Psych Pharm

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Psych Pharm
2015-03-23 21:18:36
lccc nursing psych pharm

For Cummings exam 2
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  1. 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
  2. What are categories of psychopharmacology?
    • Anti-psychotic
    • Anti-cholinergic
    • Anti-depressant
    • Anti-manic (mood stabilizers)
    • Anti-anxiety
    • Anti-obsessional
    • CNS stimulant
  3. Describe pharmacodynamics and pharmacokinetics
    • Pharmacodynamics: refers to the actions of the drug on the person
    • Pharmacokinetics: refers to the actions of the person on the drug (ADME)
  4. Describe the neurotransmitters Dopamine, Norepinephrine, Serotonin, GABA and acetylcholine
    • Dopamine: Increased in Schizophrenia and mania. Decreased in Depression and Parkinson's
    • Norepinephrine: increased in mania, anxiety, schizophrenia. Decreased in depression.
    • Serotonin: increased in anxiety. Decreased in depression.
    • GABA: increased to reduce anxiety. Decreased in anxiety disorders, schizophrenia
    • Acetylcholine: increase in depression. Decreased in parkison's, alzheimers, and huntingtons
  5. 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
    • MOA: strong antagonist of D2 receptors for dopamine
    • Side effects: EPS, drowsiness, sedation, dry mouth
  6. What are the first generation anti-psychotic medications?
    • Phenothiazines:
    • -Chlorpromazine (thorazine)
    • -Fluphenazine (Prolixin)
    • -Thiothixene (Narvane)
    • Butyrophenones:
    • -Haloperidol (Haldol) (May be given IM to relieve manic, aggressive behavior)
  7. What are the exrapyramidal side effects (EPS) of first gen anti-psychotics?
    • Acute dystonic reactions: within minutes, spasms of the face, arms, legs
    • Akinesia: muscle weakness
    • Akathisia: 1-2 mo of tx leads to continuous restlessness
    • Parkinson's syndrome: within 1-5 days. drooling, rigidity, tremor, shuffling gait
    • Oculogyric crisis: uncontrolled rolling back of eyes. Prone for young men
    • Tardive dyskinesia: 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
  8. What is neuroleptic malignant syndrome (NMS)?
    • Onset is within hours to years of treatment
    • Life-threatening dysregulation of thermo regulation
    • S/S: 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)
  9. 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
    • Side effects: weight gain, metabolic side effects such as diabetes and heart disease, occasional nausea
  10. What are examples of atypical anti-psycotic medications?
    • Risperidone (Risperidol): best at treating hallucinations
    • Quetiapine (Seroquel): sedating, give at hs
    • Olanzapine (Zyprexa) and Clozapine (Clozaril): significant weight gain of 100 lbs +
    • Aripiprazole (abilify): dopamine stabilizer used as an adjunct also for BPD. Very expensive
    • Ziprasidone (Geodon): effective for hallucinations, causes widened Qt interval, bad for cardiac pts
    • Paliperidone (Invega): active metabolite of risperdal, no generic and very expensive
    • lloperidone (Fanapt)
    • Lurasidone (Latuda)
    • Asenapine (Saphris)
  11. 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
    • Interventions: stop meds, reverse isolation, antibiotics
    • Prevention: weekly CBC, monitor WBC
  12. What side effects come from the dopamine blockage effect of anti-psychotics?
    • Movement changes:
    • -Parkinsonian
    • -Akinesia
    • -Akathisia
    • -Tardive dyskinesia
  13. What side effects come from the muscarinic blockage effect of anti-psychotics?
    • Blurred vision
    • Dry mouth (watch for H20) toxicity
    • Constipation
    • Urinary difficulty
  14. What are the anticholinergic symptoms from anti-psychotic use?
    • Dry mouth
    • Urinary hesitancy/retention
    • Constioation
    • Blurred Vision
    • Photosensitivity
    • Dry eyes
  15. What are anticholinergics used for in relation to antipsychotics?
    • Used to counteract the side effects/adverse effects of antipsychotics
    • MOA: blocks central acetylcholine receptors
    • Examples:
    • -Trihexyphenidyl (Artane)
    • -Diphenhydramine (Benadryl)
    • -Benztropine (Cogentin)
    • *one of these should always be ordered when an antipsych med is prescribed
  16. Describe TCAs. Name some commonly used TCAs. Why are they not the first line drug?
    • Use: Major Depressive Disorder (MDD)
    • MOA: blocks reuptake of norepi & to small degree sertonin; also blocks receptors for acetylcholine
    • Side effects: blurry vision, dry mouth, constipation, tachycardia**
    • Do not give freq due to cardiac SE
    • Examples:
    • -Amitriptyline (Elavil)
    • -Imipramine (Tofranil)
    • -Nortriptyline (Pamelor)
  17. Describe MAOIs. Name commonly used MAOIs
    • Monoamine Oxidase Inhibitors (MOAI)
    • Use: MDD, GAD, PTSD
    • MOA: inactivates MAO, a chemical that inactivates norepi, serotonin, dopamine, tyramine
    • Side effects: orthostatic hypotension, weight gain, change in cardiac rate/rhythm, sexual dysfunction, mania
    • Examples:
    • -Isocarboxazid (Marplan)
    • -Phenelzine (Nardil)
    • -Selegiline (EMSAM)
    • -Tranylcypromine (Parnate)
  18. What special considerations need to be taken for clients on MAOIs?
    • Special diet low in tyramine due to risk of HTN crisis and CVA
    • No:
    • -smoke meats
    • -cheeses
    • -beer
    • -bananas
    • -pepperoni, salami
    • -caffeine
    • -chocolate
  19. Describe the MOA, use, and side effects for SSRIs
    • Selective Serotonin Reuptake Inhibitors
    • MOA: blocks the reuptake of serotonin
    • Uses: MDD, OCD, social phobia, Anxiety D/O
    • SE: 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
  20. Name the common SSRIs
    • Citalopram (Celexa)
    • Fluoxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Escitalopram (Lexapro)
  21. What are SNRIs? What is their method of action and side effects? Give some examples
    • Serotonin-norepinephrine reuptake inhibitors
    • Uses: depression, smoking cesstion
    • MOA: blocks the reuptake of serotonin and norepi
    • SE: nausea, dry mouth, dizziness, constipation, seizures
    • Examples:
    • -Bupropion (Wellbutrin, Zybran): low dose used for smoking cessation
    • -Venlaxafine (Effexor)
    • - Desvenlafaxine (Pristiq): active metabolite of Effexor, no generic, very expensive
    • -Trazodone (Oleptro): sedation, give at hs
    • -Duloxetine (Cymbalta): more energy
  22. What are SNDI? Give and example
    • Serotonin-Norepinephrine Disinhibitors
    • Antagonizes (blocks) apha 2 receptors
    • Antidepressant + antianxiety + antiemetic effects
    • Example: Mirtazapine (Remeron)
  23. 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
  24. What medications are categorized as mood stabilizers?
    • Lithium
    • Anticonvulsant drugs (slow down the firing in the brain)
    • -Valproate (Depakote, depakene)
    • -Carbamazepine (Tegretol)
    • -Lamotrigine (lamictal)
    • -Gabapentin (Neurontin)
    • -Oxcarbazepine (Trileptal)
    • -Topiramate (Topamax)
  25. Describe Lithium, the MOA, and side effects
    • Mood Stabilizer
    • Uses: antimania, BPD
    • MOA: may alter the Na and K+ across the cell membrane, may balance serotonin and norepi.
    • *competes with sodium, dehydration can lead to toxicity
    • Side effects: dry mouth, diarrhea, dizziness, slurred speech, slight tremors
  26. What is the therapeutic range for lithium? What are the s/s of toxicity?
    • Therapeutic range: 0.5-1.5 mEq/L
    • -fine hand tremor, mild thirst
    • Early toxicity: 1.5 mEq/L
    • -n/v/d, slurred speech
    • Advanced: 1.5-2.0 mEq/L
    • -course tremors, confusion
    • Severe: 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
  27. 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
  28. Describe Lamotrigine (lamictal)
    • Useful for maintenance phase of BPD
    • Not used for acute mania
    • Cautions: 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
  29. 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
  30. Describe s/e of Benzodiazepines and give examples
    • Side effects: 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!
    • -Diazepam (valium)
    • -Clonazepam (klonopin)
    • -Alprazolam (Xanax)
    • -Lorazepam (Ativan)
  31. What are z-hypnotics? Give examples
    • Short acting sedative-hypnotic agents
    • Do not dose after midnight
    • Same antidote as BZD
    • Zolpidem (ambien)
    • Zaleplon (sonata)
    • Eszopiclone (Lunesta)
  32. What medication are used for obsessive disorders? What are their MOA and side effects?
    • SSRIs:
    • -fluoxetine (Prozac)- works well for OCD behaviors
    • -fluvoxamine (Luvox)
    • TCA:
    • -Clomipramine (anafranil)
    • MOA: regulation of serotonin
    • SE: drowsiness, n/v/d, stomach upset, sexual side effects
  33. What medications are used as CNS stimulants?
    • *Dextroamphetamine (Adderal, Vyvanse)
    • *Atomoxetine (strattera)- only drug approved for kids under 6 y/o
    • *Methyphenidate (Ritalin, daytrana)
    • used: for ADHD
    • SE: loss of appetite, tachycardia, GI upset
    • *dose before noon, treat like narcotic in pyxis
  34. What medications are commonly used for substance abuse? What is most successful?
    • Disulifram (Antabuse)
    • naltrexone (Revia)
    • Buprenorphine (subutrex)
    • Methadone (Dolophine)
    • LAAM
    • *Subutrex and LAAM most effective, therapy combo needed
  35. Describe Disfulfiram (Antabuse) and Naltrexone (Revia)
    • Disulfiram (Antabuse)
    • use: chronic alcoholism
    • MOA: blocks oxidation of alcohol at acetaldehyde stage, producing a reaction including HA, flusing, n/v, sweating, chest pain

    • naltrexone (revia)
    • Use: narcotic abuse
    • MOA: blocks opiate receptors, blocking mechanism of Reinforcement, lasts 72hrs
  36. Describe Buprenorphine (Subutrex) and Methadone (dolophine)
    • Buprenorphine (Subutrex)
    • use: effective for heroine
    • MOA: opioid agonist. Blocks effects of opiod withdrawal.
    • Given SL

    • Methadone (dolophine)
    • Use: opioid treatment, esp for heroine but end up addicted to the methadone instead
    • MOA: synthetic opioid (synthetic morphine) that blocks craving but is highly addictive
    • SE: drowsiness, confusion, HA, n/v. HR for resp depression
  37. What is LAAM?

    • Methadone alternative
    • Dose every 3 days
    • Properties similar to morphine, addictive
  38. What acetylcholinesterase inhibitors are used for Alzheimers?
    • Tacrine (Cognex)
    • Donepezil (Aricept)
    • Galantamine (Razadyne)
    • Revastigmine (Exelon)
    • Mematine (Namenda, Namenda XR *for mod to severe)