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Psychotic Drug Test
Nurs 206 Test 1 flash cards
| Question | Answer |
|---|---|
| Symptoms of lithium toxicity | vomit, diarrhea, appear intoxicated - slurring of speech, fine motor tremor, incontinence, memory problems |
| Signs of Atropinic Overload | Hot as a Hare - fever Red as a beet - skin flushed Dry as a bone - dry mouth and skin, no sweat, increased thirst Mad as a Hatter - increase in psychotic behavior |
| Bradykinesia | slow movement; often misdiagnosed for depression |
| akinesia | no movement, fatigue, lack of interest Mistaken for depression; need to monitor closely BEFORE giving med to see if they already have this problem |
| What does MAO enzyme do? | metabolizes excessive amounts of neurotransmitters |
| Six main receptors in the CNS | cholinergic, adrenergic, dopamine, serotonin, histamine, GABA |
| Anti-cholinergic side effects | dry mouth blurred vision constipation trouble urinating |
| What causes atropine overload? | Blocking too many cholinergic receptor sites - can cause death |
| Cholinergic receptors stimulate_______ | Stimulate release of acetylcholine causes parasympathetic response |
| Parasympathetic Response | "Rest and Digest" P = peace secretion of salivary glands, contraction of GI tract, dilation of blood vessels in erectile tissue of penis, unination |
| Sympathetic Response | "S" = stress Fight or Flight Adrenergic response |
| Adrenergic receptors stimulate ________ | Stimulate release of epinephrine and norepinephrine -sympathetic response -there are ALPHA-adrenergic receptors and BETA-adrenergic receptors |
| Alpha-adrenergic receptors | Excitatory response Blocking dopamine receptors will decrease alpha-adrenergic activity |
| Beta-adrenergic receptors | inhibitory response blocking depamine receptors will increase beta-adrenergic activity |
| Dopamine receptors | produce alpha-adrenergic activity if parasympathetic (cholinergic) and sympathetic (adrenergic) levels are imbalanced, causes EPS |
| If you have high anxiety, what is not working? | GABA |
| _____ is the main inhibitory neurotransmitter in the CNS | GABA |
| Serotonin receptors | stimulate cell firing |
| SSRI | increases levels of serotonin given for depression |
| BDNF | -brain derived neurotropic factor -a protein that influences serotonin and alters the brain's synaptic network -released by neurons in the brain -influenced by what's going on in the environment |
| BDNF Levels | HIGH BDNF is good -LOWERS with stress and trauma -INCREASES when depression is resolved with medication or psychotherapy |
| Traditional Antipsychotic Drugs | best for schizophrenia type I block dopamine receptors -Depot Drugs a) Fluphenazine (Prolixin) b) Haloperidol decanoate (Haldol decanoate) |
| Atypical Antipsychotic Drugs | Block serotonin Best for schizophrenia type II 1. Clozapine (clozaril) 2. Olanzepine (zyprexa) 3. Quetiapine (seroquel) 4. Risperidone (risperdal) |
| Dopamine System Stabilizer Drug | aripiprazole (Ambilify) Also approved to treat bipolar I |
| Anti-anxiety drugs | A. Benzodiazepines - potentially addictive; works w/ GABA B. Buspirone Hydrochloride (BuSpar) - doesn't work w/ GABA; not addictive |
| Antidepressants | A. Tricyclic Antidepressants (TCA) B. Second-generation Antidepressant - these two work similarly C. Monoamine Oxidase Inhibitors (MAOI) - LAST CHOICE D. Selective Serotonin Reuptake Inhibitors (SSRI) - 1st choice |
| Types of SSRI's | citalopram hudrobromide (celexa) escitalopram oxalate (lexapro) fluoxetine (prozac) fluovoxamine (luvox) paroxetin (paxil) sertraline (zoloft) |
| Anti-manic drugs | A. Lithium B. Antiseizure Drugs 1. Carbamazepine (tegretol) 2. Valproic Acid (depakene, depakote) Only use the latter 2 if bad reaction to lithium or if lithium doesn't work |
| site of action of antipsychotic drugs | CNS |
| antipsychotic and antidepressant drugs are metabolized ____ | in the liver by enzymes like CYP |
| Asians, hispanics, and blacks have _______ levels of CYP enzymes | LOWER levels -slower metabolism of drugs -risk for toxicity -increased severe side effects -decreased compliance (they stop taking meds bc of the side effects) |
| Risks for higher levels of CYP enzymes | faster metabolism of drugs decreased therapeutic effectiveness decreased compliance (it's not working so they quit taking meds and don't come back) |
| Schizophrenia I | GENETIC -Too many dopamine receptor sites in limbic region -give traditional antipsychotic drugs -POSITIVE symptoms ie: delusions, hallucinations, bizarre thought process |
| Schizophrenia II | -caused by retrograde virus -increased serotonin and decreased dopamine in brain -NEGATIVE symptoms (ie: social withdrawal, inappropriate emotional response, inability to experience pleasure, lack of energy or motivation give atypical antipsychotic d |
| Treatment of aggressive children with ADD | might be given antipsychotic to deal with aggression NOT the ADD (ie mellaril in combo with ritalin or strattera) |
| 1st choice in treating elderly with dementia | HALDOL -Low sedative and hypotension affect -higher EPS risk due to low anti-cholinergic properties |
| antipsychotic drugs are absorbed and distributed ___________ | Drugs are highly lipophilic and are absorbed in fatty tissues -Even after taking, drug will slowly be released -drug activity is prolonged up to 3 months after discontinuation |
| Metabolism and excretion of drugs and the elderly | -Antipsychotic drugs are metabolized in the liver by hepatic enzymes -Elderly have decrease in hepatic blood flow = toxicity -metabolized antipsychotic drugs are excreted by kidney in urine -Elderly individuals have decreased elimination capacity |
| Antiemetic | suppresses nausea and vomiting |
| Elderly and Side Effects | *more susceptible to ESP: confusion, disorientation, orthostatic hypotension, arrhythmias *67% unaware of potential drug side effects *side effects often misdiagnosed as another illness |
| Ideally we want to block _______ of dopamine receptor sites | 60% - 80% |
| Neuroleptic Malignant Syndrome (NMS) | -caused by blocking too many dopamine receptors -causes cardiac failure due to vasodilation -administer norepinephrine to constrict blood vessels -symptoms: fever, hypoventilation, decrease blood pressure, increased heart rate, muscular rigidity |
| Akathisia | restlessness and movement - look antsy; pacing, fidgeting, continual movement of hands, mouth, body -symptoms will get better when you decrease level of drug |
| Tardive dyskinesia | IRREVERSIBLE -long term use of high doses of antipsychotic drugs -involuntary movements of extremities and trunk, drooping of head, protrusion of tongue, rocking -When anxious, worse -Anti-cholinergic make WORSE. Try increasing dose of antipsychotic |
| Side effects of increased beta-adrenergic effects | -vasodilation -orthostatic hypotension (bc of vasodilatoin) -tachycardia and palpitations (rare but can happen) |
| Obstructive jaundice | Rare but might appear in 1st 5 weeks of treatment -occurs most with chlorpromazine (thorazine) |
| anti-cholinergic side effects | affects parasympathetic -dry mouth, constipation (should have prn for stool softener), urinary retention, blurred vision. *symptoms should disapper in 3 weeks |
| Photosensitivity | *allergic reaction to drug reacting with sunlight(most often with chlorpromazine (Thorazine) ) * blue-gray or purple skin discoloration |
| Depot Drugs | can give IM and will last a few weeks (good for schiz clients who won't remember to take meds) -given every 3 weeks *Fluphenazine (Prolixin) *Haloperidol decanoate (Haldol decanoate) *Risperidone (Risperdal Consta) |
| Symptoms that respond to antipsychotic drugs | agitation, rage, overreactivity to sensory stimuli, hostility, negativeness, and though disorder **lack of social stills will NOT be helped with medication** |
| antipsychotic drug that can be used to treat Tourette's | Haldol |
| Peak onset after IM injection | 30 minutes |
| Side effects on CNS | -Affects ability to regulate body temp -Depression (EXCEPT Ambilify and Geoden which treat depression -can cause NMS if administered too long -EPS |
| Synergistic Effect | occurs when antipsychotic drugs are taken in combination with CNS depressant drugs (ie: alcohol, barbituates, narcotics) -creates greater CNS depressant effect than drug given alone -can lead to respiratory depression causing pneumonia |
| heavy smoking and antipsychotic drugs | requires larger doses of medication b/c nicotine induces liver enzyme activity and increases metabolism of antipsychotic drugs |
| tricyclic antidepressant (TCA) combined with antipsychotic drugs | causes severe anticholinergic side effects (atropine overload) b/c tca drugs inhibit metabolism of antipsychotic drugs (and vice versa) |
| full drug trial takes _______ weeks | 3 - 6 weeks EXCEPT Ambilify (takes 2-3 weeks) |
| How to evaluate level of anxiety | Observation -pulse -blood pressure -ability to focus on problems -ability to connect to feelings, thoughts, actions |
| Recommended duration of benzodiazepine and meprobamate | 4 months -high addictive potential |
| Only antianxiety drug that is not addictive | Buspirone (BuSpar) |
| anti-anxiety co-morbidity | If you do not treat anxiety effectively, will become co-morbid with depression |
| When should you NOT give a long-acting drug | if patient is elderly OR has liver problems |
| Of the benzodiazepines, ______ has the LONGEST duration of action | chlordiazepoxide (Librium) |
| Of the benzodiazepines, ______ has the SHORTEST duration of action | triazolam (Halcion) |
| Long-acting benzodiazepines | 1-3 Days -clorazepate -chlordiazepoxide -Diazepam -Flurazepam -Quazepam |
| Intermediate-acting benzodiazepines | 10-20 Hours -alprazolam -estazolam -lorazepam -temazepam |
| Short-acting benzodiazepines | -oxazepam -triazolam |
| Mechanism of action of antianxiety drugs | 1. Sedation -depressant action 2. Skeletal muscle relaxatoin ie: valium 3. Reduction of anxiety -benzodiazepines increase effectiveness of GABA which inhibits cell firing and cell excitability -BuSpar does NOT effect GABA |
| How BuSpar works | -anxiety disorders have lower levels of serotonin in amygdala -blocks presynaptic serotonin receptors=increase release of reotonin -takes 1 week + b/c body tries to re-regulate -increased metabolism of N.E. causes blood vessels to relax and back to nor |
| Most commonly prescribed psychotropic medications | Antianxiety drugs -only 20% written by mental health professionals -80% written by PCP |
Created by:
nursenora
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