Psychotropic Medication Review

Front 1

Typical antipsychotics work by blocking ___.

Back 1

dopamine

Front 2

Typical antipsychotics target ___ symptoms.

Back 2

positive

Front 3

Atypical antipsychotics block ___ and ___.

Back 3

dopamine; 5-HT2

Front 4

Atypical antipsychotics target what symptoms?

a.) positive
b.) negative
c.) positive and negative

Back 4

c.)positive and negative

Front 5

Typical or atypical antipsychotics have a lower incidence of EPS?

Back 5

Atypical

Front 6

3 classes of typical antipsychotics?

Back 6

-Phenothiazines
-Thioxanthenes
-Butoyrophenones

Front 7

6 atypical antipsychotics?

Back 7

-Clozapine (Clozaril)
-Risperidone (Risperdal)
-Quetiapine (Seroquel)
-Olanzapine (Zyprexa)
-Aripiprazole (Abilitat)
-Ziprasidone (Geodon)

Front 8

Brand name of drug in the class Butoyrophenones?

Back 8

Haldol

Front 9

Brand name drug under the class Thioxanthenes?

Back 9

Navane

Front 10

5 brand name drugs in the class phenothiazines?

Back 10

-Thorazine
-Trilafon
-Prolixin
-Mellaril
-Stelazine

Front 11

2 long acting typical antipsychotics given IM?

Back 11

-Haldol Decanoate (IM)
-Prolixin Decanoate (IM)

Front 12

1 long acting atypical antipsychotic given IM?

Back 12

-Risperdal Consta (IM)

Front 13

In typical antipsychotics S/E, such as ___ and ___ occur due to norepinephrine blockade on smooth muscle cells.

Back 13

-orthostatic hypotension
-ejaculatory difficulties

Front 14

In typical antipsychotics S/E, such as ___ and ___ occur due to histamine blockade.

Back 14

-sedation
-substantial weight gain

Front 15

Dopamine blockade in the basal ganglia result in ___.

Back 15

EPS

Front 16

In typical antipsychotics EPS include (5)?

Back 16

-Parkinsonism
-Akinesia
-Akathisia
-Dystonia
-Tardive dyskinesia

Front 17

5 signs of Parkinsonism?

Back 17

-shuffling gait
-cogwheeling (mvmt that has a rachety appearance)
-drooling
-pill-rolling

Front 18

Muscular weakness or paucity of spontaneous gestures is called?

Back 18

akinesia

Front 19

The inability to stand still or restlessness is called?

Back 19

akathisia

Front 20

___ is characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions.

Back 20

dystonia

Front 21

___ and ___ are 2 examples of dystonias.

Back 21

-oculogyric crisis,
-neck torticollis

Front 22

Excessive blinking and fine movements of the tongue are symptoms of ___.

Back 22

tardive dyskinesia

Front 23

Involuntary trunk and limb movements are symptoms of ___.

Back 23

tardive dyskinesia

Front 24

Are excessive blinking and fine movements of the tongue early signs or late symptoms?

Back 24

early

Front 25

Are involuntary trunk and limb movements an early or late symptom?

Back 25

late

Front 26

5 medications for EPS S/E?

Back 26

-Symmetrel
-Cogentin
-Akineton
-Benadryl
-Artane

Front 27

Neuroleptic Malignant Syndrome is characterized by (4):

Back 27

-hyperpyrexia
-altered LOC
-autonomic dysfunction
-lab abnormalities

Front 28

Autonomic dysfunction in neuroleptic malignant syndrome causes:

Back 28

-increase in HR
-increase in BP
-increase in R
-profuse sweating
-pallor
-dysphagia

Front 29

Lab abnormalities in neuroleptic malignant sydrome would show:

Back 29

-increase CPK
-increase WBCs
-increase in LFTs
-renal decline or failure

Front 30

Atypical antipsychotics work by:

Back 30

binding to dopamine receptors and decrease S/E

Front 31

Atypical antipsychotics targets negative symptoms by:

Back 31

antagonizing 5-HT2 (serotonin)

Front 32

6 S/E of Clozapine (Clozaril):

Back 32

-agranulocytosis
-seizures
-drowsiness/sedation
-hypersalivation
-tachycardia
-dizziness

Front 33

3 S/E of Risperidone (Risperdal):

Back 33

-motor difficulties at higher doses
-orthostatic hypotension
-sedation

Front 34

2 S/E of Quetiapine (Seroquel)?

Back 34

-sedation
-weight gain

Front 35

A S/E of Olanzapine (Zyprexa)?

Back 35

weight gain

Front 36

Drugs that influence the rate of hepatic detoxification of antipsychotics?

Back 36

-Cimetidine (Tagamet)
-Anticonvulsants
-Tricyclic antidepressants
-Some cardiac drugs
-Epinephrine and Thorazine

Front 37

___ and ___, drugs that influence the rate of hepatic detoxification, can cause severe hypotension.

Back 37

epinephrine; Thorazine

Front 38

2 nursing responsibilities of antipsychotics:

Back 38

1. Managing S/E and thus enhance compliance
2. Preventing tardive dyskinesia

Front 39

4 types of antidepressants?

Back 39

-Tricyclics
-Selective Serotonin Reuptake Inhibitors
-Monoamine Oxidase Inhibitors
-Atypicals

Front 40

___ block the reuptake of NE and 5-HT.

Back 40

tricyclics

Front 41

___ block reabsorption of 5-HT in synapse.

Back 41

Selective serotonin reuptake Inhibitors

Front 42

___ block enzyme (monoamine oxidase) needed to metabolize NE, 5-HT & D

Back 42

monoamine oxidase inhibitors

Front 43

3 tricyclic antidepressants?

Back 43

-Amitriptyline (Elavil)
-Imipramine (Tofranil)
-Nortriptyline (Pamelor)

Front 44

5 SSRIs?

Back 44

-Fluoxetine (Prozac)
-Sertraline (Zoloft)
-Paroxetine (Paxil)
-Citalopram (Celexa)
-Fluvoxamine (Luvox)

Front 45

4 MAOIs?

Back 45

-Isocarboxazid (Marlpan)
-Phenelzine (Nardil)
-Selegiline (Eldepryl)
-Tranylcypromine (Parnate)

Front 46

5 atypical antidepressants?

Back 46

-Trazodone (Desyrel)
-Nefazodone (Serzone)
-Venlafaxine (Effexor)
-Mirtazpine (Remeron)
-Bupropion (Wellbutrin)

Front 47

3 S/E of TCAs?

Back 47

-anticholinergic S/E
-histamine blockade
-cardiovascular - dysrhythmias, MI, heart block

Front 48

S/E of SSRIs?

Back 48

-fatigue
-nausea
-diarrhea
-dry mouth
-dizziness
-tremor
-sexual dysfunction or lack of sex drive
-serotonin syndrome

Front 49

Symptoms of serotonin syndrome? (8)

Back 49

-abdominal pain
-sweating
-increased T
-increased P
-increased BP
-altered LOC
-cardiovascular shock
-death

Front 50

7 foods that contain tyramine?

Back 50

-aged cheeses
-pickled or smoked fish
-wine
-yeast breads
-lunch meats
-draft beer
-soy sauce

Front 51

Chemical monoamine drugs:

Back 51

-Any product that contains ephedrine, phenylephrine hydrochloride or phenylpropanolamine = OTC cold, allergy, & congestion meds
-tricyclic antidepressants
-narcotics
-some antihypertensive meds
-sedatives
-general anesthetics
-stimulants

Front 52

Alcohol and antidepressants:

Back 52

-Alcohol adds to the CNS depression of antidepressant meds
-Impairment occurs after fewer drinks than in person not taking these meds

Front 53

Evaluation of antidepressants:

Back 53

-Target the symptoms
-Antidepressant effect:
-Tricyclics - at least 4
to 6 weeks
-SSRIs - 2 to 4 weeks
-Drug levels - available for some tricyclic meds

Front 54

Serotonin syndrome is a hyperserotonic state characterized by:

Back 54

-mental changes
-altered muscle tone
-hypertension or hypotension
-CNS changes
-hyperthermia

Front 55

3 types of mood stabilizers?

Back 55

-lithium
-anticonvulsant drugs
-antipsychotics

Front 56

5 anticonvulsant drugs?

Back 56

-Valproic acid (Depakote)
-Carbamazepine (Tegretol)
-Clonazepam (Klonopin)
-Lamotrigine (Lamicita)
-Topiramate (Topamax)

Front 57

Antipsychotic med?

Back 57

Olanzapine (Zyprexa)

Front 58

Lithium dosage:

___ - ___meq/L in maintenance

___ - ___meq/L toxic

Back 58

-.5, 1.2
-1.2, 1.5

Front 59

Lithium Dosage:

Back 59

-Narrow therapeutic window - narrow range for symptom relief without toxicity
-Thus may monitor blood levels
-Higher doses during acute mania, lower maintenance dose

Front 60

10 Common lithium S/E:

Back 60

-thirst
-polyuria
-edema
-fine intentional tremor
-weight gain
-muscle weakness and fatigue
-metallic taste
-nausea
-abdominal discomfort
-mild diarrhea

Front 61

Toxic S/E of lithium:

Back 61

-confusion
-slurred speech
-ataxia
-blurred vision
-myoclonic twitching
-incontinence
-mod diarrhea
-tinnitus
-arrhythmias
-hypotension
-seizures
-spasticity
-stupor
-twitching of muscle groups
-coarse tremor
-nystagmus
-coma

Front 62

Teaching for lithium:

Back 62

-Adequate fluid intake (3L/d)
-Awareness of heavy sweating and need to replace F/E
-Take with food or milk
-Don't change salt intake
-Sx of toxcity

Front 63

Lithium drug interactions:

Back 63

Any drug that affects sodium levels may interact with lithium:

-Diuretics
-Low-salt diet
-NSAIDs
-Haldol
-Aminophylline

Front 64

S/E of valproic acid:

Back 64

-Well tolerated
-Black box warning for life-threatening pancreatitis
-Rare, fatal liver damage thus requires lab monitoring
-Weight gain

Front 65

S/E of Carbamazepine:

Back 65

-Well tolerated
-Dizziness and drowsiness
initially
-Weight gain
-Toxic effect - agranulocytosis requiring lab monitoring

Front 66

S/E of lamotrigine (Lamictal):

Back 66

-well tolerated - no wt. gain
-occasionally Steven Johnson Syndrome & DIC

Front 67

S/E of oxcarbazepine (Trileptal):

Back 67

-Low long term risks but expensive

Front 68

S/E of valproic acid (Depakote):

Back 68

-Metabolized by liver
-Prolong anticoagulant effect of Coumadin
-Increase effects of MAOIs

Front 69

S/E of carbamazepine (Tegretol):

Back 69

-Drugs that affect liver cytochrome sytem
-Erythromycin and Cimetidine may increase Carbamazepine levels

Front 70

Evaluation of mood stabilizers:

Back 70

- 1 to 2 weeks for effect in mania
- 4 to 6 weeks for effect in depression

Front 71

3 types of anxiolytics?

Back 71

-benzodiazepines
-nonbenzodiazepines
-antihistamines

Front 72

4 benzodiazepines?

Back 72

-diazepam (Valium)
-Clonazepam (Klonopin)
-Aprazolam (Xanax)
-Lorazepam (Ativan)

Front 73

A nonbenzodiazepine?

Back 73

Buspirone (BuSpar)

Front 74

2 antihistamines?

Back 74

-Hydroxyzine hydrochloride (Atarax)
-Hydroxyzine pamoate (Vistaril)

Front 75

Benzodiazepines:

Back 75

-Primary neurotransmitter gamma-aminobutyric acid (GABA)
-Benzo binds to specific receptors adjacent to the GABA receptors. Binding of benzo at the same time as GABA is present allows GABA to inhibit more forcefully than it would if binding alone.

Front 76

BuSpar:

Back 76

-Does not produce immediate calming effect (not a prn)
-Initial effect in 2-3 weeks; full effects 4-6 weeks
or more
-Does not cause dependence
-Used in GAD
-Well tolerated - occasional dizziness, H/A, and nausea that improves with continued use

Front 77

Antihistamines:

Back 77

-No dependence, tolerance, or intoxication
-Anticholinergic S/E
-Sedation as a S/E

Front 78

Benzodiazepine drug interactions?

Back 78

-Other CNS depressants (i.e. ETOH, opiates, TCAs)
-Antacids
-Cimetidine
-Phenytoin (Dilantin)

Front 79

Stimulants are used to treat (6):

Back 79

-ADHD
-Adult ADHD
-Treatment resistant depression
-Narcolepsy
-Chronic medically-debilitating conditions
-Treatment-resistant obesity

Front 80

4 types of stimulants:

Back 80

-Dextroamphetamine
-Methylphenidate
-Pemoline
-Phendimetrazine

Front 81

2 dextroamphetamines?

Back 81

-Dexadrine
-Adderall

Front 82

3 methylphenidates?

Back 82

-Ritalin
-Concerta
-Metadate CD

Front 83

A pemoline med?

Back 83

Cylert

Front 84

2 phendimetrazine meds?

Back 84

Plegine or Prelu-2

Front 85

Stimulants:

Back 85

-Act by directly releasing catecholamines into synaptic clefts and thus onto postsynaptic receptor sites
-Block the reuptake of catecholamines and thereby prolonging their actions

Front 86

4 Anticholinesterase drugs:

Back 86

-Tacrine (Cognex)
-Donepezil (Aricept)
-Rivastigmine (Exelon)
-Galantamine (Reminyl)

Front 87

Anticholinesterase drugs:

Back 87

-Indirectly increases the concentration of acetylcholine at the synapse by inactivating the enzyme acetylcholinesterase which breaks down the neurotransmitter acetylcholine.

Front 88

Drugs used in substance abuse:

Back 88

-Methadone
-Disulfiram (Antabuse)
-Nicotine replacement
-Opioid receptor antagonists

Front 89

Name of an opioid receptor antagonist?

Back 89

suboxone (buprenorphine)

Front 90

___ and ___ are used for the management of ETOH withdrawal.

Back 90

-benzodiazapines
-anticonvulsants

Front 91

___ is used for opioid and nicotine withdrawal.

Back 91

Clonidine (Catapres)

Front 92

___ and ___ are used for hallucinogenic drug intoxication.

Back 92

-antipsychotics
-benzodiazapines

Front 93

Medication compliance:

Back 93

-S/E
-Knowledge deficits
-Patient/Therapist relationships - Identify reasons for treatment resistance