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about psych meds
more about psych meds & what you need to know
| Question | Answer |
|---|---|
| efficacy | maximal therapeutic effect that a drug can achieve |
| potency | amount of the drug needed to achieve that maximum effect. low potency drugs require higher doses to achieve efficacy |
| half life | time it takes for half the drug to be removed from the blood stream. drug to leave completely after it has been discontinued is about 5 times its half life |
| off label use | used for things other than what it was originally tested for |
| black box warning | serious life threatening side effect |
| rebound | temporary return of symptoms |
| withdrawal | new symptoms resulting from discontinuation of the drug |
| what benzodiazepine is typically used to treat alcohol withdrawal? | Chlordiazepoxide (Librium) |
| benzodiazepines are | highly addictive & don't fix underlying problem |
| What classification of drugs treat OCD? | SSRI antidepressants |
| What drugs treat positive signs (delusions, hallucinations, disturbed thinking)? | conventional antipsychotics |
| What drug diminishes positive symptoms and lessen negative signs (social withdrawal, apathy, anhedonia, lack of motivation)? | atypical antipsychotics |
| What are EPS (extrapyramidal side effects)? | EPS are reversible movement disorders induced by neuroleptic medication they include dystonic reactions, parkinsonism, and akathisia. |
| EPS is typically treated with what medications? | Diphenhydramine (Benadryl) given IV or IM Benztropine (Cogentin) given IM |
| Neuroleptic malignant syndrome (seizures, Agranulocytosis-failure of bone marrow to produce adequate WBC) | increased muscle enzymes especially creatine phosphokinase leukocytosis, increased leukocytes 0.1%-1% develop NMS |
| Norepinephrine levels may be deficient in? | depression |
| Norepinephrine levels may be increased in? | mania |
| As a rule, the dosage of antidepressants should be _______ before being discontinued. | tapered |
| What class of drugs produce few sedating, anticholinergic, & cardiovascular side effects, which makes them safer for use in older adults? | SSRI's |
| When are tricyclic antidepressants contraindicated? | Severe impairment of liver function & in myocardial infarction (acute recovery phase) & can't be give concurrently w/MAOI's |
| Tricyclic antidepressant overdose occurs over several days & results in? | agitation, hallucinations, hyperprexia, and increased reflexes |
| Atypical antidepressants are used when the client has an inadequate response to or side effects from? | SSRI's |
| What are used infrequently because of potential fatal side effects & interactions with numerous drugs, both Rx & OTC preparations? | MAOI's |
| The most serious side effect is hypertensive crisis, a life threatening condition that can result when a client taking MAOI's ingests? | Tyramine containing foods (aged meats & cheese) and fluids or other medications. Produces symptoms within 20-60 minutes after ingestion. |
| How long is the lag period between the time that MAOI's are discontinued and another class of antidepressant is started? | Washout period of 5-6 weeks are recommended. |
| Serotonin Syndrome occurs when there is an inadequate washout period between taking? | MAOI's & SSRI's or when MAOI's are combined w/Imperidine |
| Symptoms of Serotonin Syndrome include? | Change in mental state (confusion, agitation) Neuromuscular excitement (muscle rigidity, weakness, sluggish pupils) Autonomic abnormalities (hyperthermia, tachycardia, etc...) |
| What are potentially lethal when taken in overdose? | Cyclic compounds & MAOI's |
| What is considered the most effective treatment for depressive disorders? | A combination of psycotherapy & medication. |
| Treatment of bipolar disorder involves a lifetime regimen of medications either? | An antimanic agent (Lithium)or a Anticonvulsant medication used as a mood stabilizer. |
| Clients taking lithium must ingest adequate amounts of what to avoid overdosing & underdosing? | Adequate salt & water, because lithium salt uses the same postsynaptic receptor sites as sodium chloride does |
| Serum lithium levels (narrow range of safety)What is the therapeutic range? | 0.5-1.5 mEq/L Maintenance levels 0.5-1.0 Treatment levels 0.8-1.5 Toxic levels 1.5mEq/L and above |
| A nurse is teaching a female client who has schizophrenia about risperione (Risperdal) What should the nurse include in the teaching? | This medication may cause an elevated blood sugar. Menstrual irregularities may occur while taking this medication. You may experience dizziness while taking this medication. |
| A client who is severely depressed has been receiving amitriptyline (Elavil) for 1 week. What outcome should the nurse expect? | Greater risk of attempting suicide as affect and energy improve |
| A client who has Korsakoff's syndrome has a secondary dementia caused by a? | Thiamine deficiency |
| A nurse is caring for a client with a new Rx for Lithium what lab value would make this contraindicated? | BUN 45mg/dL |
| A client with paranoid schizophrenia & is physically violent toward others has received several IM injections of haloperidol (Haldol) & is now being given benzotropine mesylate (Cogentin) to treat what side effect of halperidol? | Stiff and stooped posture |
| What is a high priority for a client diagnosed with bipolar disorder who is taking valproic acid (Depakote)? | The client has not slept in 24 hours |
| Treatment of client with personality disorders focuses on what? | The clients symptoms rather than the particular subtype. |
| Benzodiazepine Anxiolytics therapeutic uses (2) | GAD (generalized anxiety disorder) panic disorder |
| Other uses for benzodiazepines (5) | Seizure disorders insomnia muscle spasm Alcohol withdrawal (Librium) Induction of anesthesia |
| Benzodiazepine (Diazepam) is contraindicated in clients with? | sleep apnea and/or respiratory depression |
| Use diazepam (Benzos) cautiously in clients who have: | Liver disease and/or history of substance abuse |
| Therapeutic uses for non-benzo anxiolytics (4) | Panic disorder OCD Social anxiety disorder PTSD |
| Use buspirone (non-benzo) cautiously in: | older adult clients clients with liver and/or renal dysfunction |
| Buspirone (non-benzo) is contraindicated for concurrent use with: | MAOI antidepressants or 14 days after MAOI's are discontinued Hypertensive crisis may result |
| What will increase the effects of buspirone (non benzo anxiolytic) (3) | Erythromycin Ketoconazole grapefruit juice |
| How long does it take Non Benzo anxiolytics effects to work? | It may take a week to notice 1st therapeutic effects & several more weeks to reach full therapeutic benefits. Med should be taken on a regular basis, than as needed basis |
| Therapeutic uses of SSRI paroxetine (Paxil) (6) | GAD panic disorder OCD social anxiety disorder PTSD depressive disorder |
| Therapeutic uses of SSRI sertraline (Zoloft) (4) | panic disorder OCD social anxiety disorder PTSD |
| Therapeutic uses of SSRI Escitalopram (Lexapro) (2) | GAD OCD |
| Therapeutic uses of SSRI Fluoxetine (Prozac) (2) | panic disorder GAD |
| Therapeutic uses of SSRI Fluvoxamine (Luvox) (2) | OCD social anxiety disorder |
| Therapeutic uses of SSRI Duloxetine (Cymbalta) (1) | GAD |
| Signs of Serotonin Syndrome | Agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, hyperreflexia, fever, diaphoresis, incoordination tremors. Usually begins 2 to 72 hours after initiation of treatment. Resolves when medication is discontinued |
| SSRI Paroxetine (Paxil) is contraindicated in clients taking? | MAOI's |
| Clients taking SSRI Paroxetine (Paxill) should avoid? | alcohol |
| Use SSRI Paroxetine (Paxil) cautiously in clients with: | Liver and renal dysfunction seizure disorders Hx of gastrointestinal bleeding |
| Use SSRIs cautiously in clients who have bipolar disorder due to the risk of? | Mania |
| Concurrent use of MAOI's or Tricyclic antidepressants with SSRI Paroxetine (Paxil) can cause? | Serotonin Syndrome |
| SSRI therapeutic effects may not be experienced for? | 1-3 weeks |
| Side effects of SSRI is bruxism which means? | Grinding & clenching of teeth, usually during sleep |
| SSRI's are more likely to cause what in older adults taking diuretics? | Hyponatremia (low sodium levels) |
| Antidote for benzodiazepine overdose or toxicity? | Flumazenil (Romazicon) |
| What type of medication is use to treat Schizophrenia? | antipsychotic medication |
| What medications are used mainly to control positive symptoms of psychosis (schizophrenia)? | conventional antipsychotics |
| What medication relieves both positive & negative symptoms of schizophrenia? | atypical antipsychotics |
| Atypical antipsychotics has fewer or no? | EPS (extrapyramidal symptoms) including: tar dive dyskinesia die to less dopamine blockade. |
| Therapeutic uses for conventional antipsychotics (7) | Treatment of acute & chronic psychosis Schizophrenia Bipolar disorder (primarily manic phase) Tourette's syndrome Delusional & schizoaffective disorder Dementia Prevention N & V thru blocking of dopamine in the chemoreceptor trigger zone of medulla |
| Conventional antipsychotic medications block (4) | Dopamine (D2) Acetylcholine Histamine Norepinephrine (NE) receptors in the brain & periphery |
| Side/Adverse effects of conventional antipsychotics Acute dystonia? | Severe spasm of the tongue, neck, face, & back Crisis situation that requires rapid treatment Begins 5 hours to 5 days after administration of 1st dose |
| Treat side effects of Acute dystonia (conventional antipsychotic) with anticholinergic agents such as: | benztropine (Cogentin) or diphenhydramine (Benadryl) |
| Side/Adverse effects of conventional antipsychotics Parkinsonism | Bradykinesia Rigidity Shuffling gait Drooling Tremors Observe for S & S for the 1st month after initiation of therapy |
| Treat side effects of Parkinsonism with: | benztropine (Cogentin) diphenhydramine (Benadryl) amantadine (Symmetrel) |
| Side/Adverse effects of conventional antipsychotics Akathisia is: | inability to sit or stand still continual pacing & agitation Observe for S & S 1st 2 months after initiation of treatment Manage symptoms w/Beta-blockers, benzos, & anticholinergic meds |
| Conventional Antipsychotics Late extrapyramidal side effects (EPS) Tardive dyskinesia | involuntary movements of the tongue & face, such as lip smacking Involuntary movements of the arms, legs, and trunk Administer lowest dosage possible to control symptoms |
| Manifestations of late EPS Tardive dyskinesia may occur: | months to years after the imitation of therapy evaluate client after 12 months of therapy then Q3months If signs of TD appear, lower dose or switch town atypical agent Use (AIMS) abnormal involuntary Movement scale to screen for the presence of EPS |
| Conventional antipsychotics signs of Neuroleptic malignant syndrome (6) | Sudden high fever blood pressure fluctuation dysrhythmias muscle rigidity changes in level of consciousness coma |
| If neuroleptic malignant syndrome occurs….from use of conventional antipsychotics | Stop antipsychotic meds monitor clients vital signs apply cooling blanket administer antipyretics (ASA/tylenol) increase clients fluid intake administer either Dantrolene or bromocriptine to induce muscle relaxation wait 2 wks b4 resuming therapy |
| Anticholinergic effects of conventional antipsychotics (6) | Dry mouth blurred vision photophobia urinary hesitancy or retention constipation tachycardia to decrease anticholinergic effects: chew sugarless gum, sip water, avoid hazardous activities, eat food high in fiber, reg exercise, fluid intake 2-3L/day, |
| Greatest risk of getting seizures when taking conventional antipsychotics? | Is those clients who have an existing seizure disorder |
| Agranulocytosis in patients with conventional antipsychotics | Advise client to observe for signs of infection (fever & sore throat) & notify provider If sign of infection appear, obtain clients baseline WBC Meds should be discontinued if lab tests indicates the presence of infection |
| Conventional antipsychotics contraindicated in clients who? (6) | in a coma severe depression parkinson's disease prolactin-dependant cancer of breast severe hypotension older adult clients with dementia |
| use conventional antipsychotics cautiously in clients with: (6) | glaucoma paralytic ileus prostate enlargement heart disorders liver or kidney disease seizure disorders |
| What counteracts effects of antipsychotic agents? | Levodopa |
| Therapeutic uses of atypical antipsychotic (3) | negative & positive symptoms of schizophrenia psychosis induce by levodopa therapy relief of psychotic symptoms in other disorders, such as bipolar disorder |
| Side/Adverse effects of atypical antipsychotics | new onset of diabetes or loss of glucose control weight gain hypercholesterolemia (increased risk hypertension or CVD) anticholinergic effects agitation, dizziness, sedation, sleep disruption, mild EPS such as tremors |
| Atypical antipsychotics Risperidone (Risperdal) should not be used for? | Dementia-related psychosis use of these meds may cause death related to CVA or infection |
| Convention antipsychotic treat what manifestations of schizophrenia? (4) | Auditory hallucinations Delusions of grandeur loose associations pressured speech |
| Extrapyramidal side effects (EPS) resulting from conventional antipsychotic meds are: (4) | Parkinson-like symptoms involuntary pelvic & hip movement muscle spasm in the neck restlessness, jitteriness |
Created by:
moo2youk
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