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Mental Health Nursing Exam 2 > WK6: Brains, Drugs, and Nurses > Flashcards

WK6: Brains, Drugs, and Nurses Flashcards

1
Q

syndromes

A

clusters of many symptoms

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2
Q

the cortex is made up of

A

fissures and gyri

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3
Q

the frontal lobe

A

mood and personality

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4
Q

Limbic system function

A

responsible for basic emotions, needs, drives, and instincts

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5
Q

Hippocampus

A

memories

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6
Q

thalamus

A

sensory input (touch, taste, ect)

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7
Q

hypothalamus

A

homeostasis, temperature, hunger

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8
Q

amygdala

A

flight or fight response

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9
Q

Autonomic Nervous System: Neurons

A

Efferent (motor system)

Afferent (sensory)

Sympathetic and parasympathetic nervous system (table 8.1) involved in “fight or flight” response

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10
Q

Neuroplasticity

A

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

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11
Q

Neurotransmitters

A

directly or indirectly control opening or closing of ion channels

exitatory or inhibitory

Types: cholinergic, biogenic amines, amino acid, neuropeptides (table 8.2)

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12
Q

Cholinergic neurotransmitters: Acetylcholine

A

excitatory

greatest concentration in PNS

role in memory and intellectual functioning

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13
Q

Biogenic Amines: Dopamine

A

excitatory; cognition, motor and neuroendocrine functions (figure 8.9); stimulates the “feel good”, reward pathways in the brain

Decreased in parkinsons; increased in schizophrenia

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14
Q

Biogenic amines: Norepinephrine

A

excitatory; mood states (figure 8.10)

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15
Q

Biogenic amines: Serotonin

A

Excitatory

emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite, see figure 8.11

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16
Q

Receptors

A

each neurotransmitter witha sepcific receptor, or protein, for which it and only it will fit (lock nd key)

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17
Q

Risk assessment: Assaultive or homicidal ideation

A

Do you intend to harm someone? Who?

Plan? Details?

Means to carry out plan? Weapon?

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18
Q

Interventions to promote pt safety

A

observation, de-escalation, seclusion, restraints

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19
Q

efficacy

A

ability to produce response

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20
Q

potency

A

drug dose needed for effect

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21
Q

desensitization

A

decrease in drug effects

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22
Q

tolerance

A

gradual decrease in drug action

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23
Q

toxicity

A

drug concentration harmful to body

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24
Q

therapeutic index

A

ratio of maximum nontoxic dose to minimum effective dose

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25
Q

phases of drug treatment

A

initiation, stabilazation, maintenance, discontinuation

26
Q

classes of psych meds

A

antipsychotics, mood stab, antidepressants, antianxiety/sedative-hypnotics, stimulants

27
Q

Antipsychotic Meds: Indications

A

schizophrenia, mania, autism, hallucinations, delusions, disorg. thinking

28
Q

Antipsych meds are metabolized in the

A

liver

29
Q

Excretion of antipsych meds

A

slow; high lipid solubility

30
Q

Typical antipsychotic meds

A

chlorpromazine (thorazine)

prolixinnavane

loxitane

haldol

moban

31
Q

Atypical antipsych meds

A 
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
32
Q

Antipsych meds: side effects

A 
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
33
Q

Antipsych meds: side effects

A 
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
34
Q

Med related Movement Disorders: Dystonia

A

onset w/in a few days on initiating therapy

35
Q

Med related movement disorders: pseudoparkinsonism

A

abrupt or sudden onset w/ in first 30 days of tx

36
Q

Med related movement disorders: akathisia

A

possibly misdiagnosed as agitation or increased psychotic sympts, most difficult of movement disorders to relive

may need more than anticholernigics (betablockers, anxiolytics)

37
Q

Med related movement disorders: Tardive dykinesia

A

long term antipsychotic use

irreversible

38
Q

Gold standard for treatment (mood stabilizers)

A

lithium

39
Q

mood stabilizers

A

lithium

anticonvulsants

atypical antipsychotics

40
Q

Lithium indications

A

mania, depressive episodes of bipolar illness

41
Q

Lithium actions

A

crosses cell membranes, altering sodium trnaport, not protein bounds

42
Q

Lithium therapeutic blood levels

A

0.8 - 1.4 mEq/L

43
Q

Lithium side effects

A

thirst, metallic taste, increase urinary frequency, head tremor, drowsiness

44
Q

Lithium Monitoring

A

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

45
Q

Anticonvulsants

A

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)

46
Q

Lamotrigine (lamictal)

A

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

47
Q

Antidepressant Meds

A

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

48
Q

Serotonin syndrome symptoms

A

Mental status changes
Autonomic instability
Neuromuscular problems: hyperreflexia, incoordination
Nausea, vomiting, diarrhea)

Serotonin syndrome can be life threatening

Discontinuation of medication

49
Q

Antidepressant Meds: SSRIs

A

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

50
Q

Antidepressant Meds: SNRIs

A

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

51
Q

Antidepressant meds: NDRI

A

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

52
Q

Antidepressant meds: TCAs

A

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

53
Q

Tricyclic Antidepressants

A

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

54
Q

Antidepressants: MAOIs

A

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)

55
Q

Antianxiety and Sedative-Hypnotic Meds: Benzodiazepines

A

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

56
Q

Antianxiety and Sedative-hypnotic meds: Nonbenzodiazepine

A

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

57
Q

Antianxiety and Sedative–Hypnotic Medications: Sedative-Hypnotics

A

Benzodiazepines
GABA enhancers
Melatonergic hypnotics
Antihistamines (see Table 11.12)

58
Q

Stimulants and Wakefulness-Promoting Agents

A

Stimulants:
Methylphenidate (Ritalin), dexmethylphenidate (Focalin)
D-amphetamine (Dexedrine), amphetamine/ dextroamphetamine (Adderall)
Lisamphetamine (Vyvanse)

Wakefulness-promoting agents
Modafinil (Provigil)
Armodafinil (Nuvigil) (see Table 11.13)

59
Q

ECT

A

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

60
Q

Other Biologic Treatments

A

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

61
Q

Reasons for non-adherance

A

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

Mental Health Nursing Exam 2 (5 decks)

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