Exam 1 (Chapters 1, 2, 3, 5, 7, 8, 9, 34 Flashcards
What is the difference between mental health & mental illness?
Chapter 1
- Mental Health deals with a state of well-being & an individual’s ability to cope with normal life stress, work productively, contribute to the community, rational thinking, etc.
- Mental Illness refers to all psychiatric disorders that have a definable diagnosis. The disorders can be related to developmental, biological, or psychological disturbances and mental functioning
What is resilence?
Chapter 1
ability & capacity for people to secure the resources they need to support their well-being
Explain the Diathesis Stress Model
Represents NATURE (biological predisposition) and NURTURE (environmental stress or trauma)
- most accepted explanation for mental illness
Nature + Nurture
What is stigma?
Chapter 1
belief that the overall person is flawed
Characterized By :
* social shunning
* disgrace
* shame
Explain the Mental Health Parity Act of 1996
Chapter 1
Requires insurers to provide mental health coverage through annual & lifetime benefits in the same way they would provide medical or sugical coverage
Explain the Wellstone-Bomenici Parity Act of 2008
For all group health plans (including government plans), coverage for mental health & substance use disorders can have no greater financial requirements (deductibles, copays, etc.) or treatment limitations must be on par with the coverage received for medical & surgical conditions.
Explain how the Affordable Care Act of 2010 improved mental healthcare coverage
Chapter 1
- Medical history no longer resulted in denials or higher premiums for pre-existing conditions
- Required all individual & small group health plans to cover 10 essential health benefits with no annual or lifetime dollar limits; including mental health & addiction treatment
- Made health insurance with mental health benefits available for those whom were previously uninsured
- Allowed young adults to remain on their parent’s insurance through the age of 26 (most psychiatric disorders emerge in adolesence of early 20s)
What is the DSM-5 & what is it used for?
Chapter 1
Diagnostic & Statistical Manual (5th edition)
Used to diagnose psychiatric disorders
Explain the different levels of psychiatric nursing practice
Chapter 1
Registered Nurses: after 2 years as an RN (2 years full-time, 2000 clinical hours, & 30 hours of nursing psych education), to be RN-BC in mental health
Advanced Practice
* Psychiatric-mental health advanced practice registered nurse (PMH-APRN)
* MSN or DNP, can be a CNS (not PhD)
What is consciousness?
Chapter 2
Part of the mind that contains all the material a person is aware of.
Includes:
* perceptions
* memories
* thoughts
* fantasies
* feelings
What is the preconscious?
Chapter 2
Below level of awareness. Contains material that can be retreived easily through conscious effort
What is unconsciousness?
Chapter 2
Includes all repressed memories, passions, & unacceptable urges lying deep below the surface
- Memories/ emotions associated with trauma are stored here
- Unsconscious influences conscious thoughts & feelings
- An individual is usually needs assistance from a trained therapist to retreive unconscious material
What are the 3 Personality Structure Levels?
Chapter 2
- Id
- Ego
- Superego
Describe the ID personality
Chapter 2
- Totally unconscious & impulsive
- Operates according to pleasure principle (hungry, screaming infant)
- Lacks ability to problem solve & is illogical
Characteristics are unconscious impulsive; the source of all drives instincts, reflexes, & needs
Describe the EGO personality
Chapter 2
- resides in the conscious, preconscious, & unconscious levels of awarenss
- Problem solver & reality tester (tries to navigate the outside)
- Follows the principle “you have to delay gratification for right now”
- Ex: a hungry man feels tension arising from the id that wants to be fed. His ego allows him not only to think about his hunger, but also to plan where he can eat & to seek that destination (reality-testing = factoring in reality to implement a plan to reduce tension)
THINK, PLAN< DO
Describe the SUPEREGO personality
Chapter 2
Develops between ages 3 - 5
- Represents moral component of personality
- Resides in the conscious, preconscious, & unconscious levels of awareness
- Consists of the conscience that may induce guilt
- Seeks perfection (feels guilt when it falls short)
What happens when the ID personality is too powerful?
Chapter 2
The individual lacks control over impulses
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
Who is the “mother” of psychiatric nursing?
Chapter 2
Hildegard Peplau
Who created the psychoanalytic theory & what does it involve?
Freud
- Conscious: tip of the iceberg (what you’re aware of)
- Preconscious: just below the surface of awareness
- Unconscious: repressed memories, passions, unacceptable urges that are deep below the surface
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
What are Freud’s Psychosexual Stages of Development?
Chapter 2
- Oral (birth - 1 year): new ego directs the baby’s sucking activities. If oral needs are not met appropriately, the individiual might develop habits such as **thumb sucking, fingernail biting, & chewing a pencil in childhood & overeating & smoking later in life.*
- Anal (1 - 3 years): Toliet training becomes a major issue between parents & child. If parent insists that children be trained before they’re ready or if they make too few demands, conflicts about anal control may appear in the form of extreme orderliness & cleanliness or messiness & disorder.
- Phallic (3 - 6 years): Children feel a sexual desire for the other-sex parent & hostility toward the same-sex parent. To avoid punishment & loss of parental love, they suppress these impulses and, instead, adopt the same-sex parent’s characteristics & values. As a result, the superego is formed, & children feel guilty whenever they violate standards
- Latency (6 - 11): Sexual instincts die down, & the superego develops further. The child acquires new social values from adults & same-sex peers outside the family.
- Genital (Adolescence): With puberty, the sexual impulses of the phallic stage reappear. If development has been successful during earlier stages, it leads to marriage, mature sexuality, & the birth & rearing of children. This stage extends through adulthood.
What are the ages & stages of Freud’s Psychosexual Stages?
Chapter 2
- Oral: Birth - 1 year
- Anal: 1 - 3 years
- Phallic: 3 - 6 years
- Latency: 6 - 11 years
- Genital: Adolescence
What is the difference in transference & countertransference?
Chapter 2
Transference: Patient to Healthcare worker
Countertransference: Healthcare worker to patient
Explain Transference
Chapter 2
Unconscious feelings that the patient has toward the healthcare worker that were originally felt in childhood for a significant other (family member, etc.)
- can be positive (affectionate) or negative (hostile)
Explain Countertransference
Chapter 2
Unconscious feelings that the healthcare worker has toward the patient
- EX: If the patient reminds you of someone you don’t like, you may unconsciously react as if the patient were that individual
- Problematic since it can impact the therapeutic relationship
What is the difference in psychodynamic theory & psychoanalysis?
Chapter 2
- Psychodynamic therapy = therapist has increased involvement & interact with teh patient more freely than in traditional psychoanalysis
- Psychodynamic therapy is oriented toward present, less time spent constructing development origins of conflict
What is psychodynamic therapy and who is it best for?
Chapter 2
talk therapy
- best for the “worried well”, not acutely mentally ill or have more severe disorders
What is psychoanalysis?
Chapter 2
Patient lying on couch & talks (old school)
According to Freud, which aspect of the personality motivates an individual to seek perfection?
a.) Id
b.) Ego
c.) Superego
d.) Not sure
Chapter 2
c.) Superego
What is interpersonal theory & who discovered it?
Chapter 2
Harry Stack Sullivan
A model for understanding psychiatric alteratiosn that focused on interpersonal problems
- believed human beings are driven by the need for interaction
- viewed lonliness as the most painful human condition
- emphasized early relationship with primary parenting figure (“significant other”) as crucial for personality development
- Purpose of all behavior: get needs met through interpersonal interactions, reduce or avoid anxiety
What is interpersonal therapy? What are the main types of problems that respond well to interpersonal therapy?
Chapter 2
- Short-term therapy
- Goal: reduce or eliminate psychiatric symptoms, mainly depression, by improving interpersonal functioning & satisfaction with social relationships
3 Problems that Respond Well:
* Grief & loss
* Interpersonal disputes
* Role transition
Who is Hildegard Peplau and how did she influence psychiatric nursing?
Chapter 2
Mother of psychiatric nursing
- Follower of Sullivan (interpersonal theory)
- Nurses are participants & observers in therapeutic conversation
- Identified that psych-mental health nursing is an essential element of general nursing & as a specialty
- self-awareness of the nurse is essential for keeping focus on the patient (and keeping the social & personal needs of the nurse out of the nurse-patient conversation)
Explain Peplau & the Therapeutic Relationship
Chapter 2
Patient-focused, therapeutic, meet the needs of the patient, work with the patient, decrease anxiety
What are the different types of behavioral therapy?
Chapter 2
Modeling: therapist may model the behavior, the patient learns through imitation. Therapist may do the modeling, proivde another person to model the behavior, or present a video for the purpose.
Operant Conditioning: uses positive reinforcement to increase desired behaviors. When goals are achieved or behaviors are performed patients may be rewarded with tokens, known as a token economy, when they can be exhanged for things
Exposure therapy: used for people who experience anxiety due to fears, phobias, or traumatic memories. Patients are slowly exposed to things that trigger them.
Aversion Therapy: uses negative stimuli when patients engage in harmful behaviors like EtOH use disorder, paraphilic disorders, shoplifting, aggressive behaivor, self-mutilation, etc.
Biofeedback: used to control the body’s physiological resposnes to stress & anxiety. Clinicians use technology to monitor various vital signs.
CBT: involves efforts to change thinking patterns. Strategies might include learning to recognize ones distortions & thinking that are creating problems & then to re-evaluate them in light of reality. Cognitive Distortions = Automatic Thoughts.
DBT: integration of opposites & helps people give up extreme positions. Developed for people with intractable behavioral disorders inolving emotional dysregulation. Success has been seen in patients of suicidal, self-injuring women with borderline personality disorder, etc. (previously thought to be untreatable populations)
What is the modeling behavioral therapy?
Chapter 2
the therapist provides a role model for specific identified behaviors & the patient learns through imitation
What is the Operant Conditioning behavioral therapy?
Chapter 2
basis for behavior modification uses positive reinforcement to increase desired behaviors
What is Exposure Therapy (behavioral therapy)?
Chapter 2
used for individuals who experience anxiety due to fears, phobias, or traumatic memories. Patients are enocuraged to face their fears & emotionally process them in a safe enviornment
What is Aversion Therapy (behavioral therapy)?
Chapter 2
Using negative stimuli to extinguish an undesirable behavior
What is biofeedback (behavioral therapy)?
Chapter 2
helps individuals control their body’s physiological response to stress & anxiety.
Explain Maslow’s Hierarchy of Needs
Chapter 2
1.) Physiolgoical Needs: food, water, oxygen, rest, elimiantion, sex, warmth, homeostasis
2.) Security & Safety: financial security, protection, stability, structure, limits
3.) Love & Belonging / Social Needs friendships, romance / sexual intimacy, meaningful relationships in social / community groups, affiliation, love, family and home
4.) Self-Esteem: confidence, respect by others, feeling accomplished, value / self-worth
5.) Self-Actualization: full potential, create, learn, problem solve, morals, no prejudice (becoming everything one is capable of)
What are different types of biologial therapies / models?
Chapter 2
Pharmacotherapy:
* dramatically improve the lives of those who suffer from severe psychiatric difficulties
* Psychotropic meds modify various neurotransmitters & help restore brain function
Electro-convulsant Therapy (ECT)
* involves electrical stimulation of the brain
* Treats psych & neuro dx like Parkinson’s, epilepsy, & pain conditions
What are Erikson’s 8 Psychosocial Stages? Include the Ages, Crisis, & Focus associated with each stage
Chapter 2
1.) Infancy
* Birth - 18 Months
* Trust vs. Mistrust
* Safety with caregiver
2.) Early Childhood
* 2 - 3 Years
* Autonomy vs. Shame & Doubt
* Independent from parents
3.) Preschool
* 3 - 5 years
* Initiative vs. Guilt
* Powerful within family & exploring
4.) School Age
* 6 - 11 years
* Industry vs. Inferiority
* Good with neighbors, classmates, & friends
5.) Adolescence
* 12 - 18 years
* Identity vs. Role Confusion
* Socializing & fitting in with peers
6.) Early Adulthood
* 19 - 25 years
* Intimacy vs. Isolation
* Love, partners, & friends
7.) Adulthood
* 26 - 64 years
* Generativity vs. Stagnation
* Family & occupation
8.) Old Age / Maturity
* 65+ years
* Integrity vs. Despair
* Reflection on life / facing death
What is the theory of moral development and who made it? Explain each of the 3 stages in a simple matter.
Chapter 2
Moral development coincides with cognitive development
Lawrence Kohlberg
- Preconventional (kids under 5) - doing something for a reward
- Conventional (6 - 12 years) - how do my actions affect others?
- Postconventional (13+ years) - thinking about the world in a more complex way
Explain the stages within the Theory of Moral Development
Chapter 2
PRECONVENTIONAL (children under 5)
1.) Obedience & Punsihment: focus on rules, listen to authority, obedience is the first method to avoid punishment
2.) Individualism & Exchange: learn that not everyone thinks the way you do. If someone decides to break the rules, they are risking punishment
CONVENTIONAL
3.) Good Interpersonal Relationships: Children begin to view right or wrong as related to motivations, personality, or the goodness or badness of the person. In general, people should get along & have similar views
4.) Maintaining the Social Order: “Rules are rules” mindset. Listening to authority maintains social order.
POST-CONVENTIONAL
5.) Social Contract & Individual Rights: Social order is important, but social order must be good (not corrupt). People’s rights should be protected.
6.) Universal Ethical Principles: Actions should create justice for everyone involved. We are obligated to break unjust laws
Explain Cognitive Development Theory (Piaget)
Chapter 2
Sensorimotor Stage (birth - 2 years): they think in the present moment through senses
Preoperational (3 - 6 years): imaginative, symbolic thought,“Magical Thinking”
* do NOT understand cause & effect
Concrete Operational (7 - 11 years): Logical thought; follow the rules, rigid thinking, there is only 1 way to do something
Formal Operational (12 - 15 years): Developing through abstract thought (Cause & Effect)
What is the Theory of Object Relations & who created it?
Chapter 2
Past relationships influence a person’s sense of self & their relationships
Created by Margaret Mahler
- Believed psychological problems were the result of disruption of separation
- Describes attachment
Explain the Ethics of Care Theory & who created it.
Chapter 2
Carol Gilligan went off Kohlber’s theory
1.) Preconventional = I love ME –> I love YOU
2.) Conventional = I love you more than me
3.) Postconventional = I love myself & you
- Feminist
- Emphasized importance of relationships, banding together, & putting our loved ones’ needs in front of strangers’ needs
Which theorist most influenced the professional practice of psychiatric nursing?
a.) Harry Stack Sullivan
b.) Hildegard Peplau
c.) Erik Erikson
d.) Ivan Pavlolv
Chapter 2
B.) Hildegard Peplau
Explain the Western Traditions
Chapter 5
Psychiatric mental health nursing is grounded in western culture
- Values autonomy, independence, & self-reliance
- Separates body & mind
- Disease has a specific, measurable, & observable cause
- Practitioners goal = treatment focuses on eliminating cause
- Time is linear
Psychiatric mental health nursing is grounded in what type of culture?
Chapter 5
Western Culture / Tradition
Explain Eastern Tradition
Chapter 5
- Based on Chinese & Indian philosphers
- Family = basis for person’s identity
- Family interdependence & group decision making = norm
- Having child that is mentally ill may be viewed as punishment for one’s behavior in a past life
- Time is circular
Explain the Indigenous Culture
Chapter 5
- Place significance on the place of humans within the natural world, less of a concept of person
- A person is an entity in relation to others holistic view of mind, body, spirit
- Disease may be considered lack of harmony with others or the enviornment
Explain the key differences in Western, Eastern, & Indigenous Cultures
Chapter 5
WESTERN:
* autonomy, independence, self-reliance
* Mind & Body are separate
* Time is linear
EASTERN:
* Based on Chinese & Indian philosophers
* Family = basis of person’s identity
* Time is circular
INDIGENOUS
* person = entity in relation to others holistic views of mind, body, & spirit
* Disease may be lack of harmony w/ enviornment
What are some potential impacts of culture on mental health?
Chapter 5
Nonverbal communication, etiquette, beliefs, & values
Avoid ethnocentrism (universal tendency of humans to think that their way of thinking & behaving is the only correct & natural way*)
Describe cultural barriers to quality mental health services
Chapter 5
- Barriers prevent culturally non-dominant persons from seeking care
- Prevents psych nurses from providing the care they want to give
- Issues may be communication barriers, stigma, misdiagnoses, cultural concepts of distress, & genetic variations in pharmacodynamics
What are cultural syndromes?
Chapter 5
When clusters of symptoms occur in specific groups
- These symptoms are recognized by these groups as a known pattern of experience
May seem exotic or rational to nurses trained in western framework
Explain the standards of care in nursing
Chapter 7
- patient-centered care
- work in interdisciplinary teams
- use evidence based practice
- apply quality improvement
- utilize informatics
Age considerations when assessing children
Chapter 7
- Child is best source but also ask parents / caregiver
- Consider developmental levels
- Assess through interview & observation
Age considerations when assessing adolescents
Chapter 7
- Concerned with confidentiality & fear you might tell their parents
- Adolescent & family should be given an overview of how information sharing will work, what information will be shared, with whom, and when
- Identification of risk factors - HEADSSS
* Home enviornment
* Education & employment
* Activities
* Drug or EtOH or tobacco use
* Sexuality
* Suicide, depression, other mental health sx
* Safety
What are the 3 components of a diagnosis?
Chapter 7
1.) Problem: unmet need
2.) Etiology: probable cause
3.) Supporting data: signs & symptoms
What are two types of diagnoses?
Chapter 7
1.) Problem focused diagnoses
2.) Risk diagnoses
What is involved / assessed in psychosocial assesments of patients?
Chapter 7
- previous hospitalizations
- educational background
- occupation
- social patterns
- sexual partners
- interests
- substance use
- coping abilities
- spiritual assessment
- health behaviors
List the components of a mental status exam
Chapter 7
- appearance
- behavior
- speech
- mood
- disorders of the form of thought
- perceptual disturbances
- cognition
- ideas of harming self or others
What components are involved in psychiatric mental health nursing?
Chapter 7
- Establish rapport
- Obtain understanding of problem
- Review physical status & obtain baseline vitals
- Assess for risk factors & safety
- Perform a mental status exam
- Assess psychosocial status
- Identify mutual goals for treatment
- Formulate a care plan
- Document data
Explain the difference in the roles of a psychiatric mental health RN & APRN.
Chapter 7
RN: coordinate care, advocate for the family, health teaching, self-care activities, recent advancements, ensure secure enviornment
APRN: consultation, prescriptive authority & treatment, psychotherapy
What is the difference in incidence and prevalence?
Chapter 1
Incidence: coveys infromation about the risk of contracting a disease
Prevalence: describes the total number of cases (new & existing) in a given population at a specific time regardless of when they became ill
What is incidence?
Chapter 1
Information about the risk of contracting a disease
What is prevalence?
Chapter 1
Total number of cases (new & existing) in a certain population during a specific period of time regardless of when they became ill
What is the memory trick for Erikson’s Psychosocial Stages
Trust Autonomy to Initiate the Industry, Identify Intimacy and Generate Integrity
1 = Trust
2 = Autonomy
to
3 - 5 = Initiate
6 - 12 = Industry
Teen = Identify
20s - 30s = Intimacy
and
40s - 50s = Generate
Elderly = Integrity
What is the memory trick for Erikson’s Psychosocial Stages
Trust Autonomy to Initiate the Industry, Identify Intimacy and Generate Integrity
1 = Trust
2 = Autonomy
to
3 - 5 = Initiate
6 - 12 = Industry
Teen = Identify
20s - 30s = Intimacy
and
40s - 50s = Generate
Elderly = Integrity
Which part of the nervous system are symptoms of mental illness linked to?
Chapter 3
Central Nervous System (dysfunction of the brain)
What are two potential causes of mental illness / disturbances in mental funciton?
Chapter 3
Genetics
Neurotransmitters
What makes up the limbic system and what is its function?
Chapter 3
Function: emotional status & phsychological function using Norepinephrine, Serotonin, & Dopamine
- Facilitates memories
- Establishes emotional states
- Links the conscious with the unconscious of the brain
What can excess transmission of dopamine from the presynaptic neurons lead to?
Chapter 3
Psych disorders like schizophrenia
What does GABA (NT) play a role in?
Chapter 3
Neuronal excitability & anxiety
What does HIGH acetylcholine lead to?
Chapter 3 - KNOW THIS!!!
Depression
What does low Acetylcholine lead to?
**Chapter 3 - KNOW THIS!!!*
Dementia
What does HIGH Dopamine lead to?
**Chapter 3 - KNOW THIS!!!*
Schizophrenia
What does low Dopamine lead to?
**Chapter 3 - KNOW THIS!!!*
ADHD
What does HIGH Norepinephrine lead to?
Chapter 3 - KNOW THIS!!!
anxiety, schizophrenic mania
What does low norepinephrine lead to?
Chapter 3 - KNOW THIS!!!
Depression
What does HIGH serotonin lead to?
Chapter 3 - KNOW THIS!!!
Anxiety
What does low serotonin lead to?
Chapter 3 - KNOW THIS!!!
depression
What does HIGH GABA lead to?
Chapter 3 - KNOW THIS!!!
decreased anxiety
What does low GABA lead to?
Chapter 3 - KNOW THIS!!!
increased anxiety
Changes in what neurotransmitters can lead to depression?
Chapter 3
- HIGH Acetylcholine
- low Norepinephrine
- low Serotonin
Changes in what neurotransmitters can lead to anxiety?
Chapter 3
- HIGH Norepinephrine
- HIGH Serotonin
- low GABA
What are various types of brain imaging techniques?
- EEG (Electroencephalography): records electrical signals (asleep, awake, anesthetized)
- CT: can detect lesions, abrasions, infarct areas, aneurysms, & can show cognitive disorders & schizophrenia (Series of 3D images)
- MRI: can detect schizophrenia
- fMRI (Functional MRI): measures brain activity indirectly by changes in blood oxygen
- fMRI vs. MRI: MRIs create pictures of body’s interiro, fMRIs record metabolic acitivty over time
- PET Scan: can be used to detect schizophrenia, abnormalities in the limbic system, mood disorders, ADHD, decreased utilization of glucose (radioactive tracer injected whcih travelsl to the brain & is detected as bright spots in the skin; conveys images of activity)
- SPECT: can detect circulation of CSF
What is the difference in pharmacodynamics & pharmacokinetics?
Chapter 3 - KNOW THIS!!!
Pharmacodynamics: what the drug does to the body
Pharmacokinetics: actions of the body on the drug (movement of the drug throughout the body; excretion)
What is pharmacokinetics?
Chapter 3
Actions of the body on the drug; movement of the drug through the body
- Absorption
- Distribution
- Metabolism
- Exrection
ADME
What is the difference in drug agonism & drug antagonism?
Chapter 3 - KNOW THIS!!!
- Agonist works WITH the body (helps the body do what it’s supposed to do)
- ANTAGonist works AGAinst the body (blocks the body from doing what it normally does)
Agonist = WITH while the ANTAGonist works AGAinst the body
List classes of Anxiolytic Agents (anti-anxiety drugs & hypnotics)
Chapter 3 - KNOW THIS!!!
Benzodiazepines: “-pam” or “-lam”
* alprazolam – (Xanax)
* clonazepam – (Klonopin)
* diazepam – (Valium)
* lorazepam – (Ativan)
* flurazepam – (Dalmane) – insomnia
* tempazepam – (Restoril) – insomnia
* triazolam – (Halcion) – insomnia
* chlordiazepoxide (Librium) – EtOH withdraw
* diazepam (Valium) – EtOH withdraw
* lorazepam (Ativan) – EtOH withdraw
Nonbenzodiazepine Receptor Agonists (Z-Drugs)
* zolpidem – (Ambien)
* zaleplon – (Sonata)
* eszopiclone – (Lunesta)
Melatonin Receptor Agonists
* ramelteon – (Rozerem)
Orexin Receptor Antagonists: “-rexant”
* suvorexant – (Belsomra)
* lemborexant – (Dayvigo)
Buspirone (Buspar)
What benzodiazepines are used for insomnia?
Chapter 3
All have a “Z” in the name + “-lam” or “-pam”
- flurazepam (Dalmane)
- temazepam (Restoril)
- triazolam (Halcion)
How do benzodiazepines work & what do they cause?
Chapter 3 - KNOW THIS!!!
bind to GABA receptors to enhance action of GABA (increases frequency of calcium chloride channels opening causing hyperpolarization which inhibits cellular excitability)
CALMING Effect
Side Effects of benzodiazepines
Chapter 3 - KNOW THIS!!!
- sedation
- ataxia
- anti-convulsant
- muscle relaxers
- retrograde amnesia
- potential for abuse
- decreased RR
- decreased BP
- decreased HR
sedate, amnesia, decreased RR, BP, HR
What are Non-benzodiazepine receptor agonists / Z-drugs used for & how do they work?
Chapter 3 - KNOW THIS!!!
**Hypnotic & amnestic effects **without anti-anxiety, anti-convulsant, or muscle relaxer properties
Work on GABA, but more selective with receptors
All have Z in the name, but NO “lam” or “pam”
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
What are side effects of melatonin receptor agonists?
Chapter 3
- Headache
- Dizziness
What are Orexin receptor antagonists used for & what are rare side effects of it?
Chapter 3
Sleep Aid
SEs: sleep paralysis, hallucinations when waking up or falling asleep, cataplexy like symptoms (loss of muscle tone promoted by strong emotions like laughter)
List all of the anxiolytic agent drug classes and whether they have misuse potential
Benzodiazepines – addictive & controlled
- Z-Drugs (non-benzo receptor agonists) – controlled substance, less dependance than benzos
- Melatonin Receptor Agonists – not controlled & no misuse potential
- Orexin Receptor Agonists – controlled substance
- Buspirone – no potential for abuse
What is Buspirone (Buspar) used for, what are common side effects and what does it work on?
Chapter 3 – KNOW THIS!!!
Works on SEROTONIN
SEs: headaches, dizziness, nausea
used for generalized anxiety disorder
What drug class is the first line treatment for anxiety?
Chapter 3
Antidepressants
List types (classes) of Antidepressant medications
Chapter 3 - KNOW THIS!!!
SSRIs
* fluoxetine (Prozac)
* sertraline (Zoloft)
* paroxetine (Paxil)
* citalopram (Celexa)
* escitalopram (Lexapro)
* fluvoxamine (Luvox)
NaSSA (nonadrenergic & specific serotonergic antidepressants)
* mirtazapine (Remeron)
TCAs
* amitriptyline (Elavil)
* impiramine (Tofranil)
* nortriptyline (Pamelor)
MAOIs (monoamine oxidase inhibitors)
* isocarboxazid (Marplan)
* phenelzine (Nardil)
* selegiline (EMSAM)
* tranylcypromine (Parnate)
SNRIs
* venlafaxine (Effexor)
* desvenlafaxine (Pristiq)
* duloxetine (Cymbalta)
* levomilnacipran (Fetzima)
NDRI (norepinephrine dopamine reuptake inhibitor)
* bupropion (Wellbutrin)
SARI (serotonin antagonists & reuptake inhibitors)
* nefazodone (formerly sold as Serzone)
* trazodone (formerly sold as Desyrel; now Oleptro)
* brexpiprazole (Rexulti)
SPARI (serotonin partial agonist reuptake inhibitor)
* vilazodone (Viibryd)
Serotonin modulator & stimulator
* vortioxetine (Trintellix)
Which two neurotransmitters play a big role in mood regulation, specific to depression?
Chapter 3 - KNOW THIS!!!
Norepinephrine & Serotonin
What is the monoamine hypothesis of depression?
Serotonin, Norepinephrine, or Dopamine deficiency
- increase in NTs alleviate depression
- long-term use may help neurons survive & help generate new axons
What are SSRIs, what do they work on, and what are side effects?
Chapter 3 - KNOW THIS!!!
Block reuptake of serotonin so it’s more available in the synapse
end in “-ine” or “-pram”
SEs: apathy, low libido, nausea, vomiting
- fluoxet”-ine” – (Prozac)
- sertral”-ine” – (Zoloft)
- paroxet”-ine” – (Paxil)
- citalo”-pram” – (Celexa)
- escitalo”-pram” – (Lexapro)
- fluvoxam”-ine” – (Luvox)
What are the top 5 most common anti-depressant drug classes that are used?
Chapter 3
1.) SSRIs
2.) SNRIs
3.) TCAs
4.) MAOIs
5.) Atypicals (wellbutrin & trazodone)
How do SSRIs work? What are possible side effects?
Chapter 3 - KNOW THIS!!!
inhibit reuptake of serotonin back into the neuron – more serotonin floating around in the brain = better mood
SEs: weight gain, insomnia, sexual dysfunction, nausea, vomiting, apathy
How do SNRIs work? What are major side effects?
Chapter 3 - KNOW THIS!!!
inhibit reuptake of serotonin AND norepinephrine into the neuron – more serotonin & norepinephrine floating in the brain
SEs: loss of appetite, sexual dysfunction (less than SSRIs), sweating, increased BP & HR, insomnia
How do TCAs work & what are the side effects?
Chapter 3 - KNOW THIS!!!
block serotonin & norepinephrine reuptake
SEs: anticholinergic blurred vision, dry mouth, arrhythmia, tachycardia, urinary retention, constipation, lethal OD potential
How do MAOIs work? What are common side effects?
Chapter 3 - KNOW THIS!!!
block the destruction of serotonin, norepinephrine, dopamine, & tyramine – increase 5HT, NE, DA, & Tyramine in the brain
SEs: agitation, anxiety, decreased BP, HTN crisis
Interacts with MANY foods like aged cheese, pickled or smoked fish, wine, chocolate, sausage & cured meats, caffeine, figs, excess amount of bananas, avocado, fermented foods & beverages, yeast, soy, etc.
SPIT
- selegiline – (EMSAM)
- phenelzine – (Nardil)
- isocarboxazid – (Marplan)
- tranylcypromine – (Parnate)
What foods can you not eat while taking MAOIs?
Chapter 3 - KNOW THIS!!!
- Aged cheese
- Pickled or smoked fish
- Wine
- Chocolate
- Sausage & cured meats
- Caffeine
- Figs
- Excess amount of bananas
- Avocado
- Fermented foods & beverages
- Yeast
Soy
What are side effects of NaSSA (noradrenergic & specific serotonergic antidepressants)?
Chapter 3
- Sedation
- Appetite stimulation
- Weight gain
fewer GI & sexual dysfunction issues than SSRIs
What can Doxepin (Silenor) be used to treat?
Chapter 3
- Depression
- Nerve pain
- Insomnia
TCA Antidepressant
What are side effects of NDRIs (Norepinephrine & Dopamine Reuptake Inhibitors)
Chapter 3
- Insomnia
- Tremor
- Anorexia
- Weight loss
Bupropion (Wellbutrin) = dopamine reuptake inhibitor
- amitriptyline– (Elavil)
- imipramine – (Tofranil)
- nortriptyline – (Pamelor)
What are side effects of SARIs (Serotonin agonist & reuptake inhibitors)?
Chapter 3
End in “-zadone”
- Sedation
- Headache
- Nausea
- Dizziness
- Blurred vision
- nefa”-zodone” – (Serzone)
- tra”-zadone” – (Desyrel)
**What is the first line mood stabilizer for treatment of bipolar disorder? What are common side effects? What is the therapeutic blood level?*
Chapter 3 - KNOW THIS!!!
Lithium
Blood Level = 0.8 - 1.4
SE:nausea, vomiting, thirst, polyuria, tremors, weight gain
Explain the difference in lithium toxicity & serotonin syndrome
Chapter 3
Lithium Toxicity: ataxia, coma, nausea, vomiting, tremors
Serotonin Syndrome: sweating, fevers, shiver, tremors
* SS = Temperature Change
What is the difference in typical & atypical antipsychotics?
Chapter 3 - KNOW THIS!!!
Typical (1st Generation):
* decrease dopamine in CNS
* affect POSITIVE sx of schizophrenia (delusions, hallucinations)
* SEs: EPS (acute dystonic reactions, akathisia, parkinsonism, tardive dyskinesia, ataxia = movement issues), weight gain
Atypical (2nd Generation):
* serotonin & dopamine receptor antagonist
* Fewer EPS SEs; can cause metabolic syndrome (weight gain, increase glucose, dyslipidemia, > risk for DM, HTN)
* affect positive (+) AND negative (-) schizophrenia symptoms
Typical (1st Gen)
* Adasuve
* fluphenazine
* Haldol
* haloperidol
* Haloperidol LA
* Haldol Decanoate
* loxapine
Atypical (2nd Gen): end in “-zole”, “-pine”, & “-done”
* cloza”-pine” – (Clozaril)
* risperi”-done” – (Risperdal)
* quetia”-pine” – (Seroquel)
* olanza”-pine” – (Zyprexa)
* ziprasi”-done” – (Geodon)
* aripipra”-zole” – (Abililfy)
* paliperi”-done” – (Invega)
* iloperi”-done” – (Fanapt)
* lurasi”-done” – (Latuda)
* asena”-pine” – (Saphris)
What are positive & negative symptoms of schizophrenia?
Chapter 3
Positive (+): delusions & hallucinations
Negative (-): poor hygiene, avoiding people, disconnected from feelings
