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90 Cards in this Set

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Psychiatric medications: Role of the Nurse
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
Goal of medication administration
-achieve a steady state
balance b/w competing metabolism, elimination and distribution of meds.
The longer the 1/2 life of the medication will cause what effect?
The drug will be in pts body longer
in order for psych drugs to cross the blood brain barrier they must be?
lipid soluble
Blocks CNS receptors
work on neurotransmitters
blocks dopamine 2 receptor, causes decrease in D2 receptivity?
Antipsychotic medications
An 80% block of D2 may cause what side effects?
EPS: extrapyramidal
-
What do Extrapyramidal tract consist of ?
motor neurons from the brain to parts of the spinal cord. role: gross motor movements
Name the symptoms of EPS?(5)
1.Dystonia
2.Drug induced Parkinsonism
3.Akathisia
4.Dopamine-acetylcholine imbalance in EPSystem
5.Tardive Dyskinesia
sustained involuntary muscle contractions.
(torticollis,opisthotonos,oculogyric)
Dystonia
twisting of the neck
Torticollis
spasms of the neck, forcint it to bend backward
Opisthotonos
crisis-a fixedupward stare, seen with 1st generation antipsychotic
Oculogyric
cogwheeling, tremor, pill rolling of fingers, regular rhythmic oscillations of extremities
Drug induced parkisonism
restless, not able to sit, need to keep moving(confused with anxiety)
Akathisia
hallucinations,
dry mouth,
blurred vision,
decreased absorption of antipsychotics,
decrease gi motility, tachycardia and urinary retention
Dopamine-Acetylcholine Imbalane in the extrapyramidal system
late onset after tx c antipsychotics, irreversible abnormal mvmts,lip smacking,tongue protrusion,rocking, foot tapping
Tardive Dyskinesia
Medications used to prevent EPS are?
Cogentin
Benedryl,
Artane,
antiparkisonian agents
Other S.E of EPS?
Increase BSL(diabetic sx)
high prolactin levels(d/c milk in females
What class of meds interfer with normal transmission of nerve impulse by acetylcholine and epinephrine centrally and peripherally?
Anticholinergic
Antiadrenergic
Anticholinergic S.E?
1.dry mouth
2.blurred vision
3.constipation
4.urine retention/hesistency
5.paralytic ileus(rare)
Antiadrenergic S.E.?
orthostatic hypotension:falls,check BP standing and sitting
Neuroleptic malignant syndrome-severe and life threatening name S.E?
1. muscle rigidity
2. hyperpyrexia(fever)
3. aloc
4. diaphoresis
Watch for interactions w/o drugs or herbal preparations. Give an example?
OTC Tagamet can reduce the effectiveness of antipsychotics.
Which class of meds used to tx psychosis (schizo),(bipolar d/o manic phase?How does it work?
Antipsychotic meds
-decreases agitation,
belligerence,uncooperativenes
confusion
delusions
hallucinations
What effect does antipsychotic meds have on patients? Choice of meds depends on? Route?
Sedating
sx,individual rspnse,past exp
IM(rapid effect,emergent situations)
Causes of older antipsychotic? avoid giving to? if exposed to sun may cause?
Increase EPS symptoms
orthostatic hypotension
Elderly(Thorazine)
Skin Rash
Lacting acting form of antipsychotics?Route? lasts?purpose?
Deconate(prolixin,haldol)
IM, 2-4wks,
stabilize behavior,increase compliance
Newer antipsychotics(2nd generation/atypicals)TX what sx?
positive and negative
-represent deficit-withdrawal,
lack of energy and interest
flat affect
alogia(lack of speech)
avolition(no motivation)
Reason for 2nd generation S.E?
Affinity for D2(dopamine) and 5HT(serotonin)receptors
(low D2,high 5HT)
addlt: antidepressant effect(low suicidal potential)
S.E of clozapine? what must be checked?
Agranulocytosis(low WBC's)
CBC weekly
Zyprexa comes in what form?
FDA approved for use in?
S.E?
SL form(Zydis)
mania
weight gain
Acts as 5HT(serotonin)sometimes (NE)to decrease reuptake and increase availability in the synapse?
Antidepressants
Antidepressants helps to improve what symptoms?
Mood loss of interest
inability to exp pleasure
EMA(early am awakeness)
psychomotor agitation/retardation
wt changes guilt
SIGEGAPS take several weeks to achieve a therapeutic blood level, must educate pt?
Not to expect immediate effect
Define SIGEGAPS?
change in sleep -chgs appetit
loss of intererest
guilt -psychmtr chngs
low energy -suicide
low concentration
Blocks reuptake of 5HT and NE
Tricyclics (TCA's)
What should it be used cautiously?
easy to overdose, commit suicide
How should it be prescribed?
small supply (4dys worth)
once daily: 1/2 life=24hrs
Side effects of TCA's
Weight gain
cardiac changes(ekg prior adm
It TCA combined with SSRI will cause?
If combined with antipsychotic?
1.Serious cardiac effects
2.high anticholinergic effect
(problem for elderly)call MD
Tofranil
Elavil
Pamelor
interfer with enzyme responsible for the breakdown of Neurotransmitters?
MAOIs
monoamine oxidase inhibitors
1.Describe MAOIs how it works?
2. Side effects?
1.long acting metabolites
(wait 2wks before starting new antidepressants)
2.hepatic necrosis, HTN crisis
HTN crisis leads to ICB caused by?
eating foods high in tyramine
signs of impending HTN crisis?
headache
stiff neck
N/V
increase BP
Which foods contain Tyramine?
pickled, fermented,smoked,aged
Meat and Fish
-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
decrease depression and suicide, decrease OCD? main reason for use?
1.SSRIs
2.safe not lethal
3.low risk birth defects
do not give SSRI with what, may cause fatal interaction?
MAOI and SSRI(prozac)
Name SSRI
celexa,lexapro,luvox,paxil(more sex se.) prozac, zoloft
Other S.E of SSRI?
GI symptoms sexual dysfunct
agitation
wt loss/gain
dizziness
Name new generation antidepressants?(block reuptake)
effexor:inhibits 5HT and NE
wellbutrin: inhibits D2 & NE
(used smoking cessation)
(no wt gain,no sexual dysfunc
Lithium(lithobid) is what class of meds?
antimanic agents(mood stabilizer)
1.Lithium use best for?
2.long term use may cause?
1.decreasing suicidality
2.thyroid/kidney problems
(good salt/water intake)
therapeutic levels of lithium?
0.5 -1.0 maintenance
1.0-1.5 therapeutic range
>1.5 toxic
very narrow range, check blood levels before admini.
SS of lithium toxicity?
V/D/lethargy, muscle twitching
Anticonvulsants can be used to stabilize mood.
Name some meds?
NEVER STOP ABRUPTLY, SEIZURES
tegretol and depakote
Neurontin,lamictal(rash)
topamax(wt loss)
trileptal
act by increasing GABA(inhibitory)
Anxiolytics
Precautions with anxiolytics why?
dependency(physical/mental)
addiction and tolerance
anxiolytics can cause?
to treat?
RELIEF TEMP,PT MUST COPE WITH ANXIETY.
disinhibition,induce sleep,
to tx withdrawal and detox
decrease N/V from chemo
decrease mvmt d/o
NAME ANXIOLYTICS
1.BENZOS(XANAX,ATIVAN,LIBRIUM,VALIUM,HALCION
2.OTHERS: BUSPAR(LESS DEPENDENCY GOOD FOR PT WITH DUAL DX OR RECOVERING SUBST DEPENDENT,LESS SEDATING.
USE IT THE TX OF DEMENTIA WHICH IS THOUGHT TO BE CAUSED BY AN IMBALANCE B/W DOPAMINE AND ACETYLCHOLINE?
ACETYLCHOLINESTERASE INHIBITORS
CHOLINERGIC SYSTEM INVOLVE WITH EXECUTIVE FUNCTIONING?
LOGICAL THINKING
MEMORY
PROBLEM SOLVING
RECOGNITION
ALZHEIMERS PTS HAVE DEFICITS WITH ?
ACETYLCHOLINE NEUROTRANSMITTER.
MEDS: ARICEPT, eXELON
WHAT ARE CATACHOLAMINES?
DOPAMINE
EPINEPHRINE
NOREPINEPHRINE
BLOCKS ALL DOPAMINE RECEPTORS,IN THE LIMBIC AREA, REDUCES SX OF PSYCHOSIS,ORGANIZES THOUGHTS
CONVENTIONAL ANTIPSYCHOTIC
thorazine
prolixin
haldol
mellaril
S.E OF CONVENTIONAL ANTIPSYCHOTIC
EPS,TD,NMS,ANTICHOLINERGIC EFFECTS,SEDATION,ORTHOSTATIC HYPOTENSION,PHOTOSENSITIVITY,HIGH PRL,LOW LIBIDO,LOW ORGASM,WT GAIN
blocks D2 receptors,reduces pos sx and improves neg sx of psychotic d/o, reduces mania?
Atypical antipsychotic
abilify seroquel
clozaril risperdal
zyprexia geodon
S.e of atypical antipsychotic?
less eps,more anticholinergic effects
restores dopamine:acetylcholine ratio, increase levels of dopamine?
Adjunctive medication to counteract EPS of high potency antipsychotics
CONGENTIN
BENADRYL
SYMMETREL
s.E OF ADJUNCTIVE MED TO COUNTERACT EPS OF HISH POTENCY ANTIPSYCHOTIC?
ANTICHOLINERGIC EFFECTS
NAUSEA DIZZINESS
GI UPSET LOW BP
SEDATION EXACERBATION
INCREASE FUNCTIONAL LEVELS OF NEUROTRANSMITTERS
DECREASE DEPRESSION,ANXIETY,PANIC,OCD,GAD?
ANTIDEPRESSANTS
WELLBUTRIN NARDIL EFFEXOR
PROZAC ZOLOFT
PAXIL PARNATE
SE: OF ANTIDEPRESSANTS?
ANTICHOLINERGIC EFFECTS
SEDATION
LOW BP
LOW SEIZURE THRESHOLD
HIGH HR,MULT SEX SE
CAUSES CNS DEPRESSION BY POTENTIATING EFFECTS OF GABA IN LIMBIC SYSTEM, DECREASE ANXIETY,PANIC,OCD,GAD?
ANTIANXIETY
XANAX KLONOPIN
TENORMIN* VALIUM
BUSPAR* ATIVAN
LIBRIUM RESTORIL
SE OF ANTIANXIETY?
DROWSINESS
CONFUSION
LETHARGY
PHYSICAL/MENTAL DEPENDENCE
TOLERANCE,
ANTIMANIC,DECREASE IMPULSIVITY,AGGRESSION,MOST ANTICONVULSANTS INCREASE LEVEL OF GABA?
MOOD STABILIZER:
TEGRETOL CATAPRES
NEURONTIN LAMICTAL
TOPAMAX DEPAKOTE
LITHOBID
SE OF MOOD STABILIZER:
DROWSINESS,DIZZINESS,UNSTEADYGAIT,LOW MENTAL ALERTNESS,N/V,
AGRANULOCYTOSIS,LIVER DAMAGE
CNS STIMULANTS POTENTIATE NOREPINEPHRINE,EPI,DOPAMINE:
TO TX ADHD,TOURETTES D/O
CAUSES: INCREASE ALERTNESS,BY BLOCKING OUT IRRELEVENT THOUGHTS AND IMPULSES
STIMULANT:
CYLERT
DEXEDRINE
ADDERAL
RITALIN
SE OF STIMULANTS:
TREMOR,RESTLESNESS,ANOREXIA,
INSOMNIA
AGITIATION
MAJOR NEUROTRANSMITTER CHANGES IN DELIRIUM:
1.DOPAMINE
2.SEROTONIN
3.ACETYLCHOLINE
4.GABA
1.INCREASED:USE ANTIPSYCHOTIC
2.DECREASED:
3.DECREASED:AVOIC ANTICHOLINERGIC AGENTS
4.INCREASED:AVOID BENZOZ
NEUROTRANSMITTERS CHANGES IN PSYCH D/O:
BIPOLAR MANIC:
DA GABA GLUTAMATE
BIPOLAR DEPRESSED:
5HT NE BABA
UNIPOLAR DEPRESSED:
5HT NE
PSYCHOSIS:
DA 5HT
ADHD:
DA NE
ANXIETY D/O
5HT GABA
DELIRIUM:
DA 5HT NE GABA
GLUTAMATE
ACH
NEUROTRANSMITTERS ACTION OF PSYCHOTROPIC MEDICATIONS:
1.BIPOLAR MANIC
2.BIPOLAR DEPRESSED:
1. DA 5HT NE GABA GLUT

2. DA 5HT NE
CHANGES IN PSYCHOTROPIC MEDS:

UNIPOLAR DEPRESSED:
DA 5HT NE
CHANGES IN PSYCHOTROPIC MEDS:

PSYCHOSIS:
DA
CHANGES IN PSYCHOTROPIC MEDS:

ADHD:
DA NE
CHANGES IN PSYCHOTROPIC MEDS:

ANXIETY DISORDER:
5HT GABA