Psychiatric Medications Review - Psych Mental Health Nursing - generic names
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| Atypical antipsychotics | Clozaril, Risperidal, Seroquel, Zyprexa, Abilify, Geodon, Invega, Latuda, Saphris, Fanapt
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| Anti-Manic & Mood Stabilizing Drugs | Lithium, Depakote, Lamictal, Tegretol, Trileptal
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| Tricyclic Antidepressants | Anfranil, Elavil, Norpramin, Pamelor, Sinequan, Tofranil,Vivactil
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| SSRIs | Prozac, Paxil, Celexa, Zoloft, Luvox, Lexapro, St. John's Wort
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| MAOIs | Marplan, Nardil, Parnate, EMSAM-Patch
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| SNRI | Effexor, Pristiq, Cymbalta
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| Benzodiazepines/ Anxiolytics | Ativan, Klonopin, Librium, Tranxene, Valium, Xanax
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| other compounds | Wellbutrin
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| Typical Antipsychotics | Haldol, Mellaril, Prolixin, Stelazine, Thorazine, Moban, Loxitane, Serentil, Trilafon,
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| EPS Side Effect Treatment Agents | Artane, Benadryl, Cogentin, Symmetrel
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| Non-Benzodiazepine- Anxiolytics | Buspar, Inderal, Kava-Kava, Vistaril
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| Hypnotics & Herbals | Ambien, Desyrel, Lunesta, Melatonin, Restoril, Valerian, Sonata, Rozerem
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| Substance Abuse Related Drugs | Antabuse, Campral, Catapress, Methadone, Suboxone, Topamax
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| CNS Stimulants- ADHD Treatment | Adderall, Focalin, Ritalin, Strattera, Vyvanse
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| Nursing Interventions for Atypical Antipsychotics | Blood Pressure Checks, BMI measurements, blood glucose, lipids, monitor for hyperglycemia, assess for sedation or hypotension
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| Atypical Antipsychotics Side Effects | risk of metabolic syndrome, increased weight, blood glucose, triglycerides, hypotension, sedation, dizziness
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| Tricyclic Antidepressants Side Effects | dizziness, drowsiness, diarrhea, dry mouth, urinary retention, and orthostatic hypotension
serious adverse reactions are paralytic ileus, acute renal failure, hypertension, and hypertensive crisis, depending on the specific product.
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| Tricyclic Antidepressants Nursing Interventions | Blood Pressure, pulse, Monitor laboratory studies, weight increase, appetite increase, mental status, mood, sensorium, affect, suicidal tendencies,Urinary retention, constipation
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| Which medication is indicated for Parkinson's dementia (mild to moderate) | Rivastigime
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| Which medication is FDA indicated for Parkinson's disease psychosis? | Pimavanserin (Nuplazid)
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| What is the MOST effective treatment for Parkinson's? | Levodopa/Carbidopa (Sinemet)
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| What is an unpleasant side effect of amantadine (Symmetrel)? | Confusion/memory problems
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| What two neurotransmitters are regulated in Parkinson's disease with anitcholinergics? | Dopamine and Acetylcholine
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| Which medication can be used in all stages of Alzeheimer's | Donepezil (Aricept)
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| Should galantamine (Razadyne) be used with renal impairment? | Should be used with caution in those with renal and hepatic impairment.
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| What is the MOA of memantine (Namenda) | NMDA glutamate receptor
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| What is the Aricept/Namenda combination medication | Namzaric
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| Are there any FDA approved medications for dementia related behavioral distrubances? | No, everything is off-label.
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| What test is required prior to starting Nuedexta? | ECG
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| Which medication is FDA approved for anorexia nervosa | No FDA medication approved; can use SSRIs and antipsychotics off label for the treatment of comorbid depression/anxiety/mood
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| Which medication is FDA approved for bulimia | Fluoxetine (Prozac) 60-80mg daily
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| Which medication is FDA approved for binge eating disorder? | Lisadexamfetamine (Vyvanse).
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| Can you use Vyvanse in those with hyperthyroidism? | No, contraindicated in hyperthyroidism and glaucoma
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| What two medications are used for alcohol abstinence | acomprosate (Campral) and disulfiram (Antabuse)
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| How long should a client be abstinent of alcohol before starting disulfiram (antabuse)? | at least 12 hours from last drink
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| Should a person with ESRD be prescribed acomprosate (Campral) | No, this medication is contraindicated in renal impairment
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| What two medications are used for etoh dependence? | Nalmefene (Selincro) and Naltrexone (Vivitrol)
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| What two class of medications are used for etoh withdrawal? | Benzodiazepines and alpha 2 agonist
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| What can happen when methadone (Dolophine) is mixed with other CNS depressants? | Death
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| What medical issues are contraindicated with methadone (Dolophine) use? | Respiratory depression, acute or severe bronchial asthma, gastrointestinal obstruction including a paralytic ileus
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| What is the MOA of buprenorphine (Suboxone)? | Suboxone is an opioid partial agonist that binds to opiate receptors, preventing exogenous opioids from binding.
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| How long must a client be clean before starting naltrexone (Vivitrol)? | The client must be opioid free for 7-10 days before starting treatment and must be confirmed by drug screens
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| What are all the forms of NRT? | Gum, Patch, Nasal Spray, and Inhaler.
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| What part of the brain is thought to be involved with ADHD? | Prefrontal Cortex
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| Which neurotransmitters are involved with ADHD? | Dopamine and norepinephrine
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| What measure tools are used in diagnosing ADHD? | Connors and Vanderbilt
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| What are the types of ADHD? | Combined, predominately inattentive, and predominately hyperactive-impulsive
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| Symptoms of impulsivity appear to involve which area of the brain? | Orbitofrontal cortex
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| What is the mechanism of actions of stimulants? | Increasing norepinephrine and dopamine by blocking reuptake
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| What part of family medical history is extremely important before prescribing stimulants? | Cardiac disease history
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| What medical condition is contraindicated with stimulant use? | Glaucoma
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| What can delay peak action of stimulants for 2-3 hours? | Taking the stimulant dose with food
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| What test and vitals are important to monitor with stimulants | ECG, BP, height, weight
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| What medical conditions are amphetamine used in caution with? | Hepatic and cardiac impairments
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| Which medication condition is contraindicated with use of Vyvanse? | Hyperthyroidism
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| What labs should be monitored periodically with Vyvanse? | CBC, platelets, and LFTs
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| People that lose their appetite for dinner may benefit from which two stimulant options? | Metadate CD and Ritalin LA
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| What is a rare side effect of methylphenidates? | Priapism
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| Which SNRI is FDA approved for ADHD ages 6 and older? | Straterra
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| How long can it take for Strattera to be effective? | 2-3 months
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| What is the MOA of clonidine? | Alpha 2 agonist but also norepinephrine receptor agonist
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| Which enzyme metabolizes guanfacine? | CYP450 3A4
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| Which antipsychotic is FDA indicated for Autism related irritability ages 5-16? | Risperdal
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| What is designed to provide guidelines in prescribing high risk medications in the elderly? | Beers criteria
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| How does a practitioner decide on medications in pregnancy? | Risk vs benefit discussion
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| What is recommended to supplement with Lamictal if taken when pregnant? | Extra folic acid
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| What is lithium levels so important to monitor frequently in pregnancy? | Due to fluid shifts
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| What the “D”s in the D approach in deprescribing? | Diagnosis,
dangerous,
dosages,
duplicate,
deficient,
desire, and
duration
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| Which SSRI is FDA indicated for bulimia nervosa? | fluoxetine (Prozac)
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| Which two SSRIs are FDA approved for treating children with MDD? | i. Escitalopram (Lexapro) 12 and up,
ii. Fluoxetine (Prozac) 8 and up
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| Which SSRI is not FDA approved for MDD or depression? | Fluvoxamine (Luvox) (OCD)
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| Which SSRI should be dosed at night due to sedation? | Paroxetine (Paxil), long 1/2 life life
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| Which SSRIs are FDA indicated for PMDD? There are 3 of them. | i. Fluoxetine (Prozac),
ii. Paroxetine (Paxil), and
iii. Sertraline (Zoloft)
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| Which enzyme does Duloxetine (Cymbalta) inhibit? And can you remember from week one what other substance inhibits this exact enzyme. | CYP450 1A2 and the substance is cigarettes (nicotine)
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| Which SNRI is indicated for MDD and neuropathic pain? | Duloxetine (Cymbalta)
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| What OTC medication can reduce clearance of Venlafaxine (Effexor)? | Cimetidine (Tagamet HB)
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| What vital signs should be assessed before initation of Levomilnacipran (Fetzima)? | i. Heart rate and
ii. blood pressure
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| Which SNRI is not FDA indicated for mental illness disorders? | Milnacipran (Savella)
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| Which antidepressant is contraindicated with epilepsy or eating disorders? | Buproprion (Wellbutrin)
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| Which class of antidepressants are known for a three ring structure? | TCA’s
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| What is the biggest concern with prescribing TCA’s to a suicidal client? | Overdose, this should be not given to a suicidal client if you can avoid, but if necessary, no more than a weeks supply should be considered;
only takes 7x normal dose for OD; bicarbonate is needed to reverse
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| What ingredient in food should be avoided in those taking a MAOI? | Tyramine
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| Which OTC class of medications should be avoided with MAOIs? | Cold medicines
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| Which pain medication can increase risk for seizures in those taking antidepressants? | Tramadol (Ultram)
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| Which populations require a lower recommended starting dose of antidepressants? | i. Elderly and
ii. children
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| What is the black box warning for antidepressants? | May increase risk of suicidality, especially in young adults
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| What are symptoms of serotonin syndrome? | i. Shivering,
ii. Hyper-reflexia/ myoclonus
iii. Increased temperatures,
iv. Vital sign instability,
v. Encephalopathy/altered LOC,
vi. Restlessness,
vii. Sweating
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| How many days must the client wait after discontinuation of a MAOI before starting a SSRI? | 14 days
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| What labs are necessary prior to starting Carbamazepine (Tegretol)? | i. CBC,
ii. LFTs,
iii. kidney and
iv. thyroid function.
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| If taking Lamotrigine (Lamictal) what is the most deadly side effect? And how many days can a patient miss before starting back at initial dosing? | i. Stevens Johnson Syndrome.
ii. 5 days or more must restart at initial dosing.
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| What is the therapeutic range for lithium? | i. 0.6-1.2mEq/L
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| What are symptoms of severe lithium toxicity? | i. Hyperthermia,
ii. hypotension,
iii. seizures,
iv. renal failure,
v. coma,
vi. death
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| What is the therapeutic range for Valproate (Depakote)? | 50-125ug/mL
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| Which neurotransmitter is directly related to Alzheimer's and impaired memory? | Acetylcholine
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| Which amino acid has excitatory properties, and an increase presents as bipolar affective disorder? | Glutamate
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| Which neurotransmitter reduces arousal, aggression, and anxiety? | GABA
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| Which neurotransmitter is related to extrapyramidal side effects and prolactin dysregulation? | Dopamine
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| Which neurotransmitter is related to depression and anxiety and is found in the brain as well as the GI system? | Serotonin
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| What is the outermost layer of the cerebrum? | Cerebral Cortex
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| What is the largest part of the brain? | Cerebrum
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| What is the newest identified lobe of the brain? | Insula
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| Wrinkled ball of tissue that helps coordinate movement? | Cerebellum
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| Name the three parts of the brainstem | i. Midbrain,
ii. medulla oblongata, and
iii. pons
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| Thinking, planning, organizing, problems solving, and short-term memory are in which lobe? | Frontal
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| Temperature, taste, touch, and movement are process in which lobe of the brain? | Parietal
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| Which brain lobe process primarily vision and has been linked to visual hallucinations? | Occipital
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| Which lobe of the brain processes memories, integrating them with sensations of taste, sound, sight, and touch? | Temporal
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| Which lobe of the brain is associated with conscious desires and decodes bodily states? | Insula
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| What structure processes all incoming information except for smell? | Thalamus “Hal”.
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| Which structure of the brain processes smell and attaches emotions to stimuli? | Amygdala “Amy"
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| What structure of the brain functions as the library/google, memory center? | Hippocampus “Campus”
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| Which structure is the hormone monitor and tells others which hormones are needed? | Hypothalamus ”little Hal” –he is bossy!
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| What structure is considered the danger protector and stimulates hormones? | i. Pituitary gland and
ii. basal ganglia “bee gees”
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| Molecular changes produced by a drug when binding to receptor site is termed? | Drug action
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| What are the route, absorption, distribution, binding, inactivation, and excretion considered? | Factors of drug action
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| What is the pharmacokinetic parameter that is defined as the time for the drug concentration in the plasma to be reduced by 50%? | Half life
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| What is calculated by adding 4-5 half life’s of a medication? | Steady state
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| What is a common enzyme family that break down hormones and medications? | PYC450
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| Which benzodiazepine is FDA indicated for Generalized Anxiety Disorder and Panic Disorder? | Alprazolam (Xanax)
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| Which enzyme most commonly metabolizes benzodiazepines? | CYP450 3A4
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| Benzodiazepines should not be tapered any faster than 3 day increments with specific dose reduction. True or False | True
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| Benzodiazepines are habit forming. True/False | true
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| 5. There are safer options for the treatment of anxiety, especially in those with a history of drug abuse, compared to benzodiazepines. True or False | true
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| Insomnia is common in those with mental illness. True/False | true
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| Which stage of sleep does the body temperature decrease? | stage 2
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| What class of insomnia medications are known to cause sleep driving? | Hypnotics
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| Which hypnotic is only FDA approved for short term insomnia? | Zaleplan (Sonata)
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| What is the mechanism of action for Ramelteon (Rozerem)? | Ramelteon (Rozerem) is a melatonin receptor agonist.
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| Which receptor/neurotransmitter is related to EPS? | Dopamine, D4
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| How do we know if a side effect is related to the medication prescribed? | a. Practitioners should be aware of the receptor the drug binds to and of the possibility of the client exhibiting those side effects relating to that receptor.
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| Which antipsychotics are associated with the least side effects? | Atypical antipsychotics
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| Which atypical antipsychotics could be passed in a bowel movement by the patient intact? | Paliperidone (Invega)
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| What aspect of client care would indicate the need of a long-acting injection? | History non-compliance
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| NMS is common. True/False | False
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| NMS is life threatening. True/False | True
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| What is the first thing the practitioner should do with the medications if NMS is suspected? | Discontinue the antipsychotic
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| Should NMS be treated outpatient? | No, medical support is necessary
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| NMS only happens in the first few days of starting antipsychotics. True/False | FAlse
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| In order to minimize side effects, practitioners should avoid multiple simultaneous medication changes. True/False | True
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| What can help sweating with antidepressants? | Clonidine (Catapress) or Benztropine (Cogentin)
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| What is bruxism? | Bruxism is involuntary grinding and gnashing of teeth
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| What class of medications treat acute dystonia? | Anticholinergics
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| What medication works for priapism? | None, priapism requires an emergency room visit
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