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NUR 271 GWCC
Psychopharmocology
| Question | Answer |
|---|---|
| First line treatment for major depression. Prevents re-uptake of serotonin | Selective Serotonin Reuptake Inhibitors i.e. Zolft, Paxil, Prozac, Celexa |
| Nursing Considerations for SSRI | Taken once in am, avoid ETOH, CI with MAOIs, Assess for serotonin syndrome and discontinuation syndrome. |
| Side Effects of SSRIs | N/V/D, insomnia, fatigue, agitation, dry mouth, hyponatremia, sexual side effects (anorgasmia, low libido) |
| Serotonin Syndrome | Life threatening syndrome caused by too high a dose or interaction with other drugs. AMB Abdominal pain, diarrhea, bloating, fever, tachycardia, elevated BP, delirium, muscle spams, seizures. Can induce high fever, cardiovascular shock, death. |
| Interventions for Serotonin Syndrome | Remove offending agent, initiate treatment: cyproheptadine, methysergide, propranolol, clooing blankets, anticonvulsants, artificial ventilation. |
| Discontinuation Syndrome | AKA Serotonin Withdrawal. AMB dizziness, insomnia, irritability, nervousness, nausea, agitation. TX: wean on schedule. |
| Celexa (citalopram) | SSRI |
| Lexapro (Escitalopram) | SSRI |
| Prozac (fluoxetine) | SSRI |
| Luvox (Fluvoxamine) | SSRI |
| Paroxetine (paxil) | SSRI |
| Sertraline (Zoloft) | SSRI |
| SNRI - Serotonin Norepinephrine Reuptake Inhibitor | Popular next step after SSRIs. Prevents reuptake of serotonin and norepinephrine. |
| Side Effects of SNRIs | Nausea, insomnia, dry mouth, sweating, agitation, headache, sexual dysfunction. |
| Venlafaxine (Effexor) | SNRI. Causes hypertension. Monitor blood pressure. Do not exceed 150 mg/day |
| Duloxetine (Cymbalta) | SNRI. Has advantage of decreasing neuropathic pain. |
| Nursing considerations with SNRIs. | Monitor blood pressure with effexor, discontinuation syndrome. |
| Norepinephrine Reuptake Inhibitors (NRIs) | Blocks reuptake of norepinephrine and enhances its transmission. Useful with severe depression and impaired social functioning. |
| ADEs of NRIs | Insomnia, sweating, dizziness, dry mouth, constipation, urinary hesitancy, tachycardia, decreased libido. |
| Reboxetine (Vestra) | NRI |
| Serotonin Receptor Antagonists/agonists | Selective blockage of serotonin receptors and alpha-adrenergic receptors. Lower risk of long-term weight gain than SSRIs and TCAs. Lower risk of sexual ADEs than SSRI. |
| Serotonin Receptor Antagonists/agonists ADEs | Sedation, hepatotoxicity, dizziness, hypotension, paresthesias. |
| Nursing Considerations with Serotonin Receptor Antagonists/agonists | Life-threatening liver failure possible, priapism of penis and clitoris is rare, CI with MAOIs |
| Nefaxodone (Serzone) | Serotonin Receptor Antagonists/Agonist |
| Norepinephrine Dopamine Reuptake Inhibitor (NDRI) | Blocks reuptake of norepinephrine and dopamine. Stimulant action may reduce appetite, and increase sexual desire. Also used as an aide to quit smoking. |
| ADES for NDRI | Agitation, insomnia, headache, nausea, and vomiting. May have seizures (low risk) CI if high risk for seizure |
| Bupropion (Wellbutrin) | NDRI |
| Serotonin Norepinephrine Disinhibitors (SNDIs) | Blocks alpha 1 adrenergic receptors that normally inhibit norepinephrine and serotonin. Antidepressant effects equal SSRIs and may occur faster. |
| Side effects of SNDIs | Weight gain, sedation, dizziness, headache, sexual dysfunction (rare) |
| Nursing Considerations for SNDIs | Drug-induced somnolence exaggerated by ETOH, Benzos and other CNS depressants. CI with MAOIs. |
| Mirtazapine (Remeron) | SNDI |
| Tricyclic Antidepressants (TCAs) | Inhibits the reuptake of serotonin and norepinephrine. |
| TCA ADEs | ANTICHOLINERGIC EFFECTS: Dry mouth, constipation, urinary retention, blurred vision, orthostatic hypotension, cardiac toxicity sedation. |
| Length of time before mood elevation occurs with TCAs | 7-28 days. Full response may take 3-8 weeks. |
| Nursing considerations with TCAs | Lethal in OD, use cautiously in older adults, cardiac dx, elevated intraocular pressure, hyperthyroidism, seizure disorders, liver/kidney dysfunction. CI with MAOIs |
| When to administer TCAs | At bedtime r/t dizziness, drowsiness |
| Suddenly stopping TCAs can cause: | nausea, altered heartbeat, nightmares, and cold sweats in 2-4 days. |
| Amitriptyline (Elavil) | TCA |
| Clomipramine (Anafranil) | TCA |
| Desipramine (Norpramin) | TCA |
| Doxepin (Adapin, Sinequan) | TCA |
| Imipramine (Tofranil) | TCA |
| Nortiptyline (Aventyl, Pamelor) | TCA |
| Protriptyline (Vivactil) | TCA |
| Monoamine Oxidase Inhibitors (MAOIs) | Inhibits the enzyme monoamine oxidase, which normally breaks down neurotransmitters, including serotonin and norepinephrine. |
| ADES for MAOIs | Insomnia, nausea, agitation, and confusion, weight gain. Potential for hypertensive crises or serotonin syndrome with concurrent use of other antidepressants. |
| Nursing Considerations for MAOIs | Monitor BP routinely for first 6 weeks, avoid TOH, CNS depressants, OTC decongestant drugs, excessive caffeine, foods containing tyramine. CI for 2 wks following surgery |
| Hypertensive crisis with MAOIs | Occurs within a few hours of ingestion of substance, begins with HA, stiff/sore neck, palpitations, increase or decrease in HR, N/V, pyrexia. TX: emergency...CCBs, phentolamine, nifedipine |
| MAOI dietary restrictions | Avocados, bananas, figs, raisins. Pickles, sauerkraut. Beer, soy sauce, yeast, meat tenderizers, licorice, sour cream, yogurt, snails. Avoid chinese restaurants, aged cheeses (camembert, brie, cheddar, gruyere, processed american cheese) Avoid aged meats. |
| Phenelzine (Nardil) | MAOI |
| Selegiline Transdermal System Patch (EMSAM) | MAOI |
| Tranylcypromine (Parnate) | MAOI |
| Lithium Carbonate | Tx of bipolar disorder. Limits about 80% of manic and hypomanic episodes within 10-21 days. Reduces elation, grandiosity, flight of ideas, manipulation, anxiety. |
| Lithium therapeutic levels | Takes 7-14 days to reach level During active phase = 0.8-1/4 mEq/L. During maintenance phase = 0.4-1.3 mEq/L |
| Lithium Toxicity level and intervention | Serious toxicity occurs at levels> 2.0 mEq/L. Interventions: gastric lavage and tx with urea, mannitol, aminophylline can increase lithium excretion. |
| How often should lithium levels be checked? | within 5 days of initiating therapy or after dose change. Once therapeutic level is reached, check monthly for 6 months, after 6 months to a year measure every 3 months. |
| What time of day should lithium be checked? | Blood should be drawn in the am, 8-12 hours after last dose of lithium is taken. |
| Two major long-term risks of lithium therapy are... | Hypothyroidism and impairment of the kidney's ability to concentrate urine. |
| S/Sx of lithium toxicity | Tremor, ataxia, confusion, convulsions, N/V/D, arrthymias, polyuria, polydipsia, edema |
| Anticonvulsant drugs for bipolar disorder | valproate (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Superior for continuously cycling patients. |
| Valproate (Depakote) | Anticonvulsant for bipolar d/o. IND for lithium non responders in acute mania. MONITOR liver fx and platelet count periodically. |
| Carbamazepine (Tegretol) | Monitor liver function and platelet count periodically. Blood levels of carbamazepine should be monitored weekly for first 8 weeks. Can cause bone marrow suppression and liver inflammation. |
| Tegretol Toxic Level | > 12mcg/mL |
| Lamictal (Lamotrigine) | First-line treatment for bipolar depression (can worsen mania). A potentially Life-threatening rash may occur. Seek medical attn. |
| Clozapine (Clozaril) | Atypical Antipsychotic. Causes agranulocytosis, higher risk for seizure. Pt must have weekly WBC for first 6 months, and frequent monitoring thereafter. |
| Atypical Antipsychotics | First-line treatment because they treat both positive and negative symptoms of schizophrenia and produce little EPS or tardive dyskinesia. |
| Risperidone (Risperdal) | Atypical antipsychotic |
| olanzapine (Zyprexa) | Atypical Antipsychotic. High weight gain, high ACh effect. |
| Quetiapine (Seroquel) | Atypical Antipsychotic |
| ziprasidone (Geodon) | Atypical Antipsychotic |
| Aripiprazole (Abilify) | Atypical Antipsychotic |
| ADEs of Atypical Antipsychotics | tendency to cause significant weight gain, metabolic syndrome (weight gain, dyslipidemia, altered glucose metabolism), sedation, low to moderate EPS symptoms |
| Conventional antipsychotics | Blocks dopamine receptor sites in motor areas and causes extrapyramidal side effects (EPS). Treats positive symptoms of schizophrenia. May take 2-6 weeks for full effect. |
| ADES of Conventional Antipsychotics | Anticholinergic effect, sedation, weight gain, sexual ADEs, tardive dyskinesia, orthostatic hypotension, photosensitivity, lowered seizure threshold. |
| Haloperidol (Haldol) | Conventional Antipsychotic. High EPS. |
| Chlorpromazine (Thorazine) | Conventional Antipsychotic. High sedation and ortho HOTN. |
| Thioridazine (Mellaril) | Conventional Antipsychotic. High sedation, ortho HOTN, ACh. |
| Loxapine (Loxitane), Molindone (Moban), Perphenazine (Trilafon) | Medium potency conventional antipsychotics. |
| Thiothixene (Navane) | High potency conventional antipsychotic |
| Fluphenazine (Prolixin) | High potency conventional antipsychotic |
| Pimozide (Orap) | High potency conventional antipsychotic. |
| Drugs that decrease EPS | Centrally acting antiACh drugs i.e. cogentin, benadryl and symmetrel. |
| Anticholinergic toxicity s/sx and interventions | Dry mucous membranes, mydriasis, nonreacctive pupils, hot, dry, red skin, unstable V/S, delirium, seizure. LIFE THREATENING: Hold med/call PCP, emergency cooling measures, benzos, physostigmine. |
| Pseudoparkinsonism s/sx and interventions | Masklike facies, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" Intervention: admin antiparkinsonian agent (trihexyphenidyl or benztropine), call pcp. |
| Acute dystonic reactions s/sx and interventions | Acute contractions of tongue, face, neck, and back. Administer trihexyphenidyl or benztropine. Or benadryl. |
| Tardive Dyskinesia s/sx and interventions | Protruding and rolling tongue, smacking lips, rapid purposeless movements. Interventions: No known tx, may continue after D/C drug, teach pt ways to conceal movements |
| Agranulocytosis s/sx and interventions | Sore throat, fever, malaise, and mouth sores. Usually occurs during first 12 weeks of therapy. Blood work done Q week for 6 months, then every 2 months. If test positive, D/C drug and reverse isolation. |
| Neuroleptic Malignant Syndrome (NMS) s/sx and interventions | Severe EPS, Hyperprexia (high temp), Autonomic dysfunction (HTN, Tachycardia, diaphoresis, incontinence) Delirium. MEDICAL EMERGENCY: stop drug, Parlodel (relieves muscle rigidity and lowers fever), Dantrium, cool body maintain hydration |
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crna2b
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