Exam 2 Flashcards
1
Q
Adrenaline
A
Fight or flight
Produced in stressful situations
Increased HR and blood flow, leading to physical boost and heightened awareness
2
Q
GABA
A
Calming
Calms firing nerves in the central nervous system
High levels improve focus, low levels cause anxiety
Also contributes to motor control and vision
3
Q
Noradrenaline
A
Concentration
Affects attention and responding actions in the brain
Contracts blood vessels, increasing blood flow
4
Q
Acetylcholine
A
Learning
Involved in thought, learning, and memory
Activates muscle action in the body
Also associated with attention and awakening
5
Q
Dopamine
A
Pleasure
Feelings of pleasure, also addiction, movement, and motivation
People repeat behaviors that lead to dopamine release
6
Q
Glutamate
A
Memory
Most common neurotransmitter
Involved in learning and memory
Regulates development and creation of nerve contacts
7
Q
Serotonin
A
Mood
Contributes to well-being and happiness
Helps sleep cycle and digestive system regulation
Affected by exercise and light exposure
8
Q
Endorphins
A
Euphoria
Released during exercise, excitement, and sex, producing well-being and euphoria, reducing pain
9
Q
Anticholenergic side effects
A
Dry mouth
Constipation
Urinary retention/hesitance
Blurred vision
Photophobia
Nasal congestion
Decreased memory
Tachycardia
10
Q
Extrapyramidal symptoms
A
- Antipsychotic side effects
Dystonia
Akathisia
Pseudoparkinson
Tardive Dyskinesia
11
Q
Dystonia
A
Involuntary muscle spasms
Men, people less than 25
Emergent
Tx: Cogentine (benztropine)
12
Q
Akathisia
A
Motor restlessness/fidgeting
More common in women
13
Q
Pseudoparkinsons
A
Tremors, shuffling gait, drooling
Women, elderly, dehydrated
14
Q
Tardive Dyskinesia
A
Bizarre face and tongue movements
Irreversible
15
Q
Tardive dyskinesia tx
A
Austedo (deutrabenazine) and Ingrezza (valbenazine)
16
Q
Supplements and vitamins that help control movement (tardive dyskinesia)
A
Ginko biloba
Melatonin
Vitamin B6
Vitamin E
17
Q
Meds to treat Extrapyramidal sx
A
Cogentin
Benadryl
Artane
Symmetrel
18
Q
Neuroleptic malignant syndrome
A
Rare but fatal complication from all antipsychotic drugs
Seen more with 1st gen drugs
Severe muscle rigidity
19
Q
Serotonin syndrome
A
May begin 2-72 hrs after the start of treatment
Too much serotonin
20
Q
Serotonin syndrome s/sx
A
- Mental confusion
- Difficulty concentrating
- Agitation
- Fever
21
Q
Expected action of antipsychotics
A
Block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery
22
Q
Examples of low potency antipsychotics
A
chlorpromazine (Thorazine)
thioridazine (Mellaril)
23
Q
Examples of high potency antipsychotics
A
haloperidol (Haldol)
fluphenazine (Prolixin)
24
Q
Therapeutic uses for antipsychotics
A
Acute/chronic psychosis
Schizophrenia
Bipolar disorder
Tourette’s syndrome
Delusional and schizoaffective disorder
Dementia
25
Typical antipsychotic drug AE
Extrapyramidal side effects (EPS)
Orthostatic hypotension
Sedation
Neuroendocrine effects (Gynecomastia, galatorrhea, menstrual irregularities)
Sexual dysfunction
Agranulocytosis
Neuroleptic malignant syndrome
Skin effects - photosensitivity, contact dermatitis
26
Neuroleptic malignant syndrome characteristics
Sudden high fever, BP fluctuations, dysrhythmias, muscle rigidity, changes in LOC, coma
27
Contraindication for antipsychotics
Pt with coma, severe depression, Parkinson's disease, prolactin-dependent breast cancer, dementia, and severe hypotension
28
Use precautions with antipsychotics for pt with
Glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver/kidney disorders, seizures
29
Antipsychotic drug interactions
Concurrent use with other anticholinergic drugs, CNS depressants, levodopa
30
Teaching with antipsychotic drugs
Administer anticholinergic, beta-blockers, benzodiazepines - to control EPS effects
Take as prescribed/regular schedule
Therapeutic effects take 2-4 weeks to several months
31
Advantages of atypical drugs
Relieves both positive and negative symptoms
Fewer EPS effects
Fewer anticholinergic effects
Decrease in affective symptoms (depression) and suicidal behaviors
Improvement in cognition
32
Atypical antipsychotic examples
risperidone (Risperdal)
clozapine (Clozaril)
quetiapine (Serpquel)
aripiprazole (Abilify)
olanzapine (Zyprexa)
ziprasidone (Geodon)
33
Atypical antipsychotic drug uses
Positive and negative symptoms of schizophrenia
Bipolar disorders
Levodopa (Parkinson's med) induced psychosis
34
Atypical antipsychotics AE
Low WBC count - agranulocytosis
New onset diabetes or loss of glucose control
Weight gain
Hypercholesterolemia
Orthostatic hypotension
Anticholinergic effects
Mild EPS effects
35
Lithium action
May stabilize electrical activity in the neurons and **block serotonin receptors**
- Gold Standard treatment
36
Lithium use
Mood stabilizer
Treatment of bipolar disorders (controls acute mania)
37
Lithium nursing consideration
Has the lowest therapeutic index of psychiatric drugs
- Easy to become toxic
38
Lithium AE
GI distress (N/V early sign of toxicity)
Fine hand tremors
Polyuria, mild thirst
Weight gain
Nephrotoxicity
Goiter and hypothyroidism (long term tx)
Bradydysrhythmias
Hypotension
Electrolyte imbalances (Esp. K+ and Na)
39
Normal lithium range
0.6-1.2 mEq/L
Monitor frequently
40
Lithium toxicity s/sx
N/V, weakness, delirium, seizures
41
Lithium pregnancy category
X or D (teratogenic)
42
How long does Lithium take to reach therapeutic levels
1-3 weeks
43
Anticonvulsant examples
carbamazepine (Tegretol)
valporic acid (Depakote)
lamotrigine (Lamictal)
44
Anticonvulsant action
Potentiating the inhibitory effects of GABA (Gamma-aminobutyric acid)
45
Anticonvulsant uses
Tx of bipolar disorders, especially mixed episodes
46
Anticonvulsants AE
CNS effects (nystagmus, double vision, vertigo, staggering gait, H/A)
Blood dyscrasias (Leukopenia, anemia, thrombocytopenia)
Hepatotoxicity
Serious skin rashes (Stevens-Johnson syndrome)
Teratogenic
47
MAOI examples
phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)
selegline (Emsam) patch
48
MAOI's action
Prevents the destruction of serotonin, norepinephrine, dopamine, and tyramine
- Increases in the brain
49
MAOI's uses
Atypical depression
Bulimia nervosa
Obsessive compulsive disorder
50
MAOI adverse effects
Orthostatic hypotension
Hypertensive crisis - due to intake of dietary tyramine
CNS stimulation (anxiety, agitation)
51
Tyramine containing foods
Aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, beers, red wine
52
MAOI interactions
Concurrent use with **TCA's** (HTN crisis)
Concurrent use with **SSRI's** (serotonin syndrome)
Concurrent use with **vasopressors/caffeine** (hypertension)
Concurrent use with OTC **decongestants**/cold remedies (HTN crisis)
53
Tricyclic antidepressant examples
amitriptyline (Elavil)
imipramiine (Tofranil)
doxepin (Sinequan)
nortriptyline (Aventyl) (Pamelor)
amoxapine (Asendin)
54
Tricyclic antidepressant actions
Block the reuptake of norepinephrine and serotonin in the synaptic space
55
Tricyclic antidepressant uses
Depression
Bipolar disorders (depressive)
56
Tricyclic antidepressant AE
Orthostatic hypotension
Anticholinergic effects
Sedation
Excessive sweating
57
Tricyclic antidepressant contraindications
Clients with seizure disorder
Caution in clients with CAD, DM, liver/kidney/resp disorders, urinary retention, glaucoma, BPH, hyperthyroidism
Avoid concurrent use with MAOI's, antihistamines, CNS depressants
58
SSRI examples
fluoxetine (Prozac)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)
59
SSRI actions
Blocks the reuptake of serotonin in the synaptic space (high concentration of serotonin in synaptic cleft)
Affects mood, relieving depression
60
SSRI uses
Major depression
OCD
Bulimia nervosa
Panic and PTSD disorders
61
SSRI AE
Sexual dysfunction
CNS stimulation
Serotonin syndrome
Withdrawal syndrome
GI bleeding
62
SSRI contraindications
Increase risk of birth defects
Concurrent use with MAOI's and TCAs
63
SSRI interactions
Increase risk of serotonin syndrome with St. John's wort
Increase warfarin levels with Coumadin
64
Atypical antidepressant examples
bupropion (Wellbutrin)
duloxetine (Cymbalta)
mirtazapine (Remeron)
venlafaxine (Effexor)
65
Atypical antidepressant action
Bupropion inhibits dopamine uptake
Others block the reuptake of serotonin and norepinephrine
66
Atypical antidepressant uses
Depression
Quit smoking aid
67
Atypical antidepressant AE
Suppression of appetite
HA, dry mouth, GI distress, constipation, tachycardia, insomnia, seizures
68
Atypical antidepressant contraindication/precautions
Cautious use with seizure disorders
Concurrent use with MAOI's is contraindicated
69
Benzodiazepine examples
diazepam (Valium)
alprazolam (Xanax)
lorazepam (Ativan)
choloridizepoxide (Librium)
clorazepate (Tranxene)
70
Benzodiazepine action
Enhances the inhibitory effects of GABA in the CNS
71
Benzodiazepine uses
Generalized anxiety disorder
Seizure disorders
Insomnia
72
Benzodiazepine AE
CNS depression - sedation, lightheadedness, ataxia
Withdrawal symptoms
73
Benzodiazepine contraindications
Schedule 4
Do not use with sleep apnea or respiratory depression
Hx of substance abuse
Concurrent use with other CNS depressants
74
Atypical antianxiety examples
buspirone (BuSpar)
75
Atypical antianxiety action
Unknown; does bind to serotonin and dopamine receptors
76
Atypical antianxiety uses
Panic disorder
OCD
PTSD
77
Atypical antianxiety AE
CNS depression
Paradoxical worsening of anxiety
78
Atypical antianxiety interactions
Grapefruit juice increases the effects of buspirone
79
Stimulant examples
methylphenidate (Ritalin)
amphetamine (Adderall)
80
Stimulant expected action
Raise levels of norepinephrine, serotonin, and dopamine into the CNS
81
Stimulant uses
ADHD
Conduct disorder
82
Stimulant AE
CNS stimulation
Weight loss
CV effects - dysrhythmias, chest pain, HTN
Development of psychotic symptoms
Withdrawal reaction
83
Stimulant interactions
Concurrent use with **MAOI**'s may cause HTN crisis
**Dilantin**, **Coumadin** and **phenobarbital** may increase serum levels with concurrent use
84
Models of psychotherapy include
Psychoanalysis and Psychoanalytic Psychotherapy
Interpersonal psychotherapy
Reality Therapy
Cognitive behavioral therapy
Dialectical behavioral therapy
85
What is the goal for Psychoanalysis?
For client to gain insight about current relationships and behavior patterns by confronting unconscious conflicts
86
Psychoanalytic psychotherapy
A briefer version of psychoanalysis that is focused on specific conflicts
87
Who developed interpersonal psychotherapy and why
Sullivan for MDD tx
88
Interpersonal psychotherapy
Considered a brief psychotherapy
Assumes that symptoms of depression are correlated with difficulties in interpersonal relationships
89
Interpersonal psychotherapy goal
To improve interpersonal skills through specific interventions targeted at resolving identified problems
90
Reality therapy developed by who
Glasser
91
Reality therapy
Belief that individuals behave in ways to fulfill 5 basic needs: power, belonging, freedom, fun, and survival
Suggests that all individuals are responsible for what they choose to do
92
Reality therapy goal
Therapist helps the client to identify needs that are not being met and change behavior to more effectively meet needs
93
Cognitive behavioral therapy (CBT) was developed by (and for what)
Beck for tx of mood disorders
94
CBT is used for what disorders
Schizophrenia, PTSD, substance use disorder, and personality disorders
95
Goal of CBT
Change automatic thought patterns that contribute to mood and thought disturbances
96
Who developed dialectical behavioral therapy and why
Linehan as tx for borderline personality disorder and suicidal ideation
97
Dialectical behavioral therapy
Similar foundation to CBT
Focuses on regulating troubling emotions by learning nonjudgmental self-acceptance, distress tolerance, interpersonal effectiveness, and structuring the environment to reinforce progress
98
Milieu therapy
Therapeutic community
Scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual
99
"Assumptions" of Milieu therapy
The health in each individual is to be realized and encouraged to grow
Every interaction is an opportunity for therapeutic intervention
The individual owns their environment
Each individual owns their behavior
Peer pressure is a useful and powerful tool
Inappropriate behaviors are dealt with as they occur
Restrictions and punishments are to be avoided
100
Nurse's role in Milieu therapy
Medication administration
Development of a one-to-one relationship
Setting limits on unacceptable behavior
Client education
101
Methods of relaxation therapy
Deep-breathing exercises
Progressive relaxation
Meditation
Mental imagery
Biofeedback
102
Goal of assertiveness training
Teaching clients to express what they feel and need without becoming defensive or violating the rights of others
103
Seven practices to encourage spiritual growth
Transform motivation
Cultivate emotional wisdom
Live ethically
Concentrate and calm your mind
Awaken your spiritual vision
Cultivate spiritual intelligence
Express spirit in action
104
Conditions that promote a therapeutic community
Containment
Structure
Involvement
Support
Validation
105
6 principles of a therapeutic milieu
Contagious calmness
Respect for inherent human dignity
Nurse's care for self and one another
Intellectual engagement
Caritas
Safe and restorative physical surroundings
106
Crisis
A sudden life event during which the usual coping mechanisms cannot resolve the problem
Disturbs homeostasis
107
Dispositional crisis
Lack of information causes crisis (not knowing what job to take, what medical treatment to seek, options for living arrangements)
108
Crisis of anticipated life transitions
Normative, common crisis
Ex. Midlife career change, getting married, becoming a parent, divorce, onset of chronic illness, changing schools
109
Crisis resulting from traumatic stress
Crisis precipitated by an unexpected external stressor over which the individual has little/no control and as a result feels emotionally overwhelmed and defeated
110
Maturational/developmental crisis
Crisis that occur in response to failed attempts to master developmental tasks associated with transitions in the life cycle
111
Crisis reflecting psychopathology
A crisis that is influenced or triggered by pre-existing psychopathology
Ex. Personality disorders, anxiety disorders, bipolar disorders, and schizophrenia
112
A major difference between anger and aggression is
Intent
113
Anger characteristics
Frowning, clenched fists, low-pitched voice, yelling, shouting, easily offended, flushed face, intense eye contact, defensive, emotional, passive-aggressive, discomfort
114
Aggression characteristics
Pacing, restless, verbal threats, threats of homicide/suicide, loud voice, tense facial/body language, suspiciousness, increased agitation with stimuli, panic anxiety -> misinterpreting environment, disturbed thought processes, angry mood (disproportionate)
115
Roberts' seven stage crisis intervention model (in order)
1. Psychosocial and lethality assessment
2. Rapidly establish rapport
3. Identify the major problems or precipitating factors
4. Deal with feelings/emotions
5. Generate and explore alternatives
6. Implement action plan
7. Follow up
116
Suicide protective factors
Family
Pregnancy
Religion/culture
Social support
Coping skills
Medical care
117
Suicide risk factors
Marital status
Gender/age
Religion
Socioeconomic status
Ethnicity
Biological
Cultural/societal
Psychological
Impulsive/aggression
Family history
Incarcerated
Chronic illness
118
Suicide developmental risk factors
Substance abuse
Aggression
Disruptive behaviors
Depression
Social isolation
119
Suicide statistics (for over 65 and young adults/adolescents)
Third leading cause of death for 14-24
65+ have highest rate of suicide
120
