Chapt 20 and 21.central and peripheral nervous system

Question 1

What is the biochemical imbalance theory?

Answer 1

Mental disorders – associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain

Question 2

*Neurotransmitter
What is the difference between negative and positive?

Answer 2

-Positive means excitatory
-Negative is inhibitory

Question 3

*Neurotransmitter
What dopamine do?(Both expictory and inhibitory)

Answer 3

Influences both motor and thinking areas of the brain- addiction, paranoia, schizophrenia

Question 4

*Neurotransmitter
What does norepinephrine do?(Excitatory)

Answer 4

Affects stress sleep, attention, and focus and ANS

Important for attentiveness, emotions, sleeping
-More norephinerphine increase anxiety
-Less norepinephrine decreases insomnia

Question 5

What does serotonin do? - inhibitory

Answer 5

regulates moods, emotions, cognition, memory, learning,
sensory perception – mood disorders
mood disorders

Question 6

What does GABA do ? - inhibitory

Answer 6

regulates brain activity – regulates anxiety/ panic d/o

Gabby gabs non stop and it makes her sleepy

Question 7

Describe anxiety?

Answer 7

Tension, nervousness, apprehension, fear; symptoms associated with SNS stimulation

Question 8

Describe sedation?

Answer 8

Loss of awareness to stimuli. Could be used in preop before antesthia

Question 9

Describe hypnosis?

Answer 9

Extreme sedation, loss of ability to sense incoming stimuli. More sever sedation

Question 10

What is lorazepam(Ativan)

Answer 10

BENZODIAZEPINES

Question 11

What is therapeutic actions of lorazepam(Ativan)

Answer 11

BENZODIAZEPINES
Enhance effects of GABA

Question 12

What is the indication for lorazepam(Ativan)?

Answer 12

BENZODIAZEPINES
-Anxiety disorders (first line drugs)
* Anticonvulsant
* ETOH withdrawal
* Hyperexcitability and agitation
* Pre-op  anxiety, tension
* Often given concurrently with antidepressants,
antipsychotics, and mood stabilizers

Question 13

What are pharmacokinetics for lorazepam(Ativan)?

Answer 13

Schedule IV drugs

Question 14

What is the antidote for lorazepam(Ativan)?

Answer 14

Antidote: flumazenil (Romazicon) – benzo antagonist

Question 15

What are adverse effects for lorazepam(Ativan)?

Answer 15

CNS depression  sedation, confusion, depression, lethargy
* CV effects  hypo/hyper-tension, arrhythmias, palpitations
* Respiratory difficulties
* GI  N/V, dry mouth, constipation
* Paradoxical reactions
* Withdrawal symptoms occur if medications are stopped
abruptly – high dosing for >4 months then abrupt stop

Question 16

What are contras for lorazepam(Ativan)?

Answer 16

Allergy, psychosis, narrow angle glaucoma
* Pregnancy/ lactation

Question 17

What are cautions for lorazepam(Ativan)?

Answer 17

Renal/liver dysfunction
* Older adults  Monitor for fall and
hypotensive effects

Question 18

What are drug interactions for lorazepam(Ativan)?

Answer 18

CNS depressants, ETOH
* Oral contraceptives  benzo effect
may be increased

Question 19

What is depression a deficiency of ?

Answer 19

Norepinephrine (NE), dopamine, serotonin(5HT)

Question 20

What is fluoxetine (Prozac)?

Answer 20

Selective serotonin reuptake inhibitor

Question 21

What is the thereapeutic action of fluoxetine (Prozac)?

Answer 21

-Selectively inhibit serotonin reuptake
-Little or no effect on norepinephrine or dopamine reuptake
-Result in increased serotonin concentrations at nerve endings
-**Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system

Question 22

What do does SSRIs help with?

Answer 22

-Depression
-Bipolar disorder
-Obesity
-Eating disorders
-Obsessive-compulsive disorder
-Panic attacks or disorders
-Social anxiety disorders
-Posttraumatic stress disorders (PTSD)
-Treatment of various substance abuse problems – bupropion [Wellbutrin] is used for smoking cessation treatment at low levels

Question 23

What are adverse affects of fluoxetine (Prozac)?

Answer 23

-CNS effects -> HA, drowsiness, dizziness
-GI -> N/V/D, dry mouth, weight gain (paroxetine)
Suicidal ideation (esp. in early weeks of therapy) more for children
**Read Focus on The Evidence Box 21.2

Question 24

Who should you be cautious of with fluoxetine (Prozac)?

Answer 24

-Renal and hepatic dysfunction
-Pregnancy only if the benefit outweighs the risk

Question 25

What are drug to drug interactions SSRIs?

Answer 25

-Caution when used with other antidepressants
-Herbs – St. John’s wort (serotonin syndrome), evening primrose (seizures)

Question 26

What is Venlafaxine (Effexor)?

Answer 26

**Serotonin Norepinephrine Inhibitors (SNRIs)

Question 27

What is therapeutic actions of Venlafaxine (Effexor)?

Answer 27

Decrease reuptake of serotonin and
norepinephrine

Question 28

What are indications of **venlafaxine (Effexor)?

Answer 28

Major depressive disorder

Question 29

What are adverse effects with **venlafaxine (Effexor)??

Answer 29

GI  N/V, constipation
* CV  tachycardia, palpations

Question 30

What are cautions with **venlafaxine (Effexor)??

Answer 30

BBW: Severely depressed, suicidal

Question 31

What are drug interaction with **venlafaxine (Effexor)??

Answer 31

MAOIs  serotonin syndrome
* SSRIs or TCAs  increased risk of AE
* NSAIDs, anti-plt, anti-coags  increased
risk bleeding

Question 32

Describe bupropion (Wellbutrin)

Answer 32

Weakly blocks reuptake of norepinephrine, serotonin, and dopamine
* Low doses  smoking cessation

Question 33

Describe trazodone (Desyrel)?

Answer 33

Blocks serotonin uptake
* Many AE  orthostatic hypotension, priapism, drowsiness, fatigue, syncope
* BW: risk of SI in young patients

Question 34

What to assess with Co-morbidities anti-depressants

Answer 34

Co-morbidities
* Liver, Renal
* Sz; CV
* Allergies
* Severe depression or suicidality
* Female patients: pregnant or breastfeeding
* R/O other causes

Question 35

What are nursing diagnosis with antidepressants

Answer 35

Impaired nutrition r/t GI effects
* Disturbed thought processes r/t CNS effects
* Risk for injury r/t CNS effects

Question 36

what is implementation for anti depressants

Answer 36

Monitor for up to 4 weeks to assess full
therapeutic effect before changing dose
* Est suicide precautions for severely depressed
* Educate to use barrier contraceptives
* Monitor VS
* Monitor GI effects  ok with food to minimizes

Question 37

What is evaluations with anti-depressants?

Answer 37

Monitor pt response  alleviation of s/s
depression