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Psychopharmacology-copy.pptx
- 1.
- 4. Located primarilyin the brainstem Regulates emotional response Synthesized from tyrosine DOPAMINE PARKINSON’S DISEASE SCHIZOPHRENIA
- 5. Causes changesin attention, learning and memory, sleep and wakefulness, mood NOREPINEPHRINE MEMORY LOSS, WITHDRAWAL, DEPRESSION ANXIETY DISORDERS
- 6. Controls Fightor Flight Response EPINEPHRINE MEMORY LOSS, WITHDRAWAL, DEPRESSION ANXIETY DISORDERS
- 7. May haveneurotoxic effects GLUTAMATE STROKE, HYPOGLYCEMIA, HYPOXIA, ISCHEMIA, ALZHEIMER’S AND HUNTINGTON’S
- 9. Controls foodintake, sleep and wakefulness, temp, pain sexual behaviors, emotions SEROTONIN DELUSIONS, HALLUCINATION WITHDRAWN BEHAVIOR
- 10. Major inhibitoryneurotransmitter Modulates other neurotransmitters GABA DELUSIONS, HALLUCINATION WITHDRAWN BEHAVIOR
- 12. Controls sleepand wakefulness cycle Signals muscles to become alert ACETYLCHOLINE ALZHEIMER’S DISEASE MYASTHENIA GRAVIS
- 14. Controls alertness,gastric secretions, cardiac stimulation, peripheral allergic responses HISTAMINE
- 15. Enhance, prolong,inhibit, or limit the effects of principal neurotransmitters NEUROPEPTIDES
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- 20. Neuroleptics ◦Treats symptomsof psychosis ◦Blocks receptors of Dopamine
- 21. DSS (DopamineSystem Stabilizers) – stabilize Dopamine output > Aripiprazole (Abilify) DEPOT INJECTIONS – Use sesame oil > Prolixin (Decanoate Fluphenazine) Haldol (Decanoate Haloperidol)
- 22. 1. Extrapyramidal sideeffects (EPS) Acute dystonia – Torticollis, Opisthotonus, Oculogyric crisis Pseudoparkinsonism Akathisia 2. Neuroleptic Malignant Syndrome (NMS) High fever, unstable BP, diaphoresis, pallor, delirium & elevated CPK levels
- 23. 1. Extrapyramidal sideeffects (EPS) Acute dystonia – Torticollis, Opisthotonus, Oculogyric crisis Pseudoparkinsonism Akathisia 2. Neuroleptic Malignant Syndrome (NMS) High fever, unstable BP, diaphoresis, pallor, delirium & elevated CPK levels
- 24. Clients areoften mute Clients are often confused Clients may fluctuate from agitation to stupor Dehydration and poor nutrition increase the risk
- 25. 3. Tardive Dyskinesia Continuous, involuntary movement of the tongue, facial, & neck muscles, upper & lower extremities, & truncal musculature Tongue thrusting & protruding, lip smacking, blinking, grimacing It is irreversible
- 26. 3. Anticholinergic sideeffects Orthostatic hypotension, dry mouth, constipation, urinary retention, blurred near vision, dry eyes, photophobia, nasal congestion
- 27. Breast enlargementand tenderness Diminished libido Erectile and orgasmic dysfunction Menstrual irregularities Weight gain
- 28. F – FluphenazineDecanoate H - Haloperidol M – Molindone Hydrochloride C – Chlorpromazine Hydrochloride P - Pimozide TYPICAL
- 29. A - Aripiprazole C- Clozapine O - Olanzapine R - Risperidone Q - Quetiapine Z - Ziprasidone ATYPICAL
- 30. May lengthenthe QT interval leading to cardiac dysrhythmias and cardiac arrest DROPERIDOL, THIORIDAZINE, MESORIDAZINE
- 31. May causeAGRANULOCYTOSIS CLOZAPINE
- 32. Management for EPS Lowering the dosage of antipsychotic as prescribed Changing to a different antipsychotic Administering anticholinergic (Benadryl, Cogentin, Akineton)
- 33. Management for NMS Immediate discontinuance of all antipsychotic medications Supportive medical care to treat dehydration Use cooling blanket to lower body temp.
- 34. Management for TARDIVEDYSKINESIA Changing to a different antipsychotic Lowering the dosage of antipsychotic as prescribed If it progresses, Immediate discontinuance of all antipsychotic medications is NECESSARY
- 35. Management for ANTICHOLINERGIC SIDEEFFECTS Advise client to take calorie-free beverages or hard candy Use of stool softeners Adequate fluid intake High fiber foods
- 36. When clients aretaking antipsychotics advise them to: Wear sunscreen Wear dark glasses when going out Avoid driving and activities that require mental alertness Let their WBC levels and liver enzymes be checked
- 37. When clients aretaking antipsychotics Inform them that the full therapeutic effect may not be evident for 3-6 weeks following initiation of therapy Observable therapeutic response may be apparent after 7-10 days Advise them to avoid CNS depressants
- 38. When clients aretaking antipsychotics Advise them to report signs of agranulocytosis Advise them to discontinue the medication dosage gradually
- 39. Treatment formajor depressive illness, anxiety disorders, and depressed phase of bipolar disorder include: TCAs SSRIs MAOIs Others (VBTN)
- 40. Mechanism ofaction is unknown Are effective only after several weeks of therapy TCAs – after 4-6 weeks MAOIs – after 2-4 weeks SSRIs – 2-3 weeks Generally – 2-6 weeks
- 41. block cholinergicreceptors Prevents the reuptake of Norepinephrine Clients taking TCAs usually report sexual dysfunction Can cause weight gain Have more side effects than SSRIs
- 42. S - Sinequan T- Tofranil E - Elavil P - Pamelor N - Norpramin A - Anafranil
- 43. Check BP– hypotension Check heart rate – cardiac dysrhythmia
- 44. Have fewerside effects Causes diminished sexual drive and sexual dysfuction Can cause weigh gain, sedation, sweating, diarrhea and headaches Fluoxetine (Prozac) – most common
- 45. PRO-PA-ZO PRO – Prozac PA– Paxil ZO - Zoloft
- 46. Assess forsexual dysfunction Assess for nausea, weight gain, Assess for sweating Assess for GI disturbances
- 47. Can causeHypertensive crisis side effects: daytime sedation, insomnia, weight gain, hypotension, dry mouth Best taken after meals
- 48. PA-NA-MA PA - Parnate NA– Nardil MA -Marplan
- 49. Report headache Monitor BP Avoid TYRAMINE-RICH containing foods A – Avocado B – Banana C – Cheese (aged) S – Soysauce and preserved foods
- 50. Bupropion Venlafaxine Trazodone Nefazodone
- 51. Can causePRIAPISM When this happens, discontinue the drug TRAZODONE
- 52. May causeliver damage Monitor for liver enzymes NEFAZODONE
- 53. Can causeSEIZURES Risk increases for clients: Having seizure history Having cranial trauma Taking alcohol BUPROPION
- 54. Results fromtaking MAOI and an SSRI at the same time Symptoms: agitation, sweating, fever, tachycardia, hypotension, hyperreflexia SEROTONERGIC SYNDROME
- 55. SSRIs mustbe taken in the morning If the client forgets a dose of an SSRI, he can take it up to 8 hours after the missed dose Cyclic compounds must be taken at night in a single daily dose If the client forgets a dose of TCA, he could still take it within 3 hours after the missed dose Educate client on tyramine-rich foods
- 56. Used totreat Bipolar disorder by stabilizing the client’s mood. Normalizes the reuptake of certain neurotransmitters Reduces the release of Norepinephrine through competition with calcium
- 57. Does notcome in parenteral form Maintenance level – 0.5 mEq/L to 1.5 mEq/L Therapeutic level – 0.6 mEq/L to 1.2 mEq/L LITHIUM
- 58. < 0.5mEq/L – rarely therapeutic > 1.5 mEq/L – Toxic LITHIUM
- 59. Best takenafter meals adequate fluid and salt Avoid activities that increase perspiration It takes 10 -14 days before therapeutic effect becomes evident LITHIUM
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- 61. Can causehepatic failure liver function tests must be done for the first 6 months Can produce NTDs (Spina bifida) Causes pancreatitis VALPROIC ACID AND ITS DERIVATIVES
- 62. Causes aplasticanemia and agranulocytosis hematologic data is needed WBC/platelet count must be obtained CARBAMAZEPINE
- 63. Can causeserious rashes including Stevens-Johnson syndrome and epidermal necrolysis LAMOTRIGINE
- 64. Used totreat anxiety and anxiety disorders, insomnia, OCD, depression, PTSD, and alcohol withdrawal Depress the CNS, thereby increasing GABA, produces relaxation, and may depress the limbic system Include BENZODIAZEPINES & NON BENZODIAZEPINES
- 65. Alprazolam Clonazepam Diazepam Flurazepam Lorazepam Oxazepam Temazepam Triazolam
- 66. Can causePhysical and Psychological dependence are contraindicated to clients with acute narrow-angle glaucoma Administered IV, reverses intoxication in 5 minutes FLUMAZENIL (ROMAZICON) – Benzodiazepine antagonist
- 67. AVOID ALCOHOL MONITOR FORVISUAL DISTURBANCES MONITOR LIVER AND RENAL FUNCTION TEST
- 68. DON’T STOP MEDICATION ABRUPTLY TAPERTHE MEDICATION GRADUALLY OVER 2-6 WEEKS MONITOR FOR RESTLESSNESS, IRRITABILITY, INSOMNIA
- 69. ANXIOLYTICS ARE BEST TAKENBEFORE MEALS
- 70. Used forclients with ADHD Include Amphetamines, Methylphenidate, Pemoline They act by causing the release of the neurotransmitters (norepinephrine, dopamine, and serotonin)
- 71. Weight loss Irritability Nausea Anorexia LONG TERM EFFECTS: GROWTH AND WEIGHT SUPPRESSION IN CHILDREN
- 72. Potential forabuse is high May lead to drug dependence AMPHETAMINES
- 73. may causegrowth suppression in children METHYLPHENIDATE
- 74. Can causeLIVER failure Consent must be secured before initiating this drug PEMOLINE
- 75. Monitor VS obtain baseline ECG monitor liver enzymes instruct parents to avoid giving child with OTC meds give the drug in the morning last dose must be given 6 hours before bedtime avoid caffeine-rich foods
- 76. inhibits theenzyme aldehyde dehydrogenase which is involved in the metabolism of ethanol only used as a deterrent to drinking alcohol in persons who are motivated to abstain from drinking
- 77. Never giveto a client who is using alcohol DISULFIRAM
- 78. M -Mouthwash O – OTC Cold remedies F - Food sauces (Wine-based) F – Fruit-flavored extracts A – Aftershave lotions V - Vinegar S – Skin products
Editor's Notes
- #3 **Chemical substances manufactured in the neuron **Transmission aider **Fit into specific receptor cells embedded in the membrane of the dendrite **Either excitatory or inhibitory
- #5 Controls complex movements, motivation, cognition
- #6 Most prevalent neurotransmitter, also called Noradrenaline
- #7 Also called Adrenaline , has a limited distribution in the brain.
- #8 Huntington's disease (HD) is a neurodegenerative genetic disorder that affects muscle coordination and leads to cognitive decline and psychiatric problems
- #10 Derived from tryptophan, a dietary amino acid
- #13 Found in brain, spinal cord and peripheral nervous system particularly at the neuromuscular junction of skeletal muscles
- #14 a substance, other than a neurotransmitter, released by a neuron and transmitting information to other neurons, altering their activities.
- #18 Efficacy- maximal therapeutic effect that a drug can achieve Potency – the amount of the drug needed to achieve that maximum effect
- #19 Halflife – time it takes for half of the drug to be removed from the bloodstream Off label – use of drugs other than its original purpose. Ex. Anticonvulsant drugs used to treat mood disorders
- #20 ***Rebound - he production of increased negative symptoms when the effect of a drug has passed or the patient no longer responds to the drug. If a drug produces a rebound effect, the condition it was used to treat may come back even stronger when the drug is discontinued or loses effectiveness. (recurrence of original symptoms ***Withdrawal - occurrence of new symptoms resulting from drug discontinuation
- #21 ***Off-label uses – tx of anxiety and insomnia, aggressive behavior, delusions and hallucinaitions and other disrptive behavior of Alzehiemers *** Subcategories: D1,D2,D3,D4,D5 D234 – typical antipsychotics D2,D3,D4 – Associated with mental illness
- #22 (Abilify) the very first DSS Sesame oil – absorbed slowly overtime, thus less frequnet adminsitraion is required.
- #23 ***EPS - serious neurologic symptoms. Major side effect. Result from the blokage of d2 receptors in the midbrain region ***Dystonia – muscle rigidity, twisitng of head and neck, tighetness of entire body with head back and an arched neck, eyes rolled back in a locked position TX – im cogentin, benadryl
- #24 *** Pseudo – stiff stooped posture, masklike facies, decreased arm swing, shuffling festinating gait, cogwheel rigidity, drooling, tremor, bradycardia, coarse-pill rolling of thumb and fingers at rest TX – adding oral anticholinergic/amantadine w.c increases transmission of dopamine *** Aka – intensed need to move about, restlessness TX – additing of beta blocker, anticholinergic, benzodiazepine
- #25 ***NMS, potentially fatal. Often occurs in the first two weeks of therapy or after an increase in dosage. *** TX – discontinuation tx of dehydration and hyperthermia
- #26 syndrome of permanent, involuntary movements *** unfortunately, antispychotic can mask the beginning symptoms, the increase of dosage causes temporary disaprreance *** Tx- Prevention, keeping dosgaes as low as possible, and periodic monitoriiing of appeance of ths s/sc
- #27 ***usually decrease within 3-4 weeks of treatmentm but do not entirely remit *** using calorie-free beveragesm hard candy may alleviate dry mouth Stool softeners, increase fulid intake, inclusion of grains and fruits
- #29 Typical antipsychotics (sometimes referred to as conventional antipsychotics or conventional neuroleptics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia), and are generally being replaced by atypical antipsychotic drugs.
- #30 The atypical antipsychotics, also known as second generation antipsychotics and serotonin–dopamine antagonists, are a group of antipsychotic drugs largely introduced after the 1970s and used to treat psychiatric conditions Atypical antipsychotic drugs, by definition, differ from typical antipsychotic agents in producing significantly fewer extrapyramidal symptoms and having a lower risk of tardive dyskinesia in vulnerable clinical populations at doses that produce comparable control of psychosis.
- #32 MONITOR WBC EVERY WEEK THROUGHOUT TREATMENT AND 4 WEEKS AFTER DISCONTINUATION OF CLOZAPINE Agranulocytosis - A serious condition that occurs when there is an extremely low number of granulocytes (a type of white blood cell) in the blood
- #37 Take food upon drinking meds or after meals
- #39 Agranulocytosis means a failure of the bone marrow to make enough white blood cells (neutrophils). Bone marrow is the soft tissue inside bones that helps form blood cell Infection, fever, sore throat
- #40 Off label uses, chronic pain, migraine, peripheral and diabetic neuropathies, panice disorders Venlafaxine Bupropion Trazadone Nefazadones
- #41 Selective serotonin reuptake inhibitors (SSRIs) ... Serotonin-noradrenaline reuptake inhibitors (SNRIs) ... Noradrenaline and specific serotonergic antidepressants (NASSAs) ... Tricyclic antidepressants (TCAs) ... Serotonin antagonists and reuptake inhibitors (SARIs) ... Monoamine oxidase inhibitors (MAOIs)
- #42 > Causes dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, blurre dvision
- #45 > Block the reuptake of serotonin
- #48 > MAOIs interfere with enzyme metabolism
- #52 Priapism a persistent and usually painful long-lasting erection
- #55 Serotonin syndrome can occur when you increase the dose of certain medications or start taking a new drug. It's most often caused by combining medications that contain serotonin, such as a migraine medication and an antidepressant. Which means that one drug must be cleared from the person’s system before initiation of the other
- #56 Interferes wth sleep TCAs To minize side effects
- #58 tablets, capsules, liquid and sustained—release for Common side effects, mild nausea or diarrhea, anoroexia, fine hand tremors, polydypsia, poluuria, mettalic tase in the moht, fatigue/lehtharty
- #59 Lithium level must be monitored every 2-3 days while therapeutic dosage is determined then weekly Taken 12 hours after the last dose was taken
- #60 Avoid excessive, tea, coffee, or cola, have diuretic efect Missed dose may be taken within 2 hours after missed dose or else skip and take the next dose the schedulted time
- #61 1.5 mild 1.5-2.5 moderate >2.5 severe Nausea, anorexia, vomiting, diarrhea, abdominal cramping, drowsiness, muscle wekaness, end is renal failure and coma DOC. Diamox or mannitol
- #63 Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells
- #64 *** Steven-Johnsons - serious disorder in which your skin and mucous membranes react severely to a medication or infection. *** can start with non-specific symptoms such as cough, aching, headaches, and feverishness. This can be followed by more specific symptoms such as a red rash across the face and the trunk of the body, which can continue to spread to other parts of the body. The rash can form into blisters, and these blisters can form in areas such as the eyes, Necrolysis - : a skin disorder characterized by widespread erythema and the formation of flaccid bullae and later by skin that is scalded in appearance and separates from the body in large sheets
- #67 Because it can increase intraocular pressure