Test 2 Study Guide Flashcards
Neuroleptic Malignant Syndrome (NMS)
- Symptoms- temp above 99.5 for no reason, “leadpipe” muscle rigidity, autonomic hyperactivity, stupor/coma
- 3-9 days or even years after treatment
- Life threatening, rapid progression
- Discontinue antipsychotic immediately
- Cooling blanket and send Pt to ICU
- Occurs in 1% of people on antipsychotics. Acute dopamine reduction plays a role.
- Meds- Parlodel/Bromocriptine (mild) (dopamine agonist); Dantrium/Dantroline (severe) (muscle relaxant)
What are meds to treat Neuroleptic Malignant Syndrome?
- Parlodel/Bromocriptine (mild)
- Dantrium/Dantroline (severe)
How do you treat Schizophrenia?
- Typical antipsychotics- strong dopamine antagonists, affinity for cholinergic, alpha adrenergic, and histaminic receptors
- ->Treats positive symptoms
- ->Can lead to EPS
- Atypicals- weak dopamine antagonists, potent 5HT2A antagonists, antagonism for cholinergic, histaminic, and adrenergic receptors
- ->Treats positive AND negative symptoms
abnormal movements of jaw, face, mouth, choreonic limb movements, lip smacking, tongue rolling, grimacing, blinking, rocking, “pill rolling”; more prevalent with typicals than aytpicals, and is worse with high potency drugs
Tardive Dyskinesia
Extrapyramidal Symptoms
-more prevalent with typicals than atypicals, and worse with high potency drugs
- dystonia- fixed posture of face/extremities, involuntary contractions
- pseudoparkinsonism- resting tremor, shuffling gait, cogwheeling
- akathisia- restlessness, pacing, shifting foot to foot
- akinesia- muscular weakness
- oculogyric crisis- rolling back eyes
- Diphenhydramine (Benadryl): helps with dystonia and oculogyric crisis
- Other anticholinergics for EPS: benztropine/Cogentin; trihexyphenidyl/Artane
How would you treat Tardive Dyskanisia?
benztropine/Cogentin (anticholinergic)
What is the first line of treatment for Anxiety Disorder (AD)
Psychotherapy
What are the phases of a therapeutic nurse-patient relationship?
- Preinteraction Phase
- Orientation (introductory) phase
- Working Phase
- Termination Phase
Pre-Interaction Phase
Prep for encounter with pt by obtaining available info about pt and examining our own feelings about working with that particular pt
Orientation (introductory) Phase
Nurse & client acquainted. Establish trust, rapport, contract for intervention, ID client’s strengths/limitations, nursing diagnoses, set mutually agreeable goals, develop plan of action
Working Phase
Maintain trust and rapport, promote client’s insight, problem-solving, overcome resistance if applicable, continuously evaluating progress towards goal
Termination
-goals may be reached; client may be discharged; end of a clinical rotation.
-Therapeutic conclusion of relationship occurs when
–>Progress has been made
–>Established plan of action for more adaptive coping
Recognized/Explored feelings about termination
Medications for Generalized Anxiety Disorder (GAD):
Anti-anxiety Agents
- Anxiolytics: Benzodiazepines have been used with great success, can be prescribed as needed basis. Risks with benzodiazepine therapy include physical dependence, tolerance and life-threatening withdrawal symptoms (patients should be tapered off)
- Antidepressants: Several antidepressants are effective as major antianxiety agents. TCAs are used less often than SSRIs because their tendency to produce severe side effects. SSRIs dose must be titrated slowly b/c clients appear to be sensitive to the overstimulation.
- Antihypertensive agents: Beta blockers and alpha2-receptor agonists. Appears effective in acute situational anxiety, but not first line drug of choice in panic and GAD.
Medications for Phobias
- Anxiolytics: Benzodiazepines have been successful in the treatment of social anxiety disorder, well tolerated and rapid onset, but b/c potential for abuse are not first line of choice
- Antidepressants: Tricyclic imipramine and phenelzine, a monoamine oxidase inhibitor (MAOI), are effective in diminishing symptoms of agoraphobia and social anxiety. SSRI’s are the first line treatment for social anxiety disorder. Specific phobias are not generally treated with medications, unless accompanied by panic attacks.
- Antihypertensive Agents: Beta-blockers, propranolol and atenolol have been successful with anticipatory performance anxiety (stage fright), that entails symptoms such as sweaty palms, racing pulse, trembling hands, dry mouth, memory loss…beta blockers are very effective in reducing these.
Medications for Obsessive Compulsive Disorder (OCD)
-Antidepressants: SSRIs dosed in excess of what is required for depression may be required to treat OCD. Side effects include sleep disturbances, headache and restlessness, these effects are transient and less troublesome compared to tricyclic. Tricyclic’s efficacy in treating OCD are well established but the adverse effects make it less desirable than taking SSRIs
