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NSG 470 - Exam 3 > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

5HT Serotonin

A

regulates sleep, appetite, pain, and libido

dec –> poor impulse control, dec appetite, sex drive, + irritability

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2
Q

NE decreased (norepinephrine)

A

anergia, anhedonia, dec concentration, dec libido

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3
Q

dopamine (DA)

A

reward and incentive process

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4
Q

acetylcholine

A

memory + learning

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5
Q

GABA

A

calming, inhibiting neurotransmitter

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6
Q

depression (prevalence + comorbidity)

A

most common mental illness
15% - commit suicide
untreated - #1 risk in youth for suicide
affects all family members
women 18 - 45 (majority)
*brain atrophy if undiagnosed for long time

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7
Q

selective serotonin reuptake inhibitors (SSRI) pharmaco + use

A

Fluoxetine (Prozac)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
selectively blocks reuptake of serotonin = more seratonin in synaptic space

used for depression + bipolar disorder
can be used for OCD, bulimia, panic, PTSD

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8
Q

SSRI s/s

A

Common: nausea (take w/ food), diarrhea, fatigue, dizziness, DRY MOUTH, sexual dysfunction

Other: insomnia, agitation, anxiety, weight change, hyponatremia (older on diuretics), rash, GI bleed, bruxism, sleepiness, faintness, lightheadedness

Immediate attention: onset/inc suicidal thoughts, unusual bleeding, severe HA, rash or hives, weight loss (rare), tachycardia, activation/impulsivity

Lower anticholinergic SE (dry mouth, blurry vision, urinary retention)
Low lethality for OD; full effect 6-8 wks (some 2 wks)

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9
Q

SSRI patient education

A

dont stop abruptly - withdrawal s/s (HA, n/v, visual disturbances, anxiety, dizziness, tremors) - esp w/ Paxil (short half life)

NO alc - counteracts med

grapefruit juice –> inc plasma levels of Zoloft

contraindicated w/ MAOIs + TCAs (r/o serotonin syndrome), interacts w/ warfarin + lithium

fluoxetine + paroxetine –> inc birth defects

late use in preg –> inc withdrawal risk or pulmonary HTN (newborn)

**WEIGHT GAIN + watch for bruising, GI upset (esp w/ NSAIDS or anticoag), order EKG (QT prolongation)

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10
Q

what is serotonin syndrome?

A

toxic state caused by inc serotonin in brain 5-HT

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11
Q

serotonin syndrome s/s

A

hyperactivity or restlessness, tachycardia, HIGH FEVER, inc BP, delirium, myoclonus (muscle spasms), mood swings, GI disturbances, diarrhea, seizures (late), abdominal pain, apnea (late)

**greatest risk when combined w/ second serotonin enhancing agent (MAOI)

MEDICAL EMERGENCY

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12
Q

serotonin syndrome interventions

A

MEDICAL EMERGENCY

discontinue serotonergic agents

cooling blankets (hyperthermia)

anticonvulsants (seizure preventions)

blockade of 5 HT receptors: propranolol (Dec BP)

dantrolene (Dantrium) or Diazepam (Valium) –> muscle rigidity

artificial ventilation

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13
Q

dual-action reuptake inhibitors (SNRIs) pharmaco + use

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta) - hypoglycemia, orthostatic hypotension (1st week)
Desvenlafaxine (Pristiq) - GI bleed, cholesterol, glaucoma

inhibits uptake of 5HT + NE = inc availability of serotonin + NE in synaptic space

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14
Q

SNRI s/s

A

anticholinergic (dry mouth, blurry vision, constipation flushed face), fatigue, sweating, yawning, sexual dysfunction, HA, hyponatremia (older adults), WEIGHT LOSS

monitor BP often (risk for inc systolic BP)

risk for withdrawal: dizziness, nausea, HA, sweating, irritability, fatigue

**duloxetine should NOT be used if pt has liver disease or drinks excessive alcohol

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15
Q

atypical antidepressants

A

Bupropion (Wellbutrin, Zyban)

Trazodone (Desyrel)

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16
Q

Bupropion (Wellbutrin, Zyban)

A

inhibits reuptake of dopamine + NE

indications: depression, alt to SSRI in clients w/ sexual SE, smoking cessation, seasonal depressoin

SE: insomnia, HA, nausea, dizziness, WEIGHT LOSS, agitation, GI distress, restlessness, tachycardia, arrhythmias, HTN, insomnia, seizures (high doses), SI, mood changes, abnormal dreams

may exacerbate tics

contraindicated w/ eating disorders or hx of seizures; MAIOs

reduces craving in smoking cessation

*dont crush, split or chew

17
Q

Trazodone (Desyrel)

A

moderate selective blockade of serotonin receptor = inc amount of serotonin available for impulse transmission

indications: sleep inducing effects (older adults), SSRI induced insomnia

usually used w/ other AD (taken @ bedtime); caution w/ cardiac disease

can cause priaprism - painful persistent erection (EMERGENCY) - ice or needle

SE: vivid dreams, nightmares, nervousness, dry mouth, N/V, EKG changes, nervous ness, orthostatic hypotension

Inc liver levels, QT prolongation, mon mood + BP (WEIGHT LOSS)

18
Q

tricyclic antidepressants (TCA)

A

Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor, Aventyl)
Doxepin (Sinequan)

inhibits reuptake of 5HT + NE = inc serotonin + NE in synaptic gap; sedative effect from antihistamine action

indications: neuropathic pain, fibromyalgia, anxiety, insomnia, bipolar

10 - 14 days to see effectiveness; full effect 4 - 8 wks; usually given @ night

contraindication: in seizure disorders, MI, narrow angle glaucoma, preg

INC SUICIDE RISK

interactions: MAOIs, antihistamines, anticholinergic, sympathomimetic, alcohol, benzos, opioids, CNS depressants

19
Q

TCA s/s

A

anticholinergic SE: dry mouth, blurry vision (constipation, urinary retention, immediate attn)

sedation, sexual dysfunction, weight gain, orthostatic hypotension, dec seizure threshold, excess sweat, hyponatremia, inc appetite

toxicity: CARDIAC EFFECTS (SERIOUS) - tachycardia, dysrhythmias, ECG changes, mental confusion, seizure, coma, death

Lethal in OD: 10 day supply - only give 1 week supply, monitor VS, baseline ECG

20
Q

monoamine oxidase inhibitors (MAOI)

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline transdermal system (STS)

prevent breakdown of 5HT, NE, DA = inc levels available for transmission impulses

effective for refractory depression + anxiety, atypical depression

indications: panic disorder, social phobias, GAD, OCD, PTSD, bulimia

21
Q

MAOI s/s

A

SE: anxiety, agitation, hypomania, orthostatic hypotension, HTN crisis, rash

avoid food w/ high tyramine! aged, smoked, or fermented meats/fish, protein dietary supplements, yeast extract, beers, red wine, soy sauce/soybean paste, avocado, fava bean, aged cheese
RISK FOR HTN CRISIS, CVA - HA, nausea, inc HR/BP

interactions: indirect-acting sympathomimetric (ephedrine), TCAs, antihypertensive, meperidine, vasopressors

22
Q

bipolar disorders

A

mania + depression

alternating mood episodes characterized by mania, hypomania, depression, concurrent mania + depression

23
Q

lithium carbonate

A

eskalith, lithane, lithobid, carbolith

5 - 7 days to notice; up to 3 wks (control mania)

less effective for rapid cycling, mixed mania, or atypical features
NARROW THERAPEUTIC WINDOW OF TOXICITY
draw q 2/3 days until therapeutic –> 1-3 mo when maintaining

at least 9 - 12 months of therapy; usually life long

reduces: elation, grandiosity, expansiveness, flight of ideas, irritability + manipulativeness, anxiety, insomnia, psychomotor agitation, threatening behavior, hypersexuality, paranoia

24
Q

mild lithium toxicity

A

<1.5 mEq/L

metallic taste in mouth, fine hand tremor (resting), nausea, polyuria, polydipsia, diarrhea or loose stools, muscular weakness or fatigue, weight gain, edema, memory impairment

*norm 0.6 - 1.0

25
Q

moderate lithium toxicity

A

1.5 - 2.5 mEq/L

severe diarrhea, dry mouth, nausea/vomiting, mild to mod ataxia, incoordination, dizziness, sluggishness, giddiness, vertigo, slurred speech, tinnitus, blurred vision, inc tremor, muscle irritability/twitching, asymmetric deep tendon reflexes, inc muscle tone

*norm 0.6 - 1.0

26
Q

severe lithium toxicity

A

> 2.5 mEq/L

cardiac arrhythmias, blackout, nystagmus, coarse tremor, fasciculations, visual or tactile hallucinations, oliguria, renal failure, peripheral vascular collapse, confusion, seizures, coma/death

27
Q

lithium toxicity tx

A

moderate to severe tx

hold lithium

immediately obtain a blood lithium level

push fluids

contact physician

28
Q

lithium interventions

A

edema - monitor I/Os, sodium, and weight, elevate legs

fine hand tremor - provide support + reassurance, more freq smaller doses

mild diarrhea - take lithium w/ meals, fluid replacement, notify prescriber

muscle weakness, fatigue, or memory - provide support + reassurance, short term memory aids

metallic taste - sugarless candies/throat lozenges, freq oral hygiene

29
Q

lithium patient education

A

maintain norm diet w/ CONSISTENT salt + fluid intake (1500 - 3000 mL/day) - 6 12 oz glasses

if Na intake falls - lithium tox

if dehydrated, sweating, vomiting, diarrhea - discontinue + call prescriber

if too much Na, lithium will be less effective

avoid diuretics

GI irritant - take w/ food

dont dc after manic episode, risk of relapse

MONITOR LITHIUM BLOOD LEVELS

drug-drug interactions: diuretics, NSAIDs, TCAs, Antihistamines, ETOH

severe caution in pregnancy

30
Q

anxiolytics

A

Clonazepam (Klonopin)
Lorazepam (Ativan)
Diazepam (Valium)
Alprazolam (Xanax)

tx: resistant mania
psychomotor agitation

31
Q

atypical antipsychotics

A

2nd gen
olanzapine (Zyprexa)
risperidone (Risperdal) – avail IM
aripiprazole (Abilify)
ziprasidone (Geodon)
quetiapine (Seroquel)
Sedative properties

Indications: psychosis, manic symptoms, affective instability, acute agitation

Target s/s: hallucinations, delusions, paranoia, bizarre thinking, assaultive behavior & mood stabilization

32
Q

anticonvulsants (antiepileptic)

A

Valproate (Depakote)
Carbamazepine (Tegretol)

33
Q

Carbamazepine (Tegretol)

A

Better for rapid-cycling, paranoid hostile s/s
Mon blood level – can increase liver enzymes
Many drug interactions
Little weight gain
Interferes with oral contraceptives

Common SE: sedation, HA, nystagmus vertigo, double vision

Adverse effects: agranulocytosis & aplastic anemia, teratogenesis, hypoosmolality
Stevens-Johnson syndrome

34
Q

Valproate (Depakote)

A

Effective at decreasing impulsive, aggressive behavior

Common SE: sedation, weight gain, headache, tremor, dizziness, GI s/s (usually self-limiting)

Adverse effects: agranulocytosis & aplastic anemia, hepatoxicity, pancreatitis, teratogenesis

Neural tube defects in fetus
Not advised for women of child-bearing age
MONITOR LEVEL FOR TOXICITY

35
Q

Neuroleptic malignant syndrome (NMS)

A

Life threatening emergency from antipsychotic medications

Changes in mental status (agitation, delirium)

Rigidity
High Fever (101F-103F)
Autonomic instability (tachycardia, elevated BP, tachypnea, diaphoresis, dysrhythmias)

36
Q

NMS tx

A

Recognize s/s early
Stop medication & any dopamine antagonists (gastric reflux med)
Control cardiac and respiratory status
**Apply cooling blankets for hyperthermia, ice packs, APAP
Rehydrate
Muscle relaxants
Frequent monitoring of VS
Monitor labs

NSG 470 - Exam 3 (7 decks)

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