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62 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is another term for anti-psychotic drugs?
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Neuroleptics
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What behavior is seen to be psychotic?
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Disorder thinking, inappropriate emotional response, deterioration of lefel of occupational and social function, hallucinations, delusions, bizarre behavior
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Hallucinations deal with __________.
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the 5 physical senses: hear, see, smell, touch and taste
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In traditional (typical) anti-psychotics, 70-90% of _______ is blocked.
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DOPAMINE
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Pharmacodynamics of antipsychotic agents I: _______a variety of receptors in/out of CNS
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BLOCK
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Therapeutic effects of traditional (typical) anti-psychotics are thought to be primarily realted to dopamine receptor blockade= ______________.
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D2 RECEPTOR ANTAGONISTS
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Neurotransmitter receptors that are blocked by traditional (typical) anti-psychotics
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1. DOPAMINE
2. ACH 3. HISTAMINE 4. NOREPI |
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Adverse effects of traditional (typical) anti-psychotics, specifically Extrapyramidal Effects
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1. ACUTE DYSTONIA
2. PARKINSONISM 3. AKATHISIA 4. TARDIVE DYSKINESIA |
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Adverse effects of traditional (typical) anti-psychotics.
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1. Neuroleptic Malignant Syndrome**
2. Anticholinergic Effects 3. Orthostatic Hyptotension 4. Sedation 5. Seizures 6. Sexual dysfuction 7. Skin effects 8. Agranulocytosis 9. Severe dysrhythmias |
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Drug Interactions with traditional (typical) anti-psychotics
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Anticholinergic drugs, CNS depressants, Levodopa
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Low-potency anti-psychotic drugs: (2)
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Chlorpromazine (Thorazine)
Thioridazine (Mellaril) |
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Medium-potency anti-psychotic drugs: (3)
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Loxapine (Loxitane)
Molindone (Moban) Perphenazine (Trilafon) |
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High-potency anti-psychotic drugs: (4)
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Haloperidol (Haldol)
Fluphenazine (Prolixin) Trifluoperazine (Stelazine) Thiothixene (Navane) |
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Nursing Implications: Pre-adminstration of atypical anti-psychotic drugs:
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1. Mental status & physical exam
2. Family and social history 3. Vitals, CBC, other blood tests |
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Nursing Implications: Adminstration of atypical anti-psychotic drugs:
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1. Single dose at bedtime or divided doses
2. Protect oral preps from sunlight 3. Liquid meds can cause contact dermatitis |
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Nursing Implication: Patient education for atypical anti-psychotic meds:
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1. Written and verbal instructions
2. Must take on schedule and NOT miss dose 3. May not see optimal results for several weeks |
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Evaluation of atypical anti-psychotics
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1. Improvement in s/sx
2. Minimal side effects |
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Atypical anti-psychotics cause ______ to _______ EPS.
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few to no
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Aytpical anti-psychotics block ___________, ___________, ______ and ________. (4)
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dopamine-2, serotonin, Ach, alpha-1 (norepi)
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2 requirements for use of Clozapine (Clozaril), atypical anti-psychotic.
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1. Requires national registry
2. Used only for Tx for resistant schizophrenia. |
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This drug is in a new class called dopamine system stabilizers (DSSs)
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Aripiprazole (Abilify)
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Drug Interactions with atypical anti-psychotics.
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Bone Marrow suppressants
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Tricyclic Antidepressants (TCAs) block the reuptake of ______ & ________ which ______ the effects of the two neurotransmitters.
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Norepi & serotonin; intesifies
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Use of antidepressants
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Depression and bipoloar disease
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Adverse effects of antidepressants
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1. Anticholnergic effects
2. Diaphoresis 3. Sedation 4. Orthostatic hypotension 5. Cadiac Toxicity** |
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Antidepressant drug interactions
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1. MAOIs
2. Catecholamines 3. Anticholinergics |
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Nursing Implications: Pre-administration of antidepressants
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1. Are they a high risk client?
2. Mental status exam 3. Cardiac status 4. Liver function |
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Nursing Implications: Adminstration of antidepressant
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PO ONLY!!
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Patient education for antidepressant medication regimine
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1. Must take as scheduled
2. Don't stop taking meds 3. Takes 1-4 weeks for maximum response to occur. |
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Evaulation of antidepressants
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Decreased s/sx, has a therapeutic effect occured?, any adverse effects?
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Amitryptiline (Elavil)
Doxepin (Sinequan) Imipramine (Tofranil) Nortyptiline (Aventyl) |
4 Examples of antidepressant meds
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MAOIs inhibit monoamine oxidase which prevents _________ of ____, _____ & _________.
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inactivation; norepi, epi & serotonin
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Pharmacokinetics of MAOIs
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1. PO
2. Metabolized in liver (hepatic) 3. Excreted via kidneys (renal) |
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MAOIs not first choice in tx of ___________. May be used for ____, _______ & ______.
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depression; OCD, bulimia, & panic disorder
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Adverse effects of MAOIs
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CNS stimulation, orthostatic hypotension, hypertensive crisis
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Drug/Food Interactions with MAOIs
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NO FOODS HIGH IN TYRAMINES!!
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LOOK AT TABLE 31-5 IN TEXT!!
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Drug/Drug Interactions with MAOIs
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Fluoxetine (Prozac), TCAs, antihypertensives, Merperidine (Demerol), sympathomimetics
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Isocarboxazid (Marplan)
Phenelzine (Nardil) Tranylcypromine (Parnate) |
Examples of MAOIs
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Nursing Implication: Administration of MAOIs
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1. Given PO
2. Do not give at bedtime |
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Patient Education with MAOIs
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1. Dietary restricitions-no food with tyramines
2. Take drug as scheduled 3. Orthostatic hypotension 4. Drug/drug interactions |
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Evaulation of MAOIs
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Therapeutic effects reached?
Any adverse effects/reactions? |
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Abbreviation for SELECTIVE SEROTONIN REUPTAKE INHIBITORS
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SSRIs
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Pharmacodynamics of SSRIs: Selective inibition of ________ reuptake=_______ _________.
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serotonin; more serotonin
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SSRIs are used for what medical diagnoses?
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Depression, OCD, bulimia, suppress appetitie
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Pharmacokinetics of SSRIs
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1. Good oral absorption
2. Metabolized through liver 3. Urinary excretion 4. Long half life |
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Adverse effects of SSRIs
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CNS stimulation, headaches, sexual dysfunction, nausea, insomina, weight gain, serotonin syndrome, withdrawl syndrome
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Drug/Drug Interactions with SSRIs
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MAOIs, other highly protein-binding drugs
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Nursing Implications: Pre-administration of SSRIs
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Mental status check, high risk clients
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Nursing Implications: Adminstration of SSRIs
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PO!!
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Patient Education of SSRIs
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1. Take with meals
2. Take in the AM 3. Don't D/C the drug abruptly 4. Take as scheduled |
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Fluoxetine (Prozac, Sarafem)
Sertraline (Zoloft) Fluvoxamine (Luvox) Paroxetine (Paxil) Citalopram (Celexa) Excitalopram (Lexapro) |
SSRI drugs
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This drug is used to treat bipolar disease, actue maina, acute depression and mood stablizer.
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LITHIUM
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Lithium has properties in common with ________ & ________.
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sodium & potassium
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Pharmacokinetics of Lithium:
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Good oral absorption with wide distribution, short half-life, rapid kidney (renal) excretion
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Lithium toxcitiy is result of what?
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Sodium depletion that decreases renal excretion of lithium!!
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A highly toxic drug with narrow therapetuic index=
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PLASMA LITHIUM LEVELS
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EARLY adverse effects of Lithium
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Nausea, diarrhea, bloating, anorexia, fatigue, muscle weakness, polyuria, thirst
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Long-term adverse effects of Lithium
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Goiter, hypothyroidism, renal toxicity.
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Drug/Drug Interactions with Lithium
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Diuretics, NSAIDS (increase lithium levels), anticholinergic drugs
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Nursing Implications: Pre-administration of lithium
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Baseline data, high risk clients
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Nursing Implications: Administration of Lithium
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Individualized dosing, take with meals, patient education
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Evaluation of Lithium
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Plasma levels, therapeutic response, & adverse effects
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