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NRSG 220 > Neuro Starred > Flashcards

Neuro Starred Flashcards

1
Q

Anxiety disorder symptoms

A

Apprehension
Worry, fear
palpitations
shortness of breath
heartburn
dry mouth
excess sweating

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2
Q

High levels of anxiety can be mistaken for

A

heart attack

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3
Q

If someone comes in for a heart attack, what are the steps?

A

MI first - diagnostic tests and ECG
then obtain a hx of recent events that might trigger anxiety or that might indicate drug abuse

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4
Q

What is needed to make an accurate diagnosis of anxiety

A
  1. Medications that may worsen/cause anxiety
  2. Medical conditions associated with anxiety
  3. Nonpharmalogical interventions that will reduce stressors prior to Rx intervention
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5
Q

Benzo’s cautions (5 points)

A

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

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6
Q

what is benzos last name

A

azepam

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7
Q

Lorazepam considerations (8 points)

A

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

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8
Q

Phenobarbital ADEs (8 points)

A

Oversedation
“hangover” effect, lethargy
hallucinations
blood dyscrasias
hypocalcemia
hepatic disease
N/V/D/C
paradoxical excitation in children, older adults

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9
Q

Serious ADEs in phenobarbital

A

coma
SJS
angioedema
periorbital edema
thrombophlebitis

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10
Q

Phenobarbital considerations (8 points)

A

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

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11
Q

What is depression

A

A mood disorder that is persistant disturbance in emotion that impairs ability to effectively deal with ADLs

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12
Q

What are the two primary types of mood disorders

A

depression and bipolar disorder

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13
Q

What are some causes of depression

A

environmental
situational
hereditary
no longer thought to be from parenting or unresolved childhood conflicts

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14
Q

What does depression often co exist with

A

anxiety disorder
substance abuse
HTN or arthritis

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15
Q

What kind of people are diagnosed with major depression

A

majority of the people who commit suicide

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16
Q

How many weeks may be required before patient’s mood begins to improve?

A

three or more weeks

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17
Q

How long will it take for antidepressant therapy to reach maximal benefit?

A

6-8 weeks

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18
Q

When is risk of attempted suicide the highest

A

the month before pharmacotherapy

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19
Q

What is the nurses role in care for a depressed patient

A

careful monitoring of suicide talk
weekly/dailing patient contact
careful monitoring of medications

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20
Q

Disadvantages of tricyclic antidepressants

A

withdrawal symptoms if not tapered
may take 3 weeks to see effects and 6 weeks to see optimum benefits
SE’s

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21
Q

What are SEs of tricyclic antidepressants

A

anticholinergic effects/sympathomimetic effects
orthostatic hypotension
sedation (worsened by concurrent use of other CNS depressants
high incidence of sexual dysfunction

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22
Q

Imipramine contraindications

A

Heart attack, heart block, dysrhythmias
asthma, GI disorders, alcoholism, schizophrenia, bipolar
avoid use with alcohol
seizure disorders

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23
Q

Imipramine precautions

A

suicidal tendencies
urinary retention
prostate hyperplasia
cardiac/hepatic disease
increased intraocular pressure
hyperthyroidism
Parkinson’s disease

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24
Q

Imipramine considerations (5 points)

A

monitor for suicidal ideation
be sure patient swallows each dose
encourage compliance
monitor for urinary retention or constipation
treat for dry mouth

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25
Q

Fluoxetine ADEs

A

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)

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26
Q

Fluoxetine Contraindications/precautions

A

Bipolar disorder
cardiac dysfunction
diabetes
seizure disorders
carefully observe paediatric patients for hyperkinesia and personality changes/disorders
late pregnancy

27
Q

MAOIs

A

rare use
high incidence of ADEs

28
Q

What to avoid with MAOIs

A

foods with tyramine (aged or fermented)
cheese, alcohol, condiments, certain aged meats
avoid L tyrosine
avoid caffeine

29
Q

What off label uses are MAOIs used for

A

panic disorder
social anxiety disorder
migraine prophylaxis
potentiates effect insulin, diabetic drugs

30
Q

MAOIs ADEs

A

dizziness/orthostatic hypotension
drowsiness/HA
sexual dysfunction
anorexia/diarrhea

31
Q

MAOIs serious ADEs

A

Hypertensive crisis (foods with tyramine)
dysrhythmias
SIADH - like symptoms

32
Q

MAOIs have high what

A

incidence of ADEs
high level of NON COMPLIANCE

33
Q

MAOIs precautions

A

epilepsy
severe frequent headaches
HTN
dysrhythmias
suicidal tendencies

34
Q

MAOI considerations (5 points)

A

assess for suicidal ideation
encourage compliance
avoid tyramine foods (aged or fermented)
avoid L tyrosine
avoid caffeine

35
Q

What is Bipolar disorder

A

alternated between extreme feelings of sadness and extreme mania
significantly impacts social and occupational functioning

36
Q

Nonpharmacologic interventions for bipolar disorder

A

support groups
ECT

37
Q

Pharmacologic interventions for bipolar disorder

A

highly individualized based on severity and predominant symptoms

38
Q

What is a serious problem with bipolar treatment

A

non adherence

39
Q

Lithium drug interactions diuretics

A

increase risk of lithium toxicity

40
Q

Antithyroid drugs (drugs that contain iodine) cause what with lithium

A

increase in hypothyroid effect

41
Q

Haloperidol with lithium causes what

A

increased neurotoxicity

42
Q

NSAID’s with lithium

A

increase lithium levels

43
Q

SSRI’s, MAOIs, dextramethorphan may result in what wit lithium

A

SES

44
Q

Lithium considerations

A

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)

45
Q

being dehydrated does what to lithium levels

A

increases them

46
Q

Etiology of schizophrenia

A

precise ethology remains unknown
genetic component of some sort

47
Q

what is the risk of having a first degree relative with schizophrenia

A

5 to 10 x greater risk

48
Q

What is another possible reason for schizophrenia

A

neurotransmitter imbalance
- overactive dopaminergic pathways in basal nuclei
- association with dopamine type 2 receptors

49
Q

what are the drugs of choice in the tot of schizophrenia

A

second generation (atypical) antipsychotics have become drugs of choice for the tmt of schizophrenia

50
Q

Managing psychoses

A

first dose may be higher than normal as may need to sedate an agitated, aggressive, dangerous patient

51
Q

What is the most common drug given to relax the patient so an antipsychotic can kick in?

A

Benzodiazepenes (lorazepam)

52
Q

How often do acute psychoses symptoms last

A

usually resolve in 3-7 days

53
Q

What is EPS

A

refers to locations in the CNS associated with postural and automatic movements

54
Q

EPS includes

A

acute dystonia
akathisia
Parkinsonism
tardive dyskinesia (TD)

55
Q

Acute dystonia

A

speech is heavy/not understandable

56
Q

Akathiasis

A

quick repeated movements (feels like jumping out of skin)

57
Q

Parkinsonism

A

parkinsons rigid movement/frozen

58
Q

Tardive dyskinesias

A

repetitive movement on face or body

59
Q

Haloperidol ADEs

A

anticholinergic symptoms (blurred vision, dry eyes, glaucoma)
weight gain
headache
anemia
phytotoxicity

60
Q

Haloperidol serious ADEs

A

tachycardia
cardiac arrest
laryngospasm
resp depression
seizures
agranulocytosis/leukopenia/leukocytosis
neuroleptic malignant syndrome

61
Q

Risperidone considerations

A

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

62
Q

Drugs similar to risperidone

A
  1. Quetiapine
  2. Olanzapine
  3. Clozapine
63
Q

Second gen (atypical) antipsychotic considerations

A

monitor for EPS symptoms or anticholinergic effects
ensure adequate nutrition/fluid
monitor for signs of neuroleptic malignant syndrome (NMS)
watch labs (liver)

64
Q

Second gen (aytpical) patient education

A

monitor for weight gain or changes in sexual characteristics (lactation in men)
no alcohol use/illegal drug use
no caffeine use
no smoking

NRSG 220 (8 decks)

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