n101.test-3.pysch_meds.txt

dysphoric or depressed state.

• (SIG-E-CAPS)
• Sleep
• Interest
• Guilt
• Energy
• Concentration
• Appetites
• Psychomotor retardation
• Suicidal ideations

Depression that occurs without apparent precipitating cause.

• Anxiety: doxepin
• Enuresis: imipramine
• Chronic pain syndrome: amitriptyline
• Smoking cessation: bupropion
• Bulimia: fluoxetine
• OCD: fluoxetine, sertraline
• GAD: venlafaxine, paroxetine

• Antidepressants prevent the reuptake or breakdown of neurotransmitters.
• Serotonin
• Norepinephrine
• Dopamine

• SSRI: Selective Serotonin Reuptake Inhibitor
• SNRI: Serotonin Norepinephrine Reuptake Inhibitor
• MAOI: Monoamine Oxidase Inhibitor
• TCA: Tricyclic antidepressant
• Tetracyclic: e.g. Mirtazapine (Remeron)
• Other: e.g. buproprion (Welbutrin)

• Hypersensitivity
• Narrow-angle glaucoma
• Pregnancy
• Lactation
• Immediately after MI

• Older clients with cardiovascular disease
• Elderly with prostate enlargement (urinary retention)
• Anticholinergic effects may require dosage modifications or d/c
• Dosage - slow titration
• Full therapeutic effect may take 3-4 weeks
• May ↓SZ threshold especially with burpropion (Wellbutrin)

There is an increased risk of suicide as antidepressants start to work, secondary to an increased energy level.

• Sudden sense of well being
• Giving away prized objects

• Hydrazines: phenelzine sulfate (Nardil)
• Nonhydrazines: tranylcypromine sulfate (Parnate)

• Absorbed rapidly from the GI tract
• Metabolized in the liver into metabolites
• Excreted mainly in the urine

• MAOIs appear to work by inhibiting monoanimine oxidase.
• Monoanimine oxidase normally metabolizes norepinephrine and serotonin, making these neurotransmitters more available to the receptors.

• Treatment of choice for atypical depression
• Used to treat typical depression when other treatments are unsuccessful; phobic anxieties, neurodermatitus, hypochondriasis, refactory narcolepsy

• Tyramine: Hypertensive crisis
• merperidine (opiod analgesics): hypo- or hypotensive coma or death
• Hypotensive: Additive effect with antihypertensives or spinal anasthesia
• Hypoglycemic: additive effect with oral hypoglycemic or insulin

• Food
• TCAs
• levodopa
• amphetamines
• vasoconstrictors
• sympathomimetric drugs

• Red wines - beer - liqueurs
• aged cheese
• processed meats - smoked or pickled fish
• chicken or beef liver pate
• yeast, yogurt
• fava beans

phentolalamine (Regitine) - off label use

• Many oral drugs undergo deactivation and sometimes activation when altered by hepatic metabolism.
• Alternative routes can bypass the first-pass effect e.g. sublingual, rectal, or parenteral.

• imipramine hydrochloride (Tofranil)
• amitriptyline hydrochloride (Elavil)
• amoxapine (Acendin)
• nortriptyline hydrochloride (Aventyl, Pamelor)

• Absorbed completely when PO
• First-pass effect
• Metabolized in liver
• excreted in urine
• Extremely fat-soluble (long half-life)

Increases NOR and serotonin by preventing reuptake and storage in presynaptic nerves.

• Treat episodes of major depression
• Less effective with:
• .... hypochondriasis
• .... atypical depression
• .... depression with delusions
• Inverstigated for use with:
• .... migraine headaches
• .... phobias
• .... urinary incontinence
• .... attention deficit disorder
• .... ulcers
• .... diabetic neuropathy

• Many commonly used drugs
• May prevent therapeutic response to some antihypertensives
• Additive effect with drugs with anticholineric effects
• cimetidine (Tagamet) impairs metabolism

• Orthostatic hypertension
• Arrhythmias
• Sedation
• Increase risk in the elderly

They have fewer side effects TCAs and MAOIs

• fluoxetine hydrochloride (Prozac)
• paroxatine hydrochloride (Paxil)
• sertraline hydrochloride (Zoloft)

• Almost completely absorbed when PO
• Highly protein bound
• metabolized in liver
• excreted in urine

Selectively inhibits neuronal reuptake of the neurotransmitter serotonin

• Treat major depressive episodes.
• Depending on the SSRI:
• .... anxiety disorders
• .... eating disorders
• .... personality disorders
• .... impulse control disorders

• Competitively inhibits a liver enzyme that is responsible for the oxidation of numerous drugs.
• MAOIs: can cause serious and potentially fatal reactions.

• Anxiety
• Insomnia
• Sleepiness
• Palpitations
• Serotonin Syndrome

• The excessive accumulation of serotonin.
• May be due to Rx and/or OTC meds

• At least three of the following:
• .... change in MS
• .... agitation
• .... myoclonus
• .... hyperreflexia
• .... fever
• .... diaphoresis
• .... ataxia
• .... diarrea
• May include:
• .... abdominal pain
• .... ↑BP
• .... tachycardia
• .... ↑ motor activity
• .... mood changes
• Severe reactions:
• .... high fever
• .... cardiovascular shock → death

• maprotiline hydrochloride (Ludiomil)
• mirtazapine (Remeron)
• bupropion hydrochloride (Wellbutrin)
• venlafaxine hydrochloride (Effexor)
• trazodone hydrochlorine (Desyrel)

• Mood swings of extreme euphoria and Depression
• Mania: catecholamine stimulation
• Depression: diminished catecholamine stimulation

• lithium carbonate (Eskalith)
• divalproex (Depakote)
• lamotrigine (Lamictal)
• Carbamazepine (Tegretol)
• Oxcarbazepine (Trileptal)
• Topiramate (Topamax)
• Tiagabine (Gabitril)

• Absorbed rapidly and completely when PO
• Distributed to body tissues.
• Crosses placenta; enters breast milk
• Not metabolized
• Excreted unchanged by kidneys

• Regulates catecholamine release in CNS:
• .... increases NOR and serotonin uptake
• .... reduces the release of NOR from synaptic vesicles in presynaptic neuron
• .... inhibits NOR's action in postsynaptic neuron

Treatment of acute mania and prophylaxis of recurrance

• Therapeutic Range (TR): 0.5 - 1.5 mEq/L (narrow)
• Serious reactions can occur

• Salt restricted diet can cause toxicity
• .... vomiting
• .... diarrhea
• .... tremor
• .... muscle weakness
• .... slurred speech
• .... decreased coordination
• .... drowsiness

Antipsychotic drugs

• Schizophrenia
• Acute mania
• Psychotic depression
• Schizoaffective disorders
• Drug induced psychosis
• Children with extreme behavior

• agressive, disruptive, and delusional behavior
• Hallucinations
• Anxiety
• Insomnia that sometimes accompanies Alzheimer's disease

• Block dopamine receptors; D 1,2,3,4,5
• D 2,3,4 haave been associated with mental illness

• Dopamine stabilizer
• .... When dopamine is too low → Abilify enhances it
• .... When dopamine is too high → Abilify reduces it

• Most are EPS
• Treat with anticholinergic meds:
• .... benztopine (Cogentin)
• .... diphenhydramin (Benadryl)

• Dystonia (acute)
• Pseudo-parkinsonium
• Akathisia
• Tardive dyskinesia
• Neuroleptic Malignant Syndrome (NMS)

• Muscle rigidity and cramping
• .... stiff neck
• .... thick tongue
• .... swallowing issues

• bradykinesia
• tremor

• Intense desire to move
• "Can't stay still"

• Permanent involuntary movement
• .... lip smacking, chewing, tongue protrusion,
• .... blinking, chorieform limb movements

• Can be fatal
• High fever
• rigidity
• unstable blood pressure
• delirium
• elevated enzymes

A break from reality.

• Positive symptoms are thoughts, behaviors, or sensory perceptions present in a person with a mental disorder, but not present in people in the normal population.
• Negative symptoms are thoughts, feelings, or behaviors normally present that are absent or diminished in a person with a mental disorder.
• (http://www.minddisorders.com/Ob-Ps/Positive-symptoms.html)
• (http://www.minddisorders.com/Kau-Nu/Negative-symptoms.html)

• Hallucinations: can effect any of the senses
• Delusions: a false or fixed belief.

• Affect disturbance
• Anergia
• Alogia
• Avolition
• Ambivalence
• Anhedonia

• A lack of energy
• (Taber's Dictionary of Medical Terms)

• Completely speechless.
• (Taber's Dictionary of Medical Terms)

• "A general lack of desire, drive, or motivation to pursue meaningful goals".
• (http://en.wikipedia.org/wiki/Avolition)

Simultaneous opposite feelings regarding something

Inability to experience pleasure

They block D 2,3,4 dopamine receptors. They are used to treat negative symptoms of schizophrenia and have no effect of positive symptoms

• They are weaker D2 dopamine receptor blockers so:
• .... less risk of EPS
• .... less risk of TD (Tardive Dyskinesia)
• They effectively treat positive and negative symptoms

• Phenothiazines: chloropromazine (Thorazine)
• .... low potency
• .... high sedation
• .... low EPS
• Nonphenothiazines: haloperidol (Haldol)
• .... high potency
• .... low sedation
• .... high EPS

• clozapine (Clozaril): argranulocytosis, seizures (monitor WBCs)
• olanzapine (Zyprexa): weight gain
• aripiprazole (Abilify): anxiety
• risperidone (Risperdal): can have prolactin issues
• quetiapine (Seroquel): sedation
• ziprasidone (Geodon): Q-T wave prolongation

• Administer medication
• Reassure client

Use AIMS scale, report score

Abnormal Involuntary Movement Scale

• Stop antipsychotic meds
• Notify PCP immediately

• Administer meds as ordered
• Assess for effectiveness

• Protect client from injury
• Stop meds
• Notify PCP
• provide privacy

Caution about alert activities (car driving)

• Avoid exposure
• Wear sunscreen
• Wear protective clothing

Teach client to inform PCP or impotence or diminished libido

• Encourage balanced diet
• Encourage regular exercise
• Focus on minimizing gain

• Ice chips
• Sugarless hard candy
• Should decrease with time, if not notify PCP

• Increase fluid
• Increase dietary fiber
• May need stool softener

Teach to report if no improvement

• Teach to rise slowly from lying to sitting or standing
• Do not ambulate until no longer dizzy or light headed.