Mental Health N4615 Module II Flashcards
What is Schizophenia Spectrum?
It, and other psychotic disorders are those that distrub the fundamental ability to deteremine what is real or what is not.
All people who have Schizophrenia, have at least one of the following psychotic symptoms
hallucinatioins
delusions
and / or disorganized speech
What is the epidemiology of Schizophrenia
(when does it normally occur)
usually presents in late teens / early twenties.
What are the prodromal signs of schizophrenia
they are the initial signs indicating that a pt. might be leading toward a schizophrenic break
Withdrawal
misinterpreting
poor concentration
preoccupation with religion
What is early on-set Schizophrenia
(18 to 25) occurs more often in males
associated w/poor functioning before onset & more structural brain damage
What is later on-set Schizophrenia
(25 to 35) more likely to be female
less structural brain damage
better outcomes
What are some of the comorbidities associated w/ Schizophrenia
1) Substance abuse disorders - nearly 50% (sucide)
2) Nicotine dependence 70% - 90%
3) Anxiety, depression
4) Physical Health Illnesses
5) Polydipsia - can lead to fatal water intoxication (20% have insatiable thirst) may be due to medications
What is the etiology of Schizophrenia
scientific consesus is that Schizophrenia occurs due to multiple inherited genetic abnormalities combined with nongenetic factors.
called the diathesis-stress model of Schizophrenia
What are some of the genetic factors for Schizophrenia
Increased levels of dopamine (1st generations treat)
Increased levels of serotonin (2nd generation meds treat)
glutamate - which is a major neurotransmitter during neuronmaturation
Brain Structure Abnormalities - reduced volume of “grey matter” (temporal / frontal lobes) — more hallucinations.
What are some of the psychological / environmental
factors associated w/ Schizophrenia
1) prenatal stressors (poor nutrition & hypoxia)
2) psychological stressors (stress w/ incr cortisol level which imped hypothalamic development)
3) environmental stressors (toxins, ie. solvent tetrochoroethylene in dry cleaning)
all increase chances w/ those vulnerable to Schizophrenia
Schizophrenia def.
The most severe form of Schizphenia Spectrum
It is a potentially devastating brain disorder that affects a person’s thinking, language, emotions, social behavior, and ability to perceive reality accurately.
What are the Phases of Schizophrenia
Phase I - Acute
Phase II - Stabilization
Phase III - Maintenance
Def. Phase I - Schizophrenia
Acute
onset or exacerbation of distruptive symptoms (ie. hallucinations, delusions, apathy w/draw)
w/ loss of functional abilities - increased care or hospitalization may be required.
Def. Phase II - Schizophrenia
Stabilization
symptoms are diminishing, and there is movement towards one’s previous level of functioning (baseline)
Def. Phase III - Schizophrenia
Maintenence
pt. is at or near baseline functioning
symptoms are absent or significantly decreased.
What are the 4 main symptom groups of Schizophrenia
Positive symptoms
Negative symptoms
Affective Symptoms
Congnitive Symptoms
What are postive symptoms of Schizophrenia
associated w/acute onset
The presence of something that is not normally present
hallucinations
delusions
disorganized speech
bizarre behavior
will generally respond to medication
What are negative symptoms of Schizophrenia
absence of something that should be present
- Poverty of thought (interest in hygiene)
- Avolition (loss of motivation / energy or drive)
- Blunted affect (minimal emotional response)
- Alogia (poverty of speech)
- Anhedonia (loss of joy in something previously enjoyed)
- Anergia (lack of energy)
more presistent / crippling b/c they reduce motivation & limit social & vocational success
What are cogntitive symptoms of Schizophrenia
often subtle changes in memory, behavior, attention or thinking
ie. impaired executive functioning (ability to set priorities or make decisions)
What are affective symptoms of Schizophrenia
symptoms involving emotions and their expression
dysphoria (dissatisfaction w/ life)
suicidality
hopelessness
Positive symptoms are broken down into
what four categories
alterations in
1) thought
2) speech
3) perception &
4) behavior
What is “concrete thinking”
refers to the impaired ability to think abstractly
ie. When you ask a pt. what brought them to the hospital — they would say “ a cab”
Concreteness reduces one’s ability to understand and address abstract concepts such as love or the passage of time.
What is “clang association”
choosing words based on their sound rather then their meaning
ie. rhyming “on the track… have a Big Mac”
What is “word salad” (schizohasia)
jumbled words that are meaningless to the listener and possible to the speaker
ie. “red chair out town board”
What are Neologisms?
made-up words that have meaning to the pt. but a different or nonexistent meaning to others
What are Echolalia
pathological repeating of anothers words
ie. Nurse…Mary, come get your medication
Mary…come get your medication
What is Depersonalizaiton
feeling that one is somehow different or unreal or has lost his / her identity
may feel body parts don’t belong to them.
What is Derealization
a false perception that the environment has changed - surroundings seem strange and unfamilar
What is associative looseness
refers to jumbled thoughts inchoherently expressed to the listener.
Illusion is def as
A false belief about a perception
Based on a real perception (sight, sound, taste or feeling) that is misinterpreted
ex. the person actually sees something but believes they see something else
Hallucinations are def as
Perceptions involving the senses (sight, sound, odor, taste or feeling on the skin)
The body’s ability to detect things in the environment that are not detected by others.
Hallucinations vs. Illusions
both are perceptions
Hallucinations involve perceiving a sensory experience for which no external stimulus exist
Illusions are misperceptions or misinterpretations of a real experience (external stimulus); a false belief about a perception
ie. pts see the coat rack, but believes it is a bear
What are the types of hallucinations
experienced by 60% of pts. with Schizophrenia
Auditory: hearing voices or sounds
Visual: seeing persons or things
Olfactory: smelling odors
Gustatory: experiencing taste
Tactile: feeling bodily sensations
ex. I see; I hear; I taste; I smell; I feel
What are the worst types of hallucinations
Command hallucinations
those that direct pts to take action. voices may command the pt. to hurt themselves or others.
What is the MOST EFFECTIVE intervention for hallucinaitons?
Medications
RN-patient relationship
Reduce environmental stimuli
Increase internal stimuli (exercise) - tell the hallucinations to go away…listen to my voice or music
What is “Catatonia”
pronounced decrease in the rate and amount of movement
Generally pts. may move little if at all
What is Echopraxia
mimicking the movements of another
What is Anosognosia
inability to realize they are ill (caused by the illness itself)
The resulting lack of insight can make assessment / treatment challenging.
What does the “recovery model” stress
stresses hope, living a full and productive life, and eventually recovery rather than focusing on controlling symptoms and adapting to the disability
What is the overall goal for the acute phase
patient safety and stabilization
What goals does phase II (stabilization) focus on
helping the pt understand the illness and treatment, become stabilized on medications, and be able to control or cope with symptoms.
What goals does phase III (maintenance) focus on
adhering to medication, preventing relapse, and achieving independence and a satisfactory quality of life.
What is “waxy flexiblity”
the ability to hold distorted postures for extended periods of time.
What are some of the signs of a potential relapse in schizophrenia
feeling tense
difficultly concentrating
trouble sleeping
increased w/drawal
increased bizarre or magical thinking
Relapse can occur even w/ medication compliance
Delusions are def. as
false fixed beliefs that cannot be corrected by reasoning. Pt will agree w/ RN about facts but disagree w/ interpretation.
75% of those w/ schizophrenia experience these
persecutory
gradiose or
those involving religious or hypochondriacal ideas
ex. I think; I believe; I interpret; My opinion
Delusion vs. Illusion
A delusion (false belief) does not change w/ the use of logic.
An illusion (false belief about a perception) can often change once a person is given evidence that the belief is not true.
Delusions may be bizarre or non-bizarre
Bizarre type are unreal and impossible beliefs
i. e. Pt believes body organs replaced in absence of scars
i. e. Pt believes they are another animal (not human)
Non-bizarre types of delusions
- Delusions of control
- Ideas of reference
- Persecution
- Grandeur
- Somatic
- Erotomanic
- Jealousy
Def. of control delusions
Believing that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior
i.e. Pt covers his apartment walls w/ aluminum foil to block government efforts to control his thoughts
Def. of ideas of reference
Giving personal significance to unrealated or trivial events; perceiving events as relating to you when they are not
i.e. Pt believes that birds sing when she walks down the street just for her.
Def. of persecution delusions
Believing that one is being singled out for harm by others; this belief often takes the form of a plot by people in power.
i.e. Pt believes the Secret Service was planning to kill him by poisoning his food; therefore, he would eat only prepackaged food.
Def. of grandeur delusions
Believing that one is a very powerful or important person
i.e. Pt believed he was a famous playwright and tennis pro
Def. of somatic delusions
Believing that the body is changing in unusual ways (i.e. rotting inside)
i.e. Pt said his heart had stopped and was rotting away.
Def. of erotomanic delusions
Believing that another person desires you romantically.
i.e. Although he barely knew her, Patti insisted that Eric would marry her if only his current wife would stop interfering.
Def. of jealousy delusions
Believing that one’s mate is unfaithful
i.e. Pt wrongly accused her spouse of going out w other women. Her proof was that he twice came home from work late (even though his boss explained that everyone had worked late).
What is paranoia?
An unrealistic fear of harm
What is the HIGHEST PRIORITY intervention for delusional thinking?
- Reinforce reality for the pt.
- Establish a relationship or milieu that promotes trust
- Give meds on time (do not be late w/ prescribed meds)
Characteristics of psychotic thinking
- Limited ability to focus when lots of things are happening
- Concrete thought
- black/white thinking
- right/wrong judgments
- relationship w/ objects
- ambiguous boundaries btwn reality & fantasy
- ambiguous boundaries btwn self & others
Psychosis key points
- psychosis is frightening to the pt - provide safety
- use kindness & respect
- pts experiencing psychosis NEED an anchor to reality
Hierarchy of needs for psychosis intervention
Priorities will change depending on the situation and context (use critical thinking)
- Physical integrity
- Establishing trust
- Preventing inappropriate behavior
- Treating symptoms: hallucinations/delusions
- Enhancing compliance w/ treatment
- Reinforcing reality
What neurotransmitter is targeted by traditional antipsychotics?
Dopamine
Traditional antipsychotics block excessive dopamine, an excitatory neurotransmitter, so that symptoms r/t psychosis are reduced.
Typical (1st generation) Antipsychotic info
Reduce positive symptoms of psychosis
Blocks Dopamine
Uses: quick hallucination remission (delusions take longer to respond); out-of-control aggression; acute manic episodes
Safe, highly effective, very affordable
Poor compliance d/t bothersome SEs (i.e. EPS)
Common Typical (1st generation) Antipsychotics
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Prochlorperazine (Compazine)
Haloperidol (Haldol)
What are common side effects of Haldol (Haloperidol)?
- Sedation
- Muscle stiffness
- Akathisia
- alters effectiveness of exogenous insulin
Antipsychotics often produce sedation & EPS effects (i.e. stiffness, gait disturbance). The pt might describe the medication as making them feel like a “robot”.
2nd generation Atypical antipsychotics
- targets both positive & negative symptoms of schizophrenia
- block dopamine & serotonin
- high incidence of significant weight gain, diabetes, & hyperlipidemia w/ use
- low incidence of tardive dyskinesia
- produces drowsiness (sedates w/o causing confusion; can use for severe anxiety instead of benzodiazapines)
- may cause constipation
Ex. Latuda (Lurasidone); Zyperxa (Olanzapine)
3rd generation Atypical antipsychotics
- effective against both positive & negative symptoms of schizophrenia
- block dopamine & serotonin
- causes little / no weight gain
- causes no increase in glucose, cholesterol, or triglycerides
Good choice for pts w/ obesity &/or heart disease
Ex. Abilify (Aripiprazole)
Common Atypical (2nd & 3rd generation) Antipsychotics
Aripiprazole (Abilify)
Clozapine** (Clozaril)** - risk of Agranulocytosis
Lurasidone (Latuda)
Olanzapine (Zyprexa) - significant wt gain
Quentiapine (Seroquel)
Risperidone** (Risperdal)**
Ziprasi_done_ (Geodon) - prolonged QT interval
Side effects of antipsychotics
Fewer overall SEs w/ Atypical antipsychotics
iSHADE
impotence
Sedation, seizures (reduce seizure threshold)
Hypotension, orthostatic
Akathisia (inability to sit still)
Dermatological effects (risk of severe sun burn)
Extrapyramidal rxns (acute dystonias, rigidity, tremor, tachycardia)
Extrapyridamidal Side Effects (EPS)
movement disorders resulting from effects of antipsychotics on extrapyramidal motor system (primarily Typcial antipsychotics)
4 types of EPS reactions:
- acute dystonia
- pseudo-parkinsonism
- akathisia*
- tardive dyskinesia
*most common EPS
Acute Dystonia
EPS rxn characterized by severe spasm of muscles of tongue, face, neck, or back
Torticollis (head turned & arched) & oculogyric crisis (upward deviation of eyes) occurs
rxn develops w/in 1st few wks of drug therapy; possibily w/in hrs of 1st dose
Requires rapid intervention if intense rxn
Anticholinergics used for initial trmt
Psuedo-Parkinsonism
Mild EPS rxn characterized by bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cog wheeling, & stooped posture
Rxn develops w/in 1st month of drug therapy
Treat w/ central acting anticholinergics (i.e. benztropine (Cogentin), diphenhydramine)
Must AVOID use of Levadopa (promotes activation of dopamine; will induce psychosis)
Akathisia
Serious & troublesome EPS rxn characterized by pacing & squirming (uncontrollable need to be in motion); profound sense of restlessness
Rxn develops w/in 1st 2 months of drug therapy
Most common reason for non-compliance w/ meds
Trmt is beta blockers & benzodiazapines (does not respond to anticholinergics)
Only “cure” is to stop taking antipsychotic
Tardive Dyskinesia
Serious & troublesome EPS rxn characterized by abnormal muscle movements (i.e. slow, worm-like movements of the tongue, tongue flicking, lip smacking, pursing lips, grimacing)
Movements become constant; exhausting for the pt
Occurs late in antipsychotic drug therapy; 1 in 5 pts
Only trmt is to stop taking antipsychotic; maybe irreversible
Prevention is best approach; antipsychotics s/b used in lowest effective dose & for shortest time required; AIMS test every 3 mo. if long term use
Acute Dystonic Reaction
Acute & dangerous EPS rxn
Acute dystonia that becomes life-threatening d/t involvement of the throat muscules
Inability to swallow & respiratory distress
Emergent use of anticholinergics necessary
What medication is used to provide immediate relief to a pt. experiencing a dystonic reaction?
Dystonic reactions are emergencies & require intervention (can be caused by antipsychotics)
Diphendhydramine (Benadryl) IM or IV
or
Benztropine (Cogentin) IM or IV
IV response is 5 mins; IM response is 15 - 20 mins
Other anticholingerics may be used
Neuroleptic Malignant Syndrome (NMS)
Acute & dangerous EPS rxn; life-threatening medical emergency; transfer to ICU
NMS symptoms: FEVER
- Fever, sudden & high (1050+)
- Encephalopathy
- Vital signs unstable (dysrhythmias, BP fluctations)
- Elevated enzymes (CK)
- Rigidity of muscles
Death can result from respiratory failure, cardiovascular collapse, or dysrhythmias
Tmt is immediate w/drawal of antipsychotic, supportive measures & drug therapy
The Bipolar Spectrum
Bipolar disorder mood cycling:
Mania
Hypomania
Normal mood
Mild depression
Major depression
Manic episode
mnemonic
MANIC EPISODE
Mood swings
Active, agressive behavior
Nothing is wrong (denial)
Impulsive, intrusive behavior
Can’t sit still, can’t stop talk
Euphoric mood
Poor judgement, provocative behavior
Increased sexual interest
Substance (stimulant) abuse
Omnipotent feelings
Decreased need for sleep
Endless energy
Rapid stabilization of the manic pt
Antipsychotics & benzodiazapines
Typical “cocktail” given in psych ER:
Haldol 5 - 10 mg w/ Avtivan 2 mg
Bipolar disorder medications
Lithium (used for mood stabilization)
Anticonvulsants (used for mood stabilizaiton)
- Depakote (valproate)
- Tegretol (carbamazepine)
- Lamictal (lamotrigine)
Antipsychotics (used for acute manic phase)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
- Geodon (ziprasidone)
- Ambilify (aripiprazole)
- Risperdal (resperidone)
- Haldol (haloperidol)
Antidepressants and Mania
Use very cautiously w/ bipolar pts
All antidepressants induce mania in bipolar pts
If pt is bipolar, antidepressants should always be used in conjuction w/ a mood stabilizer.
What are the 3 types of
bipolar disorder
Bipolar I
Bipolar II
Cyclothymic disorder
Bipolar I disorder is def. as
mood disorder that is characterized by at least one-week long manic episode that results in excessive activity and energy
The presence of three of the following behaviors constitues mania:
Extreme drive & energy
Inflated sence of self-importance
Drastically reduced sleep requirements
Excessive talking combined w/ pressured speech
Personal feeling of racing thoughts
Distraction by environmental events
Unusually obsessed with and overfocused on goals
Purposeless arousal and movement
Dangerous activities (ie. indiscriminate spending, reckless sexual encounters, or risky investments)
Bipolar II disorder is def. as
low-level mania alternated with profound depression
this is called hypomania…unlike mania, psychosis is generally never present.
Cyclothymic disorder is def. as
symptoms of hypomania alternate with symptoms of mild to moderate depression for at least two years in adults & one year in children.
What are the 3 phases associated with bipolar disorders
Acute Phase
Continuation Phase
Maintenence Phase
What is the primary outcome in the acute phase of bipolar disorders
The primary goal is
injury prevention
outcomes in the acute phase reflect both physiological and psychiatric issues
the primary outcome in the continuation phase of bipolar disorders is:
can last for 4 - 9 months
overall outcome is relapse prevention, but consist of
Psycheducational classes for the pt. & family to:
a) understand the disease process
b) medication knowledge
c) knowledge of the early warning signs of replapse
the primary outcome in the maintenence phase of bipolar disorder is:
continuing to focus of relapse prevention & limiting the severity and duration of future episodes.
Personality disorders characteristic’s
defined
Pts with personailty disorders are inflexible & deomonstrate maladaptive responses to stress
- they are unable to develop true intimacy with others
- unable to develop trusting relationships.
“Impaired soical interaction”
What are the 10 Personality disorders according to the American Psychiatric Association (APA)
1) Avoidant 2) Antisocial
3) Borderline 4) Dependent
5) Histrionic 6) Narsicistic
7) Paranoid 8) Obsessive-complusive
9) Shizioid 10) Schizotypical
What are the Cluster “A” personality disorders?
Cluster “A” = odd or eccentric
- Paranoid
- Schizoid
- Schizotypal
What are the Cluster “B” personality disorders?
Cluster “B” = dramatic, emotional, erratic
- Antisocial
- Borderline
- Histrionic
- Narcissistic
What are the Cluster “C” personality disorders?
Cluster “C” = anxious, fearful
- Avoidant
- Dependent
- Obsessive-Compulsive
Paranoid personality disorder
characterized by a longstanding distrust & suspiciousness of others based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive them.
- difficult to treat b/c they distrust everyone
- have a need for space & reassurance
- are hypervigilant
Projection is the dominant defense mechanism; they blame others for their shortcomings.
Schizoid personality disorder
exhibits a poor ability to function in their lives…Relationships are particularly affected due to their prominent feature of emotional detachment.
need for soical isolation
Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
Schizotypal personality disorder
more common in men then women.
It is the 1st of the schizophrenia spectrum.
severe social and interpersonal deficits.
These individuals experience extreme anxiety in social settings & conversations tend to ramble w/ lengthy, unclear & overly detailed content.
eccentricity, odd or unusual beliefs (magical thinking)
prefer periods of solitude
Histrionic personality disorder
characterized by emotinal attention-seeking behaviors & melodramatic, including self-centeredness, low frustration tolerance, & excessive emotionality
demonstrates poor verbal boundaries
- In general, those with this disorder do not believe they need psychiatric help.
- flirtatious - overly intense attachment w/ the opposite sex; provocative.
- Psychotherapy is the txmt of choice.
Narcissistic personality disorder
comes across as arrogant & w/ an inflated view of thier own self-importance (grandiose self-importance).
needs constant admiration
lack of empathy for others
pathological traits include: antagonism, represented by grandiosity and attention-seeking behaviors.
txmt includes cognitive-behavioral therapy, family & group therapy.
Avoidant personality disorder
main traits are low self-esteem associated w/ feelings of inferiority compared to peers.
timid, socially uncomfortable
they tend to avoid engaging in new or unfamilar activities involving new people d/t fear of criticism or rejection
Dependent personality disorder
people with this disorder have a high need to be taken care of, which can lead to patterns of submissiveness with fears of separation & abandonment by others.
urgently seek relationships
have a constant need for reassurance
lack self-confidence
Psychotherapy is the txmt of choice
Obsessive-Complusive personality disorder
the most prevalent disorder in the general community - associated w/ the highest burden of medical cost.
main traits include: rigidity & inflexible standards of self & others — along with persistence of goals long after they are necessary.
They will typically rehearse over & over for situations where they will deal with others.
perfectionists (interferes w/ task completion)
SSRI’s & prozac may help.
Anti-social personatily disorder
most studied & researched personality disorder
- concerned with personal pleasure & power; does not conform to social norms
- characterized by decietfulness, impulsiveness, aggressiveness, disregard for others, lack of remorse, & manipulation.
usually presents w/ depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others
Txmt w/one caregiver is preferred to avoid having the manipulative nature play one staff against another.
Borderline personality disorder
has the central characteristic of instability in affect, identity, & relationships
desperately seek relationships to avoid feeling abandoned, but often drive others away with excessive demands, impulsive behavior, or uncontrolled anger.
chronic feelings of emptiness
assess for suicidal & self-mutilating behaviors, especially during times of stress…Risk for self-directed violence.
teach pt to identify triggers & positive coping
The frequent use of the defense of splitting strains personal relationships & creates turmoil in health care settings.
What is Splitting
involves loving a person, then hating the person b/c the pt. is unable to recognize that an individual can have both positive and negative qualities.
black & white thinking
defense mechanism often used with BPD
Which medication is the drug of choice for safe alcohol w/drawals
Benxodiazepines
Which medicaton is used in the treatment of both alcohol and opiod addiction
Naltrexone (ReVia) - it is an opiod antagonist that blocks the action of opiods & reduces alcohol cravings.
Types of Antidepressants
- SSRIs
- SNRIs
- TCAs
- MAIOs
SSRI info
First-line approach for trmt of depression
Increases Serotonin levels in brain
Uses: Major Depressive Disorder, anxiety disorders, panic disorders & OCD
Mood responds gradually (over 2 wks)
Do NOT STOP taking ABRUPTLY
Common SSRIs
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRI side effects mnemonic
BAD SSRI
Body wieght increase Seritonin Syndrome
Anxiety Stimulation of the CNS
Dizziness Reproductive dysfuntion
Insomnia
Serotonin Syndrome
Toxicity resulting from SSRI use w/ other meds that increases serotonin
Manifestions: HARM
Hyperthermia
Autonomic instability (delirium)
Rigidity
Myoclonus
- Be alert for sweating & diarrhea
- Late sign is apnea & death
Serotonin Syndrome interventions
Stop SSRI
Administer serotonin-receptor blocker
Cooling blankets or meds to reduce fever
Benzodiazepines for seizures & muscle rigidity
Anticonvulsants for seizures
Ventillation support for apnea
SNRI info
Increases Serotonin & Norepinephrine levels in brain
Treats both chronic neuropathic pain & depression
Common SNRIs
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
SNRI side effects mnemonic
BAD SNRI
Body wieght increase Suicidal thoughts
Anxiety Nausea / vomiting
Dizziness Reproductive dysfuntion
Insomnia
TCA info
Boosts Norepinephrine
Uses: adjunctive therapy to treat chronic neuropathic pain & anxiety disorders; used only when other antidepressants fail or need to be boosted
SEs much more bothersome than SSRI class; results in nonadherence
Effects are slow to work
Do NOT stop taking abruptly
Common TCAs
Amitriptyline (Elavil)
Clomipramine (Anafranil) - risk for glacoma
Imipramine (Tofranil)
Tricyclic antidepressant (TCA)
side effects mnemonic
TCAS
Thrombocytopenia (low platelets)
Cardiac (arrythmia, MI, stroke)
Anticholinergic effects (tachycardia, urinary retention dry mouth, etc)
Seizures
TCA overdose
TCA toxicity / overdose can be fatal
Signs associated w/ toxicity:
- altered LOC / delirium
- arrhythmias: VTach, VFib, prolonged QRS, QT & PR intervals
- vomiting
- fever
- coma
- hypoventilation from CNS depression
MAOI info
Rarely used d/t danger they present when combined w/ certain pharmaceuticals & foods
Uses: _Atypical depressio_n (oversleeping & overeating); adjunctive med for anxiety disorders & bulemia
Monitor BP
AVOID tyramine, alcohol, & yeast
Do NOT take w/ oral decongestant
Dietary & med restrictions to stay in place 2 wks after MAIO stopped
Common MAOIs
Phenelizine (Nardil)
Isocaroxzid (Marplan)
Tranylcyproine (Parnate)
MAOI side effects mnemonic
HAHA
Hypotension, orthostatic
Anticholinergic effects
Hypertensive crisis (avoid tyramine foods)
Anxiety, agitation, anorexia
MAOI toxicity
Toxicity can occur when MAOIs are combined w/ certain foods & medications resulting in Hypertensive Crisis & death
MAOIs prevent the break down of tyramine & certain meds; results in significant vasoconstriction
Tyramine containing foods
Aged & fermented foods:
- All hard cheese (use caution w/ Italian & Mexican foods)
- pickled or smoked meats
- olives, pickles, sauerkraut
- soy sauce (avoid Asian foods)
- ripe alvocados
Bupropion (Wellbutrin)
“Other” antidepressant
Boosts Norepinephrine & Dopamine
Only antipressant w/out unpleasant sexual SEs
Lowers seizure threshold
Not very effective w/ anxiety or pain
Effective in treating nicotine addiction & ADHD
Anxiolytic info
2 types: Benzodiazipines & Non-benzodiazipines
Benzodiazepines:
- target GABA
- uses: sedative effect for anxiety; anticonvulsant effect for seizures (Klonopin); prevention of seizures induced by alcohol w/drawal (Librium)
- lead to physical & psychological dependence
- short term use only (1-2 wks)
- do NOT discontinue abruptly
- when combined w/ alcohol can result in overdose & death by respiratory suppression
Common Anxiolytics
Benzodiazapines:
- Aloprazolam (Xanax)
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium) - use for severe DTs
- Diazepam (Valium)
- Clonazepam (Klonopin) - effective anticonvulsant
Non-benzodiazapines:
- Buspirone (BuSpar)
Buspirone (BuSpar)
Does not result in tolerace or addicition
Targets Serotonin & Dopamine
Does not have rapid onset of action
Takes up to 2 wks to be effective
Must be taken daily; not for PRN use
AVOID drinking grapefruit juice
Antimania meds (mood stabilizers)
Lithium
Anticonvulsants: treat/prevent mood episodes in Bipolar by slowing neuron firing & mood cycling
- Valproate / Valproic acid (Depakote)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal) - risk of SJS (severe rash)
- Clonazepam (Klonopin) - anxiolytic/benzodiazepine effective for seizures
Depakote & Tegretol require blood levels to be monitored for therapeutic effect; periodic monitoring of liver enzymes & CBC
Lithium info
- Lithium is a salt; regulated by body like sodium
- Be very alert for SUDDEN DROPS in sodium
- Lowering of dietary sodium intake, use of diuretics, excessive sweating or vomiting can have drastic effect on lithium; if Sodium goes DOWN, Lithium goes UP
- Narrow therapeutic index (0.6 - 1.2)
- 3 wks to reach therapeutic level; not for quick control of mania
- Teach strict adherence to dosing regimen
- Fluid intake 1-2qt/day & maintain normal salt intake
Acute Lithium Toxicity symptoms
mnemonic
CAN HAM SUCS
Confusion
An increase of urine & thirst
Nausea
Hand tremors (coarse)
Ataxia (uncoordinated arm & leg movements)
Muscle twitches
Seizures
Uncontrollable eye movements
Coma
Slurred speech
Medications for treatment of Alcohol Abuse
Naltrexone hydrochloride (ReVia, Vivitrol)
Disulfiram (Antabuse)
- causes unpleasant effects when alcohol is consumed; negative reinforcer
- AVOID foods/products containing alcohol (cough syrup, mouthwash, cooking wine)
- extremely poor compliance; does not reduce alcohol cravings
Acamprosate (Campral)
- eliminated thru kidneys; pts w/ kidney disease at risk for adverse rxns
- eases discomfort of w/drawal & prevents cravings
- stimulates GABA
