Medication exam material - NURS 383 - Psychiatric
Mental Health Nursing
-- original from the 1950's and 1960's, treat schizophrenia, psychosis, aggression and behavioral
problems
-- typical antipsychotics target psychosis and the positive symptoms of schizophrenia
-- more sedating and high potential for EPS (dystonia, Tardive dyskinesia, pseudoparkinsonism
(tremor, shuffling gait, drooling, rigidity)) - correct answer Typical Antipsychotics
-- Newer generation of antipsychotics; first emerged early 1990s
-- Effective in treating negative and positive symptoms
-- Lower side effects, include sedation & EPS, but still affect BP (especially if on BP meds)
Takes 1-2 weeks to see any affect and 6-10 weeks to really see changes - correct answer
Atypicals Antipsychotics
Atypical antipsychotic that causes hyperprolactinemia: causes lactation - correct answer
Risperidone (Risperdal)
**R-obin Brou and her way of remembering lactation and R-isperdal
Atypical antipsychotic that can cause agranulocytosis (risk for fevers, immunocompromised) -
use as a drug of last resort - correct answer Clozapine (Clozaril)
Ziprasidone (Geodon) is an atypical antipsychotic, what is there a risk of causing? Who
shouldn't you give it to? - correct answer Prolonged QT on EKG (don't give to anyone with a
heart issue)
High blood sugar is a risk with these two atypical antipsychotics (be careful with diabetics)? -
correct answer Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Therapeutic level for lithium? - correct answer 0.6-1.5
Valproic Acid (Depakote/Depakene) therapeutic level: - correct answer 50-100
If a pt is on typical/atypical antipsychotics, they most likely will be on ______ too? Why? -
correct answer Cogentin
To treat EPS
,What else can be given for EPS besides Cogentin? - correct answer Amantadine
Benadryl
Name a typical and atypical antipsychotic that has NMS as a risk factor? - correct answer
Haloperidol (Haldol)
Olanzapine (Zyprexa)
You have a patient who is experiencing hallucinations, what might be the cause of them besides
the antipsychotics? - correct answer Assess for drug or ETOH use
4 categories of drugs for mood disorders? - correct answer SSRIs, SNRIs, TCAs, MAOIs
Safest of the meds for mood disorders? - correct answer SSRI/SNRIs
Antidepressant with much fewer side effects?
Safer in overdose
Side effects: GI, sexual dysfunction, ______ gain
Adverse effects: ______ Syndrome - correct answer SSRIs, Prozac, Zoloft, Celexa
weight
Serotonin
Efficacy established
Less expensive than SSRIs
Side effects: anticholinergic, orthostatic hypotension, cardiac
Lethal in overdose
Several off-label uses
Cardio toxic, neurotoxic
Very narrow therapeutic index - correct answer TCAs, Amitriptyline (Elavil)
Least used antidepressant d/t side effects
May precipitate hypertensive crisis - correct answer MAOIs, Phenelzine (Nardil)
Patients taking MAOIs should avoid what? - correct answer Avoid tyramine-containing foods or
ephedrine or epinephrine
Red wine, cheese, raisins, chocolate
Gold standard for mood stabilizers, well-studied
,Takes __-__ days to reach therapeutic level
Blood drawn _______ in beginning - correct answer Lithium
7-14
weekly
Larger side effects of lithium - correct answer Affects Thyroid
Polyuria
Lithium's side effects at levels > 2.0 mEq/L - correct answer Anorexia, N/V, diarrhea, tremors,
lethargy, ataxia
Lithium's severe side effects at levels >2.5 mEq/L - correct answer Fever, decreased urine
output, decreased BP, irregular HR, seizures, impaired LOC
toxins not bound by charcoal - correct answer iron, lead, & lithium
Supportive treatment for Lithium toxicity?
Pharmacological? - correct answer Hydrate
I&Os
Ensure adequate NaCl
Dialyze
Chelation
Dimercaprol, Penicillamine, EDTA
Anticonvulsants, like _________, all affect ____ receptors - correct answer Valproic Acid
(Depakote)
GABA
What labs will we check with Depakote? - correct answer ALT, AST
Think LIVER with Depakote
Alcoholism, bleeding issues
Anticonvulsant/mood stabilizer with side effects: Dizziness, headache, dbl vision, sedation, rash,
Stevens-Johnson syndrome - correct answer Lamictal (lamotrigine)
, Tegretol (carbamazepine), class of drug?
Therapeutic levels? - correct answer Anticonvulsant/Mood Stabilizer
6-12 mcg/ml
Side effects for ____________: Drowsiness, dizziness, dbl vision, fatigue, agranulocytosis
Mood stabilizer - correct answer Carbamazepine (Tegretol)
Oxcarbazepine(Trileptal) - analogue of _________, fewer side effects
Drug Class? - correct answer Carbamazepine (Tegretol)
Mood stabilizer/anticonvulsant
A patient comes in with depression. Rule out _______ and don't give __________ with
________ disorder because it keeps serotonin in the brain and turns them _______ - correct
answer bipolar
SSRI/SNRIs
bipolar
manic
Lithium can cause hypo or hyper__________ - correct answer thyroidism
3 classes of drugs to treat dementia? - correct answer Cholinesterase inhibitors
N-methyl-D aspartate
Atypical/Typical antipsychotics
Names of some Cholinesterase inhibitors for dementia - correct answer Glantamine
(Razadyne)
Rivastigmine (Exelon)
Donepezil (Aricept)
Side effect of Cholinesterase inhibitors that is especially bad in old people with
dementia/Alzheimer's - correct answer anorexia
Risperidone (Risperdal)
Aripiprazole (Abilify)
Paliperidone (Invega)
Mental Health Nursing
-- original from the 1950's and 1960's, treat schizophrenia, psychosis, aggression and behavioral
problems
-- typical antipsychotics target psychosis and the positive symptoms of schizophrenia
-- more sedating and high potential for EPS (dystonia, Tardive dyskinesia, pseudoparkinsonism
(tremor, shuffling gait, drooling, rigidity)) - correct answer Typical Antipsychotics
-- Newer generation of antipsychotics; first emerged early 1990s
-- Effective in treating negative and positive symptoms
-- Lower side effects, include sedation & EPS, but still affect BP (especially if on BP meds)
Takes 1-2 weeks to see any affect and 6-10 weeks to really see changes - correct answer
Atypicals Antipsychotics
Atypical antipsychotic that causes hyperprolactinemia: causes lactation - correct answer
Risperidone (Risperdal)
**R-obin Brou and her way of remembering lactation and R-isperdal
Atypical antipsychotic that can cause agranulocytosis (risk for fevers, immunocompromised) -
use as a drug of last resort - correct answer Clozapine (Clozaril)
Ziprasidone (Geodon) is an atypical antipsychotic, what is there a risk of causing? Who
shouldn't you give it to? - correct answer Prolonged QT on EKG (don't give to anyone with a
heart issue)
High blood sugar is a risk with these two atypical antipsychotics (be careful with diabetics)? -
correct answer Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Therapeutic level for lithium? - correct answer 0.6-1.5
Valproic Acid (Depakote/Depakene) therapeutic level: - correct answer 50-100
If a pt is on typical/atypical antipsychotics, they most likely will be on ______ too? Why? -
correct answer Cogentin
To treat EPS
,What else can be given for EPS besides Cogentin? - correct answer Amantadine
Benadryl
Name a typical and atypical antipsychotic that has NMS as a risk factor? - correct answer
Haloperidol (Haldol)
Olanzapine (Zyprexa)
You have a patient who is experiencing hallucinations, what might be the cause of them besides
the antipsychotics? - correct answer Assess for drug or ETOH use
4 categories of drugs for mood disorders? - correct answer SSRIs, SNRIs, TCAs, MAOIs
Safest of the meds for mood disorders? - correct answer SSRI/SNRIs
Antidepressant with much fewer side effects?
Safer in overdose
Side effects: GI, sexual dysfunction, ______ gain
Adverse effects: ______ Syndrome - correct answer SSRIs, Prozac, Zoloft, Celexa
weight
Serotonin
Efficacy established
Less expensive than SSRIs
Side effects: anticholinergic, orthostatic hypotension, cardiac
Lethal in overdose
Several off-label uses
Cardio toxic, neurotoxic
Very narrow therapeutic index - correct answer TCAs, Amitriptyline (Elavil)
Least used antidepressant d/t side effects
May precipitate hypertensive crisis - correct answer MAOIs, Phenelzine (Nardil)
Patients taking MAOIs should avoid what? - correct answer Avoid tyramine-containing foods or
ephedrine or epinephrine
Red wine, cheese, raisins, chocolate
Gold standard for mood stabilizers, well-studied
,Takes __-__ days to reach therapeutic level
Blood drawn _______ in beginning - correct answer Lithium
7-14
weekly
Larger side effects of lithium - correct answer Affects Thyroid
Polyuria
Lithium's side effects at levels > 2.0 mEq/L - correct answer Anorexia, N/V, diarrhea, tremors,
lethargy, ataxia
Lithium's severe side effects at levels >2.5 mEq/L - correct answer Fever, decreased urine
output, decreased BP, irregular HR, seizures, impaired LOC
toxins not bound by charcoal - correct answer iron, lead, & lithium
Supportive treatment for Lithium toxicity?
Pharmacological? - correct answer Hydrate
I&Os
Ensure adequate NaCl
Dialyze
Chelation
Dimercaprol, Penicillamine, EDTA
Anticonvulsants, like _________, all affect ____ receptors - correct answer Valproic Acid
(Depakote)
GABA
What labs will we check with Depakote? - correct answer ALT, AST
Think LIVER with Depakote
Alcoholism, bleeding issues
Anticonvulsant/mood stabilizer with side effects: Dizziness, headache, dbl vision, sedation, rash,
Stevens-Johnson syndrome - correct answer Lamictal (lamotrigine)
, Tegretol (carbamazepine), class of drug?
Therapeutic levels? - correct answer Anticonvulsant/Mood Stabilizer
6-12 mcg/ml
Side effects for ____________: Drowsiness, dizziness, dbl vision, fatigue, agranulocytosis
Mood stabilizer - correct answer Carbamazepine (Tegretol)
Oxcarbazepine(Trileptal) - analogue of _________, fewer side effects
Drug Class? - correct answer Carbamazepine (Tegretol)
Mood stabilizer/anticonvulsant
A patient comes in with depression. Rule out _______ and don't give __________ with
________ disorder because it keeps serotonin in the brain and turns them _______ - correct
answer bipolar
SSRI/SNRIs
bipolar
manic
Lithium can cause hypo or hyper__________ - correct answer thyroidism
3 classes of drugs to treat dementia? - correct answer Cholinesterase inhibitors
N-methyl-D aspartate
Atypical/Typical antipsychotics
Names of some Cholinesterase inhibitors for dementia - correct answer Glantamine
(Razadyne)
Rivastigmine (Exelon)
Donepezil (Aricept)
Side effect of Cholinesterase inhibitors that is especially bad in old people with
dementia/Alzheimer's - correct answer anorexia
Risperidone (Risperdal)
Aripiprazole (Abilify)
Paliperidone (Invega)
