Ch. 10: Mental Health and Behavioral Problems Flashcards
Antianxiety agents/anxiolytics
BNZs, BNZ agonists, certain antidepressants including SSRIs/SNRIs
Action and uses of antianxiety drugs
act with GABA receptors to chance GABA effects (inhibitory), recommended for short term use, can cause anxiety with too high blood drug levels
Buspirone
reduces anxiety by affecting the serotonin and dopamine
can take 1 to 2 weeks for full effect, 3 to 6 for maximal effects
reduces the risk of dependence and sedation
Expected Side Effects/Adverse Reactions of antianxiety drugs
BNZs and BNZ agonists cause drowsiness and memory loss, dizziness, headaches, or hypotension
confusion, apnea, and seizures
Drug Interactions of antianxiety drugs
Sodium oxybate (for narcolepsy), respiratory depression and coma Avoid opioids or any drug that results in CNS depression
Do not give buspirone
with MAOIs, opioids, or drugs for TB
grapefruit juice increases blood levels
Assessment of antianxiety drugs
Check vitals, BP, HR, respiratory rate, and assess patient’s alertness before giving the drug
Assess mental status
before giving the drug
Assess patient for any history of
alcohol or chemical dependency
Planning and Implementation of antianxiety drugs
monitor patient for side effects of drowsiness, dizziness, increased risk for falls
report mental status changes
Flumazenil (Romazicon)
can quickly reverse effects of respiratory depression
Evaluation of antianxiety drugs
ask the patient about relief from anxiety
do not use if pregnant/breastfeeding
Psychosis
loss of control with reality
also called delirium
Acute vs Chronic psychosis
delirium vs schizophernia/bipolar
Dementia patients can have an increased risk for
stroke, cognitive impairment, and mortality
Positive and Negative psychosis with Schizophrenia
Those that add to normal behaviors, those that subtract from the normal behavior
Positive psychosis examples
hallucinations, delusions, disorganized thoughts, and speech
Negative psychosis examples
poor hygiene, difficulty with social relationships, lack of interest in activities, lack of motivation
Typical antipsychotics
1st generation, treats positive symptoms
blocks dopamine 2 D2 receptors
blocking of dopamine receptors helps treat positive symptoms of psychosis, does not affect negative symptoms
Schizophrenia
disease of overstimulation of dopamine
Which drug can cause pseudoparkinsonism and other extrapyrimidal symptoms?
typical antipsychotics
Phenothiazines
block transmission of dopamine at the dopamine receptors
also blocks ACh and alpha-adrenergic receptors
Nonphenothiazines
similar action but are chemically different from phenothiazines
side effects/adverse reactions are basically the same
Side effects/adverse reactions of antipsychotics
headache, drowsiness, nausea, constipation, and dry mouth
Main adverse effects of antipsychotics
ESPs related to decrease of dopamine, pseudoparkinsonism, acute dystonia, akathisia, and tardive dyskinesia
Acute dystonia is managed with
anticholingeric drugs and BNZs, exhibits facial grimacing, involuntary upward eye movement, muscle spasms of face, neck, back, laryngeal spasms
Examples of antipsychotics
chlorpromazine (Thorazine), fluphenazine (Prolixin), halperidal (Haldol), risperidone (Risperidal), ziprasidone (Geodon), quetapine (Seroquel), aripiprazole (Abilify)
Akathisia
restless, trouble standing still, paces the floor, feet in constant motion
Tardive Dyskinesia
protrusion and rolling of the tongue, sucking and smacking of the lips, chewing motions, involuntary movements
increase risk in patients with bipolar disorder
These drugs affect the body’s ability to regulate core body temperature
can cause hypothermia in rare cases
increases risk of hypothyroidism, brain injury, or cold environmental temperature
Neuroleptic malignant syndrome (NMS)
hyperpyrexia, confusion changes in BP, and ESPs
can lead to coma and death
more often in men
Drug Interactions
acetaminophen, diuretics such as furosemide or hydrochlorothiazide, certain calcium channel blockers, and several antidiabetic agents
Assessment of antipsychotics
determine baseline level of consciousness
components of the mental status exam
include factors as patient’s appearance, behavior, mood, affect, and thought processes
Monitor vital signs carefully
for significant changes: increase in temperature or severe changes in blood pressure can indicate the severe adverse effects of NMS