Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pharm II - Week 3
Psychotropic Drugs
| Question | Answer |
|---|---|
| True or false: generally, psychotropic drug levels can be measured in the blood stream | False; can only follow "clinically" by asessing for therapeutic and adverse effects |
| For psychotropic drugs, it often takes ___ months to find right drugs and doses due to trial and error | 6-24 |
| With psychotropic drugs, often _____ is poor | Adherence |
| If a pt. has been on psychotropic meds prior to hospitalization, a nurse must do this: | Medication reconciliation to know what pt. was on before and during hospital stay so medications aren't forgotten |
| What is dysthmia? | Chronic depression that has somewhat less severe symptoms than major depression |
| Depression is thought to be ____ and ____ | Acute and chronic |
| Depression is thought to be a chemical imbalance. NT at nerve terminals are insufficient quantities for following reasons: | Excessive reuptake, poor initial production, excessive deactivation |
| Depression needs to be differentiated from other physiological problems such as... | Low estrogen, low thyroid, tumors |
| True or false: anxiolytics are the newest drug category in western medicine | False. Antidepressants |
| Most antidepressants affect CNS and also have ____ effects | Anticholinergic |
| Antidepressants have ____ half-lives and highly ____ and _____ dosing | Long; individualized and variable |
| What is the goal of antidepressant therapy? | Improved mood and functionality. To fully eradicate depressive symptoms is not the goal. |
| Antidepressants can also be effective with... | Anxiety disorders, smoking cessation, pre-menstrual disorders |
| Anticholinergic effects include ______ and _____ | Physical, psychological |
| Anticholinergic peripheral effects include: | Dry mouth, decreased bronchial secretions, constipation, urinary retention, bowel obstruction, dilated pupils (photophobia), blurred vision, increased HR, decreased sweating |
| Anticholinergic central effects include: | Impaired concentration, confusion, attention deficit, memory impairment |
| Of 25 most prescribed meds to elderly, ____ have anticholinergic effects | 13 |
| Drug categories with anticholinergic effects include | Most psychotropic drugs and antisezure medications |
| Key problem in non-adherence of antidepressants is | Sexual dysfunction (can become erect, but cannot ejaculate for men; no or prolonged climax phase for women) |
| Antidepressants can cause _____ and ______ problems, which is why you should time dose appropriately | sleep and alertness |
| With antidepressants, you are more likely to ___ weight | Gain |
| True or false: drug holidays still recommended to pts. to decrease AEs | False. Not advised at this point since pt. may require increased doses after holiday or discontinue drug altogether |
| List the antidepressant classes and corersponding prototypes | SSRIs (fluoxetine/Prozac), SNRIs (vanlafaxine/Effexor), Tricyclic (amitriptyline/Elavil), MAOIs (phenelzine/Nardil), atypical (bupropion/Wellbutrin/Zyban), and mood stabilizers/bipolar (lithium) |
| How do SSRIs work? | Prevents reuptake of serontin into pre-synaptic terminals to enhance serotonin levels at nerve endings |
| SSRIs are used to treat... | Depression, OCD, increased appetite for anorexics/cancer pts., smoking cessation, depression due to chronic pain |
| True or false: SSRIs can be combined with SNRIs | False! Can only be combined with other SSRIs |
| Fluoxetine is absorbed well through _____ route, has ____ protein-binding, and strnogly affects ______ | PO, high, and liver |
| When treating pt. with SSRIs, RN must consider that they can give enough energy for the pt to... | Commit suicide |
| True or false: although SSRIs treat symptoms of depression, it may possibly cure postpartum depression | True |
| List the adverse effects of Prozac | CNS stimulation OR sedation, N&D, rash, weight gain, anticholinergic effects |
| What are some important teaching points for pts. on fluoxetine? | Discuss AE before they occur, note long time for relief (1-3 weeks), should not withdraw abruptly due to discontinuation syndrome (severe anxiety) |
| How do SNRIs work? | Increase levels of serotonin and NE by inhibiting reuptake; NTs stay in synapse and have prolonged effect |
| At low doses, venlafaxine affects primarily ____, at moderate doses ______, and high doses ______ | Only serotonin; NE and serotononi; also affects dopamine |
| True or false: SNRIs have very similar AE but less sexual ones reported | True |
| SNRIs raise NE, causing _____ effects | Adrenergic |
| Tricyclics are ____ and potentiate effects of which NTs in CNS? | Nonselective; NE/dopamine/serotonin |
| Tricyclics have what sort of therapeutic effects? | Mood elevation, increased appetite |
| Amitriptyline is well absorbed in ____, _____ protein bound, and can cross ______ | GI, highly, placenta/enters milk |
| Elavil should not be used with ______. Especially, ______ as can be fatal | other antidepressants; MAOIs |
| Amitriptyline can mask _____ tendencies and should not be used with other CNS _____ | Suicidal; stimulants |
| If overdosed on Elavil, can result in ____ | Death |
| Tricyclic antidepressants reduce ____ threshold | Seizure |
| True or false: tricyclic drugs are the most difficult to assess and monitor symptoms in terms of outcome measures (how person is doing) | True |
| AEs of amitriptyline include... | Sedation or insomnia, weight gain, strong anticholinergic effects |
| MAOI stands for... | Monoamine oxidase inhibitors |
| How does phenelzine work? | Inhibits MAO enzyme which is found in brain, platelets, liver, spleen, kidneys. This allows accumulation of dopamine, NE, serotonin |
| Phenelzine has good GI absoprtion, is highly protein bound and half life is _____ | Unknown |
| To use MAOIs you must wait ____ after discontinuing use of SSRIs | 5 weeks |
| Using MAOIs with opioids can result in | hyper/hypotension, coma, seizures, death |
| With antihypertensives, MAOI can cause | Severe hypotension |
| MAOIs must be discontinued ____ prior to surgery | Several weeks |
| Which antidepressant is category of last choice? | MAOIs. Used when cannot tolerate other antidepressant categories |
| MAOIs cause excessive CNS ____, which manifests in ______ and ______ | Stimulation; mania and agitation |
| When using MAOIs, hypertensive crisis can occur with certain foods high in ____ or _____ | Tyrosine (precursor to epinephrine) and tyramine (immediate of tyrosine) |
| Foods with tyramine include | Bananas, alcohol, cheese, raisins, chocolate, sausage, peas, potatoes, yogurt, soy sauce, avocado |
| Welbutrin/bupropion is weaker than _____ but still inhibits reuptake of dopamine, serotonin, and NE | SSRIs |
| What are the beenfits of choosing Zyban? | Cost and formularies. Less AE (sexually) |
| List AE of bupropion | More hypotension, headache, dizziness, agitation/sedation, queasiness, seizures, anticholinergic |
| Onset of bupropion is _____ days, peak at ____ | 7-10 days; 3-4 weeks |
| True or false: when taking bupropion, do not need to worry about driving | False. Avoid driving initially due to AE |
| Describe serotonin syndrome | Extreme elvation of serotonin, usually when taking serontonin drug with St. John's worst. Cause extreme activation of CNS and sympathetic NS. |
| Lithium has a ____ effect rather than a _____ one | Dampening; activating |
| What is the major therapeutic effect of lithium? | Changes action potential, smoothes out spikes in epi/NE/serotonin/dopamine at synaptic junctions |
| AE with lithium include: | Toxicity, thryoid disturbances, many DDIs |
| Lithium is a category _____ drug and can cause ______ pills to be less effective | D; birth control |
| True or false: like other psychotropic drugs, lithium cannot be measured in the body | False. One of few that can be measured |
| What labs would you check for a pt. on lithium? | Serum lithium level, liver panel, Cr/BUN, TSH/T3/T4 |
| Use of ___ can increase lithium excretion | Table salt |
| Lithium toxicity increases with use of _____ or ______ | Diuretics, NSAIDs |
| Lithium toxicity manifests in... | V&D, slurred speech, ataxia, drowsiness, muscle weakness and twitching (extrapyramidal and anticholinergic) |
| True or false: many of lithium's adverse and toxic effects will occur in therapeutic range | True |
| Anxiety is often triggered by an event but can cause a ______ in NTs | Imbalance |
| The criteria for treatment of anxiety is | Lack of functionality |
| Anxiety often coexists with ______ and ______, which often have to be treated first | Depression; substance abuse |
| True or false: depression is more common in US than anxiety disorder | False. Anxiety more common |
| List a prototype for anxiolytics | Diazepam/Valium |
| How do anxiolytic drugs work? | Depress CNS by increasing GABA, which inhibits cells from firing and reduces limbic system's anxiety-related messages from reaching cortex. Slows down excitatory messages in brain. |
| True or false: tolerance of diazepam is common | True, along with abuse and depression |
| True or false: with overdose of benzodiazepines, one can reverse sedation but not respiratory depression | True |
| Naloxone does not reverse ______ | Respiratory depression induced by anxiolytic overdose |
| Besides benzodizepines, what other drugs can be used for anxiety? | Antihistmines (diphenhydramine/Benedryl, hydroxyzine/Vistaril) |
| Alprazolam is another name for... | Xanax |
| Benzodiazepines are _______ and increase ____ risk | highly addictive; suicide |
| Vistaril/hydroxyzine used to potentiate ______ in post-surgical patients | Opioids |
| One cannot drink alcohol with antianxiety drugs or _____ | drive |
| Antianxiety drugs produce ______ effects | Anticholinergic |
| Antipsychotic drugs include convention (list two) and atypical (one) | chlorpromazine/Thorazine, haloperidol/Haldol. Atypical is clozapine |
| Antipyschotic drugs are pregnancy category _____ | C |
| Antipsychotic drugs used to treat... | Schizophrenia, bipolar disease, delusional disorders, severe nausea (cancer) |
| How do antipsychotics work? | Psychoses may be due to excessive dopamine in blood. Block dopamine receptors in brain to decrease dopamine response. For nausea, depress chemoreceptor trigger zones in medulla |
| Because antipsychotic adherence is poor, sometimes ____ preparations are used | Depot |
| Antipsychotic drugs have ___ effects with other CNS depressants | Additive |
| Extrapyramidal effects of antipsychotics include... | Tardive dyskinesia, dystonia, Parkinsonism, akathisia (can't stay still), neuroleptic malignant syndrome, tremors, sedation, photosensitivity |
| What is neuroleptic malignant syndrome? | Includes hypertonicity, hyperthermia, incontinence, pulmonary congestion, HTN or hypotension |
| What is the difference between photosensitivity and photophobia? | Photosensitivity is heightened response to sunlight/UV whereas photophobia is pain in eyes due to light exposure |
Created by:
choel
Popular Pharmacology sets