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Psychiatric Nursing > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

four humors

A

(1) irritable and hostile choleric (yellow bile)
(2) pessimistic melancholic (black bile)
(3) overly optimistic and extraverted sanguine (blood)
(4) apathetic phlegmatic (phlegm)

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2
Q

clusters of personality disorders

A

A. odd eccentric (paranoid, schizoid, schizotypal)
B. dramatic, erratic (antisocial, borderline, histrionic, narcissistic)
C. anxious, fearful (avoidant, dependent, obsessive-compulsive)

*The Weird (A), The Wild (B), and The Willy (C)

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3
Q

schizoid and schizotypal

A

-schizoid is lesser degree of schizotypal

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4
Q

paranoid characterized by

A

pervasive, persistent, and inappropriate mistrust of others

**more common in MEN
1-4% in population

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5
Q

clinical picture paranoid

A
  • on guard constantly (hypervigilant)
  • trust no one
  • tests honesty of others
  • oversensitive
  • insensitive to others feelings
  • tends to misinterpret minute cues
  • magnify and distort cues in environment
  • does not accept responsibility for his/her own behavior
  • attributes shortcomings to others
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6
Q

predisposing factors paranoid personality

A

-subject to early parental antagonism and harassment

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7
Q

schizoid personality disorder characterized by….

A

….primarily profound defect in ability to form personal relationships & failure to respond to others in meaningful emotional way

**more common in men
3-5% in population

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8
Q

clinical picture schizoid personality

A
  • aloof and indifferent to others
  • emotionally col
  • no close friends (prefers being alone)
  • appears shy, anxious, uneasy to others
  • inappropriately serious about everything and difficulty acting in light-hearted manner
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9
Q

schizoid personality predisposing factors

A
  • childhood characterized by:
  • bleak
  • cold
  • unempathetic
  • notably lacking in nurturing
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10
Q

schizotypal personality disorder characterized by

A

odd and eccentric but does not decompensate to level of schizophrenia

(graver form of less severe schizoid)

3% population

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11
Q

schizotypal clinical picture

A
  • aloof and isolated
  • behave in bland/apathetic manner
  • bizarre speech pattern
  • when under stress, can decompensate and demonstrate psychotic symptoms
  • right on verge of psychosis (odd unusual behaviors)
  • magical thinking
  • ideas of reference
  • illusions
  • depersonalization
  • superstitiousness
  • withdrawal into self
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12
Q

predisposing factors

A
  • physio (anatomic deficits or neurochem dysfxn)
  • family dynamics (indifference, impassivity, formality)
  • pattern of discomfort w/ personal affection and closeness
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13
Q

antisocial personality–behavior that is:

A
  • socially irresponsible
  • exploitative
  • w/out remorse
  • disregard for rights of others

*2-4% in men to about 1 percent in women

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14
Q

clinical picture of antisocial personality

A
  • fails to sustain consistent employment or academic performance
  • fails to conform to law
  • fails to develop stable relationships (can’t form long-lasting monogamous relationship)
  • can’t fxn as responsible parent
  • belligerent and argumentative
  • unable to delay gratification/impulsive/reckless
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15
Q

borderline personality disorder characterized by

A
  • pattern of intense and chaotic relationships w/ affective instability (clients fall on border between neuroses and psychoses)
  • fluctuating and extreme attitudes regarding other ppl
  • highly impulsive

(1-2 percent of population and more common in women)

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16
Q

borderline clinical picture

A
  • emotionally unstable
  • directly/indirectly self-destructive (unstable self-image)
  • lacks clear sense of identity
  • chronic depression
  • inability to be alone
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17
Q

histrionic personality disorder characterized by..

A

-colorful, dramatic, extroverted behavior in excitable and emotional people

2-3% (more common in women)

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18
Q

clinical picture of histrionic

A
  • self-dramatizing
  • ATTENTION-SEEKING
  • overly gregarious
  • seductive
  • manipulative
  • exhibitionistic
  • EASILY influenced by others (follower)
  • highly distractible
  • difficulty forming close relationships
  • strongly dependent
  • somatic complaints common
  • require constant approval and affirmation
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19
Q

predisposing factors histrionic personality

A
  • link to noradrenergic and serotonergic systems
  • biogenetically determined temperament
  • learned behavior patterns
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20
Q

narcissistic personality disorder characterized by…

A
  • exaggerated self-worth
  • lack of empathy
  • inalienable right to special consideration

*6% prevalence (more common in men)

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21
Q

narcissistic clinical picture

A
  • exploits others to fulfill own desires
  • mood (often grounded in GRANDIOSITY) is usually optimistic, relaxed, cheerful, and care-free
  • mood can easily change if clients do not: meet self-expectations OR receive positive feedback that they expect
  • criticism from others can cause them to respond with rage, shame, humiliation
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22
Q

predisposing factors personality

A
  • as children, fears, failures, or dependency needs were responded to w/ criticism, disdain, or neglect
  • narcissistic parents
  • parents overindulged child/failed to set limits on inappropriate behavior
  • parent lives vicariously thru child
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23
Q

avoidant personality disorder characterized by…

A
  • extreme sensitivity to rejection
  • social withdrawal

(1% and is equally common in men and women)

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24
Q

clinical picture avoidant personality disorder

A
  • awkward and uncomfortable in social situations
  • desire close relationships but avoid them because of fear of being rejected
  • perceived as timid, withdrawn, or cold/strange
  • view others as critical and betraying
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25
Q

predisposing factors personality disorder

A

NO CLEAR CAUSE

  • combo of bio, genetic, and psychosocial
  • primary psychosocial influence: parental rejection and censure (often reinforced by peers)
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26
Q

dependent personality disorder characterized by…

A

-pattern of relying on others for emotional support

relatively common, and more common in women and in youngest children of family

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27
Q

clinical picture of dependent personality

A
  • have notable lack of self-confidence apparent in: Posture, Voice, Mannerisms
  • overly generous and thoughtful while underplaying own attractiveness and achievements
  • low self-worth and easily hurt by criticism and disapproval
  • avoid positions of responsibility and become anxious when forced into them
  • assume passive and submissive roles in relationships
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28
Q

predisposing factors dependent personality

A

from overprotective parents:

  • stimulation and nurturance are experienced exclusively from one source
  • singular attachment is made by infant to exclusion of all others
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29
Q

obsessive-compulsive personality disorder characterized by

A
  • inflexibility about way in which things must be done and devotion to productivity at exclusion of personal pleasure
  • relatively common and more common in men and most common in oldest children
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30
Q

obsessive-compulsive personality clinical picture

A
  • esp. concerned w/ matters of organization and efficiency
  • tend to be rigid and unbending
  • socially polite and formal
  • rank-conscious (ingratiating with authority figures and autocratic and condemnatory with subordinates)
  • on surface, appear to be calm and controlled but underneath: ambivalence, conflict, hostility
  • problems with decision-making
  • thrive in chaos
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31
Q

predisposing factors

A
  • overcontrol by parents
  • notable parental lack of positive reinforcement for good behavior
  • frequent punishment for undesirable behavior
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32
Q

who staff splits

A

-borderline personality disorder

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33
Q

patterns of interaction with borderline

A
  • clinging and distancing behaviors
  • splitting
  • manipulation
  • self-destructive behaviors (self-harm)
  • impulsivity
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34
Q

psychosocial influences borderline

A
  • childhood trauma & abuse
  • fixed in rapprochment phase of development (16 to 24 mo)
  • child fails to achieve task of autonomy
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35
Q

goals for client w/ borderline

A
  • able to identify true source of anger
  • relates to more than one staff member
  • completes ADL’s independently
  • express anger appropriately
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36
Q

antisocial personality disorder behaviors characterized by…

A

…reactive to perceived threats, control, and negative affect

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37
Q

psychopathy….

A
  • low fear
  • low empathy
  • domination
  • callous cruelty
  • emotional insensitivity
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38
Q

predisposing factors antisocial personality

A
  • disruptive behavior as child (ADHD/hyperactivity dx/conduct dx)
  • hx severe physical abuse
  • absent/inconsistent parental discipline
  • extreme poverty
  • removed from home
  • growing up w/out parental figure of both sexes
  • always being rescued when in trouble
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39
Q

DBT…

A

…antisocial personality tx

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40
Q

schizotypal tx

A

CBT not effective

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41
Q

antisocial

A

-do not tx w/ pharm

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42
Q

Freud and dissociation

A

-type of repression (active defense mechanism used to remove unacceptable mental contents from awareness)

**unexpressed emotions converted into physical symptoms

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43
Q

Richard Asher

A

-termed Munchausen Syndrome/Factitious Disorder

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44
Q

conversion dx epidemiological

A
  • more in women
  • more in adolescents and YA
  • lower socioeconomic/less education/rural populations
  • military personnel exposed to combat
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45
Q

DIDs epidemiology

A

*dissociative disorders

  • more in women
  • symptoms usually being in adolescence or early adulthood
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46
Q

single brief episodes of dissociation

A
  • severe psychosocial stress
  • sleep-deprived
  • during travel to unfamiliar places
  • intoxicated
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47
Q

somatic symptom dx basic definition

A
  • chronic dx w/ symptoms beginning before age 30

- periods of remission and exacerbation

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48
Q

common complications of somatic symptom dx

A

-drug abuse

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49
Q

personality characteristics of somatic symptom disorder

A
  • heightened emotionality
  • strong dependency needs
  • preocccupation with symptoms and oneself
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50
Q

illness anxiety dx

A
  • preoccupation and fear of having serious dz

- anxiety and depression common and OC traits accompany dx

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51
Q

dissociative amnesia and dx

A

-difficult to dx in kids because mistaken for inattention or oppositional behavior

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52
Q

conversion dx

A
  • loss or change in body fxn that cannot be explained by any known medical dx
  • symptoms affect voluntary motor or sensory functioning suggestive of neurological disease
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53
Q

pseudocyesis

A

-false pregnancy

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54
Q

hereditary

A
  • somatic symptom dx
  • conversion dx
  • illness anxiety dx
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55
Q

biochem in somatic symptoms dx

A

-decreased levels of serotonin and endorphins (may play role in pain)

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56
Q

defenses in psychodynamic theory of somatic symptom disorder (illness anxiety dx)

A
  • ego defense mechanism
  • physical complaints=expression of low-self esteem

*defense against guilt

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57
Q

conversion disorder psychodynamic theory

A

-emotions associated with traumatic event that are unacceptable to express

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58
Q

tertiary gain

A

-somatization brings some stability to fam and positive reinforcement to child

**dysfunctional fam

**shift focus away from family issue

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59
Q

primary gain

A

-may avoid obligations/be excused from unwanted duties w/ somatic complaints

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60
Q

secondary gain

A

-become prominent focus of attention because of illness

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61
Q

dissociative amnesia

A

-defined as inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness (no substance use)

**onset follows severe psychosocial stress

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62
Q

most common types of dissociative amnesia

A
  • localized amnesia (unable to recall incidents associated w/ stressful period)
  • selective amnesia (can recall only certain incidents associated w/ stressful event for specific period after event)
  • generalized type (amnesia for his/her identity and total life history)
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63
Q

dissociative fugue

A

**subtype of dissociative amnesia

-sudden, unexpected travel away from customary places or by bewildered wandering w/ inability to recall some or all of one’s past (sometimes assumes new identity)

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64
Q

termination of dissociative amnesia

A

-usually abrupt and followed by full recovery

**reoccurrences are unusual

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65
Q

dissociative identity disorder transition

A

-transition from one personality state to another may be sudden or gradual (sometimes quite dramatic)

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66
Q

parent in Munchausen

A
  • depressed or anxious

- past hx of abuse

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67
Q

tx for Munchausen

A
  • remove child from situation

- therapy for parent (sometimes lie in therapy tho)

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68
Q

depersonalization-derealization disorder

A

-temp change in quality of self-awareness, often taking on form of

1-feelings of unreality
2- changes in body image
3-feelings of detachment from environment
4-a sense of observing oneself from outside body

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69
Q

DID characteristics

A

-fragments of identity rather than separate personalities

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70
Q

DID symptoms

A
  • voices in head
  • sudden emotions have no control over
  • constant change thru behavior, mem, perception, motor function
  • gaps in mem
  • thoughts suicide common trait
  • depression & anxiety (from depersonalization and derealization)
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71
Q

depersonalization vs derealization

A
  • depersonalization: disturbance in perception of oneself

- derealization: alteration in perception of external environment

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72
Q

s/s depersonlization-derealization disorder

A
  • anxiety/depression
  • fear of going insane
  • obsessive thoughts
  • somatic complaints
  • disturbance in subjective sense of time
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73
Q

genetics and dissociative dx

A

-no evidence of genetic contribution

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74
Q

DID predisposing factors

A
  • hx physical/sexual abuse (survival strategy for child in traumatic environment)
  • depersonalizaton=evidenced w/ migraines and MJ use, responds to SSRIs (serotonergic involvement)
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75
Q

risk for suicide

A

DID

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76
Q

meds in somatic symptom dx

A

-not effective unless being used to tx underlying depression/anxiety

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77
Q

amobarbital

A
  • retrieval lost mem in amnesia

- reveal historical info r/t trauma

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78
Q

abreaction

A

-recall past traumas in detail

“remembering w/ feeling”

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79
Q

tx w/ depersonlization-derealization

A

inconclusive

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80
Q

3 D’s in geriatric psychology

A

(1) delirium (reversible)
(2) dementia
(3) depression

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81
Q

s/s delirium

A
  • difficulty sustaining/shifting attention
  • disorganized thinking
  • rambling speech (pressured/incoherent)
  • disorientation to time and place
  • impairment of recent mem
  • misperceptions about environment (HALLUCINATIONS & DELUSIONS)
  • disturbances in sleep/wake cycle/nightmares
  • psychomotor activity that fluctuates between agitation and restlessness and vegetative state
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82
Q

autonomic manifestations of delirium

A
  • tachy
  • sweating
  • flushed face
  • dilated pupils
  • elevated blood pressure
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83
Q

delirium due to medical condition

A
  • systemic infections
  • febrile illness
  • metabolic disorders (electrolytes imbalances, hypoglycemia)
  • hypoxia/COPD
  • head trauma
  • hepatic/renal failure
  • migraine headaches
  • seizures
  • brain abscess/neoplasm
  • stroke
  • nutritional deficiency
  • uncontrolled px
  • burns
  • heat stroke
  • orthopedic and cardiac sx
  • social isolation
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84
Q

precipitating factors for delirium for elderly (over 65)

A
  • dementia
  • depression
  • falls
  • elder abuse
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85
Q

med-induced delirium

A
  • anticholinergics
  • antihypertensives
  • corticosteroids
  • anticonvulsants
  • cardiac glycosides
  • analgesics anesthetics
  • antineoplastic agents
  • antiparkinson drugs
  • H2 receptor antagonists (CIMETIDINE)
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86
Q

neurocognitive disorders defined as…

A

…cognitive fxns closely linked to particular areas of the brain

-impairment in cog fxn of thinking, reasoning, memory, learning and speaking

NCD (defined as MILD or MAJOR)

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87
Q

mild NCD

A

AKA mild cognitive impairment

early signs of dementia

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88
Q

major NCD

A

-progressive decline in cog ability in presence of clear consciousness

MANY cog deficits involved

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89
Q

reversible NCD

A

temporary dementia

  • can occur as result of:
  • stroke
  • depression
  • side effects of meds
  • nutritional deficiencies (esp b12 or folate)
  • metabolic disorders
  • normal pressure hydrocephalus
  • CNS infections
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90
Q

primary NCD

A

-ex: AD

**NCD itself is major sign of organic brain dz not directly r/t any other organic illness

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91
Q

secondary NCD

A

-ex: HIV, cerebral trauma

**caused by or r/t another dz or condition

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92
Q

cognition in NCDs

A
  • abstract thinking impairment
  • judgement impairment
  • poor impulse control
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93
Q

behavior in NCDs

A

**conventional rules of social conduct often disregarded

-uninhibited and inappropriate behavior

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94
Q

language in NCDs

A

may or may not be affected

  • trouble naming objects or language may seem vague and imprecise
  • aphasia (in severe forms)
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95
Q

personality change in NCDs

A

common (accentuation or alteration of premorbid characteristics)

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96
Q

as dz progresses, symptoms may include:

A
  • aphasia
  • apraxia (inability to carry out motor activities despite intact motor fxn)
  • irritability/moodiness/sudden outbursts
  • inability to perform ADLs
  • wandering away from home
  • incontinence
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97
Q

stages of progressive symptoms of AD

A
  • Stage 1: no apparent symptoms
  • Stage 2: forgetfulness (losses in short term mem common)
  • Stage 3: mild cog decline (pt. where we want to try to get tx started; interference w/ work performance which becomes noticeable to coworkers)
  • Stage 4: mild-to-mod cog decline
  • Stage 5: mod cog decline
  • Stage 6: mod-to-severe cog decline
  • Stage 7: severe cog decline
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98
Q

categories of etiology of NCDs

A
  • NCD due to AD
  • Vascular neurocognitive dx
  • frontotemporal neurocognitive dx
  • NCD due to TBI
  • NCD due to Parkinson’s
  • NCD due to Lewy body dementia
  • NCD due to HIV infection
  • substance-induced neurocognitive dx
  • NCD due to Huntington’s
  • NCD due to prion dz
  • NCD due to another med condition
  • NCD due to multiple etiologies
  • unspecified NCD
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99
Q

NCD due to AD course of disorder

A

-progressive and deteriorating

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100
Q

predisposing factors to NCD due to AD

A
  • neurotransmitter alterations (depression r/t alzheimer’s; acetylcholine reduction which reduces amount of NT that is released to cells in cortex and hippo)
  • plaques and tangles (Tau’s)
  • head trauma
  • genetic factors (40% of AD pts have fam hx)
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101
Q

vascular NCD

A
  • cerebrovascular dz (blood flow in brain impaired)
  • more abrupt onset than seen in AD && course is more variable

**symptoms in STEPS rather than gradual deterioration (at times, symptoms tend to clear up)

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102
Q

etiology vascular NCD

A
  • HTN
  • cerebral emboli
  • cerebral thrombosis
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103
Q

frontotemporal NCD

A

-result of shrinking of frontal and temporal anterior lobes of brain

(previously called PICK’s dz)

***predominantly main one

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104
Q

symptoms of frontotemporal NCD

A

*fall into two clinical patterns:
1-behavioral and personality changes

2-speech and language problems

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105
Q

NCD due to traumatic brain injury

A

-amnesia is the MOST COMMON neurobehavioral symptom following head trauma (posttraumtic amnesia)

  • LOC
  • disorientation/confusion
  • neuro signs
  • changes in speech, vision, personality
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106
Q

repeated head trauma

A

can result in dementia pugilistica

*syndrome characterized by:

  • emotional lability
  • dysarthria (slurred speech)
  • ataxia
  • impulsivity
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107
Q

NCD due to Lewy body dz

A
  • similar to AD but progresses MORE RAPIDLY and early appearance of (1) hallucinations and (2) parkinsonian features
  • depression and delusions also common
  • Lewy bodies in cerebral cortex and brainstem
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108
Q

NCD cases and Lewy body

A

25% of all NCD cases

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109
Q

NCD due to Parkinson’s

A

*loss of nerve cells located in substantia nigra and decrease in dopamine activity

(cerebral changes in NCD from Park. resemble those of AD)

75% of parkinson’s clients

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110
Q

NCD due to HIV

A

-caused by brain infections w/ opportunistic organisms or by HIV-1 directly

  • *symptoms:
  • range from barely perceptible changes to acute delirium to profound cog impairment
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111
Q

substance-induced NCD

A

-substance rxns, overuse, or abuse (s/s persist beyond usual duration of intoxication and acute withdrawal)

  • alc/sedative/hypnotic/anxiolytics/inhalants
  • drugs causing anticholinergic effects
  • toxins like lead/mercury
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112
Q

NCD due to Huntington’s

A

**more gene-related

  • damage in basal ganglia and cerebral cortex
  • declines into PROFOUND state of dementia and ataxia
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113
Q

NCD due to Prion dz

A
  • insidious onset and rapid progression (dx to death in 2 yrs)
    ex: infected meat products/Mad cow dz
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114
Q

manifestations of NCD due to prion dz

A
  • probs w/ coordination
  • other movement disturbances
  • rapidly progressing dementia
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115
Q

development of NCD due to prion

A

-develop at any age but typically between 40 and 60 y/o

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116
Q

NCD due to another med condition

A 
-hypothyroidism/hyperparathyroidism/
pituitary insufficiency 
-uremia 
-encephalitis 
-brain tumor 
-pernicious anemia (B12) or thiamine deficiency (B1) or pellagra (niacin deficiency) 
-MS 
-uncontrolled epilepsy 
-cardiopulm insufficiency 
-fluid/electrolyte imbalances 
-CNS and systemic infections 
-lupus
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117
Q

client hx/assessment for NCDs

A

(1) type, frequency, and severity of mood swings, personality/behavioral changes, and catastrophic emotional rxns
(2) cog changes (attn span, thinking process, prob-solving, mem)
(3) language difficulties
(4) orientation to person, place, time, situation
(5) appropriateness of social behaviors

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118
Q

most common mental illness in elderly

A
  • depression (but is often misdiagnosed)

* cog symptoms of depression may mimic NCD and providers are too eager to make this dx

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119
Q

dx lab tests (blood and urine)

A

test for:

  • infections
  • hepatic/renal dysfxn
  • DM or hypoglycemia
  • electrolyte imbalance
  • metabolic/endocrine dx
  • nutritional deficiency
  • toxic substances
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120
Q

janitor cells for amyloid beta

A

microglia

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121
Q

risk factors alz’s

A
  • age
  • genetics (DNA alone does not determine if we get Alz)
  • sleep (glial cells work hard w/ deep sleep)
  • cardio health (high BP, DM, obesity)
  • **aerobic exercise decreases amyloid beta
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122
Q

neuroplasticity and cognitive reserve

A

*form more synapses (creating and strengthening new neural connections when we learn something new)

cognitive reserve=more functional synapses available

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123
Q

evaluation of client with NCD

A
  • based on series of short-term goals rather than long-term goals
  • Outcomes: measured in terms of slowing down process rather than stopping or curing
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124
Q

additional attention in delirium

A
  • fluid/electrolyte status
  • hypoxia
  • anoxia
  • DM probs
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125
Q

staff and client w/ delirium

A

-staff to remain w/ client at all times to monitor behavior and provide reorientation/assurance

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126
Q

meds for delirium

A

*some choose not to give meds to delirium clients as they may only compound syndrome of brain dysfxn

BUT if so:
-psychosis w/ agitation and aggression may require meds/restraint ((low-dose antipsychotics))

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127
Q

substance withdrawal

A

can use benzodiazepines for delirium w/ substance withdrawal

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128
Q

pharm agents for cognitive impairment

A
  • Physostigmine (Antilirium)= cholinesterase inhibitor (mild to moderate AD)
  • Tacrine (Cogex)=cholinesterase inhibitor

-Donepezil (Aricept)
-Revastigmine (Exelon)
-Galantamine (Razadyne)
^^all these are acetylcholine inhibitors

-Memantine (Namenda) =mod to severe tx

129
Q

combo meds

A
  • donepezil & memantine (Namzaric)

- aducanumab (Aduhelm) which is an ANTI-AMYLOID antibody IV admin/infusion

130
Q

pharm agents for agitation, aggression, hallucination, thought disturbances, wandering

A
  • risperidone (Risperdal)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • ziprasidone (Geodon)

**these have fewer anticholinergic effects and EPS than do older antipsychotics

**black box warning that all atypical antipsychotics associated w/ increased risk of death in elderly pts w/ dementia

131
Q

pimavancerin

A

*Nuplazid

-specifically for tx of hallucinations and delusions in Parkinson’s dz psychosis’
(serotonin agonist and antagonist activities)

132
Q

anticholinergic effects

A

*many antipsychotics, antidepressants, and antihistaminic meds produce these

  • confusion
  • blurred vision
  • constipation
  • dry mouth
  • dizzy
  • difficulty urinating

**elderly specifically sensitive to these effects because of decreased cholinergic reserves

133
Q

AD/depression comorbidity

A

40% with AD suffer from major depression

**difficult to distinguish from NCD

134
Q

Tricyclic antidepressants

A

-avoided due to anticholinergic and cardiac side effects

135
Q

Trazadone

A

*Desyrel

**good choice for clients with insomnia/depression (use at bedtime)

136
Q

dopaminergic agents

A

-methylphenidate, amantadine, bromocriptine, bupropion

**may be helpful in tx of severe apathy

137
Q

pharm agent for anxiety

A

**should not be used routinely for prolonged periods

**usually in early stages of NCD

-Librium (chlordiazepoxide), Xanax (alprazolam), Ativan (lorazepam), Serax (oxazepam), Valium (diazepam)

138
Q

sleep disturbances

A

-among the problems that most frequently initiate need for client placement in long-term care facility

**intensify as NCD progresses

139
Q

pharm therapy for sleep disturbances

A

**SHORT-TERM only

-Dalmane (flurazepam), Restoril (temazepam), Halcion (triazolam), Ambien (zolpidem), Sonata (zaleplon), Rozerem (ramelteon), Lunesta (eszopiclone), Desyrel (trazadone), Remeron (mirtazapine)

140
Q

substance related disorders compromised of 2 groups

A
  • substance-use disorders (addiction)

- substance-induced disorders (intoxication, withdrawal, delirium)

141
Q

MAT

A

medication assisted therapy

*meds AND behavioral therapy

142
Q

providers who are wavered

A

go thru federal certification training to prescribe these meds

**in TN, don’t allow advanced practice RN to prescribe, so they might go through training but still can’t prescribe

143
Q

what makes ppl relapse

A

CRAVINGS

*MAT eliminates cravings and helps keep them comfortable while they withdraw

144
Q

substance intoxication

A

REVERSIBLE SYNDROME of symptoms following excessive use of substance

**direct effect on CNS (disruption in physical and psychological fxn-ing)

**judgment is disturbed and social/occupational fxn-ing impaired

145
Q

stimulants

A

caffeine and tobacco

146
Q

biochem factors

A

-alcohol may produce morphine-like substances in brain that are responsible for alc addiction

147
Q

certain personality traits that increase tendency toward addictive behavior

A 
1-low self-esteem 
2-frequent depression 
3-passivity 
4-inability to relax or defer gratification 
5-inability to communicate effectively
148
Q

dopamine

A

reward system

**creates cravings that encourage behaviors that help us survive

**pleasure stimulated by other NTs in hedonic hot spots in brain

149
Q

dorsal striatum

A

-form habits (based on pleasurable things youve done)

150
Q

prefrontal cortex

A

w/ help of glutamate, rich images of cravings are conjured

151
Q

amygdala

A

dopamine causes neurons hear to be stimulated by learned emotional responses

152
Q

cocaine

A

prevent removal of excess dopamine

153
Q

methamphetamine

A

floods synapses with dopamine

154
Q

heroin

A

blocks dopamine inhibitors

155
Q

baclofen

A

-can tx alcohol dependency

156
Q

electromagnetic stimulation

A

can tx cocaine cravings

157
Q

cultural/ethnic influences of alcohol use

A
  • increase in Native Americans and Irish
  • decrease in Italians despite wine being part of meals
  • Asians (genetic intolerance)
158
Q

nations #1 health issue/factor in more than half of all homicides, suicides, and traffic accidents

A

-alcohol use disorder

159
Q

Phase I and II patterns of use (alcohol)

A

Phase I: PREALCOHOLIC–characterized by use of alc to relieve everyday stress and tensions of life

Phase II: EARLY ALCOHOLIC– begins with BLACKOUTS (periods of amnesia); alcohol now required by the person

160
Q

Phase III and IV patterns of use (alcohol)

A

Phase III: CRUCIAL– person lost control; physiological dependence is clearly evident

Phase IV: CHRONIC– emotional and physical disintegration; person intoxicated more than sober

161
Q

peripheral neuropathy

A

**effect of alc on body

-associated to B1 (Thiamine) deficiency characterized by:

  • peripheral nerve damage
  • pain
  • burning
  • tingling
  • prickly sensations of extremities
162
Q

alcoholic myopathy

A
  • thought to results from same B vitamin deficiency that contributes to peripheral neuropathy
  • Acute: sudden onset muscle pain, swelling, and weakness; reddish tinge to urine; rapid rise in muscle enzymes in blood
  • Chronic: gradual wasting and weakness in skeletal muscles
163
Q

Wernicke’s encephalopathy

A

-most SERIOUS form of thiamine deficiency in alc patients

“Wet Brain”

  • paralysis of ocular muscles
  • ataxia
  • somnolence/stupor
164
Q

Korsakoff’s psychosis

A

**syndrome of confusion, loss of recent memory, and confabulation in alc patients

-frequently found in pts recovering from Wernicke’s encephalopathy

165
Q

alcoholic cardiomyopathy

A

-effect of alc on heart is accumulation of lipids in myocardial cells, resulting in enlargement and weakened condition

**CHF or arrhythmia

166
Q

esophagitis

A

-inflammation and pain in esophagus occurs because of toxic effects of alc on esophageal mucosa and also because of frequent vomiting associated w/ alc use

167
Q

gastritis

A

**effects of alc on stomach: breaks down protective mucosal barrier which allows the hydrochloric acid to erode stomach wall

  • epigastric distress
  • n/v
  • distention
168
Q

normal serum amylase

A

23-85

*pancreatitis lab: above 200 U/L

169
Q

acute pancreatitis

A

-occurs 1-2 days after binge of excessive alc consumption

s/s:

  • constant, severe epigastric px
  • n/v
  • abd distention
170
Q

chronic pancreatitis

A

-pancreatic insufficiency results in:

  • steatorrhea
  • malnutrition
  • weight loss
  • DM
171
Q

alcoholic hepatitis labs

A

LFT’s

  • elevated Bilirubin/Albumin
  • elevated ALT (alanine transaminase)
  • elevated AST (aspartate transaminase)
172
Q

alcoholic hepatitis

A

s/s:

  • enlarged, tender liver
  • n/v
  • lethargy
  • anorexia
  • elevated WBC
  • fever
  • jaundice

**ascites and weight loss in severe cases

173
Q

cirrhosis

A
  • end-stage of alcoholic liver disease
  • widespread destruction of liver cells which are replaced by fibrous (scar) tissue
  • same symptoms as alcoholic hepatitis plus blood coagulation abnormalities
174
Q

4 complications of cirrhosis of the liver

A

1- portal hypertension
2-ascites
3-esophageal varices
4-hepatic encephalopathy

175
Q

portal hypertension

A

-elevation of BP thru portal circulation results from defective blood flow thru cirrhotic liver

176
Q

ascites

A

-excessive amount of serous fluid accumulates in abd cavity

**occurs in response to portal hypertension

177
Q

esophageal varices

A

-veins in esophagus become distended from excessive pressure from defective blood flow through cirrhotic liver

RUPTURE=hemorrhage/death

178
Q

hepatic encephalopathy

A

-response to inability of diseased liver to convert ammonia to urea for excretion

***continued rise in serum ammonia (can cross BBB) if allowed to progress can lead to coma and eventual death

179
Q

leukopenia

A

**effect of alc on body

-impaired production, function, and movement of WBC

180
Q

WBC normal range

A

(4,500-11,000)

181
Q

thrombocytopenia

A

**effects of alc on body

-platelet production and survival are impaired as result of toxic effects of alcohol

182
Q

platelet normal range

A

150,000-450,000

183
Q

sexual dysfunction

A

**effects of alc on body

  • short-term: enhanced libido and erectile dysfxn
  • long-term: gynecomastia, sterility, impotence, decreased libido
184
Q

FASDs

A

Fetal alcohol spectrum disorders

185
Q

FAS

A

**problems w/ learning, memory, attention span, communication, vision, and hearing

186
Q

characteristics of FAS

A
  • abnormal facial features
  • small head size
  • shorter-than-average height
  • low body weight
  • poor coordination
  • hyperactive behavior
  • difficulty paying attention
  • poor memory
  • difficulty in school
  • learning difficulties
  • speech/language delays
  • intellectual disability
  • poor reasoning skills
  • sleep/sucking problems as baby
  • vision/hearing problems
  • problems w/ heart, kidneys, or bones
187
Q

alcohol intoxication occurs at…

A

…BAL between 100-200 (TN legal limit is .08%)

188
Q

alcohol withdrawal occurs w/in

A

-4-12 hrs of cessation of or reduction in heavy/prolonged alcohol use

189
Q

sedative/hypnotic substance use disorder

A
  • barbiturates
  • non-barbiturate hypnotics
  • antianxiety agents
  • club drugs
190
Q

sedative/hypnotic use disorder effects on body

A
  • effects on sleep/dreaming (less time spent dreaming; upon withdrawal–intense dreams)
  • respiratory depression
  • cardiovascular effects (hypotension, cardiovasc. collapse)
  • renal fxn (oliguria in high doses)
  • hepatic effects (stimulate production of liver enzymes which inhibits metabolism of other drugs)
  • body temp
  • sexual fxn-ing (biphasic response: initial increase in libido, then impaired sexual pleasure)
  • pupil constriction
191
Q

half-lives and withdrawal

A
  • short-acting (short half lives) sedative hypnotics (like lorazepam)
  • long half lives (diazepam, phenobarbital, chlordiazepoxide)
192
Q

severe withdrawal from CNS depressants

A

can be life-threatening

193
Q

stimulant use disorder drugs

A
  • amphetamines
  • synthetic stimulants
  • non-amphetamine stimulants
  • cocaine
  • caffeine
  • nicotine
194
Q

cocaine and cardio

A

can result in severe vasoconstriction and MI

195
Q

pulmonary effects stimulants

A

-smooth muscle relaxation of bronchioles

196
Q

GI and renal effects stimulants

A
  • usually urine retention

- GI decrease in motility (constipation)

197
Q

amphetamine and cocaine intoxication

A
  • euphoria
  • pupil dilation
  • impaired judgment/confusion
  • vital sign changes (coma/death poss.)
198
Q

caffeine intoxication

A

**usually consumption of 250mg or over

-restlessness & insomnia most common symptoms

199
Q

amphetamine and cocaine withdrawal

A
  • dysphoria
  • fatigue
  • sleep disturbances
  • increased appetite
200
Q

withdrawal from caffeine

A
  • HA
  • fatigue/drowsiness
  • irritability
  • muscle pain/stiffness
  • n/v
201
Q

withdrawal from nicotine

A
  • dysphoria
  • anxiety
  • difficulty concentrating
  • irritability
  • restlessness
  • increased appetite
202
Q

inhalant use disorder (profile of substance)

A
  • aliphatic and aromatic hydrocarbons found in substances such as:
  • fuels, solvents, adhesives, aerosol propellants, paint thinners
203
Q

CNS effects inhalants

A

up then down (excitement then extreme drowsiness)

204
Q

respiratory effects inhalant use dx

A

-increased airway resistance from inflammation in passages

205
Q

GI effects inhalant use dx

A

-abd px, n/v

206
Q

renal effects inhalant use dx

A
  • acute/chronic renal failure

* renal toxicity from toluene exposure

207
Q

symptoms of inhalant intoxication

A
  • dizziness
  • ataxia, muscle weakness
  • euphoria/excitation/disinhibition
  • slurred speech
  • nystagmus
  • blurred/double vision
  • dilated pupils
  • psychomotor retardation/ hypoactive reflexes
  • stupor/coma
208
Q

opioids of natural origin

A
  • morphine

- codeine

209
Q

opioid derivative

A
  • heroin

- oxycodone

210
Q

synthetic opiate-like drugs

A
  • methadone

- fentanyl

211
Q

opioids and cardio

A
  • at high doses

- hypotension

212
Q

opioids and sexual fxn

A

decreased sexual fxn/libido

213
Q

s/s opioid intoxication

A
  • euphoria followed by apathy
  • dysphoria
  • pupil constriction
  • psychomotor agitation or retardation and impaired judgment
214
Q

short-acting opioids and withdrawal

A
  • heroin

- s/s occur w/in 6-8 hrs, peak w/in 1-3 days, gradually subside in 5-10 days

215
Q

long-acting opioids and withdrawal

A
  • methadone

- s/s occur w/in 1-3 days, peak at 4-6 days, subside in 14-21 days

216
Q

ultra-short-acting opioids and withdrawal

A
  • Demerol

- s/s begin quickly, peak in 8-12 hrs, subside in 4-5 days

217
Q

symptoms of opioid withdrawal

A
  • dysphoria
  • muscle aches
  • n/v
  • lacrimation or rhinorrhea
  • pupillary dilation
  • sweating
  • abd cramping, diarrhea
  • yawning
  • fever
  • insomnia
218
Q

naturally-occurring hallucinogens

A
  • Mescaline-Peyote Cactus

- Psilocybin mushrooms

219
Q

synthetic compounds (hallucinogens)

A
  • angel dust
  • LSD
  • PCP
220
Q

s/s of hallucinogen intoxication

A
  • perceptual alteration
  • depersonalization
  • derealization
  • tachycardia
  • palpitations
  • pupil dilation
221
Q

symptoms of PCP intoxication

A
  • belligerence and assaultiveness
  • may proceed to seizures or coma

**pts can be VERY dangerous =

222
Q

hallucinogen physiological effects on body

A
  • n/v
  • chills
  • pupil dilation
  • increased BP and pulse
  • loss of appetite
  • insomnia
  • elevated blood sugar
  • decreased respirations
223
Q

hallucinogen psychological effects on body

A
  • heightened response to color/sounds
  • distorted vision
  • sense of slowed time
  • magnification of feelings
  • paranoia, panic
  • euphoria, peace
  • depersonalization/derealization
  • increased libido
224
Q

cardio effects cannabis

A
  • tachy

- decrease in BP (orthostatic hypotension)

225
Q

respiratory effects cannabis

A

-bronchodilation initially

226
Q

reproductive effects cannabis

A
  • men have decrease in sperm count

- women, suppression of ovulation and disruption in menstrual cycles

227
Q

CNS

A

“high” equivalent to alcohol

  • euphoria/decreased inhibitions
  • depersonalization/derealization
228
Q

toxicity of MJ

A

-paranoia

229
Q

sexual fxn cannabis

A

-increase sexual pleasure

230
Q

pupils in cannabis use

A

dilated pupils

231
Q

s/s cannabis intoxication

A

-impaired motor coordination (impairment of motor skills lasts for 8-12 hrs)

  • euphoria
  • anxiety
  • sensation of slowed time
  • impaired judgment
232
Q

physical symptoms cannabis intoxication

A
  • conjunctival injection
  • increased appetite
  • dry mouth
  • tachy
233
Q

s/s of withdrawal in cannabis dx

A

*s/s occur w/in week following cessation of use

  • irritability
  • anger/aggression
  • anxiety
  • sleep disturbances
  • decreased appetite
  • depressed mood
  • stomach px
  • tremors
  • sweating
  • fever/chills
  • HA
234
Q

assessment tools for substance abuse

A
  • CIWA (clinical institute withdrawal assessment of alcohol scale)
  • MAST (Michigan Alcoholism Screening Test)
  • CAGE questionnaire
  • COWS (Clinical Opiate Withdrawal Scale)
235
Q

CAGE questionnaire

A
  • have you ever felt you should CUT down on drinking?
  • have ppl ANNOYED you by criticism?
  • have you felt bad or GUILTY about drinking?
  • have you ever had drink first thing in morning? (EYE-opener)
236
Q

management of illness education

A

(1) activities to substitute for substance in times of stress
(2) relaxation techniques (progressive relaxation, tense and relax, deep breathing, autogenics)
(3) problem-solving skills
(4) essentials of good nutrition

237
Q

nurses suffering from dz of chemical dependency

A

10-15%

-alcohol most widely abused, followed by narcotics

238
Q

signs chemically impaired nurse

A
  • poor concentration
  • difficulty meeting deadlines
  • inappropriate responses
  • poor memory/recall
  • probs w/ relationships
  • irritability, tend to isolate, elaborate excuses for behaviors
  • unkempt appearance, impaired motor coordination, slurred speech, flushed face
  • pt complaints of inadequate pain control, discrepancies in documentation
239
Q

during suspension period

A
  • completion of inpatient/outpatient/individual counseling tx
  • evidence of regular attendance at nurse support groups or 12-step program
  • random negative drug screens
  • employment or volunteer activities
240
Q

peer assistance programs

A

-serve to assist impaired nurses to:

  • recognize their impairment
  • obtain necessary tx
  • regain accountability w/in profession

TnPAP (Tennessee Professional Assistance Program)

241
Q

codependency traits

A
  • sacrifice their own needs for fulfillment of others to achieve sense of control
  • derive self-worth from others and feels responsible for happiness of others
  • denies problems exist
  • keep feelings in control, and often releases anxiety in form of stress-related illnesses or compulsive behaviors (eating, spending, working, use of substances)
242
Q

predisposing factors codependency

A
  • experienced abuse or emotional neglect as child
  • outwardly focused on other and know very little about how to direct their lives own sense of self *** (BIG part of codependency)
243
Q

tx of codependency

A

**Cermak (1986)

(1) survival stage (let go of denial)
(2) re-identification stage (able to take responsibility for their own dysfunctional behavior and can tell themselves they are codependent)
(3) core issues stage (detach from willful efforts to control things out of their control; realize relationships cannot be managed by force of will)
(4) reintegration stage (reclaim personal power of their own lives; relinquish power over others that wasnt theirs)

244
Q

AA based on concept of

A
  • peer support
  • acceptance
  • understanding from others who have experienced same prob
245
Q

only cure for alcohlism

A
  • total abstinence

* person can never safely return to social drinking

246
Q

disulfiram

A

(Antabuse)

**pharm for alcoholism

-client must have abstained from alcohol for at least 12 hrs before administering (and after d/c-ing, sensitivity may last for up to 2 weeks)

247
Q

disulfiram

A

**avoid alcohol-containing substances

  • cold medicines
  • aftershave
  • cologne
  • mouthwash
  • nail polish remover
  • vanilla extract
248
Q

other meds for alcholism

A
  • ReVia (naltrexone)
  • Revex (nalmefene)
  • SSRIs
  • Campral (acamprosate)
249
Q

pharm for substance intoxication/substance withdrawal

ALCOHOL

A
  • benzodiazepines
  • anticonvulsants
  • multivitamin therapy
  • thiamine
250
Q

pharm for intoxication/withdrawal

OPIOIDS

A

-narcotic antagonists (Narcan-naloxone, Revia/Vivitrol-naltrexone, Revex-nalmefene)

  • Methadone
  • Buprenorphine
  • Clonidine
251
Q

pharm for intoxication/withdrawal

DEPRESSANTS

A

(barbiturates, alcohol)

  • phenobarbital (Luminal)
  • long-acting benzos
252
Q

pharm for intoxication/withdrawal

STIMULANTS

A
  • minor or major tranquilizers
  • anticonvulsants
  • antidepressants
253
Q

pharm for intoxication/withdrawal

HALLUCINOGENS & CANNABINOLS

A
  • benzodiazepines

- antipsychotics

254
Q

psychosocial influences gambling disorder

A
  • loss of parent before age 15
  • inappropriate parental discipline
  • exposure to gambling as adolescent
  • family emphasis on material and financial symbols
  • lack of family emphasis on saving/planning/budgeting
255
Q

pharm for gambling

A
  • SSRIs
  • clomipramine
  • lithium
  • carbamazepine
  • naltrexone
256
Q

vivitrol dose

A

-380 mg (4mL injection)

257
Q

vivitrol injection site rxn

A

-induration, swelling, erythema

258
Q

14 days after vivitrol dosing

A

concentrations slowly decline

259
Q

vivitrol admin and opioid-free

A

*must be opioid free for minimum of 7-10 days before admin to avoid precipitation of withdrawal that may be severe enough for hospitalization

260
Q

onset of schizophrenia

A

-late adolescence into early adulthood

261
Q

schizophrenia characterized by:

A

-disturbance of thought processes, perception, affect

262
Q

s/s schizo.

A

-severe deterioration of social and occupation fxn-ing

263
Q

Phase I schizo development

A

(Premorbid)

  • social withdrawal
  • irritability
  • antagonistic behavior
  • poor relationships and school performance
  • display antisocial behavior
264
Q

Phase II schizo development

A

(Prodromal Phase)
**SEE CARDINAL s/s

  • last 2-5 yrs but can be as short as month
  • negative & positive symptoms
265
Q

negative s/s

A
  • poor sleep and ADLs
  • increased anxiety, irritation and depression
  • decreased concentration
  • fatigue
  • intentional peer avoidance leading to isolation
  • ANHEDONIA
  • FLAT AFFECT
  • WAXY FLEXIBILITY
266
Q

positive s/s

A
  • stimuli (hallucinations)
  • magical thinking and delusional thought and ideas of reference

*hypervigilance emerges in latter stage of this phase (sets stage for onset of stage III)

267
Q

Phase III schizo

A

(Schizophrenia)

*active phase where POSITIVE symptoms are prominent (persists for more than 6 mo)

Expect to See:

  • delusions/hallucinations
  • disorganized speech
  • bizarre behaviors
268
Q

negative symptoms in phase III

A

-decreased functioning in work/relationships/ADLs/academic performance

269
Q

w/ positive symptoms, you must FIRST r/o:

A
  • schizoaffective DO
  • depressive DO’s
  • bipolar DO’s that include psychotic features
270
Q

Phase IV schizo

A

(Residual Phase)

  • periods of remission and exacerbation
  • no longer see acute stage s/sx (specifically the + symptoms)
  • negative symptoms may continue (flat affect and role fxn-ing impairment still)
271
Q

more positive prognosis associate w/

A
  • later onset of 1st psychotic break
  • being female (poor prognosis for men)
  • abrupt symptom onset (gradual, poorer prognosis)
  • rapid resolution of active phase
272
Q

biochem of schiz

A
  • dopamine (excess)

- glutamate (when very high, hippocampus begins to atrophy and hippo shrinkage strongly associated w/ schiz)

273
Q

viral hypothesis schiz

A

-increased risk if mother suffers exposure to influenza after after reaching prenatal state (histological changes in fetal hippocampus

274
Q

enlarged ventricles

A

correlates w. negative symptoms, poor tx response, & cog. impariment

275
Q

downward drift hypothesis

A

-typical symptoms associated w/ schiz inhibit these individuals from remianing employed leading to DRIFT DOWN into lower socioeconomic level

276
Q

stress and schiz

A

NO scientific evidence to support stress as causative factor of schiz

-stress may contribute to severity and course of illness which may include increased rates of relapse

277
Q

delusional disorder

A
  • hallucinations not prominent and no bizarre behavior

* if delusional content is bizarre, then needs to be categorized

278
Q

categorize delusions

A
  • erotomaniac (belief famous person is in love with them)
  • grandiose (their own worth, talent, knowledge, power is enormously greater than reality of situation; may voice SPECIAL RELATIONSHIP w/ famous person sometimes assuming identity of that person)
  • jealous (belief person’s sexual partner is unfaithful, person may attack imagined lover)
  • persecutory (MOST COMMON TYPE*****)
  • somatic (have medical condition that they don’t really have)
  • mixed (no single theme is dominant)
279
Q

substances causing active psychosis

A
  • alcohol
  • amphetamines
  • THC
  • cocaine
  • hallucinogens
  • opioids
280
Q

psychotic d/o due to another med condition

A
  • acute intermittent porphyria
  • deafness
  • electrolyte imbalance
  • hypo-hyper thyroidism
  • hypoglycemia
  • migraine HA
  • B12 deficiency
281
Q

schizoaffective disorder

A
  • combo of psychotic symptoms coupled w/ mood d/o
  • 2-week period of hallucinations/delusions occurring w/out major mood or mania episode (prominent mood d/o must be evident for majority of time)
282
Q

positive symptoms

A
  • better tx response to meds

* ex: delusion, paranoia, circumstantiality

283
Q

negative symptoms

A
  • more difficult to treat, less responsive to antipsychotic med tx
  • more destructive in tat they are associated w/ anergia and avolition

**ex: alogia (poverty of speech), waxy flexibility/catetonia/ pacing/rocking, anergia, decreased abstract thinkingn

284
Q

delusion of religiosity

A

**don’t discourage if it provides comfort

285
Q

MAGICAL THINKING

A

thoughts have control over specific situations or ppl (common in kids)

286
Q

associative looseness

A

-pt unaware that comments are not connected

287
Q

concrete thinking

A

literal interpretation of environment

288
Q

mutism

A

-unable or unwilling to speak

POSITIVE symptom

289
Q

perseveration (speech)

A

-persistently repeats same word/idea in response to diff questions

290
Q

echolalia

A

-repeats words they hear

**attempt to identify w. person they are speaking to

291
Q

hallucination vs illusion

A

-illusion is misinterpretation of REAL external stimuli

292
Q

formication

A

(tactile hallucination)

-something crawling on or under skin

293
Q

echopraxia

A

-pt. purposelessly imitates movement made by others

294
Q

lack of interpersonal interaction skills

A

*negative symptom

3 types:
1-cling to others
2-ambivalent toward everyone
3-withdrawn altogether (asociality)

295
Q

anosognosia

A

1 predictor of nonadherence to tx and predict higher relapse rate

**lack of insight (negative symptom)

-no awareness of their affliction

296
Q

waxy flexibility considered…

A

…negative symptom

297
Q

posturing

A

*another negative symptom

298
Q

anhedonia

A

-compels some to attempt suicide (very distressing symptom)

299
Q

regression

A
  • another negative symptom
  • retreat to earlier developmental level (defense mechanism to decrease anxiety)

***(FOUNDATION for many of the behaviors r/t schizophrenia)

300
Q

typical antipsychotic

A

dopaminergic blockers in hypothalamus and limbic systems

301
Q

atypical antipsychotics

A
  • weak dopamine antagonists

- potent 5HT2a antagonists

302
Q

FGAs

A
  • thorazine

- haldol

303
Q

SGAs

A
  • zyprexa
  • risperidone
  • geodon

(may help to also tx negative symptoms)

304
Q

gold standard for schizophrenia tx

A

clorazil (SGA)

305
Q

Alpha-1 (adrenergic blockers)

A
  • dizziness

- orthostatic hypotension

306
Q

side effects antipsychotics

A
  • rash
  • orthostatic hypotension
  • photosensitivity
  • ECG changes
  • increased risk of mortality in elderly clients with dementia
  • reduction in seizure threshold
  • agranulocytosis (typicals AND atypical clonazepine)
  • hypersalivation
  • decreased libido
307
Q

antipsychotics and elderly

A

-increased risk for suicide with dementia-related psychosis

308
Q

contraindications SGAs

A
  • DM
  • prolonged QT interval hx
  • hypotension
  • pregnant/children
309
Q

top 3 typical antipsychotics

A
  • Thorazine (chlorpromazine
  • Prolixin (fluphanazine)
  • Haldol
310
Q

top 5 atypical antipsychotics

A
  • Clozaril (clozapine)
  • Zyprexa (olanzapine)m
  • Seroquel (quetiapine)
  • Risperidal (risperidone)
  • Geodon (ziprasidone)
311
Q

EPS

A
  • pseudoparkinsonism (shuffle gait, drooling, rigidity)
  • akinesia (muscle weakness)
  • akathisia (restlessness/fidget, sense of doom; more common in women)
  • dystonia (involuntary muscular movements/spasms of Face/Neck, Arms/Legs; more often in men and clients younger than 25)
  • oculogyric crisis (uncontrolled rolling back of eyes)
312
Q

dystonia and oculogyric crisis

A

txx as EMERGENCY situation

313
Q

tx for acute EPS

A
  • Cogentine
  • Trihexyphenidyl (Artane)
  • Benadryl
314
Q

TD

A
  • bizarre facial/tongue movements
  • stiff neck
  • difficulty swallowing

**potentially irreversible symptoms

315
Q

NMS nursing intervention

A

-frequent temp checks w/ parkinsonian symptom observation

316
Q

NMS symptoms

A
  • severe Parkin. muscle rigidity
  • VERY HIGH FEVER
  • tachycardia/tachypnea
  • BP fluctuations
  • diaphoresis
  • rapid deterioration of mental status to stupor and coma
317
Q

DM/hyperglycemia

A
  • can result from atypical antipsychotics

- obtain fasting BS before 1st admin

318
Q

lab draw weekly

A

w/ clozapine tx

319
Q

prolactin

A

FGA/SGA tx

-decrease dopamine, which increases prolactin release, increases lactation

Psychiatric Nursing (2 decks)

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