disease, alzheimers disease and Huntington's chorea
What are the anti-psychotic first generation/standard medications used for? What are the side effects? What is MOA?
- Use: treat + symptoms of schizophrenia
- MOA: strong antagonist of D2 receptors for dopamine
- S/E: EPS, drowsiness, sedation, dry mouth
What are the examples of standard-first generation anti-psychotics?
- Clorpromazine (thorazine)
- Fluphenazine (prolixin)
- thiothixene (Narvane)
- *Haloperidol (haldol)
What are the EPS s/e of standard first gen meds?
- Acute dystonic reactions-within minutes, involuntary spasms of face, arms, legs.
- Akinesia: muscle weakness
- Akathisia: 1-2 months of tx, continuous restlessness
- Parkinson's syndrome: within 1-5 days, drooling, rigidity, tremor, shuffling gait
- Oculogyric crises: uncontrolled rolling back of eyes
- Tardive Dyskinesia: long term use, involuntary movements ie; tongue protrusion, lip smacking, grimacing, blinking
- STOP THE MED; irreversible, NO treatment
What are the life threatening s/e of standard-first gens?
- neuroleptic malignant syndrome: *Onset- withing hours-years of tx; dysregulation of thermo regulator system (hyperpyrexia to 107 degrees, tachycardia, rigidity, labile BP, diaphoresis, rapid deterioration of mental status
What are second generation (atypical) antipsychotic drugs?
- produce fewer EPS side effects
- target both the negative and positive symptoms
- *first line treatment
For what other reasons are Atypical anti-psychotic meds used for? What is the MOA? What are the side effects of atypical meds?
- Also used for: anti-emetic, intractable hiccoughs, tics, vocal, utterances in tourette's
- Moa: unknown; thought to bind to dopamine receptors in limbic system= increased effectiveness, decreased motor side effects
- Side effects: weight gain, metabolic side effects, few to no EPS or sedation, occasional nausea
What are the Atypical anti-psychotics?
- Risperidone (risperdol)
- quetiapine (seroquel)
- Olanzapine (zyprexa)
- aripiprazole (abilify)-dopamine stabilizer
- ziprasidone (geodon)
- clozapine (clozaril)
- paliperidone (invega)
- lloperidone (fanapt)
- lursaidone (latuda)
- asenapine (saphris)
What side effect must you watch for in Clozapine? When is it usually seen? What are the interventions? How is it prevented?
- Agranulocytosis- potentially fatal
- Symptoms: abrupt onset fever, malaise, sore throat, leukopenia
- The first 3 months
- Interventions: Stop the med, reverse isolation, antibiotics
- prevention: weekly CBC, monitor WBC
What are the s/e you will see resulting from antisypchotics? (dopamine blockage, musscarinic blockage, and anticholinergic, metabolic)
- Dopamine: parkinsonian, akinesia, akathesia, and tardive dyskinesia
- Muscarinic: blurred vision, dry mouth, constipation, urinary difficulty
- Anticholinergic: dry mouth, urinary hesitancy/retention, constipation, blurred vision, photosensitivity, dry eyes
- Metabolic: wieght gain (clozaril, zyprexa), diabetes type 2, hyperlipidemia
What is the purpose of anti-cholinergic meds? what is the MOA? what are the side effects? examples of anticholinergics?
- Use: conteract side effects of antipsychotic meds
- MOA: blocks central acetylcholine receptors
- side effects: dry mouth, blurry vision, constipation
- trihexyphenidyl (artane)
- diphrnhydramine (benadryl)
- benztropine (cogentin)
What is the use, MOA, Side effects, and examples of Tri-cyclic-depressants (TCA)
- Use: Major depressive disorder
- MOA: block reuptake of norepi and to a smaller degree serotonin; also blocks receptors for acetylcholine
- side effects: blurry vision, dry mouth, constipation, Tachycardia
- Examples: amitriptyline (elavil)
- imipramine (tofranil)
- nortriptyline (pamelor)
What is the use, MOA, and side effects of monoamine oxidase inhibitors? (MAOIs)
- Use: MDD, Generalized anxiety disorder, PTSD
- MOA: inactivates MAO-chemical that inactivates norepi, serotonin, dopamine, tyramine
- Side effects: orthostatic hypotension, weight gain, change in cardiac rate.rythm, sexual dysfunction, mania
What is the MAOI diet?
- No tyramine-containing foods/drinks due to potential for HTN crises
- Foods: smoked meats, pepperoni, salami, cheeses, beer, bananas, caffeine, chocolate
What are the examples of MAOIs?
- Isocarboxazid (marplan)
- Phenelzine (nardil)
- Selegiline (EMSAM)
- Tranylcpromine (Parnate)
What is the use, MOA, and side effects of SSRIs?
- Use: MDD, OCD, social phobia, anxiety D/O
- MOA: block reuptake of serotonin
- Side effects: lower incidence of anti-cholinergic effects, abdominal discomfort, diarrhea, irritability, insomnia, sexual side effects
What are the examples of SSRIs?
- citalopram (celexa)
- fluoxetine (prozac)
- fluvoxamine (luvox)
- paroxetine (paxil)
- Sertraline (zoloft)
- escitalopram (lexapro)
What is the use, MOA, and side effects of Serotonin-norepi reuptake inhibitors?
- Uses: depression, smoking cessation
- MOA: blocks reuptake of serotonin and norepi Side effect: nausea, dry mouth, dizziness, constipation, seizures
What are the examples of the SNRIs?
- bupropion (wellbutrin, zyban)
- venlaxafine (effexor)
- duloxetine ( cymbalta)
- trazodone (oleptro)
- desvenlafaxine (pristiq)
What is the only atypical antidepressant med? Whats its use? and MOA?
- Serotonin-norepi dis-inhibitor
- MOA: antagonizes (blocks) alpha2 receptors
- Use: antidepressant + antianxiety + antiemetic
- example: mirtazapine (remeron)
What client teaching is needed for meds?
- it can take weeks for months to reach a therapeutic blood level
- Side effects can be experienced with days
- do not stop taking medication, must notify provider
What medications are "mood stabilizers?"
- Anti-convulsant drugs
- Valporate (depakote, depakene)
- carbamazepine (tegretol)
- lamotrigine (lamictal)
- gabapentin (neurontin)
- toripramate (topamax)
- oxcarbazepine (trileptal)
What is the use, MOA, and side effects of lithium?
- Use: Anti-mania, bipolar
- MOA: may alter Na and K across the cell membrane; may balance norepi and serotonin
- Side effect: dry mouth, diarrhea, dizziness, slurred speech
What is the therapeutic effect of lithium? what s/e can you expect from this blood level
- Therapeutic: 0.5-1.5 mEq/L
- S/E: fine hand tremors, mild thirst (most common)
What is early toxicity? what s/e would you expect to see?
- level: 1.5 mEq/L
- s/e: N/V, diarrhea, slurred speech
What is advanced toxicity? what s/e would you expect to see? What is severe toxicity? what side effects would you expect to see?
- advanced: 1.5-2.0 mEq/L
- s/e: course tremors, confusion
- severe: 2.0 mEq/L and above
- s/e: confusion, abd pain, seizures, hypotension, incontinence, EKG changes
What client teaching is necessary for lithium?
- Blood work will be drawn periodically
- Must maintain a diet adequate in sodium, no restrictions. salt substitutes
- Maintain hydration, but do not drink too much
What is Lamotrigine (lamictal) used for? What must you caution for with this drug?
used for maintenance phase of bipolar disorder (not used in acute mania)
caution: Steven's Johnson syndrome
What are the uses and classes/MOA of anti-anxiety meds?
- Uses: anxiety, sleep induction, acute alcohol withdrawl, phobias, pre-med for surgery
- Benzos: potentiates actions of GABA
- SSRIs: inhibits action of serotonin
- Beta blockers: treats somatic manifestations of anxiety- tremos, palpitations
What are the side effects of Benzos? The examples of anti-anxiety-benzos
- Sedation, dizziness, drowsiness, blurry vision, physical dependance, tolerance, withdrawal,
- BZD + ETOH = deadly
- diazepam (valium)
- clonazepam (Klonopin)
- Alprazolam (xanax)
- Lorazepan (ativan)
What are the short acting sedative-hypnotic sleep agents (Z-hypnotics)
- Zolpidem (ambien)
- Zaleplon (Sonata)
- Eszopiclone (lunesta)
What is the use, moa, and s/e of Anti obsessional drugs? What classes/examples?
- Use: OCD
- Moa: regulation of serotonin
- S/E: drowsiness, n/v, diarrhea, stomach upset, sexual side effects
- Class: SSRIs (fluoxetine, fluvoxamine) and TCA- (clomipramine)
What is the use of CNS stimulants? examples?
- use: attention deficit hyperactivity disorder
- examples: methylphenidate (ritalin also daytrana, a transdermal system)
- dextroamphetamine(adderall, Vyvanse)
- atomoxetine (strattera)
What is the use, moa, and s/e of Disfulfiram (antabuse)?
- Use: chronic alcoholism
- MOA: blocks oxidation of alcohol at acetaldehyde stage; accumulation of acetaldehyde which produces a "alcohol reaction"
- S/e: flushing, headache, n/v, chest pain
What is the use, and MOA of Naltrexone (revia)
- Use: narcotic abuse
- MOA: blocks opiate receptors, blocking mechanisms of reinforcements-lasts 72 hours
What is buprenorphine (subutrex)? how is it given?
- it is an opioid agonist; blocks the effects of opioid withdrawal
- given SL
What is the use, MOA, and side effects of Methadone (dolophine)
- use: opioid treatment-heroin, (may get addicted to methadone instead)
- MOA: synthetic opiate that blocks craving, highly addictive
- side effects: drowsiness, confusion, headach, n/v
What is LAAM (Levo-alpha-acetylmethadol)? How often is the dose?
a methadone alternative, it is addictive, with properties similar to morphine
dose: every 3 days
What are acetylcholinesterase inhibitors for? examples?
- For Alzheimer's disease
- Tacrine (cognex)
- Donepezil (aricept)
- galantamaine (razadyne)
- revastigmine (exelon)
- Memantine (namenda, namenda XR)[ moderate to severe stages of disease]
What are the positive symptoms of schizo?
Positive symptoms are those that most individuals do not normally experience but are present in people with schizophrenia. They can includedelusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis.
What are the negative symptoms of schizo?
A lack of behaviors or feelings that usually are present,such as:Losing interest in everyday activities, like bathing, grooming, or getting dressed Feeling out of touch with other people, family, or friends Lack of feeling or emotion (apathy)Having little emotion or inappropriate feelings in certain situations Having less ability to experience pleasure