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NRSG 126: Mental Health > Chapter 2: Neurobiologic Theories and Psychopharmacology > Flashcards

Chapter 2: Neurobiologic Theories and Psychopharmacology Flashcards

1
Q

What does the pineal gland influence?

A

Its an endocrine gland that influences activities of the pituitary gland, islets, parathyroids, adrenals, and gonads

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2
Q

What does the left hemisphere control?

A

Controls right side of body and is center for logical reasoning and analytic functions like reading, writing, and math

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3
Q

What does the right hemisphere control?

A

Left side of body. Center for creative thinking, intuition and artistic abilities

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4
Q

Cerebral hemisphere is divided how?

A

Frontal, parietal, temporal, and occipital

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5
Q

Front lobe conrols what?

A

Organization of thought, body movement, memories, emotions, and moral behavior

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6
Q

Disorders of the Frontal Lobe is associated with what disease?

A

Schizophrenia, ADHD, and DEmentia

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7
Q

What does the Parietal Lobe interpret?

A

Sensations of taste and touch and assist with spacial orientation

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8
Q

What does the Temporal Lobe do?

A

Centers for senses of smell and hearing and for memory and emotional expression

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9
Q

Occipital Lobes do what?

A

Assist in coordinating language generation and visual interpretation, such as depth perception

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10
Q

What does the cerebellum do?

A

Center for coordination of mvoements and postural adjustments . Receives information from all over the body

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11
Q

Lack of Dopamine in Cerebellum associated with what?

A

Lack of smooth coordinated movemenets in diseases like parkinsons and dementia

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12
Q

Brainstem includes what

A

midbrain, pons, and medulla oblongata

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13
Q

What does the medulla control?

A

Contains vital centers for respiration and cardiovascular functions

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14
Q

What does the pons do?

A

Serves as a primary motor pathway

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15
Q

What does the medulla oblongata do?

A

Contains retricular activating system (influences motor activity, sleep, consciousness, awareness) and extrapyramidal system (relays information about movement and coordination from brain to spinal nerves)

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16
Q

What does the limbic system include?

A

Thalamus, Hypothalamus, Hyppocampus, and Amygdala

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17
Q

What does the Thalamus do?

A

Regulates activity, sensation and emotion

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18
Q

Hypothalamus does what?

A

Temperature regulation, appetite control, endocrine function, sexual drive, and impulse behavior with anger and rage

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19
Q

What do the Hypocampus and amygdala do?

A

Involved in emotional arousal and memory

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20
Q

Disturbances in the limbic system are associated with what mental illnesses?

A

Memory loss with dementia and poorly controlled emotions and impulses seen with psychotic or manic behavior

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21
Q

What is a synapse?

A

Gap between the cells . Electrochemical messages cross here by way of special chemical messengers

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22
Q

What are neurotransmitters?

A

Chemical substances manufactured in neuron that aid in transmission of information throughout body

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23
Q

Where do Neurotransmitters fit?

A

Fit into specific receptor cels embedded in the membrane of the dendrite

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24
Q

Dopamine MOA

A

Excitatory

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25
Q

Dopamine Physiologic Effects?

A

Controls complex movements, motivation, cognition: regulates emotional response

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26
Q

Norepinephrine MOA

A

Excitatory

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27
Q

Norepinephrine Physiologic Effects

A

Causes change in attention, learning and memory ,sleep and wakefulness, mood

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28
Q

Epinephrine MOA

A

Excitatory

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29
Q

Epinephrine Physiologic Effects

A

Controls fight or flight response

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30
Q

Serotonin MOA

A

Inhibitory

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31
Q

SErotonin Physiologic Effects

A

Controls food intake, sleep and wakefulness, temp, pain, sexual behaviors, emotions

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32
Q

Histamine MOA

A

Neuromodulator

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33
Q

Histmaine Physiologic Effects

A

Controls alertness, gastric secretions, cardiac stimulation, peripheral allergies

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34
Q

Acetylcholine MOA

A

Excitatory or Inhibitory

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35
Q

Acetylcholine Physiologic Effects

A

Controls sleep and wakefullness cycle, signals muscles to become alert

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36
Q

Neuropeptides MOA

A

NEuromodulators

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37
Q

NEuropeptides Physiologic Effects

A

Enhance, prolong, inhibit, or limit efects of neurotransmitters

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38
Q

GLutamate MOA

A

Excitatory

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39
Q

Glutamate Physiologic Effects

A

REsults in neurotoxicity if levels too high

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40
Q

Y-Aminobutyric Acid MOA

A

Inhibitory

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41
Q

Y-Aminobutyric Acid Physiologic Effects

A

Modulates other neurotransmitters

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42
Q

What does Dopamine control?

A

COmplex movements, motivation, cognition, and regulation of emotional responses

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43
Q

Dopamine is implicted in what disorders?

A

Schizophrennia and movement disorders like Parkinsons

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44
Q

Antipsychotic medications work how?

A

By blocking dopamine receptors and reducing dopamine activity

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45
Q

What is the mostprevelent neurotransmitter in the nervous sytem?

A

Norepinephrine

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46
Q

What does Norepinephrine do?

A

Plays role in attention, leanring and memory, sleep and wakefulness and mood regulation

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47
Q

Excess Norepinephrine associated with

A

several anxiety disorders

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48
Q

Deficit of Norepinephrine and Epinephrine may contribute to what?

A

Memory loss, social withdrawal, and depression

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49
Q

How do some antidepressants work with Norepinephrine and Epinephrine?

A

BLock reuptake of norepinephrine while others inhibit MAO from metabolizing it

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50
Q

What does Epinephrine control?

A

Fight or lfight response in peripheral nervous sytem

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51
Q

What does Serotonin control?

A

Control of food intake, sleep and wakefulness temp regulation, pain control, sexual behavior and regulates emotions

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52
Q

SErotonin is associates with what illness?

A

Anxiety, mood disorders, schizophrenia

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53
Q

SErotonin has been foudnt ocontribute to what seen in schizophrenia?

A

Delusions, Hallucinations, and Withdrawn behavior

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54
Q

How to Antidepressants affect SErotonin?

A

Block serotonin reuptake, staying longer in synapse and improving mood

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55
Q

Some psychotropic drugs block histamine, resulting in

A

weight gain, sedation, and hypotension

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56
Q

Where is Acetylcholine found?

A

Brain, spinal cord, and peripheral nervous sytem.. Particularly at neuromuscular junction of skeletal muscle

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57
Q

Where can Acetylcholine be synthesized from?

A

Found in red meat and vegetables and found to affect the sleep-wake cycle and signal muscles to become active

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58
Q

What illness are due to acetylcholine?

A

Alzhemier and Myasthenia Gravis

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59
Q

When can GLutamate be implicated in the brain?

A

Stroke, hypoglycemia, sustained hypoxia and Huntington or Alzheimer disease

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60
Q

Drugs that increase GABA are and do what?

A

Benzodiazepines and treat anxiety and induce sleep

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61
Q

What can a CT diagnose?

A

Primary tumors, metasteses and effusions and to determine size of ventricles (Thsoe with Schizo have enlarged ones)

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62
Q

What is SORL1?

A

Its a variation in a gene in those with Alzheimers

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63
Q

What are Twin Studies?

A

Used to compare rate of certin mental illness or traits in monozygotic (identical) and dizygotic (fraternal) twins

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64
Q

What are adoption studies?

A

Used to determine a trait among biologic veruss adoptive family members

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65
Q

What are family studies?

A

Used to ocmpared whether a treat is more common amove first-degree relatives than more distant relatives

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66
Q

What is Psychoimmunology?

A

Examines effect of psychosocial stressors on the body’s immune system . such as someone with an compromised immune system

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67
Q

What is Efficacy?

A

Refers to maximal therapeutic effect that a drug can achieve

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68
Q

What is Potency?

A

Amount of drug needed to achieve maximum effect

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69
Q

What are antipsychotic drugs used to treat?

A

Symptoms of psychosis, such as delusions and hallucinations seen in schizo, schizoaffective disorders, and manic phaase of bipolar

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70
Q

Antipsychotics: Off lab use includes

A

treatment of anxiety and insomnia, aggressive behavior, and delusions and hallucinations with alzheimers

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71
Q

Antipsychotics: How do these drugs work?

A

By blocking receptors of the neurotransmitter dopamine

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72
Q

Antipsychotics: These are the primary medical treamtent for what illness?

A

Schizophrenia and also used in acute mania, psychotic depression and drug-induced psychosis

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73
Q

Antipsychotics: How does this affect Alzhemiers?

A

Use a low dose for those with psychotic symptoms

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74
Q

Antipsychotics: Benefit for second-generation?

A

Can increase mortality rates in elderly clients with dementia-related psychosis

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75
Q

Antipsychotics: Short term therapy may be used for what?

A

transient psychotic symptoms such as those with borderline personality disorder

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76
Q

Antipsychotics: Major action of this drug?

A

Block receptors for the neurotransmitter.

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77
Q

Antipsychotics: What are dopamine receptors classified into?

A

D1, D2, D3, D4, D5

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78
Q

Antipsychotics: Which dopamine receptors are associated with illness?

A

D2, D3, D4

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79
Q

Antipsychotics: First generation drugs are potent antagonists of what?

A

D2, D3, and D4 but produce many side effects due to D2

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80
Q

Antipsychotics: Newer, second-generation drugs like Clozapien (Clozaril) are weak blockers of what?

A

D2, resulting in lower side efects

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81
Q

Antipsychotics: What else do second generation drugs inhibit?

A

Inhibit the reuptke of serotonin, as do some antidepressants, increasing their effectiveness in treating depressive aspects of schizophrenia

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82
Q

Antipsychotics: What are the newest second gen drugs?

A

Paliperidone (Invega), Iloperidone (Fanapt), Asenapine (Saphris) and Lurasidone (Latuda)

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83
Q

Antipsychotics: What is the difference between Paliperidone (Invega) and Risperidone (Risperdal)?

A

Extended relase, meaning you only take one time a day

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84
Q

Antipsychotics: How is Asenapine (Saphris) taken?

A

Sublingually, avoid food or drink 10-15 minutes after med dissolves

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85
Q

Antipsychotics: What do third generation drugs do?

A

Dopamine system stabilizers. Thought ot stabilize dopamine output . Increase when low and decrease when high

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86
Q

Antipsychotics: What are the third generation drugs?

A

Aripiprazole (Abilify)
Cariprazine (Vraylar)
Brexpiprazle (Rexulti)

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87
Q

Antipsychotics: What are the third generation drugs used for?

A

Schizo, Manic Episodes, and Adjunct Medication in both bipolar and depression

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88
Q

Antipsychotics: SIde effects of third generation drugs?

A

Weight gain, akathisia, headache, anxiety, and nausea

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89
Q

Antipsychotics: What is Depot injection?

A

A time release form of intramuscular medication for maintenance therapy

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90
Q

Antipsychotics: Decanoate Fluphenazine (Prolixin) duration?

A

7-28 days

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91
Q

Antipsychotics: Decanoate Haloperidol (Haldol) duration?

A

4 weeks

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92
Q

Antipsychotics: Once patient condition is stablized with oral condiiton , administration by depot injection required how often?

A

2-4 weeks to maintian therapeutic effect

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93
Q

Antipsychotics: How do Risperidone (Riseperdal Consta), Paliperidone (Invega Sustenna) and Olanzapine Pamoate (Zyprexa RElprevv) second gen drugs work?

A

Encapsulate active medicationinto polymer based microspheres tht degrade slowly in the body

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94
Q

Antipsychotics: How often is Risperdal Consta given?

A

25 mgevery 2 weeks

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95
Q

Antipsychotics: How often is Invega Sustenna given?

A

117 mg every 4 weeks

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96
Q

Antipsychotics: How often is Zyprexa Relprevv given?

A

210 mg every 2 weeks or 405 mg every 4 weeks. May cause postinjection delirium/sedation syndrome

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97
Q

Antipsychotics: Signs of postinjection dlirium/sedation syndrome?

A

Sedation, confusion, disorientation, agitation and cogntiive impairment that leads to ataxia, convulsions, weakness, and hypertension. Must be observed for 3 hours after injection

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98
Q

Antipsychotics: What are Extrapyramidal symptoms (EPS)?

A

Serious neurologic symptoms and side effects of antipsychotic drugs

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99
Q

Antipsychotics: EPS of this drug?

A

Acute Dystonia, Pseudoparkinsonism and Akathisia

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100
Q

Antipsychotics: What is responsible for the development of EPS?

A

Blockade of D2 reeptors

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101
Q

Antipsychotics: Which drug rarely causes EPS?

A

Ziprasidone (GEodon)

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102
Q

Antipsychotics: Geodon is contraindicated in those with?

A

History of QT prolongation

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103
Q

Antipsychotics: How to treat EPS?

A

lowering the dose, change to a different drug, or administer anticholinergic meds

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104
Q

Antipsychotics: What is Acute Dystonia?

A

Acute muscular rigidity and cramping, a stiff or thick tongue, and laryngospasm and respiratory difficulties

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105
Q

Antipsychotics: When is Dystonia most likely to occur?

A

In the first week of treatment, those <40 and in males and those receiving haloperidol and thiothixene

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106
Q

Antipsychotics: Spasms or stiffness is muscle groups can produce what?

A

Torticollis (twisted head and neck), Opisthotonus (tightness in entire body with the head back and an arched neck) or oculogyric crisis (eyes rolled back in locked position)

107
Q

Antipsychotics: Treatment for Actue Dystonia includes what?

A

Anticholinergic drugs like intramuscular benztropine mestylate (Cogentin) or IM/IV Benadryl

108
Q

Antipsychotics: What is Pseudoparkinsonism?

A

Drug induced parkinsonism

109
Q

Antipsychotics: Symptoms of one with Psuedoparkinsonism?

A

Stiff, stooped posture

Masklike Facies

Decreased Arm Swing

Shuffling, Festinating Gait

Cogwhell Rigidity

Drooling, Tremor, Bradycardia, Pill-Rolling movemenets of thumb

110
Q

Antipsychotics: How is Pseudoparkinsonism treated?

A

Changing to an antipsychotic medication that has lower EPS or adding oral anticholinergic agent or amatadine )dopamine agonist)

111
Q

Antipsychotics: How does a client report Akathisia?

A

An intense need to move about. Restless or anxious and agitated.

112
Q

Antipsychotics: How ccan Akathisia be treated?

A

By a change in antipsychotic meds or by addition of an oral agent such as beta blocker, anticholinergic, or benzodiazepine

113
Q

Antipsychotics and NMS: What is Neuroleptic Maligant Syndrome (NMS)?

A

Potentially fatal idiosyncratic reaction to antipsychotic drug.

114
Q

Antipsychotics and NMS: Symptoms of this?

A

Rigidity, high fever, autonomic instability such as unstable BP diaphoresis and pallar, delirium, and elevated levels of enzymes

115
Q

Antipsychotics and NMS: When does this most often occur?

A

During the first 2 weeks of therapy or after an increase in dosage

116
Q

Antipsychotics and NMS: What else can increase the risk for this?

A

Dehydration, poor nutrition and concurrent medical illness

117
Q

Antipsychotics and NMS: Treatment for this?

A

Discontinuance of all antipsychotic medsd and institution of supporitive medical care to treat dehydration and hyperthermia

118
Q

Antipsychotics and TD: What is this?

A

Tardive Dyskinesia. A syndrome of permanent involuntary movements due to long-term use

119
Q

Antipsychotics and TD: Symptms of this?

A

involuntary movements of the tongue, facial and neck muscles, upper and lower extremities. Tongue thrusting and lip smacking are characteristic of this . It is irreversible

120
Q

Antipsychotics and TD: First drugs to treat TD?

A

Valbenazine (Ingrezza) and Deutetrabenazine (Austedo, TEVA)

121
Q

Antipsychotics and TD: How do Valbenazine and Deutetrabenazine work?

A

VMAT2 Inhibitors. Decrease activity of monoamines like dopamine, serotonin and norepinephrine therefore decreasing abnromal movements associated with this

122
Q

Antipsychotics and TD: Valbenazine dosage?

A

40-80 mg daily

123
Q

Antipsychotics and TD: Deutetrabenazine dosage?

A

12-48 mg daily.

124
Q

Antipsychotics and TD: What side effects do Valbenzine and Deutetrabenazine cause?

A

Somnolence, QT prolongation, Akathisia, and restlessness

125
Q

Antipsychotics and TD: When specific side effects can Valbenzine cause?

A

nausea, vomiting, headache, and balance disturbances

126
Q

Antipsychotics and TD: What specific side effects can deutetrabenazine cause?

A

NMS and depression and suicidality in patients with huntington

127
Q

Antipsychotics and TD: How toprevent TD when administering drugs?

A

Keep maintenance dosage as low as possible, change meds, and monitor the client periodically for inital signs

128
Q

Antipsychotics and Anticholinergic SE: When does this occur?

A

With use of antipsychotics

129
Q

Antipsychotics and Anticholinergic SE: Side effects of this?

A 
Orthostatic Hypotension
Dry mouth
Constipation
Urinary Hesitance
Blurred Near Vision
Dry Eyes
Photophobia
Decrease Memory
130
Q

Antipsychotics and Anticholinergic SE: When do the side effects decrease?

A

Within 3-4 weeks

131
Q

Antipsychotics and Anticholinergic SE: Client taking this to treat EPS may have what side effects?

A

Increase Anticholinergic SE

132
Q

Antipsychotics and SE: What does this do to prlactin?

A

Increase it. Cause breast enlaargement and tenderness in men and women, diminished libido, erictile dysfunction and menstural irregulatories

133
Q

Antipsychotics and SE: Weight gain significant with what drugs?

A

Clozapine (Clozaril) and Olanzapine (Zyprexa)

134
Q

Antipsychotics and SE: What is Metabolic syndrome?

A

When a patient has three or more of the following:

Obesity (Excess Weight)
Increased BP
High Blood Sugar
High Cholesterol

135
Q

Antipsychotics and SE: Those with Schizo have an increase RF what?

A

Obesity. Should be involved in education program to control weight and decrease BMI

136
Q

Antipsychotics and SE: Thioridazine and Mesoridazine are used to treat…

A

psychosis

137
Q

Antipsychotics and SE: Droperidol is most often used as an adjunct with

A

anesthesia or to produce sedation

138
Q

Antipsychotics and SE: Clozapine produces fewer traditional side effects than do m ost antipsychotics drugs but has potentially fatal side efect of

A

agranulocytosis

139
Q

Antipsychotics and SE: What is Agranulocytosis characterized by?

A

Fever, Malaise, Ulcerative Sore Throat, and Leukopenia

140
Q

Antipsychotics and SE: When can Agranulocytosis begin?

A

24 weeks after initation of therapy . Need weekly WBCs drawn for first 6 months

141
Q

Antipsychotics and SE: What range do you want your WBCs to be in for someone taking Clozapine?

A

WBC at 3500 and ANC at 2,000. Monitor every 2 weeks for 6 months and then every 4 weeks

142
Q

Antipsychotics and SE: What can ease dry mouth?

A

Drinking sugar free fluids and eating sugar-free hard candy

143
Q

Antipsychotics and SE: What to do if client misses dose?

A

Can take missed dose if it is 3-4 hours late. If longer, client can omit the forgotten dose.

144
Q

Antidepressants: Primarily used to treat

A

major depressive illness, anxiety disorders, depressed phase of bipolar, and psychotic depresion

145
Q

Antidepressants: off-label uses inlcude

A

tx of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, pain disorder, eating disorder

146
Q

Antidepressants: They interact with whattwo neurotransmitters?

A

Serotonin and norepinephrine, that regulate mood, arousal, attention, sensory processiving and appetite

147
Q

Antidepressants: Four groups of antidepressants?

A

Selective Serotonin Reuptake Inhibitors (SSRI)

MAO Inhibitors (MAOIs)

Tryclic and related Cyclic Antidepreassants

Other Antidepressants

148
Q

Antidepressants: Problems with first generation drugs?

A

Varying degrees of sedation, orthostatic hypotension , and anticholinergic side efects

149
Q

Antidepressants: Problems with MAOIs?

A

Life-threatening SE, hypertensive crisis may occur if food with tyramine ingested . Cannot be given with other MAOIs or depressants.

150
Q

Antidepressants: What is the first choice in treating depression?

A

Fluxetine (Prozac) in 1987. Its an SSRI

151
Q

Antidepressants: What is effective in treating OCD?

A

SSRIs and Clomipramine

152
Q

Antidepressants: What is the only drug that can be given once a week after client stabilized on Fluoxetine?

A

Prozac Weekly. Contains 90 mg with an enteric coating

153
Q

Antidepressants: What are the drugs of choice for someone with suicidial idealiations?

A

SSRIs, Venlafaxine, Nefazodone, and Bupropion. No risk of overdose when compared to cyclic compounds and MAOIs

154
Q

Antidepressants: SSRIs only effective for what type of depression

A

mild to moderate

155
Q

Antidepressants: Major interaction occurs how?

A

With the monamine neurotransmitter system in the brain: Norepinephrine and Serotonin . Help regulate arousal, vigilance, attention, mood, sensory processing, and appetite.

156
Q

Antidepressants: What happens to Norepinephrine, SErotonin and Dopamine in the synapse?

A

Removed from synapse after release by reuptake. After reuptake, these three neurotransmitter are reloaded for subsequent release or metabolize dby enzyme MAO

157
Q

Antidepressants: What do SSRIs block?

A

Reuptake of serotonin

158
Q

Antidepressants: What do cyclic antidepressants and venlafaxine block?

A

The reuptake of norepinephrine primarily and block serotonin to some degree.

159
Q

Antidepressants: Cyclic compounds take how long to become effective?

A

4-6 weeks

160
Q

Antidepressants: MAOIs tkke how long to become effective?

A

2-4 weks

161
Q

Antidepressants: SSRIS take how long to become effective?

A

2-3 weeks

162
Q

Antidepressants and SSRI SE: Side effets may lead to

A

Anxiety, Agitation, Akathisia (Motor Restlessness), Nausea, Insomnia, and Sexual Dysfunction. weight gain too

163
Q

Antidepressants and SSRI SE: How is Akathisia treated?

A

With Beta-blocker, such as propranolol (Ideral) or benzodiazepine)

164
Q

Antidepressants and SSRI SE: Les common SE of this?

A

Sedation, Sweating, Diarrhea, Hand Tremor, And Headaches

165
Q

Antidepressants and Cyclic SE: How do these work?

A

Block cholinergic receptors, resulting in anticholinergic effecs like dry mouth, constipation, urinary retnetion, dry nasal, blurred near vision

166
Q

Antidepressants and Cyclic SE: More severe SE include

A

agitation, delirium, and ileus.

167
Q

Antidepressants and Cyclic SE: Normal SE?

A

Orthostatic hypotension, Sedation, Weight Gain, Tachycardia

168
Q

Antidepressants and MAOIs SE: Most common SE include

A

Daytime sedation, Insomnoia, Weight Gain, Dry Mouth, Orthostatic Hypotension, Adn Sexual dysfunction

169
Q

Antidepressants and MAOIs SE: Most important concern to watch for is

A

potential for hypertensive crisis if client ingests food with tyramine.

170
Q

Antidepressants and MAOIs SE: Hypertensive Crisis SE?

A

Hypertension, Hyperpyrexia, Tachycardia, Diaphoresis , Cardiac Dysrhythmias

171
Q

Antidepressants and MAOIs SE: Drugs that may cause fatal interaction with MAOIs include

A

SSRIs, certain cyclic compounds, buspirone , dextromethorphan, and opiate derivatives

172
Q

Antidepressants and Other Antidepressants SE: What drugs are included here?

A

Nefazodone, Trazodone, and Mirtazapine

173
Q

Antidepressants and Other Antidepressants SE: What do Nefazodone, Trazodone and Mirtazapien cause?

A

Sedation

174
Q

Antidepressants and Other Antidepressants SE: What do Nefazodone and Trazodone cause?

A

Headache

175
Q

Antidepressants and Other Antidepressants SE: What can Nefazodone cause?

A

Dry mouth and nausea

176
Q

Antidepressants and Other Antidepressants SE: What can Bupropion, Venlafaxine and Desvenlafaxine cause?

A

loss of appetite, nausea, agitation, and insomnia

177
Q

Antidepressants and Other Antidepressants SE: What can Venlafaxine cause?

A

Dizziness, sweating or sedation

178
Q

Antidepressants and Other Antidepressants SE: Nefazodone can cause what life threatening issue?

A

Liver damage

179
Q

Antidepressants and Other Antidepressants SE: Bupropion can cause what major issue?

A

Seizures at a rate 4x other antidepressants

180
Q

Antidepressants and Drug Interactions: What is Serotonin Syndrome?

A

Can result from taking an MAOI and a SSRI at the same time

181
Q

Antidepressants and Drug Interactions: Symptoms of Serotonin Syndrome?

A

Agitation, Sweating, Fever, Tachycardia, Hypotension, Rigidity, Hyperreflexia and even coma/death

182
Q

Antidepressants and Client Teaching: Whens hould clients take SSRI

A

in the morning

183
Q

Antidepressants and Client Teaching: which drug causes most sedation?

A

paroxetine

184
Q

Antidepressants and Client Teaching: What happens if patient forgets SSRI dose?

A

can take up to 8 hours after missed dose

185
Q

Antidepressants and Client Teaching: When should client take cyclic compound?

A

At night .

186
Q

Antidepressants and Client Teaching: What happens if client misses cyclic dose?

A

Take within 3 hours or omit dose for that day

187
Q

Antidepressants and Client Teaching: Those taking MAOI ned to be aware of what?

A

Hyperadrenergic crisis can ocur if diet restrictions arent observed

188
Q

Mood-Stabilizing Drugs: Used to treat what?

A

Bipolar disorder by stabilzing the clients mood, preventing or minimizing the highs and lows a dn treating acute episodes of mania

189
Q

Mood-Stabilizing Drugs: What is the most established mood stabilizer?

A

Lithium

190
Q

Mood-Stabilizing Drugs: What are some effective modo stabilizers?

A

Carbamazepine (Tegretol) and Valproic ACid (Depakote, DEpakene)

191
Q

Mood-Stabilizing Drugs: What is occasionaly used to treat acute mania?

A

Clonazepam (Klonopin)

192
Q

Mood-Stabilizing Drugs: What is a warning about Lamotrigine?

A

Can cause serious rashes requiring hospitalization including Stevens-Johnson Syndrome

193
Q

Mood-Stabilizing Drugs and MOA: How does Lithium work?

A

Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine and acetylcholine and dopamine. Also reduces release of norepinephrine through competition with calcium.

194
Q

Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Topiramate work?

A

Increases levels of GABA

195
Q

Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Carbamazepien work?

A

Stabilize mood by inhibiting kindling process. Is a snowball effect where minor seizures start to build up.

196
Q

Mood-Stabilizing Drugs and Dosage: Lithium is available in what form

A

tablet, capsule, liquid, and sustained-release forms

197
Q

Mood-Stabilizing Drugs and Dosage: How is Lithium dosage determined?

A

Monitoring serum lithium levels .

198
Q

Mood-Stabilizing Drugs and Dosage: Lithium dose ranges form what ot what?

A

900 - 3600 mg.

199
Q

Mood-Stabilizing Drugs and Dosage: Serum Litium level should be at what level?

A

1 mEq/L

200
Q

Mood-Stabilizing Drugs and Dosage: Serum Lithium levels less than 0.5 are rarely

A

therapeutic

201
Q

Mood-Stabilizing Drugs and Dosage: Serum Lithium levels more than 1.5 are

A

considered toxic

202
Q

Mood-Stabilizing Drugs and Dosage: How is Carbamazepien available?

A

In liquid, tablet, and chewable tablet forms

203
Q

Mood-Stabilizing Drugs and Dosage: Carbamazepien dosage range from

A

800-1200 / day. Extreme dosage is 200-2,000 mg/day

204
Q

Mood-Stabilizing Drugs and Dosage: How is Vlproic Acid available?

A

Liquid, tablet, and capsule forms and as prinkles

205
Q

Mood-Stabilizing Drugs and Dosage: Valproic Acid range”?

A

1,000 to 1,500 . Extreme dose is 750-300

206
Q

Mood-Stabilizing Drugs and Side Effects: Common side effects of Lithium include

A

mild nausea/diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic tase in mouth, and fatigue. Weight gain and acne occur later

207
Q

Mood-Stabilizing Drugs and Side Effects: Toxic effects of lithium include

A

diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination. If untreated, lead to renal failure

208
Q

Mood-Stabilizing Drugs and Side Effects: What does a Lithium level of 3 indicate?

A

Dialysis may be needed

209
Q

Mood-Stabilizing Drugs and Side Effects: SE of Carbamazepien and Valproic Acid include

A

drowsiness, sedation, dry mouth and blurred vision

210
Q

Mood-Stabilizing Drugs and Side Effects: What may Carbamazepine specifically cause?

A

Rashes and orthostatic hypotension

211
Q

Mood-Stabilizing Drugs and Side Effects: What may Valproic Acid specically cause?

A

Weight gain, alopecia and hand tremor

212
Q

Mood-Stabilizing Drugs and Side Effects: What may Topiramate cause?

A

Dizziness, sedation, weight loss, and increase incidence of renal calculi

213
Q

Mood-Stabilizing Drugs and Side Effects: What dangerous SE can Valproic Acid cause?

A

Hepatic Failure. Liver function tests should be performed often

214
Q

Mood-Stabilizing Drugs and Side Effects: What dangerous SE can occur with Carbamazepine?

A

Aplastic Anemia and Agranulocytosis at a rate 5-8x higher than normal population

215
Q

Mood-Stabilizing Drugs and Client Teaching: What is important for someone taking Lithium or Anticonvulsants?

A

Monitor blood levels periodically. Time of last dose must be accurate so labs can be checked 12 hours after lat dose.

216
Q

Antianxiety Drugs (Anxiolytics) : USed to treat what?

A

Anxiety, and anxiety disorders, insomnia, OCD , depression, posttraumatic stress disorder and alcohol withdrawal

217
Q

Antianxiety Drugs (Anxiolytics) : What has been proven to be most effective in relieving anxiety?

A

Benzodiazepines

218
Q

Antianxiety Drugs (Anxiolytics) : Why may Benzodiazepines also be prescribed?

A

Anticonvulsant and Muscle relaxant effects

219
Q

Antianxiety Drugs (Anxiolytics) : What is Buspirone?

A

Nonbenzodiazepien and often used for relief of anxiety

220
Q

Antianxiety Drugs (Anxiolytics) and MOA: How do Benzodiazepines work?

A

Medicate actions of GABA. Binds to specific site on Gaba

221
Q

Antianxiety Drugs (Anxiolytics) and MOA: How does Buspirone work?

A

Acts as a partial agonist at serotonin receptors which decreases serotonin turnover

222
Q

Antianxiety Drugs (Anxiolytics) and MOA: What is most often prescribed for sleep rather thn releif of anxiety?

A

Temazepam (Restoril)
Triazolam (Halcion)
Flurazepam (Dalmane)

223
Q

Antianxiety Drugs (Anxiolytics) and MOA: What is often prescribed to manage alcohol withdrawal and to relieve anxiety?

A

Diazepam (Valium)

Chlordiazepoxide (Librium)

224
Q

Antianxiety Drugs (Anxiolytics) and SE: Main problem with Benzodiazepines?

A

How it causes physical dependence. Buspirone does not cause thi s

225
Q

Antianxiety Drugs (Anxiolytics) and SE: SE seen with Benzodiazepines include?

A

CNS depression such as drowsiness, sedation, poor coordination and impaired memory or clouded sensorium

226
Q

Antianxiety Drugs (Anxiolytics) and SE: Common SE from Buspirone include

A

Dizziness, sedation, nausea, and headache

227
Q

Antianxiety Drugs (Anxiolytics) and client Teaching: Clients need to know what?

A

Are aimed at relieving symptoms such as anxiety or insomnia but do not treat the underlying problem

228
Q

Antianxiety Drugs (Anxiolytics) and client Teaching: Benzodiazepines strongly potentiate the efects of

A

alcohol. One drink feels like three.

229
Q

Antianxiety Drugs (Anxiolytics) and client Teaching: How should they discontinue this?

A

Withdrawal can be fatal. Never discontinnue abruptly.

230
Q

Stimulants: What were they first used for?

A

Amphetamines and other drugs were used to treat psychiatric disorders in the 1930s.

231
Q

Stimulants: Dextroamphetamine (Dexedrine) has been abused how?

A

To produce a high or to remain awake for long periods.

232
Q

Stimulants: The primary use for stimulants today is

A

for ADHD, residual attention-deficit disorder in adults, and narcolepsy

233
Q

Stimulants: Primary drugs to treat ADHD?

A

Methyphenidate (Ritalin)
Amphetamine (Addrerall)
Dextroamphetamine (Dexedrine)

234
Q

Stimulants: Wh is Pemoline (Cylert) infrequently used?

A

Because potential for liver problems

235
Q

Stimulants: What was the first nonstimulation medication specifally designed to treat ADHD?

A

Atomoxetine (Strettera) a SSRI

236
Q

Stimulants: What is a Warning about Methyphenidate?

A

Use in caution with emotionally unstable clients such as those with drug or alcohol dependnce

237
Q

Stimulants: Warning about Pemoline?

A

Can cause life-threatening liver failure

238
Q

Stimulants and MOA: Amphetamines and Methyphenidate work how?

A

Act by causing release of enurotransmitters (norepinephrine, dopamine, and serotonin) from presynaptic nerve terminals as opposed to having direct agonist effects of postsynaptic receptors. They also block reuptake of these

239
Q

Stimulants and MOA: How does Pemoline work?

A

Affects dopamine and therefore has less effects on the sympathetic nervous sytem

240
Q

Stimulants and MOA: How does Atomoxetine work?

A

Blocks the reuptake of norepinephrine into neurons, thereby leaving more of the neurotransmitter int he synapse to help convey electrical impulses

241
Q

Stimulants and Dosage: Dextroamphetamine and MEthylphenidate can be given in what dose?

A

Dose up to 20-200 mg/day. Higher doses may be needed if Nacrolepsy develops

242
Q

Stimulants and SE: Most common side effects re

A

anorexia, weight loss, nausea, and irritability . Should avoid caffeine, sugar and chocolate

243
Q

Stimulants and SE: Less common SE include

A

dizziness, dry mouth, blurred vision, and palpitations

244
Q

Stimulants and SE: Most common long term problems is

A

growth and weight suppression occurs in some children

245
Q

Stimulants and SE: What can Atomoxetine cause?

A

Decreased appetite, nausea, vomiting, fatigue, or upset stomach

246
Q

Stimulants and Client Teaching: What should be taught?

A

Take after meals.

Caffeine-Free Beverage important. Avoid chocolate and excessive sugar

247
Q

Disulfiram (Antabuse): What is this?

A

It is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body

248
Q

Disulfiram (Antabuse): Symptoms after someone ingests alcohol?

A

10 minutes later.. facial and body flushing, throbbing headache, sweating, dry mouth, n/v, dizziness

249
Q

Disulfiram (Antabuse): How logn do symptoms last?

A

30 minutes to 2 hours

250
Q

Disulfiram (Antabuse): What does Disulfiram inhibit?

A

The enzyme aldehyde dehydrogenase, which is involved in metabolism of ethanol

251
Q

Disulfiram (Antabuse): What products may contain alcohol?

A

Shaving cream, aftershave lotion, cologne, deodorant and OTC meds

252
Q

Disulfiram (Antabuse): Other side effects from this?

A

Fatigue, drowsiness, halitosis, tremor, and impotence

253
Q

Disulfiram (Antabuse): This can interfere with other drugs being taken such as

A

Phenytoin (Dilantin)
Isoniazid
Warfarin (Coumadin)
Barbiturates

Benzodiazepines such as diazepam and chlordidazepoxide

254
Q

Disulfiram (Antabuse): What is Acamprosate (Campral)

A

Prescribed for those recovering from alcohol abuse. Reduces physical and emotional discomfort

255
Q

Disulfiram (Antabuse): Acamprosate (Campral) dosage?

A

2 tabs 33 mg each 3x per day

256
Q

Disulfiram (Antabuse): SE of Acamprosate?

A

Mild and include diarrhea, nausea, flatulence, and pruritus

257
Q

Cultural Considerations: African American respond quickly to what drugs?

A

Antipsychotic and tricyclic antidepressants and have a greater risk for developing side effects

258
Q

Cultural Considerations: How do Asians handle their drugs?

A

Metabolized antipsychotics and tricyclic antidepressants more slowly than white people

259
Q

Cultural Considerations: What is St. Johns wort sued for?

A

To treat depression

260
Q

Cultural Considerations: What is Kava used for?

A

Treat anxiety and can potentiate effects of alcohol, benzodiazepines and other sedative-hypnotic agents

261
Q

Cultural Considerations: What is Valerian used for?

A

Helps produce sleep and is sometimes used to relieve stress and anxiety

262
Q

Cultural Considerations: What is Ginkgo Biloba used for

A

Primairly used to improve memory but is also taken for fatigue, anxiety, and depression

263
Q

What factors must be considered in the selection of medications to treat mental disorders?

A

The Efficacy, potency, half-life of drug. Age and Race of Client. Other Meds client taking and side effects of the drugs

NRSG 126: Mental Health (24 decks)

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