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psych final Flashcards

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1
Q

Akathisia

A

(EPS)

restlessness, inability to sit still, motoric hyperactivity

within 1-6 weeks

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2
Q

Artane (trihexyphenidyl)

A

For treatment of EPS

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3
Q

Atypical Antipsychotic Medications

A
  • block dopamine and serotonin
  • target both positive and negative symptoms (whereas traditional drugs target positive symptoms only)
  • SE: dizziness, tachy, orthostasis, syncope, weight gain, rhinitis, sleep distrubance, agranulocytosis (Cloraril only-weekly WBCs)
  • incidences of EPS and TD are much less
  • increased prolactin level, increased QTC interval, hyperglycemia, type II diabetes, increased lipids
  • can cause suicidal ideation
  • tend to be more expensive that traditional antipsychotics
  • lowers impulse control
  • get baseline weight before starting
  • (Clozaril, Risperdal, Invega (metabolite of risperdal), Invega Sustenna (long acting), Zyprexa, Zydis, Seroquel, Geodon, Abilify, Saphris, Fanapt, Latuda)
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4
Q

Cogentin (benzotropine)

A

Treatment of EPS

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4
Q

Dystonia

A
  • muscle cramping of head and neck
  • acute dystonic rxn-head twisted to one side, complain of thick tongue
  • Nurse: give Cogentin or Artane or Benedryl (IM not PO)

within 1-2 days

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4
Q

EPS

A

Acute dystonic reactions (tonic contraction of muscles in mouth and torso)

Parkinsonian reactions

Akathisia

Tardive Dyskinesia

NMS

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4
Q

Clozaril (clozapine)

A
  • atypical antipsychotic
  • restrict to sever schizophrenia resistent to traditional antipsychotic meds
  • monitor WBC and ANC
  • risk of seizures
  • risk of myocarditis
  • potentially life-threatening side effects
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5
Q

Haldol

A
  • for acute psychosis and schizophrenia
  • blocks dopamine receptors
  • causes CNS depression, narrow-angle glaucoma, hepatic disease
  • SE: EPS (TD, Parkinsonism, Acute dystonia, akathisia), NMS, QT changes and potential dysrhythmias, anticholinergic.

NURSE: assess for involuntary movements

-poor adherence is common cause of therapeutic failure

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6
Q

Parkinsonian Reaction

A

rigid expressions, shuffling gait, cogwheel rigidity

within 1-4 wks

Drugs to prevent = Artane, Cogentin, Amantadine

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7
Q

Prolixin

A
  • med for schizophrenia-traditional anti-psychotic (blocks dopamine receptors in the brain)
  • expect high EPS, low anticholinergic
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7
Q

Risperdal

A
  • atypical antipsychotic
  • highest risk of EPS among atypicals
  • SE: sexual dysfunction, orthostatic hypotension, weight gain, sedation, strange dreams
  • available in long-acting injectioin (Risperdal Consta)-q2wks
  • can be used for autism
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8
Q

Tardive Dyskinesia

A
  • EPS
  • results from long-term use of traditional agents
  • unusual mouth movements (lip smacking, tongue protrusion)
  • choreic movements (rocking)
  • NO TREATMENT for TD

develops late in treatment

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9
Q

Traditional Antipsychotics

A
  • block dopamine receptors in the brain
  • SE: sedation, anticholinergic, EPS, TD, neuroleptic malignant syndrome (NMS), hyperpyrexia, mental status changes, diaphoresis, muscle stiffness, lower seizure threshold
  • (Thorazine, Prolixin, Haldol, Mellaril, Navane, long-acting (IM) Haldol D, Prolixin D) (phenothiazines end in -zine )
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9
Q

Zyprexa (olanzapine)

A
  • Atypical antipsychotic
  • most likely to cause hyperglycemia and weight gain
  • takes 1 week to reach steady state
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11
Q

Alcohol Withdrawal

A
  • fever
  • N/V
  • anxiety
  • visual, tactile or auditory hallucinations or illusions
  • autonomic hyperactivity: sweating, tachy, HTN
  • psychomotor agitation, seizures (within 7-48h)
  • insomnia
  • hand tremor
  • long-acting benzodiazepines (prevent DTs)=Librium, Valium; short acting (if livery disfunction)=Ativan
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11
Q

Alcohol Related Delirium

A
  • develops within hours to days (12-36 hours)
  • impaired consciousness
  • change in cognition (memory, disorientation, hallucinations, illusions)
  • DTs = tachy, tachypnea, diaphoresis, tremors, hallucinations, paranoia, grand mal seizures–provide quiet, safe environment, seizure precautions, anticipate Librium.
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12
Q

Antianxiety drugs for Bipolar Disorder

A

Klonopin

Ativan

for treatment of acute mania in some pts resistant to other meds

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12
Q

Atypical Antipsychotics used in Bipolar Disorder due to mood-stabilizing properties

A

FDA approved for mania:

Zyprexa

Risperdal

Abilify

Seroquel (wt gain/diabetes)

Geodon

(used for their sedating and mood-stabilizing properties-esp. during initial treatment)

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13
Q

Benzodiazepines

A

As effective as Barbituates, but safer. Sedative/hypnotic, can be addictive.

Xanax (alprazolam)

Valium (diazepam)

Ativan (lorazepam)

Librium-long half-life, used only for alcohol withdrawal

Klonopin (clonazepam)-can cause ataxia

Serax (oxazepam)

Versed (midazolam)-used for conscious sedation

NON-Benzo anti-anxiety: Buspar (buspirone)

Flumazenil = for benzo intoxication-causes dizziness, confusion, agitation, n/v

**Withdrawal: **N/V, tachy, diaphoresis, anxiety, irritability, tremors in hands, fingers, eyelids, marked insomnia, grand mal seizures, delerium

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14
Q

Cocaine

A
  • produces physical dependence and withdrawal sx with very high relapse
  • short acting euphoria 10-20 s rush, then 15-20 minutes of less intense eurphoria
  • sudden death: heart attack

3 Phases of Withdrawal:

  1. Crash (4 days-anxiety, depression, anergia, paranoia, peak cravings)
  2. Prolonged Dysphoria (anhedonia, lack of motivation, intense cravings, relapse most likely)
  3. Intermittent Craving (support groups helpful)
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15
Q

Dissociative Disorders

A
  • altered mind-body connection
  • distubances in consciousness, memory, identity and perception.
  • unconsciousdefense mechanism-rare

ThreeTypes:

  1. Depersonalization (persistant alteration in self perception; feeling surreal; robot like.
  2. Dissociative Amnesia and Fugue (sudden travel away from usual location) precipitated by traumatic event.
  3. Dissociative Identity Disorder-long term therapy needed, rare, 2+ personality states; dissociationg is coping mechanism.
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15
Q

Depakote

(Valproic Acid)

A

anticonvulsant

useful for bipolar non-respondant to lithium

monitor liver function, platelet count

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16
Q

Drugs for agitated/combative

A

Haldol

Ativan

16
Q

Drugs for Alzheimers

A
  • Aricept-(donepezil)=cholinesterase inhibitor; slows progression SE: insomnia, dizziness, H/A, N/D (may subside), less liver toxicity
  • Tacrine (Cognex)-cholinesterase inhibitor, may delay progress, high incidence of liver SE’s and GI distress
  • Exelon (rivastigmine) cholinesterase inhibitor
  • Rezadyne (galantamine) cholinesterase inhibitor
  • Namenda (Memantine)-NMDA receptor antagonist SE: dizzy, H/A, constipation
  • Concerta and Adderall
  • overall–nausea and diarhea–take with meals
18
Q

Neuroleptic Malignant Syndrome

A
  • severe muscular rigidity, altered consciousness, stupor, catatonia, febrile, respiratory depression
  • treatment: discontinuation of meds and stabilization of symptoms
  • can give bromocritpine
  • occurs with both traditional and atypical antipsychotics-esp. phenothiazines
19
Q

Healthy Defense Mechanisms

A
  • Sublimation-unconscious process-substituting constructive, socially acceptable acivity for unacceptable activity/impulses: woman angry with boss writes short story about heroic woman.
  • Humor-deal with stress/conflict by using amusing aspects of the conflict
  • Suppression-conscious denial of disturbing situations or feelings (don’t worry about bills until after exams)
21
Q

Intermediate Defense Mechanisms

A
  • Repression-exclusion of unpleasant/unwanted experiences or emotions from conscious awareness-unconscious level-someone who has been sexually abused but can’t remember it. *cornerstone of defense mechanisms.
  • Displacement-placing emotions associated with one person/thing/situation on to another person/thing/situation that is non-threatening-a pt criticizes a nurse after family fails to visit.
  • Reaction formation-unaceptable feelings or behaviors ar controlled and kept out of awareness by develping the opposite behavior or emotion.
  • Somatization-transfer of anxiety from the psychological to a physical symptom that has n organic cause. Aka conversion.
  • Undoing-making up for an argument with a gift to undo
  • Rationalization-justifying illogical ideas, actions, or feelings by developing acceptable explanaions that satisfy the teller as well as the listener-I didn’t get the raise bc my boss doesn’t like me.
21
Q

Immature Defense Mechanisms

A
  • Passive aggression-indirectly and unassertively expressing aggression toward others.
  • Acting Out-dealing with conflicts/stressors by actions rather than reflections or feelings.
  • Dissociation-feeling unattached to self, others or environment.
  • Devaluation-giving negative value to self or others to try to appear good and reduce stress/anxiety.
  • Idealization-emotional stressors are dealt with by idealizing or exaggerating another’s qualities.
  • Splitting-inability to integrate positive and negative attributes at the same time (prevalent in people with borderline personality disorders)j.
  • Projection-placing one’s own negative attributes onto another.
  • Denial-excaping from unpleasant realities by ignoring their existence (hallmark of alcoholics/drug addicts).
22
Q

Lamictal

A

anticonvulsant

first line treatment for bipolar depression

may cause potentially life-threatening rash-Steven Johnson syndrome

23
Q

Lithium carbonate

A

for bipolar since 1800s

takes at least 2 wks

monitor blood levels

therapeutic = 0.4-1.0 (>1.5 is toxic), monitor 5 days after beginning

draw blood weekly until therapeutic levels reached, then monthly, after 6 months-year of stabiliy, measure every 3 months

SE’s: fine hand tremor, polyuria, mild thirst, mild nausea, general discomfort, weight gain

Early signs of toxicity: n/v/d, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremor

Advanced Toxicity: (1.5-2.0) coarse hand tremor, persistent GI upset, mental confusion, muscle hyperirritability, eeg changes, incoordination, sedation

Severe toxicity: (2.0-2.5) ataxia, confusion, large output of dilute urine, serious eeg changes, blurred vision, seizures, stupor, severe hypotension, coma, death

>2.5 convulsions, oliguria, death

Contraindicated for pts with impaired renal or thyroid function.

Can’t be used with diuretics

24
Q

MAOI’s

A

antidepressants-Marplan, Nardil, Parnate

only used if nothing else works

monitor tyramine inkake (causes HTN)-avoid: avacados, figs, smoked meats, cheeses, yeast extract, beer, chianti, soy sauce, OTC meds (pseudoephedrine), TCAs, narcotics, antihypertensives, sedative stimulants.

SE’s-ortho hypo, weight gain/edema, constipation, urinary hesitancy, sexual dysfunction, vertigo, muscle twitching, insomnia, fatigue

HTN crisis may begin with HA, palpitations, increased BP

hypertensive crisis-severe HA, tachy, palpitations, HTN, n/v

26
Q

Meds for Anxiety

A
  • SSRI’s=first line
  • Anxiolytics/benzodiazepines (addictive)
  • Xanax, librium, klonopin, valium, ativan
  • don’t stop abruptly (withdrawl, DTs, seizures)
  • additive effect with alcohol
  • tolerance
  • short term only

-Buspar=non-addictive (2-4 wks for full effect)

28
Q

Neurotransmitters related to altered mood states

A

serotonin

norepinephrine

28
Q

Mood Stabilizers

A

Lithium Carbonate

Therapeutic = 0.6-1.2 mEq/L

SE: hypothyroidism, weight gain, tremors, electrolyte/blood imbalance, impaired renal function

Toxicity above 1.5-begins as GI upset, CNS changes, death

Education: avoid excessive heat, diaphoresis, use of diuretics, decreased Na intake

Anticonvulsants: Tegretol, Depakote, Neurontin, Lamictal, Trileptal, Gabitril, Topamax

Antipsychotics: Seroquel, Risperdal, Abilify, geodone

30
Q

Psychostimulants

A
  • for ADD/ADHD, narcolepsy, depression (last resort)
  • SE: insomnia, increased activity/restlessness, tremor, cardiac, HTN, anorexia

Ritalin

Daytrana (patch)

sustained release = Ritalin SR, Concerta

Dexedrine

Adderall

Cylert (liver damage)

Vyvanese

Intuniv

NON-stimulant: Strattera

32
Q

Stages of Alzheimers

A
  1. Mild Alzheimer’s-loss of enerygy, drive, initiative, dificulty learning new things; personality and social behavior remain intact; depression may occur early-lessens as disease progresses
  2. Moderate AD-deterioration becomes evident; can’t rememer address or date; memory gaps that fluctuate day to day; poor hygiene; can’t dress themselves properly; labile mood-paranoia, anger, jealousy, apathy; driving is hazardous; withdrawl.
  3. Moderate to Severe-unable to recognize familiar objects/people (agnosia), needs simple directions repeated (apraxia), forgets where toilet is-incontinent, the world is frightening, nothing makes sense; agitation, violence, paranoia, delusions; wandering
  4. Late AD-agraphia (inability to read or write), hyperorality (need to chew), blunting of emotions, visual agnosia, hypermetamorphasis (touching everything in sight); ability to walk and talk are lost
  5. End-stage-stupor, coma, with death secondary to infection or choking.
34
Q

Stimulants

A

relief from fatigue, grandiosity, euphoria, impaired judgement, dilated pupils, dry mouth, excessive motor activity, twitching, increased BP, HR

Most common: cocaine, amphetamines

Tolerance develops to euphoria but not wakefulness

Prolonged/excessive use can lead to psychosis almost identical to paranoid schizophrenia

35
Q

Substance Abuse

vs. Dependence

A

Abuse: continued use despite related consequences-inability to fulfill role obligations, participation in hazardous situations while impaired, recurrent legal/interpersonal problems, continued use despite social/interpersonal problems

Dependence: severe condition or disease with physical problems, presence of tolerance, withdrawal, subs taken in higher amts, unsuccessful desire to cut down, increased time spent, reduction/absence from social, occupational, recreational activities

36
Q

Symptoms of Alzheimers

A
  • Orientation
  • Behavior (disinhibited)
  • irritable, agitated
  • psychosis (paranoid delusions, later hallucinations)
  • Motor symptoms=Parkinsonism, gait abnormalities, falls, no tremor
  • short term memory
  • executive dysfunction (prob solve, mult-task)
  • language-names of objects
37
Q

TCA’s

A

(tricyclic antidepressants)-amitriptyline, desipramine, imipramine, nortriptyline, protryptyline

inhibit re-uptake of norepinephrine and serotonin

SE’s-orthohypo, anticholinergic (dry mouth, blurred vision, urinary retention), dysrhythmias, tachy, MI, heart block

Caution: elderly, those with MI, narrow angle glaucoma, hx of seizures, PG women

Takes 10-14 d to work

OD is an issue

give at bedtime (sedating), avoid ETOH, avoid antihypertensives

38
Q

Tegretol

(carbamazepine)

A

anticonvulsant

used in bipolar-pts with rapid cycling (4+ in one year)

39
Q

Wernicke’s Korsakoff Syndrome

A
  • Severe memory disorder resulting from thiamine deficiency secondary to alcohol abuse
  • Thiamine (B1) to prevent Wernicke encephalopathy B1 needed for glucose metabolism in the brain-cell death/atrophy-nystagmus, ataxia; reversible if treated early.
  • B1-Korsakoff psychosis-follows untreated Wernicke; antegrade/retrograde memory loss; confabulation
40
Q

Alzheimers Disease

A
  • most common cause of dementia
  • 1/10 >65 1/2 >85
  • PET scan, CT scans reveal brain atrophy and rule out other conditions (neoplasms)
  • confabulation-creation of stories or answers in place of actual memories to maintain self-esteem; not the same as lying; unconscious attmept to maintain self-esteem
  • amnesia/memory impairment
  • aphasia-loss of language ability
  • apraxia-loss of purposeful movement in the absence of motor or sensory impairment
  • agnosia-loss of sensory ability to recognize objects
  • disturbances in executive functioning.
  • Average duration from onset to death is 8-10 years, but ranges from 3-20 years
41
Q

CAGE

A
  • Cut down? (feel need to)
  • Annoyed by others criticizing your drinking?
  • Guilty feelings about your drinking?
  • Eye openner needed?

1=possible problem

2=probable problem

42
Q

Chemical Restraints

A

Haldol

Ativan

44
Q

Depression in the Elderly

A
  • Often undiagnosed
  • Presents with somatic complaints
  • Mistaken for cognitive decline
  • SSRI’s are first line of therapy-Zoloft is drug of choice
  • Suicide rate is higher than any other age group, esp white males
  • Sx=insomnia, change in sleep pattern, weight loss, excessive fatigue, incr concern with bodily functions, alterations in mood, expressions of aprehension/anxiety, low self-esteem, pessimism
45
Q

Drugs for Alcohol Abstinence

A

-Naltrexone (Revia), nalmefene: opiate agonists to diminish craving

-Acamprosate (Campral), citalopram or ondansetron to diminish desire

-Antibuse (disulfiram)-interupts alcohol metabolism-severe HA, N/V, flushing, hypoTN, tachy, dyspnea, diaphoresis, chest pain, palps, dizziness, confusion; effects can last 14 days after discontinuing

47
Q

Nicotine Withdrawal

A
  • patch/gum, taper after 4-6 wks
  • Buproprion (Zyban, Wellbutrin)-non-nicotine replacement therapy
  • Clonidine (anti-hypertensive), nortriptyline (TCA)-second line
48
Q

Normal Aging Changes

A
  • hypothermia
  • decreased oxygen use and cardiac output, resulting in anoxia/hypoxia
  • muscle wasting, weakness–decreased mobility
  • limited cough reflex=risk of aspiration
  • demineralization of bones
  • decreased GI motility=constipation
  • decreased ability to interpret painful stimuli
50
Q

Opiates & Opioids

A
  • Narcotics
  • opium, morphine, meperidine (demerol), fentanyl, heroin
  • Symptoms: stupor, constipated, pinpoint pupils
  • Withdrawal is rarely life-threatening, very uncomfortable
  • methadone
  • Heroin withdrawal: subutex, clonidine (for BP), valium
  • Symptoms of Withdrawal: resemble the flu-runny nose, tearing, diaphoresis, muscle cramps, chills, fever, dilated pupils
  • Buprenorphine = opioid agonist/antagonist, used for pain, can cause confusion, diaphoresis, hallucinations, sedation, nausea
51
Q

Risk Factors for Alzheimers

A
  • apolipoprotein E (involved with amyloid depostion in the brain) E4 allele=high risk
  • family history
  • being female
  • cardiovascular: HTN, hyperlipidemia, diabetes
  • head trauma
  • lower education
52
Q

SSRI’s

A

SE’s: agitation, anxiety, sleep disturbance, tremor, sexual dysfunction, headache, dry mouth, sweating, wt change

TOXIC: serotonin syndrome=abd pain, diarrhea, sweating, fever, tachy, High BP, delerium, muscle spasm, irritiablility

incompatible with St Johns Wort (serotonin malignant syndrome)

Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft, Celexa

53
Q

Toxic Psychosis

A
  • use of LSD, PCP, stimulants
  • resembles paranoid schizophrenia
  • LSD users can be “talked down”
  • PCP/amphetamine users more lkely to strike out, panic from misconceptions; may not feel pain
  • may need restraints, benzos, high-potency anti-psychotics (Haldol/Ativan cocktail)
54
Q

Meds for ADD/ADHD

A
  • Dextroamphetamine
  • Ritalin
  • Cylert
55
Q

Schizophrenia

A

4A’s: autisim, flat affect, associations (loose), ambivalence (difficulty making decisions)

for Delusions & Hallucinations-Antiparkinsonian drugs and antipsychotics

56
Q

Antiparkinsonian Drugs

A
  • Artane
  • Cogentin
  • Symmetrel

Psychology (4 decks)

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