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CHAPTER 11
psychopharmacology. dietary, biologic
| Question | Answer |
|---|---|
| why do primary care setting nurses need an in depth knowledge about psychiatric medications | because they are increasingly prescribed in primary care settings |
| medications can have both desirable and undesirable effects | true |
| what are target symptoms | specific measurable symptoms expected to improve with treatment |
| what are side effects | when drugs cause some responses in the body that are not related to target symptoms |
| what are adverse effects | unwanted effects that cause serious physiologic consequences |
| who is in charge of ensuring the safety, efficacy and security of human drugs, animal drugs etc. | FDA |
| what is included in the prescribing information | indications, side effects, adverse effects, contraindications |
| what is a boxed warning | indication for a serious adverse reaction |
| what do psychiatric meds target | the CNS system |
| what are pharmacodynamics | the action or effects of drugs on living organisms |
| what are examples of side effects | blurred vision, dry eyes/mouth/lips, constipation, urinary retention etc. |
| what are receptors | proteins intended to respond to a chemical |
| what is the action of an agonist | initiate the same response as the chemical normally present in the body |
| what is the action of an antagonist | substances that block the response of a given receptor |
| what is selectivity | the ability of a drug to be specific for a particular receptor high selectivity- affecting only the receptor for which it was meant low selectivity- affecting more than the receptor it was meant for |
| what is affinity | the degree of attraction or strength of the bond between the drug and its biologic target |
| what is the intrinsic activity | the ability to produce a response after it becomes attached to the receptor |
| what are enzymes | proteins that act as catalysts for physiologic reactions and can be targets for drugs |
| what is a carrier protein | a membrane protein that transports a specific molecule across the cell membrane |
| what is efficacy | the ability of a drug to produce a response and is considered when a drug is selected |
| what is potency | refers to the dose of drug required to produce a specific effect |
| what is desensitization | is a rapid decrease in drug effects that may develop in a few minutes of exposure to a drug |
| what is tolerance | a gradual decrease in type action of a drg at a given dose or concentration in the blood |
| what is toxicity | it refers to the point at which concentrations of the drug in the bloodstream are high enough to become harmful |
| what is the therapeutic index | the ratio of the maximum nontoxic dose to the minimum effective dose |
| what is pharmacokinetics | the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body |
| what is absorption | the movement of the drug from the site of administration into the plasma |
| what is a consequence of the first pass effect | only a fraction of the drug reaches the systemic circulation- meaning that this does is typically higher than other forms of administration |
| what is bioavailability | describes the amount of the drug that actually reaches systemic circulation unchanged |
| what is distribution | the amount of the drug found in various tissues, particularly the target organ at the site of drug action |
| what is solubility | the ability of a drug to dissolve |
| how does a drug cross the BBB | by solubility/ protein binding |
| what is metabolism | is the process by which a drug is altered and broken down into smaller substances |
| what is a substrate | the dru or compound that is identified as a target enzyme |
| what is an inducer | it speeds up the metabolism which in turn increases the clearance of the substrate and decreases its plasma levels |
| what is pharmacogenetics | the blend of pharmacology and genetics |
| what is excretion | it refers to the removal of drugs from the body either unchanged or as metabolites |
| what is clearance | it refers to the total volume of blood, serum, or plasma from which a drug is completely removed |
| what is the half life | it refers to the expected rate of clearance |
| what is dosing | it refers to the administration of medication over time so that therapeutic levels may be achieved or maintained |
| what is a steady state | it refers to when a medication plateaus |
| what are factors that affect absorption, distribution, metabolism and excretion | age, genetics, ethnicity |
| what is ethnopsychopharmacology | investigates cultural variations and differences that influence the effectiveness of pharmacotherapies used in mental health |
| what is the initiation phase of drug administration | when a nurse determines the diagnosis, performs a cultural assessment as well as a physical examination, she observes for reactions and teaches the patient about the action,dosage and frequency of administration |
| what is the stabilization phase | this is when the prescriber adjust or titrates medications so that they achieve their maximum amount of improvement with minimal side effects |
| what is augmentation | when the patient is already on one medication but another is added to help with side effects |
| what is polypharmacy | using more than 5 medications typically seen in your older adults |
| what is the maintenance phase | when individuals target symptoms have improved but they are continuing to stay on medications so they don't relapse |
| what is a relapse | when symptoms reoccur |
| what is the discontinuation phase | when patients are tapered off medications |
| what are major psychopharmacologic drug classes | antipsychotics, mood stabilizers, abtudeoressabts, anti anxiety, sedative-hypnotic and stimulants |
| what are indications for antipsychotic medications | schizophrenia, mania, autism and symptoms of psychosis, aggressiveness, inappropriate behavior |
| what are the pharmacokinetics of antipsychotic meds | almost entirely excreted in the liver. excretion is slow with a half life of 24 hours |
| SE of antipsychotic meds | OH, prolonged QT interval, anticholinergic effects, weight gain, type 2 diabetes, breast enlargement, decreased sexual drive, blood dyscrasia, agranulocytosis, neutropenia, photosensitivity,EPS |
| what is dystonia | impaired muscle tone - involuntary muscle spasms, abnormal posture especially of the head and neck, protruding tongue, torticollis |
| what is pseudoparkinsonism | rigidity, slowed movements, tremors, muscle stiffness, loss of facial expressions decrease in the ability to initiate movements |
| what is akathisia | inability to sit still or restlessness, pacing, rocking, marching in place, crossing and uncrossing legs |
| wha is tardive dyskinesia | irregular repetitive involuntary movements of the mouth, face, and tongue, chewing, tongue protrusion, lip smacking and puckering |
| how do we score involuntary movements | using the AIMS scale |
| what is the gold standard mood stabilizer | lithium |
| what is the indication of a mood stabilizer | mania/ bipolar disorder |
| what are the pharmacokinetics of lithium | excreted by the kidneys/ half life of 8-12 hours lab work is very important to monitor for toxicity |
| what are side effects of lithium | depending on the level low- mild high- deadly |
| can anticonvulsants be used as mood stabilizers | yes |
| SE of anticonvulsants | dizziness, drowsiness, tremor, visual disturbance, N/V, SIADH constipation, urination retention blurred/double vision |
| what are examples of antidepressant medications | SSRI, SNRI, norepi/dopamine reuptake inhibitors,TCA, MAOI |
| what is the major side effect of an antidepressant med | serotonin syndrome |
| what are SE of benzos | respiratory depression, CNS depression, drowsiness, memory impairment |
| pharmacokinetics of buspirone | 2-3 hr half life administered 2-3 times a day |
| SE of buspirone | dizziness, drowsiness, nausea, excitement, HA |
| sedatives | reduce anxiety without causing sleep |
| hypnotics | cause drowsiness and facilitate sleep |
| indications for stimulants | narcolepsy ADHD |
| what is electroconvulsive therapy used for | severe depression |
| what is phototherapy | it is used to help people with depression whos symptoms worsen in the winter months or on rainy days |
| what is the action of transcranial magnetic stimulation | it is used to stimulate the cerebral cortex |
| what is vagus nerve stimulation | stimulation of the vagus nerve which controls hr rr, it is used because of its sensory perception over large amounts of the brain |
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bolenrocks
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