n101.test-3.pysch_meds.txt

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n101.test-3.pysch_meds.txt
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N101 psych medications test3
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N101 psych meds for test 3
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  1. Define depression.
    dysphoric or depressed state.
  2. What changes can be a manifestation of depression? (8)
    • (SIG-E-CAPS)
    • Sleep
    • Interest
    • Guilt
    • Energy
    • Concentration
    • Appetites
    • Psychomotor retardation
    • Suicidal ideations
  3. What is endogenous depression?
    Depression that occurs without apparent precipitating cause.
  4. List (7) other uses for antidepressants.
    • Anxiety: doxepin
    • Enuresis: imipramine
    • Chronic pain syndrome: amitriptyline
    • Smoking cessation: bupropion
    • Bulimia: fluoxetine
    • OCD: fluoxetine, sertraline
    • GAD: venlafaxine, paroxetine
  5. What is the general action of antidepressants:
    • Antidepressants prevent the reuptake or breakdown of neurotransmitters.
    • Serotonin
    • Norepinephrine
    • Dopamine
  6. List (6) types of antidepressants.
    • SSRI: Selective Serotonin Reuptake Inhibitor
    • SNRI: Serotonin Norepinephrine Reuptake Inhibitor
    • MAOI: Monoamine Oxidase Inhibitor
    • TCA: Tricyclic antidepressant
    • Tetracyclic: e.g. Mirtazapine (Remeron)
    • Other: e.g. buproprion (Welbutrin)
  7. What are are (5) contraindications to antidepressants?
    • Hypersensitivity
    • Narrow-angle glaucoma
    • Pregnancy
    • Lactation
    • Immediately after MI
  8. What are (6) precautions of antidepressant use?
    • Older clients with cardiovascular disease
    • Elderly with prostate enlargement (urinary retention)
    • Anticholinergic effects may require dosage modifications or d/c
    • Dosage - slow titration
    • Full therapeutic effect may take 3-4 weeks
    • May ↓SZ threshold especially with burpropion (Wellbutrin)
  9. What risk is there when using antidepressants with a suicidal client?
    There is an increased risk of suicide as antidepressants start to work, secondary to an increased energy level.
  10. What are some "red flags" with suicidal clients?
    • Sudden sense of well being
    • Giving away prized objects
  11. What are two classifications of MAO Inhibitors?
    • Hydrazines: phenelzine sulfate (Nardil)
    • Nonhydrazines: tranylcypromine sulfate (Parnate)
  12. What are the pharmacokinetics of MAOIs?
    • Absorbed rapidly from the GI tract
    • Metabolized in the liver into metabolites
    • Excreted mainly in the urine
  13. What are the pharmacodynamics of MAOIs?
    • MAOIs appear to work by inhibiting monoanimine oxidase.
    • Monoanimine oxidase normally metabolizes norepinephrine and serotonin, making these neurotransmitters more available to the receptors.
  14. What are the pharmacotherapeutics of MAOIs?
    • Treatment of choice for atypical depression
    • Used to treat typical depression when other treatments are unsuccessful; phobic anxieties, neurodermatitus, hypochondriasis, refactory narcolepsy
  15. What are some precautions with MAOIs?
    • Tyramine: Hypertensive crisis
    • merperidine (opiod analgesics): hypo- or hypotensive coma or death
    • Hypotensive: Additive effect with antihypertensives or spinal anasthesia
    • Hypoglycemic: additive effect with oral hypoglycemic or insulin
  16. Where is tyramine found?
    • Food
    • TCAs
    • levodopa
    • amphetamines
    • vasoconstrictors
    • sympathomimetric drugs
  17. What foods have tyramines?
    • Red wines - beer - liqueurs
    • aged cheese
    • processed meats - smoked or pickled fish
    • chicken or beef liver pate
    • yeast, yogurt
    • fava beans
  18. What may be used to treat hypertensive crisis?
    phentolalamine (Regitine) - off label use
  19. Describe the first-pass effect.
    • Many oral drugs undergo deactivation and sometimes activation when altered by hepatic metabolism.
    • Alternative routes can bypass the first-pass effect e.g. sublingual, rectal, or parenteral.
  20. What are (4) common TCAs?
    • imipramine hydrochloride (Tofranil)
    • amitriptyline hydrochloride (Elavil)
    • amoxapine (Acendin)
    • nortriptyline hydrochloride (Aventyl, Pamelor)
  21. What are the pharmacokinetics of TCAs?
    • Absorbed completely when PO
    • First-pass effect
    • Metabolized in liver
    • excreted in urine
    • Extremely fat-soluble (long half-life)
  22. What are the pharmacodynamics of TCAs?
    Increases NOR and serotonin by preventing reuptake and storage in presynaptic nerves.
  23. What are the pharmacotherapeutics of TCAs?
    • Treat episodes of major depression
    • Less effective with:
    • .... hypochondriasis
    • .... atypical depression
    • .... depression with delusions
    • Inverstigated for use with:
    • .... migraine headaches
    • .... phobias
    • .... urinary incontinence
    • .... attention deficit disorder
    • .... ulcers
    • .... diabetic neuropathy
  24. What are TCA drug-drug interactions?
    • Many commonly used drugs
    • May prevent therapeutic response to some antihypertensives
    • Additive effect with drugs with anticholineric effects
    • cimetidine (Tagamet) impairs metabolism
  25. What are some adverse reactions with TCAs?
    • Orthostatic hypertension
    • Arrhythmias
    • Sedation
    • Increase risk in the elderly
  26. What is the advantage of SSRIs?
    They have fewer side effects TCAs and MAOIs
  27. List (3) common SSRIs.
    • fluoxetine hydrochloride (Prozac)
    • paroxatine hydrochloride (Paxil)
    • sertraline hydrochloride (Zoloft)
  28. What are the pharmacokinetics of SSRIs?
    • Almost completely absorbed when PO
    • Highly protein bound
    • metabolized in liver
    • excreted in urine
  29. What are the pharmacodynamics of SSRIs?
    Selectively inhibits neuronal reuptake of the neurotransmitter serotonin
  30. What are the pharmacotherapeutics of SSRIs?
    • Treat major depressive episodes.
    • Depending on the SSRI:
    • .... anxiety disorders
    • .... eating disorders
    • .... personality disorders
    • .... impulse control disorders
  31. What are SSRIs drug-drug interactions?
    • Competitively inhibits a liver enzyme that is responsible for the oxidation of numerous drugs.
    • MAOIs: can cause serious and potentially fatal reactions.
  32. What are some adverse reactions with SSRIs?
    • Anxiety
    • Insomnia
    • Sleepiness
    • Palpitations
    • Serotonin Syndrome
  33. What causes Serotonin Syndrome?
    • The excessive accumulation of serotonin.
    • May be due to Rx and/or OTC meds
  34. What are signs and symptoms of Serotonin Syndrome?
    • At least three of the following:
    • .... change in MS
    • .... agitation
    • .... myoclonus
    • .... hyperreflexia
    • .... fever
    • .... diaphoresis
    • .... ataxia
    • .... diarrea
    • May include:
    • .... abdominal pain
    • .... ↑BP
    • .... tachycardia
    • .... ↑ motor activity
    • .... mood changes
    • Severe reactions:
    • .... high fever
    • .... cardiovascular shock → death
  35. List (5) miscellaneous antidepressants.
    • maprotiline hydrochloride (Ludiomil)
    • mirtazapine (Remeron)
    • bupropion hydrochloride (Wellbutrin)
    • venlafaxine hydrochloride (Effexor)
    • trazodone hydrochlorine (Desyrel)
  36. Define bipolar disorder.
    • Mood swings of extreme euphoria and Depression
    • Mania: catecholamine stimulation
    • Depression: diminished catecholamine stimulation
  37. What medications are used to treat bipolar disorder?
    • lithium carbonate (Eskalith)
    • divalproex (Depakote)
    • lamotrigine (Lamictal)
    • Carbamazepine (Tegretol)
    • Oxcarbazepine (Trileptal)
    • Topiramate (Topamax)
    • Tiagabine (Gabitril)
  38. What are the pharmacokinetics of lithium?
    • Absorbed rapidly and completely when PO
    • Distributed to body tissues.
    • Crosses placenta; enters breast milk
    • Not metabolized
    • Excreted unchanged by kidneys
  39. What are the pharmacodynamics of lithium?
    • Regulates catecholamine release in CNS:
    • .... increases NOR and serotonin uptake
    • .... reduces the release of NOR from synaptic vesicles in presynaptic neuron
    • .... inhibits NOR's action in postsynaptic neuron
  40. What are the pharmacotherapeutics of lithium?
    Treatment of acute mania and prophylaxis of recurrance
  41. What are lithium drug-drug interactions?
    • Therapeutic Range (TR): 0.5 - 1.5 mEq/L (narrow)
    • Serious reactions can occur
  42. What are some adverse reactions with lithium?
    • Salt restricted diet can cause toxicity
    • .... vomiting
    • .... diarrhea
    • .... tremor
    • .... muscle weakness
    • .... slurred speech
    • .... decreased coordination
    • .... drowsiness
  43. What are neuroleptics?
    Antipsychotic drugs
  44. What are the pharmacotherapeutics of neuroleptics?
    • Schizophrenia
    • Acute mania
    • Psychotic depression
    • Schizoaffective disorders
    • Drug induced psychosis
    • Children with extreme behavior
  45. What are some off label uses of neuroleptics?
    • agressive, disruptive, and delusional behavior
    • Hallucinations
    • Anxiety
    • Insomnia that sometimes accompanies Alzheimer's disease
  46. What is the action of antipsychotic drugs?
    • Block dopamine receptors; D 1,2,3,4,5
    • D 2,3,4 haave been associated with mental illness
  47. What are the pharmacodynamics of aripiprazole (Abilify)?
    • Dopamine stabilizer
    • .... When dopamine is too low → Abilify enhances it
    • .... When dopamine is too high → Abilify reduces it
  48. What are some adverse reactions of antipsychotic drugs?
    • Most are EPS
    • Treat with anticholinergic meds:
    • .... benztopine (Cogentin)
    • .... diphenhydramin (Benadryl)
  49. What are Extra-Pyramidal Symtoms (EPS)?
    • Dystonia (acute)
    • Pseudo-parkinsonium
    • Akathisia
    • Tardive dyskinesia
    • Neuroleptic Malignant Syndrome (NMS)
  50. What is dystonia?
    • Muscle rigidity and cramping
    • .... stiff neck
    • .... thick tongue
    • .... swallowing issues
  51. What is pseudo-parkinsonium?
    • bradykinesia
    • tremor
  52. What is akathisia?
    • Intense desire to move
    • "Can't stay still"
  53. What is tardive dyskinesia?
    • Permanent involuntary movement
    • .... lip smacking, chewing, tongue protrusion,
    • .... blinking, chorieform limb movements
  54. What is Neuroleptic Malignant Syndrome (NMS)
    • Can be fatal
    • High fever
    • rigidity
    • unstable blood pressure
    • delirium
    • elevated enzymes
  55. What is psychosis?
    A break from reality.
  56. What is meant by positive or negative symptoms?
    • Positive symptoms are thoughts, behaviors, or sensory perceptions present in a person with a mental disorder, but not present in people in the normal population.
    • Negative symptoms are thoughts, feelings, or behaviors normally present that are absent or diminished in a person with a mental disorder.
    • (http://www.minddisorders.com/Ob-Ps/Positive-symptoms.html)
    • (http://www.minddisorders.com/Kau-Nu/Negative-symptoms.html)
  57. What are positive symptoms of psychosis?
    • Hallucinations: can effect any of the senses
    • Delusions: a false or fixed belief.
  58. What are negative symptoms of psychosis?
    • Affect disturbance
    • Anergia
    • Alogia
    • Avolition
    • Ambivalence
    • Anhedonia
  59. What is anergia?
    • A lack of energy
    • (Taber's Dictionary of Medical Terms)
  60. What is alogia?
    • Completely speechless.
    • (Taber's Dictionary of Medical Terms)
  61. What is avolition?
    • "A general lack of desire, drive, or motivation to pursue meaningful goals".
    • (http://en.wikipedia.org/wiki/Avolition)
  62. What is ambivalence?
    Simultaneous opposite feelings regarding something
  63. What is anhedonia?
    Inability to experience pleasure
  64. What is the general action of typical (traditional) antipsychotic drugs and what are they used to treat?
    They block D 2,3,4 dopamine receptors. They are used to treat negative symptoms of schizophrenia and have no effect of positive symptoms
  65. What is the general action of atypical antipsychotic drugs and how are they used?
    • They are weaker D2 dopamine receptor blockers so:
    • .... less risk of EPS
    • .... less risk of TD (Tardive Dyskinesia)
    • They effectively treat positive and negative symptoms
  66. What are the two major groups of typical antipsychotics drugs and their attributes?
    • Phenothiazines: chloropromazine (Thorazine)
    • .... low potency
    • .... high sedation
    • .... low EPS
    • Nonphenothiazines: haloperidol (Haldol)
    • .... high potency
    • .... low sedation
    • .... high EPS
  67. List (6) atypical antipsychotic drugs and their main adverse reactions.
    • clozapine (Clozaril): argranulocytosis, seizures (monitor WBCs)
    • olanzapine (Zyprexa): weight gain
    • aripiprazole (Abilify): anxiety
    • risperidone (Risperdal): can have prolactin issues
    • quetiapine (Seroquel): sedation
    • ziprasidone (Geodon): Q-T wave prolongation
  68. What is/are nursing interventions for dystonic Rxn?
    • Administer medication
    • Reassure client
  69. What is/are nursing interventions for Tardive Dyskinesia?
    Use AIMS scale, report score
  70. What is the AIMS scale?
    Abnormal Involuntary Movement Scale
  71. What is/are nursing interventions for NMS?
    • Stop antipsychotic meds
    • Notify PCP immediately
  72. What is/are nursing interventions for akathisia or EPS?
    • Administer meds as ordered
    • Assess for effectiveness
  73. What is/are nursing interventions for seizures?
    • Protect client from injury
    • Stop meds
    • Notify PCP
    • provide privacy
  74. What is/are nursing interventions for sedation?
    Caution about alert activities (car driving)
  75. What is/are nursing interventions for photosensitivity?
    • Avoid exposure
    • Wear sunscreen
    • Wear protective clothing
  76. What is/are nursing interventions for sexual dysfunction?
    Teach client to inform PCP or impotence or diminished libido
  77. What is/are nursing interventions for weight gain?
    • Encourage balanced diet
    • Encourage regular exercise
    • Focus on minimizing gain
  78. What is/are nursing interventions for anticholinergic effects?
    • Ice chips
    • Sugarless hard candy
    • Should decrease with time, if not notify PCP
  79. What is/are nursing interventions for constipation?
    • Increase fluid
    • Increase dietary fiber
    • May need stool softener
  80. What is/are nursing interventions for urinary retention?
    Teach to report if no improvement
  81. What is/are nursing interventions for orthostatic hypotension?
    • Teach to rise slowly from lying to sitting or standing
    • Do not ambulate until no longer dizzy or light headed.

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