NP5 Psych Test 2 SFC
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| Pharmacodynamics | what the drug does to the body. Therapeutic effects. Side effects
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| Pharmacokinetics | what the body does to the drug--absorption, distribution,metabolism, elimination
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| 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
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| Antidepressants Action | Elevate Serotonin and/or Norepinephrine levels
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| Antidepressants Indications | Depression, Anxiety disorders, OCD, PTSD, Panic Disorder
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| Tricyclic Antidepressants(TCA’s)Brand (generic) | Elavil (amitriptyline),Tofranil (imipramine),Sinequan (doxepin),Norpramin (desipramine),Pamelor (nortriptyline)
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| 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
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| 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).
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| A nursing consideration for Tricyclic antidepressants (TCA's)to consider is | Impotence Note: there is increased risk of fatal overdose with TCA's
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| MAO Inhibitors (MAOI’s)Brand (generic) | Marplan (isocarboxazid)(Similar structure to Isoniazid), Nardil (phenelzine),Parnate (tranylcypromine)
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| For Monoamine oxidase inhibitors (MAOI's) be careful with Foods containing ________ may stimulate hypertensive events, possibly hypertensive crisis. | Tyramine
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| 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
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| While on monoamine oxidase inhibitors (MAOI's), foods to Consume in Moderation include | Red or white wine, Bottled or canned beer, Chocolate, Yogurt
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| Selective Serotonin Re-uptakeInhibitors (SSRI's)include | Prozac, Paxil, Luvox, Celexa, Zoloft, Lexapro
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| 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.
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| 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
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| Other Antidepressants include | Wellbutrin, Remeron, Serzone, Trazodone, Effexor, Duloxetine, Pristiq (Similar to Effexor)
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| Antipsychotics Indication & Action | Treatment of acute and chronic psychosis. Dopamine antagonist
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| 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.)
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| Antipsychotics typicals are Classified as to | potency. low, mid, high(affects S/E profile)
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| Commonly Used Antipsychotics Typicals | Haldol, Thorazine, Mellaril, Prolixin, Navane, Stelazine, Loxitane, Trilafon
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| Side Effects of Typical Antipsychotics includes | Anticholinergic:Blurred vision, Dry mouth, Urinary retention, Constipation
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| 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)
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| 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)
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| Tardive Dyskinesia May be irreversible & may be prevented by | use of low doses. Vitamin E, valproate,clonidine, Clozapine, cholinergic drugs,
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| For Tardive Dyskinesia which drugs may be useful in treating | Gabaminergic drugs
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| Test for Tardive Dyskinesia includes | AIMS Test (standardized exam)
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| Neuroleptic Malignant Syndrome (NMS)is | An idiosyncratic reaction to an antipsychotic drug, may be Potentially fatal
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| Which antipsychotics cause Neroleptic Malignant Syndrome (NMS) | All antipsychotics seem to have the potential to cause NMS
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| What increases the risk of Neroleptic Malignant Syndrome (NMS) | High dosages of high-potency drugs increase risk. Poor nutrition, dehydration, and concurrent medical illness
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| 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
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| Neuroleptic malignant Syndrome (NMS) Treatment | Immediate discontinuation of all antipsychotic medications. Supportive medical care—rehydration and hypothermic measures. Depot Therapy
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| Depot therapy can be used with what medications? | Haldol and Prolixin (Decanoate). Risperdal now available
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| 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).
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| Antipsychotics Atypicals Have more favorable | side effect profiles
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| Antipsychotics Atypicals are Effective for (type of symptoms) | both negative and positive symptoms
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| Commonly Used Antipsychotics Atypicals includes | Clozaril, Risperdal, Zyprexa, Seroquel, Geodon/Zeldox, Abilify
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| Antipsychotic Atypicals: Clozaril | Arguably the most effective for + and - Sx’s
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| 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
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| Common Side Effects Atypicals Clozaril & Zyprexa | sedation, constipation, orthostasis. Low EPS
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| Common Side Effects Atypicals: Zyprexa | may cause appetite increase and is contraindicated with Diabetes
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| Common Side Effects Atypicals: Risperdal | sedation, orthostasis-- moderate. EPS, anticholinergic—low
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| Common Side Effects Atypicals: Seroquel | orthostasis, somnolence, wt. gain
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| Common Side Effects Atypicals: Geodon | nausea, somnolence
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| Common Side Effects Atypicals: Abilify | nausea, H/A, somnolence/insomnia
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| Antiparkinsonian (Medications to combat EPS) Action | Restores balance betweenacetylcholine and dopamine
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| Antiparkinsonian (Medications to combat EPS) Indication | Treatment of parkinsonian side effects of antipsychotics: Cogentin, Artane, Symmetrel, Akineton
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| 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
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| Indications for Benzo's | Anxiety, Agitation, Insomnia, Tension, Panic disorder, Agoraphobia, Seizures (status epilepticus), Muscle spasms, Dystonias, Restless leg syndrome
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| Benzodiazepine medications include | Ativan, Xanax, Klonopin, Valium, Librium, Tranxene
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| Benzodiazepines Side effects | Drowsiness, Fatigue, Decreased concentration, Confusion, Disorientation, Decreased coordination. Note: major drawback is tolerance and dependence (serious W/D complications)
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| How long is Benzo's use recommended for | Recommended for short-term use only Benzo has Synergistic effects when combined with
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| Benzo's may not to be used for | sleep apnea
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| use ________ cautiously in COPD due to depression of the respiratory center of the brain. | Benzo's
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| Other Antianxiety Agents | Buspar (for anxiety)-works on Serotonin-- also NE and DA
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| Antimanics(Mood Stabilizers)Indicated for | bipolar/mania * (have FDA indications for treatment of manic and mixed episodes of bipolar disorder)
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| Antimanics includes | Lithium* (Lithium, lithobid), alproic acid*, (Depakote,Depakene),Zyprexa*, Tegretol, Neurontin, Lamictal, Topimax Lithium
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| Action of Lithium | modulates levels of serotonin and norepinephrine.
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| Indication of Lithium | Treatment of manic episodes --very safe. Eliminated by the kidneys in original form
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| Prior to Lithium nurse Needs to ensure | good kidney function
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| Lithium Can be toxic to | nephrotoxic/thyrotoxic
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| What lab values need to be monitored while on Lithium? | Need to monitor serum levels as well as periodic kidney/thyroid studies
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| Therapeutic level for lithium | Narrow therapeutic window--between 0.5-1.5mEq /L (according to text upper value is 1.5)
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| Lithium Expected side effects | Tremors, Polydipsia, Polyuria, Dry mouth, GI upset Pulse irregularities, Wt. Gain,
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| 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
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| Lithium Toxicity s/sx | Vomiting, Diarrhea, Lethargy, Ataxia, Slurred speech, Confusion, Seizures, Coma, Death
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| Anticonvulsant medications used | Depakote ,Tegretol, Neurontin, Klonopin, Lamictal and Topimax
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| Depakote and Tegretol require periodic ______ levels | serum
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| ________ and _________ both have undesirable S/E’s and idiosyncrasies | Depakote and Tegretol
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| Antimanic Calcium channel blockers include | Verapamil
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| Valproic acid, Tegretol, Neurontin , Lamictal, and Topimax are all are ___________ and have shown varied levels of effectiveness in management of bipolar illness | anticonvulsants
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| CNS Stimulants Action | may increase levels of dopamine, norepinephrine, and serotonin
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| CNS stimulants Indication | for use in treating ADHD, narcolepsy, adjunctively for depression
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| Common CNS stimulants to psych | Ritalin, Concerta, Amphetamine, Dexedrine, Adderal, Strattera
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| CNS stimulant Side Effects | restlessness, insomnia, tachycardia, anorexia, tolerance, psychosis, dependence
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| CNS Problems | high abuse potential, high street value, anorexigenic effects (periodic wts.)
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| Sedatives and Hypnotics Action | CNS depressant
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| Sedatives and Hypnotics Indication | Short-term relief of anxiety or insomnia
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| Sedatives and Hypntoics Common to psych | Benzodiazepines- Restoril, Halcion, Dalmane, Versed
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| Sedatives and Hypnotics Side Effects | confusion, tolerance, dependence, “hangover effect”
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| Restoril is good for _______ term use | short term use
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| ________ - non-Benzodiazepine at 10 mg provides decreased sleep latency, increased sleep efficiency, no REM suppression, low tolerance | Ambien
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| ________ 15 mg some REM suppression and tolerance | Ambien
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| _______ -newer non-Benzo—so far no tolerance, no dependence, no W/D syndrome | Sonata
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| _______ At low doses good for sleep-also may add to therapeutic effects of primary antidepressant | Trazodone (sedative and hynotic)
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| Alzheimer’s Drugs Action | —Cholinesterase inhibitor
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| Alzheimer’s Drugs indication | —treatment of cognitive impairment associated with early Alzheimer’s Disease.
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| Alzheimer’s Drugs include | Aricept, Cognex, Memantine (also for moderate to advanced stages)
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| Anti-aggression Agents includes | Antianxiety agents, Antipsychotic agents, Tegretol, Lithium, Beta blockers (Inderal, Lopressor)Others: Trazodone, Prozac, Klonopin
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