Exam 1: Chapter 16: Neuro-Psych Disorders And Drugs Flashcards
1
Q
Limbic System
A
Responsible for emotional expression, learning and memory.
Signs pass to hypothalamus.
2
Q
Reticular Activating System
A
Responsible for sleeping and wakefulness.
Though to be process responsible for feelings such as anxiety, fear and restlessness.
3
Q
Psychotherapeutic Drugs
A
Used in treatment of emotional and mental disorders.
4
Q
Three main emotional and mental disorders treated by Psychotherpeutic drugs
A
Anxiety
Affective Disorders
Psychoses
5
Q
Types of Psychotherapeutic Drugs include
A
Anxiolytics drugs Mood-Stabilizing drugs Antidepressant drugs Antipsychotic drugs Beta-Blockers
6
Q
Anxiety
A
Unpleasant state of mind characterized by a sense of dread and fear.
7
Q
Anxiety may be based on
A
May be based on actual anticipated experiences or past experiences
8
Q
Anxiety may be exaggerated responses to
A
Imaginary negative situations
9
Q
Six major anxiety disorders
A
- OCD
- PTSD
- General Anxiety Disorder
- Panic Disorder
- Social phobia (social anxiety disorder)
- Simple Phobia
10
Q
Anxiolytics Drugs include
A
Benzodiazepines
Buspirone (BuSpar)
11
Q
Anxiolytics Drugs: MOA
A
Reduces over-activity in the CNS: Depresses activity in brain stem (reticular activating system) and limbic system.
12
Q
Benzodiazepines: MOA
A
Reduces over-activity in the CNS.
Increases action of gamma-aminobutyric acid (GABA) which is an inhibitory neurotransmitter in the CNS -> depresses activity in brain stem and limbic system.
13
Q
Benzodiazepines include
A
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
14
Q
Indications for Benzodiazepines
A
Alcohol withdrawal Insomnia Muscle spasms Seizure disorders Adjunct in anesthesia Adjunct for depression
15
Q
Contraindications of Benzodiazepines
A
Known drugs allergy
Narrow-angle glaucoma
Pregnancy
16
Q
Adverse Effects of Benzodiazepines
A
Benzodiazepines adverse effects are an over expression of their therapeutic effects.
Decreased CNS activity, sedation
Hypotension
Drowsiness, loss of coordination, dizziness, headaches
N/V, dry mouth, constipation
**Potentially habit-forming and addictive
17
Q
Benzodiazepine overdose
A
Dangerous when taken with other sedatives or alcohol.
Treatment is generally symptomatic and supportive.
18
Q
What can reverse the effects of Benzodiazepines’ effects?
A
Flumazenil (Romazicon)
19
Q
Alprazolam (Xanax)
A
Most commonly used.
Indicated for GAD, short-term relief of anxiety symptoms, panic disorder and anxiety associated with depression.
20
Q
Adverse Effects of Alprazolam
A
Confusion
Ataxia
Headache
Others
21
Q
Interactions of Alprazolam
A
Alcohol
Oral contraceptives
Others
22
Q
Indications for Diazepam
A
Relief of anxiety Management of alcohol withdrawal Reversal of status epilepticus Preoperative sedation Adjunct for the relief of skeletal muscle spasms
23
Q
Diazepam Contraindications
A
Patients with hepatic dysfunction
24
Q
Adverse Effects of Diazepam
A
Headache
Confusion
Slurred speech
Others
25
Diazepam Interactions
Alcohol
Oral contraceptives
Others
26
Lorazepam
Intermediate-acting benzodiazepine
27
Lorazepam methods of administration
Can be given by IV push; useful in the treatment of an acutely agitated patient.
Continuous infusion for agitated patients who are undergoing mechanical ventilation.
28
Lorazepam is used to treat or prevent
Alcohol withdrawal
29
Buspirone: MOA
Unknown MOA
30
Buspirone
Administered on a scheduled basis.
| Lacks sedative properties and dependency potential
31
Adverse Effects of buspirone
Paradoxical anxiety
Blurred vision
Headache
Nausea
32
Insomnia
A sleep disorder that may be caused by anxiety
33
Types of insomnia
1. Short-term or behavioral insomnia
2. Long-term insomnia
3. Rebound insomnia
34
Short-term or behavioral insomnia
Attributed to stress caused by hectic lifestyles or inability to resolve daily conflicts.
Common with worries about work, marriage, children, health problems, economy.
35
Long-term insomnia
Caused by depression, manic disorders and chronic pain
36
Rebound insomnia
Occurs when a sedative drug is discontinued abruptly or after it has been after it has been taken for a long time.
Sleeplessness and symptoms of anxiety then become markedly worse.
37
Pharmacologic Interventions for Insomnia
Benzodiazepines
Nonbenzodiazepine, non barbiturate CNS depressants
Atypical antidepressants
Barbiturates
38
Benzodiazepines used to treat Insomnia include
Lorazepam (Ativan)
Temazepam (Restoril)
Triazolam (Halcion)
39
Nonbenzodiazepine, nonbarbiturate CNS depressants used to treat Insomnia include
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)
40
Atypical Antidepressants used to treat Insomnia include
Trazodone (Desyrel)
41
Zolpidem (Ambien)
Schedule IV controlled substance.
42
Zolpidem (Ambien) administration
```
Limited to short-term treatment of insomnia -> generally not more than 7-10 days.
Rapid onset (7-27) should be taken prior to expected sleep.
```
43
Adverse Effects of Zolpidem (Ambien)
Headache
Prolonged drowsiness
Dizziness
Coma
44
Contraindications of Zolpidem (Ambien)
```
Patients with:
Respiratory impairment
High risk suicide
Older adults
Concurrent use of CNS depressants
```
45
Antidepressants
Ability to reduce anxiety symptoms by altering neurotransmitters in the brain (norepinephrine and serotonin)
Assists with neurotransmitter imbalances.
46
Antidepressants Indication
```
GAD
OCD
Panic Disorder
Social Phobia
PTSD
```
47
Antidepressants include
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) (Atypical Antidepressants)
48
Tricyclic Antidepressants include
Amitriptyline*
Nortriptyline
Imipramine
49
Monoamine Oxidase Inhibitors (MAOIs) include
Phenelzine (Nardil)
50
Selective Serotonin Reuptake Inhibitors (SSRIs) include
```
Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro)
```
51
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)/Atypical Antidepressants
Duloxetine (cymbalta)
Venlaxafine (Effexor, Effexor XR)
Bupropion (Wellbutrin)
Desvenlafine (Pristiq)
52
Tricyclic Antidepressants
Have largely replaced SSRIs as first line antidepressant drugs.
53
Tricyclic Antidepressants are considered second line drugs in patients
Who fail SSRIs or other newer generation antidepressants.
| As adjunct therapy with newer generation antidepressants
54
Amitriptyline (Elavil)
Oldest and most widely used of all the TCAs
55
Amitriptyline Uses
Commonly used to treat Insomnia and neuropathic pain
| Original indication was despression
56
Amitriptyline Adverse Effects
```
Dry mouth
Constipation
Blurred vision
Urinary retention
Dysrhythmias
```
57
Tricyclic Antidepressants: Overdose
Lethal: 70-80% die before reaching the hospital
CNS and cardiovascular systems are mainly affected.
Death results from seizures or dysrhythmias.
58
Antidote for Tricyclic Antidepressant Overdose
```
No specific antidote.
Decrease drug absorption w/ activated charcoal.
Speed elimination by alkalinizing urine.
Manage seizures and dysrhythmias.
Provide basic life support.
```
59
Monoamine Oxidase Inhibitors (MAOIs)
Nonselective and Selective
| Rarely used for depression.
60
MAOIs are used for
Parkinson’s Disease
61
Disadvantage of MAOIs
Potential to cause hypertensive crisis when taken with tyramine.
62
MAOIs and Tyramine
Ingestion of food or drinks with tyramine leads to hypertensive crisis which may lead to cerebral hemorrhage, stroke, coma or death.
63
Foods that contain tyramine include
Aged, mature cheeses (cheddar, bleu, Swiss)
Smoked, pickled or aged meats, fish, poultry (sausage, corned beef, salami, pepperoni cheese pate.)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)
64
Selegiline Transdermal Patch (Emsam)
Selective MAO-B inhibitor
| Indicated for major depression
65
Selegiline Transdermal Patch Contraindication
Known drug allergy
66
Nursing Management for Selegiline Transdermal Patches
Avoid exposing the patch to external sources of heat or prolonged direct sunlight because heat speeds absorption.
67
Second Generation Antidepressants include
Vortioxetine (Brintelix)
68
Second-Generation Antidepressants benefits
Fewer adverse effects than TCAs and MAOIs
| Very few adverse drug-drug or drug-food interactions
69
Second-Generation Antidepressants
Now considered first line drugs for depression.
| Takes about 4-6 weeks to reach maximum clinical effectiveness.
70
Second-Generation Antidepressants MOA
Inhibition of Serotonin reuptake and possible effects on norepinephrine and dopamine reuptake.
71
Indications for Second-Generation Antidepressants Indications
Depression
BPD, obesity, eating disorders, OCD, panic attacks or disorders, Social anxiety disorder, PTSD, premenstrual dysphoric disorder, Neurologic disorder myoclonus and various substance abuse problems such as alcoholism.
72
Adverse Effects of Second-Generation Antidepressants
Insomnia (partly caused by reduced rapid eye movement and sleep), weight gain and sexual dysfunction
73
Bupropion
Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation.
74
Bupropion is sometimes added as
An adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy.
75
Zyban
Approved for smoking cessation treatment and was the first nicotine-free prescription medicine used to treat nicotine dependence.
76
Citalopram (Celexa)
One of the most commonly used SSRIs.
77
Citalopram (Celexa) Indications
Treatment of depression and OCD
78
Adverse Effects of Citalopram (Celexa)
Discontinuation syndrome
| Anxiety, dizziness, drowsiness, insomnia and others.
79
Duloxetine (Cymbalta) Indications
Depression
GAD
Pain resulting from diabetic peripheral neuropathy or fibromyalgia
80
Duloxetine (Cymbalta) Adverse Effects
Dizziness, drowsiness, headaches
GI upset, anorexia
Hepatoxicity
81
Duloxetine (Cymbalta) Interactions
SSRIs and Triptans (increased risk of serotonin syndrome)
Alcohol (increased risk of liver injury)
Can worsen uncontrolled angle-closure glaucoma.
82
Fluoxetine (Prozac)
Prototypical SSRI
83
Fluoxetine (Prozac) Indications
```
Depression
Bulimia
OCD
Panic Disorder
Premenstrual dysphoric disorder
```
84
Fluoxetine (Prozac) Contraindications
Known drug allergy
| Concurrent MAOI therapy
85
Fluoxetine (Prozac) Adverse Effects
```
Anxiety
Dizziness
Drowsiness
Insomnia
Others
```
86
Mirtazapine (Remeron) MOA
Promotes the presynaptic release of serotonin and norepinephrine in the brain.
Sedation
87
Mirtazapine (Remeron) Indications
Depression including BPD
Reducing sexual adverse effects in male patients receiving SSRI therapy
Appetite stimulant
88
Mirtazapine (Remeron) Contraindications
Drug allergy
| MAOIs
89
Mirtazapine (Remeron) Adverse Effects
Drowsiness
Abnormal dreams
Dry mouth, constipation, increased appetite
Asthenia
90
Mirtazapine (Remeron) Interactions
Additive CNS depressant effects with alcohol and CYP inhibitors
91
St. John’s Wort
Herbal product used for depression, anxiety, sleep disorders and nervousness.
92
St. John’s Wort may cause
```
GI upset
Fatigue
Dizziness
Confusion
Dry mouth
Photosensitivity
```
93
St. John’s Wort Interactions
Severe GI taken with MAOIs and SSRIs; many other drug interactions.
Food-drug interaction with tyramine-containing foods.
94
Ginseng
Herbal products used in stress reduction, improvement of physical endurance and concentration.
95
Ginseng Adverse Effects
```
Elevated BP
Chest pain
Palpitations
Anxiety
Insomnia
Headache
GI symptoms
```
96
Ginseng Interactions
Anticoagulants
Immunosuppressants
Anticonvulsants
Antidiabetic drugs
97
Psychotherapeutic Drugs: Nursing Implications Assessment
- Before therapy, assess emotional and physical status.
- VS and postural BP
- Liver and renal function tests.
- Contraindications, interactions and cautious use.
- Assess LOC, alertness and potential injury.
- Check mouth to make sure oral doses are swallowed.
98
Psychotherapeutic Drugs: Nursing Implications Patient Education
Provide simple explanations about the drug, its effects and the length of time before therapeutic effects can be expected.
Advise patient to avoid abrupt withdrawal.
Advise patients to change positions slowly to avoid postural hypotension and possible injury.
99
Only small amounts of meds should be dispensed at a time to
Minimize the risk of suicide attempts.
100
The combination of drug therapy and psychotherapy is emphasized because
Patients need to learn to acquire more effective coping skills
101
Simultaneous use of these drugs with alcohol or other CNS depressants can be
Fatal
102
Antianxiety drugs nursing implications in the elderly
Monitor closely for over Sedation and profound CNS depression
103
Antidepressant Nursing Implications
May take several weeks to see therapeutic effects.
Monitor patients closely for suicidal tendencies and provide support.
Assists older adults and weakened patients with ambulation and other activities because falls may occur d/t drowsiness or postural hypotension.
104
Tricyclics may need to be weaned and discontinued before
Undergoing surgery to avoid interactions with anesthetic drugs.
105
Anxiolytics: Monitor for therapeutic effects
Improved mental alertness, cognition and mood
Fewer anxiety and panic attacks
Improved sleep patterns and appetite
Less tension and irritability; fewer feelings of fear, impending doom and stress
More interest in self and others
106
Antidepressants: Monitor for therapeutic effects
Improved sleep patterns and nutrition
Increased feelings of self-esteem
Decreased feelings of hopelessness
Increased interest in self and appearance
Increased interest in daily activities
Fewer depressive manifestations or suicidal thoughts or ideations
