Psychotropic Drugs
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| 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
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| For psychotropic drugs, it often takes ___ months to find right drugs and doses due to trial and error | 6-24
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| With psychotropic drugs, often _____ is poor | Adherence
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| 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
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| What is dysthmia? | Chronic depression that has somewhat less severe symptoms than major depression
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| Depression is thought to be ____ and ____ | Acute and chronic
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| 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
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| Depression needs to be differentiated from other physiological problems such as... | Low estrogen, low thyroid, tumors
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| True or false: anxiolytics are the newest drug category in western medicine | False. Antidepressants
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| Most antidepressants affect CNS and also have ____ effects | Anticholinergic
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| Antidepressants have ____ half-lives and highly ____ and _____ dosing | Long; individualized and variable
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| What is the goal of antidepressant therapy? | Improved mood and functionality. To fully eradicate depressive symptoms is not the goal.
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| Antidepressants can also be effective with... | Anxiety disorders, smoking cessation, pre-menstrual disorders
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| Anticholinergic effects include ______ and _____ | Physical, psychological
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| Anticholinergic peripheral effects include: | Dry mouth, decreased bronchial secretions, constipation, urinary retention, bowel obstruction, dilated pupils (photophobia), blurred vision, increased HR, decreased sweating
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| Anticholinergic central effects include: | Impaired concentration, confusion, attention deficit, memory impairment
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| Of 25 most prescribed meds to elderly, ____ have anticholinergic effects | 13
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| Drug categories with anticholinergic effects include | Most psychotropic drugs and antisezure medications
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| 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)
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| Antidepressants can cause _____ and ______ problems, which is why you should time dose appropriately | sleep and alertness
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| With antidepressants, you are more likely to ___ weight | Gain
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| 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
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| 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)
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| How do SSRIs work? | Prevents reuptake of serontin into pre-synaptic terminals to enhance serotonin levels at nerve endings
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| SSRIs are used to treat... | Depression, OCD, increased appetite for anorexics/cancer pts., smoking cessation, depression due to chronic pain
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| True or false: SSRIs can be combined with SNRIs | False! Can only be combined with other SSRIs
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| Fluoxetine is absorbed well through _____ route, has ____ protein-binding, and strnogly affects ______ | PO, high, and liver
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| When treating pt. with SSRIs, RN must consider that they can give enough energy for the pt to... | Commit suicide
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| True or false: although SSRIs treat symptoms of depression, it may possibly cure postpartum depression | True
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| List the adverse effects of Prozac | CNS stimulation OR sedation, N&D, rash, weight gain, anticholinergic effects
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| 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)
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| How do SNRIs work? | Increase levels of serotonin and NE by inhibiting reuptake; NTs stay in synapse and have prolonged effect
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| At low doses, venlafaxine affects primarily ____, at moderate doses ______, and high doses ______ | Only serotonin; NE and serotononi; also affects dopamine
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| True or false: SNRIs have very similar AE but less sexual ones reported | True
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| SNRIs raise NE, causing _____ effects | Adrenergic
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| Tricyclics are ____ and potentiate effects of which NTs in CNS? | Nonselective; NE/dopamine/serotonin
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| Tricyclics have what sort of therapeutic effects? | Mood elevation, increased appetite
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| Amitriptyline is well absorbed in ____, _____ protein bound, and can cross ______ | GI, highly, placenta/enters milk
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| Elavil should not be used with ______. Especially, ______ as can be fatal | other antidepressants; MAOIs
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| Amitriptyline can mask _____ tendencies and should not be used with other CNS _____ | Suicidal; stimulants
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| If overdosed on Elavil, can result in ____ | Death
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| Tricyclic antidepressants reduce ____ threshold | Seizure
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| True or false: tricyclic drugs are the most difficult to assess and monitor symptoms in terms of outcome measures (how person is doing) | True
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| AEs of amitriptyline include... | Sedation or insomnia, weight gain, strong anticholinergic effects
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| MAOI stands for... | Monoamine oxidase inhibitors
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| How does phenelzine work? | Inhibits MAO enzyme which is found in brain, platelets, liver, spleen, kidneys. This allows accumulation of dopamine, NE, serotonin
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| Phenelzine has good GI absoprtion, is highly protein bound and half life is _____ | Unknown
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| To use MAOIs you must wait ____ after discontinuing use of SSRIs | 5 weeks
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| Using MAOIs with opioids can result in | hyper/hypotension, coma, seizures, death
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| With antihypertensives, MAOI can cause | Severe hypotension
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| MAOIs must be discontinued ____ prior to surgery | Several weeks
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| Which antidepressant is category of last choice? | MAOIs. Used when cannot tolerate other antidepressant categories
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| MAOIs cause excessive CNS ____, which manifests in ______ and ______ | Stimulation; mania and agitation
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| When using MAOIs, hypertensive crisis can occur with certain foods high in ____ or _____ | Tyrosine (precursor to epinephrine) and tyramine (immediate of tyrosine)
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| Foods with tyramine include | Bananas, alcohol, cheese, raisins, chocolate, sausage, peas, potatoes, yogurt, soy sauce, avocado
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| Welbutrin/bupropion is weaker than _____ but still inhibits reuptake of dopamine, serotonin, and NE | SSRIs
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| What are the beenfits of choosing Zyban? | Cost and formularies. Less AE (sexually)
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| List AE of bupropion | More hypotension, headache, dizziness, agitation/sedation, queasiness, seizures, anticholinergic
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| Onset of bupropion is _____ days, peak at ____ | 7-10 days; 3-4 weeks
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| True or false: when taking bupropion, do not need to worry about driving | False. Avoid driving initially due to AE
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| 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.
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| Lithium has a ____ effect rather than a _____ one | Dampening; activating
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| What is the major therapeutic effect of lithium? | Changes action potential, smoothes out spikes in epi/NE/serotonin/dopamine at synaptic junctions
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| AE with lithium include: | Toxicity, thryoid disturbances, many DDIs
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| Lithium is a category _____ drug and can cause ______ pills to be less effective | D; birth control
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| True or false: like other psychotropic drugs, lithium cannot be measured in the body | False. One of few that can be measured
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| What labs would you check for a pt. on lithium? | Serum lithium level, liver panel, Cr/BUN, TSH/T3/T4
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| Use of ___ can increase lithium excretion | Table salt
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| Lithium toxicity increases with use of _____ or ______ | Diuretics, NSAIDs
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| Lithium toxicity manifests in... | V&D, slurred speech, ataxia, drowsiness, muscle weakness and twitching (extrapyramidal and anticholinergic)
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| True or false: many of lithium's adverse and toxic effects will occur in therapeutic range | True
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| Anxiety is often triggered by an event but can cause a ______ in NTs | Imbalance
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| The criteria for treatment of anxiety is | Lack of functionality
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| Anxiety often coexists with ______ and ______, which often have to be treated first | Depression; substance abuse
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| True or false: depression is more common in US than anxiety disorder | False. Anxiety more common
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| List a prototype for anxiolytics | Diazepam/Valium
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| 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.
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| True or false: tolerance of diazepam is common | True, along with abuse and depression
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| True or false: with overdose of benzodiazepines, one can reverse sedation but not respiratory depression | True
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| Naloxone does not reverse ______ | Respiratory depression induced by anxiolytic overdose
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| Besides benzodizepines, what other drugs can be used for anxiety? | Antihistmines (diphenhydramine/Benedryl, hydroxyzine/Vistaril)
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| Alprazolam is another name for... | Xanax
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| Benzodiazepines are _______ and increase ____ risk | highly addictive; suicide
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| Vistaril/hydroxyzine used to potentiate ______ in post-surgical patients | Opioids
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| One cannot drink alcohol with antianxiety drugs or _____ | drive
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| Antianxiety drugs produce ______ effects | Anticholinergic
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| Antipsychotic drugs include convention (list two) and atypical (one) | chlorpromazine/Thorazine, haloperidol/Haldol. Atypical is clozapine
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| Antipyschotic drugs are pregnancy category _____ | C
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| Antipsychotic drugs used to treat... | Schizophrenia, bipolar disease, delusional disorders, severe nausea (cancer)
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| 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
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| Because antipsychotic adherence is poor, sometimes ____ preparations are used | Depot
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| Antipsychotic drugs have ___ effects with other CNS depressants | Additive
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| Extrapyramidal effects of antipsychotics include... | Tardive dyskinesia, dystonia, Parkinsonism, akathisia (can't stay still), neuroleptic malignant syndrome, tremors, sedation, photosensitivity
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| What is neuroleptic malignant syndrome? | Includes hypertonicity, hyperthermia, incontinence, pulmonary congestion, HTN or hypotension
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| 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
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