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93 Cards in this Set
- Front
- Back
Typical antipsychotics work by blocking ___.
|
dopamine
|
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Typical antipsychotics target ___ symptoms.
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positive
|
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Atypical antipsychotics block ___ and ___.
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dopamine; 5-HT2
|
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Atypical antipsychotics target what symptoms?
a.) positive b.) negative c.) positive and negative |
c.)positive and negative
|
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Typical or atypical antipsychotics have a lower incidence of EPS?
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Atypical
|
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3 classes of typical antipsychotics?
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-Phenothiazines
-Thioxanthenes -Butoyrophenones |
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6 atypical antipsychotics?
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-Clozapine (Clozaril)
-Risperidone (Risperdal) -Quetiapine (Seroquel) -Olanzapine (Zyprexa) -Aripiprazole (Abilitat) -Ziprasidone (Geodon) |
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Brand name of drug in the class Butoyrophenones?
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Haldol
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Brand name drug under the class Thioxanthenes?
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Navane
|
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5 brand name drugs in the class phenothiazines?
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-Thorazine
-Trilafon -Prolixin -Mellaril -Stelazine |
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2 long acting typical antipsychotics given IM?
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-Haldol Decanoate (IM)
-Prolixin Decanoate (IM) |
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1 long acting atypical antipsychotic given IM?
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-Risperdal Consta (IM)
|
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In typical antipsychotics S/E, such as ___ and ___ occur due to norepinephrine blockade on smooth muscle cells.
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-orthostatic hypotension
-ejaculatory difficulties |
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In typical antipsychotics S/E, such as ___ and ___ occur due to histamine blockade.
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-sedation
-substantial weight gain |
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Dopamine blockade in the basal ganglia result in ___.
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EPS
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In typical antipsychotics EPS include (5)?
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-Parkinsonism
-Akinesia -Akathisia -Dystonia -Tardive dyskinesia |
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5 signs of Parkinsonism?
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-shuffling gait
-cogwheeling (mvmt that has a rachety appearance) -drooling -pill-rolling |
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Muscular weakness or paucity of spontaneous gestures is called?
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akinesia
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The inability to stand still or restlessness is called?
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akathisia
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___ is characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions.
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dystonia
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___ and ___ are 2 examples of dystonias.
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-oculogyric crisis,
-neck torticollis |
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Excessive blinking and fine movements of the tongue are symptoms of ___.
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tardive dyskinesia
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Involuntary trunk and limb movements are symptoms of ___.
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tardive dyskinesia
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Are excessive blinking and fine movements of the tongue early signs or late symptoms?
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early
|
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Are involuntary trunk and limb movements an early or late symptom?
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late
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5 medications for EPS S/E?
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-Symmetrel
-Cogentin -Akineton -Benadryl -Artane |
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Neuroleptic Malignant Syndrome is characterized by (4):
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-hyperpyrexia
-altered LOC -autonomic dysfunction -lab abnormalities |
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Autonomic dysfunction in neuroleptic malignant syndrome causes:
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-increase in HR
-increase in BP -increase in R -profuse sweating -pallor -dysphagia |
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Lab abnormalities in neuroleptic malignant sydrome would show:
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-increase CPK
-increase WBCs -increase in LFTs -renal decline or failure |
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Atypical antipsychotics work by:
|
binding to dopamine receptors and decrease S/E
|
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Atypical antipsychotics targets negative symptoms by:
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antagonizing 5-HT2 (serotonin)
|
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6 S/E of Clozapine (Clozaril):
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-agranulocytosis
-seizures -drowsiness/sedation -hypersalivation -tachycardia -dizziness |
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3 S/E of Risperidone (Risperdal):
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-motor difficulties at higher doses
-orthostatic hypotension -sedation |
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2 S/E of Quetiapine (Seroquel)?
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-sedation
-weight gain |
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A S/E of Olanzapine (Zyprexa)?
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weight gain
|
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Drugs that influence the rate of hepatic detoxification of antipsychotics?
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-Cimetidine (Tagamet)
-Anticonvulsants -Tricyclic antidepressants -Some cardiac drugs -Epinephrine and Thorazine |
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___ and ___, drugs that influence the rate of hepatic detoxification, can cause severe hypotension.
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epinephrine; Thorazine
|
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2 nursing responsibilities of antipsychotics:
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1. Managing S/E and thus enhance compliance
2. Preventing tardive dyskinesia |
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4 types of antidepressants?
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-Tricyclics
-Selective Serotonin Reuptake Inhibitors -Monoamine Oxidase Inhibitors -Atypicals |
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___ block the reuptake of NE and 5-HT.
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tricyclics
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___ block reabsorption of 5-HT in synapse.
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Selective serotonin reuptake Inhibitors
|
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___ block enzyme (monoamine oxidase) needed to metabolize NE, 5-HT & D
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monoamine oxidase inhibitors
|
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3 tricyclic antidepressants?
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-Amitriptyline (Elavil)
-Imipramine (Tofranil) -Nortriptyline (Pamelor) |
|
5 SSRIs?
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-Fluoxetine (Prozac)
-Sertraline (Zoloft) -Paroxetine (Paxil) -Citalopram (Celexa) -Fluvoxamine (Luvox) |
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4 MAOIs?
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-Isocarboxazid (Marlpan)
-Phenelzine (Nardil) -Selegiline (Eldepryl) -Tranylcypromine (Parnate) |
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5 atypical antidepressants?
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-Trazodone (Desyrel)
-Nefazodone (Serzone) -Venlafaxine (Effexor) -Mirtazpine (Remeron) -Bupropion (Wellbutrin) |
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3 S/E of TCAs?
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-anticholinergic S/E
-histamine blockade -cardiovascular - dysrhythmias, MI, heart block |
|
S/E of SSRIs?
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-fatigue
-nausea -diarrhea -dry mouth -dizziness -tremor -sexual dysfunction or lack of sex drive -serotonin syndrome |
|
Symptoms of serotonin syndrome? (8)
|
-abdominal pain
-sweating -increased T -increased P -increased BP -altered LOC -cardiovascular shock -death |
|
7 foods that contain tyramine?
|
-aged cheeses
-pickled or smoked fish -wine -yeast breads -lunch meats -draft beer -soy sauce |
|
Chemical monoamine drugs:
|
-Any product that contains ephedrine, phenylephrine hydrochloride or phenylpropanolamine = OTC cold, allergy, & congestion meds
-tricyclic antidepressants -narcotics -some antihypertensive meds -sedatives -general anesthetics -stimulants |
|
Alcohol and antidepressants:
|
-Alcohol adds to the CNS depression of antidepressant meds
-Impairment occurs after fewer drinks than in person not taking these meds |
|
Evaluation of antidepressants:
|
-Target the symptoms
-Antidepressant effect: -Tricyclics - at least 4 to 6 weeks -SSRIs - 2 to 4 weeks -Drug levels - available for some tricyclic meds |
|
Serotonin syndrome is a hyperserotonic state characterized by:
|
-mental changes
-altered muscle tone -hypertension or hypotension -CNS changes -hyperthermia |
|
3 types of mood stabilizers?
|
-lithium
-anticonvulsant drugs -antipsychotics |
|
5 anticonvulsant drugs?
|
-Valproic acid (Depakote)
-Carbamazepine (Tegretol) -Clonazepam (Klonopin) -Lamotrigine (Lamicita) -Topiramate (Topamax) |
|
Antipsychotic med?
|
Olanzapine (Zyprexa)
|
|
Lithium dosage:
___ - ___meq/L in maintenance ___ - ___meq/L toxic |
-.5, 1.2
-1.2, 1.5 |
|
Lithium Dosage:
|
-Narrow therapeutic window - narrow range for symptom relief without toxicity
-Thus may monitor blood levels -Higher doses during acute mania, lower maintenance dose |
|
10 Common lithium S/E:
|
-thirst
-polyuria -edema -fine intentional tremor -weight gain -muscle weakness and fatigue -metallic taste -nausea -abdominal discomfort -mild diarrhea |
|
Toxic S/E of lithium:
|
-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 |
|
Teaching for lithium:
|
-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 |
|
Lithium drug interactions:
|
Any drug that affects sodium levels may interact with lithium:
-Diuretics -Low-salt diet -NSAIDs -Haldol -Aminophylline |
|
S/E of valproic acid:
|
-Well tolerated
-Black box warning for life-threatening pancreatitis -Rare, fatal liver damage thus requires lab monitoring -Weight gain |
|
S/E of Carbamazepine:
|
-Well tolerated
-Dizziness and drowsiness initially -Weight gain -Toxic effect - agranulocytosis requiring lab monitoring |
|
S/E of lamotrigine (Lamictal):
|
-well tolerated - no wt. gain
-occasionally Steven Johnson Syndrome & DIC |
|
S/E of oxcarbazepine (Trileptal):
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-Low long term risks but expensive
|
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S/E of valproic acid (Depakote):
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-Metabolized by liver
-Prolong anticoagulant effect of Coumadin -Increase effects of MAOIs |
|
S/E of carbamazepine (Tegretol):
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-Drugs that affect liver cytochrome sytem
-Erythromycin and Cimetidine may increase Carbamazepine levels |
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Evaluation of mood stabilizers:
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- 1 to 2 weeks for effect in mania
- 4 to 6 weeks for effect in depression |
|
3 types of anxiolytics?
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-benzodiazepines
-nonbenzodiazepines -antihistamines |
|
4 benzodiazepines?
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-diazepam (Valium)
-Clonazepam (Klonopin) -Aprazolam (Xanax) -Lorazepam (Ativan) |
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A nonbenzodiazepine?
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Buspirone (BuSpar)
|
|
2 antihistamines?
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-Hydroxyzine hydrochloride (Atarax)
-Hydroxyzine pamoate (Vistaril) |
|
Benzodiazepines:
|
-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. |
|
BuSpar:
|
-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 |
|
Antihistamines:
|
-No dependence, tolerance, or intoxication
-Anticholinergic S/E -Sedation as a S/E |
|
Benzodiazepine drug interactions?
|
-Other CNS depressants (i.e. ETOH, opiates, TCAs)
-Antacids -Cimetidine -Phenytoin (Dilantin) |
|
Stimulants are used to treat (6):
|
-ADHD
-Adult ADHD -Treatment resistant depression -Narcolepsy -Chronic medically-debilitating conditions -Treatment-resistant obesity |
|
4 types of stimulants:
|
-Dextroamphetamine
-Methylphenidate -Pemoline -Phendimetrazine |
|
2 dextroamphetamines?
|
-Dexadrine
-Adderall |
|
3 methylphenidates?
|
-Ritalin
-Concerta -Metadate CD |
|
A pemoline med?
|
Cylert
|
|
2 phendimetrazine meds?
|
Plegine or Prelu-2
|
|
Stimulants:
|
-Act by directly releasing catecholamines into synaptic clefts and thus onto postsynaptic receptor sites
-Block the reuptake of catecholamines and thereby prolonging their actions |
|
4 Anticholinesterase drugs:
|
-Tacrine (Cognex)
-Donepezil (Aricept) -Rivastigmine (Exelon) -Galantamine (Reminyl) |
|
Anticholinesterase drugs:
|
-Indirectly increases the concentration of acetylcholine at the synapse by inactivating the enzyme acetylcholinesterase which breaks down the neurotransmitter acetylcholine.
|
|
Drugs used in substance abuse:
|
-Methadone
-Disulfiram (Antabuse) -Nicotine replacement -Opioid receptor antagonists |
|
Name of an opioid receptor antagonist?
|
suboxone (buprenorphine)
|
|
___ and ___ are used for the management of ETOH withdrawal.
|
-benzodiazapines
-anticonvulsants |
|
___ is used for opioid and nicotine withdrawal.
|
Clonidine (Catapres)
|
|
___ and ___ are used for hallucinogenic drug intoxication.
|
-antipsychotics
-benzodiazapines |
|
Medication compliance:
|
-S/E
-Knowledge deficits -Patient/Therapist relationships - Identify reasons for treatment resistance |