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Psych Meds - Quiz 1 - UNF

Terms in this set (58)

atropine sulfate, glycopyrrolate
(Robinul)
Several medications are associated with ECT. Either
of these medications may be ordered to decrease secretions
and counteract the effects of vagal stimulation
induced by the ECT.
thiopental sodium (Pentothal), methohexital sodium
(Brevital), succinylcholine chloride (Anectine),
In the treatment room, the anesthesiologist administers
intravenously a short-acting anesthetic, such as
___ ___ (___) or ___ ___ (___). A muscle relaxant, usually ___ ___ (___) is given intravenously to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fractured or dislocated bones.
succinylcholine chloride (Anectine),
Because this ___ ___ (___) paralyzes respiratory muscles as well, the client is oxygenated with pure oxygen during and after the treatment, except for the brief interval of electrical stimulation, until spontaneous respirations return.
monoamine oxidase inhibitor (MAOI) iproniazid
In the early 1950s, patients with tuberculosis were being treated with?
tricyclic antidepressants, imipramine
The ___ ___ (TCAs) had a similar
introduction. In the late 1950s, ___ was
being investigated as a treatment for schizophrenia,
and although it did not relieve psychotic symptoms, it
appeared to elevate mood.
antidepressants
These drugs ultimately work to increase the concentration
of norepinephrine, serotonin, and/or dopamine
in the body.
monoamine oxidase
the enzyme, ___ ___,
is known to inactivate norepinephrine, serotonin,
and dopamine, is inhibited at various sites in the
nervous system
Antidepressant
___ drugs are contraindicated in individuals
with hypersensitivity.
myocardial infarction, glaucoma
TCAs are contraindicated in the acute recovery phase following ___ ___ and in individuals with angle-closure ___.
MAOIs
TCAs, heterocyclics, SSRIs, and SNRIs are contraindicated with concomitant use of ___s.
children, adolescents
All antidepressants carry an FDA black box warning
for increased risk of suicidality in ___ and
___.
hepatic, renal, cardiac
Caution should be used in administering antidepressants to elderly or debilitated clients and those with ___, ___, or ___ insufficiency. (The dosage usually must be decreased.)
hypertrophy, seizures
Caution is also required with psychotic clients, with clients who have benign prostatic ___, and with individuals who have a history of ___ (may decrease seizure threshold).
suicide
As these drugs take effect and mood begins to
lift, the individual may have increased energy
with which to implement a ___ plan. This
potential often increases as level of depression
decreases. The nurse should be particularly alert to
sudden lifts in mood.
Tricyclic Antidepressants
● Increased effects of tricyclic antidepressants may
occur with bupropion, cimetidine, haloperidol,
SSRIs, and valproic acid.
● Decreased effects of tricyclic antidepressants may
occur with carbamazepine, barbiturates, and rifamycins.
Tricyclic Antidepressants
● Hyperpyretic crisis, convulsions, and death may
occur with MAOIs.
● Coadministration with clonidine may produce
hypertensive crisis.
Tricyclic Antidepressants
● Decreased effects of levodopa and guanethidine
may occur with tricyclic antidepressants.
● Potentiation of pressor response may occur with
direct-acting sympathomimetics..
Tricyclic Antidepressants
● Increased anticoagulation effects may occur with
dicumarol.
● Increased serum levels of carbamazepine occur with
concomitant use of tricyclics.
● Increased risk of seizures occurs with concomitant
use of maprotiline and phenothiazines
Monoamine Oxidase Inhibitors
● Serious, potentially fatal adverse reactions may
occur with concurrent use of all other antidepressants,
carbamazepine, cyclobenzaprine, buspirone,
sympathomimetics, tryptophan, dextromethorphan,
anesthetic agents, central nervous system (CNS)
depressants, and amphetamines. Avoid using within
2 weeks of each other (5 weeks after therapy with
fl uoxetine).
Monoamine Oxidase Inhibitors
● Hypertensive crisis may occur with amphetamines,
methyldopa, levodopa, dopamine, epinephrine,
norepinephrine, guanethidine, guanadrel, reserpine,
vasoconstrictors, or ingestion of tyramine-containing
foods (Table 15-4).
● Hypertension or hypotension, coma, convulsions,
and death may occur with opioids (avoid use
of meperidine within 14 to 21 days of MAOI
therapy).
Monoamine Oxidase Inhibitors
● Excess CNS stimulation and hypertension may
occur with methylphenidate.
● Additive hypotension may occur with antihypertensives,
thiazide diuretics, or spinal anesthesia.
● Additive hypoglycemia may occur with insulins or
oral hypoglycemic agents.
Monoamine Oxidase Inhibitors
● Doxapram may increase pressor response.
● Serotonin syndrome may occur with concomitant
use of St. John's wort.
● Hypertensive crisis may occur with ingestion of
foods or other products containing high concentrations
of tyramine.
Monoamine Oxidase Inhibitors
● Consumption of foods or beverages with high caffeine
content increases the risk of hypertension and
arrhythmias.
● Bradycardia may occur with concurrent use of
MAOIs and beta blockers.
● Risk of toxicity from the 5-HT-receptor agonists
occurs with concurrent use of MAOIs.
Selective Serotonin Reuptake Inhibitors
● Toxic, sometimes fatal, reactions have occurred with
concomitant use of MAOIs.
● Increased effects of SSRIs occur with cimetidine,
l-tryptophan, lithium, linezolid, and St. John's wort.
● Serotonin syndrome may occur with concomitant
use of SSRIs and metoclopramide, sibutramine, tramadol,
or 5-HT-receptor agonists (triptans).
● Concomitant use of SSRIs may increase effects of
hydantoins, tricyclic antidepressants, cyclosporine,
benzodiazepines, beta blockers, methadone, carbamazepine,
clozapine, olanzapine, pimozide,
haloperidol, phenothiazines, St. John's wort, sumatriptan,
sympathomimetics, tacrine, theophylline,
and warfarin.
● Concomitant use of SSRIs may decrease effects of
buspirone and digoxin.
● Lithium levels may be increased or decreased by
concomitant use of SSRIs.
● Decreased effects of SSRIs occur with concomitant
use of carbamazepine and cyproheptadine.
Selective Serotonin Reuptake Inhibitors
● Serotonin syndrome may occur with concomitant
use of SSRIs and metoclopramide, sibutramine, tramadol,
or 5-HT-receptor agonists (triptans).
● Concomitant use of SSRIs may increase effects of
hydantoins, tricyclic antidepressants, cyclosporine,
benzodiazepines, beta blockers, methadone, carbamazepine,
clozapine, olanzapine, pimozide,
haloperidol, phenothiazines, St. John's wort, sumatriptan,
sympathomimetics, tacrine, theophylline,
and warfarin.
Selective Serotonin Reuptake Inhibitors
● Concomitant use of SSRIs may decrease effects of
buspirone and digoxin.
● Lithium levels may be increased or decreased by
concomitant use of SSRIs.
● Decreased effects of SSRIs occur with concomitant
use of carbamazepine and cyproheptadine
Others (Heterocyclics and SNRIs)
● Concomitant use with MAOIs results in serious,
sometimes fatal, effects resembling neuroleptic malignant
syndrome. Coadministration is contraindicated.
● Serotonin syndrome may occur when any of the
following are used together: St. John's wort, sibutramine,
trazodone, nefazodone, venlafaxine, desvenlafaxine,
duloxetine, SSRIs, 5-HT-receptor agonists
(triptans).
Others (Heterocyclics and SNRIs)
● Increased effects of haloperidol, clozapine, and
desipramine may occur when used concomitantly
with venlafaxine.
● Increased effects of venlafaxine may occur with
cimetidine.
● Increased effects of duloxetine may occur with
CYP1A2 inhibitors (e.g., fl uvoxamine, quinolone
antibiotics) and CYP2D6 inhibitors (e.g., fl uoxetine,
quinidine, paroxetine).
Others (Heterocyclics and SNRIs)
● Increased risk of liver injury occurs with concomitant
use of alcohol and duloxetine.
● Increased risk of toxicity or adverse effects from drugs
extensively metabolized by CYP2D6 (e.g., fl ecainide,
phenothiazines, propafenone, tricyclic antidepressants,
thioridazine) occurs when used concomitantly
with duloxetine, desvenlafaxine, or bupropion.
Others (Heterocyclics and SNRIs)
● Decreased effects of bupropion and trazodone may
occur with carbamazepine.
● Altered anticoagulant effect of warfarin may occur
with bupropion, venlafaxine, desvenlafaxine, duloxetine,
or trazodone.
May Occur With All Chemical Classes
● Dry mouth
* Offer the client sugarless candy, ice, frequent sips of water.
* Strict oral hygiene is very important.
May Occur With All Chemical Classes
● Sedation
* Request an order from the physician for the drug to be given at bedtime.
* Request that the physician decrease the dosage or perhaps order a less-sedating drug.
* Instruct the client not to drive or use dangerous equipment while experiencing sedation.
May Occur With All Chemical Classes
● Nausea
* Medication may be taken with food to minimize
GI distress.
May Occur With All Chemical Classes
● Discontinuation syndrome
* All classes of antidepressants have varying potential
to cause discontinuation syndromes. All antidepressant medication should be tapered gradually to prevent withdrawal symptoms
half-life
Fluoxetine is less likely to result in withdrawal symptoms because of its long ___-___.
tricyclics
Abrupt withdrawal from ___ may produce hypomania, akathisia, cardiac arrhythmias, gastrointestinal upset, and panic attacks.
MAOIs
The discontinuation syndrome associated with ___ includes fl ulike symptoms, confusion, hypomania, and worsening of depressive symptoms.
SSRIs
Abrupt withdrawal following long-term therapy with ___, venlafaxine, desvenlafaxine, and duloxetine may result in dizziness, lethargy, headache, and nausea
Tricyclics, Heterocyclics
Discontinuation syndrome symptoms
most Commonly Occur With ___ and ___
● Blurred vision
● Constipation
● Urinary retention
● Orthostatic hypotension
● Reduction of seizure threshold
● Tachycardia; arrhythmias
● Photosensitivity
● Weight gain
SSRIs , SNRIs
Discontinuation syndrome symptoms
Most Commonly Occur With ___ and ___
● Insomnia; agitation
● Headache
● Weight loss (may occur early in therapy)
● Sexual dysfunction
● Serotonin syndrome
Serotonin syndrome
(may occur when two drugs that potentiate serotonergic neurotransmission are used concurrently [see "Interactions"])
* Most frequent symptoms include changes in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremors.
* Discontinue the offending agent immediately.
MAOIs
Discontinuation syndrome symptoms
Most Commonly Occur With ___
● Hypertensive crisis
● Application site reactions (with selegiline transdermal
system [Emsam])
Miscellaneous Side Effects
Discontinuation syndrome symptoms
● Priapism (with trazodone)
● Hepatic failure (with nefazodone)
Priapism
* ___ is a rare side effect, but it has occurred
in some men taking trazodone.
* If the client complains of prolonged or inappropriate
penile erection, withhold medication dosage
and notify the physician immediately.
* this can become very problematic, requiring
surgical intervention, and, if not treated successfully,
can result in impotence.
hypertensive
Avoid consuming the following foods or medications
while taking MAOIs: aged cheese, wine (especially
Chianti), beer, chocolate, colas, coffee, tea,
sour cream, smoked and processed meats, beef or
chicken liver, canned fi gs, soy sauce, overripe and
fermented foods, pickled herring, raisins, caviar,
yogurt, yeast products, broad beans, cold remedies,
diet pills. To do so could cause a life-threatening ___ crisis.
tricyclic
Avoid smoking while receiving ___ therapy.
Smoking increases the metabolism of this,
requiring an adjustment in dosage to achieve the
therapeutic effect.
alcohol
Avoid ___ use while taking antidepressanttherapy.
These drugs potentiate the effects of each other.
trazodone
Notify physician immediately if inappropriate or prolonged penile erections occur while taking ___. If the erection persists longer than 1 hour, seek emergency department treatment. This condition is rare, but has occurred in some men who have taken this. If measures are not instituted immediately, impotence can result.
bupropion
Not "double up" on medication if a dose of ___ (Wellbutrin) is missed, unless advised to do so by the physician. Taking this in divided doses will decrease the risk of seizures and other adverse effects.
selegiline
Follow the correct procedure for applying the ___
transdermal patch:
• Apply to dry, intact skin on upper torso, upper thigh, or outer surface of upper arm.
• Apply approximately the same time each day to a new spot on the skin, after removing and discarding old patch.
• Wash hands thoroughly after applying the patch.
• Avoid exposing application site to direct heat (e.g., heating pads, electric blankets, heat lamps, hot tub, or prolonged direct sunlight).
• If patch falls off, apply new patch to a new site and resume previous schedule.
Tyramine
High ____ Content (Avoid while on MAOI
therapy) Aged cheeses (cheddar, Swiss, Camembert, blue cheese,
Parmesan, provolone, Romano, brie) Raisins, fava beans, fl at Italian beans, Chinese pea pods Red wines (Chianti, burgundy, cabernet sauvignon) Smoked and processed meats (salami, bologna, pepperoni, summer sausage) Caviar, pickled herring, corned beef, chicken or beef liver Soy sauce, brewer's yeast, meat tenderizer (MSG)
14
Ingestion of the following substances while on MAOI therapy could result in life-threatening hypertensive crisis. A __-day interval is
recommended between use of these drugs and an MAOI.
All other antidepressant medications (e.g., SSRIs, TCAs, SNRIs, heterocyclics) Sympathomimetics (epinephrine, dopamine, norepinephrine, ephedrine, pseudoephedrine, phenylephrine, phenylpropanolamine, over-the-counter cough and cold preparations) Stimulants (amphetamines, cocaine, diet drugs)
Antihypertensives (methyldopa, guanethidine, reserpine) Meperidine and possibly other opioid narcotics (morphine, codeine)
Antiparkinsonian agents (levodopa)
tricyclics
Amitriptyline
Amoxapine
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Aventyl; Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Sarafem)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Monoamine Oxidase Inhibitors
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline transdermal system (Emsam)
Heterocyclics
Bupropion (Zyban, Wellbutrin)
Maprotiline
Mirtazapine (Remeron)
Nefazodone‡
Trazodone
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Psychotherapeutic Combinations
Olanzapine and fluoxetine (Symbyax)
Chlordiazepoxide and fluoxetine (Limbitrol)
Perphenazine and amitriptyline (Etrafon)
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