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Psych Meds Quiz
Second Semester
48
Nursing
Undergraduate 3
10/06/2012

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Term
Monoanime Oxidase Inhibitors (MAOIs)
[Nardil, Marplan, Parnate]
Definition
Not well tolerated by the elderly.
MAOI-A = depression
MOA: MAO break down catecholamines (NE, E, DA)
Fatal in overdose.
Increases tyramine, which increases NE, which leads to a HTN crisis.
Be careful with OTC drugs
Interacts with certain food (has tyramine)
NO cheddar, BUT roast beef is ok!
Therapeutic lag time is 3-4 wks, with 2 wk wash-out
Taken with SSRIs, can cause "serotonin syndrome"
If you have a HA when taking MAOI, then you can take CCB
Term
Tricyclic Antidepressants (TCAs)
[Tofranil, Elavil, & Anafranil]
Definition
Not well tolerated by the elderly -> causes confusion & psychosis.
MOA: Inhibits reuptake of NE or 5-HT
s/e: Anticholinergic (Anti-SLUDGE), wt gain, sexual dysfunction, hypotension.
Therapeutic lag time: 2-3 wks
Therefore, this is NOT for suicidal pts
Term
Norepinephrine Dopamine Reuptake Inhiitors (NDRI)
[Wellbutrin]
Definition
MOA: Inhibits reuptake of NE & DA
Used in smoking cessation.
When used with SSRIs, it DECREASES the sexual dysfunction.
Precaution in pts with hx of seizures.
may cause insomnia.
NO WEIGHT GAIN
Term
BuSpar
Definition
used for ANXIETY.
has 7-10 day lag time
Term
Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
[Effexor & Cymbalta]
Definition
Cymbalta is a new SNRI approved for DIABETIC NEUROPATHY & now for GAD.
Effexor is an ANTIDEPRESSANT
MOA: Potent inhibitor of 5-HT & NE reuptake & weak inhibitor of DA reuptake.
May be used for ANXIETY WITH DEPRESSION with anxiety component
Term
Selective Serotonin Reuptake Inhibitor (SSRIs)
[Prozac, Zoloft,Lexapro, Luvox, Paxil]
Definition
Luvox is used for treatment of OCD & ANXIETY disorders.
MOA: blocks 5-ht receptors, which INCREASES 5-HT.
Better tolerated with elderly.
S/E: fewer anti-cholinergic effects, wt loss, sexual dysfunction, akathesia
Paxil has the WORST S/E (sexual dysfunction)
Lexapro has the LEAST sexual dysfunction S/E profile
INDUCES TEGRETOL
Term
Common causes of antidepressant failure
Definition
Not adequate dosage.
Not taking long enough.
Not taking as prescribed.
Sexual effects.
Term
Lithium
Definition
Anti-manic "Gold-Standard"
Reduces suicidal behavior.
Important Labs: BUN, Creatinine, TSH
Therapeutic window: 1-1.5
Tremors = toxic
Term
Bipolar Disorder
Definition
Depakote
S/E: HA, wt gain, blurred vision
Lamictal
3rd generation anticonvulsant
FDA aprroved for BIpolar Disorders I & II
S/E: SJS (rash)
Zyprexa
S/E: wt gain
FDA approved for MIGRANES
Term
Depakene & Depakote
Definition
2nd generation anti-convulsants.
FDA approved for ACUTE MANIA, rapid cycling MIGRAINE HA px, exlosive disorder, panic disorder, efficacy for borderline personality disorder
Monitor: CBCs & LFTs
S/E: Liver toxicity (1st 6 months), Wt gain
Comes in oil-based shot
Term
Neurontin
Definition
3rd Gen. Anticonvulsant
NOT FDA approved for MOOD DISORDERS
used for bipolar II as djunct a lot of axiety
Poor efficacy for mood disorders
FDA approved for post herpetic neuralgia, NEUROPATHIC PAIN.
Off-Label: Sedative, hypnotic
S/E: dry month, diplopia, wt gain, sedation
Term
Tegretol
Definition
2nd Gen. Anticonvulsant
FDA approved for rapid-cycling, explosive disorders, panic disorder.
Monitor: CBC & LFTs
REDUCES effectiveness of BIRTH CONTROL
Term
Topamax
Definition
3rd Gen. Anticonvulsant
NO FDA approval for mood stabilization, BUT adjunct for Bipolar Disorders I & II.
FDA approved for px of migraines
REDUCES effectiveness of BIRTH CONTROL
NO wt gain
Term
Benzodiazepines
Definition
Pallitaive.
MOA: Bind to GABA sites as agonist of GABA (inhibitory hormone)
Most widely used is Clonazepam (Klonopin)
Taper off by reducing to 1/2 of total dose per wk unti drug free
Term
Antihistamines
[Benadryl, Visteral, Atarax]
Definition
DECREASE EPS
Term
Beta Blockers
[Inderal]
Definition
MOA: REDUCES akathesia & physiological signs of anxiety
DO NOT give non-selective with asthma or COPD pts.
used in HYPERTHYROIDISM & to treat ANS symptoms of panic disorder
Term
Antipsychotic
Definition
MOA: DA 2 receptor
EVERY effective antipsychotic agent know appears to block or partially block DA 2 recepts.
Blockage of GABA LOWER seizure threshold along with INCREASED DA
Increased DA in meso-cortical system may lessen negative symptoms of schizophrenia.
5-HT Antagonism reverse D2 Antagonism in nigrostriatal system to block 80% (not the near 100% blockage as a typical 1st gen. antipsychotic)
Over 80% blockage of D2 prduces the EPS of typical antipsychotics.
Term
Abilify
Definition
Partial agonist at the D2 receptor & 5-HT1a receptors.
Partial antagonist at the 5-HT2a receptor.
3rd Gen Anti-Psychotic
S/E: Hypotension
Term
Clozapine (Clozaril)
Definition
"Gold Standard" 2nd Gen Anti-Psychotic
S/E: Agranulocytosis
Monitor: WBC (>/= 3500/mm), absolute neutrophil (>/= 2000/mm)
Causes psychosis with elderly with dementia.
Always Monitor Bld Glucose & Wt Gain with they're prove to DM
Term
Risperdal
Definition
2nd Gen Anti-Psychotic
EPS (only 2nd Gen Anti-Psychotic that has EPS)
S/E: Prolactenemia, photosensitivity, ameneuria
Term
Zyprexa
Definition
2nd Gen. Anti-Psychotic
FDA approved for psychosis, schizophrenia, bipolar, & depression.
1x daily = steady state
S/E: wt gain & sedation
Titrate up
Check Bld Glucose
Wt gain is a MAJOR PROBLEM
HIGHEST rate for type II DM
Term
Seroquel
Definition
2nd Gen Anti-Psychotic
S/E: Sedation (give at bed) & increased Prolactin
FDA approved for schizophrenia, bipolar disorder, & depression.
Check Bld Glucose
Term
Geodon
Definition
2nd Gen Anti-psychotic
Initial sedation & increase prolactin
Increased QT interval ->Monitor ECG
Term
High Potency vs. Low Potency
Definition
High potency: ie Haldol= HIGH EPS & low sedation
Low potency: ie Thorazine = LOW EPS & high sedation
Not used in elderly d/t cardiac & BD effects
Term
Ritalin SR
Definition
Stimulant
Used for ADHD & Narcolepsy
Term
Nameda
Definition
N-methyl-D-aspartate (NMDA)
receptor agonist
Used for dementia d/t Alzheimers
Term
Drugs used in Substance Dependency "C.A.R."
Definition
Catapres (Clonidine)
Anatabuse (Disulfiram)
ReVia (naltrexone)
Dont give "C.A.R."within 48 hrs of last drink
Term
Inhibitor vs Inducer
Definition
Inhibitor: Grapefruit, Praxil, Prozac, TCAs
Inducer: smoking
Term
1st vs 2nd vs 3rd Gen Anti-Psychotic
Definition
1st: EPS
2nd: Less EPS, except Risperdal
3rd: Lowest S/E risks
Term
What is he goal of medication administration?
Definition
To achieve a STEADY STATE with a balance metabolism, administration, & medicine distribution
Term
What 2 anticonvulsants reduce the effectiveness of birth ontrol pills?
Definition
Tegretol & Topamax
Term
How do you prescribe medication?
Definition
Taper on, Taper off, & do NOT stop adruptly
Term
What are EPS symptoms?
Definition
Dystonia- irregular muscle movement
Akathesia- restlessness
Akinesia- Can't move
Pseudoparkinsonism- fine tremor, shuffling gailt
Tardive Dyskinesa- tongue & face movements
Uncontrolled chewing movements
Term
What is the duration of action for Haldol & Prolixin?
Definition
2-4 wk duration of action
Term
What drugs can be used for treatment of EPS?
Definition
Benadryl : Antihistamine
Artane : Anticholinergic
Symmetrel : DA Agonist
Inderal : Non-selective Beta Blocker
Cogentin : Anticholinergic
Parlodel : hyperprolactenemia agent & DA agonist
Aspirin
Term
What generation of Antipsychotics does not cause TD?
Definition
Usually not caused by 2nd or 3rd gen.
Only 2nd gen antipsychotic that has EPS is Risperdal
Term
What can be used to treat TD symptoms?
Definition
Vitamin E to 1600 i.u.
Term
What do you monitor with Clozaril?
Definition
WBC & ANC (neutrophil)
Term
What labs should you monitor with Lithium?
Definition
Na, BUN, Creatinine, TSH
Term
How longs does it take BuSpar to take effect?
Definition
7-10 days
Term
What drug as the least & best s/e for the elderly?
Definition
Seroquel
Term
Which SSRI is especially useful for treatment of OCD & anxiety?
Definition
Luvox
Term
Are TCA's P450 Inducers or Inhibitors?
Definition
P450 Inhibitors
Term
T/F: Is lithium broken down by the liver?
Definition
False
Term
What drugs can be used for mania?
Definition
Lithium, Lamictal, Zyprexa
Term
What drugs are FDA approved for Bipolar Disorder?
Definition
Lamictal, Depakene, Depakote, Lithium
Term
What is the biggest risk for atypicals?
Definition
metabolic syndrome (Syndrome X)
Term
Do Paxil & Prozac inhibit or induce the P450 system?
Definition
P450 Inhibitor
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