psychiatric meds

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Psychiatric medications: Role of the Nurse: 1.assess if meds change behavior
2.causes S.E
3.proper adm of meds
4.aware of interactions w/o meds
5.pt/fm edu. reg. meds
Goal of medication administration: -achieve a steady state
balance b/w competing metabolism, elimination and distribution of meds.
The longer the 1/2 life of the medication will cause what effect?: The drug will be in pts body longer
in order for psych drugs to cross the blood brain barrier they must be?: lipid soluble
Blocks CNS receptors work on neurotransmitters blocks dopamine 2 receptor, causes decrease in D2 receptivity?: Antipsychotic medications
An 80% block of D2 may cause what side effects?: EPS: extrapyramidal
-
What do Extrapyramidal tract consist of ?: motor neurons from the brain to parts of the spinal cord. role: gross motor movements
Name the symptoms of EPS?(5): 1.Dystonia
2.Drug induced Parkinsonism
3.Akathisia
4.Dopamine-acetylcholine imbalance in EPSystem
5.Tardive Dyskinesia
sustained involuntary muscle contractions. (torticollis,opisthotonos,oculogyric): Dystonia
twisting of the neck: Torticollis
spasms of the neck, forcint it to bend backward: Opisthotonos
crisis-a fixedupward stare, seen with 1st generation antipsychotic: Oculogyric
cogwheeling, tremor, pill rolling of fingers, regular rhythmic oscillations of extremities: Drug induced parkisonism
restless, not able to sit, need to keep moving(confused with anxiety): Akathisia
hallucinations, dry mouth, blurred vision, decreased absorption of antipsychotics, decrease gi motility, tachycardia and urinary retention: Dopamine-Acetylcholine Imbalane in the extrapyramidal system
late onset after tx c antipsychotics, irreversible abnormal mvmts,lip smacking,tongue protrusion,rocking, foot tapping: Tardive Dyskinesia
Medications used to prevent EPS are?: Cogentin
Benedryl,
Artane,
antiparkisonian agents
Other S.E of EPS?: Increase BSL(diabetic sx)
high prolactin levels(d/c milk in females
What class of meds interfer with normal transmission of nerve impulse by acetylcholine and epinephrine centrally and peripherally?: Anticholinergic
Antiadrenergic
Anticholinergic S.E?: 1.dry mouth
2.blurred vision
3.constipation
4.urine retention/hesistency
5.paralytic ileus(rare)
Antiadrenergic S.E.?: orthostatic hypotension:falls,check BP standing and sitting
Neuroleptic malignant syndrome-severe and life threatening name S.E?: 1. muscle rigidity
2. hyperpyrexia(fever)
3. aloc
4. diaphoresis
Watch for interactions w/o drugs or herbal preparations. Give an example?: OTC Tagamet can reduce the effectiveness of antipsychotics.
Which class of meds used to tx psychosis (schizo),(bipolar d/o manic phase?How does it work?: Antipsychotic meds
-decreases agitation,
belligerence,uncooperativenes
confusion
delusions
hallucinations
What effect does antipsychotic meds have on patients? Choice of meds depends on? Route?: Sedating
sx,individual rspnse,past exp
IM(rapid effect,emergent situations)
Causes of older antipsychotic? avoid giving to? if exposed to sun may cause?: Increase EPS symptoms
orthostatic hypotension
Elderly(Thorazine)
Skin Rash
Lacting acting form of antipsychotics?Route? lasts?purpose?: Deconate(prolixin,haldol)
IM, 2-4wks,
stabilize behavior,increase compliance
Newer antipsychotics(2nd generation/atypicals)TX what sx?: positive and negative
-represent deficit-withdrawal,
lack of energy and interest
flat affect
alogia(lack of speech)
avolition(no motivation)
Reason for 2nd generation S.E?: Affinity for D2(dopamine) and 5HT(serotonin)receptors
(low D2,high 5HT)
addlt: antidepressant effect(low suicidal potential)
S.E of clozapine? what must be checked?: Agranulocytosis(low WBC's)
CBC weekly
Zyprexa comes in what form? FDA approved for use in? S.E?: SL form(Zydis)
mania
weight gain
Acts as 5HT(serotonin)sometimes (NE)to decrease reuptake and increase availability in the synapse?: Antidepressants
Antidepressants helps to improve what symptoms?: Mood loss of interest
inability to exp pleasure
EMA(early am awakeness)
psychomotor agitation/retardation
wt changes guilt
SIGEGAPS take several weeks to achieve a therapeutic blood level, must educate pt?: Not to expect immediate effect
Define SIGEGAPS?: change in sleep -chgs appetit
loss of intererest
guilt -psychmtr chngs
low energy -suicide
low concentration
Blocks reuptake of 5HT and NE: Tricyclics (TCA's)
What should it be used cautiously?: easy to overdose, commit suicide
How should it be prescribed?: small supply (4dys worth)
once daily: 1/2 life=24hrs
Side effects of TCA's: Weight gain
cardiac changes(ekg prior adm
It TCA combined with SSRI will cause? If combined with antipsychotic?: 1.Serious cardiac effects
2.high anticholinergic effect
(problem for elderly)call MD
Tofranil
Elavil
Pamelor
interfer with enzyme responsible for the breakdown of Neurotransmitters?: MAOIs
monoamine oxidase inhibitors
1.Describe MAOIs how it works? 2. Side effects?: 1.long acting metabolites
(wait 2wks before starting new antidepressants)
2.hepatic necrosis, HTN crisis
HTN crisis leads to ICB caused by?: eating foods high in tyramine
signs of impending HTN crisis?: headache
stiff neck
N/V
increase BP
Which foods contain Tyramine? pickled, fermented,smoked,aged Meat and Fish: -pickled herring
dried fish
unrefrigerated fermented fish
liver,caviar,fermented sausage(bologna,salami,pepperoni,summer sausage)HOISON SAUCE;(fermented oyster sauce,used in oriental dishes
decrease depression and suicide, decrease OCD? main reason for use?: 1.SSRIs
2.safe not lethal
3.low risk birth defects
do not give SSRI with what, may cause fatal interaction?: MAOI and SSRI(prozac)
Name SSRI: celexa,lexapro,luvox,paxil(more sex se.) prozac, zoloft
Other S.E of SSRI?: GI symptoms sexual dysfunct
agitation
wt loss/gain
dizziness
Name new generation antidepressants?(block reuptake): effexor:inhibits 5HT and NE
wellbutrin: inhibits D2 & NE
(used smoking cessation)
(no wt gain,no sexual dysfunc
Lithium(lithobid) is what class of meds?: antimanic agents(mood stabilizer)
1.Lithium use best for? 2.long term use may cause?: 1.decreasing suicidality
2.thyroid/kidney problems
(good salt/water intake)
therapeutic levels of lithium?: 0.5 -1.0 maintenance
1.0-1.5 therapeutic range
>1.5 toxic
very narrow range, check blood levels before admini. SS of lithium toxicity?: V/D/lethargy, muscle twitching
Anticonvulsants can be used to stabilize mood. Name some meds? NEVER STOP ABRUPTLY, SEIZURES: tegretol and depakote
Neurontin,lamictal(rash)
topamax(wt loss)
trileptal
act by increasing GABA(inhibitory): Anxiolytics
Precautions with anxiolytics why?: dependency(physical/mental)
addiction and tolerance
anxiolytics can cause? to treat? RELIEF TEMP,PT MUST COPE WITH ANXIETY.: disinhibition,induce sleep,
to tx withdrawal and detox
decrease N/V from chemo
decrease mvmt d/o
NAME ANXIOLYTICS: 1.BENZOS(XANAX,ATIVAN,LIBRIUM,VALIUM,HALCION
2.OTHERS: BUSPAR(LESS DEPENDENCY GOOD FOR PT WITH DUAL DX OR RECOVERING SUBST DEPENDENT,LESS SEDATING.
USE IT THE TX OF DEMENTIA WHICH IS THOUGHT TO BE CAUSED BY AN IMBALANCE B/W DOPAMINE AND ACETYLCHOLINE?: ACETYLCHOLINESTERASE INHIBITORS
CHOLINERGIC SYSTEM INVOLVE WITH EXECUTIVE FUNCTIONING?: LOGICAL THINKING
MEMORY
PROBLEM SOLVING
RECOGNITION
ALZHEIMERS PTS HAVE DEFICITS WITH ?: ACETYLCHOLINE NEUROTRANSMITTER.
MEDS: ARICEPT, eXELON
WHAT ARE CATACHOLAMINES?: DOPAMINE
EPINEPHRINE
NOREPINEPHRINE
BLOCKS ALL DOPAMINE RECEPTORS,IN THE LIMBIC AREA, REDUCES SX OF PSYCHOSIS,ORGANIZES THOUGHTS: CONVENTIONAL ANTIPSYCHOTIC
thorazine
prolixin
haldol
mellaril
S.E OF CONVENTIONAL ANTIPSYCHOTIC: EPS,TD,NMS,ANTICHOLINERGIC EFFECTS,SEDATION,ORTHOSTATIC HYPOTENSION,PHOTOSENSITIVITY,HIGH PRL,LOW LIBIDO,LOW ORGASM,WT GAIN
blocks D2 receptors,reduces pos sx and improves neg sx of psychotic d/o, reduces mania?: Atypical antipsychotic
abilify seroquel
clozaril risperdal
zyprexia geodon
S.e of atypical antipsychotic?: less eps,more anticholinergic effects
restores dopamine:acetylcholine ratio, increase levels of dopamine?: Adjunctive medication to counteract EPS of high potency antipsychotics
CONGENTIN
BENADRYL
SYMMETREL
s.E OF ADJUNCTIVE MED TO COUNTERACT EPS OF HISH POTENCY ANTIPSYCHOTIC?: ANTICHOLINERGIC EFFECTS
NAUSEA DIZZINESS
GI UPSET LOW BP
SEDATION EXACERBATION
INCREASE FUNCTIONAL LEVELS OF NEUROTRANSMITTERS DECREASE DEPRESSION,ANXIETY,PANIC,OCD,GAD?: ANTIDEPRESSANTS
WELLBUTRIN NARDIL EFFEXOR
PROZAC ZOLOFT
PAXIL PARNATE
SE: OF ANTIDEPRESSANTS?: ANTICHOLINERGIC EFFECTS
SEDATION
LOW BP
LOW SEIZURE THRESHOLD
HIGH HR,MULT SEX SE
CAUSES CNS DEPRESSION BY POTENTIATING EFFECTS OF GABA IN LIMBIC SYSTEM, DECREASE ANXIETY,PANIC,OCD,GAD?: ANTIANXIETY
XANAX KLONOPIN
TENORMIN* VALIUM
BUSPAR* ATIVAN
LIBRIUM RESTORIL
SE OF ANTIANXIETY?: DROWSINESS
CONFUSION
LETHARGY
PHYSICAL/MENTAL DEPENDENCE
TOLERANCE,
ANTIMANIC,DECREASE IMPULSIVITY,AGGRESSION,MOST ANTICONVULSANTS INCREASE LEVEL OF GABA?: MOOD STABILIZER:
TEGRETOL CATAPRES
NEURONTIN LAMICTAL
TOPAMAX DEPAKOTE
LITHOBID
SE OF MOOD STABILIZER:: DROWSINESS,DIZZINESS,UNSTEADYGAIT,LOW MENTAL ALERTNESS,N/V,
AGRANULOCYTOSIS,LIVER DAMAGE
CNS STIMULANTS POTENTIATE NOREPINEPHRINE,EPI,DOPAMINE: TO TX ADHD,TOURETTES D/O CAUSES: INCREASE ALERTNESS,BY BLOCKING OUT IRRELEVENT THOUGHTS AND IMPULSES: STIMULANT:
CYLERT
DEXEDRINE
ADDERAL
RITALIN
SE OF STIMULANTS:: TREMOR,RESTLESNESS,ANOREXIA,
INSOMNIA
AGITIATION
MAJOR NEUROTRANSMITTER CHANGES IN DELIRIUM: 1.DOPAMINE 2.SEROTONIN 3.ACETYLCHOLINE 4.GABA: 1.INCREASED:USE ANTIPSYCHOTIC
2.DECREASED:
3.DECREASED:AVOIC ANTICHOLINERGIC AGENTS
4.INCREASED:AVOID BENZOZ
NEUROTRANSMITTERS CHANGES IN PSYCH D/O: BIPOLAR MANIC:: DA GABA GLUTAMATE
BIPOLAR DEPRESSED:: 5HT NE BABA
UNIPOLAR DEPRESSED:: 5HT NE
PSYCHOSIS:: DA 5HT
ADHD:: DA NE
ANXIETY D/O: 5HT GABA
DELIRIUM:: DA 5HT NE GABA
GLUTAMATE
ACH
NEUROTRANSMITTERS ACTION OF PSYCHOTROPIC MEDICATIONS: 1.BIPOLAR MANIC 2.BIPOLAR DEPRESSED:: 1. DA 5HT NE GABA GLUT

2. DA 5HT NE
CHANGES IN PSYCHOTROPIC MEDS: UNIPOLAR DEPRESSED:: DA 5HT NE
CHANGES IN PSYCHOTROPIC MEDS: PSYCHOSIS:: DA
CHANGES IN PSYCHOTROPIC MEDS: ADHD:: DA NE
CHANGES IN PSYCHOTROPIC MEDS: ANXIETY DISORDER:: 5HT GABA

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