N140 OLOL Psych ~ Psychopharmacology
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| Benzodiazepines (Ativan/lorazepam) | Used to treat:anxiety, insomnia, seizures, panic disorders, & alcohol withdrawal. Acts by depressing the CNS.
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| Benzodiazepines | Most common side effects are: sedation, & when given IV, it can cause hypotension & cardiac arrest.
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| Benzodiazepines (Ativan/lorazepam) | Dangerous if used with other CNS depressants (alcohol, opiods, etc.)
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| Benzodiazepines | Should be d/c slowly to prevent withdrawal.
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| Benzodiazepines | These are schedule IV drugs which have some potential for abuse.
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| Antidepressants | Used to treat depressed mood, feelings of sadness, emotional upset, & chronic pain.
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| Depression | ___ is attributed to decreased amounts of the neurotransmitters norepinephrine & serotonin in the brain & neurotransmitter receptor function.
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| Four major classes of Antidepressants | Tricyclic; SSRI's; SNRI's; MAOI's (all take 2 weeks or more to become therapeutic)
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| Tricyclic Agents | Elavil/amitriptyline (Antidepressant)
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| 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.
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| Tricyclic Agents | Side Effects:sedation;orthostatic hypotension,& anticholinergic effects (dry mouth, constipation, urinary retention,&blurred vision).
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| Tricyclic Agents | Bc of their anticholinergic properties, use cautiously with: sympathomimetics; MAO inhibitors; anticholinergics
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| Cardiac toxicity / arrhythmias | Most serious side effect of Tricyclic agents.
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| SSRIs | Selective Serotonin Reuptake Inhibitors
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| SSRIs | Prozac/fluozetine
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| SSRIs | very effective in treating major depression.
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| SSRIs | Side effects include: sexual dysfunction(70%), weight gain, nausea, headaches, insomnia, & anxiety.
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| Serotonin Syndrome | usually begins with first few days of therapy; usually caused by drug interaction with other serotonergics/MAOI's.
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| Serotonin Syndrome | Side effects include: HTN, altered mental status, sweating, incoordination, fever, etc.
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| Serotonin Syndrome | Should be withdrawn slowly to prevent withdrawal syndrome.
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| Serotonin Syndrome | Symptoms of withdrawal include: dizziness, tremor, dysphoria, & sensory disturbances.
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| SNRIs | Serotonin & Norepinephrine Reuptake Inhibitors
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| SNRIs | Effexor/venlafaxine
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| MAOIs | Parnate/tranylcypromine
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| MAOIs | As effective as other antidepressants, but more dangerous.
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| MAOIs | Often used in atypical depression, bulimia, panic attacks, obsessive-compulsive disorders.
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| MAOIs | Adverse effects: CNS stimulation (anxiety, agitation, hypomania), orthostatic hypotension (this does not subside).
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| Hypertensive crisis | A ___ can occur while taking MAOIs, if a patient eats foods containing tyramine, which promotes the release of norepinephrine.
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| MAOIs | Has many drug interactions, mostly those that have vasoconstrictive properties (ie OTC cold meds, etc.) & enhance hypertensive crisis.
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| 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.
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| St John's Wort | Side effects include: photosensitivity, increases metabolism of many drugs (coumadin/ Warfarin; oral contraceptives).
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| Lithium | Mood regulator to treat Bipolar disorder.
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| Depakote / valproic acid | Antiepileptic agent used to treat Bipolar disorder.
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| 0.5 - 1.5mEq/L | Therapeutic level of Lithium
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| Informed consent | Narrow therapeutic range of Lithium, often requires ____ due to high risk for toxicity.
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| Twelve hours | Blood levels of Lithium are drawn ___ after last dose.
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| Lithium | ___ is a salt, and therefore is regulated by the body as sodium.
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| 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.
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| 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.
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| 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.
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| Which diagnostics would be important to obtain prior to the patient beginning Lithium therapy? | Electrolyte studies, CBC, Thyroid studies, EKG, & BUN/Creatinine
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| 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.
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| Client & family education is essential to prevent Lithium toxicity. Teaching points include: | avoiding the sun, potential overheating, & dehydration.
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| Which neurotransmitter is not affected by Lithium? | Serotonin
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| Depakote | Antiepileptic agent that works faster than Lithium, with less side effects.
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| Depakote | Side effects include: GI disturbances & weight gain (usually eliminated when drug is enteric coated).
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| Teratogenic defects | What is a major concern regarding Depakote?
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| Antipsychotics | Used to treat psychosis associated primarily with schizophrenia.
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| Antipsychotics | ___ work by decreasing amounts of neurotransmitters, primarily dopamine & serotonin in the CNS.
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| What is the goal of antipsychotics? | To make the patient think more clearly. Schizophrenia is called a "thought disorder".
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| Positive effects | Schizophrenia characterized by agitation, delusions, hallucinations, paranoia.
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| Negative effects | Schizophrenia characterized by a blunted affect, poor hygiene, poverty of speech, social withdrawal.
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| Typical Antipsychotics | Haldol / haloperidol
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| Typical Antipsychotics | More effective at treating positive effects rather than negative effects of schizophrenia; have many side effects & require careful patient monitoring.
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| Hypertension | SNRI's are similar to SSRI's, however, side effects may include ___.
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| St John's Wort | "Mother Nature's Prozac"
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| St John's Wort | Currently, research has not supported FDA approval.
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| Extrapyramidal symptoms | (EPS) early symptoms (usually occurring hours or days after initiating treatment) include: akathisia, parkinsonism, & dystonia.
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| Akathisia | Continuous restlessness, inability to sit still.
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| Parkinsonism | Muscle tremors, shuffling gait, drooling, rigidity.
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| Dystonia | Spasms, prolonged contractions of muscle groups; *Dangerous & painful & can be treated.
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| Benadryl and Cogentin | Medications used to treat EPS (Extrapyramidal Symptoms).
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| Tardive Dyskinesia | (TD) involuntary movements of the tongue & face. ("fly catching", smacking); Assess often,using AIM(Abnormal Involuntary Movement) assessment form; *Usually IRREVERSIBLE*
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| Neuroleptic Malignant Syndrome | Most serious of all side effects; Characterized by "lead-pipe" rigidity, sudden high fever & changes in cognition.
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| Dantrium / dantrolene | Drug used for treatment of Neuroleptic Malignant Syndrome.
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| Neuroleptic Malignant Syndrome | Side effects include: anticholinergic effects(dry mouth, urinary retention, constipation, blurred vision); sexual dysfunction; orthostatic hypotension.
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| Risperidone / Risperdal | Atypical Antipsychotic agent.
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| Ziprasidone / Geodon | Atypical Antipsychotic agent.
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| Atypical Antipsychotics | Effective in treating both negative & positive symptoms of schizophrenia; these agents cause fewer extrapyramidal(EPS) symptoms.
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| Atypical Antipsychotics | Side effects include: orthostatic hypotension, sedation, & anticholinergic effects.
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| 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.
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| Depot drugs | These are long-acting, injectable formulations. Typically given every 2-4 weeks. The goal is to prevent relapse of schizophrenia.
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| Depot drugs | drugs now available are Haldol & Risperdal. They are called ____.
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