NURS 340 - Psychopharmacology (Exam 2)

fluoxetine (SSRI)

SSRI: most activating—more insomnia + nervousness

paroxetine (SSRI)

SSRI: most anticholinergic

paroxetine (SSRI)

SSRI: most calming

sertraline (SSRI)

SSRI: most GI side effects

fluvoxamine (SSRI)

SSRI: most sedating, only SSRI taken at night

citalopram (SSRI)

SSRI: prolongs the QT

bupropion

misc antidepressant: seizure risk

bupropion

misc antidepressant: used for smoking cessation

bupropion

misc antidepressant: decreases appetite

bupropion

misc antidepressant: insomnia—take in morning

nefazodone

misc antidepressant: MANY drug interactions

trazodone

misc antidepressant: causes priapism

trazodone

misc antidepressant: cardiac issues with toxicity (don't use in patients with cardiac issues)

esketamine

misc antidepressant: for treatment resistant depression

esketamine

misc antidepressant: for acute suicide

esketamine

misc antidepressant: causes dissociation

brexpiprazole

misc antidepressant: for postpartum depression that accompanies schizophrenia

brexpiprazole

misc antidepressant: scheduled drug

vortioxetine

misc antidepressant: improved cognitive function in geriatric patients

vortioxetine

misc antidepressant: NO sexual side effects

vilazodone

misc antidepressant: take with food for absorption

vilazodone

misc antidepressant: causes insomnia

SNRIs

drug class: for depression & pain

mirtazapine

misc antidepressant: improved sleep—sedation (take at night)

venlafaxine (SNRI)

SNRI: withdrawal risk (flu-like symptoms)

duloxetine (SNRI)

SNRI: best for pain

duloxetine (SNRI)

SNRI: contraindicated in chronic alcohol abuse + liver failure

levomilnacipran (SNRI)

SNRI: causes hypertension + urinary hesitancy

milnacipran (SNRI)

SNRI: for fibromyalgia only

TCAs

drug class: can be lethal in overdose, never a 90 day supply, do not give to suicidal patient

MAOIs

drug class: no tyramine foods (cheese, processed meats, fish, beer, red wine, avocados, figs, bananas, yeast extract, protein supplements, soup, shrimp paste, soy sauce)

selegiline (MAOI)

MAOI: transdermal patch

tachycardia—cardiovascular shock, restlessness, fever, hypertension, delirium, seizures, tonic rigidity, abdominal pain, diarrhea

clinical manifestations of serotonin syndrome:

cooling blankets, diazepam for muscle rigidity, anticonvulsants

nursing interventions for serotonin syndrome:

hypothyroidism, weight gain, water issues (edema, polydipsia, polyuria), sedation, fine tremor, ataxia

adverse effects of lithium:

0.6-1.2

maintenance range for lithium:

bipolar MAINTENANCE

indications of lithium:

bipolar ACUTE MANIA + PREVENTION OF MANIA

indications of valproate:

valproate (anticonvulsant)

anticonvulsant: highest rate of birth defects

valproate (anticonvulsant)

anticonvulsant: monitor liver function + CBC

< 12 mcg/mL

blood levels of carbamazepine should remain < _____ to avoid toxicity

bipolar ACUTE MANIA + MIXED EPISODES

indications of carbamazepine:

lamotrigine (anticonvulsant)

anticonvulsant: causes rhinitis + pharyngitis

bipolar MAINTENANCE

indications of lamotrigine:

oxcarbazepine (anticonvulsant)

anticonvulsant: causes drowsiness—take at night

ADD-ON THERAPY for bipolar and ETOH + BENZO WITHDRAWAL

indications of oxcarbazepine:

1st gen antipsychotics

drug class: failure of nurse to address side effects increases noncompliance

1st gen antipsychotics

drug class: not lethal in OD, swallowing risk possible (drooling, choking)

1st gen antipsychotics

drug class: for POSITIVE symptoms of schizo

fluphenazine + haloperidol (1st gen antipsychotic)

1st gen antipsychotic: VERY high risk EPS

chlorpromazine (1st gen antipsychotic)

1st gen antipsychotic: sedation + orthostatic hypotension

chlorpromazine, thioridazine, haloperidol, pimozide (1st gen antipsychotic)

1st gen antipsychotic: prolongs the QT

haloperidol (1st gen antipsychotic)

1st gen antipsychotic: neuroleptic malignant syndrome

2nd gen antipsychotics

drug class: first-line antipsychotics

2nd + 3rd gen antipsychotics

drug class: for POSITIVE + NEGATIVE symptoms of schizo

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: for treatment resistant schizo

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: highest risk of metabolic syndrome

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: causes bone marrow suppression + neutropenia

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: smoking lowers drug levels

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: MUST GET REGULAR LAB WORK—follow agency protocol for obtaining absolute neutrophil counts, order WBC count

clozapine (2nd gen antipsychotic)

2nd gen antipsychotic: increased infection risk

schizophrenia + bipolar ACUTE MANIA

indications of risperidone:

risperidone (2nd gen antipsychotic)

2nd gen antipsychotic: highest risk of EPS among all 2nd gens (only 2nd gen that causes EPS)

risperidone (2nd gen antipsychotic)

2nd gen antipsychotic: monitor for gynecomastia in adolescent boys

paliperidone (2nd gen antipsychotic)

2nd gen antipsychotic: pill may be in stool

paliperidone, quetiapine, ziprasidone, iloperidone, asenapine (2nd gen antipsychotic)

2nd gen antipsychotic: prolongs the QT

schizophrenia + bipolar ACUTE MANIA AGITATION

indications of olanzapine:

olanzapine (2nd gen antipsychotic)

2nd gen antipsychotic: don't draw up in same syringe as lorazepam

schizophrenia, bipolar ACUTE MANIA + bipolar DEPRESSION

indications of quetiapine:

quetiapine (2nd gen antipsychotic)

2nd gen antipsychotic: known for sedation + orthostatic hypotension

schizophrenia + bipolar ACUTE MANIA

indications of ziprasidone:

ziprasidone (2nd gen antipsychotic)

2nd gen antipsychotic: must take with food for absorption

ziprasidone (2nd gen antipsychotic)

2nd gen antipsychotic: has less sedating effects than other drugs for acute violent behavior

ziprasidone (2nd gen antipsychotic)

2nd gen antipsychotic: a lot of cardiac considerations—MONITOR EKG BEFORE ADMINISTERING

iloperidone (2nd gen antipsychotic)

2nd gen antipsychotic: high risk orthostatic hypotension with initiation (start with low dose + increase slowly)

scizophrenia + bipolar ACUTE MANIA

indications of asenapine:

asenapine (2nd gen antipsychotic)

2nd gen antipsychotic: administered sublingual or transdermal

asenapine (2nd gen antipsychotic)

2nd gen antipsychotic: no food or water for 10 min after sublingual dose

asenapine (2nd gen antipsychotic)

2nd gen antipsychotic: causes oral hypoesthesia (only with sublingual form)

asenapine (2nd gen antipsychotic)

2nd gen antipsychotic: not effective if swallowed

lurasidone (2nd gen antipsychotic)

2nd gen antipsychotic: must take with food to absorb medication correctly

schizophrenia + bipolar DEPRESSION

indications of lurasidone:

lumateperone (2nd gen antipsychotic)

2nd gen antipsychotic: high risk sedation

lumateperone (2nd gen antipsychotic)

2nd gen antipsychotic: take qd with food

aripiprazole, brexpiprazole (3rd gen antipsychotic)

3rd gen antipsychotic: increase in impulsive behaviors (gambling, shopping, sex)

aripiprazole, brexpiprazole (3rd gen antipsychotic)

3rd gen antipsychotic: has little to no side effects—seen taken with other antipsychotics

schizophrenia + bipolar ACUTE MANIA

indications of aripiprazole:

brexpiprazole (3rd gen antipsychotic)

3rd gen antipsychotic: for MDD

schizophrenia, bipolar ACUTE MANIA + bipolar DEPRESSION

indications of cariprazine:

cariprazine (3rd gen antipsychotic)

3rd gen antipsychotic: highest risk of EPS among all 3rd gens (only 3rd gen that causes EPS)

cariprazine (3rd gen antipsychotic)

3rd gen antipsychotic: has long half life—may take weeks to appear

bipolar DEPRESSION

indications of olanzapine + fluoxetine [symbyax]:

schedule IV

schedule of benzos

benzodiazepines

drug class: prevents seizures and delirium tremens in alcohol withdrawal

alprazolam (benzodiazepine)

benzo: causes paradoxical reactions

diazepam (benzodiazepine)

benzo: genetic component (asians poor metabolizers)

diazepam (benzodiazepine)

benzo: use caution with OA (rapid onset of action + long half-life)

lorazepam (benzodiazepine)

benzo: drug of choice for acute violent behavior

lorazepam (benzodiazepine)

benzo: use caution with liver insufficiency

ETOH WITHDRAWAL

indications of alprazolam: