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120 Cards in this Set
- Front
- Back
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Benzodiazepines
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Alpraxolam/Xanax
Chlordizaepoxide hydrochloride/Librium Diazepam/Valium Lorazepam/Ativan Oxazepam/Serax |
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Anti anxiety/Anxiolytics(Non Benzo)
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Buspirone/Buspar
Hydroxyzine/Atarax, Vistaril Meprobamate/Miltown |
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SSRIs
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Fluoxetine/Prozac
Paroxetine/Paxil Sertraline/Zoloft Citalopram/Celexa Fluvoxamine/Luvox Escitalopram/Lexapro |
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TCAs(Tricyclics)
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Amitriptyline/Elavil
Clomipramine/Anafranil Despipramine/Norpramin Doxepin/Adapin, Sinequan Imipramine/Trofranil Nortriptyline/Aventyl, Pamelor Protriptyline/Vivactil Trimipramine/Surmontil |
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MAOIs
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Isocarboxazid/Marplan
Phenelzine/Nardil Tranylcypromine/Parnate |
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Antidepressants (Novel Antidepressants)
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Bupropion/Wellbutrin
Trazodone/Desyrel Venlafaxine/Effexor Nefazodone/Serzone Maprotiline/Ludiomil Mirtazapine/Remeron Duloxetine/Cymbalta |
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Antimania
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Lithium Carbonate/Lithobid, Eskalith, Lithane
Carbamazepine/Tegretol Valporic Acid/Depakene •Clonzaepam/Klonopin Gabapentin/Neurontin |
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Typical Antipsychotics
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Chlorpromazine/Thorazine
Thioridazine/Mellaril Fluphenazine/Prolixin Halperidol/Haldol |
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NDRI
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Bupropion /Wellbutrin
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SNRIs
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VenlafaxineEffexor
Duloxetine/Cymbalta |
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Atypical Antipsychotics
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Clozapine/Clozaril
Risperidone/Risperdal Olanzapine/Zyprexia Quetiapine/Seroquel Ziprasidone/Geodon Aripiprazole/Abilify |
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Antiparkinson Agents
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Trihexphenidyl/Artane
Benztropine/Cogentin Procyclidine/Kemardrin Diphendydramine/Benadryl |
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Alcohol Deterrent
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Disulfiram/Antabuse
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Stimulant
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Methylphenidate/Ritalin
Dextroamphetamine/Dexedrine Pemoline/Cylert Dextroamphetamine Samphetamine/Adderall |
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Narcotic Antagonist
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Naloxone/Narcan
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Alzheimer’s Tx (Cholinesterase inhibitor)
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Tacrine/Cognex
Donepezil/Aricept Memantine/Namenda |
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Non-stimulant ADHD Tx & SNRI
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Atomoxetine/Strattera
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Highest Risk of agranulocytosis
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Clozaril (clozapine)
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Mainly targets the positive symptoms of schizophrenia
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Thorazine Family
(Chlorpromazine) |
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Often given to decrease drug induced Parkinson’s
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Benedryl
(diphenhydramine) |
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Most often given in alcohol withdrawal
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Librium (Chlordiazepoxide)
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Often given to clients who are noncompliant
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Prolixin Deconate (fluphenazine)
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non-addicting anxiolytic
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Buspar (Buspirone HCL)
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Phenothiazines decrease the seizure threshold
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True
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Cogentin is effective in treating tardive dyskinesia
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False
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Benzodiazepines are less addictive than barbiturates
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True
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MAOIs and TCAs can be taken together
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False
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Children on Ritalin (Methylphenidate) may experience decreased appetite and slowed physical growth
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True
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In general, ECT works faster than the antidepressants
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True
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Tyramine-rich foods like cheese, chocolate, and raisins need to be avoided with SSRIs
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False
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Paxil (Paroxetine) is an SSRI
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True
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MAOIs work by inhibitating the reuptake of serotonin
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False
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Seizures can occur if a benzodiazepine is abruptly withdrawn
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True
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Wellbutrin or Zyban (Bupropion) in large quantities can cause seizures.
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True
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Cogentin (benztropine) and Benadryl ( Diphenhydramine) are effective in treating occulogyric crisis
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True
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Atypical (newer) antipsychotics have fewer EPS side effects than the traditional antipsychotics
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True
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While most atypical antipychotics have weight gain as a side effect, Abilify (aripiprazole) is an antipsychotic that does not significantly affect weight
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True
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What are the symptoms of hypertensive crisis
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• Severe increase in blood pressure (systolic >180, diastolic >120)
•Severe headache •Severe anxiety •Shortness of Breath |
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How would you know if a client was developing agranulocytosis? Describe clinical symptoms
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•May be attacked with sudden fever, rigors, sore throat. Septicemia. Also may have gingival bleeding, saliva increase, or halitosis
•Granulocytes drop below 100 cells/mm3 |
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What are EPS (extrapyramidal symptoms)?
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•Various movement disorders such as acute dystonic reactions, pseudoparkinsonism, or akathisia suffered as a result of taking dopamine antagonists, usually antipsychotic drugs, which are often used to control psychosis
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Describe Oculogyric Crisis. What is the treatment?
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•Eyes locked upward
•Diphenhydramine hydrochloride(Benadryl) or benztropine |
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What is tardive dyskinesia? What are the first signs of its development? What causes it and what is the treatment?
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•A movement disorder that affects a person’s ability to perform voluntary muscular movements. Often permanent and untreatable
•Continuous and repetitive movements of the mouth, tongue, and jaw. Facial grimacing. Lip smacking. Puffing of the cheeks. Uncontrollable movements of the arms, legs, fingers, and toes. Swaying motions of the trunk or hips •The most common cause is long term use of metroclopramide, which inhibits delivery of messages to parts of the body. •Prevention is the best treatment, reducing metroclopramide or stopping metroclopramide altogether. Some dopamine agonists help relieve symptoms. |
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What is neuroleptic malignant syndrome (NMS)? Treatment? What causes it?
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•Life threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.
•Characterized by muscular cramps, fever, and instability of the autonomic nervous system(blood pressure/cognition/delirium/coma) •Symptoms include fever, confused/altered consciousness, diaphoresis, muscle rigidity •Individuals using haloperidol, and chlorpromazine are at the greatest risk. Dopaminergic use of Levodopa can also cause this. |
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What are anticholinergic effects? What teaching needs to be done regarding these?
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•Loss of coordination, Decreased mucus production(dry mouth), increased body temperature, double vision(diplopia), increased heart rate, urinary retention, increased intraocular pressure, shaking, constipation
•Fall risk(loss of coordination/diplopia), will make you thirsty(fever, decreased mucus production), urinary retention, and constipation |
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What are Parkinsonian symptoms? What is the treatment for drug induced Parkinsonian symptoms?
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•Muscle rigidity. Tremor. Slowing of physical movement(bradykinesia). Loss of physical movement(akinesia)
•Treated with dopamine agonists, such as Levdopa. Or MAO-B inhibitors |
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What teaching needs to be done regarding orthostatic hypotension?
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•Stand slowly rather then quickly. Take a deep breath and flex your abdominal muscles, while rising. Maintain an elevated salt intake. Maintain proper fluid intake.
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What teaching needs to be done regarding photosensitivity?
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Before you go outdoors apply a sunscreen that has a spf of at least 15. Use sunblock on your lips. Limit your time outdoors.
•If you develop a rash, go inside as quickly as possible |
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What teaching needs to be done regarding CNS depressants? Which of the psychotropic drug categories are CNS depressants?
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•Anti-cholinergic side effects. Fall risk, thirst, urinary retention, constipation.
•Benzodiazepines, antipsychotic |
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Which of the psychotropic drug categories create dependency?
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•SSRIs. Anti-Anxiety/Anxiolytics. Benzodiazepines
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What is serotonin syndrome? What causes it?
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• Too much Serotonin in the brain
• Occurs if SSRI is combined with; MAOIs, Selective MAOI, Tryptophan-serotonin precursor, St John’s Wort • Symptoms include: Confusion, hypomania, restlessness, agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, ataxia, headaches |
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Differentiate between high potency and low potency drugs
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• High potency drugs cause a stronger reaction with a lower dose, whereas low potency drugs require more medication to obtain the same reaction
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What does it mean to taper a drug? Give examples of drugs you need to taper
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• To slowly titrate the dose either up or down over time.
• Drugs that create dependency need to be tapered slowly (SSRIs, Benzodiazepines, Anti-Anxiety) |
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Describe the role of the following neurotransmitters:
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Acetylcholine – Decreased in Alzheimer’s
Norepinephrine – Decreased in Depression. Increased in Mania Dopamine – Increased in schizophrenia Serotonin – Decreased in depression. Increased in mania. Gamma-Aminobuturic Acid (GABA) – Decreased in anxiety disorder |
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Tolerance
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When a subjects reaction to a drug or substance decreases so that more of that substance is required to achieve the desired effect
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Amenorrhea
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Absence of menstruation
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Akinesia
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slowness of normal motor function resulting in impaired muscle movement
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Akathisia
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Feeling of restlessness associated with increased motor activity. May occur as a manifestation of nervous system drug toxicity or other conditions
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Dystonia
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Persistent attitude or posture due to the co-contraction of agonists and antagonist muscles in one region of the body. Most often affects the large axial muscles of the trunk and limb girdles
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Lag time
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The time elapsed between when a drug is administered, and when it begins to take effect
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Blood dyscrasias
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the pathologic conditions or disorders such as leukemia or hemophilia in which the constituents of the blood are abnormal or are present in abnormal quantity
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Neurotransmitter
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signaling molecules secreted by neurons that alter the behavior of neurons or effector cells
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Reuptake
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the reabsorption of a neurotransmitter by a neurotransmitter transporter of a pre-synaptic neuron after it has performed its function of transmitting a neural impulse
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Seizure threshold
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balance between excitatory and inhibitory forces in the brain which affects how susceptible one is to seizures
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Neuron
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basic cellular units of nervous tissue. Each neuron consists of a body, and axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the Nervous System
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Synapse
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a junction that permits a neuron to pass an electrical or chemical signal to another cell
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Receptor site
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a location on a cell surface where certain molecules, such as enzymes, neurotransmitters, or viruses, attach to interact with cellular components
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High and Low potency drugs
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Potency is measured by the amount of drug it takes to receive a reaction. High potency means that a small amount of drug is needed to achieve the same reaction that a low potency drug would obtain
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Antipsychotics are given for which conditions?
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•Used to treat positive and negative symptoms of schizophrenia
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What are other names for antipsychotics?
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•Neuroleptics. Dopamine agonists. Dopamine-seratonin agonists
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Differentiate positive and negative symptoms of schizophrenia
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•Positive symptoms (hallucinations, delusions) – Think ‘added to’
•Negative symptoms(flattened effect, avolition) – Think ‘taken from’ |
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Are typical antipsychotics more helpful with the positive or negative characteristics of schizophrenia? Atypicals are most helpful with?
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•Typical antipsychotics are used to treat positive characteristics of schizophrenia
•Atypicals are used to treat positive and negative symptoms of schizophrenia |
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What are the side effects of the typical antipsychotics? Nursing interventions? Discuss symptoms generally associated with high and low potency antipsychotics
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•EPS, NMS, sedation, orthostatic hypotension, anticholinergic arrhythmias, agranulocytosis
•Typical nursing interventions are: Rapid neurolepization, decanoate preparations, use sunscreen, take as prescribed, report sore throat/fever/malaise, weigh regularly |
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What are the side effects of the atypical antipsychotics?
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•Sedation, weight gain, sexual dysfunction, metabolic syndrome, orthostatic hypotension, anticholinergic side effects, arrhythmias, agranulocytosis
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What antipsychotics are often given to non-compliant clients? Why?
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•Fluphenazine/Prolixin
•Given because it’s more potent, and has a much longer half-life then other antipsychotics |
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Describe the action of antipsychotics as they relate to neurotransmitters
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•Decreases levels and blocks the action of dopamine, atypical also block serotonin receptors
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Why are clients often non-compliant with antipsychotics?
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•The side effects, particularly weight gain, and sexual dysfunction are high contributors to non-compliance with antipsychotics
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What is a common dangerous side effect of Clozoril?
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•Agranulocytosis is a dangerous side effect, and scheduled WBC counts are required
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When are antipsychotics contraindicated?
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• Drug induced blood dyscrasia
•Severe debilitation •Uncontrolled seizure disorder |
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Which newer antipsychotic does not produce weight gain?
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•Ziprasidone/Geodon, and Aripiprazole/Abilify
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ANTIPARKINSONIAN AGENTS:Why are these drugs often given to mental health consumers?
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• Because symptoms related to parkinsonism are often caused by a decreased availability of dopamine in the brain, resulting from antipsychotics
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If you have a prn order for benzotropine (Cogentin), how do you know when to give it? (Describe client symptoms)
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•Extrapyramidal symptoms, or tardive dykinesia
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Benadryl (diphenhydramine) an antihistamine and Cogentin (benztropine), an anticholinergic, are commonly used for drug induced parkinsonism. What are the side effects of Cogentin? Benadryl? Nursing implications?
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•Cogentin side effects include – nausea, vomiting, dry mouth, confusion, disorientation, memory impairment, blurred vision, urinary retention, dysuria, heat stroke, hyperthermia
•Benadryl side effects include – drowsiness, motor impairment(ataxia), dry mouth and throat, flushed skin, pupil dilation(mydriasis), urinary retention, constipation, benadryl |
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ANTIMANIA:What drug has traditionally been prescribed to prevent and treat manic episodes of bipolar disorder? What percent of the bipolar population does it seem to help?
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•Lithium Carbonate
•60-70% receive a full initial response, 20% receive partial response, 10% have no response |
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Why would an antipsychotic be given during lithium lag periods?
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•Because it has an immediate reaction to help calm the patient
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What is the relationship between lithium and salt (sodium)? Fluids?
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•Decreased fluid volume increases lithium levels
•Increased dietary sodium decreases lithium levels |
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What is the lag period for lithium?
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•7-14 days
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What are the side effects of lithium? Which are expected? Which will gradually disappear? Which indicate toxicity? What are the appropriate nursing interventions?
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•Tremor, Nausea, Vomiting, Diarrhea, Anorexia, Abdominal Pain, Nephrogenic Diabetes(polydipsia and polyuria), hypothyroidism, blurred vision, dry mouth, sexual dysfunction
•Long term side effects are hypothyroidism, and kidneys inability to concentrate urine •Nervous system side effects gradually resolve during pregnancy |
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What are therapeutic ranges of serum lithium for (these will vary somewhat from text to text):
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a.Acute mania : .8 – 1.4 mEq/L
b.Maintenance : .5 – 1.3 mEq/L |
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How often should lithium levels be monitored? When should blood samples be drawn?
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•Weekly until therapeutic level has been reached, then montly
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Why is lithium a dangerous drug?
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•Because it has a narrow therapeutic window
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What nursing action is appropriate if lab work indicates a lithium level of 1.7 mEq/L?
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•Suspect early signs of lithium toxicity. Hydrate, increase dietary sodium, titrate lithium dose down
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When is lithium therapy contraindicated?
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•Contraindicated in people with cardiovascular disease, brain damage, renal disease, thyroid disease, or myasthenia gravis. May also harm fetus of pregnant women.
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ANTIDEPRESSANTS: What does SSRI stand for? Name some of these drugs. How do they work?
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•Selective Serotonin Reuptake Inhibitor
•Prozac, Paxil, Zoloft, Celexa •By inhibiting the reuptake of Serotonin in the brain, thereby increasing the amount of serotonin in the brain |
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How do tricyclics affect neurotransmitters? Name some of these drugs
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•Blocks the reuptake of serotonin and norepinephrine
•Elavil, Anafraril, Norpramin, Trofranil |
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What does MAOI stand for? Name some of these drugs
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•Monoamine Oxidase Inhibitors
•Marplan, Nardil, Parnate |
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How long does it take for antidepressants to work?
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•1-3 weeks for effects to begin, and 1-3 months for full benefit
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How do the SSRIs differ from the tricyclics?
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•SSRIs, are selective to serotonin, while the tricyclics also block the reuptake of norepinephrine
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What teaching needs to be done with the MAOIs? (Discuss food and drug interactions)
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•Heavy teaching regarding foods to avoid
oWine, Pickles, smoked meats, cheeses •Drug/Drug interactions include oBarbiturates, Tricyclic Antidepressants, Antihistamines, CNS Depressants, Antihypertensives, OTC Cold meds |
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What is a Parnate Cheese Reaction? What is tyramine?
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•Parnate/Cheese reaction can result in sudden high blood pressure, which may be experienced as severe headache, nausea, vomiting. This is especially true in fermented/aged cheese
•Tyramine is a naturally occurring monoamine compound and trace amine derived from the amino acid tyrosine |
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Can the MAOIs be given with other antidepressants?
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•Yes, but “No Popular Meds”. No tricyclics, nothing that depresses the CNS
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Describe the side effects of the antidepressant categories (SSRI, MAOI, Tricyclic).
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•SSRIs: nausea, insomnia, weight gain, sexual dysfunction, serotonin syndrome
•Tricyclics: sedation, orthostatic hypotension, anticholinergic, cardiac toxicity, seizures •MAOIs: hypertensive crisis, CNS stimulation, orthostatic hypotension |
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Why might a depressed suicidal client only be given a weeks supply of their tricyclic medication?
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•Because they can easily overdose on it, if they decide to commit suicide
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What does SNRI stand for? Name a drug in this category.
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•Seratonin Norepinephrine Reuptake Inhibitor
•Venlafaxine/Effexor |
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ANTIANXIETY AGENTS:What are other names for the antianxiety classification of drugs?
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•Anxiolytics
•Non-Benzo |
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These drugs are indicated for which conditions?
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•Used to decrease anxiety. Sedate Patients. Control Seizures. Help with drug withdrawl.
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In general, why are benzodiazepines not a good choice for long-term symptom management?
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•Create a physical dependence
•Develop tolerance •Withdrawl syndrome |
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What are side effects and nursing implications for this drug classification?
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•Drowsiness, fatigue, slow reflexes, confusion. Physical dependence
•Not for minor stresses(use short term). Avoid OTC. Do not exceed prescribed dose. Avoid alcohol and other CNS depressants |
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How does BuSpar (buspirone) differ from other antianxiety drugs?
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•Nonsedating. No highs. No dependence, withdrawal, tolerance. Few drug/drug interactions.
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Antihistamines, benzodiazepines, and propanediols are chemical groups in this category. Benzodiazepines are commonly prescribed for anxiety. Name some benzodiazepines.
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•Alpraxolam/Xanax, Diazepam/Valium, Lorazepam/Ativan
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What are contraindications for the benzodiazepines?
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•People with myasthenia gravis, sleep apnea, bronchitis, and COPD
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Are benzodiazepines safer to use than the barbiturates? Explain your answer. Which are more addictive? Which are more lethal in overdose?
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•Barbituates act as CNS depressants, and produce a wide spectrum of effects. Barbituates are both more addicitive, and more dangerous
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Why should benzodiazepines not be discontinued abruptly?
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•Because benzodiazepine withdrawal syndrome could result, as benzodiazepine’s are physically addictive
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When is Librium given during alcohol withdrawal? (Describe symptoms.) Should an addicted client be discharged on an addictive drug?
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•When physical signs of alcohol withdrawal start to manifest themselves. Seizures, Delirium Treemens, severe Nausea and Vomiting, and tachycardia.
•If possible clients should not be discharged on an active drug |
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SSRIs are given with which anxiety based conditions?
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•Social Anxiety Disorder, and post traumatic stress disorder
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Discuss nonpharmacologic ways to reduce anxiety
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• Therapeutic communication
•Health teaching and promotion •Psychotherapy |
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Why is Antabuse considered aversion therapy? What are the dangers? How long does it stay in the body?
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•Because it’s used in combination with alcohol, but produces ill effects(nausea, vomiting, headache, to go with it)
•Half life is 60-120 hours |
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What drugs are commonly given during an ECT treatment? Why are they given? Nursing considerations?
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•Patient is given short acting anesthetic such as methodhexital, etomidate, or thiopental, a muscle relaxant such as suxamethonium, and occasionally atropine to inhibit salivation.
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What drug is given for narcotic overdose?
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•Nalaxone
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4. Ritalin is often given to children with attention deficit hyperactivity disorder. Why would a stimulant be given to a hyperactive child? When would a stimulant be contraindicated? What other drugs might be given to a hyperactive child?
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•Because a sluggish frontal lobe is thought to be the cause of the disorder
•A stimulant would be contraindicated when used concomitantly with tricyclic antidepressants, desipramine, MAOIs. Patients exhibiting drug seeking behavior •Adderall |
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5. What drugs are commonly given to clients with Alzheimer’s? Are they curative? What is their therapeutic effect? What are the side effects? Discuss the role of these drugs and acetylcholine
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•Cholinesterase Inhibitors
•Not curative, but help preserve some function. •Inhibit cholinesterase, and therefore restore acetylcholine |
