CNS and ANS: Infor from Blackboard Collaborate Flashcards
What population of adults have anxiety disorder?
What are the different types of anxiety disorders?
Major Depressive Disorder (MDD) remains the top reason for _______ in the US.
What is the most serious complication of depression?
How prevalent is death by suicide r/t depression?
Are anxiety and depression treatable?
What percentage of individuals with mental illness do NOT seek treatment each year?
What are common symptoms of depression?
What are common symptoms of anxiety?
Approximately 1 in 5 adults has an anxiety disorder
Panic disorder (PD)
Generalized anxiety disorder (GAD)
Obsessive-compulsive disorder (OCD)
Post traumatic stress disorder (PTSD)
Disability
Major Depressive Disorder (MDD) remains the top reason for disability in the US.
Death by suicide
10th leading cause of death
Yes, highly treatable
40%
- Sadness
- Sleeping too much/little
- Eating too much/little
- Low energy
- Worrying
- Restlessness
- Palpitations
- Fatigue
How long does it take for antidepressants to start working?
If a patient isn’t responding to an antidepressant you prescribed them, when should you adjust the dose?
What should you check for before starting a patient on an antidepressant?
Why should the practitioner be looking for certain conditions in the patients hx before starting a patient on an antidepressant?
Which condition can CAUSE depression rather than MIMIC it?
How can you cure depression caused by Hypothyroidism?
What is the most serious side effect associated with antidepressants that warrant a Black Box Warning?
What should the practitioner do prevent a patient from having poor outcomes related to adverse effects when starting an antidepressant?
What is important to consider when working with a patient and their support system when starting an antidepressant?
What is an example of a depressed patient you may encounter?
What should the practitioners role be in the situation using the example above?
In combination with medication therapy what else should the practitioner prescribe?
What condition should the nurse assess clients for to avoid psychotic events when considering prescribing an antidepressant?
How do antidepressants effect patients with Bipolar Disorder differently?
What can occur when treating a patient diagnosed with depression that can lead the practitioner making a new diagnosis of Bipolar Disorder?
What is an example of a patient with failure to thrive?
What is important to consider when treating the example failure to thrive patient?
How would you treat the example failure to thrive patient?
What is an example of a patient that would need a different treatment plan than the one made for the example failure to thrive patient?
Which antidepressants do not effect weight?
What type of drugs are Prozac and Zoloft?
When do mediations for anxiety and depression work best?
At least 3-4 weeks
Not until the 4-6 week mark
Check for conditions such as:
- Hypothyroidism
- Anemia
- Kidney impairment
- Cardiac disease
- HIV
- Hepatitis
Many of these conditions can mimic depression-like symptoms
Hypothyroidism
By treating the hypothyroidism. Once it is under control depression will subside.
Increased risk of suicidal ideation
Ensure the client has a strong support system to assist with monitoring their mood and behavior.
Offer ongoing assessment of patient
Educate not only the patient about moods and SI but also their support system.
- You have a patient with low energy
- They may have SI but don’t have enough energy to do anything about it
- Then you give them an antidepressant
- It bumps their energy up a little bit
- Now they are still having SI and have enough energy to do something about it
The practitioner should be carefully assessing and monitoring when starting on antidepressant and also during the whole treatment.
Counseling
Bipolar Disorder
If you prescribe an antidepressant alone to patients diagnosed with Bipolar Disorder it may treat symptoms of depression but not those of mania.
Therefore symptoms of mania can be induced.
The patient’s depression symptoms may subside with initiation of an antidepressant but then they show symptoms of mania. (Since antidepressants don’t treat mania)
- You have an elderly patient with failure to thrive
- They are underweight- you want to pick
Lifestyle assessment
Remeron:
- Atypical antidepressant
- Causes weight gain
- You have an 25 y/o patient with failure to thrive
- She is weight conscious but not under weight
SSRIs
In conjunction with counseling/therapy
What are SSRIs used to treat?
What is serotonin?
What does serotonin do?
How do SSRIs treat depression (steps)?
What are common side effects of SSRIs?
What can QT elongation cause to occur?
What can increase risk of QT elongation with use of SSRIs?
What other medications elongate QT?
What is an important action a practitioner must take when prescribing a patient a new medication when they’re already on one or more?
What line are SSRIs?
Why are SSRIs first line?
What is a rare but serious side effect to monitor for in patients taking SSRIs?
How serious is Serotonin Syndrome?
How does Serotonin Syndrome to occur?
What is often the cause of Serotonin Syndrome?
Symptoms of Serotonin Syndrome?
What is the treatment for Serotonin Syndrome?
What is an example of a patient who wants to be prescribed Prozac for depression but is at risk for Serotonin Syndrome? What action would you take?
Which are the first SSRIs you try when prescribing? Why?
What time of day should SSRIs be taken? Why?
What is important to remember when considering dosing changes with SSRIs?
Why do we taper patients off SSRIs?
What are some common symptoms of SSRI withdrawal?
- GAD
- PD
- PTSD
- depression
A chemical messenger
Carries signals between neurons
- Normally neurons will reabsorb serotonin after it has delivered its message
- SSRIs work by blocking the reabsorption
- This leaves increased levels of serotonin in the brain
- Allowing serotonin to pass further messages
- Fatigue
- Insomnia
- Weight loss/gain
- Decreased libido
- QT prolongation
- Agitation
Ventricular arrhythmia
Taking SSRIs in conjunction with other medications that elongate QT
- Some antibiotics
- Some cardiac medications
Research all medications your patient is taking to avoid any interactions.
First line
Easily handled (less side effects)
Serotonin Syndrome
Potentially fatal
Overstimulation of serotonin receptors
Interaction between multiple medications being taken in conjunction
- Anxiety
- Agitation
- Delirium
- Diaphoresis
- Tachycardia
- HTN
- Hyperthermia
- Tremors
- Muscle rigidity
- Hyperreflexia
Stop the medications causing it
- You have a patient who is on…
- Prozac for depression
- Trazadone for insomnia
- Adderal for ADHD
If you know they were already on trazadone and Adderall it would be recommended to adjust the doses of one or the other before adding an SSRI
- fluoxetine (Prozac)
- sertraline (Zoloft)
(do not effect appetite)
In AM due to potential for sleep disruption and agitation
- Start dose low and increase slowly
- Always taper off SSRIs slowly
To avoid withdrawal symptoms
- Insomnia
- Changes in mood
- Flu-like symptoms
What is the second type of medication you would try prescribing if SSRIs did not have desired effect?
Are SNRIs well tolerated?
What are the most common examples of SNRIs?
How are SSRIs and SNRIs similar?
How are SSRIs and SNRIs different?
Why would a practitioner choose an SSRI over an SNRI?
When would you try using an SNRI?
What other condition other than anxiety and depression are SNRIs used to treat?
What is the third type of medication you would try prescribing if SSRIs and SNRIs did not have desired effect?
What are common examples of TCAs
How do TCAs treat depression?
Who are TCAs contraindicated in?
What is a serious side effect of TCAs?
Within what window of time do cardiac arrhythmias occur when starting TCAs?
Why can TCAs cause cardiac arrhythmias?
Why are SSRIs used more commonly than TCAs?
How are TCAs and SSRIs similar?
What are some benefits of TCAs over SSRIs?
Can you overdose on TCAs?
Who should you avoid giving TCAs to?
In what specialty are TCAs not used much?
What other conditions are TCAs prescribed for?
SNRIs-Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Yes
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Onset
- Efficacy
- Treatment usage
- Sides effects
Inhibit re-uptake of Serotonin AND Norepinephrine
SSRIs are easier to taper off with less possible withdrawal symptoms
- You started with an SSRI (didn’t work)
- You tried another SSRI (didn’t work)
- You can now try an SNRI
- Chronic pain
- Premenopausal symptoms
- Hot flashes
TCAs-Tricyclic Antidepressants
- amitriptyline (Elavil)
- doxepin (Sinequan)
Inhibit reuptake of Norepinephrine AND 5HT
Life threatening cardiac arrhythmias
Less than one week
Direct alpha adrenergic blocking effects
They have more troublesome side effects
Equally efficacious
They cost less
Yes
Someone that is suicidal
Primary care
- Chronic pain
- Fibromyalgia
What is the fourth type of medication you would try prescribing if SSRIs, SNRIs and TCAs did not have desired effect?
What is a common example of a MAOI?
How do MAOIs treat depression (steps)?
What do MAIOs interact with?
What are examples of foods that interact with MAIOs?
What specialty are MAIOs rarely used in?
Why are MAIOs used less than TCAs?
What is an important action for the practitioner to take when considering prescribing a MAIO?
What is a fifth type of medication you could try prescribing for anxiety/depression?
What are some common examples of Atypical antidepressants?
Wellbutrin is contraindicated in what pateints?
Other than anxiety/depression what is Wellbutrin used to treat?
What medication is Wellbutrin typically prescribed in conjunction with?
What is an adverse effect of Wellbutrin to monitor for when prescribing?
MAOIs-Monoamine Oxidase Inhibitor
Phenelzine (Nardil)
- Blocks monoamine oxidase
- The enzyme responsible for the oxidative deamination of neurotransmitters
- Inhibition of the metabolism of norepinephrine
- More norepinephrine in brain
Foods or medications that increase BP
- Tyramine (yogurt)
- Chocolate
Primary care
They interact with SO much
Medicine reconciliation with patients to confirm there are no interactions
Atypical Antidepressants
- bupropion (Wellbutrin, Zyban)
- mirtazapine (Remeron)
Hx of seizure disorder
Smoking cessation
An SSRI
Increased anxiety
What are the major categories of anti-anxiety medications? (not including anti depressants)
What are some common examples of Serotonergic Anxiolytics?
What are some common examples of Benzodiazepines?
What line are Benzodiazepines? Why?
What has long term use of Benzodiazepines been linked to?
Who should you avoid prescribing Benzodiazepines to?
For what condition is Buspar NOT indicated for use?
Why is Buspar NOT indicated for panic attacks?
What is a serious adverse effect that can occur when taking Haldol?
Why are EPSs dangerous?
What are the EPSs?
How are EPSs treated?
- Serotonergic Anxiolytics
- Benzodiazepines
- Buspirone (Buspar)
- Haloperidol (Haldol)
- Lorazepam (Ativan)
- Alprazolam (Xanax)
NOT first line due to potential for abuse
Demetia
Young people
Panic attacks
- Prolonged onset
- Can exacerbating panic.
extrapyramidal symptoms (EPSs)
They can cause short or long term effects
- Continuous spasms in muscles
- Motor restlessness
- Parkinson like characteristics
* Rigidity
* Bradykinesia
* Tremors
Medications that inhibit the dopaminergic neurotransmission
-not something that happens a lot but something we need to know about
What other category of drugs effect the CNS?
What are anticonvulsant Medications used to treat?
What are some common examples of Anticonvulsant Medications?
Which mood disorder can be treated with Lamictal?
Other than seizures and mood disorders what can gabapentin be used to treat?
Anticonvulsant Medications
- Seizures
- Mood disorders
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Ethosuximide (Zarontin)
- Gabapentin (Neurotin)
Bipolar 1 disorder
- Post neuralgia
- Neuropathic pain
What group of medications does Phenytoin (Dilantin) belong to?
What is Phenytoin (Dilantin) used to treat?
What line medication is Phenytoin (Dilantin)?
Why is Phenytoin (Dilantin) a first line medication?
Is Phenytoin (Dilantin) used often?
Who is Phenytoin (Dilantin) contraindicated in?
Seizures:
- Tonic
- Clonic
- Partial complex
It is the least sedating to treat seizures
Most often used in its class
Pregnancy
What mediation is Carbamazepine (Tegretol) structurally related to?
What is Carbamazepine (Tegretol) used to treat?
What is important to be aware of when prescribing Carbamazepine (Tegretol)?
Who is at highest risk for developing toxic symptoms when taking Carbamazepine (Tegretol)?
What does one Black Box Warning warn about Carbamazepine (Tegretol)?
Why is there a BBW about blood disorders in Carbamazepine (Tegretol)?
What action should be taken by the practitioner in regards to the BBW about blood disorders when taking Carbamazepine (Tegretol)?
What blood components might be changed in a patient experiencing a blood disorder related to taking Carbamazepine (Tegretol)?
TCAs
- Epilepsy
- Bipolar affective disorder
- Aggression
- Assaultive behavior
Has many black box warnings
Asians
Can be fatal
Check CBCs
Leukopenia
Thrombocytopenia
Anemia
What is Levetiracetam (Keppra) used to treat?
Is Levetiracetam (Keppra) used alone or in combination?
What ages is Levetiracetam (Keppra) used for?
Why is Levetiracetam (Keppra) unique?
Why is Levetiracetam (Keppra) in its own drug class?
What is contraindicated with use of Levetiracetam (Keppra)?
What is a serious adverse effect that can occur when taking Levetiracetam (Keppra)?
Although increased risk of SI is common with psychiatric medications Levetiracetam (Keppra) is different in which way?
How long does the symptom of increased risk of SI last when taking increased risk of SI?
Is the brand or generic name cheaper for Levetiracetam (Keppra)?
What may occur in a patients labs when taking Levetiracetam (Keppra)?
partial onset seizures
Combination
Children and adults
In its own unique drug class
Chemically unrelated to any other antiepileptic drug
Sensitivity to the drug itself
Increased risk of SI
Increased risk of SI can happen within one week
Can last throughout the entire time the client is taking it
Generic is much cheaper
- May cause a transient decrease in WBCs (esp neutrophils) BUT it is not effected much and usullay reverts back to normal without intervention
Is Gabapentin (Neurontin) commonly used?
What type of patient may use Gabapentin (Neurontin) to treat neuropathic pain and post neuralgia?
How does Gabapentin (Neurontin) treat seizures?
What is GABA?
Any medication in the same class as Gabapentin (Neurontin) and that use GABA treat what?
Where is Gabapentin (Neurontin) metabolized?
How is Gabapentin (Neurontin) excreted?
In what form is Gabapentin (Neurontin) excreted in?
What is important to remember when considering changing a dose of Gabapentin (Neurontin)?
How long should you take to taper off Gabapentin (Neurontin)?
If you abruptly d/c Gabapentin (Neurontin) what can occur?
What is Status Epilepticus?
How serious is Status Epilepticus?
What is important to do when considering starting Gabapentin (Neurontin)?
Very common
Patient with shingles
Effect GABA
An inhibitory neurotransmitter
Pain
- Urine
- Stool
Unchanged
- Never abruptly d/c
- Taper off
At least a week
Status Epilepticus
When a patient has one or more back to back seizures in which they do not return to their normal baseline in between
Life threatening
- You wont want to just prescribe for a few doses
- Must monitor for Status Epilepticus
Opioids
Opioids are generally classified as agonists, mixed agonist-anti-agonists, and partial agonists
Agonists: codeine (Tylenol #3 or #4), hydrocodone (Vicodin), morphine (MSIR), oxycodone (Percocet)
- also there are mixed agonist antagonists which have less potnetial for abuse which include STADOL
- there are also partial agonsists which can be used ias a replacement as a treatment for heroine and methdone dependent
- example is BUPRENIX?
Habit forming = because they trigger the reward center of the brain, releasing dopamine.
- hwever these lower doses do not stop someone seaking opiods so just becareful if you have a repeat pt who always has a cough b/c/ they may just be trying to seek the opiod without triggering you
- when you practice look into your states controleld substance reporting system so every state has one abd when you get your lisence you able to get access to this. anytiome you perscripe an opiod you should log into this system and put in pt info to make sure they do not have an abuse hx- you can see how often they have had opiods perscibed, which provider perscibed them and which pharmacies. so you will be able to tell if someone is hopping around pharmacy to pharmacy every month which isusualy an indication that these clients need help from you.
Opioids and Safe Prescribing Practices
- risk factors include: pregnancy, kidney disease, being over 65, having mental health issues, having substance use disorder, having a rior non fatal overdose
- specifically for chrinic pain- evelute benefits vs harms within 1 to 4 weeks of starting threrapy and then obviously thtoughtout therapy
Opioids should be used for acute pain only such as with an acute injury/fracture.
(3-7 days maximum)
When starting opioid therapy for chronic pain management, begin with immediate-release opioids and prescribe the lowest effective dosage.
Avoid prescribing both opioids and benzos concurrently - both very sedating and habit forming
naloxone (Narcan)
Has a short half life - may require multiple doses - can be administered every 2-3 minutes
Onset of action = within 2-12 minutes
Call EMS due to risk of rebound CNS and respiratory depression
National Suicide Prevention Lifeline 1-800-273-TALK- put in bathrrom b/c this is a provate place that someone could go and easily rip off a number
What happens to the client if they do not have any opioids on board when you give narcan?
there is no effect
