psych final Flashcards
1
Q
Akathisia
A
(EPS)
restlessness, inability to sit still, motoric hyperactivity
within 1-6 weeks
2
Q
Artane (trihexyphenidyl)
A
For treatment of EPS
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)
4
Q
Cogentin (benzotropine)
A
Treatment of EPS
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
4
Q
EPS
A
Acute dystonic reactions (tonic contraction of muscles in mouth and torso)
Parkinsonian reactions
Akathisia
Tardive Dyskinesia
NMS
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
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
6
Q
Parkinsonian Reaction
A
rigid expressions, shuffling gait, cogwheel rigidity
within 1-4 wks
Drugs to prevent = Artane, Cogentin, Amantadine
7
Q
Prolixin
A
- med for schizophrenia-traditional anti-psychotic (blocks dopamine receptors in the brain)
- expect high EPS, low anticholinergic
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
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
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 )
9
Q
Zyprexa (olanzapine)
A
- Atypical antipsychotic
- most likely to cause hyperglycemia and weight gain
- takes 1 week to reach steady state
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
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.
12
Q
Antianxiety drugs for Bipolar Disorder
A
Klonopin
Ativan
for treatment of acute mania in some pts resistant to other meds
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)
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
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:
- Crash (4 days-anxiety, depression, anergia, paranoia, peak cravings)
- Prolonged Dysphoria (anhedonia, lack of motivation, intense cravings, relapse most likely)
- Intermittent Craving (support groups helpful)
15
Q
Dissociative Disorders
A
- altered mind-body connection
- distubances in consciousness, memory, identity and perception.
- unconsciousdefense mechanism-rare
ThreeTypes:
- Depersonalization (persistant alteration in self perception; feeling surreal; robot like.
- Dissociative Amnesia and Fugue (sudden travel away from usual location) precipitated by traumatic event.
- Dissociative Identity Disorder-long term therapy needed, rare, 2+ personality states; dissociationg is coping mechanism.
15
Q
Depakote
(Valproic Acid)
A
anticonvulsant
useful for bipolar non-respondant to lithium
monitor liver function, platelet count
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
Neuroleptic Malignant Syndrome
- 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
Healthy Defense Mechanisms
- **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
Intermediate Defense Mechanisms
- **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
Immature Defense Mechanisms
- **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
Lamictal
anticonvulsant
first line treatment for bipolar depression
may cause potentially life-threatening rash-Steven Johnson syndrome
23
Lithium carbonate
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
MAOI's
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
Meds for Anxiety
- 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
Neurotransmitters related to altered mood states
serotonin
norepinephrine
28
Mood Stabilizers
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
Psychostimulants
- 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
Stages of Alzheimers
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
Stimulants
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
Substance Abuse
vs. Dependence
**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
Symptoms of Alzheimers
* 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
TCA's
(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
Tegretol
(carbamazepine)
anticonvulsant
used in bipolar-pts with rapid cycling (4+ in one year)
39
Wernicke's Korsakoff Syndrome
- 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
Alzheimers Disease
- 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
CAGE
- **C**ut down? (feel need to)
- **A**nnoyed by others criticizing your drinking?
- **G**uilty feelings about your drinking?
- **E**ye openner needed?
1=possible problem
2=probable problem
42
Chemical Restraints
Haldol
Ativan
44
Depression in the Elderly
* 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
Drugs for Alcohol Abstinence
**-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
Nicotine Withdrawal
- patch/gum, taper after 4-6 wks
- Buproprion (Zyban, Wellbutrin)-non-nicotine replacement therapy
- Clonidine (anti-hypertensive), nortriptyline (TCA)-second line
48
Normal Aging Changes
* 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
Opiates & Opioids
- 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
Risk Factors for Alzheimers
* 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
SSRI's
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
Toxic Psychosis
- 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
Meds for ADD/ADHD
* Dextroamphetamine
* Ritalin
* Cylert
55
Schizophrenia
4A's: autisim, flat affect, associations (loose), ambivalence (difficulty making decisions)
for Delusions & Hallucinations-Antiparkinsonian drugs and antipsychotics
56
Antiparkinsonian Drugs
- Artane
- Cogentin
- Symmetrel
