Psych Drugs - Lithium, Antianxiety & Antipsychotics

Front 1

examples of lithium products

Back 1

Eskalith
also Lithane, Lithonate, Lithobid, Cibalith-S

Front 2

precautions before beginning lithium

Back 2

check renal function because it’s excreted thru kidneys. Check thyroid function – s/e hypothyroidism.
Routine EKG to check c/v status.
Not given in pregnancy and cautious in childbearing range or if breastfeeding.
Also not if have MG and to children under 12.

Front 3

Acute lithium level for mania

Back 3

1-1.5 mEq/L

Front 4

Maintenance lithium level

Back 4

0.6 – 1.2 mEq/L

Front 5

how long does it take to feel affects of lithium

Back 5

Feel some effects after 1 week but take 2-3 weeks to get full effect

Front 6

Lithium OD is highly lethal
Toxic level starts at

Back 6

2.0 mEq/L – 1.5 & higher, assess patient to see if they have s/e

Front 7

side effects of lithium

Back 7

fine hand tremors, polyuria, polydipsia, mild nausea – take w/food, will subside or can be dose related. Weight gain is disturbing to many patients. Leg edema, diarrhea, abdominal pain. Hypothyroidism and kidney impairment – monitor thyroid & renal function Q6mo on maintenance dose or test if problem noted.

Front 8

S/S lithium toxicity

Back 8

Early signs - ataxia, tinnitus, N/V/D
Late signs - slurred speech, muscle weakness & twitching (bad hand tremors), confusion, kidney impairment

Front 9

important teaching aspects for lithium use

Back 9

side effects, toxicity effects, maintain normal diet no salt or fluid restrictions. If sick w/flu or dehydration – can drive up lithium level. No diuretics, no binge diets.

Front 10

which drug is the first choice for treating mania

Back 10

lithium

Front 11

describe action of lithium

Back 11

decreases level of serotonin & norepinephrine

Front 12

why are antipsychotics prescribed

Back 12

treatment of acute & chronic psychoses, schizophrenic, severe depression & biopolar disorders

Front 13

How do first generation antipsychotics treat symptoms

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They block dopamine to block symptoms of hallucinations, delusions, primary symptoms

Front 14

How do second generation antipsychotics treat symptoms

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They treat primary & secondary including motivation, social, goal oriented problems

Front 15

common first generation antipsychotic meds

Back 15

Prolixen, Haldol, Trilafon
other include
thorazine, loxitane, serentil, moban, orap, mellaril, navane, stelazine

Front 16

common second (newer) generation antipsychotic meds

Back 16

Abilify, Clozaril, Zyprexa, Zydis, Seroquel (can be used for depression); Geodon – should check EKG before prescribing – must be taken w/food – won’t work without taking w/food

Front 17

antipsychotic IM injections should be given using what method

Back 17

z-track

Front 18

common side effects of antipsychotics

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anticholinergics, blurred vision, dry mouth, constipation, older ones cause photosensitivity (teach sun protection), ortho hypotension, weight gain

Front 19

extrapyramidal effects of antipsychotics

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akathisia, akinesia, parkinson-like syndrome, dystonia, tardive dyskinesia

Front 20

akathisia, akinesia, parkinson-like syndrome, dystonia can all be reversible if what happens

Back 20

giving anti-Parkinsonian agent Cogentin, Artane or Benadryl

Front 21

associated w/long term antipsychotic use usually. Potentially and most often irreversible
Looks like they are chewing gum – involuntary jaw movements, tongue thrusting, tongue twisting, stiff neck, difficulty swallowing

Back 21

Tardive Dyskinesia

Front 22

test used to check Tardive Dyskinesia

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Ames Test - fingers to thumbs while watching mouth for movements

Front 23

bad side effect of any antipsychotic

Back 23

can lower the seizure threshold

Front 24

Serious life-threatening side effects of antipsychotics

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oculogyric crisis - roll back in head
agranulocytosis
liver damage
neuroleptic malignant syndrome

Front 25

which antipsychotic has the potential fatal side effect of agranulocytosis

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Clozaril

Front 26

newer antipsychotic drugs have been known to cause what disease?

Back 26

diabetes mellitus - monitor 3 P's

Front 27

onset can occur hours or years after initiation of antipsychotic meds, progresses rapidly 48-72 hrs. Leads to renal failure and cardiac problems.

Back 27

neuroleptic malignant syndrome (NMS)

Front 28

s/s of NMS

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severe lead-pipe rigidity, high fever, tachycardia, BP fluctuations, confusion, stupor, coma, drooling, dilated pupils, incontinence.

Front 29

anti-Parkinsonian given to dimish toxicity in CNS

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Parlodil

Front 30

differences in s/s between serotonin storm and NMS

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SS - agitated, shivering, GI - abdominal pain, D/N

NMS - severe lead-pipe rigidity, high fever, tachycardia, dilated pupils, incontinence.

Similarities - BP fluctuations, hypersalivation/drooling, confusion

Front 31

classification of meds used to relieve EPS

Back 31

anti-Parkinsonians

Front 32

symptoms of agranulocytosis

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infection high fever sore throat malaise ulcers of mucous membranes.

Front 33

CBC diff levels to detect agranulocytosis

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WBC less than 2,000 or granulocytes less than 1,000 med will be discontinued.

Front 34

Three ways psych meds work on neurotransmission

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1. Prevent reuptake
2. Affect enzymatic action
3. Increase amount that’s released

Front 35

name some of the Benzodiazepines

Back 35

clonipin, ativan, valium, Librium, xanax

Front 36

how do benzo's work

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Increases GABA – will decrease symptoms of anxiety
•Inhibitory
•Decrease firing rate=decrease in symptoms of anxiety

Front 37

side effects of benzo's

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drowsiness, dry mouth, slows systems, withdrawal/tolerance issues, orthostatic hypotension

Front 38

class of antianxiety medication used to manage alcohol withdrawl

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benzodiazepines

Front 39

class of antianxiety meds that are fast acting and potentially addictive, with long term use can develop a tolerance

Back 39

benzodiazepines

Front 40

class of meds that can be taken PRN for anxiety

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benzodiazepines except for BuSpar

Front 41

how long must BuSpar be taken before effect is felt?

Back 41

2-4 weeks

Front 42

what medication may be given for long-term anxiety because it does not have the side effect of being potentially addictive

Back 42

BuSpar

Front 43

class of meds (atypical) mainly used to manage anxiety to help people who have performance anxiety. Give speech for example. Used PRN.

Back 43

Beta blockers (Inderal)