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Terms in this set (94)
Psychotropic medications are not intended to cure mental illness. They are used in addition to ___________________ or ___________________ _____________________.
Individual, group psychotherapy
Psychotropic medications ___________________ physical and behavioral symptom; they do not resolve emotional problems.
Benzodiazepines (BZDs) are the largest and most commonly prescribed anxiolytic drug class also called _______________ _________________ because they cause sedation.
MOA of BZDs: depress ___________________ in the _____________ and the limbic system by potentiating (increasing) the effects of the amino acid _______________, thereby producing a calmative effect.
activity, brain, GABA
alprazolam (Xanax), chlordiazepoxide(Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan)
Therapeutic uses of benzodiazepines
relieve anxiety, sedate, produce muscle relaxation, control seizures, treat depression, and treat alcohol withdrawal.
Benzodiapezines side effects and adverse effects are mostly because they are ________________ __________________.
Side effects/ ADR of BZD
drowsiness, blurred vision, constipation, lethargy, headache, dry mouth, ataxia, N/V, abdominal cramping, dizziness, slurred speech, confusion
Paradoxical reactions of BZD
insomnia, increased excitability, hallucinations
Interactions of BZD--________________________ depression or arrest when taken with other CNS depressants including alcohol.
Clinical Implications of BZD-- mostly used on a short term basis because of high incidence of ______________, ______________, and ____________________.
abuse, tolerance, dependence
BZDs should not be withdrawn abruptly--must ________________; withdrawals symptoms----tremors, N/V, insomnia, agitation, sweating, psychosis, coma, SEIZURES
An example is Phenobarbital. This medication is used for alcohol withdrawal and anti-anxiety If the patient has been abusing/using benzo will use these in its place. What am I?
Buspirone (BuSpar) does not _________________ CNS; is not a benzodiazepine; lag period is ___________ days; useful for patients with substance use disorder because not ___________________. Can use BZD PRN until BuSpar reaches therapeutic level.
depress, 7-10, addictive
MOA for MAOIs: prevents the monoamine oxidase from breaking down _________________ and _________________, thereby increasing the levels of these neurotransmitters.
Most common MAOIs
phenelzine (Nardil), isocarboxazid (Marplan), tranlcypromine-Parnate, selegiline (Esmam-transdermal patch)
Onset of action for MAOIs
Side effects and ADR of MAOIs
dry mouth, blurred vision, urinary retention, constipation, drowsiness, sexual dysfunction, insomnia, wt gain, orthostatic hypotension
Interactions with MAOIs;TCAs
additive effects and results in increased therapeutic and toxic effects (hyperthermia, delirium, and convulsions, coma)
Interactions with MAOIs: Meperidine
interferes with metabolism and results in agitation; hyperpyrexia, circulatory collapse
Must be off other antidepressants __________________ before starting an MAOI
Amino acid tyramine results in _______________ ___________________.
Tyramine is an amino acid that regulates ___________________ __________________; MAO breaks down excess tyramine; MAOIs prevent this breakdown , which results in increased blood pressure when foods or beverages are consumed with increased levels of tyramine.
Signs and Symptoms of MAOIs: severe occipital _______________, stiff ________________, flushing, palpitations, ________________ and __________________/__________________; can lead to ___________________ hemorrhage, stroke, _________________ and _____________________.
headache, neck, diaphoresis, nausea/vomiting, cerebral, coma, death
Aged mature cheeses: blue, cheddar, swiss, parm, provolone.
Aged fermented meats
Foods high in tyramine
pasteurized light and pale beer
chocolate, caffeine beverages (less than 2 cups/day)
fruits-grapes, pineapple, oranges
Foods with moderate tyramine content
Cyclic Antidepressants- TCAs
MOA for TCA: blocks the reuptake of the neurotransmitters _____________________ and _________________ thus increasing concentration at nerve endings.
amitriptyline (elavil), doxepin (sinequan), imipramine (tofranil), clomipramine (Anafranil)
Onset of action for TCAs is _______________ weeks, so not useful in ____________________ depression (grief)
Side effects/ADR for TCAs
tachycardia, sedation, impotence, dysrhythmias, orthostatic hypotension, weight gain, anorexia, seizures in high doses
TCAs cause an increased risk of ___________________ because they increase energy.
TCAs are extremely lethal because they are ___________________.
TCAs interact with ___________________ _______________________
MAOIs and warfarin
TCAs are normally given at _________________ because of sedation and they are not as addictive as sleep aides.
SSRIs MOA: inhibit the ________________ of _____________________.
SSRIs are superior to TCAs because
1)______________ side effects
3) not ___________________ so patient is not as likely to OD
fewer, fewer, interaction, cardiotoxic
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), citalopram (Celexa), fluvoxamine (Luvox), vilazodone (Viibryd)
SSRIs onset of maximum clinical effectiveness _________________ weeks
Give SSRIs with ________________ in the ____________________.
SSRIs side effects/ADR
headache, nausea, insomnia, nervousness, dry mouth, dizziness, diarrhea, sweating, tremor, fatigue, constipation, male sexual dysfunction, bruxism
Potentially serious side effects of SSRIs:
seizures, mania, hostility, suicidal ideation
SSRIs interaction: MAOIs-____________ _____________ and TCAs _______________ TCA toxicity; serotonin syndrome
serotonin syndrome; increases
Serotonin syndrome can happen ___________ hours after initiation
Serotonin syndrome: changes in ________________ status, restlessness, ___________________, tachycardia, _________________, blood pressure, _______________, shivering/tremors, hallucinations, agitation
mental, hyperreflexia, labile, diaphoresis
Do not abruptly stop SSRIs; leads to __________________________/_______________________ signs and symptoms--dizziness, lethargy, __________________, nausea, anxiety, tremors
Common atypical antidepressants:
bupropion (Wellbutrin), duloxetine (Cymbalta), venlafaxine (effexor), olanzapine and fluxoetine (Symbyax), mirtazapine (remeron), trazodone (desyrel)
Drug of choice to treat Bipolar disorder...
Lithium normalizes the reuptake of certain neurotransmitters such as ________________, __________________,_______________, and ________________; replaces _____________ in the intracellular spaces
serotonin, norepinephrine, dopamine, acetylcholine, sodium
Do not use lithium if you are.....
Narrow therapeutic index--normal lithium level is _______________ mEq/L; maintenance level _______________ mEq/L; levels are usually drawn twice a week during the initial therapy and then monthly after stabilization; samples drawn 12 hours after dose administered.
Side effects of Lithium
fine hand tremors, polyuria, harmless EKG changes, headache, nausea, wt gain, acne, edema, metallic taste, fatigue
Lithium toxicity symptoms
cardiac arrhythmias, seizures, vomiting, tinnitus, drowsiness, twitching, diarrhea, coarse hand tremors, slurred speech, hypotension, ataxia
coma and death may occur at levels (lithium)
Long term treatment using lithium may cause hypothyroidism and ________________ __________________. Check T3/T4, BUN, Sr. Cr. and GFR for baseline
Factors which affect Serum litihium levels: Inreased (lithium is retained by)---_________________,______________, or dehydration, low-salt diets, ____________ ______________ or strenuous exercise.
diarrhea, diuretics, high fever
Factors which affect serum lithium levels: Decreased (lithium is excreted by)-- high ____________ intake, high intake of _______________ bicarbonate.
Lithium is not used for bipolar patients who are ________ ________ because the lithium is unable to keep up.
Nursing implications of lithium
-encourage patient to maintain fluid intake of 2000-30000ml/day
-avoid excessive sweating
-maintain diet adequate in sodium
Second choice of medications for patients with Bipolar Disorder:
valproic acid (Depakote), gabapentin ( Neurontin), topirmate (Topamax), clonazepam (Klonopin), lamotrigine (Lamictal), carvamazepine (tegretol), oxcarbazepine (trileptal)
Drug of choice for _____________ _____________ bipolar patient is anticonvulsants
Other uses of anticonvulsants in patients with psychiatric disorders:
______________________ _____________________ (hint they all begin with D)
delirium, dementia, drug withdrawal
Therapeutic effects for anticonvulsants occur approximately ________________ days
What are the other two choices of medications for Bipolar patients?
atypical antipsychotics, calcium channel blockers
Calcium channel blockers are a good choice for _____________ women.
Antipsychotics block______________ receptors in the brain and thus ______________ the dopamine concentration in the CNS
Typical or first generation antipsychotics are called ________________ and ________________
neuroleptics, major tranquilizers
Common typical antipsychotics:
chlorpromazine (Thorazine), fluphenazine (Prolixin) , haloperidol (Haldol), thioridazine (Mellaril)
Side effects/ ADR of typical antipsychotics:
dry mouth, blurred vision, urinary retention, constipation, decrease seizure threshold, sedation, change in libido, orthostatic hypotension, increase weight gain, photosensitivity
Typical antipsychotics caution being in _____________ ______________.
If patient has psychosis will need ____________ ______________ and a ______________ for agitation.
standing order, PRN
EPS (extrapyramidal symptoms) a positive AIMS examination is a score of ________ in two or more movements (1-7) or a score of ______ or _________ in a single movement
The drug of choice for treatment in EPS
Treatment for dystonia
benztropine (cogentin) or diphenhydramine (Benadryl)
Treatment for Akathisia
clonidine (catapres), lorazepam (Ativan), propranalol (inderal)
Treatment for pseudoparkinsonism
Toxicity-NMS (neuroleptic malignant syndrome)- rare but often fatal ____________ ________________ to antipsychotic medications; etiology unknown; 25% mortality rate secondary to CV collapse, pulmonary edema, or acute renal failure.
Signs and symptoms of NMS-- increased temperature, increased HR, increased or decreased ________________________, dystonia, muscle ____________, mutism, urinary _________________.
blood pressure, rigidity, retention
Treatment of NMS: d/c ________________; requires 1-3 weeks, as ordered, administer fluids and electrolytes, skeletal muscle relaxants, _______________ blanket, artificial _______________.
medication, cooling, ventilation
Medications of interactions with typical antipsychotics:
antacids- decrease absorption of phenothiazines
Atypical antipsychotics--more specific action in the brain so minor or no _______________.
Clozapine (Clozaril) effective in treatment resistant _____________________.
Atypical antipsychotic biggest risk is agranulocytosis (_________________ _______________)so weekly blood work
aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), quetiapine (Seroquel), sertindole (Serlect), lurasidone (latuda), cariprazine (Vraylar), paliperidone (Invega)
ALL atypical antipsychotics are contraindicated in elderly patients with _____________ ______________ _______________.
dementia related psychosis
Psychostimulants MOA: induce ___________ stimulation
detroampetamine (dexedrine), methyphenidate (Ritalin), amphetamine (adderall), lisdexamfetamine dimesylate (Vyvanse)
ADHD, narcolepsy, vegetative depression, obesity
Side effects/ADR for psychostimulants
anorexia, irritability, abdominal pain, weight loss, insomnia, mood changes, hypertension, growth and weight suppression (use drug holidays to help prevent), agitation, headache, tachycardia
Psychostimulants have a strong potential for _____________,_____________, and ________________.
tolerance, abuse, dependence
Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor; not a CNS stimulant but is used for _______________.
Nursing implications for psychostimulants
Assessment: hypersensitivity, baseline vital signs, risk for suicide ( check for cheeking), use of alcohol and other CNS depressants, patient teaching, cautious use in children and elderly, pregnancy, liver and renal studies, side effects, safety, compliance
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