Pharm 3 Unit 2 CNS Depressants/ Psychotherapeutic Drugs

Side effects of levodopa/carbidopa

ortho hypotension, rebound symptoms if stop abruptly, discolored urine

How is EPS treated?

By prescribing antiparkinsonian drugs such as benztropine, diphendyramine, or binperiden.

Side effects of benzodiazepines

CNS depression (Sedation, light-headedness, ataxia, decreased cognitive function) Anterograde amnesia (difficulty recalling events after dosing) Acute toxicity Paradoxical response (insomnia, excitation, anxiety, euphoria, rage) Withdrawal symptoms

What is a prototype of Citalopram?

Celexa

Psychological conflict turns into physical symptoms

Conversion

What is a prototype of Duloxetine?

Cymbalta

Side effects of psychosis?

Disorganized thoughts, distortion of reality, delusions/hallucinations, incoherence, catatonia, aggressive/violence

Affective (Mood) Disorders

Disturbances in mood in which the person is either excessively depressed (loss of interest or pleasure) or elated (manic) or both (bipolar) * Depression * Manic Disorder *Bipolar Disorder

Levadopa/Carbidopa

Dopamine replacement for PD, Has a "wearing off" effect

What is a prototype of Venlafaxine?

Effexor

What is a prototype of Amitriptyline?

Elavil

Who is at higher risk for decreased kidney/liver function

Elderly

How often do you draw lithium levels?

Every week until therapeutic

Typical Antipsychotic side effects?

Extrapyramidal AE: parkinsonian syndrome, acute dystonias, akathisia, Neuroleptic malignant syndrome: rigidity, dystonia, agitation, high fever, sweating, tachycardia, HTN, Tardive Dyskinesia

What safety measure should be made aware of while taking a benzo of any kind?

Fall risk, risk for dependence or overdose

What is the depression side of bipolar disorder?

Fatigue, sad or hopeless, appetite changes, thinking/attempting suicide

What are the Signs and Symptoms of affective (mood) disorders?

Flat affect, poor grooming habits, no energy, no pleasure in what you used to do (anhedonia), feeling of wothlessness/hopelessness, suicide risk

What is the Benzodiazepine antidote?

Flumazenil

A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks? 1- Lithium 2- Diazepam 3- Fluvoxamine 4- Fluphenazine

Fluphenazine

Tricylics

For depression and OCD

When given a large dosage of a CNS depressant, what is this helping?

General anesthetic

What is the prototype of Haloperidol?

Haldol

Side effects of serotonin syndrome?

Hallucinations, diaphoresis, agitation

What is the manic side of bipolar depression?

Happy for long periods of time, talking fast/racing thoughts, easily distracted, overconfidence in abilities

Hypertensive crisis symptoms

Headache (insufficient blood/oxygen to brain), Visual problems (insufficient blood supply to optic nerve), Alteration of consciousness, Seizure, Angina pectoris, SOB (fluid overload), Edema/swelling

What is important to teach a client about when they are taking MAOI's?

Hypertensive crisis

What is the mode of action for a medication to treat parkisons?

Increase dopamine at receptor sites

What is a prototype of Clonazepam?

Klonopin

What is an example of an Antimania drug?

Lithium

Which antidepressant doesn't play well with any other meds?

MAOI's

While taking lithium patients should:

Maintain sodium intake

A level of anxiety where a person is alert, and this may enhance their learning

Mild anxiety

A level of anxiety where a person only focuses on immediate concern only

Moderate anxiety

When is amitriptyline given?

Mostly given at nighttime due to sedative effect

What does lithium interact with?

NSAIDS, Diuretics

Side effects of SRNI's?

Nightmares, irritability, N/V

SSRIs can also be used to treat

OCD & PTSD

What is Fluphenazine?

Prolixin, a Typical antipsychotic, a type of phenothiazine

What is a prototype of Fluoxetine?

Prozac

Uses of Benzodiazepines

Reduced anxiety postoperative; promotes amnesia; produces mild sedation with moderate to very little respiratory depression when titrated, substance abuse withdrawl

What is a prototype of Temazepam?

Restoril

Anti psychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism. Select all that Apply 1. Rigidity 2. Tremors 3. Mydriasis 4. Photophobia 5. Bradykinesia

Rigidity, Tremors, Bradykinesia

What is a prototype of Risperidone?

Risperdal

Side effects of TCAs

SE: sedation, anticholinergic effects, impotence, orthostatic hypotension (safety), sedation, diaphoresis, sexual dysfunction, cardio toxicity

A level of anxiety where reduction in focus and cognitive ability are impaired

Severe anxiety

A level of anxiety where someone has difficulty functioning & thinking

Severe anxiety

Side effects of SSRIs

Sexual dysfunction, CNS stimulation, Weight loss in early therapy, weight gain with long-term, Serotonin Syndrome, Withdrawal Syndrome, Hyponatremia Rash, Sleepiness, faintness, lightheadedness, GI Bleeding, Dry mouth, headache

Serotonin Syndrome

Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity

How do we prevent EPS?

Start with a low dose of med, AIMS test, patient education, early monitoring

Symptoms related to anxiety

Tachycardia, tachypnea, increased BP, dilated pupils

A client with chronic undifferentiated schizophrenia is receiving an antipyschotic medication. For which potentially irreversible extrapyramidal side effect should a nurse monitor the client? 1. Torticollis 2. Oculogyric crisis 3. Tardive dyskinesia 4. Pseuodoparkinsonism

Tardive Dyskinesia

anxiety

The condition of feeling uneasy or worried about what may happen

What are some Patient education points for antidepressants?

They may take 2-4 weeks and up to 6 weeks to reach their therapeutic levels, do not stop abruptly, monitor for suicide risk, avoid other CNS depressants including ETOH, they have supplement & herbal reactions, may cause weight gain

Do atypical or typical anti psychotics have more side effects?

Typical anti psychotics

What is a prototype of Diazepam?

Valium

What is a prototype of Alprazolam?

Xanax

What is a prototype of Sertraline?

Zoloft

Phenothiazines

a group of antihistamine drugs that became the first group of effective antipsychotic medications

Selective Serotonin Reuptake Inhibitors (SSRIs)

a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters

Schizophrenia

a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions

Neuroleptic Malignant Syndrome

a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp, hyperrigidity

negative symptoms of schizophrenia

absence of appropriate behaviors, flat affect, withdrawal, difficulty thinking

When given a low dosage of a CNS depressant, what is this helping?

anti anxiety effects

How do antipsychotics work?

block dopamine receptors (dopaminergic antagonist)

sedative-hypnotics

drugs that cause calmness, sleepiness, and slow down bodily functions

Antidepressants

drugs that combat depression by affecting the levels or activity of neurotransmitters in the brain. They increase the availability of serotonin.

Benzodiazepines

drugs that lower anxiety and reduce stress

rationialization

finding 'good reason' for things that we really know are wrong

haloperidol decanoate

given to pt noncompliant of antipsychotics; slow release form given IM monthly

extrapyramidal system

groups of neurons within the central nervous system that are responsible for the refinement of movement patterns

Lithium side effects?

headache, memory impairment, blurred vision, dental caries, lethargy, drowsiness, dizziness, tremors, anorexia, hypotension, etc

Which organ excretes most drugs?

kidneys

What organ metabolizes drugs?

liver

psychosis

loss of contact with reality

What is bipolar disorder treated with?

mood stabilizers

SSRIs

most commonly used drug treatment for depression

coping mechanisms

patterns of behavior used to neutralize, deny, or counteract anxiety

When given a high dosage of a CNS depressant, what is this helping?

produce sleep

Denial

psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful realities.

Regression

return to an earlier or less advanced condition

Normal level for lithium

0.6-1.2 mEq/L

A client has been receiving fluphenazine for several months. For which side effects should the nurse assess the client? Select all that apply 1- Tremors 2- excess salivation 3- Rambling speech 4- reluctance to converse 5- minimal use of nonverbal expression 6- uncoordinated movement of extremities

1- Tremors 6- Uncoordinated movement of extremities

A monoamine oxidase inhibitor (MAOI) is prescribed. What should the nurse include in the teaching plan about what to avoid when taking this drug? 1. Ingesting aged cheese 2. Prolonged exposure to the sun 3. Engaging in active physical exercise 4. Over the counter antihistamine drugs

1. Ingesting aged cheese

hypertensive crisis

180/110

Lithium toxicity

2 or greater, tremors, metallic taste, severe diarrhea, excessive sweating, vomiting

A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client it will take before noticing a significant change in the depression? 1. 4 to 6 days 2. 2 to 4 weeks 3. 5 to 6 weeks 4, 12 to 16 hours

2- 2 to 4 weeks

Neuroleptic malignant syndrome is a potentially fatal reaction to an antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? Select all that Apply 1. Jaundice 2. Diaphoresis 3. Hyperrigidity 4. Hyperthermia 5. Photosensitivity

2- Diaphoresis 3- Hyperrigidity 4- Hyperthermia

A health care provider prescribes haloperidol (haldol) for a client. What should the nurse teach the client to avoid while taking this medication? 1- Driving at night 2- Staying in the sun 3- Ingesting aged cheeses 4- Taking medications containing aspirin

2- Staying in the sun

A client with depression is to receive fluoxetine (Prozac). What precaution should the nurse consider when initiating with this drug? 1. It must be given with milk and crackers to avoid hyperacidity and discomfort 2. Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis 3. Blood levels may not be sufficient to cause noticeable improvement for 2-4 weeks 4. Blood levels should be obtained weekly for 3 months to monitor for appropriate levels

3- Blood levels may not be sufficient to cause noticeable improvement for 2-4 weeks

Typical Antipsychotics (conventional)

A class of older drugs to treat schizophrenia and related psychotic disorders primarily by reducing excess levels of dopamine in the brain.

Parkinson's disease

A disorder of the central nervous system that affects movement, often including tremors.

bipolar disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

Isocarboxazid

A type of MAOI drug

What is a prototype of Aripiprazole?

Abilify

Serotonin

Affects mood, hunger, sleep, and arousal

What foods must you AVOID while taking MAOI's?

Aged cheese, wine and beer, processed meats, pickled foods, cream, yogurt, coffee, chocolate, bananas, raisins, liver, yeast, soy sauce A.K.A super bowl foods

What is the cause of psychosis?

An imbalance of dopamine in the brain (too much)

Trazadone

Antidepressant for insomnia by inhibiting serotonin reuptake. This can be taken more long term

What are some types of atypical drugs?

Aripiprazole, risperidone

What is a prototype of Lorazepam?

Ativan

These anti psychotics treat both negative and positive symptoms

Atypical anti psychotics

What lab levels should you monitor while a patient is taking lithium?

BUN/Creatine, AST/ALT, TSH, TS3,TS4, Sodium, lithium levels

Pharmacological interventions for anxiety

Benzodiazepines (anxiolytic), antidepressants

A primary nurse observes that a client has become jaundiced after 2 weeks of antipsychotic drug therapy. The primary nurse continues to administer the anti psychotic until the health care provider can be consulted. What does the nurse manager conclude concerning this situation? 1. Jaundice is sufficient reason to discontinue the antipsychotic 2. The blood level of antipsychotics must be maintained once established 3. Jaundice is a benign side effect of antipsychotics that has little significance 4. The prescribed dose for the antipsychotic should have been reduced by the nurse.

1- Jaundice is sufficient reason to discontinue the antipsychotic

A nurse teaching clients about dietary restrictions when taking a monoamine oxidase inhibitor (MAOI). What response does the nurse tell them to anticipate if they do not follow these restrictions? 1. Occipital headaches 2. Generalized urticaria 3. Severe muscle spasms 4. Sudden drop in blood pressure

1- Occipital headaches (hypertensive crisis)

Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode, manic episode. What cautionary advice should the nurse give the client? 1- Sit up slowly 2- Report double vision 3- Expect increased salivation 4- Take the medication on an empty stomach

1- Sit up slowly

A client is receiving lithium. What is an important nursing intervention while this medication is being administered? 1. Restrict the clients daily sodium 2. Test the clients urine specific gravity weekly 3. Monitor the clients drug blood level regularly 4. Withhold the clients other medications for several days

3- Monitor the clients drug blood level regularly

A client in the the hyperactive phase of a mood disorder, bipolar type, is receiving lithium carbonate. The nurse identifies that the client's lithium blood level is 1.8 mEq/L. It is most important for the nurse to: 1. Continue the usual dose of lithium and note any adverse reaction 2. Discontinue the drug until the lithium serum level drops to 0.5 mEq/L 3. Ask the physician to increase the dose of lithium because the blood lithium level is too low 4. Hold the drug and notify the physician immediately because the blood lithium level may be toxic

4- Hold the drug and notify the PCP immediately because the blood lithium level may be toxic

A nurse administers an anti psychotic to a client. For which common manageable side effect should the nurse asses the client? 1. Jaundice 2. Melanocytosis 3. Drooping eyelids 4. Unintentional tremors

4- unintentional tremors

atypical antipsychotics

Antipsychotics that do not have significant side effects common to older antipsychotics

Parkisons is the imbalance of what?

Decreased dopamine, and increased acetylcholine

Amitriptyline

Elevates mood, increases interest in ADL's, decreases insomnia

Nonpharmacological interventions for anxiety

Providing calm & peaceful environment, establishing a trusting relationship, self care ( diet, exercise, relaxation)

What is a prototype of Levadopa/Carbidopa?

Sinemet

What demographic population is at higher risk for taking sedative-hypnotics and why?

The elderly because they are CNS depressants and are at risk for falls, etc

What do antipsychotics treat?

They reduce the symptoms of hallucinations, delusions, and thought disorders. Used primarily in the treatment of schizophrenia and severe cases of bipolar disorder.

Patient teaching for levadopa/carbidopa

Urine discoloration is normal, position change slowly (orthostatic hypotension), eat a low protein meal (meds bind better)

Bupropion uses?

Weight loss, smoking cessation

What is a prototype of Bupropion?

Wellbutrin

positive symptoms of schizophrenia

hallucinations, delusions, racing thoughts, bizzare thinking, agitation

Serotonin Norepinephrine Reuptake Inhibitors (SRNI'S)

second-generation antidepressants that work by increasing both norepinephrine and serotonin activity by inhibiting their reuptake.

Tolerance

the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect

Non-phenothiazines

thiothixene (Navane), haloperidol (Haldol), loxapine (Loxitane), molindone (Moban)