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98 Cards in this Set
- Front
- Back
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what is psychosis
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severe emotional disorder that often impairs mental function to the point of significant disability regarding ADLs. A hallmark of psychosis is a loss of contact with reality.
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what are affective disorders
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mood disorders) are characterized by changes in mood and range from mania to depression. Bipolar disorder.
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what is anxiety
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unpleasant state of mind chiefly characterized by a sense of dread and fear.
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common symptoms of depression
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feelings worthless, losing interest in most normal daily activities, increase or decrease in appetite, insomnia
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what is OCD
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what a person does the same thing over and over again loke washing hands
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what is posttramatic stree syndrome
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when they have a bad life altering experience like going to war, polio, raped
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what is generalized anxiety disorder
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people experience more than normal anxiety day to day
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what is panic disorder
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intense fear of something which makes you have physcial effects
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what is social phobia
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dont want to be around people
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what is simple phobia
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any phobia a person may have
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what is the biochemical concept of mental illness
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Abnormal levels of endogenous chemicals in the brain known as neurotransmitters
Catecholamines – dopamine, norepinephrine Indolamines – serotonin and histamine GABA – gamma-aminobutyric acid ACh and various inorganic ions-K,Na, and Mg |
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what are benzodiazepines?
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anxiolytic effect by depressing activity in the brainstem and limbic system. Increase the GABA Action and have specific receptor binding sites.
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what are antihitamines
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sedating effects (Atarax and Vistaril). benedryl
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what are misc antianxiety drugs
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BuSpar (non-sedating and non-habiting forming).
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waht do benzodiazepines govern the release of
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GABA which causes sedation and muscle relaxation
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what is the anthistamine hydroxyzine most commonly used for
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anxiety
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what are the 2 salt forms of antihistamines
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hydrochloride-atarax adn hydroxyzine pamoate-vistaril
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side effects of anti-anxiety drugs
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sedative, hypnotic, appetite stimulation, analgesic, and anti convulsion effects
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what else do anti-anxiety drugs treat
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sedation, muscle relaxation, contol seizures, depression, alcohol withdrawl
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what else to midazolam used for
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sedative and anestheic during invasive painful medical procedures, also used in the ICU to control anxiety and agitation
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side effects of anti-anxiety
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hypotension, in pedi/adolescent hyper activity and aggressive behavior, increase seizure frequency, and haibit forming and addictive
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extreme cases of OD use what drug for TX
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physostigmine in normal toxicity use syrup of ipacac, gastic lavage, activated charcoal, saline cathartic.
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what are S/S of OD on anti-anxiety drugs
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somnolence, confusion, coma, respiratory depression
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Valium-diazepam
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most common, used for anxiety, alcohol withdrawl, and seizure disorders, sedation, muscle spasms, liver dysfunctions bc it is metabolized in the liver
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ativan-lorazepam
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short-term releif of anxiety, perop medication, chemothearpy-related nausea and vomitting and acute alcohol withdrawl
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xanax-alprazolam
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depression, panic, and aniexty
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klonopin
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seizures and panic
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librium-cholordiazepoxide
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alcohol withdrawl, anxiety, preop sedative drug
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versed
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only IV for moderate sedation, gives amnesia is minor surgery
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what is physostigmine - cholinergic
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Used for overdose of antihistamines
Used for overdose of tricyclic antidepressants IV – 0.5 – 3mgs (do not give faster than 1mg/min) |
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what is romazicon
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used for benzodiazepine overdose
0.2 mg over 15 seconds and may repeat 0.2 mg every 60 seconds for 4 additional doses or a cumulative dose of 1 mg. |
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what is elavial
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given IV goes sright to brain, give in small doese, narrow thearpeutic range
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what is effected in a person with mania
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dopamine, notepinephrine, serotonin
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lithium
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narrow range of therapeutic index
Very Toxic – must have lab work Maintenance ranges are 0.6 – 1.2 mEq/L Mania – levels can be 1.0 to 1.5 mEq/L Half-life is 18-24 hours Many medications used in conjunction to lithium (valporic acid, ACE inhibitors). Recommend po dose of lithium is 600-1200 mg/day. Difficult for compliance because do not like the “down” feeling. |
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what are s/s of OD on lithium
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GI discomfort, tremor, confusion, somnolence, seizures, death, drowiness, slurred speach, epileptic-type seizures, wavelike muscle movements, disturbed muscle coordination, hypothyroidism
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what is an alternative to lithium usually in elderly
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valproic acid bc it has a narrow therapeutic index
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anti-depressants are useful in treating
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dysthymia, schizophrenia, eating disorders, personality disorders, and bipolar disoder
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what is biogenic amine hypothesis
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that depression results from a deficiency or neuronal and synaptic catecholamines and mania from an excess of amines at the adrenergic receptor sites in the brain
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what is premissive hypothesis
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reduces concentrations of serotonin as the predisposing factor in patients with affective disorders
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what is dysregualtion hypothesis
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views depression and affective disorders
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if you have a nonresponse to atleast to trails you are
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treatment resistant depression and you made need to add a second drug
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black box warning
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In 2005 – Regular monitoring for worsening depressive symptoms
Monitoring of suicide ideations |
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what are the first SSRI's
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Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, & Cymbalta
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what are the second generation antidepressants
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Desyrel and Wellbutrin
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what is the third generation antidepressants
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Effexor, Remeron
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what is good about SSRIs
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Less side effects than tricyclic drugs and MAOIs. SSRIs have little or no effect on the Cardiovascular system.
Inhibit serotonin reuptake and have weak effects on norepinephrine and dopamine reuptake |
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sertaline inhibit what
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inhibits serotonin
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nefazodone and trazodone inhibit what
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serotonin and norepinephrine reuptake
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how does mirtazapine work
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promoting presynaptic release of norepinephrine and serotonin
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The three classed of new generation antidepressants treat what
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depresssion, BPD, obesity, eating disorders, PTSD, panic attacks, social aniexty disorder, and neurological disorder, alcohol dependance
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what are side effects
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Insomina
Weight gain Sexual dysfunction chest pain palpitations on EKG prolong QT |
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what is serotonin syndrome signs
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delirium, agitation, tachycardia, sweating, muscle spasms, hyperreflexia, shivering, coarse tremors, and extensor plantar muscle spasms.
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fluoxetine-prozac, sarafem
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SSRI
150-450mg bid or tid 10-80mg qd bid depression, OCD, bulimia, prementral dysphoric disorder |
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sertraline-zoloft
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SSRI,
25-200mg qd depression, OCD, panic disorder, PTSD |
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paroxetine-paxil
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SSRI
10-50mg qd depression, OCD, panic disorder, social anxiety disorder, GAD |
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citalopram-celexa
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SSRI
20-40mg qd depression |
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escitalopram-lexapro
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SSRI
10-20mg qd depression, general anxiety disorder |
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duloxetine-cymbalta
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SNRI
30-60mg depression, and pain from diabetic neuropathy |
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what are tricyclic antidepressants
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correct the imbalance in the neurotransmitter concentrations or serotonin and norepinephrine at nerve endings by blocking reuptake of neurotransmitters
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what do TCAs inhibit and block
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norepinephrine and serotonin and block muscarinic, histaminergic, adrenergic, dopaminergic, and serotonergic receptors
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what are TCAs good for treating
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bedwetting in children, OCD, pain syndromes,
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side effects of TCAs
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sedation, impotence, orthostatic hypotension, cardiac conduction, alter seizure threshold, elderly suffer more from dizziness, postural hypotension, constipation, delayed micturation, edema, and muscla tremors
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TCA OD tx
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they are highly lethal, multiple doses of activated charcoal, sodium bicarbonate speeds up elimination, antidysrhythmics
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elavil and endep
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effect heart and cause lethal dysrhythmias and seizures
15-300mg divided elderly 100-150mg divided |
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what are MAOIs
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1st generation of antidepressants but have move to the last of the line
Very toxic and many side effects Nardil and Parnate Interact with food containing tyramine and cause hypertensive crisis Can not use Demerol with MAOIs – hypertensive crisis long half life remains in body 2wks |
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MAO-A metabolizes
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serotonin, norepinephrine, and tyramine
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MAO-B metabolizes
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dopamine
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nardil
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inital does 45-90mg tid, followed by dose reduction
depression and panic disorders |
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parnate
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20-60mg divided bid
depression |
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s/s of OD of MAOIs
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tachycardia, circulatory callapse, seizures, coma, hyperthermia annd miosis
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TX of OD of MAOIs
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gastric lavage, urine acidification, and hemodialysos
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what antipsychotic drugs
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treat serious mental illness such as depressice and druf induced psychoses, schizophrenia, and autism,extreme mania, BPD, certain movement disorders
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what are phenothiazine
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Phenothiazines are the largest group of antipsychotic drugs.
Block dopamine receptors in the brain, thus decreasing the dopamine concentration in the CNS. |
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side effects of phenothiazines
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agranlocytosis and hemolytic anemia, exfoliative dermatitis, drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, tardive dyskinsea.
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what three groups are phenothiazines divided into
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aliphatic, peperidine, adn piperazine
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what are phenothiazine used to treat
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thioxanthenes, butyrophenones, dihydroindolones, and dibenzoxazepines
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second generation antipsychotic
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have different mechanisms than first gen. block dopamine 2 and serotonin 2 receptors
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first generation antipsychotic disadvantage
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cause extrapyrmidal symptoms rigidity, tremor, bradykinesia and bradyphrenia
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what is neuroleptic malignant syndrome
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life-threatening adverse effect that may include high fever, unstable blood pressure, and myoglobienmia.
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what is extrapyramidal symptoms
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involuntary motor symptoms similar to pseudoparkinsonsism
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what is tardive dyskinesia
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late onset of contractions of oral and facial muscles, involuntary tongue thrusting and wave like movement of the extremities. Usually after long term therapy.
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what are ocular effects of antipsychotic
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blurred vision. corneal leans changes, epithelial keratopathy, pigment retinopathy
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what are other side effects of antipsychotic
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postural hypotension, EEC changes long QT waves
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what are the antipsychotic drug interactions
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Antacids decrease absorption
Antihypertensive have an added effect CNS depressants have an added effect Tannic acids (tea, grapes, wine) decrease absorption |
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what are the antipsychotic drugs
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Thorazine
Prolixin Haldol Loxitane Moban Navane |
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thorazine
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alipatic phenothiazine
adult 25-500mg pedi IV or IM 0.5-1mg q6-8hrs |
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prolixin
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piperidine phenothiazine
adult only PO 0.5-20mg IM 1.25-10mg |
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haldol
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xadult PO IM 0.5-5mg
pedi PO 25-50mg IM 2-5mg q1h |
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loxitane
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PO 10mg bid up to 250mg
IM 12.5-50mg q4-6h |
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moban
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PO 50-225mg divide doses
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navane
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2mg tid to 60mg
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atypical antipsychotic drugs
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Clozaril
Risperdal Zyprexa Seroquel Geodon Abilify |
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clozaril
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25-900mg divide larger doses
psychotic disorder |
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risperdal
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PO 1-8mg IM 25-50 every two weeks
psychotic disorder |
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zyprexa
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5-20mg
schizophrenia, bipolar mania |
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seroquel
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25-800mg divide large doses
schizophrenia |
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geodon
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20-80mg
schizophrenia |
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abilify
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10-30mg once daily
schizophrenia, bipolar mania |
