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OLOL~Psychopharm.
N140 OLOL Psych ~ Psychopharmacology
| Question | Answer |
|---|---|
| Benzodiazepines (Ativan/lorazepam) | Used to treat:anxiety, insomnia, seizures, panic disorders, & alcohol withdrawal. Acts by depressing the CNS. |
| Benzodiazepines | Most common side effects are: sedation, & when given IV, it can cause hypotension & cardiac arrest. |
| Benzodiazepines (Ativan/lorazepam) | Dangerous if used with other CNS depressants (alcohol, opiods, etc.) |
| Benzodiazepines | Should be d/c slowly to prevent withdrawal. |
| Benzodiazepines | These are schedule IV drugs which have some potential for abuse. |
| Antidepressants | Used to treat depressed mood, feelings of sadness, emotional upset, & chronic pain. |
| Depression | ___ is attributed to decreased amounts of the neurotransmitters norepinephrine & serotonin in the brain & neurotransmitter receptor function. |
| Four major classes of Antidepressants | Tricyclic; SSRI's; SNRI's; MAOI's (all take 2 weeks or more to become therapeutic) |
| Tricyclic Agents | Elavil/amitriptyline (Antidepressant) |
| Tricyclic Agents | Act by blocking uptake of norepinephrine & serotonin; no longer the first line drug treatment for depression; Has more side effects than newer agents. |
| Tricyclic Agents | Side Effects:sedation;orthostatic hypotension,& anticholinergic effects (dry mouth, constipation, urinary retention,&blurred vision). |
| Tricyclic Agents | Bc of their anticholinergic properties, use cautiously with: sympathomimetics; MAO inhibitors; anticholinergics |
| Cardiac toxicity / arrhythmias | Most serious side effect of Tricyclic agents. |
| SSRIs | Selective Serotonin Reuptake Inhibitors |
| SSRIs | Prozac/fluozetine |
| SSRIs | very effective in treating major depression. |
| SSRIs | Side effects include: sexual dysfunction(70%), weight gain, nausea, headaches, insomnia, & anxiety. |
| Serotonin Syndrome | usually begins with first few days of therapy; usually caused by drug interaction with other serotonergics/MAOI's. |
| Serotonin Syndrome | Side effects include: HTN, altered mental status, sweating, incoordination, fever, etc. |
| Serotonin Syndrome | Should be withdrawn slowly to prevent withdrawal syndrome. |
| Serotonin Syndrome | Symptoms of withdrawal include: dizziness, tremor, dysphoria, & sensory disturbances. |
| SNRIs | Serotonin & Norepinephrine Reuptake Inhibitors |
| SNRIs | Effexor/venlafaxine |
| MAOIs | Parnate/tranylcypromine |
| MAOIs | As effective as other antidepressants, but more dangerous. |
| MAOIs | Often used in atypical depression, bulimia, panic attacks, obsessive-compulsive disorders. |
| MAOIs | Adverse effects: CNS stimulation (anxiety, agitation, hypomania), orthostatic hypotension (this does not subside). |
| Hypertensive crisis | A ___ can occur while taking MAOIs, if a patient eats foods containing tyramine, which promotes the release of norepinephrine. |
| MAOIs | Has many drug interactions, mostly those that have vasoconstrictive properties (ie OTC cold meds, etc.) & enhance hypertensive crisis. |
| While on an MAOI, teach patient to refrain from eating foods containing tyramine. List foods containing tyramine. | Aged cheeses, red wine, beer, sausages like bologna, pepperoni, salami, & aged fish or meat. |
| St John's Wort | Side effects include: photosensitivity, increases metabolism of many drugs (coumadin/ Warfarin; oral contraceptives). |
| Lithium | Mood regulator to treat Bipolar disorder. |
| Depakote / valproic acid | Antiepileptic agent used to treat Bipolar disorder. |
| 0.5 - 1.5mEq/L | Therapeutic level of Lithium |
| Informed consent | Narrow therapeutic range of Lithium, often requires ____ due to high risk for toxicity. |
| Twelve hours | Blood levels of Lithium are drawn ___ after last dose. |
| Lithium | ___ is a salt, and therefore is regulated by the body as sodium. |
| 75% of patients taking Lithium will have one or more of these side effects when drug is in the therapeutic range. List side effects. | fine hand tremors; weight gain; fatigue; polydypsia; polyuria; edema; GI upset; slurred speech. |
| When the Lithium level is above 1.5, side effects include: | coarse hand tremors; confusion; EKG changes; sedation; blurred vision & tinnitus. *These symptoms progress to seizure & death. |
| Patient teaching regarding the administration of Lithium. | adequate fl intake&Na+ moderation;avoid sweating;frequent drug serum levels;side effects include wt gain&hypothyroidism;stress the importance of medication compliance;there are many drug-drug interactions(NSAIDS increase Li levels)&inform MD of all meds. |
| Which diagnostics would be important to obtain prior to the patient beginning Lithium therapy? | Electrolyte studies, CBC, Thyroid studies, EKG, & BUN/Creatinine |
| What does Lithium do? | It alters sodium transport in nerve and muscle cells and inhibits the release of norepinephrine and dopamine. It does not, however, inhibit the release of serotonin. |
| Client & family education is essential to prevent Lithium toxicity. Teaching points include: | avoiding the sun, potential overheating, & dehydration. |
| Which neurotransmitter is not affected by Lithium? | Serotonin |
| Depakote | Antiepileptic agent that works faster than Lithium, with less side effects. |
| Depakote | Side effects include: GI disturbances & weight gain (usually eliminated when drug is enteric coated). |
| Teratogenic defects | What is a major concern regarding Depakote? |
| Antipsychotics | Used to treat psychosis associated primarily with schizophrenia. |
| Antipsychotics | ___ work by decreasing amounts of neurotransmitters, primarily dopamine & serotonin in the CNS. |
| What is the goal of antipsychotics? | To make the patient think more clearly. Schizophrenia is called a "thought disorder". |
| Positive effects | Schizophrenia characterized by agitation, delusions, hallucinations, paranoia. |
| Negative effects | Schizophrenia characterized by a blunted affect, poor hygiene, poverty of speech, social withdrawal. |
| Typical Antipsychotics | Haldol / haloperidol |
| Typical Antipsychotics | More effective at treating positive effects rather than negative effects of schizophrenia; have many side effects & require careful patient monitoring. |
| Hypertension | SNRI's are similar to SSRI's, however, side effects may include ___. |
| St John's Wort | "Mother Nature's Prozac" |
| St John's Wort | Currently, research has not supported FDA approval. |
| Extrapyramidal symptoms | (EPS) early symptoms (usually occurring hours or days after initiating treatment) include: akathisia, parkinsonism, & dystonia. |
| Akathisia | Continuous restlessness, inability to sit still. |
| Parkinsonism | Muscle tremors, shuffling gait, drooling, rigidity. |
| Dystonia | Spasms, prolonged contractions of muscle groups; *Dangerous & painful & can be treated. |
| Benadryl and Cogentin | Medications used to treat EPS (Extrapyramidal Symptoms). |
| Tardive Dyskinesia | (TD) involuntary movements of the tongue & face. ("fly catching", smacking); Assess often,using AIM(Abnormal Involuntary Movement) assessment form; *Usually IRREVERSIBLE* |
| Neuroleptic Malignant Syndrome | Most serious of all side effects; Characterized by "lead-pipe" rigidity, sudden high fever & changes in cognition. |
| Dantrium / dantrolene | Drug used for treatment of Neuroleptic Malignant Syndrome. |
| Neuroleptic Malignant Syndrome | Side effects include: anticholinergic effects(dry mouth, urinary retention, constipation, blurred vision); sexual dysfunction; orthostatic hypotension. |
| Risperidone / Risperdal | Atypical Antipsychotic agent. |
| Ziprasidone / Geodon | Atypical Antipsychotic agent. |
| Atypical Antipsychotics | Effective in treating both negative & positive symptoms of schizophrenia; these agents cause fewer extrapyramidal(EPS) symptoms. |
| Atypical Antipsychotics | Side effects include: orthostatic hypotension, sedation, & anticholinergic effects. |
| Clozaril / clozapine | Atypical antipsychotic that has a major side effect of agranulocytosis - WBC monitored frequently & patients are taught to report sore throat, fever, mucous membrane ulceration, & fatigue. |
| Depot drugs | These are long-acting, injectable formulations. Typically given every 2-4 weeks. The goal is to prevent relapse of schizophrenia. |
| Depot drugs | drugs now available are Haldol & Risperdal. They are called ____. |
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