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Mental Health/Psych
Psychopharmacology
| Term | Definition |
|---|---|
| Psychotropic Drugs | antipsychotics, antidepressants, mood stabilizers, anxiolytics and stimulants |
| Off-label use | A drug that proves effective for a disease that differs from the one involved in the original testing and FDA approval |
| Black box warning | When a drug is found to have serious or life-threatening side effects, even if such side effects are rare. Package inserts must have a highlighted box, separate from the text containing a warning |
| Tricyclic antidepressants | can require 4 to 6 weeks before optimal therapeutic benefit |
| As a rule, older adults | require lower dosages of medications than do younger clients to experience therapeutic effects; may take the drug longer to achieve full therapeutic effects in older adults |
| Psychotropic medications are | decreased gradually (tapered) rather than decreased abruptly |
| Rebound | Temporary return of symptoms or recurrence of the original symptoms or withdrawal |
| Withdrawal | New symptoms resulting from discontinuation of the drug |
| Antipsychotic drugs (neuroleptics) | Used the treat the symptoms of psychosis, such as the delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder. |
| Off-label uses of antipsychotics | Treatment of anxiety and insomnia; aggressive behavior; and delusions, hallucinations, and other disruptive behaviors that sometimes accompany Alzheimer's disease. |
| Second-generation antipsychotics | Can increase mortality rates in elderly clients with dementia-related psychosis |
| Conventional or First-Generation Antipsychotics | Chlorpromazine, Fluphenazine, Thioridazine, Haloperidol |
| Atypical or Second-Generation Antipsychotics | Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Paliperidone |
| Third-Generation Antipsychotic | Aripiprazole |
| Fluphenazine deconoate | Depot injection that has a duration of 7 to 28 days. Uses sesame oil as the vehicle for injection so the medication is slowly absorbed over time |
| Haloperidol deconoate | Depot injection that has a duration of 4 weeks. Uses sesame oil as the vehicle for injection so the medication is slowly absorbed. |
| Depot injection maintenance | After client's condition has stabilized with oral doses of medications, administration of depot injection is required every 2 to 4 weeks to maintain therapeutic effect |
| Extrapyramidal Side Effects (EPS) | Serious neurologic symptoms, are major side effects of antipsychotic drugs. They include dystonia, pseudoparkinsonism, and akathisia. |
| Acute dystonia | Acute muscular rigidity and cramping, stiff or thick tongue with difficulty swallowing, and in severe cases, largyngospasm and respiratory difficulties. Spasms or stiffness in muscle groups can produce torticollis, opisthotonus, and oculogyric crisis |
| Dystonia is most likely to occur | In first week of treatment, in clients younger than 40, in males and those receiving high potency drugs, such as haloperidol and thiothixene. |
| Torticollis | Twisted head and neck |
| Opisthotonus | tightness in the entire body with the head back and arched neck |
| Oculogyric crisis | Eyes rolled back in a locked position |
| Treatment of Dystonia | Immediate anticholinergic drugs: IM benztropine or IM/IV diphenhydramine usually brings rapid relief |
| Drug-induced parkinsonism or Psedoparkinsonism | Resemble those of Parkinson's disease and include a stiff, stooped posture; mask like facies; decreased arm swing, shuffling, festinating gait; cogwheel rigidity, drooling, tremor, bradycardia, coarse pill movmements |
| Treatment of Parkinsonism | Changing to an antipsychotic medication that has a lower incidence of EPS or by adding an oral anticholinergic or amantadine |
| Akathisia | Intense need to move about. Client appears restless or anxious and agitated, often with a rigid posture or gait and a lack of spontaneous gestures. |
| Treatment of akathisia | Change in psychotic medication or addition of an oral agent such as a beta-blocker, anticholinergic or benzodiazepine |
| Neuroleptic Malignant Syndrome (NMS) | Potentially fatal idiosyncratic reaction to an antipsychotic (neuroleptic) drug. Major symptoms: rigidity, high fever, autonomic instability (fluctuating BP), diaphoresis, pallor, delirium, elevated level of CPK |
| NMS | Most often occurs in the first 2 weeks of therapy or after an increase in dosage, but can occur anytime. Dehydration, poor nutrition and concurrent medical illness all increase risk for NMS. |
| Treatment of NMS | Immediate discontinuance of all antipsychotic medications and the institution of supportive medical care to treat dehydration and hyperthermia until the client's physical condition stabilizes |
| Tardive Dyskinesia (TD) | Syndrome of permanent involuntary movements, most commonly caused by long-term use of conventional antipsychotic drugs. |
| Symptoms of TD | Involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing and other excessive unnecessary facial movements are characteristic |
| Treatment of TD | TD is irreversible, although decreasing or discontinuing antipsychotic medications can arrest its progression |
| Anticholinergic Side Effects | Occur with use of antipyschotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory |
| Treatment of anticholinergic side effects | Side effects usually decrease within 3 to 4 wks; do not entirely remit. Using sugar-free beverages or hard candy may alleviate dry mouth; stool softeners, adequate fluid intake, inclusion of grains and fruit in diet my prevent constipation |
| Other side effects | Antipsychotic drugs may increase blood prolactin levels; causing breast enlargement and tenderness in men and women; diminished libido, erectile and orgasmic dysfunction and menstrual irregularities and increased risk for breast cancer; weight gain |
| Weight gain increases most significant in | clozapine and olanzapine |
| Metabolic Syndrome | Cluster of conditions that increase the risk for heart disease, diabetes, and stroke. DX when three or more are present: Obesity, Increased BP, High blood sugar level, High cholesterol |
| Antipsychotic drugs that can cause a lengthening of the QT interval | thioridazine, droperidol, mesordizaine; can cause torsade de pointes |
| Clozapine | produces fewer traditional side effects than most antipsychotic drugs, but has the potentially fatal side effect of agranulocytosis |
| Agranulocytosis | Occurs suddenly; characterized by fever, malaise, ulcerative sore throat, and leukopenia. May not be manifested immediately and can occur up to 24 wks after initiation of therapy |
| Initially with Clozapine | Clients need to have a weekly WBC count that is above 3500 per mm3 to obtain the next wks supply. Currently, all must have wkly WBCs drawn for first 6 months. ANC must also be above 2000 mm3. Monitored every 2 wks for 6 months then every 4 wks |
| If a dose is forgotten | With antipsychotic medication: can take missed dose if it is only 3 or 4 hours late. If more than 4 hrs you omit forgotten dose |
| Antidepressant drugs | Primarily used in treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression. |
| Off-label uses of antidepressants | Include tx of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders. |
| Antidepressants divided into four groups | Triclyclic and related cyclic antidepressants; SSRIs; MAOIs; Other depressants: desvenlafaxine, venlafaxine, bupropion, duloxetine, trazadone, and nefazadone |
| SSRIs | fluoxetine, sertraline, paroxetine |
| Cyclics | Imipramine, Amitriptyline, Mirtazapine, Clomipramine |
| Other Compounds | Bupropion, Venlafaxine, Trazodone, Nefazodone, Duloxetine |
| MAOIs | Phenelzine, Trancyclopromine, Isocarboxazid |
| Cyclic compounds | Cause varying degrees of sedation, orthostatic hypotension and anticholinergic side effects. Potentially lethal if taken in an overdose |
| MAOIs | Must be used with extreme caution: Life-threatening SE hypertensive crisis; cannot be given in combination with other MAOIs, tricyclic antidepressants, meperdine, CNS depressants, many hypertensives or general anesthetics; potentially lethal in overdose |
| SSRIs | First choice in treating depression; equal in efficacy and produce fewer troublesome side effects. Effective ONLY for mild and moderate depression |
| SSRIs and clomipramine | Effective in treatment of OCD |
| Clients at high risk for suicide | SSRIs, venlafaxine, nefazadone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive; they carry no risk for lethal overdose |
| Cyclic compounds may take | 4 to 6 weeks to be effective |
| MAOIs may take | 2 to 4 weeks for effectiveness. Should be taken in the morning |
| SSRIs may take | 2 to 3 weeks to be effective |
| Akathisia usually treated with | A beta blocker (propranolol) or a benzodiazepine |
| Side Effects of SSRIs | Common: anxiety, agitation, akathisia, nausea, insomnia, and sexual dysfunction, specifically diminished sexual drive or difficulty achieving erection or orgasm. Weight gain. |
| Side Effects of Cyclic antidepressants | Anticholinergic effects: dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, blurred near vision. Older adults: agitation, delirium and ileus may occur. Other common SE: orthostatic hypotension, sedation, weight gain, tachycardia |
| Side Effects of MAOIs | Most common: daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension and sexual dysfunction. |
| Serious side effect of MAOI | Hypertensive crisis; If patient ingests food containing tyramine or takes sympathomimetic drugs |
| Signs of Hypertensive Crisis | Hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias |
| Fatal interactions with MAOIs | SSRIs, certain cyclic compounds, buspirone, dextromethorphan and opiate derivatives such as Meperdine |
| Side Effects of other Antidepressants | sedation, headache, dry mouth and nausea, loss of appetite, agitation, and insomnia. Venlafaxine: dizziness, sweating or sedation. |
| Novel antidepressants (nefazadone, trazadone, mirtazapine, buproprion, venlafaxine, desvenlafaxine) | Sexual dysfunction is less common; Trazadone CAN cause priapism (sustained and painful erection), may result in impotence |
| Serotonin Syndrome | Uncommon but potentially serious drug interaction that can result from taking an MAOI and an SSRI at the same time. Can also occur if one of the drugs is taken too close to end of therapy with the other. |
| Symptoms of Serotonin Syndrome | agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflxia, and in extreme reactions, coma and death |
| When should SSRIs be taken? | First thing in the morning unless sedation is a problem, generally, paroxetine most often causes sedation. |
| When should cyclic compounds be taken? | At night in a single daily dose to minimize sedation effects |
| Mood-stabilizing drugs | Used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. |
| Lithium | Most established mood stabilizer. Available in tablet, capsule, liquid and sustained-release forms. Effective dosage determined by monitoring serum lithium levels and clinical response to drug. Dosages range from 900 to 3600 mg |
| Serum Lithium levels | Should be 1.0 mEq/L. Levels 1.5 and higher are considered toxic. Monitored q2 to 3 days when dosage is being determined. Then monitored weekly until condition is stable and then monthly or less frequently |
| Side Effects of Lithium therapy | Common: mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste, fatigue or lethargy. Weight gain and acne occur later in therapy |
| Toxic Effects of Lithium | Severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination. Lithium should be d/c immediately. If levels are 3.0 or > dialysis may be indicated |
| Propranolol | Often improves fine tremor with lithium therapy |
| Valproic Acid | Available in liquid, table, capsule forms and sprinkles with dosages ranging from 1000 to 1500 mg/day; Serum drug levels obtained 12 hrs after last dose |
| Side Effects of Valproic Acid | Drowsiness, sedation, dry mouth and blurred vision |
| Lamotrigine | Can cause rashes including Stevens-Johnson syndrome or life-threatening (rare) toxic epidermal necrolysis |
| Kindling Process | Snowball-like effect seen when minor seizure activity seems to build up into more frequent and severe seizures. |
| Anxiety drugs or Anxiolytics | Used to treat anxiety and anxiety disorders, insomnia, OCD depression, PTSD and alcohol withdrawal. Most widely prescribed medications today. |
| Benzodiazepines | Proved to be the most effective in relieving anxiety and most frequently prescribed. May be prescribed for their anticonvulsant and muscle relaxant effects |
| Buspirone | Nonbenzodiazepine often used for the relief of anxiety. Does not cause physical dependence |
| Benzodiazepines | Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam |
| Anxiolytics used to manage alcohol withdrawal | Diazepam, chlordiazepoxide and clonazepam |
| Side Effects of Benzodiazepines | One chief problem is the tendency to cause physical dependence |
| Most common Side effects of benzodiazepines | CNS depression, drowsiness, sedation, poor coordination, impaired memory or clouded sensorium. If used for sleep, may complain of next-day sedation or hangover effect |
| Common side effects of buspirone | Dizziness, sedation, nausea, and headache |
| Benzodiazepine withdrawal | Can be fatal. Taper drug down! |
| Stimulant drugs | Dextroamphetamine, methylphenidate, amphetamine and dextromethamphetamine |
| Treatment of narcolepsy | Both dextroamphetamine and methylphenidate are given in doses totaling 20 to 200 mg/day. Higher doses may be needed due to tolerance. |
| Side Effects of stimulants | Most common: anorexia, weight loss, nausea, and irritability. Client should avoid caffeine, sugar and chocolate. Most common with long-term is growth and weight suppression that occurs in some children.; "drug holidays" can prevent this |
| "Drug Holidays" | Times when children do not take their stimulant medication such as on weekends and holidays or during summer vacation, helps restore normal eating and growth patterns |
| Disulfiram (Antabuse) | Sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. It's only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism. Useful for persons motivated to abstain and not impulsive. |
| Side Effects of Disulfiram | Five to ten minutes after ingesting alcohol, SX appear: facial & body flushing from vasodilation, throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, & weakness. Severe cases: chest pain, dyspnea, severe hypotension, confusion and death |
| Additional Side Effects of Disulfiram | Sx progress rapidly and last from 30 min to 2 hrs. most effective in persons whose liver enzymes are within normal range. Client must select products that are alcohol free while on this medication. |
| Other side effects of Disulfiram | Fatigue, drowsiness, halitosis, tremor, and impotence. Can interfere with drugs such as phenytoin, isoniazid, warfarin, barbiturates and benzodiazepines: diazepam and chlordiazepoxide |
| Acamprosate | Sometimes rx for persons in recovery from alcohol abuse or dependence. Helps reduce physical & emotional discomfort encountered during first few weeks or months of sobriety:sweating, anxiety & sleep disturbances. Dose is two tablets 333 mg each 3x daily |
| St. John's wort | Used to treat depression and commonly purchased herbal product in the US |
| Kava | Used to treat anxiety and can potentiate the effects of alcohol, benzodiazepines, and other sedative-hypnotic agents |
| Ginkgo biloba | Primarily used to improve memory but is also taken for fatigue, anxiety and depression |
| Electroconvulsive Therapy (ECT) | Used to treat depression in select groups, such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses. In addition, pregnant women can safely have an ECT with no harm to fetus |
| ECT | Involves application of electrodes to the head of the client to deliver an electrical impulse to the brain causing a seizure. |
| Treatment schedule for ECT | Usually a series of 6 to 15 treatments scheduled three times a week. Generally a minimum of six treatments are needed to see sustained improvement. Maximum benefit is achieved in 12 to 15 treatments |
| Preparation for ECT | NPO after midnight, removal of any fingernail polish, voids just before procedure, IV line started for administration of medication. |
| During ECT | Initially client receives short-acting anesthetic so not awake during the procedure. Receives a muscle relaxant/paralytic, usually succinylcholine. Electrodes placed on head bilateral/unilateral. Electrical stimulation delivered; monitered by EEG. |
| Clozapine (antipsychotic) | Schizophrenia unresponsive to or intolerant of standard therapy. To reduce recurrent suicidal behavior in schizophrenic patients |
| Chlorpromazine (antipsychotic) | Second line treatment for schizophrenia and psychoses after failure with atypical antipsychotics |
| What drink to avoid with Benzodiazepines? | Grapefruit juice |
| Venlafaxine (SNRI) | First SNRI approved for major depression |
| Foods that contain Tyramine | Cheese, cream, yogurt, coffee, chocolate, bananas, raisins, Italian Green beans, liver, pickled foods, sausage, soy, yeast, beer and redwines |
| Important to remember with Lithium | Monitor serum sodium levels. Use with caution with diuretics. Adequate intake of fluid intake of 1 to 2 L daily |
| Nursing Interventions for Benzodiazepines | Observe for side effects, observe for physical and psychological dependency, can occur with most anxiolytics. Monitor V/S, especially BP and pulse; Orthostatic hypotension may occur. Do not consume alcohol. Teach ways to control stress and anxiety |
| Chlorpromazine common side effects | May produce pronounced orthostatic hypotension. May cause a harmless pinkish to red-brown urine color |
| Contraindications with haloperidol | Narrow-angle glaucoma, severe hepatic, renal and cardiovascular diseases; CNS depression |
| Atypical Antipsychotics | Effective in treating both positive and negative symptoms of schizophrenia |
| Clozapine | Only indicated for treatment of severely ill schizophrenic pts who have not responded to traditional antipsychotic drugs |
| Risperidone | Treats positive and negative symptoms of schizophrenia. Action similar to clozapine, occurrence of EPS and TD is low. Does not cause agranulocytosis |
| Nursing Considerations for treating mood disorders | Monitor BP q2 to 4 hrs during initial therapy; Assess pt taking MAOI for hypertensive crisis; Monitor liver function & CBC when pt is tkng trycyclic; Administer SSRIs in AM w/or w/out food; Advise pt to avoid alcohol; Monitor serum drug levels of lithium |
| Naloxone | For opioid reversal. Administered IV or IM or subq every 2 to 3 minutes. Rapidly reverses opioid-induced CNS depression and increases respiratory rate within 1 to 2 minutes |
| Benztropine (anticholinergic) | To decrease involuntary symptoms of parkinsonism or drug induced parkionsonism. |
| Side Effects of Benztropine | N/V, dry mouth, constipation, restlessness, flushing, dizziness, blurred vision, photophobia, pupil dilation, amnesia, confusion, depression, hallucinations, anhidrosis, weakness, hyperthermia, paresthesia |
| Adverse Reactions of Benztropine | Tachycardia, palpitations, urinary retention, Life-threatening: Paralytic ileus |
Created by:
JennG2017
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