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132 Cards in this Set
- Front
- Back
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where does the destruction of neurotransmitters take place
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out side of the cell or inside the presynaptic cell
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what does dopamine do
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involved in fine muscle movement, integration of emotions and thoughts and decision making
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what is dopamines association with mental health
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decreases parkinsons and depression
increase in schizophrenia and mania |
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what does norepinephrine do
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involved in mood regulation. Stimulates sympathetic branch of autonomic nervous system for 'fight or flight' in response to stress
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what is norepinephrine in association with mental health
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decrease in depression
increase in mania, anxiety states, schizophrenia |
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what does serotonin do
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plays a role in sleep regulation, hunger, mood states, pain perception and aggression
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what is serotonin in association with mental health
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decrease depression
increase anxiety states |
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what does GABA do
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plays a role in inhibition, reduces aggression, excitation, anxiety
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what does GABA do for mental health
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decrease anxiety disorders and schizophrenia
increase reduction of anxiety |
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what does acetylcholine do
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plays a role in learning, memory, regulates mood, affects aggression
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what is acetylcholines association with mental health
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decrease alzheimers and parkinsons
increase depression |
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what does excess receptors mean
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relative symptoms are seen
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when is the onset of action antidepressants
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10 days to 4 weeks
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what can antidepressants treat
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depression, anxiety, eating disorders, pain disorder and smoking cessation
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what is the first line of therapy for depression and anxiety
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SSRIs
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what do SNRIs do
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inhibit reuptake of both serotonin and norepinephrine
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what do NDIs do
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inhibit norepinephrine and dopamine reuptake
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what are SSRI indicated for treatment of
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Major depression
Dysthymia Depressed phase of bipolar d/o OCD Panic d/o Bulimia |
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what are examples of SSRIs
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Fluoxetine (Prozac)
Dose/day 20-80 mg Fluvoxamine (Luvox) Dose/day 100-300 mg Paroxetine (Paxil) Dose/day 20-50 mg Sertraline (Zoloft) Dose/day 50-200 mg Citalopram (Celexa) Dose/day 20-40 mg Ecitalopram (Lexapro) 10-20 mg |
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where does the destruction of neurotransmitters take place
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out side of the cell or inside the presynaptic cell
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what does dopamine do
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involved in fine muscle movement, integration of emotions and thoughts and decision making
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what is dopamines association with mental health
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decreases parkinsons and depression
increase in schizophrenia and mania |
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what does norepinephrine do
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involved in mood regulation. Stimulates sympathetic branch of autonomic nervous system for 'fight or flight' in response to stress
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what is norepinephrine in association with mental health
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decrease in depression
increase in mania, anxiety states, schizophrenia |
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what does serotonin do
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plays a role in sleep regulation, hunger, mood states, pain perception and aggression
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what is serotonin in association with mental health
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decrease depression
increase anxiety states |
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what does GABA do
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plays a role in inhibition, reduces aggression, excitation, anxiety
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what does GABA do for mental health
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decrease anxiety disorders and schizophrenia
increase reduction of anxiety |
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what does acetylcholine do
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plays a role in learning, memory, regulates mood, affects aggression
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what is acetylcholines association with mental health
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decrease alzheimers and parkinsons
increase depression |
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what does excess receptors mean
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relative symptoms are seen
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when is the onset of action antidepressants
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10 days to 4 weeks
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what can antidepressants treat
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depression, anxiety, eating disorders, pain disorder and smoking cessation
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what is the first line of therapy for depression and anxiety
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SSRIs
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what do SNRIs do
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inhibit reuptake of both serotonin and norepinephrine
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what do NDIs do
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inhibit norepinephrine and dopamine reuptake
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what are SSRI indicated for treatment of
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Major depression
Dysthymia Depressed phase of bipolar d/o OCD Panic d/o Bulimia |
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what are examples of SSRIs
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Fluoxetine (Prozac)
Dose/day 20-80 mg Fluvoxamine (Luvox) Dose/day 100-300 mg Paroxetine (Paxil) Dose/day 20-50 mg Sertraline (Zoloft) Dose/day 50-200 mg Citalopram (Celexa) Dose/day 20-40 mg Ecitalopram (Lexapro) 10-20 mg |
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how do SSRIs work
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Block the reuptake of 5-HT into the presynaptic neuron
Results in increased 5-HT in the synapse SSRIs have minimal direct effects on other receptors l/t fewer SE |
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how much are SSRIs administered
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once daily-have long half lives
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what is the elimination of prozac and zoloft
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have active metabolisms
Elimination of Prozac’s metabolite is 7-15 days Elimination of Zoloft’s metabolite is 3 days |
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SSRIs can increase the levels of what other drugs
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Antiarrhythmics
Anticonvulsants Anticoagulants Antipsychotics Oral hypoglycemics Lithium |
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what are the side effects of SSRI
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Agitation
Anxiety Sleep disturbance Tremor Tension H/A Sexual dysfunction (primarily anorgasmia) Autonomic Related Dry mouth Sweating Weight change Mild nausea Loose bowel movements |
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what are the toxic effects of SSRIs
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central serotonin symptoms
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what is the cause of central serotonin symptoms
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Caused by too high dose or a interaction w/ other drugs.
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what does an SNRI do
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Blocks the reuptake of both 5-HT and NE
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what are the emergency measures of central serotonin syndrome
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Remove offending agent(s)
Initial symptomatic treatment Cooling blankets Chlorpromazine for hyperthermia Diazepam or dantrolene for muscle rigidity or rigors Anticonvulsants Serotonin receptor blockade: give propanolol or methysergide Artificial ventilation |
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what is a dose related side effect of SNRI
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hypertension
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what are the adverse effects of SNRI
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Hypertension
Tachycardia Diaphoresis Nausea Constipation Dry mouth Dizziness Withdrawal syndrome |
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what is Mirtazapine (Remeron)
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a NSSRI-Blocks presynaptic alpha2 NE receptors increasing the release in both NE and 5-HT
for depression |
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what are the side effects of mirtazapine
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Somnolence – limits usefulness
Increased appetite Weight gain Dizziness |
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what are 5-HT2A antagonists
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Tazodone (Desyrel)
Dose/day 25-500 mg Nefazodone (Serzone) |
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what are the side effects of 5-HT2A antagonists
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GI upset
Orthostatic hypotension Sedation Priapism—Trazodone H/As Restlessness |
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what is buproprion used for and its side effects
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NDI-Also known as Zyban—marketed for smoking cessation
Blocks the reuptake of dopamine; has minimal reuptake effects on NE Most common side effects are headache agitation and insomnia Can cause dose related seizures Maximum dose is 150 mg tid FDA indication for seasonal affective disorder Used adjunctively for ADHD, with SSRIs for treatment of neurovegatative symptoms Use with extreme caution in patients considering suicide |
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what are TCAs for
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Indicated for the Rx of major depression, the depressed phase of bipolar d/o, and dysthymia, panic disorder, OCD, fibromyalgia
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how do TCAs work
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Inhibits the reuptake of NE & 5HT by the presynaptic neurons increase amount of time the NE & 5HT are available to the postsynaptic receptors
This increase is believed to be responsible for mood elevation |
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what are TCAs adverse effects
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Anticholinergic
Dry mouth Blurred vision Tachycardia Constipation Urinary retention Esophageal reflux |
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when should you give TCAs
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at night-aids in sleep
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what mediates immediate medical attention of TCAs
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Urinary retention & severe constipation warrant immediate medical attention
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what should you teach clients about TCAs
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Mood elevation may take up to 28 days. Up to 6-8 weeks may be required for full effect to be reached.
Take dose within 3 hours of missed dose, otherwise wait until the usual medication time the next day. Suddenly stopping TCAs can cause nausea, altered heartbeat, nightmares, and cold sweats in 2-4 days. Client should contact MD or take 1 dose until the MD can be contacted. |
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what are TCAs Potential Toxic Effects
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Dysryhthmias
Tachycardia Myocardial infarction Heart block Considered a risk in clients with cardiac disease and in the elderly. Clients should have a thorough cardiac workup before beginning TCA therapy |
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what are TCAs contraindications
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Lower seizure threshold
Use cautiously in individuals with known seizure d/o Known cardiac effects Contraindicated in pts with underlying conduction disturbances TCAs slow impulse conduction and may precipitate bundle branch block Individuals with narrow-angle glaucoma Pregnant women use only with extreme caution & careful monitoring Avoid ETOH Can precipitate mania Must be used with extreme caution if at all in patients with suicidal ideation |
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what are MAOIs used for
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Major depression
Atypical depression The depressed phase of bipolar d/o Panic d/o Bulimia Borderline personality d/o |
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how do MAOIs work
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MAOIs inhibit the action of two isoenzymes: MAO-A & MAO-B
These 2 enzymes degrade NE and 5-HT in the presynaptic neuron MAOIs inhibit the enzyme MAO This leads to an increase in NE and 5-HT |
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what are side effects of MAOIs
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Hypotension
Sedation, weakness, fatigue Insomnia Changes in cardiac rate & rhythm Muscle cramps Sexual dysfunction Urinary hesitancy Constipation Weight gain Hypomanic/manic behavior Edema Hypotension is the most critical SE (10%); the elderly, especially may sustain injuries from it. |
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what are MAOIs potential toxic effects
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Hypertensive crisis
Occurs when MAOI is taken with a substance containing tyramine Tyramine, an amino acid, is normally degraded by MAO in the intestine With MAOI use, tyramine is not degraded Ingestion of a substance that contains tyramine leads to a massive outpouring of NE that can’t be metabolized This leads to the sx of a hypertensive crisis |
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what are symptoms of hypertensive crisis
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Sudden onset of severe H/A – usually within a few hours of ingesting contraindicated substance
Can be accompanied by neck stiffness, nausea, sweating, and palpitations BP increases abruptly Can lead to hyperpyrexia, intracranial hemorrhage, convulsions, coma and death |
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what foods should be avoided with MAOIs
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All cheeses (with the exception of cottage, cream, ricotta, American)
Hydrogenated yeast products Beer, red wine Sauerkraut Soy sauce Smoked or pickled fish Sausage, pepperoni, salami, bologna |
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what client teaching should go along with MAIOs
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Tell client to go to the ER immediately if severe HA.
Monitor BP during 1st 6 weeks of treatment. After MOA is stopped, maintain dietary restrictions for 14 days. |
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what happens when you mix SSRI and MAIOs
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Combination of MAOIs with SSRIs causes serotonergic syndrome
Agitation Confusion Myoclonus HTN Tremor Diarrhea Hypomania Do not start SSRI therapy until the MAOI has been d/c for 2 weeks |
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what are the warnings of antidepressants
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Induction of mania
Can occur with use of any antidepressant Must be used with caution in patients with a family history of bipolar disorder Must be used for the least amount of time at the lowest dose possible Can lead to chronic irritable state Safest antidepressants in patients with FMH Bipolar |
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what are mood stabilizers for
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Used to stabilize recurrent episodes of depression and mania
May help maintain the individual’s functioning Rarely used as monotherapy, usually used in combination with an atypical antipsychotic agent Goal of therapy is euthymia |
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what is lithium carbonate used to treat
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Oldest and most established mood stabilizer
Indicated in the Rx of acute manic episodes, the prevention of bipolar d/o, and augmentation of antidepressant therapy Usual dosage is 900-1200 mg/day – does have sustained release formula Must reach therapeutic levels for effectiveness Therapeutic levels usually take 7-14 days, or longer for some clients |
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what are lithium effects
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Mania
Elation, grandiosity, expansiveness Flights of ideas Irritability Manipulativeness Anxiety Insomnia Psychomotor agitation Threatening or assaultive behavior Distractibility Hypersexuality Depression |
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what are the side effects of lithium levels .04-1.0
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Fine hand tremors
Polyuria Mild thirst Mild nausea General discomfort Weight gain |
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what are the early signs of lithium toxicity (less than 1.5)
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Nausea
Vomiting Diarrhea Thirst Polyuria Slurred speech Muscle weakness |
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what are the interventions of lithium levels less than 1.5
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Medication should be withheld
Blood lithium levels measured Dosage reevaluated |
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what are the advanced signs of lithium toxicity (1.5-2.0)
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Course hand tremors
Persistent GI upset Mental confusion Muscle hyperirritability Incoordination EEG changes |
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what are the interventions of lithium toxicity (1.5-2.0)
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Interventions outlined for early or severe signs of toxicity should be used, depending on severity of circumstances
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what are the signs of severe lithium toxicity (2.0-2.5)
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Ataxia
Serious EEG changes Blurred vision Clonic movements Large output of dilute urine Seizures Stupor Severe hypotension Coma Death is usually 2o to pulmonary complications |
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what are the interventions of severe lithium toxicity
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There is no known antidote to Lithium poisoning.
The drug is stopped and excretion is hastened. If client is alert, administer emetic. Otherwise, gastric lavage and treatment with urea, mannitol, and aminophylline are used to hastened lithium excretion. |
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what are the signs of lithium levels greater than 2.5
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Confusion
Urinary / fecal incontinence Coma Cardiac arrhythmia Peripheral circulatory collapse Abdominal pain Proteinuria Oliguria death |
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what are additional interventions of lithium levels greater than 2.5
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hemodialysis
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what is depakote used for
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Acute mania
Simple or complex absence seizures |
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how does dopakote work
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Increases the levels of the inhibitory NT GABA
Appears that these drugs also effect second messenger systems--influence both the metabolism and action of multiple NTs |
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what are the side effects of dopakote
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Nausea
Heartburn Anorexia Sedation Hand tremor Weight gain Thrombocytopenia Elevated LFTsliver failure Prenatal exposure can lead to an increased incidence of spina bifida and neural tube defects |
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what is Carbamazepine (Tegretol) used for
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Acute mania
Temporal lobe and limbic seizures Chronic pain d/os Trigeminal neuralgia Neuropathic pain |
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what are the side effects of tegretol
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Sedation
Drowsiness Rash Neurological reactions Dizziness Clumsiness Ataxia Diplopia Bone marrow depression Agranulocytosis Aplastic anemia Monitor for fever, sore throat, pallor, petechiae, or easy bruising Sinus bradycardia Heart block |
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what are topiramate and gabapentin
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anti convulsants
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what is topiramate used for
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Adjunctive therapy for aggression and mania
Weight neutral |
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what is gabapentin used for
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Helpful as an adjunct for sleep and anxiety associated with bipolar disorder
Useful for peripheral neuropathies |
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what is Lamotrigine Lamictal for
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Maintenance treatment of Bipolar I
Long term and especially effective against bipolar depression Seizure disorders Must be loaded over a long period of time to avoid dermatological complications |
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what are the side effects of lamictal
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Serious rash leading to Steven Johnson’s Syndrome
Dizziness, HA, blurred or double vision, lack of coordination, sleepiness, N&V, insomnia, rash When given with valproate need to cut does by ½ No blood monitoring |
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what are antipsychotics used for
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Schizophrenia
Schizoaffective disorder Acute psychotic states Mania Psychotic depression Severe N/V Intractable hiccups |
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how do antipsychotics work
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Symptoms of psychosis are believed to be r/t excess of DA
Even though excess DA is released by the presynaptic cell, it will not cause a corresponding response in the postsynaptic cell because the receptors to which DA must attach are blocked by the medication. |
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what are the side effects of antipsychotics
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Low-potency drugs cause more sedation and hypotension
High-potency drugs cause more EPS Drugs vary greatly in the amount of anticholinergic effects they cause Drugs that are more likely to cause EPS have < anticholinergic effects |
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what are extra pyramidal side effects
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Da blockade causes a variety of movement disorders known as EPS
EPS presents as: Acute dystonia Neuroleptic-induced pseudoparkinsonism Akathisia Tardive dyskinesia |
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what is acute dystonia
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Muscular spasm that may
occur in up to 10% of clients May effect different muscle groups Blepharospasm—eye closing Torticollis—neck muscle contraction; pulling head to one side Oculogyric crisis—severe upward deviation of the eyeballs |
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what treats acute dystonia
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Anticholinergic drugs
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how should severe acute dystonia be treated
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Severe presentations should be treated with IM injection
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what is Neuroleptic-Induced Pseudoparkinsonism the result from
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Results from imbalance between
Da and ACh in the nigrostriatal pathway |
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what are the symptoms of Neuroleptic-Induced Pseudoparkinsonism
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Tremors
Bradykinesia/akinesia Cogwheel rigidity Shuffling gait Masked facies Hypersalivation and drooling |
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how do you treat Neuroleptic-Induced Pseudoparkinsonism
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anticholinergic drugs
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what are the components of akathisia
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Objective sx include:
Motor restlessness Pacing Rocking Foot tapping Subjective c/o include: Inner restlessness—tension, irritability, inability to sit or lie down |
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what is tardive dyskinesia associated with
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Generally associated with
long-term antipsychotic use. irreversible |
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what is tardive dyskinesia
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Characterized by choreoathetoid movements—rapid, jerky, and slow, writhing
Clients generally experience involuntary movements of the mouth, tongue, and face Arm, finger, leg, feet, and truncal movements are also noted |
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what is Neuroleptic Malignat Syndrome
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Potentially fatal reaction to antipsychotics
Characterized by: Muscular rigidity Hyperthermia Altered consciousness Autonomic dysfunction |
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what are the lab findings of neuroleptic malignat syndrome
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Leucocytosis
Increased creatine phosphokinase Increased myoglobinuria |
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when does neuroleptic malignat syndrome occur in treatment
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Can occur at any time during Rx but is more frequent shortly after initiation of antipsychotics or dose increases
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what is the treatment of neuroleptic malignat syndrome
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First D/C antipsychotic
Hydration and cooling are of major importance May also give muscle relaxant IV Dantrolene or bromocriptine (Da agonists) can also be prescribed to relieve rigidity |
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what makes atypical atypical
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Dissolute or partial blocking of the D2 receptors
Addition of 5HT2A antagonism Less negative and cognitive symptoms Less problem with movement disorders Better compliance |
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what are problems with atypical antipsychotics
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More problems with weight gain
Cardiovascular and metabolic consequences Induction of Type II Diabetes Elevation of serum lipids |
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what is clozaril
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1st atypical antipsychotic
1st antipsychotic to demonstrate a significant improvement in negative sx Use is restricted to the Rx of refractory schizophrenia secondary to SE Blocks 5-HT more than Da Less EPS |
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what are the sideeffects of clozaril
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Life-threatening agranulocytosis
Risk greatest in 1st 6 months of Rx Weekly monitoring of the WBC count is necessary for the 1st 6 months of Rx followed by biweekly monitoring Seizures—dose-related SE Others include: sedation, tachycardia, hypotension, GI upset, anticholinergic effects, and hypersalivation |
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what is risperdal
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Doses > 6 mg/day may cause EPS
Other SE include: Anxiety Rhinitis Somnolence Tachycardia Mild weight gain |
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what is Invega
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similar to risperdal but with less chance of EPS, less adverse effects
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when are side effects seen in zyprexa
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Doses > 10 mg/day may produce mild EPS
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what are side effects of zyprexa
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EPS, Orthostatic hypotension
Dizziness Constipation Substantial weight gain High risk of cardiovascular and metabolic consequences of use |
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what are side effects of Seroquel
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Indications for refractory depression, GAD
Some problems with sedation Significant problems with weight gain Significant metabolic and cardiovascular risk Can be loaded very quickly for use with acute mania |
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what is Geodon
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Weight neutral
Partial dopamine agonist Often underdosed which can lead to poor control of positive symptoms Must be given with at least 500 calorie meal/snack |
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what is Abilify
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Works by different mechanism than other atypicals – presynaptic dopamine blocker
Indication for treatment of resistant depression Akathesia can occur at even low doses |
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what are Benzodiazepines used for
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Panic d/o
GAD Management of acute ETOH withdrawal Preoperative sedation Seizures Temporary relief of insomnia Short-term Rx of acute mania Akathisia |
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how do benzodiazepines work
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Exert their effect through GABA
Benzos facilitate the transmission of GABA by binding to GABA-A receptors and opening chloride channels This decreases the firing rate of neurons |
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what are the side effects of benxodiazepines
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Sedation
Fatigue Reduced motor coordination Impaired memory Cognitive dysfunction Can be teratogenic and should not be used during pregnancy Rapid discontinuation can produce withdrawal sx including: Insomnia Agitation Anxiety Sweating Irritability Nausea Seizures Rebound anxiety Begins when the benzo begins to wear off Clients notice reemergence and worsening of their anxiety Seen with meds that have a short half-life (xanax) This leads to tolerance, abuse, and dependence |
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what are the Non-Benzodiazepines
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Buspirone (Buspar)
Zolpidem (Ambien) |
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what is buspar used for
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Indicated for the Rx of anxiety d/os (specifically GAD)
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what are the side effects of buspar
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Dizziness
H/A Drowsiness Lightheadedness CNS sedation and cognitive impairment occur much less frequently with Buspar |
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what is zolpidem used for
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insomnia
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what are the side effects of zolpidem
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drowsiness and dizziness
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what are stimulants used for
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Used in the Rx of ADHD
Also used in the Rx of narcolepsy and less commonly to treat withdrawn and apathetic states in the elderly |
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what are the side effects of stimulants
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GI upset
Nausea Cramps Anorexia Weight loss and growth suppression H/A Dizziness Nervousness Irritability Rarely, emotional lability and psychosis |
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what is Atamoxetine (Strattera)
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non-stimulant adhd med.
NRI Has some adjunctive reduction of anxiety Dosed according to weight Can be taken at any time of day, has a cumulative effect Adverse effects similar to stimulants |
