NURS 2004 Pharmacology: Medication Therapy for the Central Nervous System 1

what are 3 main types of mental health disorder

1. anxiety

2. affective disorders

3. psychotic disorders

what are the 4 types of psychotherapeutic drugs

1. anxiolytic drugs

2. mood-stabilizing drugs

3. antidepressant drugs

4. antipsychotic drugs

when emotions affect people's abilities to carry out daily activities, what drugs should be used

psychotherapeutic drugs

what is the definition of anxiety

it is multiple, excessive, age-inappropriate worries about a variety of issues for an extended period of time. it is an unpleasant state of mind characterized by a sense of dread and fear

why is anxiety often diagnosed in children

their worries are not age-appropriate for them

what may anxiety be based on

anticipated experiences or actual past experiences

what is the definition of affective disorders

this is changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions

what is a common example of an affective disorder

bipolar disorder

with affective disorders, some clients may exhibit __________ and _____________

mania and depression

what is mania characterized by

an abnormally elevated, expansive, or irritable mood for at least one week + at least 3 other symptoms. may see grandiosity

what is grandiosity in mania

this is when someone thinks they're the best and that they're better than anyone else. they cannot be convinced otherwise. they have a decreased need for sleep, pressure speech, flight of ideas, distractibility, and others

what is the definition of depression

it is the presence of a sad, empty, or irritable mood accompanied by somatic and cognitive changes that affect the person's ability to function

what is the definition of psychosis

this is a severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living

what 2 things may psychosis be caused by

1. schizophrenia

2. depressive/drug induced

what is psychosis theorized to be caused by

excessive amounts of dopamine

what is the hallmark of psychosis

a loss of contact with reality

what is an example of psychosis

someone saying they can hear voices, and when you tell them that no one is there, you cannot get through to them

what is the 1st line of treatment for anxiety

anti-depressants

what do benzodiazepines depress activity in (2)

1. brainstem

2. limbic system

what do benzodiazepines increase the action of

GABA, an inhibitory transmitter

what does GABA do

it reuptakes the inhibitors of neurotransmitters, producing a calming effect

what do the majority of benzodiazepines end in

"pam"

what are the 6 indications to use benzodiazepines

1. short term anxiety

2. ethanol withdrawal

3. insomnia

4. muscle spams

5. seizure disorders

6. anaesthesia adjunct

why should benzodiazepines only be used for a short amount of time

they have a physical tolerance, and people become dependent on them

what are the 6 main adverse events of benzodiazepines

1. decreased CNS activity

2. sedation

3. amnesia

4. drowsiness

5. loss of coordination

6. dizziness

7. paradoxical reactions

what are older adults at a higher risk for when they take benzodiazepines

dizziness, increasing their risk for falls

what are paradoxical reactions

hyperactivity and aggressive behavior

who are paradoxical reactions most commonly seen in

older adults, but most often in children and adolescents

why are benzodiazepines dangerous when taken with sedatives or alcohol

they are CNS depressants such as benzos, and this can result in death

what is used to reverse the effects of benzodiazepine

flumazenil

what are the 5 indications to use diazepam

1. relief of anxiety

2. management of alcohol withdrawal

3. reversal of status epilepticus

4. preoperative sedation

5. adjunct for the relief of skeletal muscle spasms

who should avoid taking diazepam

client with hepatic dysfunction, they will not metabolize it well

what are the 3 adverse effects of diazepam

1. headache

2. confusion

3. slurred speech

what are the 2 interactions with diazepam

1. alcohol

2. oral contraceptives

what is diazepam commonly given for

wisdom tooth removal

lorazepam is an _________________ acting benzodiazepine

intermediate

what 4 routes can lorazepam be taken

1. orally

2. sublingual

3. intravenously

4. intramuscularly

what is lorazepam or ativan useful in the treatment of

an acutely agitated client. they will get continuous infusion

buspirone hydrochloride is a _________________________ anxiolytic

miscellaneous

why is buspirone hydrochloride considered to be a miscellaneous anxiolytic

because it has an unknown mechanism of action

what is buspirone hydrochloride thought to have agonist activity with

serotonin and dopamine receptors

what is buspirone hydrochloride indicated for

the treatment of anxiety

what 2 things does buspirone hydrochloride lack

1. sedative effects

2. dependency potential

buspirone hydrochloride is administered on a ____________________ basis, whereas ativan is usually PRN

scheduled

what are the 5 adverse effects of buspirone hydrochloride

1. paradoxical anxiety

2. blurred vision

3. dizziness

4. headache

5. nausea

what is a potential interaction with buspirone hydrochloride

with SSRIs - increased risk for serotonin syndrome

what are mood-stabilizing drugs used to treat

bipolar disorder

what is the main mood-stabilizing drug

lithium

what are 4 other drugs often used in combination with lithium

1. benzodiazepines

2. antipsychotic drugs

3. antiepileptic drugs

4. dopamine receptor agonists

what is lithium thought to potentiate

serotonergic neurotransmission - essentially, increases the transmission of serotonin

lithium has a ____________ therapeutic range

narrow

what is the therapeutic range of lithium

0.6-1.2 mmol/L. this is why blood monitoring is important

there is a very little _______________ in a therapeutic dose and a toxic dose with lithium

difference

what are the 4 toxicity indicators of lithium

1. GI issues

2. seizure

3. tremors

4. death

sodium levels must be ____________ to maintain therapeutic levels of lithium

normal, or 135-145 mmol/L. a decrease in sodium levels will cause lithium levels to rise and vice versa

if someone on lithium becomes overhydrated, they will have ___________ effects

toxic

if someone on lithium becomes dehydrated, what may they end up with

gastro

what are the 7 adverse effects of lithium

1. cardiac dysrhythmia (life-threatening)

2. drowsiness

3. slurred speech

4. epilepsy-type seizures

5. choreopathetotic movements (wave-like movements of extremities)

6. ataxia

7. hypotension

what may long term treatment with lithium cause

hypothyroidism

what is the 1st line of treatment for depression and anxiety

antidepressants

what 3 things do antidepressants treat the imbalance of

1. serotonin

2. dopamine

3. norepinephrine

there are ____ generations of antidepressants

2

what are the 2 main first generation antidepressants

1. tricyclic antidepressants

2. monoamine oxidase inhibitors

what are the 3 second generation antidepressants

1. serotonin reuptake inhibitors (SSRIs)

2. serotonin-norepinephrine reuptake inhibitors

3. miscellaneous

what were 2nd generation antidepressants made to do

"fix" some of the problems seen in 1st generation drugs

what is the mechanism of action of tricyclic antidepressants

they block the presynaptic reuptake of neurotransmitters, making them available for transmission of nerve impulses to adjacent neurons in the brain

what are 2 indications for tricyclic antidepressants

1. neuropathic pain

2. insomnia (will sleep well)

what are the 2 contraindications of using tricyclic antidepressants

1. use of monoamine oxidase inhibitors in the last 14 days

2. pregnancy

what are the 4 adverse effects of tricyclic antidepressants

1. anticholinergic effects (constipation and urinary retention)

2. impotence

3. orthostatic hypotension

4. dysrhythmia

why are anticholinergic effects of constipation and urinary retention seen in tricyclic antidepressants

they block Ach and will have drying effects

an overdose of tricyclic antidepressants is _____________

lethal - 70 to 80% die before reaching the hospital, and it mainly affects the CV system and CNS. will be given charcoal

what is a common tricyclic antidepressant

amitriptyline

what 2 things is amitriptyline commonly used to treat

1. insomnia

2. neuropathic pain

what are the 3 contraindications to use amitriptyline

1. known drug allergy

2. pregnancy

3. myocardial infarction

what are the 6 adverse effects of amitriptyline

1. potential anticholinergic properties

2. dry mouth

3. constipation

4. blurred vision

5. urinary retention

6. dysrhythmias

what are monoamine oxidase inhibitors mainly used for

parkinson's disease

what can monoamine oxidase inhibitors cause when taken with stimulant medications or foods containing tyramine

hypertensive crisis. if they are taken with tyramine containing foods like aged-cheeses, red wine, draft beer, smoked meats, or overripe fruits, this WILL cause a hypertensive crisis

what are the 2 types of monoamine oxidase inhibitors

1. nonselective (blocks both MAO-A and MAO-B)

2. selective (blocks MAO-B)

why are 2nd generation antidepressants such as SSRIs and SNRIs considered superior

because of their not so life threatening side effect profiles

what do SSRIs inhibit

the reuptake of serotonin

what do SNRIs inhibit

the reuptake of both serotonin and norepinephrine

what is the main indication of taking 2nd generation antidepressants

depression

what is the contraindication of using 2nd generation antidepressants

the use of monoamine oxidate inhibitors in the past 14 days

what are the 3 adverse effects of second generation antidepressants

1. insomnia

2. weight gain

3. sexual dysfunction

what are the 2 interactions of second generation antidepressants

1. highly protein bound medications

2. MAOIs (increases risk of serotonin syndrome)

what does serotonin syndrome result from

the excessive effects of serotonin - whether through overdoes or unintended drug reactions

what are the 9 common symptoms of serotonin syndrome

1. delirium

2. agitation

3. tachycardia

4. sweating

5. myoclonus

6. hyperreflexia

7. shivering

8. coarse tremors

9. extensor plantar muscle responses

what are the common symptoms in more severe cases of serotonin syndrome (6)

1. hyperthermia

2. seizures

3. rhabdomyolysis

4. chronic kidney disease

5. cardiac dysrhythmias

6. disseminated intravascular coagulation

what are 2 types of second generation antidepressants

1. bupropion hydrochloride

2. mirtazapine

what is the mechanism of action 2nd generation antidepressant bupropion hydrochloride

it is a norepinephrine dopamine reuptake inhibitor (little effect on serotonin) no risk for serotonin syndrome

what are the 3 indications to use bupropion hydrochloride

1. depression

2. smoking cessation

3. adjunct antidepressant for clients experiencing sexual adverse effects secondary to SSRI therapy

what is the mechanism of action of 2nd generation antidepressant mirtazapine

it promotes the presynaptic release of serotonin and norepinephrine - does NOT inhibit the reuptake

what are the 3 indications to use 2nd generation antidepressant mirtazapine

1. depression

2. sexual adverse effects in male clients also receiving SSRIs

3. appetite stimulate - why many people experience weight gain

what are the 6 adverse effects of taking mirtazapine

1. drowsiness due to Hi receptor activity

2. abnormal dreams

3. dry mouth

4. constipation

5. increased appetite

6. asthenia

what are the 4 indications to use st. johns wort

1. depression

2. anxiety

3. sleep disorders

4. nervousness

what are the 7 adverse effects of taking st. john's wort

1. GI upset

2. fatigue

3. dizziness

4. confusion

5. dry mouth

6. photosensitivity

7. allergic reaction

what are the 3 interactions of St. John's wort

1. MAOIs

2. SSRIs

3. tyramine containing food

what are the 3 contraindications of st. john's wort

1. bipolar disease

2. schizophrenia

3. alzheimer's disease

what are 5 negative symptoms of schizophrenia

a DECREASE of effects:

1. apathy

2. social withdrawal

3. blunted affect

4. poverty of speech

5. catatonia

what are the 3 positive symptoms of schizophrenia

1. hallucinations

2. delusions

3. conceptual disorganziation