Pharmacology Week 3 (Mental Health)

Metabolism: It goes from the portal vein into the liver to become metabolized.

the axon Recycles chemicals to make neurotransmitters

Norepinephrine, epinephrine, and serotonin

highest thought processes

-panic disorders, OCD, PTSD, and phobias -find and treat the cause of the anxiety before escorting to meds -use meds only when it interferes with life -antidepressants and benzodiazepines

-intensifies the inhibitory effect of GABA -GABA decreases anxiety (Warm Blanket) -specific meds differ in onset and duration -long term treatment of anxiety; short time treatment of insomnia or alcohol withdrawal -safer than barbiturates -no respiratory depression IV can have rapid effects on the CNS and respirations -adverse effects; drowsiness, sedation, lethargy, ataxia -less addiction potential than barbiturates

decreases anxiety (Charlie Brown's blanket)

-alprazoLAM (Xanax), clonazePAM (Klonopin) -diazePAM (Valium), lorazePAM (Ativan) temazePAM (restoril)

is used to reverse CNS depressants effects- Benzodiazepine receptor antagonist.

-affect serotonin levels -schedule IV controlled substances -caution with risk of suicide, respiratory impairment, or other CNS depressants -rapid onset (7-27 minutes) -adverse effects are minimal:Sedation (Fall risk) depression -rebound insomnia an issue

-similar to ambient -longer half-life -more daytime sedation

-probable affects D2 dopamine receptors in the brain -less CNS depression or muscle relaxation -adverse effects-dizziness, HA, and drowsiness -dependence and withdrawal less of a concern -may take several weeks to take effect

-caution with older adults at risk for falls -asess for increased depression, suicidal tendencies -PT to avoid alcohol and other CNS depressants -Avoid abrupt discontinuation- rebound anxiety/sleeplessness

-currently used primarily as anti-seizure meds -used for treatment of acute manic reactions -greater risk of addiction and dependance -possible paradoxical excitement; Stevens-Johnson syndrome -Amobarbital (amytal sodium); phenobarbital (luminal), secobarbital (seconal)

pt goes from little crazy to very crazy. (Think LSD out of nowhere).

-more common with psychiatric meds -rash that becomes more and more involved can go from epidermis to dermis -will end in result with almost third degree burns -needs to be treated in a burn center

-affective disorder -assessment of risk for suicide -increased risk of depression improves -also increased risk for homicide (Could be very flat like Eeyore) (could be BFF one minute and hating you the next)

-Pharmacologic Classifications -tricyclic antidepressants (TCA) - selective serotonin reuptake inhibitors (SSRI) -Monoamine Oxidase Inhibitors (MAOI) -delayed effect of antidepressant -risk for falls -avoid abrupt discontinuation of therapy; profound depression, seizures, or withdrawal

breaks down inhibitors and results in more neurotransmitter

Inhibits serotonin reuptake and leaves more serotonin in the synapse (Calming positive effect)

-inhibit reuptake of norepinephrine and serotonin leaving more available in the CNS -USES: -major depression -obsessive-compulsive disorder (OCD) -SIDE EFFECTS: -orthostatic hypotension -cardiac dysrhythmias -suicidal ideation -weight gain -Anticholinergic effects- -dry mouth -constipation -urinary retention -tachycardia

-amitriptyLINE (Elavil) -ClomipraMINE (anafralil) -DoxePINE (Sinequan) -ImipraMINE (Tofranil) -norty

-blocks the reuptake of serotonin leaving more in the CNS USES: -depression -anxiety -OCD -panic Adverse Effects: -sexual dysfunction -weight gain -insomnia -weight gain SAFEST of the antidepressants -less sympathomimetic and anticholinergic effects -risk of serotonin syndrome if used with MAOIs

FEVER M.A.N -Mental status changes -autonomic/GI lability -Neuromotor disturbances

-citalopram (celexa) -escitalopram (Lexapro) -Fluoxetine (Prozac) -Paroxetine (Paxil) -Sertraline (Zoloft)

-inhibits monoamine oxidose, an enzyme that breaks down norepinephrine, dopamine, and serotonin in the CNS leading to higher levels of these neurotransmitters -SIDE EFFECTS: orthostatic hypotension, HA, weight gain, and insomnia -interacting with other drugs and foods containing tyramine can cause hypertensive crisis -low safety margin (Last Resort Drug)

-cheese -wine -chocolates anything containing tyramine (Hypertensive crisis)

-isocarboazid (Marplan) -phenelyzene (Nardil) -tranylcpromine (Parnate)

-atypical antipsychotics- may be used for acute mania -ClozAPINE (clozaril)-risk for agranulocytosis -aripiprazole (Abilify) -olanzAPINE (Zyprexa) -quetiAPINE (Seroquel) -risperidone (Risperdal)

-very low white blood cells -lack of ability to fight off infection

-may be used for anti seizures or antidepressants -narrow therapeutic index -(1-3 days) -0.6-1.5mEq/L is a therapeutic level -lithium toxicity with sodium loss Pt teaching! -evaluate renal, thyroid, heart function before therapy -lithium toxicity -vomiting -diarrhea -slurred speech -drowsiness -ataxia -weakness -tremor -hypotension -seizures -lithim level low-S&S depression and/or mania

signs and symptoms

-condition characterized by delusions, hallucinations, illusions, disorganized behavior, and paranoia. -Acute or Chronic -difficult to treat as pt does not recognize their illness -many undesirable side effects with the medications -goal is to reduce psychotic symptoms to a level that allows for social relationships, and ability to care for themselves -relapse rate: 60-80%

-phenothiazines (Typicals) -chlorpromazine (Thorazine) -fluphenozine (prolixin) -halperidol (Haldol) -prochlorperazine Atypical Antipsychotics -ariprazole (Abilify) -clozapine (Clozaril) -lurasidone (latuda) -quetiapine (Seroquel)

NO! Will more than likely cause a heart attack

-dopamine receptor blockers -anti-cholinergic side effects and alpha-adrenergic blocking effects -extrapyramidal side effects -hypotension, dysrhythmias (prolonged QT) -CHF (congestive heart failure) -pulmonary edema -laryngospasm -red urine -weight gain -risk of diabetes mellitus and bone marrow suppression -risk of neuroleptic malignant syndrome -(

-dystonia -akathisia -akathisia -parkinsonism -tardive dyskinesia -benztropine (Cogentin) to treat the dystonia -Beta-adrenergic blockers and benzodiazepines are sometimes used to reduce akathisia.

-block dopamine and serotonin receptors -fewer EPS effects ADVERSE EFFECTS: -weight gain -diabetes -hypertriglycerides -possible risk of CVS and mortality

-not a cure, only controls symptoms -never stop taking medications without consulting physician -need to be tapered off -fall risk -observe for anticholinergic effects (PT may not tell you)

-treat ADHD -narcolepsy -sleep disorders SIDE EFFECTS: -anticholinergic side effects; excessive CNS stimulation -controlled substances EXAMPLES: -Armodafinil (Nuvigil) -atomoxetine (Stratteral) -dextroamphetamine (dexedrine) -lisedexamfetamine (Vyvanase -Methylphenidate (Ritalin, Concerta) -modafinil (Provigil) (Uppers)

CAUSES: -head trauma -infectious disease -metabolic disorders (fluid and electrolyte imbalance) -hypoxia -vascular disease-stroke -pediatric disorders-febrile -neoplastic disease (Cancer)

simple or complex (Maybe just an arm has a seizure)

-absense (petit mal) (Staring off into space) -tonic-clonic (Grand-mal) -myoclonic -atonic -status epilepticus -febrile

-GABA potentiate (primary inhibitory neurotransmitter in the brain) -prevents abnormal or repetitive firing -stabliizes neuronal membranes to control movement of electrolytes -hydantoins -barbiturates -bensodiazepines -succinimides

-may not eliminate seizures altogether -risk of falls due to dizziness -periodic drug levels and symptoms review -alcohol might increase adverse effects of anti seizure drugs -avoid abrupt discontinuation -sedation common

-phenytoin (Dilantin)- oldest and most common anti seizure -fosphenytoin (cerebyx) ALL SEIZURES EXCEPT ABSENCE -low abuse potential and CNS depression -narrow range of therapeutic and toxic dose-monitor blood levels ADVERSE EFFECTS: -dysarrhythmias (Bradycardia, ventricular fibrillation) hypotension, hyperglycemia, CNS-drowsiness, dizziness, agranulocytosis -mix with saline only, only MaCI in IV line. irritating to vein -use birth control

-CNS depression (Sedation) -dysarhythmias -hypotension -gingival hyperplasia -nystagmus -Stevens-Johnson syndrome -Bone-Marrow suppression with agranulocytosis -liver toxicity -mix with saline only. Only give in IV line flushed with NaCI -Irritating to Vein

-intensify effect of GABA -low margin of safety -high potential for dependence and withdrawal -cause profound CNS depression -phenobarbital (solfoton, luminol)- inexpensive, long acting, and few adverse side effects -used in all seizure types except absence -drug of choice for neonates -possible tissue necrosis at injection site

used in absence or myoclonic seizures (Caffeine and nicotine may decrease the effectiveness of benzodiazepines)

-suppress the abnormal brain activity of absence seizures -ethosuximide (Zarontin) -methsuximide (Celontin) -CNS and GI depression, bone marrow suppression with pancytopenia, Stevens-Johnson syndrome

not enough of any blood cells

-always take anti seizure meds -do not switch brands -take at the same time every day with food -monitor blood tests as ordered -do not drink alcohol -do not stop taking abruptly

-carbamazepine (Tegretol) -Gabapentin (Neurontin) -Lamotrigine (Lamictal)

-degenerative disorder of the CNS caused by death of neurons that produce the neurotransmitter dopamine. -lack of dopamine and overactivity of acetylcholine -tremors -muscle rigidity or weakness -bradykinesia -difficulty chewing, swallowing, and speaking -postural instability, shuffling gait-easily lose balance, fall risk!

-carbidopa combined with levodopa (Sinemet) helps levodopa cross the blood brain barrier before transforming to dopamine -may take up to 6 months for therapeutic effects -adverse effects0 tachycardia, hypertension, loss of appetite, nausea and vomiting, constipation, urinary retention -associated with development of melanoma -avoid vitamin B6 -Abrupt withdrawal can produce acute parkinsonism

the spinal chord and the brain, it is protected by bone and meninges

-depress or decrease CNS -regulate amounts of CNS Neurotransmitters -stimulate or block autonomic receptors -treat psychiatric disorders

-benzodiazepines -non-benzodiazepines

-relieve insomina -relieve anxiety -treat epilepsy in emergency situations -relax muscle spasms -help with moderate sedation (Pams) -they enhance GABA

-drowsiness -dizziness -tolerance develops within weeks -Withdrawal -can cause paranoia, panic attacks, muscle twitching, and hallucinations

weakness slurred speech ataxia respiratory depression (Older Adults)-watch for paradoxical excitement

Zolpidem (Ambien) Eczopiclone (Lunesta)

-daytime drowsiness -headache -anxiety -dizziness -diplopia -amnesia TAKE ON EMPTY STOMACH

-centrally acting muscle relaxants -peripherally acting muscle relaxants

-Spinal Chord Injury -multiple sclerosis -cerebral palsy -musculoskeletal injury

-no physical dependance -drowsiness/dizziness -nausea -constipation -anxiety -restlessness

-relax muscle spasms r/t -cerebrovascular accident -spinal chord injury -cerebral palsy -multiple sclerosis Prevent and treat hyperthermia (Side Effect of general Anesthesia

-prototype drug-dantrolene (Dantrium) -inhibit release of calcium

-liver toxicity -diarrhea -muscle weakness -drowsiness/ dizziness

-hydantoin -iminostilbenes -Valproic Acid -

treats: -Grand-Mal (Tonic Clonic Seizure) -partial seizure phenytoin(Dilantin)

-decrease neuronal activity of seizure producing cells in brain -by inhibiting influx of sodium through sodium channels

creatine phosphokinase (CPK)

nausea

IT will increase the amount of dopamine that can get to the brain through the blood brain barrier

-rash -drowsiness

fatigue

taking any over-the-counter antacid

Take in the morning

They should not drive until the effects of the drug are known

jaundice

-Avoid alcohol and other depressants -take 30 minutes before bedtime -taper the drug to decrease effects from withdrawal

memory impairment

tachycardia

Naloxone

premedicate with tylenol

chest pains

increased focus

begin taking at a low dosage

hypotension

change positions to prevent orthostatic hypotension

Imipramine (Tofranil)

-change position slowly -do not quit taking abruptly -take at bedtime to prevent daytime drowsiness -Increase fiber and fluid intake

Thyroid function test

drinks two or more glasses of wine each night

Furosemide (Lasix) for hypertension

-tolerance -anxiety -sedation -respiratory depression

Avoid taking NSAIDS

-do not touch the tip of the dropper -apply pressure nasolacrimal duct for 1 minute after -Remove contact lenses prior to inserting drops

acute dystonia

Phenelzine (Nardil)

withdrawal symptoms

Seratonin Syndrome

Suicidal Thoughts

wear sunscreen when exposed to light

allow 2 to 4 weeks to notice effects

hypertensive crisis

-depression -seasonal affective disorder -nicotine addiction

Ocular Stinging

blood pressure

cataracts

-tremors -confusion -nausea -muscle weakness

polyuria

asthma

bradycardia

seizure activity