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Pharm II - Week 3

Psychotropic Drugs

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