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N140 OLOL Psych ~ Psychopharmacology

Benzodiazepines (Ativan/lorazepam) Used to treat:anxiety, insomnia, seizures, panic disorders, & alcohol withdrawal. Acts by depressing the CNS.
Benzodiazepines Most common side effects are: sedation, & when given IV, it can cause hypotension & cardiac arrest.
Benzodiazepines (Ativan/lorazepam) Dangerous if used with other CNS depressants (alcohol, opiods, etc.)
Benzodiazepines Should be d/c slowly to prevent withdrawal.
Benzodiazepines These are schedule IV drugs which have some potential for abuse.
Antidepressants Used to treat depressed mood, feelings of sadness, emotional upset, & chronic pain.
Depression ___ is attributed to decreased amounts of the neurotransmitters norepinephrine & serotonin in the brain & neurotransmitter receptor function.
Four major classes of Antidepressants Tricyclic; SSRI's; SNRI's; MAOI's (all take 2 weeks or more to become therapeutic)
Tricyclic Agents Elavil/amitriptyline (Antidepressant)
Tricyclic Agents Act by blocking uptake of norepinephrine & serotonin; no longer the first line drug treatment for depression; Has more side effects than newer agents.
Tricyclic Agents Side Effects:sedation;orthostatic hypotension,& anticholinergic effects (dry mouth, constipation, urinary retention,&blurred vision).
Tricyclic Agents Bc of their anticholinergic properties, use cautiously with: sympathomimetics; MAO inhibitors; anticholinergics
Cardiac toxicity / arrhythmias Most serious side effect of Tricyclic agents.
SSRIs Selective Serotonin Reuptake Inhibitors
SSRIs Prozac/fluozetine
SSRIs very effective in treating major depression.
SSRIs Side effects include: sexual dysfunction(70%), weight gain, nausea, headaches, insomnia, & anxiety.
Serotonin Syndrome usually begins with first few days of therapy; usually caused by drug interaction with other serotonergics/MAOI's.
Serotonin Syndrome Side effects include: HTN, altered mental status, sweating, incoordination, fever, etc.
Serotonin Syndrome Should be withdrawn slowly to prevent withdrawal syndrome.
Serotonin Syndrome Symptoms of withdrawal include: dizziness, tremor, dysphoria, & sensory disturbances.
SNRIs Serotonin & Norepinephrine Reuptake Inhibitors
SNRIs Effexor/venlafaxine
MAOIs Parnate/tranylcypromine
MAOIs As effective as other antidepressants, but more dangerous.
MAOIs Often used in atypical depression, bulimia, panic attacks, obsessive-compulsive disorders.
MAOIs Adverse effects: CNS stimulation (anxiety, agitation, hypomania), orthostatic hypotension (this does not subside).
Hypertensive crisis A ___ can occur while taking MAOIs, if a patient eats foods containing tyramine, which promotes the release of norepinephrine.
MAOIs Has many drug interactions, mostly those that have vasoconstrictive properties (ie OTC cold meds, etc.) & enhance hypertensive crisis.
While on an MAOI, teach patient to refrain from eating foods containing tyramine. List foods containing tyramine. Aged cheeses, red wine, beer, sausages like bologna, pepperoni, salami, & aged fish or meat.
St John's Wort Side effects include: photosensitivity, increases metabolism of many drugs (coumadin/ Warfarin; oral contraceptives).
Lithium Mood regulator to treat Bipolar disorder.
Depakote / valproic acid Antiepileptic agent used to treat Bipolar disorder.
0.5 - 1.5mEq/L Therapeutic level of Lithium
Informed consent Narrow therapeutic range of Lithium, often requires ____ due to high risk for toxicity.
Twelve hours Blood levels of Lithium are drawn ___ after last dose.
Lithium ___ is a salt, and therefore is regulated by the body as sodium.
75% of patients taking Lithium will have one or more of these side effects when drug is in the therapeutic range. List side effects. fine hand tremors; weight gain; fatigue; polydypsia; polyuria; edema; GI upset; slurred speech.
When the Lithium level is above 1.5, side effects include: coarse hand tremors; confusion; EKG changes; sedation; blurred vision & tinnitus. *These symptoms progress to seizure & death.
Patient teaching regarding the administration of Lithium. adequate fl intake&Na+ moderation;avoid sweating;frequent drug serum levels;side effects include wt gain&hypothyroidism;stress the importance of medication compliance;there are many drug-drug interactions(NSAIDS increase Li levels)&inform MD of all meds.
Which diagnostics would be important to obtain prior to the patient beginning Lithium therapy? Electrolyte studies, CBC, Thyroid studies, EKG, & BUN/Creatinine
What does Lithium do? It alters sodium transport in nerve and muscle cells and inhibits the release of norepinephrine and dopamine. It does not, however, inhibit the release of serotonin.
Client & family education is essential to prevent Lithium toxicity. Teaching points include: avoiding the sun, potential overheating, & dehydration.
Which neurotransmitter is not affected by Lithium? Serotonin
Depakote Antiepileptic agent that works faster than Lithium, with less side effects.
Depakote Side effects include: GI disturbances & weight gain (usually eliminated when drug is enteric coated).
Teratogenic defects What is a major concern regarding Depakote?
Antipsychotics Used to treat psychosis associated primarily with schizophrenia.
Antipsychotics ___ work by decreasing amounts of neurotransmitters, primarily dopamine & serotonin in the CNS.
What is the goal of antipsychotics? To make the patient think more clearly. Schizophrenia is called a "thought disorder".
Positive effects Schizophrenia characterized by agitation, delusions, hallucinations, paranoia.
Negative effects Schizophrenia characterized by a blunted affect, poor hygiene, poverty of speech, social withdrawal.
Typical Antipsychotics Haldol / haloperidol
Typical Antipsychotics More effective at treating positive effects rather than negative effects of schizophrenia; have many side effects & require careful patient monitoring.
Hypertension SNRI's are similar to SSRI's, however, side effects may include ___.
St John's Wort "Mother Nature's Prozac"
St John's Wort Currently, research has not supported FDA approval.
Extrapyramidal symptoms (EPS) early symptoms (usually occurring hours or days after initiating treatment) include: akathisia, parkinsonism, & dystonia.
Akathisia Continuous restlessness, inability to sit still.
Parkinsonism Muscle tremors, shuffling gait, drooling, rigidity.
Dystonia Spasms, prolonged contractions of muscle groups; *Dangerous & painful & can be treated.
Benadryl and Cogentin Medications used to treat EPS (Extrapyramidal Symptoms).
Tardive Dyskinesia (TD) involuntary movements of the tongue & face. ("fly catching", smacking); Assess often,using AIM(Abnormal Involuntary Movement) assessment form; *Usually IRREVERSIBLE*
Neuroleptic Malignant Syndrome Most serious of all side effects; Characterized by "lead-pipe" rigidity, sudden high fever & changes in cognition.
Dantrium / dantrolene Drug used for treatment of Neuroleptic Malignant Syndrome.
Neuroleptic Malignant Syndrome Side effects include: anticholinergic effects(dry mouth, urinary retention, constipation, blurred vision); sexual dysfunction; orthostatic hypotension.
Risperidone / Risperdal Atypical Antipsychotic agent.
Ziprasidone / Geodon Atypical Antipsychotic agent.
Atypical Antipsychotics Effective in treating both negative & positive symptoms of schizophrenia; these agents cause fewer extrapyramidal(EPS) symptoms.
Atypical Antipsychotics Side effects include: orthostatic hypotension, sedation, & anticholinergic effects.
Clozaril / clozapine Atypical antipsychotic that has a major side effect of agranulocytosis - WBC monitored frequently & patients are taught to report sore throat, fever, mucous membrane ulceration, & fatigue.
Depot drugs These are long-acting, injectable formulations. Typically given every 2-4 weeks. The goal is to prevent relapse of schizophrenia.
Depot drugs drugs now available are Haldol & Risperdal. They are called ____.
Created by: luv*a*nurse