Post-test Psychiatric Nursing Flashcards
Repeated occurrence of stress, impulse, depression will change the sensitivity of the brain or the threshold
Kindling
Major neurotransmitters and their function
Excitatory
1. Dopamine (cognition and emotion)
2. Norepinephrine and epinephrine
3. Acetylcholine (sleep and muscle)
4. Glutamate (neurotoxic if high)
Inhibatory
1. Serotonin (almost everything)
2. Acetylcholine
Neuromodulators
1. Histamine
2. Neuropeptides
The client promises not to attempt suicide within 24 hours; not legally-bounded but a written promise
The patient should inform when tendencies rise.
No-suicide contract
Side effects of psychotropic drugs when blocking histamine
- Weight gain
- Sedation
- Hypotension
No suicide contract implies this if the client shares the tendency to commit
Constant 24-hour, one-on-one observation at arm’s length
Problems with glutamate leads to these conditions
- Alzheimer’s disease
- Huntington
*Glutamate is neurotoxic and evident in stroke and hypoglycemia.
Problems with acetylcholine is evident in patients with or leads to:
- Alzheimer’s disease
- Myasthenia gravis
Problems of dopamine lead to what disease
- Increase leads to schizophrenia
- Parkinson’s disease
*Dopamine 1 is for the heart; dopamine 2 is for the brain
DOC: Levodopa
Problems with norepinephrine and epinephrine leads to:
Norepinephrine: anxiety disorders and depression
Brain imaging technology, results, and duration
Structural Image
1. CT Scan 20-40 mins
2. MRI Scan 45 mins
Functional
1. PET Scan (with radioactive tracer) 2-3 hrs
The importance of tapering psychotropic medication
- This avoids rebound withdrawal (temporary return of symptoms)
- Withdrawal (new symptoms related to the discontinuation of the drug)
Antipsychotics are prescribed for patients with:
- Psychosis
- Schizophrenia
- Schizoaffective disorder
- Manic phase of bipolar disorder
- Transient psychotic attack in borderline personality
Off-label use
1. Anxiety and insomnia
The difference between the three generations of antipsychotics based on the dopamine levels
- First generation mainly antagonizes D2 receptors leading to higher risk for EPS
- Second generation weakly blocks D2 which leads to lesser EPS
- Second generation also inhibits re-uptake of serotonin, addressing the negative symptoms
- Third generation stabilize dopamine output; without EPS
- Common S/E for 3rd generation: sedation, weight gain, akathisia, headache, anxiety, and nausea
The four side effects of extrapyramidal side effects (EPS)
- Acute dystonia
- Pseudoparkinsonism
- Akathisia
- Tardive dyskinesia (irreversible)
The cause of the development of EPS
- Blockage of D2 receptors in the midbrain region of the brain stem
The symptoms manifested with the drug of choice for Acute Dystonia (1st stage of EPS)
This is mainly rigidity:
1. Torticollis/wry neck or stiff neck
2. Oculogyric crisis
3. Opisthotonos
DOC: dipenhydramine (Bendaryl) & benztropine (Cogentin)
*May be given IM for rapid relief
*May be given the anticholinergic and benzodiazepine
The manifestation and DOC for akathisia (2nd of EPS):
This mainly leads to restlessness and pacing:
1. Rocking motion
DOC: propranolol (blocks norepinephrine)
*Treated with changing of antipsychotic medication; use of beta-blocker, anticholinergic, and benzodiazpeine
The manifestation and DOC for pseuoparkinsonism:
- Bradykinesia (slow movement)
- Shuffling gait
- Cog wheel movement (robot movement)
- Coarse pill-rolling movement
DOC: amantadine (anticholinergic agent/dopamine-agonist)
The manifestation and DOC of tardive dyskinesia:
This is related to involuntary facial movements; irreversible.
1. Lip smacking
2. Facial grimacing
3. Tongue protrusion
3. Choreiform movement of the limbs
DOC: clozapine (Clozaril)
DOC for EPS in general: Benztropine, Diphenhydramine, Biperiden (Akineton), Amantadine (Symmetrel)
The effects of the following drugs to the eyes:
- Constriction: opioid
- Red eyes: marijuana, cocaine, and benzodiazepine
- Dilation: cocaine, LSD, and methamphetamine
A potentially fatal idiosyncratic reaction to an antipsychotic drug leading to S/Sx of (1) muscle rigidity, high fever of unknown origin, and dysautonomia—with elevated enzymes of creatine phosphokinase
Onset: 24-72 hours
Common in FGA
Risk factors: dehydration and poor nutrition
Neuroleptic Malignant Syndrome (NMS)
The most common cause of death with neuroleptic malignant syndrome (NMS)
Respiratory and cardiac arrest
The priority action and the two drug of choice for Neuroleptic Malignant Syndrome (NMS)
Priority: stop the medication and vital signs taking
DOC:
1. Valium (to decrease rigidity)
2. Dantrolene Sodium (muscle relaxant)
The most common antipsychotic to cause agranulocytosis:
Clozapine (2nd generation antipsychotic)
This refers to the failure of the bone marrow to produce adequate white blood cells or the proliferation of immature WBCs resulting to decreased mature WBCs—termed as “crowd out phenomenon”
Onset: 18-36 weeks
Common s/sx: ulcerative sore throat/dry throat/tonsilitis
Agranulocytosis
The cause of death of agranulocytosis:
Septic shock
The management of agranulocytosis
- Stop the medication
- Anticipate order for CBC, to specifically check the neutrophils d/t agranulocytosis > neutropenia
- Administer macrolide (wide-spectrum antibiotics)
How frequent should patients with antipsychotics monitor WBC count?
- Weekly for the first six months
- Fortnight >6 months
*>3.5 WBC is required before dispensing clozapine
The best organ to check for jaundice
Jaundice at the hard palate
The first drug used to treat tardive dyskinesia:
Valbenazine (-benazine)
Anticholinergic S/E
B - lurred vision
U - rinary retention
C - onstipation
O - rthostatic hypotension
P - hotosensitivity
A - mnesia
N - ight disturbances
D - ry mouth
A - taxia
N - ausea
Other side effects when taking antipsychotic drugs
- Elevate prolactin levels
- Diminished libido
- Weight gain especially 2nd generation
- Sedation
- Sexual dysfunction: ED, vaginismus, dyspareunia
- Menstrual irregularities
*Atypical have increased risk for hyperglycemia and diabetes d/t increased appetite
The only 2nd generation antipsychotic that does not cause anticholinergic side effect
Resperidone
Protocol if missed dose of antipsychotics
- If 3-4 hours after, take the medication.
- > 4 hours, skipped the medication
Aside from treating depression, these are off-label use of antidepressant drugs
- Chronic pain
- Migraine headaches
- Panic disorder
- Sleep apnea
- Eating disorders
The side effects of MAOI
- Weight gain
- Orthostatic hypotension
- WOF: Hypertensive crisis (avoid tyramine); do not combine with other MAOIs, TCAs, opioids, and antihypertensives
Pros:
1. Low incidence of sedation
2. Low incidence of anticholinergic effects
