OTA 110 - Ch. 5, 8, 10, 11 Flashcards
Changes from DSM-4 to DSM-5
- DSM-4 used Axis system; DSM-5 non-axial
- DSM-4 used “mental retardation”; 5 uses “intellectual disability”
- DSM-4 used “gender identity disorder”; 5 uses “gender dysphoria”
- DSM-4 used PDD-NOS (pervasive developmental disorder-not otherwise specified), Asperger’s, etc.; 5 uses “autism spectrum disorder”
DSM-5 structure
20 chapters based on disorder types (neurodevelopmental, psychotic, depressive, anxiety, trauma, substance use, personality, etc.)
MAOI
Monoamine oxidase inhibitors (Nardil, Parnate) – antidepressant drugs. Often used when other antidepressants ineffective. CAUTION: Must follow a special diet! Amino acid “tyramine” interacts and can be life-threatening! Avoid foods such as aged cheese, wine/beer, yogurt, tea/coffee, avocados, bananas, yeast, raisins/dates, and more.
Tyramine reaction
When foods containing amino acid tyramine interact with MAOIs; causes life-threatening hypertensive crisis (sudden loss of blood pressure), which could lead to cerebral hemorrhage and death.
Signs: sweating, palpitations, headache.
Tardive dyskinesia
(TD); side effect of antipsychotic drugs (Thorazine, Haldol, Seroquel, Risperdal). Movement disorder usually associated with older, first-gen drugs. Initial signs are involuntary facial movements, writhing tongue, writhing fingers. Can become permanent unless med is stopped.
Six major categories of psychotropic drugs:
1) Antipsychotic drugs
2) Antidepressant drugs
3) Antimanic drugs
4) Antianxiety drugs
5) Psychostimulant drugs
6) Antiparkinsonian drugs
Antipsychotic drugs
For people with schizophrenia and other psychotic disorders. Control hallucinations/delusions. Help reduce violent/dangerous behaviors.
Examples: Thorazine, Haldol, Seroquel, Risperdal
Most serious side effect is tardive dyskinesia (TD). Also photosensitivity.
Antidepressant drugs
Relief of depression/suicide. Newer meds tend to have fewer side effects (less libido loss/weight gain). May take up to 3 weeks to be effective.
Examples: Wellbutrin, Paxil, Zoloft, Prozac
Side Effects: may increase suicidal tendencies; older drugs (MAOIs) may cause tyramine reaction.
Antimanic drugs
Mood stabilizers; reduce intensity of mood swings, mania. (Sometimes anticonvulsants also work). Used with bipolar disorder.
Example: Lithium (toxic, causes fine hand tremor)
Antianxiety drugs
To control anxiety in disorders that are not psychotic (anxiety disorder, personality disorder).
Examples: Valium, Xanax (can be very addictive)
Psychostimulant drugs
Stimulate and increase mental/physical activity. Paradoxical effect on children with ADHD. Improve attention span, reduce hyperactivity.
Examples: Ritalin, Adderall
Side effects: impaired growth, tics, insomnia (sometimes loss of appetite)
Side effect: Nausea
- Have soda/graham crackers or bread
* OTC antacids sometimes recommended by dr., but get their approval in case it interferes with meds
Side effect: Photosensitivity
Extreme sensitivity to sunlight/easily sunburns (side effect of antipsychotics) • Teach patient about these effects • Wear sunscreen/sleeves/hat/sunglasses • Keep time in sun brief • Observe closely for signs of sunburn
Side effect: Dry mouth
- Allow water whenever thirsty
- Have hard candies available (lemon drops/mints)
- Teach about dehydration effects of caffeine/alcohol
Side effect: Blurred vision
- Help patient select activities that don’t require fine visual attention
- Use mats/soft equipment in gross motor activities
- Use large pieces in crafts (ie: 1-inch mosaic tiles)
- Provide magnified reading glasses
Side effect: Postural hypotension
Patient feels faint/blacks out when rising.
• Notify physician
• Teach patient to sit/stand up slowly; be prepared to support them at waist
• Encourage use of furniture/supports for balance
• Avoid activities with sudden postural changes
• Avoid gross motor activities to reduce sudden movements
Side effect: Hand tremors
(Ataxia). Common side effect of Lithium.
• If patient on new trial of lithium-based med and tremor is gross, notify dr. (may be sign of toxicity).
• Common if on lithium for month+. Help patient learn to compensate by stabilizing elbow/arm.
• If taking antipsychotic and tremor is wormlike/writhing, notify dr. Could indicate TD.
Side effect: Akathisia
Restlessness, muscular tension (often worse in legs).
• Help patient select activities that allow for movement (getting up, etc.)
• Avoid activities requiring prolonged sitting/standing
• Put patient at separate table if movement disrupts others.
Nonadherence
Not taking medication as prescribed. Some reasons:
• Feels unnatural; feel like it’s making them sicker
• Unpleasant side effects
• Hard to follow dosing/multiple meds overwhelming
• Cost
• Preference to street drugs
• Difficulty opening containers/swallowing/memory