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97 Cards in this Set
- Front
- Back
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What do Typical Antipsychotics do?
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reduce the positive symptoms of schizophrenia and decrease the risk of relapse and rehospitalization
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What do Atypical Antipsychotics do?
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have comparable efficacy with symptoms with less risk of adverse neurological events than typicals. Especially effective in treating the negative symptoms of schizophrenia
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Typical Antipsychotics work on what neurotransmitter?
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Dopamine
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Atypical Antipsychotics work on what neurotransmitter?
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Dopamine and Serotonin
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What are some typical antipsychotics?
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Thorazine Cholpromazine
Meliaril Stelazine Serentil Haldol Stelazine Prolixin |
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What are some atypical antipsychotics?
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Abilify
Geodone Seroquel Zyprexa Risperdol Clozaril |
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What are some SE of typical antipsychotics?
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EPS-extrapyramidal syndroms
weight gain hyperlipidemia hyperglycemia |
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What are some SE of atypical antipsychotics?
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Weight gain
EPS Diabetes insulin resistance Dyslipidemia CVD Hyperglycemia |
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What is EPS?
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Extrapyramidal syndromes
-pseudoparkinsonism -dystonia (impaired muscle tone) -akathisia (restlessness) -Oculogyric crisis (spasm of major muscle groups: tx with cogentin, benadryl, amantadine IM) |
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SE of Clozaril
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atypical anti psychotic
Seizures Agranulocytosis-develops abruptly with fever, malaise, ulcerative sore throat, leukopenia, neutropenia |
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SE of Zyprexa
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atypical antipsychotic
weight gain-Syndrome X |
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Serious SE of antipsychotics:
NMS-Neuroleptic Malignant Syndrome (Symptoms) |
Medical Emergency-high fever, tachycardia, sweating, muscle rigidity, incontinence, stupor, elevated CPK, leukocytosis, renal failure
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NMS (Nsg. Interventions)
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Stop any neuroleptics
hydration, renal dialysis, ventilation, dantroline or bromocriptine Always monitor temperature!! |
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FDA warning for antipsychotic drugs:
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Hyperglycemia
Diabetes Mellitus |
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Guidelines for Administering Antidepressants
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Assess level of depression
Monitor VS for baseline Assess therapeutic response and effectiveness Monitor Intake and weight Ask about other meds (St. John's Wort) |
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FDA regulations for Antidepressants
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Monitor for worsening and suicdality
Instruct families and patients to report symptoms |
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Selective Serotonin Reuptake Inhibtors (SSRI)
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1st line medication for depression
Inhibit reuptake of serotonin Serotonin present for a longer time Relieve symptoms 2-4 weeks |
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Drug Interactions (SSRIs)
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Prozac interacts with Coumadin and Tagamet-by raising SSRI concentrations by impairing hepatic metabolism
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SSRI drugs:
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Celexa
Prozac Luvox Paxil Zoloft Lexapro Symbyax |
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SSRI SE:
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anxiety
h/a-promote hydration, nourishment, rest, exercise nausea-may need to adjust admin. time diarrhea Sedation-with Paxil Sexual dysfunction-reason for noncompliance |
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SNRI-Serotonin Norepinephrine Reuptake Inhibitor
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depression
works on both serotonin and norepinephrine |
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SNRI SE:
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similar to SSRI + risk for an associated increase in blood pressure
Dry mouth nausea dizziness muscle weakness constipation tremor "Boxed Warning" for hepatic failure |
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SNRI drugs:
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Serzone
Cymbalta Effextor PRISTIQ |
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Bupropion (Wellbutrin)
Class: |
Norepinephrine-Dopamine Reuptake Inhibitor
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Bupropion (Wellbutrin)
SE: |
agitation
anxiety insomnia appetite suppression |
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Bupropion (Wellbutrin)
CI: |
people with sz disorders or at risk for sz
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Mirazapine (Remeron)
Class: |
Alpha 2 Antagonist
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Trazadone (Desyrel)
Class |
Serotonin 2 Antagonist Reuptake Inhibitor
*Not really used for depression anymore |
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Trazadone (Desyrel)
SE: |
Sedation-most common
weight gain, n/v, constipation, dizziness, fatigue, incoordination, tremor |
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Tricyclic Antidepressants Drugs:
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Amitriptyline (Elavil)
Dozepine (Sinequan) Imipramine (Tofranil) Disipramine (Norpramin) Nortriptyoine (Pamelor) Protriptyline (Vivactil) Maprotiline (Ludiomil) |
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Tricyclic Antidepressants
SE: |
sedation, orthostatic hypotension, anticholinergic effects
Potential for cardiotoxcity Neuroleptic Malignant Syndrome |
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TCA
Cautions: |
Lethal dose/therapteutic dose ratio is very narrow!
Death from cardiac arrhythmia, hypotension, uncontrollable sz Serotonin Syndrome |
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Monoamine Oxidase Inhibitors (MAOI)
Action: |
serotonin and norepinephrine activity is increased in synapse
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MAOI
Drugs: |
Selegiline (Emsam)
Phelzine (Nardil) Tranylcypromine (Parnate) |
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MAOI
SE: |
Interaction with tyramine-rich foods can cause severe h/a, palpitation, neck stiffness and soreness, n/v, sweating, HTN, stroke, death
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Foods that are restricted with MAOIs:
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cheese, meat, fish, poultry, fruits and veggies, alcoholic beverages
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What causes Serotonin Syndrome?
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administering SSRIs too close to the discontinuation of MAOIs
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Serotonin Syndrome symptoms:
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mental status changes: confusion, disorientation, agitation, ataxia, myclonus, hyper-reflexia, fever, diaphoresis, shivering, tremor, diarrhea, h/a
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Serotonin Syndrome Tx:
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Assess all meds, supplements, foods, and drugs ingested
Discontinue all serotonergic drugs Tx symptoms |
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What causes Serotonergic discontinuation syndrome?
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Abrupt discontinuation of antipsychotic drugs
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Serotonergic Discontinuation Syndrome symptoms:
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dizziness, sensory disturbances, agitation, anxiety, nausea, sweating
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Ways to promote adherence:
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shared decision making
Inquire about prior use of antidepressants Explain 2-4 weeks for therapeutic reponse Discuss common SE Advise pts to continue meds even if they feel better Explain risk of stopping meds |
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Lithium Carbonate
Class: |
Mood Stabilizer
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Lithium Carbonate is used for what?
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To control mania and prevent the recurrence of both manic and depressive episodes
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When should you monitor lithium levels when giving lithium carbonate?
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12 hours after last dose
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What is the therapeutic range for Lithium Carbonate?
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0.6-1.4 mEq/L
Important to see if patient is complying with meds, and to watch for toxicity |
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Lithium Carbonate
SE: |
wt gain/edema
nausea/anorexia mild diarrhea excessive thirst metallic taste in mouth rash slight hand tremor* thyroid dysfunction gastric irritation polyurea |
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Lithium Carbonate
Toxicity: |
vomiting
severe diarrhea coarse hand tremor* twitching ataxia lethargy dysarthria (difficulty speaking) hyperactive deep tendon reflexes vertigo/confusion muscle weakness ECG changes coma/death |
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How do you manage Li Toxicity?
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Hold lithium
Check VS Obtain Li blood level STAT Check electrolytes Hydrate 5-6 liters/day Ascertain reason for toxicity |
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Anticonvulsant/Mood stabilizer Drugs:
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Valproic Acid (Depakote)
Carbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) |
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Anticonvulsant/Mood stabilizers
used for? |
difficult to treat bipolar episodes & in stabilizing mood cycles
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What should be checked when taking anticonvulsants?
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Blood levels of the anticonvulsant meds obtained 12 hrs after the last dose
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Pharmacologic therapy:
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Antidepressants + mood stabilizers (for bipolar patients)
Antipsychotics-monotherapy for bipolar DO |
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The 3 principal medications used to treat anxiety disorders:
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antidepressants
anti-anxiety drugs beta-blockers (physical symptoms) |
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First line treatment for Anxiety:
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SSRIs
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Refractory or drug resistant patients use this for anxiety:
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TCAs
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This drug provides a quick response for anxiety:
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Benzodiazepines
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These drugs help physical symptoms of anxiety:
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Beta blockers
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This is the last choice drug for anxiety and is rarely used:
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MAO Inhibitors
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This drug is specific to GAD and is non-habit forming:
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Buspar
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Benefits to using Benzodiazapines:
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Rapid alleviation
Well tolerated-not in children Useful as prn Reduces SSRI-induced anxiety |
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Drawbacks to using Benzodiazapines:
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Sedation w/ psychomotor and cognitive impairment
Potential for abuse and overdose Not effective for comorbid depression Interacts with ETOH Discontinuation related difficulties |
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3 Benzodiazepines for Anxiety:
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Klonopin-for social phobia and GAD
Ativan-for panic disorder Xanax-panic disorder and GAD |
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Beta-Blockers:
action |
Prevent functional activity of EP and NE
Reduces effect of EP |
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Beta-Blockers:
CI |
Diabetes Mellitus (blocks s/s of hypoglycemia)
Asthma |
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Most common Beta-Blocker used for anxiety:
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Inderal
Start 10mg bid up to 80-160 mg/day |
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For what disorders are Beta blockers used?
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Social phobia
GAD |
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SSRIs for anxiety:
action |
Alter levels of serotonin in the brain, which helps brain cells communicate with one another
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SSRIs for anxiety treat what?
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Panic disorder
OCD PTSD Social phobia |
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SSRI:
SE |
nausea
anorexia tremor anxiety sexual dysfunction jitteriness insomnia |
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SSRI drugs:
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Prozac
Zoloft Paxil Luvoc Celexa Lexapro |
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Zoloft
SE: |
SSRI effects
loose stools |
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Paxil
SE: |
SSRI effects
drowsiness fatigue weight |
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Luvox
Celexa Lexapro Prozac SE: |
SSRI effects
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SNRI
drug for anxiety: |
Effexor
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SNRI
dosing consideration: |
start at low doses and gradually increase until beneficial effect
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SNRI
SE: |
n/v
dry mouth dizziness insomnia somnolence sexual dysfunction HTN at high doses |
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What is the medication of choice for alcohol detox?
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Benzodiazepines
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What are the Benzodiazepines used for ETOH withdrawal?
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Tranxene
Librium Valium Ativan |
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What is the action of Benzos?
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Decrease withdrawal symptoms by preventing CNS hyperexcitability
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How is the dosage determined for Benzos?
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Symptoms using a CIWA
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Why would you use Thiamine in ETOH withdrawal?
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To decrease the rebound effect of CNS as it adapts to the absence of ETOH and to offset the effects of thiamine deficiency
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Thiamine
dose: |
Usually given in high doses
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What drug would be used in ETOH withdrawal for a patient with a hx of withdrawal sz?
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Folate and Magnesium
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Antipsychotics may be used in ETOH when?
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If delirium ensues
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Disulfiram (Antabuse)
use: |
To deter some individuals from drinking while using other treatment modalities
NOT a detox med-a maintenance drug! |
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Disulfiram (Antabuse)
Mechanism: |
causes an accumulation of acetaldehyde
Produces a very unpleasant reaction if patient drinks ETOH |
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What to avoid when taking Disulfiram (Antabuse)?
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All substances containing ETOH
-mouthwash, aftershave, etc. |
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When does the reaction occur and how long might it last?
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5-10 min.
lasting for several hours |
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What symptoms come with reaction of Disulfiram?
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flushing, n/violent vomiting, thirst, sweating, sob, hypervintilation, throbbing h/a, hypotension, weakness, confusion
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What is a severe reaction of Disulfiram?
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coma
sz cardiovascular collapse respiratory depression death |
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How long does it take Disulfiram to clear the body after discontinuation?
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14 days
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Naltrexone
use: |
alcohol dependence
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Naltrexone
Action: |
1. can reduce craving
2. can help maintain abstinence 3. can interfere with tendency to want to drink |
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Naltrexone
Mechanism: |
blocks opioid receptors involved in rewarding effects of drinking alcohol and craving alcohol
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Naltrexone
Oral form: |
Trexan
50 mg/day |
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Naltrexone
extended-release injectable form: |
Vivitrol
380 mg/month gluteal IM |
