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NURS3314 Mental Health Nursing > Chapter 2 Neurobiologic Theories & Psychopharmacology > Flashcards

Chapter 2 Neurobiologic Theories & Psychopharmacology Flashcards

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1
Q

Psychopharmacology

A

The use of meds to treat mental illness

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2
Q

What does the brain consist of?

A

Cerebrum
Cerebellum
Brain stem
Limbic System

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3
Q

Cerebrum

A

Divided in 2 hemispheres
- All lobes & structures are in both hemispheres expect pineal gland

Further divided into 4 lobes: frontal, parietal, temporal, & occipital

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4
Q

Pineal Gland

A

An endocrine gland that influences the activities of the pituitary gland, islets of Langerhans, parathyroids, adrenals, & gonads

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5
Q

Corpus Callosum

A

A pathway connecting the LT & RT hemispheres & coordinating their functions

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6
Q

What is the LT hemisphere responsible for?

A

Controls the RT side of the body & Center for logical reasoning & analytical functions
- Reading
- Writing
- Mathematical tasks

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7
Q

What is the RT hemisphere responsible for?

A

Controls the LT side of the body & Center for:
- Creative thinking
- Intuition
- Artistic abilities

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8
Q

Frontal Lobe

A

Controls the organization of thought, body movement, memories, emotions, and moral behavior

Integration of all this information regulates arousal, focuses attention, and enables problem-solving and decision-making

Abnormalities in the Frontal Lobe are Associated w/:
- Schizophrenia
- Attention-deficit/hyperactive disorder (ADHD)
- Dementia

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9
Q

Parietal Lobe

A

Interpret sensations of taste and touch and assist in spatial orientation

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10
Q

Temporal Lobe

A

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

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11
Q

Occipital Lobe

A

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

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12
Q

Cerebellum

A

Located below the cerebrum

Center for coordination of movements and postural adjustments

Receives & integrates info from all areas of the body, such as the muscles, joints, organs, and other components of the CNS

Inhibited transmission of dopamine to this area-> Parkinson’s disease, dementia (lack of smooth coordinated mvmnts)

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13
Q

Brain Stem

A

Includes the midbrain, pons, and medulla oblongata and the nuclei for cranial nerves III through XII.

Medulla: Located at the top of the spinal cord
- Contains vital centers for respiration and cardiovascular functions.

Pons: Above the medulla and in front of the cerebrum
- Bridges the gap both structurally and functionally, serving as a primary motor pathway

Midbrain: Connects the pons and cerebellum with the cerebrum
- Measures only 0.8 in (2 cm) length and includes most of the reticular activating system and the extrapyramidal system.

The reticular activating system influences motor activity, sleep, consciousness, and awareness. The extrapyramidal system relays information about movement and coordination from the brain to the spinal nerves.

The locus coeruleus, a small group of norepinephrine-producing neurons in the brain stem, is associated with stress, anxiety, and impulsive behavior

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14
Q

Limbic System

A

An area of the brain located above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala

Hippocampus & amygdala are involved in emotional arousal & memory

Disturbances in the limbic system are implicated in mental illnesses:
- Memory loss w/dementia
- Poorly controlled emotions & impulses seen w/ psychotic & manic disorder

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15
Q

Thalamus

A

Regulates activity, sensation, & emotion

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16
Q

Hypothalamus

A

Involved in:
- Temperature regulation
- Appetite control
- Endocrine function
- Sexual drive
- Impulsive behavior associated w/: anger, rage, or excitement

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17
Q

Neurotransmission

A

Occurs when neurons communicate info w/ each other by sending electrochemical messages from neuron to neuron

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18
Q

Neurotransmitters

A

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

Necessary in just the right proportions to relay messages across the synapses.

Studies are beginning to show differences in the amount of some neurotransmitters available in the brains of people w/ certain mental disorders compared with those who have no signs of mental illness

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19
Q

Excitatory Neurotransmitters

A

Either excite or stimulate action in the cells

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20
Q

Inhibitory Neurotransmitters

A

Inhibits or stop action

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21
Q

Steps of Neurotransmission

A

1) Neurotransmitters fit into specific receptor cells embedded in the membrane of the dendrite
- Like a key into lock

2) Neurotransmitters are released into the synapse
- Relay message to receptor cells

3a) Reuptake: Transported back from the synapse to the axon to be stored for later use

3b) Metabolized and inactivated by enzymes, primarily monoamine oxidase (MAO)

22
Q

Dopamine

A

A neurotransmitter located primarily in the brain stem

Involved in the control of complex movements, motivation, cognition, and regulation of emotional responses

Generally excitatory and is synthesized from tyrosine

Abnormal Increase is associated w/:
- Schizophrenia
- Mania

Abnormal Decrease is associated w/:
- Parkinson’s
- Depression

Antipsychotic medications work via blocking dopamine receptors and reducing dopamine activity

23
Q

Norepinephrine

A

Located primarily in the brain stem (Excitatory)

Plays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation

Excess is implicated in:
- Several anxiety disorders;
- Schizophrenia
- Mania

Deficits may contribute to memory loss, social withdrawal, and depression

24
Q

Epinepherine

A

Derivative of Norepinephrine (Excitatory)

Controls fight-or-flight response

25
Q

Serotonin

A

Controls food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions (Inhibitory)

Decrease: Depression

26
Q

Histamine

A

Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses (Neuromodulator)

27
Q

Acetylcholine

A

Controls sleep and wakefulness cycle; signals muscles to become alert (Excitatory/Inhibitory)

28
Q

Gamma-Aminobutyric Acid (GABA)

A

Modulates other neurotransmitters (Inhibitory)
- Reduces aggression, excitation, anxiety

Decrease:
- Anxiety disorders
- Schizophrenia
- Mania

Increase:
- Reduction of anxiety

29
Q

Computed Tomography (CT) Scan

A

A procedure in which a precise x-ray beam takes cross-sectional images (slices) layer by layer

Can visualize the brain’s soft tissues, so it is used to diagnose primary tumors, metastases, and effusions and to determine the size of the ventricles of the brain.
-Some people with schizophrenia have been shown to have enlarged ventricles -> poorer prognosis and marked negative symptoms

Must lie motionless on a stretcher-like table for about 20 to 40 mins as the stretcher passes through a tunnel-like “ring” while the serial x-rays are taken

30
Q

Benzodiazepines

A

Antianxiety Meds

Advantages: Fast acting, effective

Disadvantages:
- Drowsiness
- Sedation
- CNS depressant
- Decrease vitals
- Dependence
- Withdrawal

31
Q

Examples of Benzodiazepines

A

Alprazolam

Chlordiazepoxide

Clonazepam

Clorazepate

Diazepam

Flurazepam

Lorazepam

Temazepam

Triazolam

32
Q

Nonbenzodiazepines

A

Antianxiety

Advantages: None of the disadvantages of benzodiazepines

Disadvantage: Takes 2-6 weeks to take effect

33
Q

Examples of Nonbenzodiazepines

A

Buspirone
SSRI’s
SNRI’s
TCA’s
Beta Blockers
Antihistamines

34
Q

SSRI’s

A

Antidepressants

Advantage: Effective

Disadvantage:
- Sexual side effects
- CNS stimulation: insomnia, agitation, anxiety
- Serotonin Syndrome

35
Q

Examples of SSRI’s

A

Fluoxetine
Fluvoxamine
Sertaline
Citalopram
Escitalopram
Paroxetine
Vilazodone

36
Q

Serotonin Syndrome

A

Excess serotonin

Occurs 2-72 hrs after start of treatment

S/s: Confusion, agitation, disorientation, anxiety, poor concentration

Resolves spontaneously when med is w/drawn

37
Q

Black Box Warning: SSRIs

A

Risk of suicide may increase especially w/ initial/early treatment

38
Q

Tricyclic Antidepressants (TCA’s)

A

Disadvantages: Cardiotoxic (tCa = cardiotoxic)
Lethal in overdose

39
Q

Examples of TCA’s

A

Imipramine
Desipramine
Trimipramine
Notriptyline
Amitriptyline

40
Q

Monoamine Oxidase Inhibitors (MAOI’s)

A

Antidepressant

Disadvantages: HTN crisis possible if foods w/tyramine are eaten

41
Q

Tyramine Foods

A

Aged Cheese
Pepperoni
Salami
Avocado
Figs
Bananas
Smoked fish
Some beers
Red wine
Fava beans

42
Q

Examples of MAOI’s

A

Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline transdermal patch

43
Q

Lithium

A

Mood Stabilizer

Therapeutic Level 0.5- 1.5

Side effects: GI, tremors

Na+2 & Lithium have an inverse relationship
- Inform patient NOT to change salt intake
- NO LOW SODIUM DIET (will increase the lithium levels)

Lithium Toxicity
- N/V
- Diarrhea
- Confusion
- Poor coordination

44
Q

Side Effects of Mood-Stabilizing Drugs

A

Carbamazepine: Rash, orthostatic HTN

Valproic Acid: Wt gain, alopecia, hand tremor

Topiramate: Dizziness, sedation, wt loss

Lamotrigine: Black Box Stevens-Johnson Syndrome

45
Q

Stevens-Johnson Syndrome

A

Rash

46
Q

1st Generation/Typical/Conventional Antipsychotic Meds

A

Advantages: Inexpensive

Disadvantages: Increased chance of EPS (Extrapyramidal Symptoms/Side Effects)

47
Q

Extrapyramidal Symptoms/ Side Effects

A

Akathisia: Feeling restless like you can’t sit still. You may have the urge to tap your fingers, fidget, or jiggle your legs.

Dystonia: When your muscles contract involuntarily. It can be painful.

Parkinsonism: Symptoms are similar to Parkinson’s disease. You may have a tremor, difficulty finishing thoughts or speaking, and stiff facial muscles. ‌But while a loss of nerve cells causes Parkinson’s disease, the medication causes Parkinsonism.

Tardive dyskinesia: Facial movements happen involuntarily. You may make a sucking or chewing motion with your mouth, stick out your tongue, or blink your eyes a lot

48
Q

Examples of 1st Generation Antipsychotic Meds

A

Haloperidol
Fluphenazine
Loxapine
Thioridazine
Thiothixene
Perphenazine

49
Q

2nd Generation Antipsychotics/Atypical/Unconventional Antipsychotic Meds

A

Advantages: Less EPS

Disadvantages: Expensive, increased risk of metabolic syndrome

50
Q

Metabolic Syndrome

A

BMI Increase
Blood glucose increase
BP & cholesterol increase

51
Q

Examples of 2nd Generation Antipsychotics

A

Clozapine, Risperidone, Asenapine, Iloperidone

52
Q

Self Awareness Issues

A

Clients and families need more than factual information; they need simple and thorough explanations.

View chronic mental illness as having remissions and exacerbations, just as chronic physical illnesses do.

Remain open to new ideas that may lead to future breakthroughs.

Understand that medication noncompliance is often part of faulty thinking and reasoning related to the illness, not willful misbehavior.

NURS3314 Mental Health Nursing (30 decks)

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