Shared Flashcard Set

Details

Psychiatric Medications
Psych Meds
41
Nursing
Undergraduate 3
05/05/2012

Additional Nursing Flashcards

 


 

Cards

Term
Typical (First-Generation or "Older") Antipsychotics
Definition
Main therapeutic action: Reduce overt psychotic symptoms (hallucinations, delusional thoughts) by blocking dopamine in specific areas of CNS

Extrapyramidal side effects (EPSE): movement disorders (dystonia, pseudoparkinsonism, akathesia, tardive dyskinesia) caused by dopamine block in EP nerve tracts

Anticholinergic side effects caused by acetylcholine block: dilated pupils, dry mouth, slow urination, constipation; rapid pulse and confusion with high doses
Other side effects: Sedation, weight gain, orthostatic hypotension, changes in endocrine & sexual function, sensitivity to sunlight, lower seizure threshold

Neuroleptic malignant syndrome (NMS) – rare but serious!Severe EPSE plus fever, tachycardia, and hypertension
Term
What are high potency typical antipsychotics?
Definition
HIGH POTENCY

Haloperidol (Haldol)
Trifluoperazine (Stelazine)
Fluphenazine (Prolixin)
Thiothixine (Navane)
Term
What are medium potency typical antipsychotics?
Definition
MEDIUM POTENCY

Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon)
Term
What are the low potency typical antipsychotics?
Definition
LOW POTENCY

Chlorpromazine (Thorazine)
Chlorprothixene (Taracton)
Thioridazine (Mellaril)
Term
Atypical Antipsychotics
Definition
Major therapeutic actions: Reduction of overt psychotic symptoms (similar to older meds); also increase motivation, alertness, & energy (selective serotonin 5-HT-2 blockade)

Side effects
Can cause side effects associated with older meds – EPSE, anticholinergic effects, etc. – but incidence is much lower

Can lead to metabolic syndrome: weight gain, hyperglycemia, hyperlipidemia, increased risk of Type II diabetes and cardiovascular problems

Neuroleptic malignant syndrome (NMS) is rare but does occur with newer drugs
Term
What atypical antipsychotic causes for the patient to get bloodwork done every week?
Definition
Clozapine (Clozaril)* – significant incidence of potentially-fatal agranulocytosis – requires CBC check & prescription refill weekly
Term
Which atypical antipsychotic causes the most amount of weight gain?
Definition
Olanzepine (Zyprexa, Zydis)*
Term
Which atypical antipsychotic causes the least amount of weight gain?
Definition
Asenapine (Saphris)**
Ziprasidone (Geodon)**
Term
What are the names of the atypical antipsychotics?
Definition
Clozapine (Clozaril)*
Olanzepine (Zyprexa, Zydis)*
Asenapine (Saphris)**
Risperidone (Risperdol), Risperdol consta
Paliperidone (Invega, Invega sustaina)
Quetiapine (Seroquel)
Ziprasidone (Geodon)**
Aripiprazole (Abilify)

*Highest incidence of wt. gain
**Least wt. gain
Term
Anticholinergic Antiparkinson drugs used to manage EPSE
Definition
Anticholinergic action (acetylcholine block) causes muscle relaxation that will minimize parkinsonian side effects associated with antipsychotic-induced dopamine block

Anticholinergic side effects include blurred vision to due dilated pupils, dry mouth due to decreased salivation, slowness of urination and peristalsis due to relaxation of smooth muscle in GU and GI tracts. Pt. complaints:
“Can’t see, can’t pee, can’t spit, can’t sh..t!”

REMEMBER: Antipsychotic drugs can also have anticholinergic side effects. When an anticholinergic is used concurrently to manage EPSE the additive effect can be significant. Tachycardia and confusion can occur with large doses.
Term
What anticholinergic and antiparkinson drugs are used to treat EPSE caused by antipsychotics?
Definition
Most commonly used:
Benztropine (Cogentin)
Diphenhydramine (Benadryl)

Other antiparkinsonian drugs could also be used
Term
Benzodiazepine Anxiolytics
Definition
Schedule IV controlled substances

Action – potentiate gamma aminobutyric acid (GABA); effects include sedation, anxiety reduction, skeletal muscle relaxation, treatment of seizures

Most common side effect is drowsiness

Best used short term due to potential for dependence
Term
What are some examples of benzodiazepines?
Definition
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
Chlorazepate (Tranxene)
Term
What drugs are used as substitutions for benzodiazepines?
Definition
Buspirone (BuSpar) – less sedating than benzos and not a controlled substance; takes effect in about 3 weeks, and usually not effective if patient has previously been on benzos

Antihistamines - histamine blockade in CNS causes sedation; not controlled substances; take effect right away, and if effective are very safe alternatives to benzos
Term
What drugs are examples of non-benzodiazepine anxiolytics?
Definition
Buspirone (BuSpar)

Antihistamines:
Hydroxyzine (Vistaril, Atarax)
Diphenhydramine (Benadryl)
Term
Mood Stabilizer: Lithium Carbonate
Definition
Modifies transport of sodium ions across neuronal cell membranes

Narrow margin of safety!

Side effects common at therapeutic blood levels:mild nausea, fine tremor of hands, polyuria

Weight gain over time also common

Toxic effects (seen at higher blood levels) include coarse tremor, poor coordination, severe nausea, vomiting, and diarrhea, dehydration, seizures, coma, death
Term
What are some brand names of lithium carbonate?
Definition
Various brand names: Carbolith, Duralith, Eskalith, Lithane, Lithicarb, Lithizine, Lithobid, Lithonate, Lithotabs, Quilinom
Term
Antileptic Drugs (AEDs) used as Mood Stabilzers
Definition
Possible actions include enhancement of GABA and stabilization of ion transfer across neuronal cell membranes

Most common side effects are sedation, poor coordination, and ataxia

CBC, renal and liver function tests need to be done periodically due to potential toxic effects

valproate/divlporate (depakote, depakene)

carbamazapine (tegretol)

lamotrogine (lamictal)

These 3 are FDA approved as mood stabilizers; however, you may see other AEDs prescribed for this purpose
Term
Which AED requires liver function tests?
Definition
Valproate/divalproate (Depakote, Depakene) – need to monitor liver function tests (LFT)
Term
Which AED requires liver function tests and complete blood counts?
Definition
Carbamazapine (Tegretol) – need to monitor LFT and CBC (can cause agranulocytosis , aplastic anemia, and liver damage
Term
Which AED has the potential to cause Stevens-Johnson syndrome?
Definition
Lamotrogine (Lamictal) – can cause rare but life threatening skin reaction (Stevens-Johnson Syndrome)
Term
SSRI Antidepressants: Selective Serotonin Reuptake Inhibitors
Definition
Inhibition of serotonin increases levels at receptor sites

First line therapy for depression and anxiety disorders

Common side effects: Initial nausea, diarrhea; headache; insomnia; sense of feeling “wired” or “spaced out”

Significant incidence of sexual problems

Rare occurrence of serotonin syndrome
Term
What are some examples of SSRIs?
Definition
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Fluvoxamine (Luvox)
Escitalopram (Lexapro)
Term
Newer Dual Action (Novel) Antidepressants
Definition
Also first line therapy for depression and anxiety disorders - incidence of sexual side effects much lower than SSRIs

Most are SNRIs (Serotonin Norepinephrine Reuptake Inhibitors)

Buproprion (Wellbutrin) is an NDRI (Norepinephrine Dopamine Reuptake Inhibitor)

NOTE: Trazadone is a much older drug used only as a bedtime sedative. Safe to use in combination with SSRIs.
Term
What are some examples of Newer Dual Action Antidepressants?
Definition
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Mirtazapine (Remeron)
Duloxetine (Cymbalta)

Buproprion (Wellbutrin, Zyban)

Trazadone (Desyrel) – Used only as bedtime sedative
Term
Tricyclic Antidepressants
Definition
Older group of antidepressants still widely used

Inhibit reuptake of norepinephrine and serotonin

Significant sedation – take at bedtime

High incidence of anticholinergic side effects

Tachycardia can be problematic

Increased appetite and weight gain common
Term
What are some examples of TCAs?
Definition
Amitriptyline (Elavil)
Amoxapine (Asendin)
Desipramine (Norpramine)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Aventyl)
Protriptyline (Vivactil)
Trimipramine (Surmontil)
Maprotiline (Ludiomil)
Term
Monoamine Oxidase Inhibitors (MAOI Antidepressants)
Definition
Inhibits monoamine oxidase (enzyme that destroys norepinephrine and serotonin)

Not first line therapy due to multiple side effects and risk of hypertensive crisis due to interactions with foods and other medications

Problem foods are those high in tyramine

Problematic medications include some commonly purchased over-the-counter IE Sudafed and other adrenergics

High risk of serotonin syndrome if taken concurrently with other antidepressants
Term
What are some examples of MAOI Antidepressants?
Definition
Phenelzine (Nardil)

Tranylcypromine (Parnate)

Seligiline (EmSam) transdermal patch – does not require dietary modification at standard doses
Term
What are some of the foods that are contraindicated for patients taking MAOIs?
Definition
Aged cheeses
Cured meats, such as sausage, pepperoni and salami
Sauerkraut
Soy sauce
Yeast-extract spreads, such as Marmite
Improperly stored or spoiled foods
Broad bean (fava bean) pods
Banana peels
Tap (draft) beer or unpasteurized beer
Some wines
Term
CNS Stimulants and Other Meds Used in Treatment of ADHD
Definition
Selective increase in CNS levels of norepinephrine improves ability to focus

Appropriate use in ADHD appears to calm person down (paradoxical effect)

Insomnia a problem if med given late in day

Decreased appeatite leading to stunted growth in children may require “drug holidays” on week-ends and/or summer vacations

Recreational use in persons who do not have ADHD causes a “high” and can lead to dependence
Term
What are some examples of CNS stimulants?
Definition
Stimulants that are controlled substances:
Methylphenidate (Ritalin, Concerta)
Amphetamine mixture (Adderal)
Dextroamphetamine (Dexedrine)

Amoxetine (Strattera) – norepinephrine reuptake inhibitor

Pemoline (Cylert) – potentiates action of norepinephrine
Term
Which CNS stimulants for ADHD are contolled substances?
Definition
Methylphenidate (Ritalin, Concerta)
Amphetamine mixture (Adderal)
Dextroamphetamine (Dexedrine)
Term
Which CNS stimulant for ADHD is a norepinephrin reuptake inhibitor?
Definition
Amoxetine (Strattera) – norepinephrine reuptake inhibitor
Term
Which CNS stimulant for ADHD potentiates the action of norepinephrine?
Definition
Pemoline (Cylert) – potentiates action of norepinephrine
Term
What drugs reduce the cognitive decline of alzheimers disease?
Definition
Acetylcholinesterase inhibitors – increase CNS levels of acetylcholine by inhibiting the enzyme that destroys it

N-methyl-D-aspartate (NMDA) receptor antagonists bind with glutamate receptors that may be overactivated in Alzheimer’s disease

Goal of therapy: stabilize cognitive function, delay decline, and improve quality of life

Increased levels of acetylcholine can result in diarrhea and eventual weight loss; especially problematic in very frail patients
Term
Which Alzhiemer medications are acetylcholinesterase inhibitors?
Definition
Donepezyl (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
Term
Which Alzheimers disease medication is a NMDA receptor?
Definition
Memantine (Namenda)
Term
Drugs to promote abstinence in substance abuse patients?
Definition
Synthetic opioids (opiate agonists) bind with opiate receptors in brain and have actions similar to heroin & morphine, but are less potent, less addicting, and can be obtained legally by prescription in US

Opiate antagonists bind with opiate receptors in brain but do not have opiate actions; however they may help reduce cravings for opiates & alcohol

Certain other meds have been noted to help reduce cravings, but their mechanism of action is unknown

Aldehyde dehydrgenase inhibitors block the liver enzyme required to break down alcohol in the body; person who consumes alcohol in any form (alcoholic beverages, alcohol-based cough medicines, deodorants, after-shave lotions, etc) will immediately develop severe nausea!
Term
What are examples of opiate agonist?
Definition
Methadone – opiate agonist that is a Schedule II controlled substance; less potent than heroin & dispensed to hard-core heroin addicts from methadone maintenance clinics

Buprenorphine (Stadol) – partial opiate agonist, less potent than heroin, can be prescribed by private physician

Naltrexone (ReVia, Vivitrol) – opiate antagonist, reduces cravings for opiates and alcohol
Term
What are some other drugs that reduce drug cravings?
Definition
Acamprosate (Camprol)
Clonidine (Catapres)

Disulfiram (Antabuse) – aldehyde dehydrogenase inhibitor used long term to promote sobriety in alcoholics; person taking antabuse must abstain from alcohol in any form to avoid extreme nausea/vomiting
Supporting users have an ad free experience!