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45 terms

Psychiatric Medications

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Form of drugs to pass blood barrier
Lipid soluble
3 ways meds act
Block, inhibit reuptake, or act on metabolism
agonist
increases activity
antagonist
decreases activity
p450 system enzyme increased
decreased blood levels of the medication
Grapefruit juice
inhibits the isoenzyme which metabolize some antidepressants, antianxiety meds and anticonvulsants, raises plasma level of drug
Antipsychotics
reduce aggression, reduce psychotic symptoms, block dopamine...80% block causes EPS
dystonia
sustained involuntary muscle contractions
torticollis
twisting of the neck that can interfere with breathing
opisthotonos
spasms of neck, causing it to bend backwards
oculogyric crisis
fixed upward stare, can only see whites of eyes.. seen with 1st generations
drug induced parkinsonism
cogwheeling, tremor, pill rolling of fingers, mask like facies, shuffling gait...can grab arm to see if it is shaking
akathisia
not able to sit, need to keep moving
tardive dyskinesis
late onset, irreversible abnormal movements, lip smacking, tongue protrusion, foot tapping
Control EPS
artane, benadryl or congentin...must be taken
EPS meds side effects
Raise blood sugar and prolactin(milk discharge), dry mouth, blurred vision, constipation, urinary retention, paralytic ileus, orthostatic hypotension
Neuroleptic Malignant Syndrome
kills patients, high b/p and temp, diaphoresiss, muscle rigidity, increased CPK (late sign)
Reduces effectiveness of Antipsychotics
tagamet
Antipsychotic effects
sedation, 2-8 weeks to act on hallucinations/delusions
1st generations antipsychotics
treat positive symptoms of schizophrenia, more likely to have EPS and cause orthostatic hypotension, avoid in elderly
Phenothiazines
skin rash if exposed to the sun, 1stgen
Dekonate
long acting oily form givenlong acting deep IM and last 2-4weeks, must stay 3 hours after injection, use oral first, 1st gen
2nd generation antipsychotics
treat positive and negative symptoms (lack of energy, interest,no talking) decrease dopamine and increase serotonin
Clozapine
serious side effect decrease WBC's so must do count weekly
2nd gen
Risperdal
orthostatic hypotension 2nd gen
zyprexa, seroquel
weight gain 2nd gen
geodon
need an EKG 2ng gen
3rd generation antipsychotic
blocks dopamine where it is to high and moderates dopamine in other areas
Antidepressants
black box for suicide on elderly and adolescents, SIGECAPS, take 2-4 weeks to work
Dexamethasone test
positive when cortisol is above baseline, indicates endogenous depression
Tricylics
block reuptake of serotonin and norepinephrine, can be used to easily overdose, EKG must be done prior, alcohol is cardiotoxic
MAOI
increase dopamine and tyramine. long acting metabolics, wait 2 weeks before starting another antidepressant, low tyramine diet, no demerol (serotonin syndrome)
SSRI
lowest risk of birth defects, can't take with MAOI
Paxil
most potential for sexual side effects
ssri
Serotonin Syndrome
restlessness, unstable vitals, increased B/P seizures, hyperthermia collapse of cardiovascular systems
Manic switch
bipolar patient presents as depressive and is given an antidepressants, agitation, loss of inhibitions, delusional thinking
Lithium
need salt and water, may cause problems with thyroid or kidney, narrow therapeutic window check blood, 2-3 weeks for therapeutic level 1-1.5
lithium toxicity
vomiting, diarrhea, ataxia or loss of coordination, tremor or muscle weakness, drowsiness and seizures
Anticonvulsants
stabilize mood, do not stop abruptly
Lamictal
rash may be first sign of Steven Johnson's syndrome anticonvulsant
Anxiolytics
increase Gaba,decrease anxiety, cause respiratory depression, temporary relief, not good for addicts, don't stop abruptly due to convulsion
Buspar
good for addicts or patients with dual diagnosis, takes 2-4 weeks to work
Hypnotics
potentiate GABA, Reticular activating system is responsible for arousal and sleep regulation, side effects are lapses in memory
Acetycholinesterase Inhibitors
raise ACh levels, treatment of dementia
Stimulants
improve attention, decrease distractibility, hyperactivity and impulsivity, used for ADHD, not good for substance abusers, do not take after 4pm, take with food