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Chapter 17 quiz Quar
psychotherapeutic drugs
| Questions | Answers |
|---|---|
| Types of Drugs | Anti-anxiety drugs Antidepressants Anti-manic drugs (bi-polar) Antipsychotics |
| Start low | and go slow |
| Psychosis | Severe emotional disorder impairs mental function of affected individual to point that individual cannot participate in activities of daily living (what’s real and what’s not real) |
| Affective Disorders (Mood Disorders) | Changes in mood ranges from mania (abnormally increased emotions) to depression (abnormally reduced emotions) |
| Anxiety | Unpleasant state of mind, characterized by a sense of dread and fear May be based on actual anticipated experiences or past experiences May be exaggerated responses to imaginary negative situations |
| Anxiety Disorders | Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) Panic disorder Social phobia Simple phobia |
| Psychotherapeutics: Pathophysiology | Biochemical imbalance theory Mental disorders are associated with abnormal levels of endogenous chemicals, such as brain neurotransmitters |
| Biochemical imbalance theory | Catecholamines Dopamine (schizophrenia too much) Norepinephrine (depression low levels) Indolamines Serotonin (depression low levels) Histamine (alertness to much to energitic, to much worry) Benadryl |
| Other bio-chemicals necessary for normal mental function | GABA ( calms us down inhibitory of stress) Acetylcholine (ACh) Glutamate/NMDA receptor (tends to be excitatory) might cause Alzheimer's |
| NEUROTRANSMITTER PATHWAYS | Mesolimbic (emotional ) Mesocortical (brain) Nigrostriatal (basal ganglia) (schizophrenia) Tuberoinfundibular- (hyopthalmus and pituitary gland) Thalamic |
| Antianxiety Drugs:MOA | reduce anxiety by reduce overactivity in the CNS |
| Antianxiety Drugs | Benzodiazepines Depress activity in brainstem & limbic system (Xansa, valium atovan) tolerance & dependence Antihistamines: Depress CNS by sedation Primarily used for allergic conditions (Benadryl) buspirone (BuSpar) Nonsedating & non–habit |
| Antianxiety Drugs (cont’d) | Barbiturates (calm but very tolerant and addicting) and carbamates: Previously used to treat anxiety Replaced by newer drugs |
| Anti-Anxiety Indications | Anxiety Sedation, seizure control Muscle relaxation Alcohol withdrawal Adjuvant first few weeks with antidepressant start on antidepression then anti anxiety 1-2 weeks if there is a lot of anxiety |
| Common Benzodiazepine Anxiolytics | diazepam (Valium) lorazepam (Ativan) (used in cancer pt before chemo) alprazolam (Xanax) clonazepam (Klonopin) chlordiazepoxide (Librium) (longer half life than alprazolam) |
| Common Benzodiazepine Anxiolytics (cont’d) | midazolam (Versed)* Reduces anxiety and patient’s memory of painful procedures that do not require general anesthesia (moderate sedation) Injection only |
| Benzodiazepine Adverse Effects | are an overexpression of their therapeutic effects ▼ CNS activity, sedation Hypotension sleepy, loss of coordination (ataxia) dizziness,HA NV, dry mouth,constipation habit-forming addictive Should be used at lowest effective dosages & frequencies needed |
| Benzodiazepines–overdose | Dangerous when taken with other sedatives or alcohol Treatment is generally symptomatic and supportive Flumazenil may be used to reverse benzodiazepine effects (AKA ROMAZLCON) |
| BUSPAR/BUSPIRONE | Non-benzodiazepine Not a controlled substance Not shown to cause tolerance or dependence May be useful in agitation No interaction with alcohol Takes 4 weeks to work hydroxyzine (Vistaril): anticholinergic to reduce anxiety |
| MOOD STABILIZERS | LITHIUM ANTICONVULSANTS ANTIPSYCHOTICS |
| ANTICONVULSANTS | TEGRETOL (carbamazepine) DEPAKOTE (divalproex) (MOST USED FOR MOOD STABELIZER) LAMICTAL (lamotrigine) TOPAMAX (topiramate) TRILEPTAL (oxycarbazepine) |
| Antimanic Drugs | Salt balance interactions Lithium is the DOC for Treatment of mania It is thought to potentiate serotonergic neurotransmission May be used with other meds to stabilize mood |
| Antimanic Drugs Con't | Narrow therapeutic range maintenance serum levels should range 0.6 -1.2 mEq/L (below not stable higher then toxicity) Lithium & Na compete for eliminated(dietetics cause issues) |
| Etiology of Depression | Biogenic amine hypothesis Depression and mania are due to an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain Depression: deficiency of catecholamine, especially norepinephrine Mania:excess amin |
| Etiology of Depression (cont'd) | Affective disorders are due to decreased concentrations of serotonin Depression results from decreases in both serotonin and catecholamine levels Mania results from increased catecholamine but decreased serotonin levels |
| Antidepressants | Newer-generation antidepressants Selective serotonin reuptake inhibitors (SSRIs) Second- and third-generation antidepressants Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs) |
| Newer-Generation Antidepressants | Fewer adverse effects than tricyclics and MAOIs Very few drug-drug or drug-food interactions Still takes about 4 to 6 weeks to reach maximum clinical effectiveness |
| Second-Generation Antidepressants | trazodone (Desyrel) (we use it for sleep than anything else) bupropion (Wellbutrin) ( used for all kinds of depression) SSRIs fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) fluvoxamine (Luvox) citalopram (Celexa) Lexapro (escitalop |
| SSRI Antidepressants | fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) fluvoxamine (Luvox) citalopram (Celexa) escitalopram (Lexapro) |
| Third-Generation Antidepressants | venlafaxine (Effexor) nefazodone (generic only) mirtazapine (Remeron) (used a lot) |
| SSRIs: Mechanism of action | Selectively inhibit serotonin reuptake Little or no effect on norepinephrine or dopamine reuptake Result in increased serotonin concentrations at nerve endings Advantage over tricyclics and MAOIs: little or no effect on CV system |
| Newer-Generation Antidepressants: Indications | Depression Bipolar disorder (should never be on just an antidepressant but should use with mood stabilizer also!!! ) Obesity Eating disorders Obsessive-compulsive disorder |
| Newer-Generation Antidepressants: Indications (cont’d) | Panic attacks or disorders Social anxiety disorders Posttraumatic stress disorders (PTSD) Myoclonus Treatment of various substance abuse problems (bupropion [Zyban] : used for smoking cessation treatment) |
| Newer-Generation Antidepressants: ADRs | CNS Headache, dizziness, tremor, nervousness, insomnia,* fatigue GI Nausea, diarrhea, constipation, dry mouth Other Sexual dysfunction, * weight gain,* weight loss, sweating * Most common and bothersome |
| Serotonin Syndrome | Delirium Agitation Tachycardia Sweating Hyperreflexia Muscle spasms Shivering (rapid) Coarse tremors More severe cases Hyperthermia Seizures Renal failure Rhabdomyolysis Dysrhythmias |
| Newer-Generation Antidepressants: Drug Interactions | Highly bound to plasma proteins Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect Inhibition of cytochrome P-450 system, MAOIs |
| Tricyclic Antidepressants: First-Generation Antidepressants | Largely replaced as first-line antidepressant drugs by SSRIs Second-line For patients who fail with SSRIs or other newer-generation antidepressants As adjunct therapy with newer antidepressants |
| Common Tricyclics | amitriptyline (Elavil, Endep) (HA BACK PAIN, 25-50 MG BUT FOR DEPRESSION HIGH DOSE) doxepin (Sinequan) imipramine (Tofranil) desipramine (Norpramin) nortriptyline (Aventyl, Pamelor) Others |
| Mechanism of Action Tricyclics | Block reuptake of neurotransmitters, causing accumulation at the nerve endings It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression |
| Drug Effects of Tricyclics | Blockade of norepinephrine reuptake Antidepressant,* tremors, tachycardia, others Blockade of serotonin reuptake Antidepressant,* nausea, headache, anxiety, sexual dysfunction *Desired therapeutic effects |
| Indications -Tricyclics | Depression Childhood enuresis (imipramine) Obsessive-compulsive disorders (clomipramine) Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia, ha, fibermyalgia. |
| Adverse Effects-Tricyclics | Sedation Impotence Orthostatic hypotension Others Older patients Dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors Anticholengeric Tachycardia Suicide potential Bad seizures, |
| Overdose-Tricyclics | Lethal—70% to 80% die before reaching the hospital CNS and cardiovascular systems are mainly affected Death results from seizures or dysrhythmias |
| Overdose Con't-Tricyclics | No specific antidote Decrease drug absorption with activated charcoal Speed elimination by alkalinizing urine Manage seizures and dysrhythmias Basic life support |
| MAOIs | Highly effective Considered second-line treatment for depression unresponsive to cyclics Disadvantage: potential to cause hypertensive crisis when taken with tyramine phenelzine (Nardil) tranylcypromine (Parnate) |
| MAOIs: Mechanism of Action | Inhibit the MAO enzyme system in the CNS Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain Result: alleviation of symptoms of depression |
| MAOIs: Indications | Depression, especially types characterized by reverse vegetative symptoms such as increased sleep and appetite Depression that does not respond to other drugs such as tricyclics |
| MAOIs: Adverse Effects | Few adverse effects—orthostatic hypotension most common Tachycardia Dizziness Insomnia Anorexia Blurred vision Palpitations Drowsiness Headache Nausea Impotence |
| MAOIs: Overdose | Symptoms appear 12 hours after ingestion Tachycardia, circulatory collapse, seizures, coma Treatment: protect brain and heart, eliminate toxin Gastric lavage Urine acidification Hemodialysis |
| Hypertensive Crisis and Tyramine | Ingestion of foods or drinks with the amino acid tyramine leads to HTN crisis, which may lead to cerebral hemorrhage, stroke, coma, or death Red wines, aged cheeses,Smoked/pickled or aged meats, fish, poultry Yeast extracts |
| Antidepressants: MAOIs | Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome If the decision is made to switch to an SSRI, there must be a 2- to 5-week “wash-out” period between MAOI therapy and SSRI therapy |
| Antipsychotics | Drugs used to treat serious mental illness Behavioral problems or psychotic disorders |
| Antipsychotics drugs | Thioxanthenes: thiothixene (Navane) Butyrophenones: haloperidol (Haldol) Dihydroindolones: molindone (Moban) Dibenzoxazepine: loxapine (Loxitane) Phenothiazines: three structural groups Atypical antipsychotics: new class |
| Antipsychotics-Mechanism of Action | Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function Dopamine levels in the CNS are decreased Result: tranquilizing effect in psychotic patients |
| Atypical Antipsychotics: Second-Generation Antipsychotics | clozapine (Clozaril) 3rd line for ppl who don’t response to others pt can have low white blood cell/ grandularcyte) √ WBC for the first 6 weeks risperidone (Risperdal) olanzapine (Zyprexa) quetiapine (Seroquel) ziprasidone (Geodon) aripiprazole (Abilify |
| Newer Antipsychotics: Mechanism of Action | Block specific dopamine receptors (dopamine 2 [D2] receptors Also block specific serotonin receptors (serotonin-2 [5HT2] receptors) This is responsible for their improved efficacy and safety profiles |
| Newer Antipsychotics-Indications | Treatment of serious mental illnesses Bipolar affective disorder Depressive and drug-induced psychoses Schizophrenia Autism Movement disorders (such as Tourette’s syndrome) Some medical conditions Nausea, intractable hiccups |
| Adverse Effects-Newer Antipsychotic | sleep, delirium Orthostatic hypoten syncope, dizziness, EKGchanges Photosensitivity,rash, hyperpigmentation, pruritus Dry mouth constipation Urinary hesitancy/retention, impaired erection Leukopenia agranulocytosis galactorrhea irregular menses polydipsia |
| Adverse Effects-Newer Antipsychotic con't | Neuroleptic malignant syndrome muscles are stiff Highfever,unstable BP myoglobinemia Extrapyramidal symptoms Involuntary muscle symptoms similar to Parkinson’s dx:Akathisia Acute dystonia Treated w/ benztropine Cogentin &trihexyphenidyl (Artane |
| Adverse Effects-Newer Antipsychotic con't | Tardive dyskinesia (TD) Involuntary contractions of oral and facial muscles Choreoathetosis (wavelike movements of extremities) Occurs with continuous long-term antipsychotic therapy |
| Psychotherapeutic Drugs: Nursing Implications | assess physical/emotional status of pt.Obtain vitals, postural BP √liver/renal function,cautious use,/potential drug interactions Assess LOC mental alertness potential for injury to self/others √ the pt mouth oral doses R swallowed |
| Antianxiety Drugs-Psychotherapeutic Drugs: Nursing Implications | In the elderly, monitor closely for oversedation and profound CNS depression |
| Antidepressants | Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants Inform patients that it may take several weeks to see therapeutic effects Monitor pt closely during this time, assess for suicidal tendencies,provide suppo |
| Antipsychotics—phenothiazines | Instruct patients to wear sunscreen due to photosensitivity Avoid taking antacids or antidiarrheal preparations within 1 hour of a dose Do not take alcohol or other CNS depressants with these medications |
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