Final Exam Flashcards by Molly S

What is Dorothea Dix known for?

Creation of asylums

2. Moral treatment

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What is Linda Richards known for?

First American psychiatric nurse

2. McLean Hospital; first to train nurses in psych setting

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Hildegard Peplau’s theory?

3 phases: orientation, working, termination

Therapeutic nurse-patient relationship

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What is Sigmund Freud’s psych theory?

All human behavior is caused & explainable
Repressed sexual impulses, desires as motivation for behavior
Id, ego, superego
Behaviors are due to subconscious thoughts

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What are differences between Id, Ego, and Superego?

Id: instinctive, for pleasure, immediate satisfaction, subconscious
Ego: rationality, logicality, reality, conscious
Superego: right & wrong, morality, ideal, sub and conscious

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Characteristics of Sullivan’s Interpersonal Theories

Five life stages
Three develop. cognitive modes:
- Prototaxic (infancy, childhood)
- Parataxic (early childhood)
- Syntaxic (school-aged)

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B.F. Skinner’s Operant Conditioning theory

All behavior is learned
rewards or punishments
recurrence of rewarded behavior

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Clubhouse Treatment Model

4 Rights of Members:
  -place to come to
  -meaningful work
  -meaningful relationships
  -place to return to (lifetime membership) 
Focus on health, not illness

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Assertive Community Treatment setting (ACT)

(one of the MOST effective!!)

one of the most effective treatment settings
problem-solving orientation
direct service instead of referral
intense; no time restraints

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4 “patterns of knowing”

Empirical (derived from nursing science)
Personal (from life experiences)
Ethical (from moral nursing knowledge)
Aesthetic (from art of nursing)

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Components of Orientation Phase

Meeting nurse, client
Establishment of roles
Discussion of purposes, parameters of future meetings
Clarification of expectations
Identification of client’s problems
Nurse–client confidentiality, duty to warn/self-disclosure

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Components of Working Phase

•Problem identification: issues or concerns identified by
client; examination of client’s feelings and responses
•Exploitation: examination of feelings and responses;
development of better coping skills, more positive self-
image, behavior change, independence
•Possible transference/counter-transference

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Components of Termination phase

•Begins when client’s problems are resolved
•Ends when relationship is ended
•Deals with feelings of anger or abandonment that may
occur; client may feel termination as impending loss.

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Nurse-Patient distant zones

Intimate (0 to 18 inches)
Personal (18 to 36 inches)
Social (4 to 12 feet)
Public (12 to 25 feet)
Therapeutic communication: most comfortable when nurse and patient are 3 to 6 feet apart

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Catharsis

To alleviate or increase feelings of anger

- Example: watching a movie knowing that it will make you cry, and you go for the purpose of crying

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Hwa-Byung Angry Behavior

Korean; insomnia, depression, somatization in lower abdomen
Experienced by middle-aged Korean females

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Bouffee delirante

-French; short-lived psychosis

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Amok Anger

-Malaysian; rage or vendetta against a person, society, or object

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Mental illnesses treated with Lithium

Bipolar
Conduct disorders
mental retardation

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Mental illnesses treated with Carbamazepine (anticonvulsant)

dementia
psychosis
personality disorders

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Mental illnesses treated with atypical antipsychotics (clozapine, risperidone, olanzapine)

dementia
brain injury
mental retardation
personality disorders

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Interventions for “Triggering” phase of anger

Approach in nonthreatening, calm manner
Convey empathy; listening
Encourage verbal expression of feelings
Suggest patient go to a quieter area
Use PRN medications
Suggest physical activity such as walking

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Interventions for “Escalation” phase of anger

Take control; provide directions in firm, calm voice
Direct patient to room or quiet area for time-out
Offer medication again
Let patient know aggression is unacceptable; nurse or staff will help maintain/regain control
If ineffective, obtain help from other staff (show of force)

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Interventions for “Crisis” phase of anger

-Inform patient that behavior is out of control, and staff
is taking control to provide safety and prevent injury

-Use of restraint or seclusion only if necessary

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Interventions for “Recovery” phase of anger

Talk about situation or trigger
Help patient relax or sleep
Explore alternatives to aggressive behavior
Provide documentation of any injuries
Debrief staff

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Interventions for “post-crisis” phase of anger

-Remove patient from any restraint or seclusion to
rejoin milieu.
-Calmly discuss behavior (no lecturing or chastising);
allow patient to return to activities, groups, and so
forth.
-Focus on appropriate expression of feelings, resolution
of problems or conflicts in non-aggressive manner

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Cycles of abuse/violence

Violent episode
Honeymoon phase
Tension building
Violent episode

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Elements of PTSD

1. Dreams or intrusive, 
recurrent thoughts of the 
trauma
2. Emotional numbing 
(feeling detached from 
others)
3. Hyper-arousal (being on 
guard, irritable)

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PTSD vs. Acute Stress Disorder

PTSD: event occurred >3 months

Acute Stress Disorder: event occurred <3 months

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PTSD Treatment Options

Psychotherapy (individual or group)
Medications (antidepressants, anxiolytics, sleep aids)
Self-help groups
Exposure therapy
Relaxation techniques
Adaptive disclosure
Cognitive processing therapy
Mental health promotion

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General Adaptation Syndrome

Physiological changes the body goes through in response to stress

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Stages of General Adaptation Syndrome

-Alarm reaction stage (preparation for defense)
-Resistance stage (blood shunted to areas needed for
defense)
-Exhaustion stage (stores depleted; emotional
components unresolved)

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Mild Anxiety

Special attention
Increased sensory stimulation
Motivational
Anxiety is not bad, but rather a warning sign

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Moderate Anxiety

Something definitely wrong
Nervousness/agitation
Difficulty concentrating
Able to be redirected

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Severe Anxiety

Trouble thinking and reasoning
Tightened muscles
Increased vital signs
Restless, irritable, angry

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Panic anxiety

Fight, flight, or freeze response
Increased vital signs
Dilated pupils
Cognitive processes focusing on defense

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How to work with patients with anxiety

Low, calm, soothing voice
Safety during panic level
Short-term use of anxiolytics (Benzos: Alprazolam, Diazepam, Lorazapam)

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Anxiety experiences for different cultures

Asian: often with somatic symptoms; koro

Hispanics: Susto (high anxiety as sadness, agitation,
weight loss, weakness, heart rate changes); due to supernatural spirits or bad air from dangerous places and cemeteries invading body

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Anxiety Treatment options

Medications (anxiolytics; antidepressants)
CBT:
- Positive reframing (turning negative messages into positive ones)
  - Decatastrophizing (making more realistic appraisal of situation)
- Assertiveness training (learn to negotiate interpersonal situations)

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Elder Anxiety

Phobias (generalized anxiety is most common)
Usually have other condition (dementia, physical illness)
Treatment: SSRIs (fluoxetine, sertraline)

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Obsession vs. Compulsion

Obsessions = recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
Compulsions = ritualistic or repetitive behaviors that a person carries out continuously in an attempt to decrease anxiety

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Self-soothing OCD behaviors

Excoriation (skin picking)
Onychophagia (nail biting)
Trichotillomania (hair pulling

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Reward-seeking OCD behaviors

Kleptomania (compulsive stealing)
Oniomania (compulsive buying)
Hoarding (excessive acquisition)
Pyromania (fire setting)

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Body identity integrity disorder

Feeling alienated from a part of the body to the extent of seeking amputation of the identified body part

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Ages of people with OCD

common in kids
usually occurs between 18-25

*Rare for it to start after age 50; usually a sign of underlying illness

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OCD Patient/Family teaching

Teach family to avoid giving advise.
Teach family to avoid trying to “fix the problem.”
Teach family to be patient with its own discomfort.
Teach family to monitor its own anxiety level.
Give family permission to “take a break” from the situation, as needed

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OCD Pharmacological Treatment

-First line: SSRIs (fluvoxamine, sertraline)
-Second line: SNRI (venlafaxine)
Treatment-resistant OCD:
-second-generation antipsychotics: Risperidone,
Quetiapine, Olanzapine

OCD Therapeutic Treatment

-Cognitive behavioral therapy (CBT): Treatment focuses on examining the relationships between thoughts, feelings, and behaviors.
-Exposure therapy: deliberately confronting situation and stimuli that one usually
tries to avoid.
-Response prevention: delay or avoid performing the rituals. Learn to tolerate the thoughts and anxiety.

OCD Nursing Interventions

Therapeutic communication
Relaxation techniques
Behavioral techniques
Daily routine completion
Diary/log
Patient, family education

When is Schizophrenia typically diagnosed?

Late adolescence to early adulthood
Men: 15-25
Women: 25-35

Catatonia

Abnormal movement; inability to move

-Ex: staying still, not talking

What’s the biggest difference between schizophrenia and schizophreniform disorder?

Schizophreniform lasts 1-6 months; Schizophrenia is life-long

Positive (hard) vs. Negative (soft) symptoms of Schizophrenia

Positive (hard)
■ Delusions, hallucinations;
grossly disorganized thinking,
speech, behavior

Negative (soft)
■ Flat affect, lack of volition,
social withdrawal, or discomfort

Pharmacological Treatment for Schizophrenia

Conventional antipsychotics (Haloperidol)
– Targeting positive symptoms
– No observable effect on negative symptoms

Atypical antipsychotics (Clozapine)
– Diminish positive symptoms
– Lessen negative symptoms

Schizophrenia Medications Neurological Side Effects

-EPS
-Acute dystonic reactions
-Akathisia
-Parkinsonism
-Tardive dyskinesia
-Seizures
-Neuroleptic malignant
syndrome

Schizophrenia Medication Non-neurological Side Effects

– Weight gain, sedation, photosensitivity
– Anticholinergic symptoms (dry mouth, blurred vision,
constipation, urinary retention)
– Orthostatic hypotension
– Agranulocytosis (clozapine)

Schizophrenia Psychosocial therapy

Individual, group therapies: Supportive, medication management, use of community supports

Social skills training: Cognitive adaptation training, Cognitive enhancement therapy (CET)

Family therapy/education

Cluster A personality disorders (odd, eccentric)

Paranoid (more common in males)
Schizoid (more common in males)
Schizotypal (slightly more common in males)

Cluster B Personality Disorders (dramatic/erratic)

Antisocial (more common in males)
Borderline (more common in females)
Histrionic (more common in females
Narcissistic (more common in males)

Cluster C Personality Disorders (anxious/fearful)

Avoidant (more common in males)
Dependent (more common in females)
Obsessive-Compulsive (more common in males)

Paranoid Personality Disorder

Mistrusting and suspicious; Unable to express empathy -Labile mood, angry, hostile
See malevolence in others where there is none
Use projection, have conflict with authority, paranoia
Have problems forming relationships, take everything seriously, very sensitive to how others respond
Nurse Intervention: allow to help develop care plan
Symptoms: aloof, withdrawn, self protective, hypervigilant

Schizoid Personality Disorder

Detached from social relationship
Display little emotion, aloof, indifferent.
No leisure or pleasurable activities.
Passive/disinterested. Patient not distressed, family is. Have fantasy relationships
Intelligent but indecisive, lack goals/direction
Loners, lack social skills

-Nurse Intervention: improve community functioning, find suitable housing with little social interaction; Case management important.

Schizotypal Personality Disorder

-Pervasive pattern of social and interpersonal deficits
- Little capacity for close relationships, cognitive/perceptual
distortions, behavioral eccentricities.
-Psychotic episodes when stressed.
-Odd appearance, unkempt, disheveled.
Coherent speech but loose, vague associations; Uses words incorrectly.
-Has restricted emotions. Flat affect or silly and inappropriate.
-Has cognitive distortions; Ideas of
reference (events have special meaning for them).
- Social and close relationships are difficult.

-Nurse Intervention: help develop self-care and social skills, community functioning, daily routine for ADLs, helpthem get involved in the community to decrease discomfort. Use role-play. Find ways around face-to-face interactions

Antisocial Personality Disorder

-Disregard rights of others.
-Enuresis, sleep walking, acts of cruelty in childhood. Childhood – lying, truancy, sexually promiscuous, cigarette
smoking, substance abuse, illegal activities, erratic, neglectful, harsh or abusive parenting.
-Have a normal appearance, charming. Have false emotions, no empathy, no remorse.
-Narrow, distorted thoughts (view world as cold, hostile)
-Use rationalization.
-Have average to above average IQ. Poor judgment, lack morals/ethics when making decisions

-Nursing Intervention: sign behavioral contract; positive-reinforcement

Borderline Personality Disorder

Pervasive pattern of unstable relationships, marked impulsivity.
Most common PD in clinical setting.
Suicide, self mutilation common.
Very hard to work with
dependent/then angry; Act out, manipulate; Reject all offers of help. Labile, unpredictable
50% have childhood abuse

-Nursing Interventions: Focus on safety; no self-harm contract; use distraction & journaling; decatastrophizing

Histrionic Personality Disorder

-Excessive emotion/attention seeking
-Colorful speech, normal appearance, overdress for situation.
-May be flirtatious, Self absorbed
-Agree with others to get attention; Have to be center of
attention.

-Nursing Intervention: give feedback about dress, behaviors; help with social skills; Use modeling, role play; help identify strengths

Narcissistic Personality Disorder

-Grandiosity, need admiration
-Arrogant, haughty, lack empathy; Belittle, disparage
others.
-Thought processing is intact but no insight.
-Fragile self-esteem; hypersensitive to criticism.
-Sense of entitlement, expect special treatment; exploit relationships.
-Ambitious, confident – problem working
with others.

-Nursing Interventions: very challenging! Be self aware of
your response. Get their cooperation. Individual psychotherapy is best approach.

Avoidant Personality Disorder

Social discomfort and low self esteem; hypersensitive to negative evaluation.
Overly inhibited as children, avoid unfamiliar situations
Anxious, fidget, poor eye contact, shy, fearful, socially awkward.
Believe inferior, afraid to make mistakes
desires social acceptance but fears rejection.

-Intervention: Identify positive traits, self affirmation, positive self talk. Reframing, decatastrophizing. Practice, role play

Dependent Personality Disorder

Need to be cared for
Submissive, clingy; Fearful of separation.
More common in the youngest child.
Seek tx due to anxiety, depression, somatic s/s.
Very pessimistic, self-critical. Unrealistic fears of being left alone. Lack decision making, confidence.
Will do almost anything to maintain a relationship.
Seek another relationship when one ends.

-Intervention: help expect grief over loss of
relationship; Help identify strengths, cognitive restructioning; help with simple things (groceries, pay bills). Support, positive feedback

Obsessive-Compulsive Personality Disorder

Preoccupied with perfectionism, mental/personal control, orderliness at expense of flexibility, openness, efficiency.
Very formal, serious, no pleasure in life.
Constricted emotions and affect
Preoccupied with rules, order, lists, schedules.
Check/recheck details.
Won’t listen to others; problems making decisions.
Have low self esteem, harsh, critical, judgmental of
themselves. Praise/reassurance do not change belief could have done better.
Few friends, no social life; Problems working with others.

-Intervention: help them complete projects, be on-time. Work on cognitive restructuring; Encourage to take risks.

Bipolar Mania

-Distinct period
-Mood is abnormally and persistently elevated, may be grandiose
-Decreased sleep, pressured speech, flight of ideas,
risk taking, excessive pleasure seeking, maybe
delusions.
-1st episode in teens, 20’s, 30’s

Major Depressive Disorder

At least 2 weeks of sadness or anhedonia with at least four other symptoms: hypersomnia or insomnia, feels fatigued, changes in weight, sleep, energy, concentration, self esteem, goals, decision making.
May last, weeks, months or years if untreated.
Twice as common in women.
High incidence in single or divorced people.

Major Depressive Disorder Treatment

-MAOIs: (Phenelzine) (can be fatal)
-Cyclic antidepressants (Amitriptyline) (can be fatal)
-SSRIs (Fluoxetine, Sertraline) (take 4-6 weeks to work)
-ECT (used when drug therapy fails)
-Psychotherapy is said to be best in combination with
medication

Clinical Course of an Alcoholic

Gets intoxicated for the first time as an adolescent
May sip as early as 8 years old
Pattern develops in mid 20’s to mid 30’s
Blackout
Tolerance
Tolerance break
Abstinence is temporary followed by escalation of alcohol use and crisis; it is a cycle
*Babies may be affected prenatally, fetal alcohol syndrome
- Families are affected sometimes for generations

Alcohol Intoxication

Initial response: relaxation, loss of inhibitions
Then: slurred speech, unsteady gait, lack of coordination and judgement; may blackout

•OD may lead to vomiting, unconsciousness, respiratory
distress, aspiration pneumonia, cardiovascular shock and death

Alcohol Withdrawal

Withdrawal 4-12 hours after cessation of drinking
Symptoms: coarse hand tremors, sweating, elevated pulse and BP, insomnia, anxiety, N&V.
Severe: hallucinations, seizures, DT’s
Generally peaks on day 2 and lasts about 5 days-2 weeks
Safe withdrawal: use benzos to suppress side effects; use CIWA

Benzos (alprazolam, diazepam) & Barbiturates (-barbital)

Intoxication and withdrawal like alcohol
When used as prescribed, cause drowsiness and reduce anxiety
Benzos in OD rarely fatal; become confused and lethargic.
Treatment: gastric lavage, ingestion of activated charcoal, dialysis for severe symptoms.
Barbiturates can be lethal with an OD. Can cause coma, respiratory arrest, cardiac failure, death.
Treated in ICU using lavage or dialysis

Stimulants (amphetamines; cocaine) Intoxication & Withdrawal

Intoxication and overdose
•High or euphoric feeling, hyperactivity, hypervigilance, anger, elevated BP, chest
•Pain, confusion, seizures, coma with overdose

Withdrawal
•Onset within hours to several days
•Primary symptom: marked dysphoria
•“crashing”
•Not treated pharmacologically

Opioid Intoxication & Withdrawal

Intoxication and overdose
•* procurement ( lots of time and money spent, medical
professionals, divert meds or write their own RX’s.)
•Psychomotor retardation
•Constricted pupils
•Slurred speech, drowsiness
•Naloxone given for overdose

Withdrawal and detoxification
•Initial symptoms: anxiety, restlessness, aching back and
legs, cravings for more opioids
•Later symptoms: N&V, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, fever, insomnia, significant distress.
-No pharmacological treatment. Drug craving may persist for weeks or months

Hallucinogens (mescaline, PCP, ecstasy) Intoxication & withdrawal

•Intoxication and Overdose: anxiety, depression, paranoid
ideation, fear of losing one’s mind, potentially dangerous
behavior. Toxic reactions are primarily psychological.

•Withdrawal and detoxification: no withdrawal symptoms.
-craving for the drug, flashbacks may persist for a few months up to 5 years.

Which type of diagnosis presents a big challenge to health care professionals?

Dual Diagnosis (mental illness + drug/alcohol addiction)
Ex: Bipolar patient with alcoholism

Intermittent Explosive Disorder

•Episode of angry, explosive, impulsive, aggressive behavior that lasts less than 30 minutes
•More common in males
•Expressed response is out of proportion to the situation
•!!!!Typically feel embarrassed and remorseful for their behavior!!!!
•May have another psychiatric disorder (ADHD, substance
abuse, anxiety, depression, etc.)

Intermittent Explosive Disorder Treatment

Meds: SSRIs (fluoxetine), mood stabilizers (lithium)
CBT, anger management, relaxation techniques, avoidance of substances
A combination for the best outcome

Oppositional Defiant Disorder (ODD)

•Pattern of behavior that is defiant, uncooperative, hostile
toward persons in positions of power, especially parents
•Behaviors are more intense than those seen in unaffected
peers
•Problems with social, academic and work situations.
•More often in males; increased risk of conduct disorder

ODD Treatment

Focus is on parents! Parents report difficulty in managing the aggressive behaviors and balancing interaction with multiple providers/agencies.
Child’s behaviors are learned and reinforced in the home so parents are the focus to develop behavioral interventions.
Work with parents to identify the most problematic behaviors, target change in those, ignore the other maladaptive responses.
Reward positive behaviors with praise and reinforcers, be consistent! Try token economy, individual psychotherapy
No meds to treat unless comorbid condition

Conduct Disorder

•A pattern of behavior that violates societal rules, norms,
rights of others
•Children express aggression toward others, animals, deceit, deception, destruction of others’ property
•!!!!!Do not express remorse or guilt about the behavior!!!!!
•Poorer outcome if diagnosed before age of 10
-Usually males before age 10, both males and females after age 10.

Degrees of Impaired Conduct (Conduct Disorders)

Mild: minor shoplifting, breaking curfew, lying
Moderate: increasingly problematic behaviors including vandalism, substance abuse, sexual behaviors, verbal bullying
Severe: physical aggression, cruelty to peers and animals, forced sexual acts, parole violation

Conduct Disorder: Internalizing Behaviors

Loner
Sulks
Won’t talk
Shy
Secretive
Somatic complaints – N/V, fatigue
Guilty
Crying
Feels unworthy and unloved

Conduct Disorder: External Behaviors

Lying
Cheating at school
Swearing
Truancy
Vandalism
Bragging
Setting fire
Inappropriate attention-seeking
Arguing
Angry outbursts

Conduct Disorder Interventions

Safety! Protect others.
Behavioral contracting
Can use a written contract but all staff must be consistent in applying the contract.
Time-out
Develop a daily schedule.
Journaling
Role-modeling
Parents must be assisted to develop appropriate social skills, problem solving and appropriate ways of expression and limit-setting

Delirium

Syndrome involving disturbance of consciousness with change in cognition

Delirium Etiology

Usually from identifiable physiologic, metabolic, cerebral disturbance or disease or from drug intoxication or withdrawal

Delirium Treatment

Sedation

- Identifying underlying cause

Delirium Nursing Interventions

-Promoting patient safety
-Managing patient’s confusion: orienting cues; speaking in
low, clear voice; avoiding sensory overload
-Promoting sleep, proper nutrition

Dementia

Multiple cognitive deficits; primarily memory plus any of the 
following:
-Aphasia (echolalia, palilalia)
-Apraxia
-Agnosia
-Disturbance in executive function

Dementia Stages

Mild – forgetful, loses things

Moderate – Confusion, memory loss, complex tasks can be performed; Still recognizes familiar people

Severe – Personality and behavioral changes; Forgets
important people, help with ADLs.

Dementia Treatment

-Underlying cause
-Usually progressive
-Medications for degenerative dementia: cholinesterase
inhibitors

Symptomatic treatment for behaviors

Antidepressants
Anti-psychotics
Mood stabilizers

Korsakoff’s Syndrome

Disturbance in memory due to long-term use of alcohol

Autism

5 times more prevalent in boys
USUALLY identified between 18 months and 3 years
Persistent difficulties in communication and socialization
Restricted interests and patterns of behavior
Little eye contact, few facial expressions
Don’t relate well to parents or peers
Hand flapping, head banging, body twisting
Late developers have speech, then lose it, then develop the other traits

Autism Treatment

Reduce behavioral symptoms, short term inpatient for severe cases
Reduce Symptoms: Haloperidol, Risperidone, Aripiprazole, Clonidine
No medicine specifically for Autism

Somatization

Transference of mental experiences and states into bodily symptoms

Somatic Symptom Illness Treatment

SSRIs (fluoxetine, sertraline, paroxetine)
Pain clinic
Avoid narcotics; use NSAID’s (Ibuprofen)
Group therapy

Night Eating Syndrome

Morning anorexia, evening hyperphagia
Eat half of their daily calories after dinner and awake at least once at night for a snack.
Often obese with failed loss weight plan

Anorexia Medications

Amitriptyline
Antihistamine cyproheptadine
Olanzapine
Fluoxetine

Erik Erikson’s Developmental Theory

8 stages of psychosocial development

- Achievements of life’s virtues

What are the 4 stages of Jean Piaget’s developmental theory?

Sensorimotor (newborn-2 years old)
Preoperational (toddler: 2-7)
Concrete (7-11)
Formal (adolescence-adulthood)

Abraham Maslow’s humanistic theory

-Hierarchy of needs
-Basic physiologic, safety and security, love and
belonging, esteem, self-actualization

Carl Rogers’ Humanistic Theory

-Client-centered therapy (focus on client’s role)

-Unconditional positive regard, genuineness,
empathetic understanding

Which theorist believed in classical conditioning?

Ivan Pavlov

What is the goal of the existential theory?

To return the person to their authentic sense of self

-Theorists: Frankl & Ellis

Maturational Crisis

when a person is unable to cope with the natural process of development
Ex: time of transition (birth of first child; retirement)

Situational Crisis

an unexpected event that is usually beyond the individual’s control
Ex: natural disaster, loss of job, assault

Adventitious Crisis

events of disaster

- Ex: flood, fire, earthquake, pandemic, war

What is concrete thinking?

Literal; thinking about the physical word

Example: Thinking that the phrase “It’s raining cats and dogs” means that it really is literally raining cats and dogs.

What medications slow down the progression of Alzheimers?

Memantine
Rivastigmine
Galantamine
Donepezil
           (How to remember: Memories Really Going Down)

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