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Stack #152435
pharm ch 15, kilgore lvl1
| Question | Answer |
|---|---|
| psychotherapeutics | the treatment of emotional and mental disorders - when the ability to cope w/anxiety, grief and depression significantly affect an individual's ability to perform normal daily functions, treatmetn w/ psychotherapeutic drugs is a possible option |
| types of psychotherapeutic drugs | -antianxiety drugs -antidepressant drugs -antimanic drugs =antipsychotic drugs |
| Three main emotional and mental disorders | -psychoses -affective disorders (mood) -anxiety |
| Psychosis | severe emo disorder that impairs individual to point that he cannot participate in ADLs -look for loss of contact w/ reality (hallucinations, etc...) -schizophrenia, depressive and drug-induced psychoses |
| Affective disorders (depressions/mood disorders) | changes in mood that range from mania to depression -some clients display both mania and depression (bipolar disorder BPD) |
| Anxiety | unpleasant state of mind characterized by sense of dread and fear -may be based on actual anticipated or past experiences -may be exaggerated response to imaginary negative situations |
| Six major anxiety disorders (persistent anxiety) | -OCD, obsessive-compulsive disorder -PTSD, posttraumatic stress disorder -GAD, generalized anxiety disorder -panic disorder -social phobia -simple phobia |
| Biochemical imbalance theory | mental disorders are assoc. w/ abnormal levels of endogenous chemicals (like NTs) in the brain |
| catecholamines | Neurotransmitters (NTs) -dopamine (extrapyramidial symptoms, PD-like symptoms) -norepienephrine |
| Indolamines | -Serotonin -Histamine |
| other biochemicals necessary for normal mental function | -GABA -ACh -Na, K, Mg |
| Antianxiety drugs | reduce anxiety by reducing overactivity in CNS |
| Benzodiazepines | Antianxiety drug (also sedative/hypnotic) -depresses activity in brainstem and limbic system -diazepam (Valium) & chlordiazepoxide (Librium) used often |
| Antihistamines | Antianxiety drug -depresses CNS by sedation -typically used for allergic conditions |
| Busprione (BuSpar) | Antianxiety drug nonsedating and non-habit forming |
| barbituates & carbamates | Antianxiety drugs sedative/hypnotic as well |
| Flumazenil | used to reverse benzodiazepine effects |
| Antimanic drugs | -lithium is drug of choice -narrow therapeutic range, serum levels need to be maintained btwn 0.6 and 1.2 mEq/L... -above 1.2 mEq/L can cause tremors, confusion, seizure and death |
| Biogenic amine hypothesis | -depression/mania due to alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in brain -depression = deficiency of catecholamine, esp norepinephrin -Mania = excess amines |
| Permissive hypothesis | -affective disorders due to decreated concentrations of serotonin -Depression=decreases in serotonin and catecholamine levels -Mania=increased catecholamine, but decreased serotonin |
| Dysregulation hypothesis | -depression and other affective disorders due to failure in regulation of catecholamine activity |
| Newer-generation Antidepressants | Selective seotonin reuptake inhibitors (SSRIs) -less AEs than tricyclics and MAOIs -very few drug/food interactions -takes 4-6 wks to reach max clinical effecctiveness |
| SSRIs (2nd generation) | fluoxetine (Prozac) Paroxetine (Paxil) sertraline (zoloft) citalopram (Celexa) |
| 3rd generation antidepressants | Effexor, Nefazonde, Remeron |
| effects of SSRIs | -selectively inhibit serotonin reuptake (more serotonin concentration at nerve endings) -little to no effect on NE or Dop reuptake -can cause bad affect on cardiovascular system |
| Serotonin Syndrom | -too high concentrations leads to dilerium, tachycardia -sever withdrawl occurs if meds stopped suddenly -can occur w/ concurrent use of MAOIs and SSRIs |
| effects of newer-generation antidepressants | -highly bound to plasma proteins (extends time they work) and have longer half lives -compete w/ other protein-binding drugs, so more free, unbound drug availible for a more pronounced drug effect -inhibits cytochrome P-450 |
| Tricyctlic antidepressants | rarely used now b/c of AEsfirst-generation of antidepressants -used for clients that fail w/ SSRIs or other newer-generation antidepressants -used as adjunct therapy w/ newer antidepressants |
| effects of tricyclic antidepressants | -block reuptake of neurotransmitters, causing accumulation at nerve endings -block NE reuptake (sympathetic system symptoms) -block serotonin reuptake |
| AEs of tricyclic antidepressants | -overdose is lethal, 70-80% die b4 reaching hosp (cardiovascular system affected via seizures or dysrhythmias) -no antidote to overdose, activated charcoal may help |
| MAOIs Monoamine oxidase inhibitor | 2nd line treatment for depression if cyclics not effctive -cheese effect (hypertensive crisis) -severe reaction w/ demerol |
| effects of MAOIs | amines (dopamine, serotonin, NE) are not broken down and higher levels remain in brain, which alleviates symptoms of depression |
| AEs of MAOIs | -orthostatic hypotension most common -cheese affect- hypertensive crisis |
| antipsychotics | drugs used to treat serious mental illness, behavioral problems or pyschotic disorders |
| Butyrophenones | used as antipsychotic -haloperidol (Haldol)= also sedative/hypnotic |
| phenothiazines | (blocks dopamine receptors in brain) newer drugs in this class have less side effects like PD-like syndrome |
| Effects of antipsychotics | block dopamine receptors in brain (limic system & basal ganglia) to produce a tranquilizing effect in psychotic clients |
| effects of atypical antipsychotics (2nd generation) | block specific dopamine receptors and specific serotonin receptors -improves efficacy and safety profiles |
| antipsychotics treat | -bipolar affective disorder -depressive and drug-induced psychoses -Schizophrenia -Autism -Tourette's syndrome (movement disorders) |
| AEs of atypical antipsychotics | -neuroleptic malignant syndrom (NMS) -extrapyramidal symptoms (EPS) :PD-like -Tardive (delayed) dyskinesia (TD) with continuous long-term therapy MANY OTHERS |
| initial 4-6 weeks of treatment | highest risk of suicide in clients during this period while waiting for medication to take full effect |
| herbs to avoid with psychotherapeutic drugs | st. John's wort |
| client education for antidepressants | -several weeks b4 therapeutic effects are seen - |
| client education for tricyclics (antidepressants) | -weaning/discontinued use may be nec b4 undergoing surgery due to drug interactions -caffeine and smoking may decrease effectiveness of med therapy -foods that need to be avoided (tyramine) |
| client education for phenothiazines (antipsychotics) | -photosensitivity: wear sunscreen -avoid alcohol and other CNS depressants -take w/ food -change positions slowly |
| AEs of tricyclic antidepressants | -overdose is lethal, 70-80% die b4 reaching hosp (cardiovascular system affected via seizures or dysrhythmias) -no antidote to overdose, activated charcoal may help |
| MAOIs Monoamine oxidase inhibitor | 2nd line treatment for depression if cyclics not effctive -cheese effect (hypertensive crisis) -severe reaction w/ demerol |
| effects of MAOIs | amines (dopamine, serotonin, NE) are not broken down and higher levels remain in brain, which alleviates symptoms of depression |
| AEs of MAOIs | -orthostatic hypotension most common -cheese affect- hypertensive crisis |
| antipsychotics | drugs used to treat serious mental illness, behavioral problems or pyschotic disorders |
| Butyrophenones | used as antipsychotic -haloperidol (Haldol)= also sedative/hypnotic |
| phenothiazines | (blocks dopamine receptors in brain) newer drugs in this class have less side effects like PD-like syndrome |
| Effects of antipsychotics | block dopamine receptors in brain (limic system & basal ganglia) to produce a tranquilizing effect in psychotic clients |
| effects of atypical antipsychotics (2nd generation) | block specific dopamine receptors and specific serotonin receptors -improves efficacy and safety profiles |
| antipsychotics treat | -bipolar affective disorder -depressive and drug-induced psychoses -Schizophrenia -Autism -Tourette's syndrome (movement disorders) |
| AEs of atypical antipsychotics | -neuroleptic malignant syndrom (NMS) -extrapyramidal symptoms (EPS) :PD-like -Tardive (delayed) dyskinesia (TD) with continuous long-term therapy MANY OTHERS |
| initial 4-6 weeks of treatment | highest risk of suicide in clients during this period while waiting for medication to take full effect |
| herbs to avoid with psychotherapeutic drugs | st. John's wort |
| client education for antidepressants | -several weeks b4 therapeutic effects are seen - |
| client education for tricyclics (antidepressants) | -weaning/discontinued use may be nec b4 undergoing surgery due to drug interactions -caffeine and smoking may decrease effectiveness of med therapy -foods that need to be avoided (tyramine) |
| client education for phenothiazines (antipsychotics) | -photosensitivity: wear sunscreen -avoid alcohol and other CNS depressants -take w/ food -change positions slowly |
| alprazolam (Xanax) | - Benzodiazepine used as anxiolytic - used as an adjunct for depression |
| amitriptyline (elavil) | -Tricyclic antidepressant -potent anticholiergic properties -prototype drug for tertiary-amines |
| bupropion (wellbutrin) | -2nd gen antidepressant -works primarily w/ dopamine and norepinephrin |
| chlordiazepoxide (Librium) | -benzodiazepine used for anxiety relief (also Alcohol withdrawl & preop seditive drug) -IM, use diluent provided -IV, use NS or sterile water |
| diazepam (Valium) | -Benzodiazepine used for anxiety (& alcohol withdrawl, status epilepticus, and sedation) -monitor for prolonged sedation/resp depression/coma |
| fluoxentine (prozac) | -SSRI used for depression -1st SSRI & most popular |
| lithium | -antimanic effect -levels exceeding 1.5-2.5 mEq/L can be toxic -cardiac dysrhythmia is serious AE |
| lorazepam (Ativan) | -benzodiazepine used for anxiety disorder mgmt (and preop sedative and amnesia) |
| mirtazapine (Remeron) | -3rd gen antidepressant -promotes presynaptic release of seotonin and norepinephrin (antagonist activity) -sedative effects due to histamine |
| olanzapine (zyprexa) | -atypical antipsychotic -blocks NT receptors -associated w. weight gain & sedation |
| risperidone | -atypical antipsychotic -used in refractory schizophrenia including negative symptoms -causes minimal EPS, but might give you "man boobs" (prolactin) |
| Anxiolytic | capable of reducing anxiety |
Created by:
gfcfnina
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