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NP5 Psych Test 2 SFC

Pharmacodynamics what the drug does to the body. Therapeutic effects. Side effects
Pharmacokinetics what the body does to the drug--absorption, distribution,metabolism, elimination
Half-life —the time it takes for plasma concentrations of a drug to decrease to half of an initial value--after 7 half lives less than 1% of a drug remains in the plasma
Antidepressants Action Elevate Serotonin and/or Norepinephrine levels
Antidepressants Indications Depression, Anxiety disorders, OCD, PTSD, Panic Disorder
Tricyclic Antidepressants(TCA’s)Brand (generic) Elavil (amitriptyline),Tofranil (imipramine),Sinequan (doxepin),Norpramin (desipramine),Pamelor (nortriptyline)
Tricyclic Antidepressants(TCA’s)Side effects Anticholinergic: blurred vision, dry mouth, urinary hesitancy/retention, constipation, Orthostasis, EKG changes(can cause or worsen cardiac problems),Anxiety,Memory & concentration disturbances, H/A, Fatigue
Monoamine Oxidase Inhibitors(MAOI’s)Action Inhibit the breakdown of monoamines specifically Serotonin and Norepinephrine by inhibiting the catabolic enzyme(Monoamine Oxidase). inhibits the metabolism of Tyramine (potent vasopressor).
A nursing consideration for Tricyclic antidepressants (TCA's)to consider is Impotence Note: there is increased risk of fatal overdose with TCA's
MAO Inhibitors (MAOI’s)Brand (generic) Marplan (isocarboxazid)(Similar structure to Isoniazid), Nardil (phenelzine),Parnate (tranylcypromine)
For Monoamine oxidase inhibitors (MAOI's) be careful with Foods containing ________ may stimulate hypertensive events, possibly hypertensive crisis. Tyramine
Restricted Foods while on monoamine oxidase inhibitors (MAOI's) includes Aged cheeses, Aged and cured meats, Dried or pickled fish, Liver, Bananas, Broad bean pods, Sauerkraut, Soy sauce and other soy condiments, Draft beer, Vitamins with Brewer’s yeast
While on monoamine oxidase inhibitors (MAOI's), foods to Consume in Moderation include Red or white wine, Bottled or canned beer, Chocolate, Yogurt
Selective Serotonin Re-uptakeInhibitors (SSRI's)include Prozac, Paxil, Luvox, Celexa, Zoloft, Lexapro
SSRI Side Effects include GI disturbancenausea, Diarrhea, ABD pain, Anxiety, Insomnia, Appetite/weight loss, H/A, Dizziness, Palpitations, Sexual dysfunction. Note: fewer serious side effects than TCA's and less dangerous in overdose.
Selective serotonin re-uptake inhibitors (SSRI's) Side Effects (serious) Serotonergic Syndrome: caused by mixing MAOI’s and SSRI’s or from overdose of SSRI’s. Sx’s: agitation, sweating, fever, rigidity, tachycardia, hypotension, hyperreflexia
Other Antidepressants include Wellbutrin, Remeron, Serzone, Trazodone, Effexor, Duloxetine, Pristiq (Similar to Effexor)
Antipsychotics Indication & Action Treatment of acute and chronic psychosis. Dopamine antagonist
Antipsychotics Typicals are Effective only for positive Sx’s of schizophrenia (hallucinations, delusions, etc.)May mask or worsen negative Sx’s(blunt affect, apathy, social withdrawal, etc.)
Antipsychotics typicals are Classified as to potency. low, mid, high(affects S/E profile)
Commonly Used Antipsychotics Typicals Haldol, Thorazine, Mellaril, Prolixin, Navane, Stelazine, Loxitane, Trilafon
Side Effects of Typical Antipsychotics includes Anticholinergic:Blurred vision, Dry mouth, Urinary retention, Constipation
General Side Effects of Typical Antipsychotics Common/early: Sedation*, Postural hypotension*, Dizziness*, Lightheadedness*, Decreased sweating, Potentiation of CNS depressants (*More common with low potency agents)
Extrapyramidal Side Effects (EPS) Akathisia,Dystonias*, Parkinsonian Sx’s(Parkinson-like Sx’s): blunted affect, mask-like facies,tremor, and shuffling gait (*more common with high potency agents)
Tardive Dyskinesia May be irreversible & may be prevented by use of low doses. Vitamin E, valproate,clonidine, Clozapine, cholinergic drugs,
For Tardive Dyskinesia which drugs may be useful in treating Gabaminergic drugs
Test for Tardive Dyskinesia includes AIMS Test (standardized exam)
Neuroleptic Malignant Syndrome (NMS)is An idiosyncratic reaction to an antipsychotic drug, may be Potentially fatal
Which antipsychotics cause Neroleptic Malignant Syndrome (NMS) All antipsychotics seem to have the potential to cause NMS
What increases the risk of Neroleptic Malignant Syndrome (NMS) High dosages of high-potency drugs increase risk. Poor nutrition, dehydration, and concurrent medical illness
Major symptoms of Neropletic Malignant Syndrome (NMS) Rigidity, High fever, elevated level of enzymes (particularly CPK), Diaphoresis, Pallor, Delirium, Autonomic instability(such as unstable blood pressure), confused, mute, fluctuate from agitation to stupor
Neuroleptic malignant Syndrome (NMS) Treatment Immediate discontinuation of all antipsychotic medications. Supportive medical care—rehydration and hypothermic measures. Depot Therapy
Depot therapy can be used with what medications? Haldol and Prolixin (Decanoate). Risperdal now available
Depot therapy is administered via & has a half life of Injectable, oil based form. Long half-life (they are active for 2-4 weeks due to slow release from muscle tissue).
Antipsychotics Atypicals Have more favorable side effect profiles
Antipsychotics Atypicals are Effective for (type of symptoms) both negative and positive symptoms
Commonly Used Antipsychotics Atypicals includes Clozaril, Risperdal, Zyprexa, Seroquel, Geodon/Zeldox, Abilify
Antipsychotic Atypicals: Clozaril Arguably the most effective for + and - Sx’s
Clozaril serious adverse reactions Bone marrow suppression--can cause leukopenia--need weekly CBC with Diff Q week for 1st 6 months--then Q 2 wks Increased risk of seizures
Common Side Effects Atypicals Clozaril & Zyprexa sedation, constipation, orthostasis. Low EPS
Common Side Effects Atypicals: Zyprexa may cause appetite increase and is contraindicated with Diabetes
Common Side Effects Atypicals: Risperdal sedation, orthostasis-- moderate. EPS, anticholinergic—low
Common Side Effects Atypicals: Seroquel orthostasis, somnolence, wt. gain
Common Side Effects Atypicals: Geodon nausea, somnolence
Common Side Effects Atypicals: Abilify nausea, H/A, somnolence/insomnia
Antiparkinsonian (Medications to combat EPS) Action Restores balance betweenacetylcholine and dopamine
Antiparkinsonian (Medications to combat EPS) Indication Treatment of parkinsonian side effects of antipsychotics: Cogentin, Artane, Symmetrel, Akineton
Antianxiety Agents(Anxiolytics): Primary class Benzodiazepines (“Benzo’s” Action Inhibit CNS excitability by binding to the Benzodiazepine-GABA-chloride receptor complex. Enhance the activity of GABA at the GABAa receptor Benzodiazepines
Indications for Benzo's Anxiety, Agitation, Insomnia, Tension, Panic disorder, Agoraphobia, Seizures (status epilepticus), Muscle spasms, Dystonias, Restless leg syndrome
Benzodiazepine medications include Ativan, Xanax, Klonopin, Valium, Librium, Tranxene
Benzodiazepines Side effects Drowsiness, Fatigue, Decreased concentration, Confusion, Disorientation, Decreased coordination. Note: major drawback is tolerance and dependence (serious W/D complications)
How long is Benzo's use recommended for Recommended for short-term use only Benzo has Synergistic effects when combined with
Benzo's may not to be used for sleep apnea
use ________ cautiously in COPD due to depression of the respiratory center of the brain. Benzo's
Other Antianxiety Agents Buspar (for anxiety)-works on Serotonin-- also NE and DA
Antimanics(Mood Stabilizers)Indicated for bipolar/mania * (have FDA indications for treatment of manic and mixed episodes of bipolar disorder)
Antimanics includes Lithium* (Lithium, lithobid), alproic acid*, (Depakote,Depakene),Zyprexa*, Tegretol, Neurontin, Lamictal, Topimax Lithium
Action of Lithium modulates levels of serotonin and norepinephrine.
Indication of Lithium Treatment of manic episodes --very safe. Eliminated by the kidneys in original form
Prior to Lithium nurse Needs to ensure good kidney function
Lithium Can be toxic to nephrotoxic/thyrotoxic
What lab values need to be monitored while on Lithium? Need to monitor serum levels as well as periodic kidney/thyroid studies
Therapeutic level for lithium Narrow therapeutic window--between 0.5-1.5mEq /L (according to text upper value is 1.5)
Lithium Expected side effects Tremors, Polydipsia, Polyuria, Dry mouth, GI upset Pulse irregularities, Wt. Gain,
Lithium Adverse Effects Electrolyte imbalance Sodium balance is important S/E’s worsen as level rises. More severe Sx’s usually correlated to levels from 2-3 mEq/L
Lithium Toxicity s/sx Vomiting, Diarrhea, Lethargy, Ataxia, Slurred speech, Confusion, Seizures, Coma, Death
Anticonvulsant medications used Depakote ,Tegretol, Neurontin, Klonopin, Lamictal and Topimax
Depakote and Tegretol require periodic ______ levels serum
________ and _________ both have undesirable S/E’s and idiosyncrasies Depakote and Tegretol
Antimanic Calcium channel blockers include Verapamil
Valproic acid, Tegretol, Neurontin , Lamictal, and Topimax are all are ___________ and have shown varied levels of effectiveness in management of bipolar illness anticonvulsants
CNS Stimulants Action may increase levels of dopamine, norepinephrine, and serotonin
CNS stimulants Indication for use in treating ADHD, narcolepsy, adjunctively for depression
Common CNS stimulants to psych Ritalin, Concerta, Amphetamine, Dexedrine, Adderal, Strattera
CNS stimulant Side Effects restlessness, insomnia, tachycardia, anorexia, tolerance, psychosis, dependence
CNS Problems high abuse potential, high street value, anorexigenic effects (periodic wts.)
Sedatives and Hypnotics Action CNS depressant
Sedatives and Hypnotics Indication Short-term relief of anxiety or insomnia
Sedatives and Hypntoics Common to psych Benzodiazepines- Restoril, Halcion, Dalmane, Versed
Sedatives and Hypnotics Side Effects confusion, tolerance, dependence, “hangover effect”
Restoril is good for _______ term use short term use
________ - non-Benzodiazepine at 10 mg provides decreased sleep latency, increased sleep efficiency, no REM suppression, low tolerance Ambien
________ 15 mg some REM suppression and tolerance Ambien
_______ -newer non-Benzo—so far no tolerance, no dependence, no W/D syndrome Sonata
_______ At low doses good for sleep-also may add to therapeutic effects of primary antidepressant Trazodone (sedative and hynotic)
Alzheimer’s Drugs Action —Cholinesterase inhibitor
Alzheimer’s Drugs indication —treatment of cognitive impairment associated with early Alzheimer’s Disease.
Alzheimer’s Drugs include Aricept, Cognex, Memantine (also for moderate to advanced stages)
Anti-aggression Agents includes Antianxiety agents, Antipsychotic agents, Tegretol, Lithium, Beta blockers (Inderal, Lopressor)Others: Trazodone, Prozac, Klonopin
Created by: stilsl