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93 Cards in this Set

  • Front
  • Back
Typical antipsychotics work by blocking ___.
dopamine
Typical antipsychotics target ___ symptoms.
positive
Atypical antipsychotics block ___ and ___.
dopamine; 5-HT2
Atypical antipsychotics target what symptoms?

a.) positive
b.) negative
c.) positive and negative
c.)positive and negative
Typical or atypical antipsychotics have a lower incidence of EPS?
Atypical
3 classes of typical antipsychotics?
-Phenothiazines
-Thioxanthenes
-Butoyrophenones
6 atypical antipsychotics?
-Clozapine (Clozaril)
-Risperidone (Risperdal)
-Quetiapine (Seroquel)
-Olanzapine (Zyprexa)
-Aripiprazole (Abilitat)
-Ziprasidone (Geodon)
Brand name of drug in the class Butoyrophenones?
Haldol
Brand name drug under the class Thioxanthenes?
Navane
5 brand name drugs in the class phenothiazines?
-Thorazine
-Trilafon
-Prolixin
-Mellaril
-Stelazine
2 long acting typical antipsychotics given IM?
-Haldol Decanoate (IM)
-Prolixin Decanoate (IM)
1 long acting atypical antipsychotic given IM?
-Risperdal Consta (IM)
In typical antipsychotics S/E, such as ___ and ___ occur due to norepinephrine blockade on smooth muscle cells.
-orthostatic hypotension
-ejaculatory difficulties
In typical antipsychotics S/E, such as ___ and ___ occur due to histamine blockade.
-sedation
-substantial weight gain
Dopamine blockade in the basal ganglia result in ___.
EPS
In typical antipsychotics EPS include (5)?
-Parkinsonism
-Akinesia
-Akathisia
-Dystonia
-Tardive dyskinesia
5 signs of Parkinsonism?
-shuffling gait
-cogwheeling (mvmt that has a rachety appearance)
-drooling
-pill-rolling
Muscular weakness or paucity of spontaneous gestures is called?
akinesia
The inability to stand still or restlessness is called?
akathisia
___ is characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions.
dystonia
___ and ___ are 2 examples of dystonias.
-oculogyric crisis,
-neck torticollis
Excessive blinking and fine movements of the tongue are symptoms of ___.
tardive dyskinesia
Involuntary trunk and limb movements are symptoms of ___.
tardive dyskinesia
Are excessive blinking and fine movements of the tongue early signs or late symptoms?
early
Are involuntary trunk and limb movements an early or late symptom?
late
5 medications for EPS S/E?
-Symmetrel
-Cogentin
-Akineton
-Benadryl
-Artane
Neuroleptic Malignant Syndrome is characterized by (4):
-hyperpyrexia
-altered LOC
-autonomic dysfunction
-lab abnormalities
Autonomic dysfunction in neuroleptic malignant syndrome causes:
-increase in HR
-increase in BP
-increase in R
-profuse sweating
-pallor
-dysphagia
Lab abnormalities in neuroleptic malignant sydrome would show:
-increase CPK
-increase WBCs
-increase in LFTs
-renal decline or failure
Atypical antipsychotics work by:
binding to dopamine receptors and decrease S/E
Atypical antipsychotics targets negative symptoms by:
antagonizing 5-HT2 (serotonin)
6 S/E of Clozapine (Clozaril):
-agranulocytosis
-seizures
-drowsiness/sedation
-hypersalivation
-tachycardia
-dizziness
3 S/E of Risperidone (Risperdal):
-motor difficulties at higher doses
-orthostatic hypotension
-sedation
2 S/E of Quetiapine (Seroquel)?
-sedation
-weight gain
A S/E of Olanzapine (Zyprexa)?
weight gain
Drugs that influence the rate of hepatic detoxification of antipsychotics?
-Cimetidine (Tagamet)
-Anticonvulsants
-Tricyclic antidepressants
-Some cardiac drugs
-Epinephrine and Thorazine
___ and ___, drugs that influence the rate of hepatic detoxification, can cause severe hypotension.
epinephrine; Thorazine
2 nursing responsibilities of antipsychotics:
1. Managing S/E and thus enhance compliance
2. Preventing tardive dyskinesia
4 types of antidepressants?
-Tricyclics
-Selective Serotonin Reuptake Inhibitors
-Monoamine Oxidase Inhibitors
-Atypicals
___ block the reuptake of NE and 5-HT.
tricyclics
___ block reabsorption of 5-HT in synapse.
Selective serotonin reuptake Inhibitors
___ block enzyme (monoamine oxidase) needed to metabolize NE, 5-HT & D
monoamine oxidase inhibitors
3 tricyclic antidepressants?
-Amitriptyline (Elavil)
-Imipramine (Tofranil)
-Nortriptyline (Pamelor)
5 SSRIs?
-Fluoxetine (Prozac)
-Sertraline (Zoloft)
-Paroxetine (Paxil)
-Citalopram (Celexa)
-Fluvoxamine (Luvox)
4 MAOIs?
-Isocarboxazid (Marlpan)
-Phenelzine (Nardil)
-Selegiline (Eldepryl)
-Tranylcypromine (Parnate)
5 atypical antidepressants?
-Trazodone (Desyrel)
-Nefazodone (Serzone)
-Venlafaxine (Effexor)
-Mirtazpine (Remeron)
-Bupropion (Wellbutrin)
3 S/E of TCAs?
-anticholinergic S/E
-histamine blockade
-cardiovascular - dysrhythmias, MI, heart block
S/E of SSRIs?
-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):
-Low long term risks but expensive
S/E of valproic acid (Depakote):
-Metabolized by liver
-Prolong anticoagulant effect of Coumadin
-Increase effects of MAOIs
S/E of carbamazepine (Tegretol):
-Drugs that affect liver cytochrome sytem
-Erythromycin and Cimetidine may increase Carbamazepine levels
Evaluation of mood stabilizers:
- 1 to 2 weeks for effect in mania
- 4 to 6 weeks for effect in depression
3 types of anxiolytics?
-benzodiazepines
-nonbenzodiazepines
-antihistamines
4 benzodiazepines?
-diazepam (Valium)
-Clonazepam (Klonopin)
-Aprazolam (Xanax)
-Lorazepam (Ativan)
A nonbenzodiazepine?
Buspirone (BuSpar)
2 antihistamines?
-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