Card Set Information
lccc nursing psych pharm
For Cummings exam 2
What was the purpose of neuroleptics when they were introduced in the 1950s?
Intended to relieve physical/behavioral symptoms, not cure disease
Does not resolve emotional problems
Intended as an adjunct to individual or group therapy
What are categories of psychopharmacology?
Anti-manic (mood stabilizers)
Describe pharmacodynamics and pharmacokinetics
: refers to the actions of the drug on the person
: refers to the actions of the person on the drug (ADME)
Describe the neurotransmitters Dopamine, Norepinephrine, Serotonin, GABA and acetylcholine
: Increased in Schizophrenia and mania. Decreased in Depression and Parkinson's
: increased in mania, anxiety, schizophrenia. Decreased in depression.
: increased in anxiety. Decreased in depression.
: increased to reduce anxiety. Decreased in anxiety disorders, schizophrenia
: increase in depression. Decreased in parkison's, alzheimers, and huntingtons
What is antipsychotic medication used for? What is the method of action? What are the common side effects?
First gen were used to treat the symptoms of schizophrenia
: strong antagonist of D2 receptors for dopamine
: EPS, drowsiness, sedation, dry mouth
What are the first generation anti-psychotic medications?
-Haloperidol (Haldol) (May be given IM to relieve manic, aggressive behavior)
What are the exrapyramidal side effects (EPS) of first gen anti-psychotics?
Acute dystonic reactions
: within minutes, spasms of the face, arms, legs
: muscle weakness
: 1-2 mo of tx leads to continuous restlessness
: within 1-5 days. drooling, rigidity, tremor, shuffling gait
: uncontrolled rolling back of eyes. Prone for young men
: long-term use, involuntary movements such as tongue protrusion, lip smacking, grimacing, blinking, chewing. Early recognition is key as this is irreversible with no treatment
What is neuroleptic malignant syndrome (NMS)?
Onset is within hours to years of treatment
Life-threatening dysregulation of thermo regulation
: hyperpyrexis up to 107 degrees, tachycardia, rigidity, labile BP, diaphoresis, rapid deterioration of mental status, photosensitivity
THIS IS AN EMERGENCY and temperatures should always be assessed for some one on a first gen antipsych
Bromocriptine (Parlodel is the antidote)
What improvements were made with second gen anti-psychotics? What other things are they used for? What is the method of action? What are the common side effects?
Produce fewer EPS side effects
Target both positive and negative symptoms
Are now the first line treatment. May also be used as an anti-emetic, intractable hiccups, tics, vocal utterance in Tourretes
MOA is unknown, but thought to bind to the dopamine receptors
: weight gain, metabolic side effects such as diabetes and heart disease, occasional nausea
What are examples of atypical anti-psycotic medications?
: best at treating hallucinations
: sedating, give at hs
Olanzapine (Zyprexa) and Clozapine (Clozaril)
: significant weight gain of 100 lbs +
: dopamine stabilizer used as an adjunct also for BPD. Very expensive
: effective for hallucinations, causes widened Qt interval, bad for cardiac pts
: active metabolite of risperdal, no generic and very expensive
What is the most significant adverse effect for Clozapine (clozaril)?
Agranulocytosis- potentially fatal
Sore throat is the first/main symptom and should never be ignored
Abrupt onset of fever, malaise, sore throat, leukopenia within the first 3 mo of treatment
: stop meds, reverse isolation, antibiotics
: weekly CBC, monitor WBC
What side effects come from the dopamine blockage effect of anti-psychotics?
What side effects come from the muscarinic blockage effect of anti-psychotics?
Dry mouth (watch for H20) toxicity
What are the anticholinergic symptoms from anti-psychotic use?
What are anticholinergics used for in relation to antipsychotics?
Used to counteract the side effects/adverse effects of antipsychotics
: blocks central acetylcholine receptors
*one of these should always be ordered when an antipsych med is prescribed
Describe TCAs. Name some commonly used TCAs. Why are they not the first line drug?
: Major Depressive Disorder (MDD)
: blocks reuptake of norepi & to small degree sertonin; also blocks receptors for acetylcholine
: blurry vision, dry mouth, constipation, tachycardia**
Do not give freq due to cardiac SE
Describe MAOIs. Name commonly used MAOIs
Monoamine Oxidase Inhibitors (MOAI)
: MDD, GAD, PTSD
: inactivates MAO, a chemical that inactivates norepi, serotonin, dopamine, tyramine
: orthostatic hypotension, weight gain, change in cardiac rate/rhythm, sexual dysfunction, mania
What special considerations need to be taken for clients on MAOIs?
Special diet low in tyramine due to risk of HTN crisis and CVA
Describe the MOA, use, and side effects for SSRIs
Selective Serotonin Reuptake Inhibitors
: blocks the reuptake of serotonin
: MDD, OCD, social phobia, Anxiety D/O
: lower incidence of anti-cholinergic effects, abd discomfort, diarrhea, irritability, insomnia, sexual side effects (dysfunction, decreased libido)
*dose at same time each day, take with meals to decrease n/v/d
*do not take with grapefruit juice, limit to 6 oz/day
*4-6 wks to reach therapeutic levels
Name the common SSRIs
What are SNRIs? What is their method of action and side effects? Give some examples
Serotonin-norepinephrine reuptake inhibitors
: depression, smoking cesstion
: blocks the reuptake of serotonin and norepi
: nausea, dry mouth, dizziness, constipation, seizures
-Bupropion (Wellbutrin, Zybran)
: low dose used for smoking cessation
- Desvenlafaxine (Pristiq)
: active metabolite of Effexor, no generic, very expensive
: sedation, give at hs
: more energy
What are SNDI? Give and example
Antagonizes (blocks) apha 2 receptors
Antidepressant + antianxiety + antiemetic effects
: Mirtazapine (Remeron)
Describe patient teaching for clients on antidepressants
Takes weeks to months to reach therapeutic blood level
1. SE that can be noticed within days
2. Do not stop taking your meds- notify your provider
What medications are categorized as mood stabilizers?
Anticonvulsant drugs (slow down the firing in the brain)
-Valproate (Depakote, depakene)
Describe Lithium, the MOA, and side effects
: antimania, BPD
: may alter the Na and K+ across the cell membrane, may balance serotonin and norepi.
*competes with sodium, dehydration can lead to toxicity
: dry mouth, diarrhea, dizziness, slurred speech, slight tremors
What is the therapeutic range for lithium? What are the s/s of toxicity?
: 0.5-1.5 mEq/L
-fine hand tremor, mild thirst
: 1.5 mEq/L
-n/v/d, slurred speech
: 1.5-2.0 mEq/L
-course tremors, confusion
: 2.0 mEq/L and above
-confusion, abd pain, seizures, hypotension, incontinence, ekg changes
* must draw levels 8-12 hrs after last dose prior to admin
*there is no antidote for toxicity, although hemodialysis and hydrating may be helpful if caught early
What patient teaching should be done for a client on lithium?
Know the side effects of toxicity and when to call provider
Do not change your dosage without speaking with provider
Stay well hydrated, dehydration can lead to toxicity
Follow up blood work will be necessary
Describe Lamotrigine (lamictal)
Useful for maintenance phase of BPD
Not used for acute mania
: steven johnson syndrome can occur at any time! (usually within first 3 mo)
Report ANY skin changes and do not change any personal care items/laundry detergent during therapy
What kinds of medications are commonly used for anxiety disorders?
Benzodiazepines- potentiates actions of GABA
SSRIs- inhibit actions of serotonin
Beta Blockers- treats somatic manifestations of anxiety- tremors, palpitations
Uses: anxiety, sleep induction, acute alcohol withdrawal, phobias, pre-med for surgery
Describe s/e of Benzodiazepines and give examples
: sedation, dizziness, drowsiness, blurry vision, physical dependence, tolerance, withdrawal if stopped
Do not stop abruptly for risk of rebound seizures
Flumazenil (romazicon) is antidote
BZD + ETOH is deadly!
What are z-hypnotics? Give examples
Short acting sedative-hypnotic agents
Do not dose after midnight
Same antidote as BZD
What medication are used for obsessive disorders? What are their MOA and side effects?
-fluoxetine (Prozac)- works well for OCD behaviors
: regulation of serotonin
: drowsiness, n/v/d, stomach upset, sexual side effects
What medications are used as CNS stimulants?
*Dextroamphetamine (Adderal, Vyvanse)
*Atomoxetine (strattera)- only drug approved for kids under 6 y/o
*Methyphenidate (Ritalin, daytrana)
: for ADHD
: loss of appetite, tachycardia, GI upset
*dose before noon, treat like narcotic in pyxis
What medications are commonly used for substance abuse? What is most successful?
*Subutrex and LAAM most effective, therapy combo needed
Describe Disfulfiram (Antabuse) and Naltrexone (Revia)
: chronic alcoholism
: blocks oxidation of alcohol at acetaldehyde stage, producing a reaction including HA, flusing, n/v, sweating, chest pain
: narcotic abuse
: blocks opiate receptors, blocking mechanism of Reinforcement, lasts 72hrs
Describe Buprenorphine (Subutrex) and Methadone (dolophine)
: effective for heroine
: opioid agonist. Blocks effects of opiod withdrawal.
: opioid treatment, esp for heroine but end up addicted to the methadone instead
: synthetic opioid (synthetic morphine) that blocks craving but is highly addictive
: drowsiness, confusion, HA, n/v. HR for resp depression
What is LAAM?
Dose every 3 days
Properties similar to morphine, addictive
What acetylcholinesterase inhibitors are used for Alzheimers?
Mematine (Namenda, Namenda XR *for mod to severe)