Term
Antipsychotic Medication Typical and Aytipical |
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Definition
Typical or conventional: haloperidol (Haldol); chlorpromazine (Thorazine) Atypical: clozapine (Clozaril); olanzapine (Zyprexa) |
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Term
| Antidepressants to know for test |
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Definition
SSRI (selective serotonin reuptake inhibitor): fluoxetine (Prozac); sertraline (Zoloft)
TCA (tricyclic antidepressant): amitriptyline (Elavil)
MAOI (monoamine oxidase inhibitor): phenelzine (Nardil)
Newer generation or atypical antidepressant: bupropion (Wellbutrin, Zyban)
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Term
| Mood stabilizers to know for test |
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Definition
Lithium carbonate (Lithobid)
Anticonvulsant: carbamazepine (Tegretol)
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Term
| Antianxiety meds to know for test |
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Definition
| Benzodiazepine: lorazepam (Ativan); chlordiazepoxide (Librium) |
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Term
| Medications used for the treatment of EPS (extrapyramidal side effects): |
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Definition
Anticholinergic: benztropine (Cogentin)
Antihistamine: diphenhydramine (Benadryl) |
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Term
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Definition
| For psychosis and agitation. They are the foundation of treatment for serious long term mental disorders, such as schizophrenia. You must know that these meds have many serious side effects that can be lethal, including extrapyramidals.e. (EPS), neuroleptic malignant syndrome (NMS), agranulocytosis(clozaril), photosensitivity, & cardiac problems (geodon- QT prolongation). |
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Term
| What other problems do Antipsychotics cause in relation to anticholinergicside effects? |
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Definition
| orthostatic hypotension, sedation, seizures, hyperglycemia, substantial weight gain (newer meds) and elevated prolactinlevels can also cause serious problems. |
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Term
| What do older antipsychotic meds do to dopamine? |
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Definition
| They block dopamine, but have significantly more side effects than newer meds. |
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Term
| Depending on the med, what do newer "Atypical" antipsychotics do? |
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Definition
| Have less s.e. and regulate serotonin, norepi, and dopamine to various degrees depending on the med. |
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Term
| Will assesment be easy with psychotic patients? |
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Definition
| Assessment of side effects will be more difficult with a psychotic patient since these patients often have difficulty communicating. Look for combinations of meds that increase sedation. |
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Term
| Can Antacids, caffeine, and smoking reduce the effectiveness of some of these meds (antipsychotics)? |
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Definition
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Term
| Older antipsychotics still in use: |
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Definition
These help decrease hallucinations and delusions (known as “positive” symptoms) but do not help apathy, social withdrawal (“negative” symptoms) and sometimes make these worse.
High potency antipsychotic: Haldol –Older antipsychotic. Tends to have more EPS, less sedation. Small doses used, especially in geriatric cases.
Low potency antipsychotic: Thorazine (old phenothiazine)- Orthostatic hypotension, more sedation, decreased gag reflex. One of the first antipsychotics, introduced more than 50 years ago.
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Term
| What are long acting forms of Pscychotropic meds? |
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Definition
Prolixin & haldol “decanoates” in oil base (older); risperdal“consta”(newer , water based slowly dissolving microspherepolymers) .Sometimes called “depot” meds. Injected I.M. q 2 wks with better compliance, but s.e. cannot be as easily controlled as with shorter acting p.o. forms.
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Term
| Newer, atypical antipsychotics are |
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Definition
| Clozaril, risperdal, zyprexa, seroquel, abilify, geodon. These affect a different neurotransmitter(s) than older antipsychotics. Older ones block dopamine; newer ones affect serotonin, norepinephrine, and/or dopamine. |
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Term
| Explain some side effects of Newer, atypical antipschotics. |
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Definition
| Less or no EPS and anticholinergiceffects but some sedation, dizziness, HA, constipation. Substantial weight gain is a big problem with most of these and can lead to obesity and diabetes. |
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Term
| Does Abilify and geodon cause weight gain? |
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Definition
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Term
| If you take geodon with food, is absorption enhanced? |
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Definition
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Term
| Geodon can cause what types of problems? |
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Definition
| geodon can cause cardiac problems (QT prolongation leading to sudden death) |
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Term
What kind of problems can Abilify cause? What was it recently approved to manage? |
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Definition
It can cause some akathisia. Manages acute mania |
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Term
| Explain some positive results from the newer antipsychotics.. |
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Definition
| The newer antipsychotics help “negative or deficit” symptoms (apathy, social w/d, lack of motivation) as well as “positive” symptoms (hallucinations, delusions). Reduced side effects and better control of symptoms has resulted in more use of these newer medications. |
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Term
| Major side effects of antipsychotics in general (mostly with older antipsychotics) |
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Definition
- *Extrapyramidalside effects: Occurs in at least 20% of pts and some sources report much higher percentage. Due to dopamine blockade. Especially with high potency ones
- Dystonia(muscle contractions of neck, jaw, back, “oculogyriccrisis” & risk of laryngospasm and airway problems).
- Akathisia(restlessness, cannot stop moving, “jumping out of their skin”).
- Pseudoparkinsonism(like real thing, shuffling gait, tremors, mask like face, akinesia, “cogwheel” rigidity.
- Tardive dyskinesia(TD-irreversible and involuntary mouth and torso movements with lip smacking, chewing, blinking, tongue thrusting, cheek puffing).
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Term
| *Extrapyramidalside, Dystonia and Akathisia can be treated with what? |
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Definition
These types of EPS can be treated with cogentin(an anticholinergic, antiparkinsonianmed) or benadryl, I.M. (if dystonia severe and cannot swallow) or p.o. Cogentin or benadryl will reduce akathisia which is sometimes mistaken for anxiety. More antipsychotic medication will make akathisia worse. |
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Term
| Can vitamin E cure T.D.(tardive dyskinesia)? |
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Definition
| No. It can only help symptoms. |
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Term
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Definition
| Prevention is key through screening with the Abnormal Involuntary Movement Scale (AIMS test) performed on a regular basis. Note tremors, shuffling gait, cogwheel rigidity, restlessness since easy to observe. |
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Term
| What is an early sign of tardive dyskinesia (TD)? |
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Definition
| Vermicular (worn like) tongue movements. |
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Term
| Neuroleptic malignant syndrome (NMS) is an antipsychotic side effect. Explain |
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Definition
Rare but can be lethal. Monitor VS, assess for lead pipe rigidity of limbs, muteness, incontinence, increased/ fluctuating VS, increased BP, fever, confusion. Hold meds; notify on-call immediately.
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Term
| Agranulocytosis is an antipsychotic side effect. Explain |
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Definition
| Rare but can be lethal. Note infection, sore throat, fever, and notify primary care provider immediately. Monitor WBC lab biweekly for agranulocytosis. |
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Term
| Photosensitivity is an antipsychotic side effect. Explain |
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Definition
| Can be lethal if sunburn is severe. Avoid peak sun hrs, use sunscreen (15+), protective clothing. |
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Term
| Orthostatic hypotension is an antipsychotic side effect. Explain |
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Definition
Falls are common. Instruct to rise slowly, monitor VS in 3 positions.
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Term
| Sedation. Antipsychotic side effect. Do you mix with alcohol or other sedating drugs? |
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Definition
| Do not mix with alcohol or another sedating drug |
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Term
| Explain Anticholinergic effects |
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Definition
Serious problem. Note constipation, urinary retention, dry eyes, mouth. The treatment for EPS (cogentin, an anticholinergicitself) can lead to additional anticholinergiceffects on top of those caused by the antipsychotics. Severe impaction and urinary retention can be huge problems. Even anticholinergic psychosis can occur. Good dental care needed to prevent decay. Use sugarless candy, push fluids, bulk in diet, monitor well.
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Term
| A side effect of antipsychotic meds, explain weight gain... |
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Definition
| Most of the newer meds cause this due to markedly increased appetite. Abilify and geodon do not cause this but have their own problems. A high percentage, perhaps as high as 40%, become obese (defined as greater than 20% overweight) and/or diabetic. |
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Term
| Antipsychotics can cause seizures. True or False? |
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Definition
| True, some of these lower seizure threshold. |
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Term
| With antipsychotic meds, can prolactin levels increase? |
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Definition
| Yes, and they can cause breast enlargement. |
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Term
| What key safety issues are associated with antipsychotic meds? |
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Definition
| ??? not sure. need to find out... |
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Term
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Definition
| Mostly for depression, but also panic, PMS, social phobia, addictions. Four basic types- SSRI’s; atypical others; tricyclics; MAOI’s. SSRI’s are used most and have few s.e. that are troubling except for sexual problems. Tricyclics and MAOI’srarely used now d/t s.e. |
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Term
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Definition
| cardiac dysrhythmias, orthostatic hypotension, sedation, anticholinergiceffects, and rarely some EPS and O/Dis quite lethal. |
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Term
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Definition
| a low tyramine diet to prevent hypertensive crisis. |
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Term
| How long do antidepressants take to work? |
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Definition
| All of these take about a month to really work, although some effects may be seen in 2 wks. |
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Term
| Do you mix MAOI AND SSRI? |
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Definition
No! Separate by at least 2-5 weeks. Combining could cause serotonin syndrome and be lethal. There are new “black box” warnings r/t possible suicidal impulses on SSRIs.
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Term
| List some SSRI's and their problems. |
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Definition
| Prozac, zoloft, paxil, celexa, lexapro. (All can cause HA, insomnia, tremors, sedation, wt. loss/gain, sexual probs but lexapro may have less sexual s.e.), luvox-for OCD. Cymbaltais a new SSNRI (inhibits reuptake of serotonin and norepi) that helps relieve the “physical problems associated with depression”. |
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Term
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Definition
| Elavil, tofranil, sinequan, norpramin (Cardiac probs, orthostatic hypotension, sedation, anticholinergic effects) |
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Term
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Definition
| Nardil, parnate (Low tyramine diet: Nothing pickled, aged, fermented plus a few other foods! Many cheeses, wines, beer, are out. Hypertensive crisis: stiff neck, high BP, severe HA. Requires emergency treatment. |
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Term
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Definition
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Term
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Definition
| Wellbutrin, also known as Zyban for nicotine addiction (do not use with patient with seizures or anorexia), effexor, remeron (work on 2 neurotransmitters-norepi and serotonin), desyrel(often used for sleep; can cause priapism), serzone |
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Term
| What are the key safety issues with antidepressants? |
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Definition
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Term
| Mood stabilizers/antimanics |
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Definition
| Used with bipolar disorder and other mood disorders. Lithium requires good renal fx, close monitoring of lithium levels, and essential fluid balance and normal salt intake. Dehydration will lead to lithium toxicity which could lead to seizures, coma, death. Anticonvulsants like depakote, tegretol, and neurontin are getting more popular and have less side effects. |
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Term
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Definition
A cool Nirvana song... No really... Lithium level around 1.0 is good. Range is 0.8-1.2 in most books. Getting toxic above 1.5. Mild s.e.: Increased thirst, urination. Diarrhea, nausea, vomiting which can lead to dehydration and toxicity. Severe toxicity: Decreased urine output, seizures, confusion, coma, death. Pt. should report probs early, avoid diuretics, and dehydration in summer and do not restrict salt. Monitor levels a few times a wk inpt and every 3-6 mons as outpt.
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Term
| Tegretol, Depkote, Neurontin |
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Definition
| Monitor blood levels, blood dyscrasias with tegretol and depakote. Depakote: also wt. gain, tremors, g.i. upset. |
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Term
| What are the key safety issues with mood stabilizers/antimanics ? |
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Definition
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Term
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Definition
Used for anxiety, detox, sleep. Safe when not overused, mixed with alcohol, other sedating drugs. Major withdrawal sxis seizures which can occur up to wk later. Can cause drowsiness, ataxic gait, slurred speech. Addictive for addicts. W/D from causes anxiety, insomnia. Enc. other coping methods before going straight to meds like exercise, relax. techniques, calling someone, music, bath, etc.
Benzodiazepines: Librium, ativan, xanax, serax (effective for detox and anxiety)
Non-benzodiazepine: Buspar, vistaril (these two not addictive), ambien |
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Term
| What are the key safety issues associated with Antianxiety/anxiolytics? |
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Definition
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Term
Antipsychotics (also called major tranquilizers/neuroleptics) Mechanism of Action w/Older Meds and Newer "atypical" meds. |
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Definition
Older meds: Block dopamine chlorpromazine (Thorazine) haloperidol (Haldol) Newer “atypical” antipsychotic meds: work on serotonin and/or dopamine · clozapine (Clozaril)
· risperidone (Risperdal)
· olanzapine (Zyprexa)
· ziprasidone (Geodon)
· aripiprazole (Abilify)
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Term
| Therapeutic Uses of Antipsychotics |
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Definition
Schizophrenia; psychotic depression; acute mania; some toxic and organic states; agitation. Older meds work best on "positive" symptoms such as hallucinations, delusions.
Newer meds also work on "negative or deficit" sx such as apathy,social withdrawal. |
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Term
| Hi and Low Dose for Antipsychotics |
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Definition
High potency (haldol): Less sedation, more EPS
Low potency (thorazine): More sedation, less EPS |
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Term
| Routes for Antipsychotics |
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Definition
P.O.; I.M.; Decanoate forms and Risperdal Consta: I.M.,long acting (2-4 weeks)
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Term
| Adverse Effects (AE)/Side Effects (SE) of antipsychotics |
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Definition
Older meds: Example: haloperidol (Haldol) (high potency):
Movement disorders, also known as extrapyramidal side effects (EPS) Newer meds:
May cause significant weight gain, diabetes
Note: agranulocytosis seen w/clozapine (Clozaril)
All antipsychotics: photosensitivity, sedation, and orthostatic hypotension, anticholinergic effects
Other AE/SE to note:
Rare, dangerous SE with some antipsychotics: neuroleptic malignant syndrome(NMS)
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Term
Define the following Extrapyramidal Side Effect (EPS) Dysotnia |
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Definition
| muscle contractions (neck, jaw, & back); laryngospasms |
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Term
Define the following Extrapyramidal Side Effect (EPS) Akathisia |
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Definition
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Term
Define the following Extrapyramidal Side Effect (EPS) Pakinsonism (pseudoparkinsonism) |
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Definition
| looks like Parkinson’s symptoms; from the dopamine blockade |
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Term
Define the following Extrapyramidal Side Effect (EPS) Tardive dyskinesia (TD) |
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Definition
| AIMS test; "vermicular" tongue movements may be one of the earliest signs. Irreversible mouth and torso movements. |
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Term
Patient teaching (Nursing Implications/Lab) |
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Definition
- A.I.M.S. test done on a regular basis
- Don’t mix with other sedating meds, drugs of abuse, OTC, alcohol
- Don’t withdraw abruptly
- Cautious use if pregnant
- Check for agranulocytosis every 2 wks with clozapine (Clozaril)
- Antacids reduce absorption, caffeine also may reduce effects
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Term
| Meds used to treat side effects of antipsychotic drugs |
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Definition
benzotropine (Cogentin) and diphenhydramine (Benadryl) Give IM or PO.
*Neither work for TD because TD is irreversible. |
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Term
| What's the diff btwn Akathisia and Anxiety? |
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Definition
Akathisia: Motor restlessness—a distressing experience of uncontrollable muscular movements that can occur as an adverse effect of many psychotropic medications.
Anxiety: The unpleasant state of mind in which real or imagined dangers are anticipated and/or exaggerated. |
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Term
Antidepressants:Know mechanism of action and neurotransmitters affected. SSRI's. |
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Definition
Also called serotonin selective reuptake inhibitors. Any of a heterogenous group of newer medications used to treat depression and certain other mental illnesses. They work by selectively reducing postsynaptic reuptake of the neurotransmitter serotonin in the brain.
· fluoxetine (Prozac)
· sertraline (Zoloft)
· paroxetine (Paxil)
· citalopram (Celexa)
· escitalopram oxalate (Lexapro)
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Term
Antidepressants TCAs (cyclics) |
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Definition
A chemical class of antidepressant drugs that block reuptake of the amine neurotransmitters serotonin and norepinephrine. They are so named because their chemical structures include a distinctive three-ring segment.
They are also associated with serious adverse effects. Therefore, patients taking them need to be monitored closely. TCA overdoses are notoriously lethal.
aminotriptyline (Elavil) |
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Term
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Definition
Monoamine oxidase inhibitor (MAOI) effects the monoamine neurotransmitters.
Any of a heterogeneous group of drugs used primarily in the treatment of depression. MAOIs, along with TCAs, represent the first generation of antidepressant drug therapy. Although MAOIs are potent drugs, they are now considered to be second- or third-line drugs for the treatment of depression that is not responsive to other pharmacologic therapies, such as the SSRIs or TCAs. As mentioned previously, such cases are known as TRD. A serious disadvantage to MAOI use is their potential to cause a hypertensive crisis when taken with a substance containing tyramine, which is found in many common foods and beverages.
· phenelzine (Nardil)
Adhere to low tyramine diet to prevent hypertensive crisis |
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Term
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Definition
bupropion (Wellbutrin or Zyban) |
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Term
| Meds that regulate serotonin and norepinephrine are: |
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Definition
venlafaxine (Effexor)
duloxetine (Cymbalta)
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Term
| Therapeutic uses of antidepressants |
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Definition
- Major depression
- Obsessive compulsive disorder (OCD)
- Panic disorders (MAOIs sometimes used)
- Eating disorders (SSRIs)
- PMS
- Chemical dependency with depression (dual diagnosis)
- Seasonal affective disorder
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Term
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Definition
Some of the most common and bothersome adverse effects include insomnia, weight gain, and sexual dysfunction. Less commonly reported cardiac effects include chest pain, palpitations, and QT-prolongation (on EKG).
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Term
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Definition
| TCAs results in many undesirable anticholinergic adverse effects, the most common being sedation, impotence, and orthostatic hypotension. |
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Term
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Definition
| Sufficient intestinal MAO-A inhibition can lead to hypertensive crisis, when foods containing tyramine are consumed (so-called "cheese syndrome"), or hyperserotonemia if foods containing tryptophan are consumed. |
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Term
Contraindications of Antidepressants TCA's and SSRIs |
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Definition
TCA's : Should not be used within 2 weeks of MAOI's (hypotension and tachycardia).
SSRI's should not be used within 2-5 weeks of MAOI's (serotonin syndrome, could be fatal with hyperthermia, rigidity, fluctuating VS, delirium, coma). |
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Term
| Patient teaching/Nursing Implications/Lab: |
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Definition
All antidepressants: Rebound depression. Do not stop abruptly.
SSRIs: Sexual probs
TCAs: Cardiac probs, fatal overdoses
MAOIs: Hypertensive crisis if not on low tyramine diet |
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Term
| List some Mood stabilizers (sometimes called antimanics) |
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Definition
· lithium carbonate (Lithobid)
· carbamazepine (Tegretol)
· valproic acid (Depakote)
· gabapentin (Neurontin) |
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Term
| lithium carbonate (Lithobid) |
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Definition
Lithium carbonate (Eskalith, Lithane, and Lithobid) and lithium citrate (Cibalith-S) are the two currently available salts of lithium. There are no absolute contraindications to lithium therapy, and the adverse effects are dependent on the serum levels. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity, including gastrointestinal discomfort, tremor, confusion, somnolence, seizures, and possibly death. The most serious adverse effect is cardiac dysrhythmia. Other effects include drowsiness, slurred speech, epileptic-type seizures, choreoathetotic movements (involuntary wavelike movements of extremities), ataxia (generalized disturbance of muscular coordination), and hypotension. Long-term treatment may cause hypothyroidism.
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Term
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Definition
| Tegretol is similar to TCA's. |
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Term
| Therapeutic use of lithium carbonate |
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Definition
Treatment of choice for mania; prevent recurrent suicidal depression. Route is PO. Lithium levels should be in a range of 0.8-1.2 or around 1.0. |
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Term
| What level is lithium toxic? |
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Definition
Lithium toxicity is 1.5 or 2.0 Fluid and salt intake is important to assess due to the fact that hyponatremia and hypovolemia place the pt at risk for lithium toxicity |
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Term
| Antianxiety Meds (Also called anxiolytic or minor tranquilizers.) |
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Definition
You will be held accountable only for the benzodiazepine classification.
· chlordiazepoxide (Librium)
· lorazepam (Ativan)
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Term
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Definition
Mechanism of Action: Potentiate GABA Therapeutic Uses: - Anxiety disorders
- Insomnia
Detox. of chemical dependency
Routes: PO & some IM
AE/SE:
Withdrawal symptoms/addictive potential:
This is the only psychotropic med category with truly addictive potential.
Mild withdrawal sx:
Severe withdrawal sx: Seizures
Patient teaching/Nursing implications/Lab:
Don’t mix with other sedative drugs.
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Term
| Other meds used in psych: Special populations |
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Definition
Substance Abuse: If you are interested in Substance Abuse, see Chapter 7, pages 74-85. 1. Alcoholics: - naltrexone (ReVia) and acamprosate (Campral)
Decrease alcohol craving Uses: Aversion therapy. Uses: helps w/nerve function. Prevents Wernicke-Korsakoff’s disease (e.g. decreases neurotoxicity) 2. Heroin addiction and opioid dependence: · Methadone · Buprenorphine or buprenorphine with naloxone (narcan) which is Suboxone |
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Term
| Other meds used in psych: Alzmheimers |
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Definition
donezepil (Aricept)
Boosts acetylcholine level
Uses: Helps w/memory but does not cure disease
Memantine (Namenda) for late stage Alzheimer’s disease; regulates glutamate
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Term
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Definition
NSAIDS (e.g. ibuprofen and ASA) Ongoing research: may decrease inflammation in CNS
Electroconvulsive therapy (ECT) - methohexital (Brevital): short-acting anesthetic
- succinylcholine (Anectine) (Electroconvulsive therapy (ECT):
Attention Deficit and Hyperactivity Disorder (ADHD):
· methyphenidate (Ritalin)
· atomoxetine (Strattera); SNRI; nonstimulant children and adults
E. Obsessive Compulsive Disorder: SSRIs often used (Zoloft, Prozac, sometimes Luvox)
“Black box” warnings and use in children Nicotine addiction and obesity (not yet approved): rimonabant (Acomplia) - Zyban or Wellbutrin also used for smoking cessation
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