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Med-reference sheet
psych exam 2 drugs
Question | Answer |
---|---|
What medication is the 1st line of defense in most anxiety and OCD disorders? | SSRIs: drug must have an x or z--> "hot" lips: LPZ L: Luvox (fluvoxane) L: Lexapro (escitalopram) P: Prozac (fluoxetine) P: Paxil (paroxetine)- helpful with PTSD; weight gain Z: Zoloft (sertraline) C: Celexa (citalopram |
Serotonin Selective Reuptake Inhibitors (SSRIs) | • First line of treatment for major depression • Some SSRIs activate and others sedate; choice depends on patient symptoms • Risk of lethal overdose minimized with SSRIs |
Serotonin Selective Reuptake Inhibitors (SSRIs) common SE? | Agitation, drowsiness, headache, dry mouth, nausea and vomiting, GI dysfunctions, sexual dysfunction |
What is Serotonin Syndrome? | Rare and life-threatening event associated with SSRIs. This syndrome is thought to be related to over-activation of the central serotonin receptors caused by either too high a dose or interaction with other drugs. Avoid taking SSRIs with MAOIs. |
Some symptoms of Serotonin Syndrome? | Hyperactivity/restlessness Tachycardia → cardiovascular shock Fever → hyperpyrexia Elevated blood pressure Altered mental states (delirium) |
Some more symptoms of Serotonin Syndrome? | Irrationality, mood swings, hostility Seizures → status epilepticus Myoclonus, incoordination, tonic rigidity Abdominal pain, diarrhea, bloating Apnea → death |
SNRI drugs? "snoring" | SNORING: (clanging) Cymbals Pristine Effective - EPC E: Effexor (used for several anxiety disorders) P: Pristiq (used to treat anxiety disorders) C: Cymbalta (Used for generalized anxiety disorder) |
MAOIs: NPM: Not Popular Meds? | Nardil, Parnate, Marplan |
Some Nursing concerns for pt taking MAOIs? | • Monitor for orthostatic hypotension and sleep disturbances • Avoid foods with tyramine; "PARTY FOODS" figs, raisins aged cheese, wine, sauerkraut, smoked or preserved meats (e.g., salami, pepperoni) MAOI + tyramine = Hypertensive crisis |
MAOIs are particularly effective for people with? | unconventional depression (characterized by mood reactivity, oversleeping, and overeating) |
In pt's taking MAOIs, Hypertensive crisis usually occurs within a few hours of ingestion of? | Tyramine = party foods |
Hypertensive crisis begin with? | HA, stiff/sore neck, irritable, restless palpitations- +/- heart rate (often with chest pain), N/V, pyrexia Hypertensive crisis suspected, immediate medical attention is crucial (tx with nitroprusside/nitroglycerine; blankets/icepacks to treat pyrexia) |
This med-- closely resembles that of antipsychotic medications, and the anticholinergic actions are similar (e.g., dry mouth, blurred vision, tachycardia, constipation, urinary retention, sexual dysfunction, orthostatic hypotension) | Tricyclic Antidepressants (TCAs) Desipramine (Norpramin) may be best for a patient who is lethargic and fatigued. If a more sedating effect is needed for agitation/restlessness, use amitriptyline (Elavil), nortriptyline (Pamelor) and doxepin (Sinequan) |
Example of a Norepinephrine-dopamine reuptake inhibitor (NDRI)? | Bupropion (Wellbutrin)- patients may experience weight loss |
Antianxiety (anxiolytic) meds? | Benzodiazepines - quick onset BUT potential for abuse/ dependence MOA - potentiate (promote activity) of GABA |
Benzodiazepines? | Antianxiety (anxiolytic) meds Benzodiazepines: quick onset BUT potential for abuse/ dependence; use short term until long-term regimen can be implemented (zepam; zolam; zepate-one) |
MAO drugs? | Antianxiety (anxiolytic) meds MOA: potentiate (promote activity) of GABA S/E: sedation, ataxia (less control of body movements), ↓cognitive function KVAX K:Klonopin V: Valium A: Ativan X: Xanax |
Individuals with bipolar disorder often require? | multiple medications for acute mania |
How long does Lithium take to reach therapeutic levels? | Takes 7-14 days to reach therapeutic levels in the blood. An antipsychotic medication and/or benzodiazepine is used in acute stabilization period until lithium is effective Therapeutic level Low 0.6-1.2 mEq/L |Moderate 1.5-2.5mEq/L/Severe >2.5 mEq/L |
First line treatment for Bipolar disorder? | Lithium- Monitor thyroid function; Alcohol - ^lithium levels Ace inhibitors may ^ lithium levels = cause toxicity/impaired kidney function ^sodium intake decrease levels: low sodium diets may ^lithium levels->toxicity Fluoxetine increases lithium levels |
Anticonvulsants approved for treatment of bipolar disorder, mania, and mixed episodes? "details" | "when treating patients with hx of seizures, you focus on details" • Depakote (valproate) • Tegretol or Equetro (carbamazepine) • Lamictal (lamotrigine) -Antidepressants not recommended because they may cause hypomania or mania |
Extrapyramidal side effects (EPS) | dystonia, akathisia and pseudoparkinsonism, Tardive Dyskinesia • Anticholinergic drugs for side effects Tardive Dyskinesia - persistent EPS (affects 10% of patients long after medication has stopped); difficult to reverse symptoms |
Neuroleptic Malignant Syndrome (NMS) | very rare 0.2% to 1% occurrence; reduced consciousness and responsiveness, generalized muscle rigidity, and autonomic dysfunction (Increased temperature, tachycardia, hypertension) May receive dopamine agonists and muscle relaxants |
First-generation (conventional) antipsychotics? “zine” | most meds end in “zine” Chlorpromazine (Thorazine) Thoridazine (Mellaril) Trifluoperazine (Stelazine) Haloperidol (Haldol) |
Second generations (atypical antipsychotics) (“pines”, “dones”, 2 “pips”, and 1 “rip”) | The primary treatment and cause less EPS but can cause metabolic syndrome |
Common SE associated with (2nd ben/atypical antipsychotics) metabolic syndrome? | which includes weight gain, dyslipidemia, and altered glucose metabolism thought to be due to increased insulin resistance |
Second generations (atypical antipsychotics)- clozapine (Clozaril) | the most effective but due to agranulocytosis; WBC is measured regularly (watch for drop in absolute neutrophil level). Protective-reduces suicidal ideation. |