WK6: Brains, Drugs, and Nurses Flashcards
syndromes
clusters of many symptoms
the cortex is made up of
fissures and gyri
the frontal lobe
mood and personality
Limbic system function
responsible for basic emotions, needs, drives, and instincts
Hippocampus
memories
thalamus
sensory input (touch, taste, ect)
hypothalamus
homeostasis, temperature, hunger
amygdala
flight or fight response
Autonomic Nervous System: Neurons
Efferent (motor system)
Afferent (sensory)
Sympathetic and parasympathetic nervous system (table 8.1) involved in “fight or flight” response
Neuroplasticity
ability of the brain to change
compensates for loss of function in specific area
nerve signals may be rerouted
cells can learn a new function
nerve tissues may be regenerated
Neurotransmitters
directly or indirectly control opening or closing of ion channels
exitatory or inhibitory
Types: cholinergic, biogenic amines, amino acid, neuropeptides (table 8.2)
Cholinergic neurotransmitters: Acetylcholine
excitatory
greatest concentration in PNS
role in memory and intellectual functioning
Biogenic Amines: Dopamine
excitatory; cognition, motor and neuroendocrine functions (figure 8.9); stimulates the “feel good”, reward pathways in the brain
Decreased in parkinsons; increased in schizophrenia
Biogenic amines: Norepinephrine
excitatory; mood states (figure 8.10)
Biogenic amines: Serotonin
Excitatory
emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite, see figure 8.11
Receptors
each neurotransmitter witha sepcific receptor, or protein, for which it and only it will fit (lock nd key)
Risk assessment: Assaultive or homicidal ideation
Do you intend to harm someone? Who?
Plan? Details?
Means to carry out plan? Weapon?
Interventions to promote pt safety
observation, de-escalation, seclusion, restraints
efficacy
ability to produce response
potency
drug dose needed for effect
desensitization
decrease in drug effects
tolerance
gradual decrease in drug action
toxicity
drug concentration harmful to body
therapeutic index
ratio of maximum nontoxic dose to minimum effective dose
phases of drug treatment
initiation, stabilazation, maintenance, discontinuation
classes of psych meds
antipsychotics, mood stab, antidepressants, antianxiety/sedative-hypnotics, stimulants
Antipsychotic Meds: Indications
schizophrenia, mania, autism, hallucinations, delusions, disorg. thinking
Antipsych meds are metabolized in the
liver
Excretion of antipsych meds
slow; high lipid solubility
Typical antipsychotic meds
chlorpromazine (thorazine)
prolixinnavane
loxitane
haldol
moban
Atypical antipsych meds
Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify)
Antipsych meds: side effects
Cardiovascular: orthostatic hypotension Anticholinergic Weight gain Diabetes Sexual side effects Blood disorders: agranulocytosis Neuroleptic malignant syndrome Photosensitivity Lowered seizure threshold Medication-related movement disorders -much worse with the “typical” or older meds
Antipsych meds: side effects
Cardiovascular: orthostatic hypotension Anticholinergic Weight gain Diabetes Sexual side effects Blood disorders: agranulocytosis Neuroleptic malignant syndrome Photosensitivity Lowered seizure threshold Medication-related movement disorders -much worse with the “typical” or older meds
Med related Movement Disorders: Dystonia
onset w/in a few days on initiating therapy
Med related movement disorders: pseudoparkinsonism
abrupt or sudden onset w/ in first 30 days of tx
Med related movement disorders: akathisia
possibly misdiagnosed as agitation or increased psychotic sympts, most difficult of movement disorders to relive
may need more than anticholernigics (betablockers, anxiolytics)
Med related movement disorders: Tardive dykinesia
long term antipsychotic use
irreversible
Gold standard for treatment (mood stabilizers)
lithium
mood stabilizers
lithium
anticonvulsants
atypical antipsychotics
Lithium indications
mania, depressive episodes of bipolar illness
Lithium actions
crosses cell membranes, altering sodium trnaport, not protein bounds
Lithium therapeutic blood levels
0.8 - 1.4 mEq/L
Lithium side effects
thirst, metallic taste, increase urinary frequency, head tremor, drowsiness
Lithium Monitoring
Blood levels for toxicity (severe diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination); drug held if symptoms occur
Creatinine concentrations, thyroid hormones, and CBC every 6 months
Renal function (kidney damage possible)
Thyroid function (possible alteration after 6 to 18 months); observation for dry skin, constipation, bradycardia, hair loss, and cold intolerance
Anticonvulsants
Reduce repetitive firing of action potentials in the nerves
Used when patients have not responded to lithium
Examples:
Valproic acid (Depakote), carbamazepine (Tegretol)
Lamotrigine (Lamictal), topiramate (Topamax)
Oxcarbazepine (Trileptal), gabapentin (Neurontin)
Lamotrigine (lamictal)
Side effects: benign skin rash, sedation, blurred or double vision, dizziness, nausea, vomiting, and other gastrointestinal symptoms
***In rare cases, severe, life-threatening rashes occurring within 2 to 8 weeks of treatment; risk highest in children
**Immediately discontinuation if a rash noted
Antidepressant Meds
Initial improvement with some within 7 days; complete relief of symptoms possibly taking several weeks
Slow tapering necessary; antidepressants are not to be discontinued abruptly because of the uncomfortable symptoms that result – and they have different half-lives and, therefore, different tapering schedules
Increased risk of suicidal behavior in children and adolescents – black box warning
Serotonin syndrome from overactivity of serotonin or an impairment of the serotonin metabolism; life-threatening condition
Serotonin syndrome symptoms
Mental status changes
Autonomic instability
Neuromuscular problems: hyperreflexia, incoordination
Nausea, vomiting, diarrhea)
Serotonin syndrome can be life threatening
Discontinuation of medication
Antidepressant Meds: SSRIs
Examples: fluoxetine (Prozac), citalopram (Celexa), escitalopram oxalate (Lexapro), sertraline (Zoloft), Paroxetine (Paxil), fluvoxamine (Luvox)
Action: inhibition of reuptake of serotonin by blocking transport into presynaptic neuron
Side effects: headache, anxiety, insomnia, transient nausea, vomiting, diarrhea, sedation, sexual dysfunction, diastolic hypertension, increased perspiration
Antidepressant Meds: SNRIs
Examples: venlafaxine (Effexor), duloxetine (Cymbalta), desipramine (Norpramin)
Action: prevention of reuptake of norepinephrine and serotonin at presynaptic site
Side effects: similar to SSRIs; increased blood pressure
Antidepressant meds: NDRI
Example: bupropion (Wellbutrin, Zyban)
Action: inhibition of norepinephrine, serotonin, and dopamine
Side effects: agitation or anxiety, insomnia, appetite suppression, psychosis
Can’t give with seizure disorders
Antidepressant meds: TCAs
Action on variety of neurotransmitter systems, including norepinephrine and serotonin reuptake systems (see Table 11.8)
As effective as SSRIs but with more serious side effects and a higher lethal potential
Most TCAs given as a once-daily single dose
If the medication causes sedation, dose given at bedtime
Tricyclic Antidepressants
Examples: amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), amoxapine (Asendin), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protryptyline (Vivactil)
Common side effects: sedation, orthostatic hypotension, anticholinergic side effects (see Table 11.1)
Other side effects: tremors, restlessness, insomnia, nausea and vomiting, confusion, pedal edema, headache, seizures, blood disorders
Antidepressants: MAOIs
Examples: phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam)
Action: inhibition of MAO increased serotonin and norepinephrine activity in the synapse
Side effects: dizziness, headache, insomnia, dry mouth, blurred vision, constipation, nausea, peripheral edema, urinary hesitancy, muscle weakness, forgetfulness, weight gain, sexual dysfunction
Hypertensive crisis: interaction with tyramine-rich foods and certain medications
Many food and medication restrictions needed (see Table 11.10)
Antianxiety and Sedative-Hypnotic Meds: Benzodiazepines
Examples: alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium), flurazepam (Dalmane), triazolam (Halcion), oxazepam (Serax)
Side effects: drowsiness, intellectual impairment, memory impairment, ataxia, reduced motor coordination, sedation, “hangover” effects; tolerance or psychological dependence
Increased CNS depression with alcohol
Abrupt discontinuation possibly leading to recurrence of the target symptoms (rebound insomnia or anxiety) and seizures
Antianxiety and Sedative-hypnotic meds: Nonbenzodiazepine
Example: buspirone
Effective for treating anxiety disorders without the CNS-depressant effects or the potential for abuse and withdrawal syndromes
Side effects: dizziness, drowsiness, nausea, excitement, headache
Antianxiety and Sedative–Hypnotic Medications: Sedative-Hypnotics
Benzodiazepines
GABA enhancers
Melatonergic hypnotics
Antihistamines (see Table 11.12)
Stimulants and Wakefulness-Promoting Agents
Stimulants:
Methylphenidate (Ritalin), dexmethylphenidate (Focalin)
D-amphetamine (Dexedrine), amphetamine/ dextroamphetamine (Adderall)
Lisamphetamine (Vyvanse)
Wakefulness-promoting agents
Modafinil (Provigil)
Armodafinil (Nuvigil) (see Table 11.13)
ECT
Use: severe depression; mania and schizophrenia when other treatments have failed
Generalized seizures initiated by electrical current
Procedure repeated two or three times per week (total, six to 12 treatments)
Rapid relief of depressive symptoms (see Box 11.5)
Side effects
Hypo- or hypertension, bradycardia or tachycardia, minor arrhythmias, headache, nausea, muscle pain immediately afterward
Memory loss for months afterward
Other Biologic Treatments
Light therapy (phototherapy)
Circadian rhythms reset
Used for seasonal depression
Transcranial magnetic stimulation (TMS)
Alternative to ECT in managing symptoms of depression
Vagus nerve stimulation (VNS): adjunct for severe depression in adults unresponsive to four or more adequate antidepressant treatments; permanent implant
Reasons for non-adherance
Side effects (most common reason)
Lack of awareness or denial of illness
Stigma
Feeling better – also a common reason for stopping meds
Confusion about dosage or timing
Difficulties in access to treatment
Substance abuse
Psychoeducation for improvement in adherence
