Unit 2 Neurobiology and Pharmacotherapy Chapter 3 Flashcards
What is the function of Serotonin (Hormone) (TRIPPLE S))
Plays role in
*sleep regulation,
* sexual function,
*hunger,
* mood,
*pain
- Plays a role in aggression
- 90% in the gut – GI side effects
What occurs when there is low levels of Serotonin?
A. Libido increase
B. Depression
C. Adequate appetite
D. Increased sensation to pain
B. Depression
Sx sleep disturbance, change in
appetite, mood, motivation alterations in sexual function
Function of Dopamine (Hormone)
Pleasure
*Involved in fine motor movement *Involved in integration of emotions and thoughts
*Involved in decision making
*Stimulates hypothalamus to release hormones
What occurs when there is low dopamine?
A. Parkinsons disease
B. Sexual libido
C. Increased appetite
D. Decreased sensation to pain
A. Parkinsons disease
Decrease:
Parkinson’s disease Depression
Increase: Schizophrenia Mania
Function of Norepinephrine(Hormone)
*Level in brain affects mood
*Attention and arousal
*Stimulates sympathetic branch of
autonomic nervous system for “fight or flight” in response to stress
What occurs when there is low Norepinephrine?
A. Parkinsons disease
B. Sexual libido
C. Depression
D. Decreased sensation to pain
C. Depression
Too much Norepinephrine – Anxiety(overstimulated), Schizophrenia, Mania
- Too little Norepinephrine – Depression
What occurs when there is a lot of Norepinephrine?
A. Anxiety
B. Sexual libido
C. Depression
D. Decreased sensation to pain
A. Anxiety
Too much Norepinephrine – *Anxiety(overstimulated), *Schizophrenia,
* Mania
Function of γ-aminobutyric acid (GABA)(off switch , relaxant)
- Plays a role in inhibition(a feeling that makes one self-conscious and unable to act in a relaxed and natural way.)
- Reduces aggression, excitation and anxiety
- Has anticonvulsant and muscle-relaxing properties
- May impair cognition and psychomotor functioning
What occurs when there is low γ-aminobutyric acid (GABA) ?
A. Anxiety
B. Sexual libido
C. Depression
D. Decreased sensation to pain
A. Anxiety
*Decrease:
*Anxiety
*Schizophrenia Mania
*Huntington’s disease
What occurs when there is an increase of γ-aminobutyric acid (GABA)
A. Reduction of Anxiety
B. Sexual libido
C. Depression
D. Decreased sensation to pain
Increase:
Reduction of anxiety
Function of Glutamate
*Excitatory
*AMPA plays a role in learning and memory
What occurs when there is low GAMA ?
A. Reduction of Anxiety
B. Sexual libido
C. Psychosis
D. Decreased sensation to pain
Decrease (NMDA):
Psychosis
What occurs when there is high GAMA?
A. Neurodegenration in Alzheimers disease
B. Sexual libido
C. Psychosis
D. Decreased sensation to pain
A. Neurodegenration in Alzheimers disease
Increase (NMDA):
Prolonged increased state can be neurotoxic
Neurodegeneration in Alzheimer’s disease
Increase (AMPA):
Improvement of cognitive performance in behavioral tasks
Which on of the Diagnostic exams can visualize blood blow to the brain?
A. Positron emission tomography(PET)
B.Computed tomography (CT)
C. Magnetic resonance imaging (MRI)
D.Electroencephalography (EEG)
A. Positron emission tomography(PET)
FUNCTION - SHOWS ACIVITY OF BRAIN
Can also detect..
*Oxygen utilization
*Glucose metabolism
*Blood flow
*Neurotransmitter-receptor interaction
Which of the following drugs are high contradicted due to a persons’s race and genetic factor?
A. Carbamazepine
B. Acetychloine
C. Valproate Acid
D. Fluoxetine
Pharmacogenetics – different genetics can lead to different
responses to meds..
- Carbamazepine (Tegretol) & Asian decent
- Life threatening Stephen Johnson Syndrome
You are a nurse is working on an interdisciplinary team of an elderly patient diagnosed with anxiety. What is the biggest nursing consideration when administering Benzodiazepines
respiratory depression
What order from the health care provider should the nurse question?
A. acetaminophen 400mg PRN
B. Diazepam 100MG Q2HR
C. Pancreatic enzymes shrinkled on food
D.Folic acid 0.4mg q.d
B. Diazepam 100MG Q2HR
Benzodiazepines should be prescribided due to CNS depression affects
- respiratory depression
-orthostatic hypotension
-low blood pressure
-sedation
Which of the following drugs are best indicated for an older adult patient who has previous substance abuse disorder and anxiety?
A. Buspirone
B. Ativan
C. Naloxone
D. Hydromorphone
A. Buspirone
- Reduces anxiety w/o strong sedative
effect - No risk for addiction or dependence
- Scheduled not PRN
- Not a CNS depressant
Your patient with anxiety doesn’t understand why he cannot drink alcohol while he’s on his anti-anxitey medications. What is the best teaching by the nurse?
A. Alcohol will increase his risk for thrombocytopenia while on this medication.
B. When anti- anxiety medications are combined with other CNS depressants like alcohol it can lead to life threatening respiratory depression.
C. Folic acid can be dangerous with this medication as well
D. Alcohol can cause life treating hypertension
B. When anti- anxiety medications are combined with other CNS depressants like alcohol it can lead to life threatening respiratory depression.
Combined w/other CNS
depressants (alcohol, TCAs,
opiates) can lead to life-
threatening CNS depression
“Antianxitey medications like benzodiazepines combines with other benzodiazepines or alcohol or antidepressants can lead to LIFE THREATENING CNS DEPRESSION
Are Benzo’s easily abused and do patients get easily dependent on them?
A. Yes
B. No
Promote GABA
* Risk for abuse and dependence
* Inhibit Neurons = useful as
anticonvulsant
* Alone – Rarely inhibit the brain
to respiratory depression
* Combined w/other CNS
depressants (alcohol, TCAs,
opiates) can lead to life-
threatening CNS depression
* Interfere with motor ability,
attention, judgement
Which medication is contradicted for combined use with a benzodiazepine?
A. Zolpidem
B. Amitriptyline.
C. Melatonin
D. Doxepin
B. Amitriptyline.(TCA Medication -Antidepressant)
*Benzo’s Combined w/other CNS
depressants (alcohol, TCAs,
opiates) can lead to life-respiratory depression
Your patient who has been diagnosed with insomnia tells you he takes zolpidem right before picking his children from school to reduce driving anxiety. What is the nurses priority action?
A. Educate the patient that a hypnotic like zolpidem should be taken right before bed and not while handling machinary due to sedation factors.
B. The patient can take this medication anytime of the day because the effect is not rapid or onset.
C. The patient may be confused and should be admitted to a psychiatric facility.
D. The patient must be reported to the police due to recklessness in driving.
A. Educate the patient that a hypnotic like zolpidem should be taken right before bed and not while handling machinary due to sedation factors.
Sedative effects without antianxiety,
anticonvulsant or muscle relaxant effects
* Potential for amnestic and ataxic side effects
* Onset of action is fast – take when ready for
sleep
* Tolerance and dependence is less that Benzos
* Reports of sleepwalking, eating and driving w/o
awareness
Zolpidem (Ambien)
* Zaleplon (Sonata)
* Eszopiclone (Lunesta)
Which of the following medications that induce sleep has the lowest chance or abuse or no dependance?
A. Melatonin
B. Zolpidem
C.Zalepon
D. Eszopiclone
A. Melatonin
- malexatonin lacks potential abuse
What is the common side effect of hypnotics that should be reported?
A. Sedation
B. Sleepwalking
C. sinus rhythm
D.Eupnea
B. Sleepwalking
- Reports of sleepwalking, eating and driving w/o
awareness
*Ataxia describes poor muscle control that causes clumsy voluntary movements.
*Amnesia refers to the loss of memories, including facts, information and experiences.
Can Doxepin be used with Phenelizine?
A. Yes
B. No
B. No
use -Insomnia – difficulty maintaining sleep
Doxepin is an old Tricyclic antidepressant and cannot be used with MAOI drugs or pts with urinary incontinence
Avoid other CNS depressants and sedating
meds like antihistamines
Suvorexant (Belsomra
locks orexin – suppresses wakefulness
* Precautions: Daytime sleepiness, abnormal thinking
and behavior changes, worsening depression and S/I,
Sleep paralysis
SSRI antidepressant , less side effects than Tricyltic antidepressants
Blocks the reuptake of Serotonin
making more available
* 1st line tx, less anticholinergic and
sedating SE than tricyclic
antidepressants (previous 1st line)
* Antianxiety effects
* Good efficacy lower SE profile
* SE – low libido, GI upset, nausea,
vomiting (90% of serotonin in gut)
-Paroxetine (Paxil) – most
anticholinergic of the class.
Not
for patients who are
contraindicated for
anticholinergics (ex: narrow
angle glaucoma
You are educating your 24 year old male patient on the Importance of being compliant with taking Paroxetine(SSRI Antidepressant. He is sexually active. What teaching would best educate the patient on the side effects of this medication?
A. There would be little to no adbonimal side effects associated with this medication
B. Inform the patient that one of the side effects of the medication is low libido and GI upset.
C. This medication can be used for Narrow angle glaucoma due to its anticholongeric affects
D. This medication increases sexual libido
B. Inform the patient that one of the side effects of the medication is low libido and GI upset.
Side effects –
*low libido,
*GI upset,
*nausea,
*vomiting (90% of serotonin in gut)
You are educating your 24 year old male patient on the Importance of being compliant with taking Mirtazapine(Tricyclic antidepressant . He is sexually active. What teaching would best educate the patient on the side effects of this medication?
A. This antidepressant has less affects on sexual libido
B. This medication has the same effect as Paroxetine.
C. This medication has induced weight loss.
D. This medication has more Gi side effects than paroxetine
A. This antidepressant has less affects on sexual libido
Mirtazapine(Norepinephrine and Serotonin Specific
Antidepressant)
- Mirtazapine (Remeron)
- Antianxiety and antidepressant effects
- Minimal sexual dysfunction
- Improved sleep
- Fewer GI SE
- Common SE – s
*edation,
*appetite stimulation(INCREASE HUNGER) and
*weight gain
NDRI (Norepinephrine Dopamine Reuptake
Inhibitor)?
A. Paroxeine
B.Bupropion
C.Mirtazpine
D. Haloperidol
B.Bupropion
Side effects of Buproprion(NDRI (Norepinephrine Dopamine Reuptake
Inhibitor)
A. weight loss and no sexual dysfunction
B.
Bupropion (Wellbutrin)
* Bupropion (Zyban) – Smoking cessation
* No sexual side effects
* SE – Insomnia, tremor, anorexia, weight loss
- Contraindicated – Seizure disorder, bulimia or anorexia or
those who are discontinuing the use of Alcohol or sedatives
(benzos included)
Your sexually active patient who has been diagnosed with anorexia and depression is asking the healthcare provider which medication would be best for him. Which of the following prescription should the nurse question?
A. Buproprion
B. Mirtazapine
C. Benadryl
D. Keterolac
A. Buproprion
- Contraindicated –
*Seizure disorder,
*bulimia or anorexia or
*those who are discontinuing the use of Alcohol or sedatives
(benzos included)
Sideffects–
*Insomnia,
*tremor,
*anorexia,
*weight loss
SARI Serotonin Antagonist and Reuptake
Inhibitors
- Tx of Depression that accompanies Schizophrenia
- SE to watch for akathisia-move a lot , weight gainSerotonin Antagonist and Reuptake
Inhibitors - Nefazodone (Serzone)
- Most common SE – Sedation, headache, fatigue, dry mouth, nausea,
constipation, dizziness and blurred vision. - Weight gain and sexual dysfunction are minimal
- Caution – Life threatening liver failure – DO NOT give to those with liver problems
- Trazodone (Desryl)
- Common SE – Sedation, dizziness and orthostatic hypotension, anticholinergic
effects (priapism) - Brexpiprazole (Rexulti)
- Tx of Depression that accompanies Schizophrenia
- SE to watch for akathisia, weight gai
Serotonin Modulator and Stimulator
Vortioxetine (Trintellix)
* Geriatric patient may experience cognitive improvement
* Common SE – Constipation, nausea and vomiting.
* More serious side effects - hyponatremia and rarely
hypomania/mania
Serotonin Norepinephrine Reuptake
Inhibitors SNRI
Venlafaxine (Effexor)
* Desvenlafaxine (Pristiq)
* Duloxetine (Cymbalta)
* Therapeutic effects on Neuropathic pain- Diabetic pt’s
* Tx depression and Anxiety
Tricyclic Antidepressants (TCA)
Were 1st line prior to the development of SSRIs
* Longer to reach therapeutic effects
* Lethal in overdose
* More side effects
* Anticholinergic SE – dry mouth, blurred vision, tachycardia,
urinary retention and constipation
* Sedation and drowsiness
* Cardiotoxic
Which of the following drug antidepressant drug classes is cardiotoxic and can lead to a lethal overdose?
A. SNRI
B.MAOI
C.TCA
D.SSRI
C.TCA
Were 1st line prior to the development of SSRIs
- Longer to reach therapeutic effects
- Lethal in overdose
- More side effects
- Anticholinergic SE – dry mouth, blurred vision, tachycardia,
urinary retention and constipation - Sedation and drowsiness
- Cardiotoxic
Which of the following drug antidepressant drug classes can cause hypertensive crisis if tyramine food is in indulged while on medication?
A. SNRI
B.MAOI
C.TCA
D.SSRI
B.MAOI
Drugs-phenelzine,isocarboxazid, tranylcypromine
Dietary restrictions
* No Tyramine
* Aged cheeses,
*pickled or smoked fish and wine
- Can produce significant vasoconstriction – threat of hypertensive crisis
What are the signs and symptoms of Hypertensive crisis?
A. Hypertension
B. Bradycardia
C. Neuropathic pain
D. Clubbing nails
A. Hypertension
Foods that are contraindicated for MAOI(Monoamine Oxidase Inhibitors (
- No Tyramine
- Aged cheeses,
*pickled or smoked fish and wine
*Meats that are fermented, smoked, or otherwise aged; spoiled meats; liver, unless very fresh
*Protein dietary supplements; soups (may contain protein extract); shrimp paste; soy sauce
What medication should a patient avoid white taking Phenelize(MAOI) due to the risk of serotonin syndrome?
A. Paroxetine
B. Benadryl
C. Aspirin
D. Tylenol
A. Paroxetine
MAIO should be avoided with buspirone and SSRI due to serotonin syndrome
-Medications that enhance serotonin (e.g., SSRIs, buspirone) should be avoided with MAOIs due to the risk of serotonin syn- drome.
What should you asses first before administering a TCA antidepressant to a patient?
A. Suicidal status
B. Safety of home
C. Hygiene status
D. Congruency of words spoke
A. Suicidal status
(Drug-Amtriptyline)
The TCAs block sodium channels on the heart, and an over- dose can be fatal secondary to cardiac conduction disturbances. Therefore, provide TCAs to suicidal patients only with great caution and for the smallest quantity possible to minimize over- dose risk.
Your eastern patient has a family history of using herbs especially ginseng. They have been clinically diagnosed with depression. They have been prescribed Phenelize. What statement by the nurse requires intervention?
A. “Since your preferred foods is mainly ginseng you drink any herbal or vitamin without notifying your health care provider.
B. When ever you are prescribed a pharmencuetical drug it may have many interactions with other drugs.
C. You cannot use Phenelize with oral decongestants.
D. While on this medication you will have to give up wine.
A. “Since your preferred foods is mainly ginseng you drink any herbal or vitamin without notifying your health care provider.
MAOI - PHENELIZE
NURSING CONSIDERATIONS
Lots of drug interactions
* Other antidepressants
* Oral decongestants
* Very important to teach patient about dietary restrictions and
medications to avoid
* Good rule of thumb – never take any medication, vitamin or herbal
supplement without speaking to Dr.
Which of the following medications are used to treat bipolar disorder?
A. Amtriptline
B. Paroxetine
C. Lithium
D. Busporpion
C. Lithium
Which of the following lab value will prevent the nurse from administering Litium? SELECT ALL THAT APPLY
A. Blood urea nitrogen 45
B. Creating 0.9
C. WBC 6,000
D. Platelet 400,000
E. NA+ 100
A. Blood urea nitrogen 45
E. NA+ 100
BUN-10-20
Creatinine-0.6-1.2(male)
0.5-1.1(women)
Lithium Narrow therapeutic index? According to Galen
0.5-1.2
Lithium cont.
* Narrow therapeutic range
* Requires follow blood draws and monitoring
AST LAB KNOW THIS FOR VALPROATE
35
What are pt’s at risk for when taking Lithium
Risk for fluid imbalances (potassium and sodium)
Symptoms:
polyuria,
edema
- Maintain their fluid and Na+ intake
- Hyponatremia can lead to lithium toxicity
Acne, alopecia, psoriasis
Digestive
Diarrhea, nausea, vomiting
Endocrine
Hypothyroidism, weight gain
Fluid and electrolyte
Edema, polydipsia, polyuria
Nervous and musculoskeletal
Ataxia-no rhyme or movement coordination, sedation, fine tremor
You have a female patient who is at the age of conception , who has a history of seizures. What is the primary test you suspect the health care provider to prescribe?
A. Genetic testing
B. Pregnancy test
C. EKG
D. PEG
B. Pregnancy test
BEFORE ADMINISTERING ANTICONVULSANTS
A pregnancy test in women of childbearing age is necessary before starting treat- ment due to the risk of serious birth defects (e.g., spina bifida).
Common adverse effect of Valproate that can eventually lead to stroke.
A. weight gain
B. Sedation
C. Hepatic faiure
D. Thrombocytopenia
D. Thrombocytopenia
- Tx mixed episodes and rapid cycling
- SE – tremor, wt gain, sedation
- Adverse –
*Thrombocytopenia, - pancreatitis,
*hepatic failure, &
*Birth defects
is Valproate toxic to liver
A. Yes
B.No
A. Yes
Priority teaching for administering Carbamazepine to a patient with asian descent?
- FDA requires genetic testing of anyone who is of Asian descent
- Tx acute mania
- SE – anticholinergic effects, orthostasis, sedation and ataxia
- Rash –report immediately Stevens-Johnson syndrome (life threatening)
Lamotrigine
- Treatment-Maintenance Therapy, Bipolar Depression,
- Congruent use with Depakote = double blood level of lamotrigine
- Report Rash immediately (Stephens-Johnson syndrome)
- Significantly decrease the risk of Stephens-Johnson syndrome – start low and increase
slowly
TYPICAL-1st Generation Antiphycotics USE
TOO MUCH DOPAMINE-Psychotic symptoms
s/s
* Anticholinergic side effects
* Drop in BP, orthostatic hypotension
* Sedation
* Weight Gain
Dopamine plays a role movement regulation
* SE can include muscle/motor abnormality
* Extrapyramidal Symptoms (EPS), Dystonia,
Parkinsonian, Tardive Dyskinesia,NMS
* Monitor for Involuntary Movements (AIMS
What falls under extrapyramidal symptoms (EPS
Different types of EPS include acute dystonic reactions, akathisia, parkinsonism, and tardive dyskinesia. Acute dystonia, akathisia, and parkinsonism develop over days, weeks, or months of treatment, whereas tardive dyskinesia develops over months to years of treatment. Tardive dyskinesia may be irreversible even after antipsychotic discontinuation.
Is Tardive dyskinesia reversible or irreversible?
irreversible
Tardive dyskinesia may be irreversible even after antipsychotic discontinuation.
S/s
-rolling tongue
-sucking , soaking movements of lips
-chewing motion
-involuntary movement of bodies and extremities
S/s of neuroleptic malignant syn- drome (NMS)
While rare, NMS is potentially life-threatening and requires immediate treatment.
Symptoms include
*muscle rigidity,
* altered mental status, *hyperthermia(sudden fever), and *abnormalities in autonomic nervous system functioning (e.g., blood pressure and heart rate fluctuations, rapid breathing).
Continued effects that Ist gen Antipsych meds cause men and women
Increased Prolactin Secretion
* Amenorrhea - women(No period
* Galactorrhea – men and women(milk production in breast)
* Gynecomastia - men(male breast production
ATYPICAL- 2nd Generation Anipych meds
less EPS symptoms
Increased risk for metabolic syndrome
* Increased weight, blood glucose and triglycerides
* Highest risk in the class – Clozapine, olanzapine
* Lowest risk in the class – aripiprazole and ziprasidon
Which of the following lab values the nurse should report, When a pt is taking an Atypical antipsychotic medication (Metabolic syndrome)?
A. Blood glucose 140
B. BMI from 26.4-23.2
C.HDL 500
D. Triglycerides 100
A. Blood glucose 140
TRIGLYCERIDES
Male: 40-160 mg/dL
Female: 35-135 mg/dL
HDL
Male: > 45 mg/dL
Female: > 55 mg/dL
LDL
< 130 mg/dL
Blood glucose 70-110
Normal Blood glucose
70-110
Normal Triglycerides
40-160(M)
35-135(W)
Normal BMI
18.5-24.5
Normal High density lipoproteins
more than 45(M)
more than 55(W)
Normal Low density lipoproteins
less than 130 (both men and women)
Which pt is more capable of getting Metabolic syndrome, following the use of an Atypical antipsychotic?
A. Diabetic patient
B. Patient with schizophrenia
C. patient with chronic coronary artery disease
D. Patient with anxiety
A. Diabetic patient
2nd generation Atypical dugs
- Clozapine (Clozaril)
- Can induce convulsions
- Potentially fatal SE – suppress bone marrow, agranulocytosis
- Risperidone (Risperdal) – available in long-acting injection
- Low potential for agranulocytosis or convulsions
- Highest risk of EPS of 2nd Gen class
- SE – Sexual dysfunction, weight gain, sedation, orthostatic hypotension
(caution in older adult) - Quetiapine (Seroquel)
- High risk of sedation – commonly Rx for sleep
- Moderate risk for wt gain & metabolic syndrome
- Risk of orthostatic hypotension
- Olanzapine (Zyprexa) - available in long-acting injection
- Risk for sedation, wt gain, hyperglycemia, new onset type 2 diabetes higher
risk for metabolic syndrome
. Which second-generation antipsychotic requires routine
absolute neutrophil count monitoring?
a. Brexpiprazole
b. Clozapine
c. Risperidone
d. Ziprasidone
b. Clozapine
Herbal treatment considerations
*Herbal treatments have interactions with prescription drugs
*While many have been studied and some show positive results, many herbals continue to lack adequate safety and efficacy data.
*Lack of regulation by the FDA is also a major concern. Studies have shown that herbals may not always contain the active ingredient displayed on the label (Brown, 2017).
What are 2 reasons why a patient may choose a herbal treatment rather than a pharmaceutical treatment?
*If patients have experienced a lack of substantial benefit with prescription medicine, they may turn to herbal treatments.
*Herbals may also be less expensive.
*Patients choose herbal treatments for a variety of reasons. They may believe that herbals are safer than prescription medications or have fewer side effects and interactions.
What cognitive ability is affected with a patient with Alzheimers disease?
A. Ability to walk
B. Ability to remember
C. Ability to enact activities of daily life
D. Ability to speak
B. Ability to remember
Much of the memory loss in Alzheimer’s disease has been attributed to insufficient acetylcholine.
Insufficient Acetylcholine (Neurotransmitter)
* Essential for mood regulation, behavior, memory, learning
* Meds – Cholinesterase Inhibitors
– Cholinesterase is the
enzyme that breaks down Acetylcholine, leave more Acetylcholine available in the body.
