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NUR409 EXAM 4 FULLY EXPLAINED WITH
VERIFIED ANSWERS.
indications for antipsychotic drugs Accurate Answer - •Schizophrenia •Delusional Disorders •Bipolar Disorder •Depression Psychoses •Drug-Induced Psychoses •Emesis Suppression •Tourette's Syndrome •Huntington's Chorea •Others ** General rule - should not be used to treat dementia related psychosis hallucinations Accurate Answer - experience w/your senses- seeing,feeling, hearing, etc something that isnt there delusions Accurate Answer - false beliefs schizophrenia Accurate Answer - chronic psychotic illness of disordered thinking and disconnection from reality. common symptoms: delusions, hallucinations, paranoia, incoherence, difficulty processing information, etc. schizophrenia positive symptoms (adding to symptoms) Accurate Answer - •Characterized by exaggeration (increase) or distortion of normal function •Examples: delusions, hallucinations, paranoia, agitation, combativeness Schizophrenia (negative symptoms) (subtraction of activity) Accurate Answer - •Characterized by decrease or lessening of function and motivation
Examples: poverty of speech, poor self care, social/emotional withdrawal, schizophrenia cognitive symptoms Accurate Answer - •Thinking difficulties •Examples: disordered thinking, inability to focus attention, prominent learning and memory difficulties. antipsychotic medication categories and MOA Accurate Answer - •First-Generation (Conventional/Traditional) Antipsychotics (FGAs) •Second Generation (Atypical) Antipsychotics (SGAs) •All (FGA & SGA) block D2 (dopaminergic) receptor: leads to movement disorders aka Extrapyramidal Symptoms (EPS) SGAs MOA Accurate Answer - •Atypicals (SGA) have weak affinity to D2 receptors: cause fewer EPS than FGA. But do cause more metabolic side effects antipsychotics AE Accurate Answer - 1.Extrapyramidal Symptoms (EPS) 2.Anticholinergic Effects 3.Cardiovascular Effects 4.Rare & Toxic Effects (Neuroleptic Malignant Syndrome - NMS) 5.Metabolic Side Effects 6.Others extrapyramidal symptoms Accurate Answer - 1.Parkinsonism 2.Acute Dystonia 3.Akathisia 4.Tardive Dyskinesia psuedoparkinsonism Accurate Answer - •Rigidity, mask-like facies, stooped posture, drooling, shuffling gait, "pill-rolling", tremor, bradykinesia, cogwheeling
•Dry Eyes •Impotence "cant see cant pee cant spit can't sht" CV effects of antipsychotics Accurate Answer - orthostatic hypotension severe dysrhythmias as a result of QT prolngation (->torsades -> vfib) rare and toxic side effects of antipssychs Accurate Answer - •Agranulocytosis •Jaundice •Neuroleptic Malignant Syndrome (NMS): can be fatal if not treated promptly! Rare but serious reaction with 5-20% risk mortality. NMS s/s Accurate Answer - •S/S: muscle rigidity, hyperpyrexia, sweating, dysrhythmias, fluctuating BP, changing LOC, confusion, seizures, coma. NMS tx Accurate Answer - IV Dantrolene & bromocriptine, supportive measures metabolic side effects/neuroendocrine effects of antipsychotics Accurate Answer - •Weight gain •Diabetes •Dyslipidemia •Increased prolactin •Menstrual irregularities (97%!!!) other antipsych AE Accurate Answer - •Sedation •Seizures •Sexual Dysfunction •Dermatologic Effects •Withdrawal in Neonate
High potency antipsychotics Accurate Answer - •Haloperidol (Haldol)* •Fluphenazine (Prolixin) •Trifluoperazine •Thiothixene (Navane) •Pimozide (Orap) haloperidol indications Accurate Answer - •schizophrenia, acute psychosis, Tourette's syndrome, severe behavioral problems in children (only as a last resort) haloperidol AE Accurate Answer - •EPS, QT interval, neuroendocrine effects (galactorrhea, gynecomastia, menstrual irregularities) chlorpromazine indications Accurate Answer - •schizophrenia, other psychotic d/o, intractable hiccups, severe behavioral problems in children chlorpromazine AE Accurate Answer - sedation, orthostatic hypotension, anticholinergic effects, neuroendocrine effects, photosensitivity (sunburn), EPS (low risk), lowers seizure threshold, QT interval clozapine indications Accurate Answer - •Schizophrenia •Bipolar D/O •Levodopa-induced psychosis clozapine AE Accurate Answer - •can cause serious agranulocytosis, reserved for other drug failure; must enroll in REMS (Risk Evaluation and Mitigation Strategies). •Common: sedation, wt gain, ortho hypotension, anticholinergic effects, tachycardia. •Minimal: neuroendocrine (gynecomastia, galactorrhea, amenorrhea) effects, sexual dysfunction.
second gen antipsychotics Accurate Answer - •Aripiprazole (Abilify) •Asenapine (Saphris) •Brexpiprazole (Rexulti) •Cariprazine (Vraylar) •Iloperidone (Fanapt) •Lumateperone (Caplyta) •Lurasidone (Latuda) •Olanzapine (Zyprexa) •Quetiapine (Seroquel) •Risperidone (Risperdal) •Ziprasidone (Geodon) depot preparations of FGA Accurate Answer - •Haloperidol (FGA) •Fluphenazine (FGA) depot preparations of SGA Accurate Answer - •Risperidone (SGA) •Paliperidone (SGA) •Olanzapine (SGA) •Aripiprazole (SGA) antidepressants indications Accurate Answer - •Indications: major depression, bipolar d/o, OCD, panic d/o, social phobia, GAD, PTSD, bulimia, PMDD (premenstrual dysphoric disorder), chronic pain •Major depression* 5 groups of antidepressants Accurate Answer - SSRIs SNRIs TCAs MAOIs Atypical Antidepressants
SSRIs action Accurate Answer - •block reuptake of serotonin into the nerve terminal of CNS enhancing its transmission at the serotonergic synapse SSRI indications Accurate Answer - •major depression, bipolar d/o, OCD, panic d/o, bulimia, PMDD. •Unlabeled - GAD, PTSD, social phobia, alcoholism, ADHD, migraine, Tourette's, bulimia, SSRIs AE Accurate Answer - •Sexual dysfunction* •Nausea •Headache •Nervousness •Insomnia •Anxiety •Dry mouth •Blurred vision •Anorexia •Drowsiness •Insomnia •Diarrhea •Suicidal ideation •Weight gain •Serotonin syndrome* •Withdrawal syndrome* •Other* SSRIs Accurate Answer - fluoxetine (Prozac) •Citalopram (Celexa) •Escitalopram (Lexapro) •Paroxetine (Paxil) •Sertraline (Zoloft) (i take the PRAM LINE at 5 fifTINE)
TCAs AE Accurate Answer - •Orthostatic hypotension •Sedation •Anticholinergic side effects •Cardiotoxity* •Seizures* •Sexual dysfunction •Diaphoresis •Hypomania* •Suicide Risk TCAs interactions Accurate Answer - •MOAIs (severe hypertension d/t excessive adrenergic stimulation); avoid concurrent use. •Increase effects of direct-acting sympathomimetics (epinephrine, dopamine). •Decrease effects of indirect-acting sympathomimetics (ephedrine, amphetamine). •Increase anticholinergic agents (antihistamines, etc.). •Increase CNS depressant effects (alcohol, opioids). TCAs toxicity Accurate Answer - •Treat with activated charcoal and gastric lavage. Physostigmine for Anticholinergic SE, treat dysrhythmias with sodium bicarb. other TCAs Accurate Answer - •Clomipramine (Anafranil) •Doxepin (Sinequan) •Imipramine (Tofranil) •Trimipramine (Surmontil) •Desipramine (Norpramin) •Maprotiline (Deprilept) •Nortriptyline •Protriptyline (LINE MINE antidepressant PIN)
atypical antidepressant actions Accurate Answer - •affect either serotonin, norepinephrine, dopamine atypical antidepressants AE Accurate Answer - •generally well tolerated, agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, tachycardia buproprion MOA Accurate Answer - •similar in structure to amphetamine. Has stimulant actions and suppresses appetite. No wt gain or sexual dysfunction. No effect on serotonin bupropion indications Accurate Answer - •MDD, prevention SAD, smoking cessation. Unlabeled use - neuropathic pain, ADHD, bipolar depression. bupropion AE Accurate Answer - seizures (rare) agitation 31% bupropion interactions Accurate Answer - •Metabolized CYP2B6. Avoid use with sertraline, fluoxetine, paroxetine mirtazapine AE Accurate Answer - somnolence weight gain nefazodone AE Accurate Answer - •life-threatening liver failure (low incidence, but avoid with pre-existing liver dx) trazodone AE Accurate Answer - •pronounced sedation, few anticholinergic. Prolong QT, priapism. Used off-label as sleep aid. amoxapine AE Accurate Answer - increased risk for EPS - reserved for pts with psychotic depression
lithium MOA Accurate Answer - •body sees lithium as it does sodium. Alters distribution of sodium, calcium, magnesium. Alters NE, serotonin, dopamine. Has effects on other transmitters too. Lithium AE Accurate Answer - •GI effects* •Nausea, diarrhea, bloating, anorexia •Transient effects* (30% pts) •Fine hand tremor* •Polyuria* (50-70% pts) •Renal Toxicity •Goiter/hypothyroidism •Teratogenic & enters breast milk •Dry mouth •Thirst - 50-70% •Other* lithium levels Accurate Answer - Ideal: 0.4- must be kept <1. early signs of lithium tox Accurate Answer - •Nausea •Vomiting •Diarrhea •Thirst •Polyuria •Slurred speech •Muscle weakness •Fine hand tremor advanced signs of lithium tox (1.5-2) Accurate Answer - coarse hand tremor persistent gi disturbance mental confusion myscle hyperirritability ECG changes incoordination
sedation severe lithium toxicity (2-2.5) Accurate Answer - •Ataxia •Giddiness •Large amounts of dilute urine •Serious ECG changes •Fasciculations •Tinnitus •Blurred vision •Clonic movements* •Seizures •Stupor •Severe hypotension •Coma •Death •>2.5: symptoms may progress rapidly to seizures, oliguria, and death lithium drug interactions Accurate Answer - diuretics NSAIDs anticholinergics antiepileptics for bipolar Accurate Answer - divalproex sodium carbamazepine lamotrigine antipsychs for bipolar Accurate Answer - •Olanzapine (Zyprexa) •Quetiapine (Seroquel) •Risperidone (Risperdal) •Aripiprazole (Abilify) •Lurasidone (Latuda) •Cariprazine (Vraylar) •Asenapine (Saphris) •Ziprasidone (Geodon)
ramelton MOA Accurate Answer - •activation of receptors for melatonin ramleton AE Accurate Answer - Very well tolerated. Can inc prolactin and dec testosterone. Small risk of allergic rxn ramleton interactions Accurate Answer - •CYP1A2 substrate (fluvoxamine) ramleton caution Accurate Answer - mod liver impairment avoid severe liver impairment suvorexant MOA Accurate Answer - •sedative that selectively blocks orexin receptors (neurotransmitter that promotes wakefulness) suvorexant AE Accurate Answer - schedule IV •somnolence, HA, dizziness, diarrhea, dry mouth, cough common; hallucinations, sleep paralysis, vivid, disturbing perceptions reported by some. suvorexant interactions Accurate Answer - •CYP3A (ketoconazole, clarithromycin) can increase levels; suvorexant can inc levels of digoxin suvorexant precautions Accurate Answer - PD or OSA (obstructive sleep apnea) due to sedation; contraindicated in pt with narcolepsy barbituates Accurate Answer - •Methohexital (ultrashort- acting) •Secobarbital (short to intermediate-acting) •Phenobarbital (long-acting) barb indications Accurate Answer - •Seizures
•Induction of anesthesia •Insomnia •Other uses* barb side effects Accurate Answer - •CNS depression (respiratory depression) •CV effects - low BP/HR •Induction of Hepatic Drug-metabolizing Enzymes •Tolerance •Physical Dependence •Suicide* •Abuse •Hangover •Paradoxical excitation •Hyperalgesia - increase sensitivity to pain barb interactions Accurate Answer - CNS depressants cyp induction barb toxicity symptoms Accurate Answer - •resp depression, coma, pinpoint pupils, hypotension, hypothermia, death barb toxicity tx Accurate Answer - •activated charcoal, forced diuresis and alkalinization of urine (sodium bicarb), fluids & NE, supportive measures barb admin Accurate Answer - oral, IV, avoid IM == can cause pain/necrosis other hypnotics Accurate Answer - •Antidepressants: •Trazodone (Oleptro) - atypical antidepressant •Doxepin - TCA •Antihistamines: •Diphenhydramine (Nytol, Sominex) •Doxylamine (Unisom)
•Diazepam (Valium) •Lorazepam (Ativan) •Oxazepam benzo AE Accurate Answer - •Sedation •Dizziness •Headache •Dry Mouth •Blurred Vision •Constipation •Leukopenia (decreased WBCs) •Fever, Malaise, Sore throat •Use cautiously with people who have substance abuse issues. •Tolerance •Physical dependence (SHOULD NOT BE ABRUPTLY DISCONTINUED) - MAY SHOW WITHDRAWAL SYMPTOMS** ampthetamines Accurate Answer - •amphetamine, dextroamphetamine, methamphetamine, lisdexamfetamine methylphenidates Accurate Answer - •Ritalin, Metadate, Methylin, Concerta, Daytrana & Dexmethylphenidate (Focalin) methylxanthines Accurate Answer - caffeinie misc CNS stimulations Accurate Answer - •modafinil (Provigil); armodafinil (Nuvigil); solriamfetol (Sunosi); pitolisant (Wakix) nonstimulants Accurate Answer - •atomoxetine (Strattera), guanfacine (Intuniv), clonidine, antidepressants, bupropion amphetamines MOA Accurate Answer - •Cause release of norepinephrine and dopamine & partly inhibiting reuptake of both. amphetamines uses Accurate Answer - ADHD
narcolepsy amphetamines and methylphenidates Accurate Answer - CNS stimulation weight loss dysrhythmias angina HTN paranoid psychosis tolerance, dependence, abuse potential theophylinne use Accurate Answer - asthma modafinil and armodafinil uses Accurate Answer - •narcolepsy, shift-work sleep disorder, obstructive sleep apnea (OSA) /hypopnea syndrome solriamfetoal uses Accurate Answer - narcolepsy OSA pitolisant uses Accurate Answer - narcolepsy misc stims AE Accurate Answer - •HA, nausea, nervousness, diarrhea, rhinitis, inc HR/BP, euphoria, rarely SJS atomoxetine AE Accurate Answer - •GI, dec appetite, dizziness, somnolence, mood swings, trouble sleeping, sexual dysfunction, urinary retention, suicidal thinking in kids, liver injury a2 agonists for adhd Accurate Answer - guanfacine clonidine a2 agonists for ADHD AE Accurate Answer - sedation hypotension fatigue
