Exam 1 Flashcards
(140 cards)
1
Q
Selective serotonin reuptake inhibitors (SSRIs)
A
Citalopram Fluoxetine Sertraline Paroxetine Fluvoxamine Escitalopram Vilazodone
2
Q
Tricyclic antidepressants
A
Amitriptyline
Desipripramine
Imipramine
Nortiptyline
3
Q
Monoamine oxidase inhibitors (MAOIs)
A
Phenelzine
Tranylcypromine
Isocarboxazid
4
Q
Atypical antidepressants (heterocyclics)
A
Bupropion Mirtazapine Nefazodone Trazodone Deplin
5
Q
Serotonin norepinephrine reuptake inhibitors
A
Venlafaxine
Duloxetine
Desvenlafaxine
6
Q
Adverse effects of SSRIs
A
Nausea, headache, agitation, insomnia, anxiety, sexual dysfunction, weight gain
7
Q
What should the client watch for when taking SSRIs?
A
Serotonin syndrome
Avoid taking st. John’s wart which can increase the risk
8
Q
For what drug must the patient try to minimize anticholinergic effects?
A
Tricyclic antidepressants
Chew gum, eat high fiber foods, increase fluid intake
9
Q
What foods should be avoided when taking MAOIs?
A
Foods with tyramine: smoked meats, avocados, liver, dried fish, most cheeses, some beer and wine
Avoid all medications, cold cut meats, pickled foods, chocolate
10
Q
Side effects of atypical antidepressants?
A
Headache, dry mouth, nausea, restlessness, insomnia
11
Q
Avoid giving atypical antidepressants to what patients?
A
Those at risk for seizures
12
Q
Side effects of SNRIs
A
Nausea, insomnia, weight gain, diaphoresis, sexual dysfunction
13
Q
Use caution giving SNRIs to what patients?
A
Those with history of hypertension
14
Q
Mood stabilizers- anti seizure medications
A
Valproic acid Carbamazepine Oxcarbazepine Levetiracetam Gabapentin Lamotrigine Topiramate
Bipolar disorder
15
Q
Antianxiety medications
A
Lorazepam Clonazepam Alprazolam Diazepam Oxazepam Chlordiazepoxide Clonazepam
Bipolar disorder
16
Q
Mood stabilizer- antipsychotics (conventional)
A
Chlorpromazine
Haloperidol
Thiothixene
Molindone
17
Q
What can ECT be used for?
A
Major depressive disorder
Schizophrenia (with catatonic manifestations)
Schizoaffective disorder
Acute manic episodes (bipolar with rapid cycling)
18
Q
ECT is contraindicated when?
A
Cardiovascular disorders
Cerebrovascular disorders
19
Q
Electroconvulsive therapy
A
Uses electric current to induce grand mal seizure activity
20
Q
How often does the patient get ECT?
A
2-3 times per week for a total of 6 to 12 treatments
21
Q
Medication given before ECT
A
Atropine sulfate to control secretions
Muscle relaxant
Anesthetic
22
Q
Complications of ECT
A
Short term memory loss
Headache, nausea, muscle soreness
23
Q
Transcranial magnetic stimulation
A
Noninvasive therapy that uses magnetic pulsation to stimulate the cerebral cortex of the brain
24
Q
How often does a patient receive TMS?
A
Daily for 4 to 6 weeks
25
What is TMS used to treat?
MDD
26
Side effects of TMS
Tingling sensation at site of electrode
Lightheadedness
Seizures rare
27
Vagus nerve stimulation
Electrical stimulation through vagus nerve to the brains through a device that is surgically placed
Believed to result in increased level of neurotransmitters
28
What is VNS used for?
Depression that isn't treated by pharmacological treatments or ECT
Epilepsy
29
How often does the VNS device deliver pulsations?
Every 5 minutes for a duration of 30 seconds
| Can be turned off using a special external magnet
30
Side effects of VNS
```
Voice changes
Hoarseness
Neck pain
Dysphagia
Dyspnea with physical exertion (turn off device when exersizing)
```
31
Mood stabilizer
Lithium carbonate
32
What do conventional antipsychotics treat?
Positive signs of schizophrenia
33
Mood stabilizers- antipsychotics (atypical)
```
Risperidone
Olanzapine
Arpiprazole
Ziprasidone
Quetiapine
Clozapine
```
34
What are atypical antipsychotics used for?
Negative symptoms of schizophrenia
35
What are SSRIs used to treat?
MDD
36
What are MAOIs used to treat?
MDD
37
What are SNRIs used to treat?
MDD
38
When are TCA's used?
When SSRIs and SNRIs don't work or if depression is related to alcohol/cocaine withdrawal
39
Side effects of TCAs
Sedation
orthostatic hypotension
Anticholinergic effects (can't pee, see, spit, shit)
Cardiotoxicity (tachycardia)
40
When are MAOIs used?
When SSRIs and SNRIs don't work
41
Side effects of MAOIs
Hypertensive crisis
| Seizures
42
What is the first line meds for depression?
SSRIs
43
Side effects of SSRIs
GI upset
Sleep difficulty
Decreased libido
44
Side effects of SSRIs and SNRIs
Anticholinergic effects
| Serotonin syndrome
45
Symptoms of serotonin syndrome
```
Nausea, vomiting, diarrhea
Fever
Sweating
Mental status change
Can progress to cardiac arrest
```
46
Treatment for serotonin syndrome
Muscle relaxants
Serotonin blocker (cyproheptadine)
Nitrates, cardiac meds
47
Side effects of benzos
Respiratory depression
Drowsiness
Dizziness
48
Side effects of toxicity of valproic acid
GI issues
49
Side effects for toxicity of carbamazepine
Blurred vision and drowsiness
50
Side effects of lamotrigine
N/V
Headache
Dizziness
Steven Johnson's syndrome
51
What is most frequently prescribed medication for bipolar disorder?
Lithium carbonate
52
Therapeutic range of lithium carbonate
0.6-1.2
| Draw levels every 6 months
53
Symptoms of toxicity of lithium carbonate
```
Polydipsia
Polyuria
N/V
Diarrhea
Headache
Muscle pain
Rash
```
54
Side effects of antipsychotics
Neuroleptic malignant syndrome (first sign increased temp)
Extrapyramidal symptoms (EPS- increased risk for conventional antipsychotics)
Disordered water balance
Metabolic syndrome (more with atypical antipsychotics)
55
Types of EPS
Acute dystonia
Pseudoparkinsonism
Akathesia
Tardive dyskinesia
56
Why is clozapine heavily monitored?
Risk of agranulocytosis
| Need to monitor WBC and infections symptoms
57
Positive signs of schizophrenia
```
Hallucinations
Feel like things are there but they are not
Delusions
Paranoia
Agitation
Illusions
```
58
Negative signs of schizophrenia
Social withdrawal
Apathy
Depression
59
1. Acute stage schizo
Late teens and early adulthood; brought on by stressor that can trigger a psychotic break
60
2. Stabilization stage schizo
Still symptomatic but symptoms lessened
| More in touch with reality than acute episode
61
3. Maintenance and recovery stage schizo
Nurses can make significant impact during this phase - even if client fully adherent to meds, still have 50% chance of relapse
62
4. Relapse stage achizo
If pt stops taking meds, could develop EPS
63
Bipolar disorder
Bouts of depression and several manic episodes
64
Manic symotoms
```
Sleep diminished
Inflated self esteem
Difficulty concentrating
Decreased appetite
Increased risky behaviors
Psychomotor agitation
```
65
Hypomanic symptoms
```
Decreased sleep
Craving more relations
Hypoactivity
Not as much reckless behavior but some experimentation with drugs and alcohol
Hyperverbal
```
66
What is the first line treatment for seasonal affective disorder?
Light therapy
67
Dysthmic disorder
Milder form of depression
Lasts 2 years
Can later become MDD
68
1. Acute phase MDD
Severe depression
6 to 12 weeks
Potential for hospitalization
69
2. Continuation phase MDD
Increased ability to function
| 4 to 9 months
70
3. Maintenance phase MDD
Remission of manifestations
| Can last for several years
71
What gender is more likely to develop depression?
Females
72
1. Acute phase bipolar
Acute mania
Hospitalization may be required
One to one supervision
Asses risk of harm to self or others
73
2. Continuation phase bipolar
Remission of manifestations
| Treatment 4 to 9 months
74
3. Maintenance phase bipolar
Increased ability to function
Treatment continues through lifetime
Prevent future manic episodes
75
How long do manic episodes last?
At least one week
76
How long does hypomania last?
At least 4 days
77
What is rapid cycling?
Four or more episodes of hypomania or acute mania within 1 year
78
What symptoms can come before a manic episode?
Sleep disturbances
79
Schizophrenia
Psychotic thinking or behavior for at least 6 months
80
Schizophreniform disorder
Manifestations similar to schizophrenia but duration is 1 to 6 months
81
Schizoaffective disorder
Disorder meets criteria for schizophrenia and depressive or bipolar disorder
82
Manifestations of things that are not normally present
Positive symptoms
83
Absence of things that are normally present
Negative symptoms
84
What drug class is the best choice for long term anxiety?
Antidepressants
85
How long does it take for antidepressants to work?
2-6 weeks
86
Use caution taking NSAIDs with what drug?
Lithium carbonate
87
What is the outcome of disordered water balance?
Seizures, coma, and/or death
88
Signs of acute dysonia (EPS)
```
Muscle rigidity
Muscle rigidity
Torticollis (twisted neck)
Oculogyric crisis
Jaw pain
```
89
What EPS will you generally see first
Acute dystonia
90
Signs of pseudoparkinsonism (EPS)
```
Tremor
Slowed movement
Rigidity
Loss of facial expression
Drooling
```
91
Signs of Akathesia (EPS)
Motor restlessness
Agitation
Hyperverbal/ difficulty communicating
92
Signs of tardive dyskinesia (EPS)
Permanent movement disorder
Lip smacking, tongue protrusion, puckering
Persistent but symptoms can be minizimed
93
Steps of nursing process
```
Assess
Diagnose (nanda)
Outcome identification
Planning
Implementation
Evaluation
```
94
Mood examples
```
Depressed
Fearful
Hopeless
Euphoric
Anxious
Happy
Neutral
Appropriate to situation
```
95
Affect examples
```
Flat
Blunted
Labor
Incongruent with mood
Congruent with mood
```
96
Premorbid stage schizo
Social withdrawal
Irritability
Antagonistic thoughts
97
Prodromal phase schizo
Decline in functioning that precedes 1st psychotic episode
98
Active phase schizo
Psychotic symptoms present
99
Residual phase schizo
Remission of symptoms
100
Erotomatic (delusional disorder)
Believing someone (often famous) is in love with them
101
Grandiose (delusional disorder)
May believe they have a special relationship with someone famous
May believe themselves to be a deity or religious leader
102
Persecutory (delusional disorder)
Believe they are being poisoned, followed, cheated, spied on
Often will contact authorities multiple times
Most common
103
Somatic (delusional disorder)
Believe they have a medical condition
104
Jealous (delusional disorder)
Focus on significant other being unfaithful
| Can be violent towards them
105
What can steroidal contraceptives cause?
Depression or periods of rage, irritability
106
When are depressed patients at highest risk for suicide?
When they seem to be coming out of depression because they have the energy to carry out their plan
107
(Just sit there and say nothing)
Using silence
| Therapeutic
108
"Yes I understand what you said"
Accepting
| Therapeutic
109
"Hello Jay. I see you made your bed"
Giving recognition
| Therapuetic
110
"I'll stay with you awhile"
Offering self
| Therapeutic
111
"What would you like to talk about today?"
Giving broad openings
| Therapuetic
112
"What seemed to lead up to..."
Placing the event in time or sequence
| Therapeutic
113
"I noticed you are pacing a lot"
Making observations
| Therapeutic
114
"Yes I see. Go on"
Offering general leads
| Therapeutic
115
"What do the voices seem to be saying?"
Encouraging description of perceptions
| Therapeutic
116
Pt: "I can't my mind is wandering"
Nurse: " you have trouble concentrating"
Restating
| Therapuetic
117
"What helped you last time you felt this way?"
Encouraging comparison
| Therapeutic
118
Pt: "i have to do everything for my mom!"
Nurse: "you're angry you don't have help"
Reflecting
| Therapeutic
119
"Maybe we can discuss this further"
Focusing
| Therapeutic
120
"Please tell me more details about this situation"
Exploring
| Therapeutic
121
"I'm not sure I understand. Can you explain?"
Seeking clarification and validation
| Therapeutic
122
"I understand the voices are real to you, but I do not hear them"
Presenting reality
| Therapeutic
123
"I find that difficult to believe"
Voicing doubt
| Therapeutic
124
Pt: "this is a waste of time"
Nurse: "are you feeling like No one understands?"
Vandalizing the implied
| Therapeutic
125
"What could you do to let your anger out without hurting anyone?"
Formulating a plan of action
| Therapeutic
126
Pt: "I'm always out in the ocean"
Nurse: "you must be feeling lonely right now"
Attempting to translate words into feelings
| Therapeutic
127
"Everything will be alright. Don't worry"
Giving reassurance
| Non therapeutic
128
"I don't wanna hear about that"
Rejection
| Non therapeutic
129
"That's right" or "That's wrong"
Agreeing or disagreeing
| Non therapeutic
130
"That's good" "That's bad" "I'm glad you..."
Approving or disapproving
| Non therapeutic
131
"I think you should..."
Giving advice
| Non therapeutic
132
"Tell me how your mother abused you as a child"
Probing
| Non therapeutic
133
"Why did you do that?"
Requesting an explanation
| Non therapeutic
134
"None of the staff would lie to you"
Defending
| Non therapeutic
135
"What makes you say that?"
Indicating the existence of an external source of power
| Non therapeutic
136
Pt: " I have no reason to live"
Nurse: "oh, everyone has bad days"
Belittling feelings expressed
| Non therapeutic
137
"Hang in there" "keep your chin up"
Making stereotypical comments
| Non therapeutic
138
Pt: "I'm nothing"
Nurse: "of course you're something, everyone is"
Using denial
| Non therapeutic
139
"What you really mean is..."
Interpreting
| Non therapeutic
140
Pt: " I have nothing to live for"
Nurse: "did you have visitors today?"
Introducing an unrelated topic
| Non therapeutic
