Exam 2-2 Flashcards
Effects of which Norepinephrine: FAM
F ight or flight
A ttention or Arousal
M ood
Effects of which Dopamine? (HEMD)
H hypothalamus hormones
E motions and thoughts
M uscle movement
D ecision making
Effects of Serotonin: MASHH
M ood A ggression S sleep and sex H unger H ormones
Effects of Histamine: IGA
I nflammatory response
G astric secretion
A lternest
Effects of GABA: MIAIAEA
M uscle-relaxant I nhibition A ggression reduced I mpair cognition and psychomotor function A nxiety E citation A nticonvulsant
Effects of Glutamate: LAME
L earning
A MPA
M emory
E xcitatory
Effects of Acetylcholine: LMMMPS
L earning M emory M ood M ania P arasympathetic S exual aggression
Part of the brain that plays role in emotional status and psychological function
Limbic system
Regulates the entire sleep/wake cycle
RAS- reticular activating system
Neurotransmitters associated with depression
**Deficiency of Serotonin and Norepinephrine
Dopamine decrease, acetylcholine increase)
Neurotransmitters associated with schizophrenia
**Increase of dopamine
Increase of norepinephrine, Decrease of GABA
Neurotransmitters associated with anxiety
**GABA decrease
Increase of norepinephrine and seratonin
Biochemical and physiological effects of drugs on the body
Pharmacodynamics
The action of the person on the drug
Pharmacokinetics
5 neurotransmitters associated with psychiatric illnesses:
Dopamine Serotonin Norepinephrine Glutamate GABA
Antianxiety drugs are associated with which neurotranmitter?
GABA-A
Diazepam (Valium) drug class
Benzodiazepine
Clonazepam (Klonopin) Drug class
Benzodiazepine
Benzodiazepines are known to be __________.
Sedative
Common side effects of benzodiazepines include:
Interference with motor ability, attention and judgement
Muscle relaxers
Falls and broken bones
Ataxia
Anticonvulsant
Should not be taken with other CNS depressants
Alprazolam (Xanax) drug class
Benzodiazepine without sedative response
Lorazepam (Ativan) drug class
Benzodiazepine without sedative response
flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion)0, estazolam (Prosom), and quazepam (Doral) are all….
Hypnotic benzodiazepines used for insomnia
Z-drugs are _________.
Hypnotics
Zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) are all…
Z-drugs (hypnotics)
-Sedative effects without anti-anxiety, anticonvulsant, or muscle relaxing effects
Doxepin (Silenor) is used for… and should be avoided….
treatment of insomnia: difficulty maintaining sleep
Avoided with severe urinary retention or on MAOIs and CNS sedatives
Ramelteo (Rozerem) is what drug class? side effects?
Melatonin receptor agonists
*headaches, dizziness, increased prolactin
Buspirone (BuSpar) has what effect? side effects?
Reduces anxiety without sedation
Dizziness and insomnia
*can be used with other CNS depressants (including alcohol)
*No addiction
What neurotransmitters is the target for antidepressants?
Norepinephrine and Serotonin
Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa), escitalopram (Lexapro), Fluvoxaine (Luvox) are all…
SSRIs
Nortiptyline (Pamelor), Amitriptyline (Elavil), and Imipramine (Tofranil) are all…
TCAs
Side effects of TCAs
Sedation
Drowsiness
Fatal Overdose (cardiac)
AntiCholinergic effects
Side effects of SSRIs
Anorexia Apathy Low libido Nausea/vomiting ** Low anticholinergic effects for patients with narrow angle glaucoma
Venlafaxine (Effexor), Desvenlafaxine (Pristiq), and Duloxetine (Cymbalta) are all…
SNRIs
SNRIs side efefcts
Hypertension
** Used to treat GAD, diabetic peripheral neuropathy, fibromyalgia pain
Mirtazapine (Remeron) is a…
SNDI
Side effects of Remeron/ SNDI
Sedation Weight Gain POSITIVE: Antiemetic (for nauseated patients) Minimal sexual dysfunction and improved sleep
MAOIs target which neurotransmitters?
ALL Monoamines: Norepinephrine, epinephrine, dopamine, and serotonin
**Tyramine
Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (EMSAM), and Tranylcypromine (Parnate) are all…
MAOIs
Bupropion (Wellbutrin, Zyban) is used for… side effects…. contraindications…
Smoking cessation
- side effects: insomnia, tremor, anorexia, weight loss
- Contraindicated in seizures, abrupt discontinuation of sedatives, and bulimia/anorexia
Vilazodone (Viibryd) and Trazodone (Oleptro) both can cause….
Insomnia
This drug has serious toxic effects including sinus bradycardia and convulsions
Lithium
Valporate (Depakote) is an….
Anticonvulsant used for rapid cycling and mixed episodes
Anticonvulsants target which neurotransmitters?
Glutamate and GABA
Side effects of Valproate (Depakote) are…
Tremor, weight gain, sedation
Serious: thrombocytopenia, pancreatitis, hepatic failure, birth defects
*Blood levels measured, liver function measured
Carbamazepine is an…
Anticonvulsant
Side effects of Carbamazepine:
Anticholinergic effects Orthostasis Sedation Ataxia **Rash-- Steven johnson syndrome
Tests performed with Carbamazepine (Tegretol)
CBCs ECG Electrolyte levels Blood levels Liver function
Lamotrigine (Lamictal) is an…
Anticonvulsant *Not effective in acute mania, but in depressive state
Lamotrigine (Lamictal) side effects:
Rash**steven-johnson syndrome
Topiramate (Topamax), oxcarbazepine (Trileptal) are both…
Anticonvulsants
First-generation antipsychotics target which neurotransmitters?
Dopamine (decrease levels)
Side effects of First- Generation Antipsychotics are:
*Motor abnormalities (parkinsonism, akinesia, akathisia, dyskinesia, tardive dyskinesia)
must be monitored for involuntary movement on AIMS scale
These drugs cause increased prolactin
First-generation antipsychotics
*Amenorrhea, galactorrhea, gynecomastia
These drugs are related to symptoms such as priapism, impaired memory, prolonged erection, sedation, weight gain, vasodilation, and orthostatic Hypotention
FIrst-generation anti-psychotics
First line of treatment for psychotic disorders because of lower EPS (Extrapyramidal side effects)
Second-generation antipsychotics
These drugs increase risk of metabolic syndrome
Second-generation anti-psychotics
Clozapine and olanzapine have the highest risk of..
causing metabolic syndrome
Aripiprazole and ziprasidone have the lowest risk of causing….
Metabolic syndrome
Clozapine (clozaril) is an …..
Second-generation antipsychotic
Side effects of Clozapine (Clozaril)…
Potential to suppress bone marrow and induce agranulocytosis Increased risk for infection (WBC labs required) Drosiness and sedation Hypersalivation Weight gain Reflex tachycardia Constipation Dizziness
Risperidones (Risperdal) is a…
Second-generation antipsychotic
*Low risk for agranulocytosis or convulsions
Side effects of Risperidone (Risperdal)…
EPS (highest risk... increased prolactin) Orthostatic hypotension Sedation Weight gain Sexual dysfunction
Tacrine (Cognex), Donepezil (Aricept), Galantamaine (Razadyne), Revastigmine (Exelon), and Memantine (Namenda, Namenda XR) are used for….
Alzheimers
Drugs used to treat Alzheimers target which neurotransmitters?
Acetylcholine and glutamate (Namenda)
Risk of bleeding is associated with which herbal combined with warfarin?
Ginkgo biloba
This herbal may increase hepatotoxicity
Kava
Taking this herbal with SSRIs can cause serotonin syndrome
St. John’s Wort
Therapeutic communication techniques include (4)
Silence
Active listening
Clarifying techniques
Questions
Attending behaviors include: (3)
Eye contact
Body language
Vocal quality
Written records of a segment of the nurse-patient session that reflect verbal and nonverbal behaviors. Useful for identifying communication patterns
Process Recordings
GAS three stages:
Alarm
Resistance
Exhaustion (Includes distress and eustress)
At least one week-long manic episode that results in excessive activity and energy. May alternate with depression or a mixed state of agitation and depression
Bipolar 1
Hypomania (euphoric and increases in functioning) alternating with profound depression
Bipolar 2
Hypomania alternating with symptoms of mild/moderate depression for at least 2 years. (1 in children)
Cyclothymic disorder
Nursing diagnosis for acute phase bipolar
Risk for injury
ECT is best used for…
Rapid cycling, treatment-resistant mania, pregnancy, to subdue severe manic behavior, severe depression, acute suicide
In which phase are the following interventions implemented for bipolar: Medical stability Safe environments Medications and ECT Seclusion
Acute
In which phase are the following interventions implemented for bipolar:
Maintaining adherence to medication regimen
Stress-reduction skills
Educational teaching
Referrals
CBT
Continuation phase
In which phase are the following interventions implemented for bipolar:
Long periods of medications
Psychotherapy
Group therapy
Maintenance
Lithium is known to cause…
Hypothyroidism and renal (kidney) impairment to concentrate urine
Lithium is contraindicated in…
Renal disease Thyroid disease Myasthenia Gravis Cardiovascular disease Brain damage Pregnancy
Occurs when feelings of depression persist consistently for at least 2 years.
Dysthymic disorder
SSRIs are used first for depression because…
They have fewer side effects and do not have anticholinergic side effects
Tachycardia, fever, restlessness, elevated BP, altered mental states (delirium), modd swings, seizures, abdominal pain, and apnea are signs and symptoms of…
Serotonin Syndrome
INterventions for serotonin syndrome include:
Remove offending agents Initiate symptomatic relief -cooling blankets -Anticonvulsants -Artificial ventilation -Induction of paralysis -Serotonin receptor blockade (cyproheptadine, methysergide, or propranolol)
Vegetables to avoid with MAOIs
Avocados, fermented bean curd, fermented soybean, soybean paste
Fruits to avoid with MAOIs
Figs, bananas
Meats to avoid with MAOIs
Fermented, smoked, or aged meats, liver, spoiled meat (bologna, pepperoni, salami and other sausages)
Fish to avoid with MAOIs
Dried or cured fish, fermented, smoked, aged or spoiled fish
Dairy and other products to avoid with MAOIs
Cheeses, foods with yeast, imported beers, chianti wines, protein supplements, shrimp paste, soy sauce, soups.
True or False: Chocolate, fava beans, ginseng, and caffeinated beverages are safe to ingest with MAOIs
False
Drugs used most often for anxiety
Benzodiazepines
Part of brain associated with anxiety
Amygdala
Which stage of treatment for trauma:
- Safety and stabilization
- Stopping self-destructive behaviors
- Education about trauma and its effects
Stage 1
Which stage of treatment of trauma: Developmental skills Nurturing self-awareness Problem-solving and social skills Coping skills
Stage 3
Which stage of treatment of trauma: Reducing arousal and regulating emotion Memory work Finding comfort from others Overcoming avoidance Decreasing dissociation
Stage 2
Three events that precipitate suicide include:
Loss of relationships
Financial difficulty
Impulsivity
SAD PERSONS
S ex A ge D epression P revious attempt E thonol use R ational thinking loss S ocial support O rganized plan N o spouse S ickness
Ratings and interventions of the SAD PERSONS scales
0-2 Send home w/ follow-up
3-4 Closely follow up, consider hospitalization
5-6 Strongly consider hospitalization
7-10 Hospitalize or commit
Fear, grief, anger, puzzlement, and condemnation of suicidal feelings/intent are abnormal responses to suicidal patients by the nurse and should be reported. True or False
False- these are normal.
Level of intervention that treats suicidal crisis.
Secondary Intervention
Level of intervention that helps survivors of person’s who commited suicide
Tertiary intervention
Level of intervention that is aimed at information and education to prevent suicide
Primary intervention
Parasuicide
Self-injury actions