Exam 1 Flashcards
(81 cards)
1
Q
Med classes used for anxiety?
A
Anti-anxiety + hypnotics
2
Q
Are benzos used short term or long term?
A
Short
3
Q
You can experience seizures as a SE with benzos if what 2 things occur?
A
Withdrawal, ETOH use :(
4
Q
Nursing safety considerations with benzos?
A
Safety, cognition, interactions with other meds, driving
5
Q
Other meds used for anxiety (4)?
A
- Buspirone (BuSpar)
- Antidepressants
- Short-acting sedative hypnotic sleep agents
- Melatonin
6
Q
What NT do short-acting sedative hypnotic sleep agents work on?
A
They act on gaba
7
Q
Nursing safety considerations with short-acting sedative hypnotic sleep agents?
A
Be mindful of patient using other sleep meds (additive effects), dx of sleep apnea
8
Q
What are mood stabilizers?
A
Medications to treat dramatic shifts in emotions, moods, and energy levels
9
Q
What’s the main mood-stabilizer used?
A
Lithium
10
Q
What is the big safety issue with Lithium?
A
Narrow therapeutic index; checking levels very important!
11
Q
Med class often used to treat bipolar?
A
Anticonvulsants
+ mood stabilizers!
12
Q
Name some common anticonvulsants used to treat bipolar (4):
A
- Depakote
- Tegretol (carbamazepine)
- Lamictal (lamotrigine)
- Valproic acid
13
Q
Main patient education for a patient on anticonvulsants?
A
Watch for warning signs of SJS!
14
Q
Re: Antidepressants. How do SSRIs work?
A
Make more serotonin available
15
Q
Name 4 common SSRIs:
A
- Paxil
- Zoloft
- Lexapro
- Prozac
16
Q
Re: Antidepressants. How do SNRIs work?
A
They are a step up from SSRI - more serotonin AND norepi available
17
Q
Name 2 common SNRIs:
A
- Effexor (venlafaxine)
* Cymbalta (duloxetine)
18
Q
Which antidepressant is used to not only treat major depressive disorder, but also stimulate appetite?
A
Mirtazapine (Remeron)
“It has been reported to also stimulate appetite and/or increase body weight, which may be beneficial in certain patient populations such as the elderly.”
19
Q
_____________ act on all NTs.
A
Tricyclic antidepressants
20
Q
Name 2 Tricyclic antidepressants:
A
- Pamelor (nortriptyline)
* Elavil (amitriptyline)
21
Q
Which meds ease depression by inhibiting the activity of one or both monoamine oxidase enzymes?
A
Monoamine oxidase inhibitors (MAOIs)
22
Q
Name a common MAOI used as an antidepressant?
A
Parnate (tranylcypromine)
23
Q
2 other common meds used for depression (NOT SSRIs or SNRIs):
A
- Wellbutrin
* Trazodone
24
Q
What is psychosis?
A
Psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality.
25
1st gen/typical antipsychotics decrease which NT?
Dopamine
26
SE of 1st gen/typical antipsychotics?
EPS + tardive dyskinesia
27
Example(s) of 1st gen/typical antipsychotic?
Haldol (haloperidol)
28
Examples of 2st gen/atypical antipsychotic (2)?
* Clozapine
| * Risperiodone
29
SE/safety consideration with Clozapine?
Agranulocytosis → infection risk
30
Examples of antipsychotics that decrease symptomatology w/o effects on movement (3)?
* Zyprexa (olanzapine)
* Geodon (ziprasidone)
* Abilify (aripiprazole)
31
SE/safety considerations with antipsychotics that decrease symptomatology w/o effects on movement? What labs might you run to keep an eye on this?
Can cause hyperglycemia, increased appetite → need frequent metabolic labs
32
First line/gold standard (for post school-age children) ADHD meds?
STIMULANTS!
33
Common stimulant SE (5)?
* Appetite changes (anorexia)
* Alterations in anxiety
* Zombie-like affect
* Insomnia
* HA
34
What effect do stimulants have on folks with ADHD?
Prescription stimulants have a calming and “focusing” effect on individuals with ADHD.
35
Name 3 common stimulants prescribed for ADHD:
* Adderal (mixed amphetamine salts containing four salts of amphetamine)
* Concerta (methylphenidate)
* Ritalin (also methylphenidate)
36
Name 2 common Alzheimers medications?
* Aricept (donepezil)
| * Namenda (memantine)
37
Re: Alzheimers medications. How do they work/on what do they act?
* Namenda: Orally active NMDA receptor antagonist
| * Aricept: Cholinesterase inhibitor that reduces or prevents acetylcholine breakdown in brain tissue
38
See if you can name all the principle neurotransmitters that are acted on with psychotropic drugs:
```
Acetylcholine
Dopamine
Epinephrine
Norepinephrine
Serotonin
Histamine
Gaba
Substance P
Glycine
Glutamate + aspartate
Somatostatin
```
39
Risk factors and management of side effects/adverse reactions with psychotropic drugs?
Possibility of adverse rxns w/other substances + medications
40
Mental health stigma prevents people from getting _________ + __________.
Help + care
41
____________ saves lives!
Talking
42
How can we address people where they’re at in a holistic manner?
Identify needs + take care of people
43
Differences between therapy + therapeutic relationships?
Therapeutic: way of acting, engaging, communication, interacting with respect, meeting them where they are, human interaxns before meds or interventions
Therapy: structured intervention
44
What is a feeling of care and concern for a patient that does not reflect sharing of emotions?
Sympathy
45
Patient limitations that could impact therapeutic interactions/communication:
* Sensory limitations, such as hearing loss
* Developmental disabilities presenting problems of comprehending and remembering
* Speech impediments
* Pain interfering with ability to think clearly and concentrate
46
What is the best mental health care model?
Integrated care
| Mental health embedded in primary care
47
What is the recovery model of care?
The recovery model is a holistic, person-centered approach to mental health care.
48
What are the 2 components of the recovery model?
* It’s possible to recover from a mental health condition
| * The most effective recovery is patient-directed
49
What are a bunch of descriptive words that apparently describe the recovery model?
Self-directed, individualized, empowerment, nonlinear, strengths-based, peer support, respect, responsibility, hope
50
What is an informal admission?
Sought by patient
51
What is a voluntary admission?
Sought by patient or guardian
52
What is an involuntary commitment?
Without patient’s consent
- Mentally ill
- Danger to self or others
- Unable to acquire basic necessities
- Cognitive or substance challenges → may have to get court-ordered treatment
53
Do patients lose their rights with an involuntary commitment?
HELL TO THE NAW
54
What does an emergency commitment (temporary admission) look like?
* Person confused or demented; emergency admission
* Used for observation, diagnosis and treatment
* Generally, for 24 to 96 hours
* Court hearing before discharge or next admission
55
What is primary wellness prevention?
Education on mental health and wellness before any symptomatology
56
What is secondary wellness prevention?
Screening measures
57
What is tertiary wellness prevention?
Ongoing management
58
What is the evidenced based 1st line therapy for anxiety + depression?
Cognitive Behavioral Therapy (CBT)
59
How does CBT work?
Exploring ways of thinking about problems and associated behaviors → transform maladaptive behaviors into healthy coping strategies
60
What supportive therapies should be done with CBT?
Supportive psychotherapy + psychoeducation should be done frequently
Ex: nursing groups (support, education, shared experiences, processing, etc): sleep hygiene, coping skills, diet, meds
61
There are 8 million other therapeutic interventions/therapy interventions. Name a few, pls.
* Taking temporary control if the patient loses control of thoughts, feelings, or behaviors
* Offering needed PRN medication
* Directing patients to a quieter, less stimulating place
* Staying with a patient at a comfortable distance
* Decrease the withdrawal and isolation of quiet, nonparticipating patients.
* Spend time with patients, even in silence.
* Limit setting to decrease or stop dysfunctional behaviors in the interest of patients.
* Point out behaviors and their negative effects on others.
* Suggest alternative behaviors.
62
What is motivational interviewing?
Identifying reason/motivation that would help patient achieve end goal (person-centered)
63
Ways of motivational interviewing?
* Exploring strategies: “What would you like to accomplish? What is the goal? What steps need to happen to help you to get there?”
* Tapping into resiliency: a person’s ability to cope + strategies they use to cope .“What have you done in the past? Or what could you do in the future?”
* Can also use with staff, coworkers, people under your delegation: what motivates them?
* Can also use on personal matters: what motivates me?
64
What should you NOT do with motivational interviewing?
Don’t give own opinion (avoid “you should…”) or do the bulk of the work, but rather help facilitate the conversation with patient on needs/goals and their strengths to help achieve them
65
Name the 4 processes of motivation interviewing (from hyperlink in ppt)?
* Engaging: establish purpose and boundaries of session; open ended question
* Focusing: simple reflection + summary (restate what client has shared)
* Evoking: using extremes to evoke change talk + empathic reflection + providing information
* Planning
66
Re: Motivational interviewing, what does restating do?
Lets client know whether an expressed statement has or hasn’t been understood
67
Re: Motivational interviewing, what does reflecting do?
Directs questions or feelings back to client so they can be recognized + accepted
68
Name some wasy of managing patients during moments of symptomatic behavior:
* Role modeling
* Be purposeful
* Calm approach
* Clear message: Keep simple + supportive
* Be aware of milieu: if patient is in crisis or experiencing extreme symptoms, and staff members are laughing about something unrelated, consider that patient could be very sensitive + this needs to be managed
69
When a patient is acting delusional, what should you do/not do?
* Don’t confront, threaten or engage
* Assess any safety factors
* Monitor risk factors around delusions
* Distraction
* Listening
70
When a patient is acting psychotic, what should you do/not do?
* Do not question
| * Be mindful of self, patient + safety
71
When a patient is having hallucinations, what should you do/not do?
* Ask for content about harm to self or others**
| * If they have voices, are they command hallucinations?
72
What is culturally responsible care?
* Understanding of different cultures + applying that to person in front of you + meeting person where they’re at
* Elements of behavior and thought that’s individual to them
* Knowledgable about cultures, giving options, providing spiritual support, meal planning
73
A deficiency of ACh causes what?
Alzheimer's disease
74
A deficiency of serotonin (5-HT) causes what?
* Depressive disorders (under-supply)
* OCD
* Eating disorders
75
A over- or under-supply of dopamine causes what?
* Parkinsonism (under-supply)
* Schizophrenic disorders (over-supply)
* Addictive disorders
76
A deficiency of GABA causes what?
* Anxiety
* Seizures/tremors (under-supply)
* Insomnia (under-supply)
77
A deficiency of NE causes what?
Depressive disorders
78
An over-supply of Glutamate (Glu) causes what?
* Schizophrenia
* Seizures
* Migraines
79
Neurotransmitters involved with ADHD?
* Dopamine
| * Norepinephrine
80
Neurotransmitters involved with anxiety?
* Norepinephrine (NE)
* Serotonin (5-HT)
* γ-aminobutyric acid (GABA)
81
Neurotransmitters involved with depression?
* Serotonin
* Norepinephrine
* Dopamine
