psych meds and MUST KNOWW pptx-jasmine

What are the key objectives in learning about psychotherapeutic medications?

Differentiate classifications, develop nursing care and education plans, recognize legal and ethical responsibilities, and create care plans for substance abuse.

What is the relationship between neurotransmitters and psychiatric medications?

Most psychiatric medications alter neurotransmitter levels in the brain to manage mental illnesses.

What is the role of serotonin in mental health?

Serotonin (5-HT) is involved in mood maintenance and helps keep emotional balance.

What is the function of norepinephrine in the brain?

Norepinephrine is responsible for attention focus, energy, and motivation.

How does dopamine affect mental health?

Dopamine is linked to feelings of joy, attention, and pleasure.

What is the role of GABA in the nervous system?

GABA is an inhibitory neurotransmitter that regulates anxiety, panic, and stress.

What are anxiolytics and their purpose?

Anxiolytics, or minor tranquilizers, are used to alleviate anxiety symptoms and help individuals return to normal functioning.

What class of drugs is most commonly used to treat anxiety?

Benzodiazepines are the most commonly used class of drugs for treating anxiety.

What is the action of benzodiazepines?

Benzodiazepines potentiate GABA inhibition, leading to CNS depression, sedation, and muscle relaxation.

What are common side effects of benzodiazepines?

Excessive sedation, hypotension (especially IV), amnesia, and paradoxical reactions like excitability.

What is the historic prototype drug for benzodiazepines?

Diazepam (Valium®) is the historic prototype drug.

What is the antidote for benzodiazepine overdose?

Flumazenil (Romazicon®) is the antidote for benzodiazepine overdose.

What is buspirone and its primary use?

Buspirone (BuSpar®) is the drug of choice for generalized anxiety, acting on serotonin rather than GABA.

What are the nursing implications for patients on anxiolytics?

Ensure safety measures, educate on the gradual discontinuation of medication, and advise against alcohol and CNS depressants.

What is the primary use of mood stabilizers?

Mood stabilizers are used to prevent or treat mania in bipolar patients.

What is the primary drug used as a mood stabilizer?

Lithium is the primary drug used for mood stabilization.

What are the therapeutic levels for lithium in acute mania?

Therapeutic levels for acute mania are 1-1.5 mEq/L.

What are common side effects of lithium?

Slowed reflexes, urinary frequency, tremors, GI upset, and risk of lithium toxicity.

What are the classes of antidepressants?

Antidepressants include TCAs, MAOIs, SSRIs, and SNRIs.

What is the black box warning associated with antidepressants?

Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

What are the side effects of tricyclic antidepressants (TCAs)?

Side effects include orthostatic hypotension, arrhythmias, dry mouth, urinary retention, and constipation.

What neurotransmitters do TCAs aim to balance?

TCAs aim to correct imbalances in serotonin and norepinephrine levels.

What is the mechanism of action for norepinephrine reuptake inhibitors?

They block the uptake of norepinephrine, increasing its levels for more energy and focus.

What is the role of antihistamines in psychiatric treatment?

Antihistamines may be used off-label as mild tranquilizers due to their sedative effects.

What should be monitored for in patients on antidepressants?

Worsening and emergence of suicidal thoughts and behaviors.

What is the primary mechanism of action for Tricyclic Antidepressants (TCAs)?

They correct the imbalance in concentrations of neurotransmitters serotonin and norepinephrine by blocking their inactivation in the brain.

What are common adverse drug reactions (ADRs) of Tricyclic Antidepressants?

Orthostatic hypotension, arrhythmias, dry mouth, urinary retention, constipation, sedation, confusion, weight gain, and lower seizure threshold.

Name two examples of Tricyclic Antidepressants.

Amitriptyline (Elavil®) and imipramine (Tofranil®).

What is the mechanism of action of Monoamine Oxidase Inhibitors (MAOIs)?

They block monoamine oxidase, the enzyme that inactivates catecholamines, leading to increased norepinephrine levels.

What are the potential life-threatening effects of MAOIs?

Hypertensive crisis if taken with tyramine-containing foods.

What are common adverse drug reactions (ADRs) of MAOIs?

Anorexia, orthostatic hypotension, dizziness, and insomnia.

What is a significant advantage of Selective Serotonin Reuptake Inhibitors (SSRIs) over TCAs?

SSRIs have fewer anti-cholinergic and anti-adrenergic effects.

What are common side effects of SSRIs?

CNS stimulation, gastrointestinal effects (nausea, diarrhea), weight loss initially followed by weight gain, and skin rash.

Name three examples of SSRIs.

Fluoxetine (Prozac®), paroxetine (Paxil®), and sertraline (Zoloft®).

What is the mechanism of action for Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?

They increase levels of serotonin and norepinephrine, and potentially dopamine, depending on the drug.

What are common adverse drug reactions (ADRs) of SNRIs?

Nausea, dry mouth, increased blood pressure, tiredness, and sexual side effects.

What is the mechanism of action of Bupropion (Wellbutrin®)?

It weakly inhibits the reuptake of dopamine, norepinephrine, and serotonin.

What are common side effects of Bupropion?

Dry mouth, insomnia, tremors, headache, and tachycardia.

What is the primary use of Mirtazapine (Remeron®)?

It is used as an antidepressant and can also serve as a sleep aid due to its sedative effects.

What is a critical nursing consideration when starting antidepressant therapy?

Monitor vital signs and provide safety measures, including suicide precautions.

What is serotonin syndrome and what are its symptoms?

A potentially life-threatening condition characterized by hyperactivity, agitation, hyper-reflexia, fever, and can lead to tachycardia and seizures.

What are the general uses of antipsychotic medications?

To treat acute psychoses and schizophrenia, addressing both positive and negative symptoms.

What are positive symptoms of psychosis?

Irrational behavior, agitation, delusions, hallucinations, and communication impairment.

What are negative symptoms of psychosis?

Social withdrawal, poor judgment, poor self-care, avolition, flat affect, and apathy.

What is the primary action of antipsychotic medications?

They primarily block neurotransmitters, especially dopamine and serotonin.

What are extrapyramidal symptoms (EPS)?

Involuntary muscle movements, tremors, stiff muscles, and drooling.

What is Tardive Dyskinesia (TD) and how is it treated?

TD is characterized by involuntary movements, often irreversible; treated with deutetrabenazine (Austedo) or valbenazine (Ingrezza).

What is Neuroleptic Malignant Syndrome (NMS)?

A rare but potentially fatal complication of antipsychotic treatment, characterized by muscle rigidity and severe temperature elevation.

What distinguishes typical antipsychotics from atypical antipsychotics?

Typical antipsychotics primarily treat positive symptoms, while atypical antipsychotics treat both positive and negative symptoms.

What is Clozapine (Clozaril) known for?

It was a game changer for treating psychosis but is used as a last resort due to serious side effects like agranulocytosis.

What are the first-line atypical antipsychotic drugs for newly diagnosed patients?

Aripiprazole, brexpiprazole, risperidone, olanzapine, ziprasidone, quetiapine, asenapine.

What is the brand name for aripiprazole?

Abilify (oral) and Abilify Maintena (monthly injection).

What are nursing implications when administering antipsychotics?

Monitor vital signs, affect, behavior, EPS status; provide a safe environment; instruct on blood work and the importance of not abruptly discontinuing medication.

What is the risk associated with antipsychotic use in elderly patients with dementia?

Increased risk for stroke.

Define drug abuse.

Using a drug in a manner inconsistent with medical or social norms.

What is addiction?

Continued use of a substance despite physical, psychological, or social harm.

What is physical dependence?

Withdrawal symptoms occur if drug use is discontinued.

What is psychological dependence?

An intense subjective need for a drug.

What are common effects of drugs of abuse?

Euphoria, altered perceptions, impaired judgment, potential feelings of panic or paranoia.

What are the physical effects of most abused drugs?

CV effects like tachycardia, hypertension or hypotension, pupil dilation (except PCP and opiates), stupor, coma, or death in high doses.

What is the most dangerous time for a client to experience alcohol withdrawal?

48 hours after the last ingestion of alcohol, risk for Delirium Tremens (DTs).

What medication is commonly used to treat Delirium Tremens?

Benzodiazepines, with lorazepam being the most common in hospitals.

What are the three legally abused substances?

Alcohol, nicotine, and opiates.

What is the mechanism of action of alcohol as a CNS depressant?

Acts on GABA receptors and serotonin receptors, leading to a feeling of reward.

What is disulfiram (Anabuse) used for?

To deter alcohol consumption by causing severe vomiting when alcohol is ingested.

What is the role of naltrexone in alcohol treatment?

It is an opiate antagonist that decreases craving for alcohol.

What are common side effects of opiates?

Dizziness, drowsiness, diaphoresis, respiratory depression, and coma.

What is the purpose of methadone in opiate detox?

To prevent withdrawal syndrome.

What is buprenorphine used for?

It is a partial agonist used for withdrawal and addiction treatment.

What are the treatments for extrapyramidal symptoms (EPS)?

Diphenhydramine and benztropine.

What is Neuroleptic Malignant Syndrome?

A life-threatening reaction to antipsychotic medications characterized by severe muscle rigidity, fever, and autonomic instability.

What medication is used to treat Neuroleptic Malignant Syndrome?

Dantrolene.

What are the withdrawal symptoms of CNS depressants?

Acute anxiety, delirium, convulsions, and symptoms opposite to the drug's effects.

What is the risk of using synthetic marijuana (K2)?

It will not show positive on urine drug screens.

What are the effects of methylenedioxymethamphetamine (MDMA)?

CNS stimulant and psychedelic effects, including hyperthermia and dehydration.

What is the risk associated with the use of PCP?

Combativeness, psychosis, and muscle incoordination.

What are the common side effects of benzodiazepines?

Drowsiness, dizziness, and potential for dependence.

What are the key points to review regarding antipsychotics?

Differences between typical and atypical antipsychotics, serotonin syndrome, EPS, TD, Neuroleptic Malignant Syndrome, and Steven-Johnson Syndrome.

Serotonin Syndrome

Any medication that increases the amount of serotonin can put a patient at risk for serotonin syndrome, commonly associated with antidepressants like SSRIs, SNRIs, TCAs, and MAO inhibitors, as well as tramadol.

Symptoms of Serotonin Syndrome

Agitation, muscle complaints, fever, elevated heart rate, severe cases can include rising temperatures, seizures, rhabdomyolysis, and death.

Treatment for Serotonin Syndrome

Discontinuation of the causative medication.

Extrapyramidal Symptoms (EPS)

Changes to the pyramidal part of the brain resulting in abnormal motions, similar to Parkinson's disease, primarily affecting dopamine receptors.

Symptoms of EPS

Dystonia, akathisia, rigidity of movements, bradykinesia, tremors, and tardive dyskinesia.

Treatment for EPS

If possible, discontinue the medication; if not, administration of benztropine (Cogentin) can help.

Tardive Dyskinesia

Serious adverse drug reaction resulting in abnormal and distressing involuntary body movements and muscle tension, characterized by repetitive and involuntary movements.

Symptoms of Tardive Dyskinesia

Facial grimacing, lip smacking, tongue protrusion, puckering and pursing of the lips, and rapid eye blinking.

Treatment for Tardive Dyskinesia

If possible, discontinue the medication; if not, deutetrabenazine (Austedo) is a newer medication specifically for the treatment of TD.

Neuroleptic Malignant Syndrome

Uncommon but serious (potentially fatal) side effect of antipsychotics.

Symptoms of Neuroleptic Malignant Syndrome

High fever (> 102, can be as high as 105), cardiovascular instability, myoglobinemia, muscle rigidity, altered mental status, seizures, and death.

Treatment for Neuroleptic Malignant Syndrome

Immediate discontinuation of the medication; drug of choice is dantrolene.

Common Antidepressants

Recognize by name: SSRIs, SNRIs, TCAs, MAO inhibitors.

Common Antipsychotics

Recognize by name: Typical antipsychotics (e.g., phenothiazines like haloperidol and chlorpromazine) and atypical antipsychotics.