Exam 2

Question 1

1. What neurotransmitters are excitatory?
2. what neurotransmitters are inhibitory?
3. What neurotransmitters are modulatory?
4. What are the effects of dopamine? High levels cause what? Low levels cause what?
5. What are effects of serotonin?

Answer 1

1. epi, norepi
2. GABA, endorphins
3. dopamine and serotonin
4. Pleasure and reward. Involved in movement. Involved in addiction (big hit of dopamine feels good). High levels cause psychosis. Low levels cause Parkinsonian movement of Parkinson’s disease.
5. Associated with anxiety and depression. Low levels cause these conditions as well as OCD, panic, sleep disruption, changes in appetite, sexual dysfunction, and excess anger in some people.

Question 2

1. Name your SSRIs and action:
2. Name your SNRIs and action:
3. Name the NDRI and action:
4. Name your TCA’s

Answer 2

1. SSRIs: (Celexa / , Lexapro / , Prozac / fluoxetine, Zoloft / , Paxil / , Luvox / Viibryd / , Brintellix/ : block the reuptake of serotonin, so that there is more serotonin at the synapse.
2. SNRIs: (Cymbalta / duloxetine, Pristiq / Desvenlafaxine, Fetzima / levomilnacipran, Effexor / venlafaxine) block the reuptake of serotonin and norepinephrine, increasing the availability of both neurotransmitters
3. NDRIs: (bupropion / Wellbutrin): block the reuptake of norepinephrine and dopamine.
4. TCAs: (amitriptyline / , desipramine / Norpramin, imipramine / Tofranil,
   nortriptyline / ): block the reuptake of norepinephrine and serotonin.

Question 3

1. Describe the relationship of glutamate and GABA:
2. Describe norepinephrine
3. Describe the effects of acetylcholine and what Aricpet does to it:
4. Describe the effects of epinephrine:

Answer 3

1. Glutamate is an excitatory neurotransmitter; GABA inhibits the effects of glutamate. In people who suffer from anxiety, there is a dysregulation of these two. LOW levels of GABA = feelings of anxiety; HIGH levels = feeling of calm.
2. Norepinephrine: both a HORMONE and a NEUROTRANSMITTER, Involved in arousal during STRESS response (increase blood pressure, etc.), learning, memory, and mood. Deficiency of norepi linked to Parkinson’s.
3. Acetylcholine: Arousal/sleep, cognition, memory, learning, contraction of skeletal muscle; Low acetylcholine = Alzheimer’s. ARICEPT blocks the break down of acetylcholine.
4. Epinephrine (adrenaline): both a hormone and a neurotransmitter, constricts blood vessels (increases cardiac output) and opens airways; activates blood and hormonal arousal during FIGHT/FLIGHT response.

Question 4

1. What might be done to improve our understanding of the neurobiology and pathophysiology of schizophrenia?
2. Name the first gen (typical) antipsychotics, what they treat, and the main side effects:
3. Name trhe 2nd gen (atypical) antipsychotics, what they treat, and the main side effects:

Answer 4

1. PET scans
2. Haldol, Chlorpromazine, fluphenazine, treats positive signs. Risk of neuroleptic malignant syndrome (NMS) and EPS
3. Clozapine, Risperidone, Olanzapine impacts serotonin and dopamine. Reduces positive and negative symptoms. Less severe side effects than 1st gen, but still cause weight gain, cardiac issues, hyperprolactinemia, diabetes. Less incidence of EPS but still can cause NMS

Question 5

1. What can we do for schizophrenic patients who forget to take meds or are non-compliant? Name the meds:
2. What is Invega Sustena?

Answer 5

1. IM injections of long-acting antipsychotics. Haldol, Decanoate, Prolixin Decanoate, and consta (Risperdal) - requires refigeration, and Abilify maintenance
2. Antipsychotic used for treatment initiations only

Question 6

1. What is the BAC % of legal intoxication? At what level causes coma and death?
2. What are the alcohol withdrawal symptoms? How long do withdrawals last?
3. What happens to the vitals during alcohol withdrawal?
4. Withdrawal from which substances should be done under medical supervision?
5. What scale is used for alcohol withdrawal?
6. What drugs may be used to help alcohol withdrawal?
7. What drugs may help with alcohol abstinence?

Answer 6

1. 0.08% Above 0.4%
2. abdominal cramps, vomiting, tremors, restless, inability to sleep, headache, hallucinations, anxiety, tonic-clonic seizures. Typically lasts from 48-72 hours. Starts as early as 4 hours after last drink
3. Increased HR, BP, RR, and temp
4. Alcohol, benzodiazepines, and barbituates
5. CIWA
6. diazepam, phenobarbitol, chlordiazepoxide (Librium) Are the most common. Naltrexone, carbamazepine, clonidine (for less severe cases),
7. Disulfuram, naltrexone, acamprosate

Question 7

1. Is withdrawal from opiates life threatening?
2. What scale do we use?
3. What are the S/S of opioid withdrawal?
4. Why would a provider order drugs for these patients, and which drugs?
5. How long to withdraw from opioids?

Answer 7

1. No, but it is miserable
2. COWS
3. piloerection (gooseflesh), cramping and other GI disturbances, such as N/V, diarrhea, restlessness, dilated pupils, rhinorrhea, agitation.
4. To avoid patients leaving AMA, Clonidine. Sometimes benzos, but risk of addiction. Also vistaril and diphenhydramine help.
5. 5-7 days

Question 8

1. How does naltrexone work, and what is it for?

2. How does disulfuram work and what is it for?

Answer 8

1. it blocks the effects of alcohol and opioids. Taken PO, called Revia-tablet, for alcohol abuse and IM, called Vivitrol, for opioid abuse.
2. Deterrent to drinking. Dosed every 24 hours. If taken within 3 days of drinking, will make patient ill. Helps impulse relapse.

Question 9

1. What is mania?
2. What is hypomania?
3. What are the steps in assessing the manic patient?

Answer 9

1. An abnormally elevated mood described as expansive or irritable. Requires hospitalization. Episodes last at least 1 week.
2. A less severe episode of mania lasting at least 4 days with 3 or more manifestations of mania. Hospitalization not required. Can progress to mania.
3. (1) Is patient a danger to self or others? (2) Assess for alcohol or drug abuse, (3) mood, (4). Behavior, (5) speech (flight of ideas, tangential), (6). Cognitive functioning, (7) inflated self-regard (delusions or grandeur), (8). Sleeping patterns, (9). Impulse control

Question 10

1. Describe Bipolar 1:
2. Describe bipolar 2:
3. Describe cyclothymic disorder:
4. Drug of choice and therapeutic range:
5. low sodium will cause …….. lithium. We need to maintain adequate ……… and drink ……. to ……… of ………… .
6. When do we draw serum lithium levels?
7. adverse effects of lithium are:

Answer 10

1. most severe characterized by severe mood episodes from mania to depression
2. a milder form of mood elevation, there are milder episodes of Hypomania that alternate with periods of severe depression,
3. brief periods of Hypomania S/S occur alternating with brief periods of depressive S/S that are NOT as extensive or as long lasting as seen in full Hypomanic episodes or full depressive episodes
4. Lithium. 0.6-1.2
5. excess, sodium, 2-3L of water per day.
6. 12 hours after last dose
7. polyuria, polydipsia, edema, dysrhythmia, anorexia, nausea, dry mouth, mild thirst, abdominal bloating, soft stools or diarrhea, fine hand tremors, inability to concentrate, muscle weakness, headache, hypothyroidism and goiter.

Question 11

1. dysthymia
2. anhedonia
3. euphoria
4. anergia
5. aphasia
6. apraxia
7. agnosia
8. dystonia
9. tactile hallucinations
10. alogia

Answer 11

1. dysthymia: milder form of depression with earlier onset (childhood or adolescence). Lasts at least 2 years for adults and 1 year for kids.
2. anhedonia: inability to express pleasure
3. euphoria: a feeling or state of intense excitement and happiness.
4. anergia: no energy
5. aphasia: loss of ability to understand or express speech
6. apraxia: inability to perform particular purposive actions
7. agnosia: inability to interpret sensations and recognize things
8. dystonia: abnormal muscle tone resulting in spasm and abnormal posture, typically due to a side effect of drug therapy.
9. tactile hallucinations: sensations of touch when nothing is there.
10. poverty of speech

Question 12

1. Name some MAOI’s:
2. Examples of tyramine foods:
3. What can happen with MAOIs and tyramine containing foods?
4. S/S of hypertensive crisis:
5. antidote for hypertensive crisis:

Answer 12

1. Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Eldepryl and Zelapar), Trianylcypromine (Parnate)
2. (avocados, bananas, beef or chicken liver, brewers yeast, broad beans, caffeine such as in coffee, tea or chocolate; cheese especially aged, except cottage cheese, eggplant, figs, meat extracts and tenderizers, overripe fruit, papaya, pickled herring, raisins, red wine, beer, sherry, sauerkraut, sausage, bologna, pepperoni, salami, sour cream, soy sauce, yogurt)
3. Hypertensive crisis
4. Hypertension, Occipital headache radiating frontally, neck stiffness and soreness, nausea and vomiting, sweating, fever and chills, clammy skin, dilated pupils, palpitations, tachycardia, or bradycardia, constricting chest pain,
5. PHENTOLAMINE BY INTRAVENOUS INJECTION

Question 13

1. normal magnesium levels:
2. normal sodium:
3. normal potassium

Answer 13

1. 1.3-2.2
2. 135-145
3. 3.5-5

Question 14

1. Schizotypal personality disorder assessment and interventions:
2. Borderline Personality assessment and interventions including limit setting for clients (what
   will this look like?)
3. Personality disorder assessment, diagnosis, and how to keep therapeutic milieu (interventions)
4. Antisocial personality disorder assessment and therapeutic communication

Answer 14

1. schizotypal (cluster A): odd beliefs, interpersonal difficulties. Eccentric appearance, magical thinking. Distortions that aren’t clear delusions or hallucinations. Respect client’s need to isolate.
2. Borderline: instability of affect, identity, and relationships. Splitting, manipulation, impulsiveness, fear of abandonment. Self-injurious. Potential for suicide. Ideas of reference are common. Nurse needs to set limits.
3. Assess for risk factors: comorbid substance abuse, crimes, sex offenses. Maladaptive stress responses, lack of social restraint, tendancy to provoke conflicts, inability to emotionally connect, crosses others boundaries. Use of defense mechanisms. Nurse must manage groups for appropriate social interactions, set limits, self-assessment, always look for safety issues.
4. Antisocial: cluster b: disregard for others, exploitation, lack of empathy, commits crimes, manipulative, impulsive, charming, no morals.

Question 15

1. Anorexia assessment, diagnosis examples, interventions: including highest priority, know how
   to assess eating patterns
2. Bulimia nervosa: assessment, interventions and client education
3. Eating disorder nursing diagnosis (from text)