Medications

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dbrattebo
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88875
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Medications
Updated:
2011-06-02 21:44:51
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  1. Typical Antipsychotics
    Only treats positive symptoms of schizophrenia, no therapeutic effect on the negative symptoms

    most common side effects are the extrapyramidal side effects
  2. EPS
    • Akathisia
    • Akinesia
    • Dystonias
    • Pseudo-parkinsonism
    • Tardive dyskinesia
    • Neuroleptic malignant syndrome

    *anticholinergics are used to prevent/manage these symptoms
  3. Akathisia
    Motor restlessness, inability to remain still

    can also occur as a subjective feeling

    treated by beta blockers or benzodiazepines
  4. Akinesia
    Absence of movement or difficulty with movement
  5. Dystonia
    Muscle spasms

    spastic movements of the neck and back

    treated by antihistamines
  6. pseudo-parkinsonism
    • shuffling and slow gait
    • mask-like facial expression
    • tremors
    • pill-rolling movements of the hands
    • stooping posture
    • rigidity

    treated by anti-parkinsonism meds (anticholinergics) and dopamine
  7. Tardive dyskinesia
    • involuntary and abnormal movements of the mouth, tongue, face, and jaw
    • may progress to the limbs
    • irreversible condition
    • may occur in months after antipsychotic medication use
  8. Neuroleptic Malignant Syndrome
    a potentially lethal side effect of antipsychotic medication that requires emergency treatment

    • manifested symptoms include:
    • -hyperthermia
    • -muscle rigidity
    • -tremors
    • -altered consciousness
    • -tachycardia
    • -hypertension
    • -incontinence
  9. Atypical Antipsychotics
    • -effective in treating the positive and negative symptoms of schizophrenia
    • -minimal to no risk of EPS
    • -decreased risk for tardive dyskinesia
    • -often chosen as a first line of treatment for schizophrenia
    • -can cause weight gain
    • -can cause metabolic abnormalities that increase risk for cardiac conditions and diabetes mellitus
  10. Mood Stabilizers
    • Lithium
    • Anticonvulsants
  11. Lithium
    • drug of choice for controlling manic episodes in clients with bipolar disorder
    • instruct pt to maintain constant sodium intake; Na depletion will decrease renal excretion of lithium, which will cause the drug to accumulate and lead to lithium toxicity
    • serum lithium must be monitored frequently because the therapeutic levels and the toxic levels are very close
    • in clients with mania, lithium reduces euphoria, hyperactivity, and other symptoms but does not cause sedation
    • Antimanic effects are usually seen 5-7 days after initial doses, although the full effect does not occur for 2-3 weeks
    • when used with benzodiazepine it will cause sedation
    • when used with antipsychotic meds short term it will rapidly decrease psychoses symptoms
    • ADVERSE EFFECTS:
    • -fine hand tremors
    • -GI upset
    • -polydipsia
    • -muscle weakness (myasthenia)

    • TOXICITY:
    • -coarse hand tremors
    • -persistent GI upset-confusion
    • -hyperirritabilty of muscles
    • -ECG changes
    • -sedation
    • -incoordination
  12. Anticonvulsants
    • Valproic acid (Depakote)
    • Carbamazepine (Tegretol)
    • Lamotrigine (Lamictal)

    Depakote has become a first line of treatment for bipolar disorder, but it can cause hepatotoxicity and thrombocytopenia (risk of bleeding)

    Carbamazepine can cause agranulocytosis with increased risk of infection

    Lamictal can cause Stevens-Johnson sydrome
  13. Antidepressant Drugs
    • Tricyclic antidepressants (TCAs)
    • Monoamine oxidase inhibitors (MAOIs)
    • Selective serotonin reuptake inhibitors (SSRIs)
    • Atypical antidepressants
  14. TCAs
    • blocks norepinephrine and serotonin reuptake, therefore intensifying their effects
    • can elevate mood, increase activity and alertness, decrease a client's preoccupation with morbidity, improve appetite, and regulate sleep patterns
    • effects seen 1-3 weeks after initial dose, but maximum effects occur after 6-8 weeks
  15. SSRIs
    • -first-line of treatment for depression
    • -effective for OCD treatment
    • -fewer side effects than TCAs and MAOIs and works faster
    • -effects can be seen after 1-3 weeks
    • -DOES NOT cause hypotension, sedation, or anticholinergic effects (like TCAs)

    • Side Effects:
    • -nausea
    • -insomnia
    • -sexual dysfunction-serotonin syndrome
  16. MAOIs
    • Monoamines: a type of organic compound, including the neurotransmitters norepinephrine, epinephrine, dopamine, and serotonin and many different drugs and food substances
    • Monoamine oxidase (MAO): an enzyme that destroys monoamines
    • Monoamine oxidase inhibitors (MAOIs): drugs that prevent the destruction of monoamines by inhibiting the action of MAO

    • used as a 2nd or 3rd choice to treat major depression
    • has some very dangerous side effects, pts need to avoid certain foods (ex: dairy, alcohol, etc) and drugs (cold remedies, other antidepressants, etc)

    Hypertensive crisis can occur when pt ingests tyramine-rich foods
  17. Most common adverse effects from antidepressant medications
    • orthostatic hypotension
    • sedation
    • cardiac toxicity
    • seizures
    • hypomania
    • sexual dysfunction
    • hypertensive crisis from dietary tyramine (MAOIs)
    • drug interactions
    • anticholinergic effects:
    • -dry mouth
    • -blurry vision
    • -constipation
    • -urinary retention
    • -tachycardia
  18. Medications used to treat anxiety disorders
    • SSRIs (first choice treatment)
    • TCAs
    • Beta adrenergic blockers
    • Antihistamines
    • Antiepileptics
    • Buspar
  19. Serotonin syndrome
    overactivation of the central serotonin receptors, caused by either too high a dose or interaction with other drugs.

    • SIDE EFFECTS:
    • -abdominal pain
    • -diarrhea
    • -sweating
    • -fever
    • -tachycardia
    • -elevated blood pressure
    • -altered mental state (delirium)
    • -myoclonus (muscle spasms)
    • -increased motor activity
    • -irritability
    • -hostility
    • -mood change

    • Severe manifestation can induce:
    • -hyperpyrexia (excessively high fever)
    • -cardiovascular shock
    • -death
  20. Benzodiazepines
    • -increases effectiveness of GABA
    • -few drug interactions
    • -anti-anxiety
    • -may reduce REM sleep

    • SIDE EFFECTS:
    • -ataxia
    • -drowsiness
    • -impaired cognition, memory, and coordination

    • SEVERE EFFECTS:
    • -sedation and death may occur when alcohol and benzodiazepines are used together

    • WITHDRAWAL SYMPTOMS:
    • -difficulty concentrating
    • -fatigue
    • -irritability
    • -insomnia
    • -muscle aches
    • -sweating
    • -tremors
  21. Buspar
    • -serotonin partial agonist used in short-term treatment of anxiety
    • -side effects rarely occur and generally decrease over time as the body adapts to the medication
    • -does not induce immediate calming effect

    • SIDE EFFECTS:
    • -dizziness
    • -drowsiness
    • -headache
    • -nausea
    • -nervousness
    • -lightheadedness
    • -excitement
  22. Beta blockers
    • -calming effect on the CNS
    • -effective in treatment of physical symptoms of anxiety, such as tremors and tachycardia
  23. Antihistamines
    • -sedative effects
    • -used to treat lower levels of anxiety
    • -anticholinergic side effects (blurry vision, urinary hesitancy, etc)

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