Term
| Types of psychotherapeutic drugs |
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Definition
anxiolytic
mood-stabilizing
antidepressant
antipsychotic |
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Term
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Definition
1. unpleasant state of mind characterized by a sense of dread and fear
2. may be based on actual anticipated experiences
3. may be exaggerated responses to imaginary negative situations |
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Term
| Six major anxiety disorders |
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Definition
OCD
PTSD
generalized anxiety disorder (GAD)
panic disorder
social phobia
simple phobia |
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Term
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Definition
mood disorders
change in mood range from mania to depression
some pts exihibit both (bipolar) |
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Term
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Definition
severe emotional disorder that impairs the mental function of the affected individual to the point they cannot participate in activities of daily living
Hallmark: loss of contact w/reality
Examples: schizophrenia and depressive and drug-induced psychoses |
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Term
| Anxiolytic drugs (for anxiety) |
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Definition
| Reduce anxiety by reducing overactivity in the CNS: benzodiazepines (depress activity in the brainstem and limbic system); misc. drug buspirone (BuSpar) - nonsedating and nonhabit forming, may have drug interactons with SSRIs (serotonin syndrome) do not administer with MAOIs |
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Term
| Benzodiazepines (list of drugs) |
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Definition
alprazolam (Xanax)
diazepam (Valium)
lorazepam (Ativan) |
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Term
| Benzodiazepines - Adverse Effects |
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Definition
overexpression of their therapeutic effects
a. decreased CNS activity
b. hypotension
c. drowsiness, loss of coordination, dizziness, headaches
d. nausea, vomiting, dry mouth, constipation
e. others |
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Term
| Benzodiazepines: overdose |
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Definition
1. dangerous when taken with other sedatives or alcohol
2. treatment is genrally symptomatic and supportive
3. flumazenil may be used to reverse benzodiazepine effects |
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Term
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Definition
misc. anxiolytic
1. unknown MOA
2. andministered on a scheduled basis
3. adverse effects: paradoxical anxiety, blurred vision, headache, nausea |
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Term
| Mood-Stabilizing Drugs list |
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Definition
lithium carbonate and lithium citrate
these drugs ma be used with lithium: benzodiazepines; antipsychotic drugs, antiepileptic drugs, dopamine receptor agonists |
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Term
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Definition
drug of choice for treatment of mania
thought to potentiate serotonergic neurotransmission
narrow therapeutic range: maintenance serum levels should range btw 0.6 and 1.2 mEq/L |
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Term
| Before administering lithium to a pt, it is most important for the nurse to assess which lab value? |
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Definition
Sodium
Lithium may become toxic if the pt has hyponatremia. Assess sodium to prevent toxicity |
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Term
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Definition
1. tricyclic antidepressants
2. monoamine oxidase inhibitors (MAOIs)
3. 2nd generation antidepressants
a. Selective serotonin reuptake inhibitors (SSRIs)
b. Serotonin-nonrepinephrine reuptake inhibitors (SNRIs)
c. others |
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Term
| Tricyclic Antidepressants |
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Definition
1. largely been replaced by SSRIs
2. considered 2nd line
3. amitriptyline (Elavil)
3. used of depression, OCDs, adjunctive analgesics for chronic pain, childhood enuresis |
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Term
| Tricyclic Antidepressants - side effects |
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Definition
| sedation, impotence, orthostatic hypotension, in older pts: dizziness, postural hypotension, constipation, delayed micturation, edema, tremors |
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Term
| Tricyclic Antidepressants - overdose |
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Definition
1. Lethal - 70-80% die before reaching hospital
2. CNS and cardiovascular affected
3. death results for seizures or dysrhythmias
4. no specific antidote - use activated charcoal to decrease drug absorption; speed elimination by alkalinizing urine; manage seizures and dysrhythmias, basic life support |
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Term
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Definition
1. highly effective
2. considered 2nd line treatment for depression
3. disadvantage: potential to cause hypertensive crisis when taken with tyramine
4. used for depression that does not respond to other drugs |
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Term
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Definition
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
selegiline (Emsam) |
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Term
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Definition
1. few adverse affects
2. orthostaic hypotension most common
3.tachycardia, dizziness, insomnia, anorexia, blurred vision, palpitations, drowsiness, headache, nausea, impotence |
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Term
|
Definition
symptoms appear 12 hours after ingestin
tachycardia, circulatory collapse, seizures, coma
Treatment- protect brain and heart, eliminate toxin with urine acidification and hemodialysis |
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Term
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Definition
ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, death
AVOID FOODS THAT CONTAIN TYRAMINE!!!! |
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Term
| Foods that contain tyramine |
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Definition
aged, mature cheeses (cheddar, blue, Swiss)
smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, pate)
Yeast extracts
red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans) |
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Term
| Second Generation Antidepressants |
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Definition
fewer adverse effects than tricyclics and MAOIs
very few drug-drug or drug-food interactions
take 4-6 weeks to reach maximum clinical effectiveness
now considered 1st line for depression
indicated for depression, bipolar disorder, obesity, eating disorders, obsessive compulsive disorder, panic attacks, social anxiety, ptsd, myoclonus, substance abuse bupropion is used for smoking cessation |
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Term
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Definition
| 2nd Generation Antidepressants: fluoxetine (Prozac); paroxetine (Paxil); sertraline (Zoloft); fluvoxamine (Luvox); citalopram (Celexa) and escitalopram (Lexapro) |
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Term
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Definition
| venlafaxine (Effexor); duloxetine (Cymbalta); desvenlafaxine (Pristiq) |
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Term
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Definition
| trazodone (Desyrel, Oleptro); bupropion (Wellbutrin); nefazodone (Serzone); mirtazapine (Remeron) |
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Term
| Second Generation Antidepressants - Adverse Effects |
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Definition
CNS - headache, dizziness, tremor, nervousness, insomnia (most common and bothersome), fatigue
GI - nausea, diarrhea, constipation, dry mouth
Other- sexual dysfunction, wt gain, wt loss, sweating |
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Term
| When pts are taking selective serotonin reuptake inhibitors (SSRIs) for the first time for depression, which is most important to monitor during the first few weeks of therapy? |
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Definition
suicidal thoughts
higher risk for suicide during the first few weeks of antidepressant therapy |
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Term
| Serotonin Syndrome Symptoms |
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Definition
Symptoms --- delirium, tachycardia, hyperreflexia, shivering, agitatiion, sweating, muscle spasms, coarse tremors
Symptoms of severe cases --- hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC) |
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Term
| When providing teaching to a pt who is prescribed a selective serotonin reuptake inhibitor (SSRI) which statement will the nurse include? |
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Definition
| The SSRI may take several weeks to have a beneficial effect |
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Term
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Definition
1. used to treat serious mental illness
2. have been known as tranquilizers
Drugs: Thioxanthenes: thiothixene (Navane); Butyrophenones: haloperidol (Haldol); Dihydroindolones: molindone (Moban); Dibenzoxazepine: loxapine (Loxitane); Phenothiazines: three structural groups; atypical antipsychotics: new class |
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Term
| Atypical Antipsychotics - List |
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Definition
| clozapine (Clozaril); risperidone (Risperdal); olanzapine (Zyprexa); quetiapine (Seroquel); ziprasidone (Geodon); aripiprazole (Abilify); paliperidone (Invega) |
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Term
| Antipsychotics - adverse effects |
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Definition
CNS - sedation, delirium
Cardiovascular - orthostatic hypotension, syncope, dizziness, ECG changes
Dermatologic - photosensitivity, skin rash, hyperpigmentation, pruritis
GI - dry mouth, constipation
GU - urinary hesitancy or retention, impaired erection
Hematologic - leukopenia and agranulocytosis
Metabolic/endocrine - galactorrhea, irregular menses, increased appetite, polydipsia |
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Term
Antipsychotics: Adverse Effects
Neuroleptic malignant syndrome (NMS) |
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Definition
potentially life threatening
high fever, unstable BP, myoglobinemia |
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Term
Antipsychotics: Adverse Effects
Extrapyramidal symptoms (EPS) |
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Definition
1. involuntary muscle symptoms similar to those of Parkinson's disease
2. Akathisia (distressing muscle restlessness)
3. Acute dystonia (painful muscle spasms)
4. treatedwith benztropine (Cogentin and triheyphenidyl (Artane) |
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Term
Antipsychotics: Adverse Effects
Tardive dyskinesia (TD) |
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Definition
1. involuntary contractions of oral and facial muscles
2. choreoathetosis (wavelike movements of extremities)
3.occurs with continuous long-term antipsychotic therapy |
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Term
Herbal Products
St. John's Wort |
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Definition
1. Used for depression, anxiety, sleep disorders, nervousness
2. may cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity
3. Severe interactions if taken with MAOIs and SSRIs; many other drug interactions
4. food-drug interaction with tyramine containing foods |
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Term
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Definition
1. 3 varieties; has been used for over 5000 years
2. uses: stress reduction, improvement of physical endurance and concentration
3. may cause elevated BP, chest pain, palpitaitions, anxiety, insomnia, headache, GI symptoms
4. interactins with anticoagulants,immunosuppressants, anticonvulsants, antidiabetic drugs |
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Term
| Nursing Implications - Assessment |
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Definition
obtain liver and renal function tests
baseline vitals including postural BP readings
assess physical and emotional state of pts |
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Term
| Nursing Implications Implementation |
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Definition
make sure pt swallows drugs
explain drug effects and time it takes to start working simply
avoid abrupt withdrawal; change positions slowly
Combine drug therapy w/psychotherapy (learn to cope)
only small amounts of meds at a time to minimize risk of suicide
DO NOT USE WITH ALCOHOL OR SEDATIVES - fatal |
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Term
| Nursing Implications - Antianxiety drugs |
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Definition
| In elderly pts monitor closely for oversedation and profound CNS depression |
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Term
| Nursing Implications - Antidepressants |
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Definition
1. many cautions, contraindications, and interactions
2. may take several wks to be therapeutic
3. monitor for suicidal tendencies, provide support
4. assist elderly or weakened pts w//ambulation and other activities - falls may occur b/c of drowsiness or postural hypotension
3. Tricyclics may need to weaned and discontinued before surgery (interactions w/ anesthetics)
4. encourage to wear ID bracelets naming drugs taken
5. caffience and sigarette smoking decrease effectiveness
6. with MAOIs instruct pts and family regarding tyramine foods and signs and symptoms of hypertensive crisis |
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Term
| Nursing Implications - Antipsychotics - phenothiazines |
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Definition
1. sunscreen/ photosenstivity
2. avoid taking antacids or antidiarrheal preparations within 1 hour of a dose
3. Inform pts to avoid alcohol or other CNS depressents
4. long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups - report to dr.
5. oral forms may be taken with meals to decrease GI upset
6. drugs may cause drowsiness, dizziness or fainting, change positions slowly |
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Term
A pt is admitted into ER. Pts hr is 112 beats/min; sweating, muscle tremors and agitated. Admits to taking too many pills.
1. what does the nurse suspect is happening w/pt?
2. What treatment does the nurse expect to implement? |
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Definition
1. ask what med prescribed, how long pt has been taking it and how much they have currently taken. Include serotonin syndrome for a possible reason for pt's symptoms
2. treatment for serotonin syndrome includes discontinuation of SRIs and supporting the pt to maintain homeostasis |
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Term
| The pt recovered, what information will nurse include in pt teaching about SSRIs? |
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Definition
| It usually takes 4-6 wks for you to experience benefits from med. Take med with food. Take SSRIs in morning to prevent sleep disturbances |
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Term
| Pt quits taking SSRI because he feels better. What should nurse say? |
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Definition
| A 1 to 2 month taper period is indicated to prevent adverse effects of abrupt drug discontinuation. Adverse effects can include dizziness, diarrhea, worsening depressive mood disorder. Serotonin syndrome is a result of taking too much med. no evidence of drug dependency associated with use of SSRIs. |
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Term
| The newest generation fo antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac) are related to |
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Definition
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Term
| Antidepressants such as SSRIs and SNRIs take _______ weeks to notice therapeutic effects. It is contraindicated for pts having ____________ as it is a black-box warning. |
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Definition
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Term
| SSRI, particularly __________________ has side effect of ___________ in up to 30%. |
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Definition
| fluoxetine (Prozac); sexual dysfunction |
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Term
| Herbal therapy (St. John's wort et. al.) may cause severe interactions with |
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Definition
| antidepressants, particularly with SSRIs |
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Term
| MAOIs are for ________________. All foods containing _______________ should be avoided because it causes hypertensive crisis. |
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Definition
| depression; tyramine (wine=cheese effect) |
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Term
| Use of tricyclic antidepressants such as amitriptyline, when combined with warfarin results in an |
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Definition
| increased anticoagulant effect |
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Term
| The therapeutic effects of the antipsychotic drugs include improvement in |
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Definition
| mood and affect and alleviation of psychotic symptoms and episodes. Emotional instablility, hallucinatiions, paranoia, delusions, garbled speech, an inability to cope should abate once the pt has been on meds for several weeks |
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Term
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Definition
Serum levels greater than 1.5 to 2.5mEQ/L begin to produce toxicity.
symptoms include GI discomfort, tremor, confusion, somnolence, seizures, and possibly death. The most serious is cardiac dysrhythmia. Other effects include drowsiness, slurred speech epilepsy type seizures, choroathetotic movements, ataxia, hypotension. |
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Term
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Definition
1. anxiolytic drug
2. aka Xanax
3. most commonly used as an anxiolytic
4. used for panic disorder
5. adverse effects confusion, ataxia, headache
6. orally dissolving tablet indicated for short term relief of anxiety symptoms |
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Term
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Definition
1. most commonly prescribed, but not for anxiety (it is an antianxiety drug)
2. longest acting -
3. relief of anxiety, alcohol withdrawal, reversal of status elepticus, preoperative sedation, adjunct for muscle spasms
4. can accumulate in pts w/hepatic dysfunction |
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Term
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Definition
1. TCA - Tricyclic antidepressant
2. oldest and most widely used
3. originally for depression, now more commonly used for neuropathic pain and insomnia
4. contraindications - MI, and pregnancy
3. very potent anticholinergic - adv. eff include dry mouth, constipation, blurred vision, urinary retention, dysrhythmias only oral |
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Term
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Definition
1. 2nd Generation antidepressant
2. first SSRI marketed for depression
3. also indicated for bulimea, OCD, panic disorder, premenstrual dysphoric disorder
4. contraindications concurrent MAOI therapy
5. anxiety, dizziness, drowsiness, insomnia, |
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Term
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Definition
1. 2nd Generation Antidepressants
2. also indicated for cessation of smoking,
adjunct for pts receiving sexual adverse effects secondary to SSRI therapy |
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Term
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Definition
| 1. advantageous properties: reduced effect on prolactin levels, improvement of the negative symptoms associated with schizophrenia,lower risk for neuromuscular malignant syndrome, extrapyramidal adverse effects, and tardive dyskinesia |
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Term
| Buspirone is indicated for the treatment of _______________ disorders. |
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Definition
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Term
| Use of tricyclic antidepressants (TCA) such as amitriptyline, when combined with warfarin, results in an __________________ anticoagulant effect. |
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Definition
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Term
| extrapyramidal symptoms are manifested by ____________ and _______________ twitching |
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Definition
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Term
| Phenothiazines produce ______________-like adverse effects of dry mouth, urinary hesitancy, and constipation |
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Definition
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Term
| The herbal product ______________ should not be sued with SSRIs. Potential intractions include confusion, agitiation, muscle spasms, twitching and tremors. |
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Definition
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