Neuro Starred Flashcards
Anxiety disorder symptoms
Apprehension
Worry, fear
palpitations
shortness of breath
heartburn
dry mouth
excess sweating
High levels of anxiety can be mistaken for
heart attack
If someone comes in for a heart attack, what are the steps?
MI first - diagnostic tests and ECG
then obtain a hx of recent events that might trigger anxiety or that might indicate drug abuse
What is needed to make an accurate diagnosis of anxiety
- Medications that may worsen/cause anxiety
- Medical conditions associated with anxiety
- Nonpharmalogical interventions that will reduce stressors prior to Rx intervention
Benzo’s cautions (5 points)
change dose gradually - do NOT stop abruptly
watch for suicidal ideation
may cause mania or psychosis
watch in use with dysfunctional kidneys, liver, CV or pulmonary system
use cautiously when using with the elderly
what is benzos last name
azepam
Lorazepam considerations (8 points)
aspirate prior to injection (IM)
Assess for paradoxical CNS excitement
advise pt to stop smoking
watch CBC, liver function and renal function
does the pt need anti anxiety drugs
assess for S&S of OD or abuse
teach nonpharmacologic methods of sleep/relaxation
assess for suicidal ideation
Phenobarbital ADEs (8 points)
Oversedation
“hangover” effect, lethargy
hallucinations
blood dyscrasias
hypocalcemia
hepatic disease
N/V/D/C
paradoxical excitation in children, older adults
Serious ADEs in phenobarbital
coma
SJS
angioedema
periorbital edema
thrombophlebitis
Phenobarbital considerations (8 points)
monitor for resp depression
assess patient given IV barbiturates Q 15 mins
monitor for signs of blood dyscrasias
aspirate prior to injection
monitor therapeutic serum concentrations of drug
assess baseline hepatic/renal and monitor
teach nonpharm methods of sleep/relaxation
if pt develops fever, angioedema, and body rash, hold med and call MD
What is depression
A mood disorder that is persistant disturbance in emotion that impairs ability to effectively deal with ADLs
What are the two primary types of mood disorders
depression and bipolar disorder
What are some causes of depression
environmental
situational
hereditary
no longer thought to be from parenting or unresolved childhood conflicts
What does depression often co exist with
anxiety disorder
substance abuse
HTN or arthritis
What kind of people are diagnosed with major depression
majority of the people who commit suicide
How many weeks may be required before patient’s mood begins to improve?
three or more weeks
How long will it take for antidepressant therapy to reach maximal benefit?
6-8 weeks
When is risk of attempted suicide the highest
the month before pharmacotherapy
What is the nurses role in care for a depressed patient
careful monitoring of suicide talk
weekly/dailing patient contact
careful monitoring of medications
Disadvantages of tricyclic antidepressants
withdrawal symptoms if not tapered
may take 3 weeks to see effects and 6 weeks to see optimum benefits
SE’s
What are SEs of tricyclic antidepressants
anticholinergic effects/sympathomimetic effects
orthostatic hypotension
sedation (worsened by concurrent use of other CNS depressants
high incidence of sexual dysfunction
Imipramine contraindications
Heart attack, heart block, dysrhythmias
asthma, GI disorders, alcoholism, schizophrenia, bipolar
avoid use with alcohol
seizure disorders
Imipramine precautions
suicidal tendencies
urinary retention
prostate hyperplasia
cardiac/hepatic disease
increased intraocular pressure
hyperthyroidism
Parkinson’s disease
Imipramine considerations (5 points)
monitor for suicidal ideation
be sure patient swallows each dose
encourage compliance
monitor for urinary retention or constipation
treat for dry mouth
Fluoxetine ADEs
N/V/D/C
anorexia
cramping/flatuelence
fluctuations in weight
sexual dysfunction
seizures
poor concentration
nightmares
hot flashes
palpitations
nervousness
serotonin syndrome (SES)
pediatric patients (personality disorders or hyperkinesia)
Fluoxetine Contraindications/precautions
Bipolar disorder
cardiac dysfunction
diabetes
seizure disorders
carefully observe paediatric patients for hyperkinesia and personality changes/disorders
late pregnancy
MAOIs
rare use
high incidence of ADEs
What to avoid with MAOIs
foods with tyramine (aged or fermented)
cheese, alcohol, condiments, certain aged meats
avoid L tyrosine
avoid caffeine
What off label uses are MAOIs used for
panic disorder
social anxiety disorder
migraine prophylaxis
potentiates effect insulin, diabetic drugs
MAOIs ADEs
dizziness/orthostatic hypotension
drowsiness/HA
sexual dysfunction
anorexia/diarrhea
MAOIs serious ADEs
Hypertensive crisis (foods with tyramine)
dysrhythmias
SIADH - like symptoms
MAOIs have high what
incidence of ADEs
high level of NON COMPLIANCE
MAOIs precautions
epilepsy
severe frequent headaches
HTN
dysrhythmias
suicidal tendencies
MAOI considerations (5 points)
assess for suicidal ideation
encourage compliance
avoid tyramine foods (aged or fermented)
avoid L tyrosine
avoid caffeine
What is Bipolar disorder
alternated between extreme feelings of sadness and extreme mania
significantly impacts social and occupational functioning
Nonpharmacologic interventions for bipolar disorder
support groups
ECT
Pharmacologic interventions for bipolar disorder
highly individualized based on severity and predominant symptoms
What is a serious problem with bipolar treatment
non adherence
Lithium drug interactions diuretics
increase risk of lithium toxicity
Antithyroid drugs (drugs that contain iodine) cause what with lithium
increase in hypothyroid effect
Haloperidol with lithium causes what
increased neurotoxicity
NSAID’s with lithium
increase lithium levels
SSRI’s, MAOIs, dextramethorphan may result in what wit lithium
SES
Lithium considerations
monitor serum levels Q1-3 days initially and 2-3 months after
assess for symptoms of bipolar disorder before and during tat
monitor for symptoms of lithium toxicity
assess daily for weight changes, edema, changes in skin turgor
lithium is a salt so think water levels in the body
monitor sodium intake (continue to take table salt to maintain osmotic hydration but dont over do it)
being dehydrated does what to lithium levels
increases them
Etiology of schizophrenia
precise ethology remains unknown
genetic component of some sort
what is the risk of having a first degree relative with schizophrenia
5 to 10 x greater risk
What is another possible reason for schizophrenia
neurotransmitter imbalance
- overactive dopaminergic pathways in basal nuclei
- association with dopamine type 2 receptors
what are the drugs of choice in the tot of schizophrenia
second generation (atypical) antipsychotics have become drugs of choice for the tmt of schizophrenia
Managing psychoses
first dose may be higher than normal as may need to sedate an agitated, aggressive, dangerous patient
What is the most common drug given to relax the patient so an antipsychotic can kick in?
Benzodiazepenes (lorazepam)
How often do acute psychoses symptoms last
usually resolve in 3-7 days
What is EPS
refers to locations in the CNS associated with postural and automatic movements
EPS includes
acute dystonia
akathisia
Parkinsonism
tardive dyskinesia (TD)
Acute dystonia
speech is heavy/not understandable
Akathiasis
quick repeated movements (feels like jumping out of skin)
Parkinsonism
parkinsons rigid movement/frozen
Tardive dyskinesias
repetitive movement on face or body
Haloperidol ADEs
anticholinergic symptoms (blurred vision, dry eyes, glaucoma)
weight gain
headache
anemia
phytotoxicity
Haloperidol serious ADEs
tachycardia
cardiac arrest
laryngospasm
resp depression
seizures
agranulocytosis/leukopenia/leukocytosis
neuroleptic malignant syndrome
Risperidone considerations
if medications cause drowsiness - take a bedtime
watch for orthodontist hypotension
assess for EPS/TD/Akathesias/NMS
educate pt for S&S of above and what to watch for and when to contact HCP
encourage sips of water or hard candies for dry mouth and anticholinergic like symptoms
avoid alcohol and caffeine
increase fluids and fibre
watch liver lab results
tell pt to report significant weight gain
ensure pt knows that definite improvement may not be seen for 6-8 weeks
Drugs similar to risperidone
- Quetiapine
- Olanzapine
- Clozapine
Second gen (atypical) antipsychotic considerations
monitor for EPS symptoms or anticholinergic effects
ensure adequate nutrition/fluid
monitor for signs of neuroleptic malignant syndrome (NMS)
watch labs (liver)
Second gen (aytpical) patient education
monitor for weight gain or changes in sexual characteristics (lactation in men)
no alcohol use/illegal drug use
no caffeine use
no smoking
