Psychiatric Meds

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Psychiatric medications: Role of the Nurse

Back 1

1.assess if meds change behavior
2.causes S.E
3.proper adm of meds
4.aware of interactions w/o meds
5.pt/fm edu. reg. meds

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Goal of medication administration

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-achieve a steady state
balance b/w competing metabolism, elimination and distribution of meds.

Front 3

The longer the 1/2 life of the medication will cause what effect?

Back 3

The drug will be in pts body longer

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in order for psych drugs to cross the blood brain barrier they must be?

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lipid soluble

Front 5

Blocks CNS receptors
work on neurotransmitters
blocks dopamine 2 receptor, causes decrease in D2 receptivity?

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Antipsychotic medications

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An 80% block of D2 may cause what side effects?

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EPS: extrapyramidal
-

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What do Extrapyramidal tract consist of ?

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motor neurons from the brain to parts of the spinal cord. role: gross motor movements

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Name the symptoms of EPS?(5)

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1.Dystonia
2.Drug induced Parkinsonism
3.Akathisia
4.Dopamine-acetylcholine imbalance in EPSystem
5.Tardive Dyskinesia

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sustained involuntary muscle contractions.
(torticollis,opisthotonos,oculogyric)

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Dystonia

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twisting of the neck

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Torticollis

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spasms of the neck, forcint it to bend backward

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Opisthotonos

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crisis-a fixedupward stare, seen with 1st generation antipsychotic

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Oculogyric

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cogwheeling, tremor, pill rolling of fingers, regular rhythmic oscillations of extremities

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Drug induced parkisonism

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restless, not able to sit, need to keep moving(confused with anxiety)

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Akathisia

Front 15

hallucinations,
dry mouth,
blurred vision,
decreased absorption of antipsychotics,
decrease gi motility, tachycardia and urinary retention

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Dopamine-Acetylcholine Imbalane in the extrapyramidal system

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late onset after tx c antipsychotics, irreversible abnormal mvmts,lip smacking,tongue protrusion,rocking, foot tapping

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Tardive Dyskinesia

Front 17

Medications used to prevent EPS are?

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Cogentin
Benedryl,
Artane,
antiparkisonian agents

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Other S.E of EPS?

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Increase BSL(diabetic sx)
high prolactin levels(d/c milk in females

Front 19

What class of meds interfer with normal transmission of nerve impulse by acetylcholine and epinephrine centrally and peripherally?

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Anticholinergic
Antiadrenergic

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Anticholinergic S.E?

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1.dry mouth
2.blurred vision
3.constipation
4.urine retention/hesistency
5.paralytic ileus(rare)

Front 21

Antiadrenergic S.E.?

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orthostatic hypotension:falls,check BP standing and sitting

Front 22

Neuroleptic malignant syndrome-severe and life threatening name S.E?

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1. muscle rigidity
2. hyperpyrexia(fever)
3. aloc
4. diaphoresis

Front 23

Watch for interactions w/o drugs or herbal preparations. Give an example?

Back 23

OTC Tagamet can reduce the effectiveness of antipsychotics.

Front 24

Which class of meds used to tx psychosis (schizo),(bipolar d/o manic phase?How does it work?

Back 24

Antipsychotic meds
-decreases agitation,
belligerence,uncooperativenes
confusion
delusions
hallucinations

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What effect does antipsychotic meds have on patients? Choice of meds depends on? Route?

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Sedating
sx,individual rspnse,past exp
IM(rapid effect,emergent situations)

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Causes of older antipsychotic? avoid giving to? if exposed to sun may cause?

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Increase EPS symptoms
orthostatic hypotension
Elderly(Thorazine)
Skin Rash

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Lacting acting form of antipsychotics?Route? lasts?purpose?

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Deconate(prolixin,haldol)
IM, 2-4wks,
stabilize behavior,increase compliance

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Newer antipsychotics(2nd generation/atypicals)TX what sx?

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positive and negative
-represent deficit-withdrawal,
lack of energy and interest
flat affect
alogia(lack of speech)
avolition(no motivation)

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Reason for 2nd generation S.E?

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Affinity for D2(dopamine) and 5HT(serotonin)receptors
(low D2,high 5HT)
addlt: antidepressant effect(low suicidal potential)

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S.E of clozapine? what must be checked?

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Agranulocytosis(low WBC's)
CBC weekly

Front 31

Zyprexa comes in what form?
FDA approved for use in?
S.E?

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SL form(Zydis)
mania
weight gain

Front 32

Acts as 5HT(serotonin)sometimes (NE)to decrease reuptake and increase availability in the synapse?

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Antidepressants

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Antidepressants helps to improve what symptoms?

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Mood loss of interest
inability to exp pleasure
EMA(early am awakeness)
psychomotor agitation/retardation
wt changes guilt

Front 34

SIGEGAPS take several weeks to achieve a therapeutic blood level, must educate pt?

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Not to expect immediate effect

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Define SIGEGAPS?

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change in sleep -chgs appetit
loss of intererest
guilt -psychmtr chngs
low energy -suicide
low concentration

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Blocks reuptake of 5HT and NE

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Tricyclics (TCA's)

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What should it be used cautiously?

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easy to overdose, commit suicide

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How should it be prescribed?

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small supply (4dys worth)
once daily: 1/2 life=24hrs

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Side effects of TCA's

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Weight gain
cardiac changes(ekg prior adm

Front 40

It TCA combined with SSRI will cause?
If combined with antipsychotic?

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1.Serious cardiac effects
2.high anticholinergic effect
(problem for elderly)call MD
Tofranil
Elavil
Pamelor

Front 41

interfer with enzyme responsible for the breakdown of Neurotransmitters?

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MAOIs
monoamine oxidase inhibitors

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1.Describe MAOIs how it works?
2. Side effects?

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1.long acting metabolites
(wait 2wks before starting new antidepressants)
2.hepatic necrosis, HTN crisis

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HTN crisis leads to ICB caused by?

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eating foods high in tyramine

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signs of impending HTN crisis?

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headache
stiff neck
N/V
increase BP

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Which foods contain Tyramine?
pickled, fermented,smoked,aged
Meat and Fish

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-pickled herring
dried fish
unrefrigerated fermented fish
liver,caviar,fermented sausage(bologna,salami,pepperoni,summer sausage)HOISON SAUCE;(fermented oyster sauce,used in oriental dishes

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decrease depression and suicide, decrease OCD? main reason for use?

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1.SSRIs
2.safe not lethal
3.low risk birth defects

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do not give SSRI with what, may cause fatal interaction?

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MAOI and SSRI(prozac)

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Name SSRI

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celexa,lexapro,luvox,paxil(more sex se.) prozac, zoloft

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Other S.E of SSRI?

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GI symptoms sexual dysfunct
agitation
wt loss/gain
dizziness

Front 50

Name new generation antidepressants?(block reuptake)

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effexor:inhibits 5HT and NE
wellbutrin: inhibits D2 & NE
(used smoking cessation)
(no wt gain,no sexual dysfunc

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Lithium(lithobid) is what class of meds?

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antimanic agents(mood stabilizer)

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1.Lithium use best for?
2.long term use may cause?

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1.decreasing suicidality
2.thyroid/kidney problems
(good salt/water intake)

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therapeutic levels of lithium?

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0.5 -1.0 maintenance
1.0-1.5 therapeutic range
>1.5 toxic

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very narrow range, check blood levels before admini.
SS of lithium toxicity?

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V/D/lethargy, muscle twitching

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Anticonvulsants can be used to stabilize mood.
Name some meds?
NEVER STOP ABRUPTLY, SEIZURES

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tegretol and depakote
Neurontin,lamictal(rash)
topamax(wt loss)
trileptal

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act by increasing GABA(inhibitory)

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Anxiolytics

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Precautions with anxiolytics why?

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dependency(physical/mental)
addiction and tolerance

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anxiolytics can cause?
to treat?
RELIEF TEMP,PT MUST COPE WITH ANXIETY.

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disinhibition,induce sleep,
to tx withdrawal and detox
decrease N/V from chemo
decrease mvmt d/o

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NAME ANXIOLYTICS

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1.BENZOS(XANAX,ATIVAN,LIBRIUM,VALIUM,HALCION
2.OTHERS: BUSPAR(LESS DEPENDENCY GOOD FOR PT WITH DUAL DX OR RECOVERING SUBST DEPENDENT,LESS SEDATING.

Front 60

USE IT THE TX OF DEMENTIA WHICH IS THOUGHT TO BE CAUSED BY AN IMBALANCE B/W DOPAMINE AND ACETYLCHOLINE?

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ACETYLCHOLINESTERASE INHIBITORS

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CHOLINERGIC SYSTEM INVOLVE WITH EXECUTIVE FUNCTIONING?

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LOGICAL THINKING
MEMORY
PROBLEM SOLVING
RECOGNITION

Front 62

ALZHEIMERS PTS HAVE DEFICITS WITH ?

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ACETYLCHOLINE NEUROTRANSMITTER.
MEDS: ARICEPT, eXELON

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WHAT ARE CATACHOLAMINES?

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DOPAMINE
EPINEPHRINE
NOREPINEPHRINE

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BLOCKS ALL DOPAMINE RECEPTORS,IN THE LIMBIC AREA, REDUCES SX OF PSYCHOSIS,ORGANIZES THOUGHTS

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CONVENTIONAL ANTIPSYCHOTIC
thorazine
prolixin
haldol
mellaril

Front 65

S.E OF CONVENTIONAL ANTIPSYCHOTIC

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EPS,TD,NMS,ANTICHOLINERGIC EFFECTS,SEDATION,ORTHOSTATIC HYPOTENSION,PHOTOSENSITIVITY,HIGH PRL,LOW LIBIDO,LOW ORGASM,WT GAIN

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blocks D2 receptors,reduces pos sx and improves neg sx of psychotic d/o, reduces mania?

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Atypical antipsychotic
abilify seroquel
clozaril risperdal
zyprexia geodon

Front 67

S.e of atypical antipsychotic?

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less eps,more anticholinergic effects

Front 68

restores dopamine:acetylcholine ratio, increase levels of dopamine?

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Adjunctive medication to counteract EPS of high potency antipsychotics
CONGENTIN
BENADRYL
SYMMETREL

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s.E OF ADJUNCTIVE MED TO COUNTERACT EPS OF HISH POTENCY ANTIPSYCHOTIC?

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ANTICHOLINERGIC EFFECTS
NAUSEA DIZZINESS
GI UPSET LOW BP
SEDATION EXACERBATION

Front 70

INCREASE FUNCTIONAL LEVELS OF NEUROTRANSMITTERS
DECREASE DEPRESSION,ANXIETY,PANIC,OCD,GAD?

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ANTIDEPRESSANTS
WELLBUTRIN NARDIL EFFEXOR
PROZAC ZOLOFT
PAXIL PARNATE

Front 71

SE: OF ANTIDEPRESSANTS?

Back 71

ANTICHOLINERGIC EFFECTS
SEDATION
LOW BP
LOW SEIZURE THRESHOLD
HIGH HR,MULT SEX SE

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CAUSES CNS DEPRESSION BY POTENTIATING EFFECTS OF GABA IN LIMBIC SYSTEM, DECREASE ANXIETY,PANIC,OCD,GAD?

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ANTIANXIETY
XANAX KLONOPIN
TENORMIN* VALIUM
BUSPAR* ATIVAN
LIBRIUM RESTORIL

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SE OF ANTIANXIETY?

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DROWSINESS
CONFUSION
LETHARGY
PHYSICAL/MENTAL DEPENDENCE
TOLERANCE,

Front 74

ANTIMANIC,DECREASE IMPULSIVITY,AGGRESSION,MOST ANTICONVULSANTS INCREASE LEVEL OF GABA?

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MOOD STABILIZER:
TEGRETOL CATAPRES
NEURONTIN LAMICTAL
TOPAMAX DEPAKOTE
LITHOBID

Front 75

SE OF MOOD STABILIZER:

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DROWSINESS,DIZZINESS,UNSTEADYGAIT,LOW MENTAL ALERTNESS,N/V,
AGRANULOCYTOSIS,LIVER DAMAGE

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CNS STIMULANTS POTENTIATE NOREPINEPHRINE,EPI,DOPAMINE:
TO TX ADHD,TOURETTES D/O
CAUSES: INCREASE ALERTNESS,BY BLOCKING OUT IRRELEVENT THOUGHTS AND IMPULSES

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STIMULANT:
CYLERT
DEXEDRINE
ADDERAL
RITALIN

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SE OF STIMULANTS:

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TREMOR,RESTLESNESS,ANOREXIA,
INSOMNIA
AGITIATION

Front 78

MAJOR NEUROTRANSMITTER CHANGES IN DELIRIUM:
1.DOPAMINE
2.SEROTONIN
3.ACETYLCHOLINE
4.GABA

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1.INCREASED:USE ANTIPSYCHOTIC
2.DECREASED:
3.DECREASED:AVOIC ANTICHOLINERGIC AGENTS
4.INCREASED:AVOID BENZOZ

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NEUROTRANSMITTERS CHANGES IN PSYCH D/O:
BIPOLAR MANIC:

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DA GABA GLUTAMATE

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BIPOLAR DEPRESSED:

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5HT NE BABA

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UNIPOLAR DEPRESSED:

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5HT NE

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PSYCHOSIS:

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DA 5HT

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ADHD:

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DA NE

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ANXIETY D/O

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5HT GABA

Front 85

DELIRIUM:

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DA 5HT NE GABA
GLUTAMATE
ACH

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NEUROTRANSMITTERS ACTION OF PSYCHOTROPIC MEDICATIONS:
1.BIPOLAR MANIC
2.BIPOLAR DEPRESSED:

Back 86

1. DA 5HT NE GABA GLUT

2. DA 5HT NE

Front 87

CHANGES IN PSYCHOTROPIC MEDS:

UNIPOLAR DEPRESSED:

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DA 5HT NE

Front 88

CHANGES IN PSYCHOTROPIC MEDS:

PSYCHOSIS:

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DA

Front 89

CHANGES IN PSYCHOTROPIC MEDS:

ADHD:

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DA NE

Front 90

CHANGES IN PSYCHOTROPIC MEDS:

ANXIETY DISORDER:

Back 90

5HT GABA