ch 4 pharmacotherapy in mental health

how do antidepressants work

block reuptake of neurotransmitters

how do antipsychotics work

bind dopamine receptors (block)

how do benzos work

increase GABA action, anxiolytic

how do psychostimulants work

increase release of norepinephrine, serotonin, and dopamine

agonists

best friends! increase the action of something

partial agonist

similar but weaker effect than an agonist

antagonist

blocks action of something

efficacy

is the treatment effective? does it have the best outcome?

potency

concentration of a drug in plasma

4 stages of pharmacokinetics

absorption, distribution, metabolism, excretion

CYP450

genetic propensity for metabolizing meds, certain groups (ex asians) need smaller doses than others

how do side effects affect efficacy

limit how much drug can be given which makes maximal efficacy unachievable

what else can anti anxiety meds be used for

alcohol withdrawal

black box warning

strongest safety warning a drug can carry and still remain on the market

what increases effects of anti anxiety agents

alcohol, narcotics, antipsychotics, antidepressants, antihistamines, or herbal depressants

what decreases effects of anti anxiety agents

cigarettes and caffeine

what else can antidepressants be used for

bulimia, premenstrual dysphoric disorder, borderline personality disorder

how do SSRIs interact with BuSpar, TCAs, and st. john's wort

serotonin syndrome

how do SSRIs interact with MAOIs

hypertensive crisis

how do SSRIs interact with NSAIDs and warfarin

increased risk of bleeding

how do SSRIs interact with alcohol and benzos

increased sedation

how do SSRIs interact with antiepileptics

lowered seizure threshold

how do TCAs interact with MAOIs

high fever, convulsions, death

how do TCAs interact with st. john's wort and ultram

seizures, serotonin syndrome

how do TCAs interact with catapres and epinephrine

severe hypertension

how do TCAs interact with acetylcholine blockers

paralytic ileus (severe abdominal blockage)

how do TCAs interact with alcohol and tegretol

blocks antidepressant action, increases sedation

how do TCAs interact with tagamet and buspar

increase TCA blood levels, increased side effects

how do MAOIs interact with morphine, narcotics, antihypertensives

hypotension

how do MAOIs interact with other antidepressants, cymbalta, cough syrup, dopamine, buspar, cocaine, etc

hypertensive crisis

how long does it take for MAOIs to completely leave your system

2 weeks

how do MAOIs interact with buspar

psychosis, agitation, seizures

how do MAOIs interact with antidiabetics

hypoglycemia

how do MAOIs interact with tegretol

fever, hypotension, seizures

what nandas do antidepressants cause

risk for suicide, risk for injury, social isolation, risk for constipation, insomnia

most frequently prescribed psych drugs

xanax, zoloft, celexa

mood stabilizing agents examples

lithium, anticonvulsant medications, and second-generation atypical antipsychotics

lithium interactions

imperfect substitute for sodium, low sodium increases risk of lithium toxicity, TEACH HIGH SALT DIET

primary meds to treat BD

lithium, lamictal

antipsychotics used for BD

abilify, seroquel

nandas mood stabilizing agents can cause

risk for injury, risk for violence, risk for injury related to lithium toxicity or adverse effects, risk for activity intolerance

lithium therapeutic range (acute mania)

1.0-1.5 mEq/L

lithium therapeutic range (maintenance)

0.6-1.2 mEq/L

what else can lithium be used to treat

antiemetic (vomiting), intractable hiccups, Tourette's, racing thoughts

lithium contraindications

coma, severely depressed, history of QT prolongation

antipsychotics contraindications

existing cardiac, hepatic, or renal insufficiency, history of seizures, diabetes, pregnant

antipsychotic action

block dopamine receptors

main dangerous side effect/drug interaction effect of antipsychotics

hypotension

how do antipsychotics interact with antihypertensives, CNS depressants, etc

additive and potentially severe hypotension

how do antipsychotics interact with oral anticoagulants with phenothiazines

less effective anticoagulant effects

how do antipsychotics interact with drugs that prolong QT intervals

additive effects

how do antipsychotics interact with drugs that trigger orthostatic hypotension

additive hypotension

how do antipsychotics interact with drugs with anticholinergic effects

additive anticholinergic effects

what side effects do first gen antipsychotics have more of

extrapyramidal side effects

what major side effects can antipsychotics cause

EPS, agranulocytosis, hormonal side effects

what nandas can be caused by antipsychotics

risk for other-directed violence, risk for injury, risk for activity intolerance, noncompliance (bc of side effects)

what can sedative-hypnotics treat

anxiety, insomnia, alcohol withdrawal

sedative action

depress CNS

sedative hypnotics contraindications

pregnancy, severe hepatic, cardiac, renal, or respiratory disease

sedatative-hypnotics interactions

benzos, zolpidem (ambien), barbiturates

what nandas can sedatives cause

risk for injury, disturbed sleep pattern, risk for activity intolerance, risk for acute confusion

sedative side effects

abnormal thinking and behavioral changes

ADHD agents action

increase levels of neurotransmitters

CNS stimulants (ADHD) contraindications

cardiovascular issues, hypertension, history of drug abuse, children, pregnancy

atomoxetine and bupropion (ADHD) contraindications

lactation, MAOIs

ADHD precautions (which populations shouldn't take it)

people with psychosis, Tourette's, anorexia, insomnia, elderly