Psych Quiz2 Drugs

Drugs used for alcohol withdrawal?

Benzodiazapines

What are the intended effects of benzodiazepines for alcohol withdrawal?

Maintain vital signs within expected reference ranges;

decrease the risk of seizures;

decrease the intensity of withdrawal manifestations;

used as substitution therapy during alcohol withdrawal.

Drugs used for alcohol maintenance?

Disulfiram

Acamprosate

Naltrexone

What is disulfiram and what are its intended effects?

Disulfiram is a daily oral aversion (behavioral) therapy medication for alcohol use disorder. When taken with alcohol it causes acetaldehyde syndrome.

What are the complications/adverse effects of disulfiram (acetaldehyde syndrome)?

Nausea, vomiting, weakness, sweating, palpitations, and hypotension;

can progress to respiratory depression, cardiovascular suppression, seizures, and death.

What client education should be provided for disulfiram?

Drinking any alcohol is potentially dangerous; avoid products containing alcohol (cough syrup, aftershave, mouthwash, hand sanitizer);

wear a medical alert bracelet;

participate in a self-help program;

How long do medication effects (risk of acetaldehyde syndrome) persist for

risk of acetaldehyde syndrome persist for 2 weeks after discontinuing disulfiram.

What are the intended effects of naltrexone?

A pure opioid antagonist that suppresses craving and pleasurable effects of alcohol; also used for opioid withdrawal.

mnemonic: NALtrexon NULLifies cravings and pleasurable effects

What client education should be provided for naltrexone?

Take with meals to decrease gastrointestinal distress.

What are the intended effects of acamprosate?

Taken orally three times a day (multiple times a day) to reduce unpleasant effects of abstinence, such as dysphoria, anxiety, and restlessness.

Drugs for opioid disorder

methadone substitution

buprenorphine

What are the intended effects and uses of methadone substitution?

intended effect: An oral opioid agonist that replaces the opioid the client is physically dependent on;

dependence is transferred from the illegal opioid to methadone.

prevents withdrawal (abstinence syndrome) and removes the need to obtain illegal opioids;

used for withdrawal and long-term maintenance;

What are the nursing actions for methadone therapy?

Encourage participation in a 12-step program;

inform the client the dose must be slowly tapered to produce detoxification;

inform the client the medication must be administered from an approved treatment center.

What are the intended effects of buprenorphine?

An agonist-antagonist opioid used for both withdrawal and maintenance treatment of opioid use disorder.

What is naloxone used for?

A specific opioid antagonist given IM, SQ, IV, or via inhalation to reverse respiratory depression, coma, and other effects of opioid toxicity.

Drugs used for nicotine use disorder

bupropion

nicotine replacement therapy (nicotine gum, nicotine patch, nicotine inhaler)

What are the intended effects of bupropion for nicotine use disorder?

Decreases nicotine craving and manifestations of withdrawal.

What patient education should be provided for nicotine replacement therapy (general)?

Nasal spray gives pleasurable smoking-like effects due to rapid rise in blood nicotine;

one spray in each nostril delivers the nicotine of one

cigarette;

spray contains menthol producing a throat sensation similar to smoking;

taper nicotine inhaler use over 2 to 3 months, then discontinue.

What are the nursing actions for nicotine replacement therapy (general)?

Nicotine nasal spray is not recommended for clients with upper respiratory disorders (chronic sinus problems, allergies, asthma);

avoid nicotine inhalers in clients who have asthma.

What patient education should be provided for nicotine gum?

Chew slowly and intermittently over 30 minutes;

avoid eating or drinking 15 minutes before and while chewing;

not recommended for use longer than 6 months.

What patient education should be provided for the nicotine patch?

Apply to clean, dry skin daily;

typically applied in the morning and removed 16 hours later at bedtime;

may cause nightmares or sleep disturbance if worn at night;

avoid other nicotine products while wearing the patch;

remove and notify the provider if a local skin reaction occurs;

remove prior to MRI.

What medications are used to treat trauma- and stressor-related disorders?

Antidepressants

Beta-blockers

Prazosin

examples of antidepressants used to treat trauma and stressor related disorders

SSRIs (paroxetine, sertraline, fluoxetine, escitalopram, fluvoxamine);

SNRI (venlafaxine);

tricyclic antidepressants (amitriptyline, imipramine);

MAOI (phenelzine).

What is the intended effect of propranolol (beta blocker) for trauma-related disorders?

Decreases elevated vital signs and manifestations of anxiety, panic, hypervigilance, and insomnia.

What is the intended effect of prazosin for trauma-related disorders?

A peripherally acting antiadrenergic that decreases hypervigilance, insomnia, and nightmares; helpful for inducing sleep in clients who have PTSD with insomnia.

What medications are used to treat illness anxiety disorder?

Antidepressants and anxiolytics.

Medications used to treat psychotic disorder?

first gen antipsychotics

second gen antipsychotics

third gen antipsychotics (ariprizaole)

antidepressants

What are first-generation (conventional) antipsychotics primarily used to treat?

used mainly to control positive symptoms of psychotic disorders - great for managing hallucinations and delusions

What are example medications for first-generation (conventional) antipsychotics?

Prototype: chlorpromazine.

Others: haloperidol (high potency), fluphenazine (high potency), loxapine (medium potency), thiothixene (high potency), perphenazine (medium potency).

What is the expected pharmacological action of first-generation antipsychotics?

They block dopamine (D2), acetylcholine, histamine, and norepinephrine receptors in the brain and periphery.

What are the complications/adverse effects of first-generation antipsychotics?

1. Agranulocytosis;

2. anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation, tachycardia);

3. extrapyramidal side effects;

4. neuroendocrine effects (gynecomastia, weight gain, menstrual irregularities, galactorrhea);

5. neuroleptic malignant syndrome;

6. orthostatic hypotension;

7. sedation;

8. sexual dysfunction.

What are the extrapyramidal side effects (EPS) of first-generation antipsychotics and their manifestations?

Acute dystonia (severe spasm of the tongue, neck, face, and back);

akathisia (inability to sit or stand still, continual pacing and agitation);

pseudoparkinsonism;

tardive dyskinesia

What is tardive dyskinesia and what are the manifestations?

it is a late-onset EPS requiring months to years of therapy to develop

manifestations: involuntary movements of the tongue and face (eg: lip smacking and tongue fasciculations) and involuntary movements of the arms, legs, and trunk

What are the manifestations of neuroleptic malignant syndrome (NMS)?

Sudden high fever, diaphoresis, blood pressure fluctuations, tachycardia, muscle rigidity, decreased level of consciousness, and coma.

What is a major contraindication for antipsychotics (especially atypical antipsychotics like Risperidone)

Dementia

⚠ In general, atypical antipsychotics should NOT be used in patients with dementia.

Nursing actions for first-generation antipsychotic complications [Agranulocytosis]

obtain a CBC if signs of infection appear,

discontinue medication if WBC is less than 3,000/mm3.

Nursing actions for first-generation antipsychotic complications [Orthostatic hypotension]

monitor blood pressure and heart rate for orthostatic changes,

hold the medication and notify the provider for significant BP decrease or HR increase,

encourage fluid intake;

tolerance typically develops in 2 to 3 months.

Nursing actions for first-generation antipsychotic complications [NMS]

stop the antipsychotic

apply cooling blankets

Administer antipyretics

increase fluid intake

administer dantrolene or bromocriptine to induce muscle relaxation.

What client education should be provided for first-generation antipsychotics?

Observe for indications of infection (fever, sore throat) and notify the provider if these occur, due to the risk of agranulocytosis.

What are second-generation (atypical) antipsychotics primarily used to treat?

used to control both positive and negative symptoms of psychotic disorders

What are example medications for second-generation (atypical) antipsychotics?

Prototype: risperidone.

Others: asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone.

What is the expected pharmacological action of second-generation antipsychotics?

They work mainly by blocking serotonin receptors, and to a lesser degree, dopamine receptors.

What are the complications/adverse effects of second-generation antipsychotics?

Agranulocytosis;

metabolic syndrome (new-onset diabetes or loss of glucose control, dyslipidemia with increased cardiovascular risk, weight gain);

orthostatic hypotension;

mild EPS such as tremor;

elevated prolactin levels;

sexual dysfunction.

What are the nursing actions for second-generation antipsychotic complications?

Obtain baseline fasting blood glucose and monitor periodically;

monitor cholesterol, triglycerides, and blood glucose if weight gain exceeds 14 kg (31 lb);

monitor for and instruct clients to recognize EPS;

Screening tool used to monitor EPS in patients taking antipsychotics?

AIMS scale

What client education should be provided for second-generation antipsychotics?

Report indications of hyperglycemia (increased thirst, urination, appetite) to the provider;

follow a healthy, low-calorie diet;

engage in regular exercise;

monitor weight gain.

What are the nursing actions specific to clozapine?

Low risk of EPS but high risk of weight gain, diabetes, and dyslipidemia;

risk for fatal agranulocytosis typically within the first 6 months with gradual onset;

requires baseline and regular WBC monitoring per protocol (weekly, bi-weekly, then monthly);

notify the provider of any signs of infection (fever, sore throat, mouth lesions);

no longer considered a first-line medication due to its adverse effect profile;

any sign of infection is a priority.

What are the nursing actions specific to aripiprazole (third-generation antipsychotic)?

Low or no risk of EPS;

low or no risk of diabetes, weight gain, dyslipidemia, orthostatic hypotension, and anticholinergic effects.

What is the role of antidepressants in treating psychotic disorders?

Used to treat the depression seen in many clients who have a psychotic disorder.