LifeSpan 2 Flashcards
1
Q
Maslows hierarchy of needs (also known as “theory of human motivation”)?
A
1: Physiological needs (02, food/fluids, rest/sleep, basic survival needs).
2: Safety and Security (physical safety, emotional security in relationships context).
3: Love and Belonging (met with meaningful relationships w/others).
4: Self-esteem (self-worth and independence met).
5: Self-Actualization (goals and life purpose developed).
2
Q
What are 2 catecholamines neurotransmitters that when deficient affect mood disorders?
A
Norepinephrine and Serotonin.
3
Q
Norepinephrine (catecholamine produced in brain) affects what when deficient?
A
Involved in affective development of affective behavioral disorders. Can trigger increase in blood pressure and exerts marked effects on metabolism.
4
Q
Serotonin (catecholamine produced in brain) when deficient affects what?
A
Sleep-wake cycles; affective and anxiety-related mood disorders. Decreased levels associated with depression. Exerts marked effects on metabolism.
5
Q
What catecholamine neurotransmitter is involved in behavioral disorders and disease involving abnormal movements. As well as responsible for parts of brain involving thoughts and emotions. Additionally stimulating hypothalamus to release the reproductive hormones estrogen and progesterone.
A
Dopamine.
6
Q
What is Gamma-aminobutyric acid (GABA) and what does it affect?
A
An inhibitory neurotransmitter that affects anxiety, seizures, aggression; decrease GABA levels may increase these behaviors.
7
Q
What is the cholinergic neurotransmitter that is decreased or absent in people with various thought disorders involving memory loss, Alzheimer’s dementia? This cholinergic neurotransmitter also contributes to normal motor function?
A
Acetylcholine.
8
Q
What basic assumptions serve as the foundation for Erickson’s theory of development?
A
Erickson’s 8 stage theory of human development assumes that each stage is characterized by conflict between a specific development task and a threat to the individual ego. The conflict must be resolved in order for a person to mature and move on to the next developmental level. If the conflict is not resolved, the person may not fully mature.
9
Q
Of the 8 stages, what are Erickson’s 1st 4 stages of development?
A
Birth to 1 yr: Trust vs. mistrust.
2-3 yrs: Autonomy vs. shame and doubt.
4-5 yrs: Initiative vs. guilt.
6-12 yrs: Industry vs. inferiority.
10
Q
Of the 8 stages, what are Erickson’s last 4 stages of development?
A
13-18 yrs: Identity vs. role confusion.
Young adult: Intimacy vs. isolation.
Middle adult: Generatively vs. self-absorption.
Old age: Ego integrity vs. despair.
11
Q
What are the 3 categories of regulatory disorders?
A
- Disorders related to impaired adrenal and pituitary function.
- Disorders related to impaired thyroid and parathyroid function.
- Disorders related to impaired renal (kidney) function.
12
Q
What are the 3 categories of metabolic disorders?
A
Disorders of:
- Gallbladder.
- Pancreas.
- Liver.
13
Q
What does NANDA-I stand for? What are the four categories?
A
North American Nursing Diagnosis Association International.
- Actual.
- Risk.
- Health Promotion.
4 Syndrome.
14
Q
What is the actual nursing diagnosis sometimes referred to as and what does it describe?
What does it identify?
A
“Problem Diagnosis”.
It describes the reaction of an individual, family, group, or community in response to life processes and health conditions.
It is a brief statement identifying an existing patient-centered problem or a potential problem for which a patient is at risk.
15
Q
How are “actual” nursing diagnosis written?
A
“Actual” nursing diagnoses are written as a three-part statement and should include identification of contributing factors (“related to”), as well as identification of associated signs and symptoms (“as evidenced by”).
16
Q
What are “risk” diagnosis and how are they written?
A
“Risk” diagnoses reflect a clinical judgement with regard to an individual, group, or community for whom, when compared to others in similar or identical circumstances, there is increased vulnerability for development of a particular problem.
“Risk” diagnoses are written as a two-part statement. To validate the diagnosis, the statement includes identification of risk factors, which may include medical conditions.
17
Q
How are “health promotion” diagnosis written?
what do they reflect?
A
“Health Promotion” diagnosis are written as a one-part statement that begin with “readiness for” and do not include designation of any related factors.
“Health Promotion” diagnosis reflect a clinical judgment used to describe the desire and willingness of an individual, group, or community to seek enhanced well-being and to actualize the potential for health in a given area.
18
Q
How are “syndrome diagnosis” written?
What do “syndrome diagnosis” reflect?
A
“Syndrome Diagnosis” are written as one-part statements and contain no designation of related factors.
“Syndrome Diagnosis” reflect the nurse’s use of clinical judgment for identification of a specific cluster of nursing diagnosis that occur simultaneously and for which the ideal plan of care involves simultaneously addressing the problems through the use of similar interventions.
19
Q
What is cyclothymia?
A
A chronic mood disorder characterized by both depressive and manic states that alternate by a period of 2 or more years and are separated by brief periods of normal states. Symptoms of mania and depression are milder than those seen with bipolar disorder.
20
Q
What are affective responses?
A
Affective responses constitute one of the primary categories of behavioral responses to life stresses; characterized by disturbances in behavior and mood.
21
Q
What are emotions?
A
Emotions, such as depression and elation, are strong feelings that can have both mental and physical manifestations. An emotion that persists over time is a “mood”.
22
Q
What is a mood disorder?
A
An emotion that persists over time is a mood. If a mood predominates over a prolonged time in which it affects activities of daily living it is considered a “mood disorder”. The 2 major categories of mood disorder are “depressive and bipolar”.
23
Q
What is a crises and what are the 3 types?
A
Crises is defined as a physical and emotional response to an acute, time-limited event that interferes with functioning and may not be able to be resolved with usual coping mechanisms.
The 3 types are:
- Maturational.
- Situational.
- Adventitious.
24
Q
Describe maturational crises?
A
- Maturational crises - said to occur when developmental milestones are reached; examples- starting kindergarten, graduating high school, getting married. At each stage of life, successful resolution of these crises helps a person develop new characteristics, qualities, and coping mechanisms.
25
Describe situational crises?
Situational crises - stressful life events such as a move, start of new job, loss of loved one. Events are not necessarily associated with a particular stage of development. Almost everyone's experiences situational crises at various points in their life.
26
Describe adventitious crises?
Adventitious crises - unplanned, unexpected events that not everyone will experience. Examples include hurricane ps and hose fires.
27
What 4 phases will ensue throughout crises?
1. Anxiety and disorganization.
2. If routine coping tactics fail, they will try different means to eliminate sense of discomfort.
3. If these fail, anxiety will escalate to panic - individual will withdraw and flee from situation.
4. If coping mechanisms remain ineffective, negative outcomes such as depression and suicide will occur.
28
What is bereavement?
The experience of dealing with the loss of a loved one.
29
What is mourning?
Mourning refers to cultural patterns displayed in response to grief and bereavement. Commons displays- wearing certain apparel, displaying certain symbols within the home, and engaging in specific social interactions deemed acceptable by one's culture.
30
What are the 5 categories of the grief cycle?
"DABDA"
1. Denial.
2. Anger.
3. Bargaining.
4. Depression.
5. Acceptance.
31
Describe the anticipated response of the 1st stage of grief, denial?
Denial - considered normal, difficult to accept reality of situation. Physiological responses may include: a vague "feeling" of numbness, or physical "hollowness" localized in stomach or chest. Others include sighing, hyperventilation, anorexia(lack of food appetite), insomnia(prolonged inability to sleep), lump in throat, and crying.
32
Describe the 2nd stage of grief, anger?
Anger - may follow denial when reality of loss sets in, can be directed toward situation or other people, including family members, health care personnel, and even God.
33
Describe the 3rd stage of grief, bargaining?
Bargaining - typically occurs post anger phase, although may come before; often seen if anticipated loss is self or loved one. People make promises, usually to God and themselves, that they will bring about personal change if their lives or lives of loved one be extended.
34
Describe response of 4th phase of grief, depression?
Depression- in this stage, it becomes impossible for person to deny reality of loss. Somatic symptoms: fatigue, uncontrollable weeping, anorexia or overeating, insomnia or sleeping more than body requirements. Guilt can occur at any stage; usually more noticeable with depression stage; especially true when person thinks they contributed to loss or had potential to change outcome.
35
Describe response of the 5th stage of grief, acceptance?
Acceptance- occurs when person is able to accept loss and cope in healthy manner. If person id unable to move into acceptance, they may feelings of despair.
36
Thyroid and cortisol hormone - how are they affected in depression? What is cortisol and where is it produced?
Thyroid levels may be diminished and cortisol levels may be elevated.
Cortisol is secreted by the adrenal gland cortex and is involved in protein and carbohydrate metabolism- also known as a glucocorticoid hormone that helps protect the body against stress when present in normal amounts.
37
What is the dexamethasone suppression test?
An assessment that helps measure cortisol response in people who have major psychotic depression. In most people, cortisol levels decrease in response to the administration of dexamethasone; this is not the case in people with severe depression marked by psychosis. It may also be beneficial in ruling out cushing's syndrome and thyroid conditions that mimic psychiatric symptoms.
38
What are the subcategories of depressive disorders?
1. Dysythmic disorder.
2. Major depressive disorder.
3. Seasonal affective disorder.
4. Postpartum depression.
39
What is a dysthymic disorder?
A depressive disorder characterized by chronically sad states; more prevalent in females. Defining characteristics of dysthymic disorder are guilt, depression, that a person may unconsciously use to help alleviate anxiety.
Others are:
```
Fatigue.
Anorexia or increased appetite.
Difficulty concentrating.
Insomnia or hypersomnia.
Impaired decision making ability.
Low self-esteem.
Feelings of hopelessness and helplessness.
```
Depression is usually present 50% of the time and extends over a 2 yr period for adults and 1 yr period for peds. Usually not severe enough to disrupt life.
40
What is major depressive disorder and some defining characteristics?
In major depressive disorder, symptoms of depression include dysthymic symptoms, however much more intense.
Other characteristics:
1. Anhedonia (inability to take pleasure in normally pleasurable things).
2. Anorexia or hyperorexia (marked increase in appetite); significant change in wt is gain or loss of more than 5% of body wt in a month.
3. Helplessness and hopelessness accompanied by thoughts of suicide ideation or death.
4. Psychosis (markedly distorted concept of reality).
5. Delusions - false or persistent fixed beliefs or feelings person hold despite all evidence to contrary.
6. Hallucinations - apparent perceptions of sight/sound not present in reality; may also be associated with senses of touch/smell. Some cases may require hospitalization.
41
What is seasonal affective disorder (SAD) and some defining characteristics?
Depressive mood fluctuation usually occurring in winter. More common in women. Abnormal serotonin transmission may contribute. Wt gain can also accompany SAD.
Serotonin - a precursor to melatonin, plays part in sleep-wake cycle and mood regulation. Excess believed to result in drowsiness, deficiency believed to produce abnormal wakefulness.
42
What us postpartum depression and some defining characteristics?
Depression following birth of infant; most often seen in 1st time mothers. May last wks to months or appear months after delivery. Mother may feel extremely anxious about infant health, feelings of hopelessness or helplessness, insomnia, fatigue, tearfulness, worries the world is an unsafe place for child, instance of committing suicide and infanticide.
43
What are bipolar responses?
Bipolar responses are when a persons mood alternates or swings widely from hyperactivity to varying degrees of depression. In between pt usually is stable. Result of neurotransmitter imbalance along with genetic predisposition. Usually occurs before age 30, often associated with higher-paying jobs demanding increased levels of creativity.
Characterized by:
Mania - state if mental excitement, could end quickly or last several months, periods of elation (extreme elevated mood), or euphoria (exaggerated feeling of well-being, irritability, loud speech - sometimes with rhyming words, flights of ideas, psychomotor activity (pacing, wringing hands), impaired judgement, delusions of grandeur(feelings of extreme overconfidence or power), wt loss and fatigue. Sometimes hypomania(symptoms present in mild forms) - less likely to need hospitalization.
44
What us depression associated with bipolar disorder and some defining characteristics?
```
Symptoms are similar to those with major depressive disorder.
Can include:
Tearfulness.
Hopelessness.
Low self-esteem.
Feeling of guilt.
Social isolation.
Psychomotor retardation.
Fatigue.
Decreased ability to concentrate.
Alterations in sleeping/eating patterns.
```
45
What is cyclothymia and its defining characteristics?
Cyclothymia is a mood disorder characterized by both depressive and manic states alternating for a period of 2 or more yrs separated by brief periods of normal mood. Similar to dysthymic disorder, same as hypomania, characterized by periods of creative thinking, decreased sleep need, increased work productivity. Onset usually during adolescence or early adulthood. Usually able to work and does not markedly impair normal life functions or ADL.
46
Explain the difference between trait anxiety and state anxiety?
State anxiety it acute anxiety while trait anxiety is chronic.
47
Agoraphobia?
Agoraphobia is fear or anxiety associated with being in situation or setting perceived to compromise safety, or that escape from might be difficult or embarrassing.
Examples - elevators, confined spaces, airplanes, or being left alone.
48
What are 5 common somatoform disorders?
1. Conversion disorder.
2. Hypochondriasis.
3. Somatization disorder.
4. Pain disorder.
5. Body dysmorphic disorder.
49
What is conversion disorder?
Conversion disorder is a somatoform disorder in which a person describes neurological symptoms, such as blindness, deafness, paralysis, that mimic known diseases. Despite symptoms, individuals rarely appear anxious about them and seem emotionally detached (known as "la belle indifference"). Actual symptoms may develop over time however following years of pseudoneurological symptoms. Related risk factors: childhood interpersonal experiences, rigid family structure, or using continued physical illness as an excuse for problems.
50
What is hypochondriasis?
The somatoform disorder Hypochondriasis - persistent belief that one has a serious illness in spite of extensive diagnostic testing and reassurance to the contrary; and in the absence of any specific physiological symptoms associated with the perceived illness.
51
What is somatization disorder?
The somatoform disorder somatization disorder - condition in which there are persistent physical complaints involving a variety of body systems. Severity may change over time, yet despite numerous tests, no physiological basis can be found.
- more common in women, usually begins before age 30.
52
What is pain disorder?
The somatoform disorder pain disorder (also known as somatic pain disorder) - characterized by chronic complaints of pain that interfere with work ability and daily functioning.
Typical sites- head, chest, abdomen, lower back, and pelvis.
53
Obsession?
| Compulsion?
Obsession- Persistent or recurring thought or idea that does not disappear with any amount of reasoning.
Compulsion- An irresistible and irrational impulse to act on a thought or idea.
Obsessive-compulsive disorder (OCD) - seeks to unconsciously control feelings of anxiety by engaging in specific repetitive thoughts and/or ritualistic behavior.
54
What is body dysmorphic image (BDD)?
The somatoform disorder body dysmorphic image (BDD) is diagnosed when an individual is noted to be preoccupied with his or her body image.
55
What is "command hallucinations"?
Hallucinations in which people hear voices that order them to take theirs lives or harm others. Not as common as visual hallucinations or auditory hallucinations (most common).
56
What is paranoia?
Paranoias chief characteristic is irrational suspicion or persistent belief that one is being persecuted or falsely accused by others. Individual may act violently towards them. Frequently manifests in middle aged people.
57
What is autism spectrum disorder?
A autism spectrum disorder - disorder of neural development characterized by impaired social interaction and communication and by restricted and repetitive behavior. Usually appears in early childhood. Typically withdraw from social interaction.
58
What is savantism?
Savantism is a type of autism spectrum disorder in which individual exhibits exceptional abilities in a specific area. Example- Dustin Hoffmans character in the movie "Rain Man".
59
Define schizophrenia?
Schizophrenia is a major mental disorder that affect persons thought processes and perception, language, emotions, and social behavior.
- separation in ones emotions and thought processes; psychotic disorder, frequent relapses are common, mind fragmented, genetic link, occurs late teens and late thirties, CT scans reveal structural changes.
Positive symptoms - observable and present.
Negative symptoms - appear to involve the absence of something; ex.flat affect, alogia (poverty of speech), lack of close relationships, short attention span, poor grooming, anhedonia (lack of pleasure or capacity to experience it), avolition (lack of motivation), depression, difficulty in carrying out routine ADL's.
Individual must exhibit one of the following for positive diagnosis: delusions, hallucinations, disorganized speech.
60
Wernicke-Korsakoff Syndrome?
Wernicke-Korsakoff Syndrome is a dementing brain encephalopathy associated with chronic alcoholism. Deficiency of thiamine (vit B1) secondary to malnutrition and malabsorption.
Symptoms of B1 deficiency- fatigue, irritability, nystagmus, ptosis, muscle tenderness, anorexia.
61
Huntington's Chorea (Huntington's disease)?
Huntington's disease is a Relatively rare hereditary dementia; usually appears after age 50. Characterized by dance-like or writhing movements of face, upper extremities - can lead to disturbance in body image. Ability to chew/swallow becomes impaired, depression, hallucinations, paranoia, may occur. Progressive- slowly brings about cognitive deterioration, memory loss, full-blown dementia.
Gene located on the 4th chromosome responsible - brings pathological changes in brain; atrophy of cerebral cortex, basal ganglia, extensive nerve cell loss, decreased white matter.
62
Parkinson's disease?
Parkinson's is a progressive degenerative disorder involving nerve cell destruction in basal ganglia of brain. Imbalance of neurotransmitter acetylcholine and dopamine.
Risk factor - age, familial tendency.
Symptoms - hand muscle rigidity/tremors, pill rolling, absence of blink reflex, drooling, inability to swallow saliva, stooped posture, shuffling gait, loss of balance, depression, emotional liability.
63
What is Antisocial Personality Disorder (ASPD)?
Behavior that is harmful to people in general and in conflict with the basic values of a society as a whole.
Primary characteristic - inability to relate to other people.
64
Regarding antisocial personality disorder (ASPD), what is Psychopathic Behavior?
Psychopathic behavior - marked by desire to harm other people, such as through mental or physical abuse.
65
Regarding antisocial personality disorder (ASPD), what is Sociopathic Behavior?
Sociopathic behavior is similar to psychopathic behavior, but implies a complete indifference to the pain of others. There is no guilt or remorse involved when a sociopathic person abuses or manipulates others.
66
Conduct disorders?
Persistent, repetitive behavior patterns resulting in come sort of violation of the rights of others. At least 3 of the following criteria present over 12 month period must be met to classify:
1. Aggressive behavior toward people or animals.
2. Some form of theft.
3. Destruction of property.
4. Breaking of some pre-established rule set by society or family.
67
Define coprolalia?
Regarding Tourette's disorder, coprolalia is a vocal tic behavior - uttering of obscenities.
It is an autosomal dominant condition. However, there is a nongenetic form associated with autism spectrum disorder, seizure disorder, OCD, ADHD.
68
What is the CAGE questionnaire used for?
CAGE questionnaire is used for alcohol screening.
Assesses 4 areas:
1. alcohol consumption and desire to cut down.
2. Annoyances when alcohol consumption is criticized by others.
3. Guilt associated with alcohol use.
4. "Eye openers" or use of alcohol in the morning.
69
Describe the characteristics of Cluster A personality disorders and their categories?
Cluster A personality disorders are characterized by detachment and distrust; individuals are odd, eccentric, more common in males, depression common.
Includes:
1. Paranoid personality disorder- extreme suspiciousness and distrust of others with no objective basis in reality.
2. Schizoid personality disorder- avoid meaningful relationships, exaggerated shyness, fear of intimacy, prefer isolation, daydreaming, theoretical speculation preferred to taking action.
3. Schizotypal personality disorder- withdrawal, detachment, inability to form close interpersonal relationships, eccentric behavior, odd beliefs, magical thinking, sometimes join cults, often manifested in childhood.
70
Describe the characteristics of Cluster B personality disorders and their categories?
Cluster B personality disorder characteristics- emotional instability and impulsiveness, dramatic, emotional, erratic, intense.
Categories:
1. Antisocial personality disorder- disregard of other person, blatant disregard to safety of self and others, breaking laws, conduct behavior, punishment useless, remorse rare, exploit others for personal gain, deceitfulness, aggressiveness, impulsivity, irresponsible.
2. Borderline personality disorder (BPD)- difficulty maintaining relationships, alternate between dependency to ignoring, outbursts of anger common, splitting (one minute like friendship, the other they hate) common, impulsive, manipulative, angry, sometimes self-mutilation.
3. Historionic personality disorder- seeks center of attention, desire for dependency and protection, conspicuous/dramatic behavior, provocative behavior, relationship often based on sex.
4. Narcissistic personality disorder- arrogant, grandiose view of successes, power, beauty, intelligence, feel entitled, lack empathy, often exploit others, when confronted with failure become depressed and suicidal.
71
Describe the characteristics of Cluster C personality disorders and their categories?
Cluster C personality disorders- characterized by anxiety and fear. Avoidant, dependent, OCD.
1. Avoidant personality disorder- feelings of inadequacy, inferiority, hypersensitive to criticism, shame, rejection, evade situations, often appear shy, inept, withdraw at 1st hint of rejection, clingy, dependent.
2. Dependent personality disorder- seek someone to care for them, irrational belief they cannot survive on their own. Lack self confidence, seek relationships with strong, confident individuals.
3. Obsessive-Compulsive personality disorder- focused on perfectionism, miserly, overly conscientious, stubborn, inflexible, unwilling to delegate tasks or discard objects, devoted to work, productive to exclusion of friendships and leisurely activities. Internal fear of catastrophe.
72
How do anxiolytics such as benzodiazepines work?
List some common benzodiazepines?
Benzodiazepines work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), thereby decreasing the electrical activity and excitability of the nerve cells in the brain.
1. lorazepam (Ativan).
2. alprazolam (Xanax).
3. temazepam (Restoril).
4. clonazepam (Klonopin).
5. diazepam (Valium).
73
What is a non-benzodiazepine anxiolytic and how does it work?
A non-benzodiazepines is buspirone hydrochloride (BuSpar).
It works by increasing dopamine and serotonin levels in the brain.
Considered non-addicting.
74
What are 2 antihistamines used in the treatment of anxiety and what else are they used for?
```
2 antihistamines are hydroxyzine hydrochloride (Atarax) and
hydroxyzine pamoate (Vistaril).
```
Given for anxiety and sometimes anti nausea effects.
75
How do antidepressants work and what are the 6 categories?
Antidepressants work by raising levels of norepinephrine and serotonin and increasing efficacy.
Six categories are:
1. Monoamine oxidase inhibitors.
2. Selective serotonin reuptake inhibitors (SSRI's).
3. Nonadrenergic and specific serotonergic antidepressants.
4. Norepinephrine-dopamine reuptake inhibitors.
5. Tricyclics.
6. Serotonin-norepinephrine reuptake inhibitors.
76
How do MAOI's work?
What are some precautions?
Monoamine oxidase inhibitors (MAOI's) increase norepinephrine and serotonin levels by interfering with the production of monoamine oxidase (MAO), an enzyme that destroys monoamines including the 2 above neurotransmitters.
Rarely used since SSRI's.
Once commonly prescribed- phenelzine sulfate (Nardil).
Precautions- certain foods and beverages containing tyramine can precipitate hypertensive crises. Tyramine is a monoamine that constricts blood vessels. Tyramine is normally destroyed by liver, however, with presence of MAOI's, tyramine is not destroyed, causing activation of neurotransmitters that further constrict vessels.
Tyramine found in: dairy (aged,natural cheeses, yogurt, sour cream), beverages (beer, red wine, caffeinated and chocolate drinks), fruits/vegetables (bananas, raisins, avocados), meats (pickled herring, sausage, organ meats), soy sauce and yeast products.
It also interferes with sympathomimetic meds such as pseudoephedrine and epi.
77
How do selective serotonin reuptake inhibitors (SSRI's) work?
They block the reuptake of serotonin by the nerve cells in the brain. Treat depressive disorders, OCD, eating disorders, social phobias.
Most common:
1. fluoxetine hydrochloride (Prozac).
2. sertraline hydrochloride (Zoloft).
3. citalopram (Celexa).
4. Escitalopram (Lexapro).
5. paroxetine hydrochloride (Paxil).
Prozac and Paxil have been effective in treating seasonal affective disorder along with bulimia and obesity. Given in morning - may cause insomniac given later in day. However, if pt fatigued, given at night to facilitate sleep. Less likely to cause anticholinergic effects, wt gain, or cardiac problems. May cause "serotonin syndrome" when combined with MAOI's.
78
How do serotonin-norepinephrine reuptake inhibitors work?
List some common meds?
SNRI's work by blocking the reuptake of both serotonin and norepi, thereby increasing the amount of these neurotransmitters in the brain.
1. venlafaxine (Effexor).
2. duoloxetine (Cymbalta).
3. desvenlafaxine (Pristiq).
4. atomexatine (Strattera) - used to treat ADHD targeting norepi receptors.
Use with caution in pt's under 25 yrs.
79
How do Norepinephrine-Dopamine Reuptake Inhibitors (NDRI's) work?
List some common meds?
NDRI's work by inhibiting the neuronal uptake of dopamine and norepinephrine to treat depression. Not recommended under age 25 yrs. Side effects - dry mouth, excessive sweating, insomnia, nausea, tinnitus, tremor. Risk for seizures.
1. bupropion HCI (Wellbutrin).
2. bupropion HBr (alplenzin).
80
What are antimanics? Side effects? List Drugs?
Antimanics, also called mood stabilizers, are meds used for manic states. They alter sodium transport, decreasing psychomotor activity.
1. Lithium carbonate (Lithane and Lithobid) is most common. Treats mania, depression, bipolar disorder. Enhances action of 4 neurotransmitters: acetylcholine, GABA, norepinephrine, serotonin. Side effects- thirst, polyuria, fine hand tremors. Blood levels must be monitored. Therapeutic levels considered close to toxic levels. Normal plasma levels - between 1.0 and 1.2 mEq/L or mmol/L. Toxicity above 1.5 mEq/L. Symptoms- muscle weakness, lack of coordination, coarse hand tremors, polydipsia, confusion, blurred vision, GI effects - N/V/D. Muscle rigidity, seizure, coma less common. Other meds like thiazide diuretic Diuril can cause dehydration contributing to toxic levels. Renal function needs monitored.
81
What are some alternatives drugs to lithium used?
Lithium alternatives are:
1. carbamazepine (Tegratol).
2. lamotrigine (Lamictal).
3. vaproic acid (Depakene, Depakote).
Tegretol - primarily used to treat tonic-clonic seizures; has sedative side effect.
Lamictal - treats depressive, bipolar disorders.
Steven-Johnson syndrome (a life-threatening necrotizing rash), may occur if Lamictal, Tegretol, Depakote, given together.
Valproic acid increases concentration of neurotransmitter GABA.
Meds also classified as anticonvulsants.
82
What are endocrine glands?
Ductless glands within body that secrete hormones directly into the bloodstream or lymph system.
Hypo/hyper secretion can contribute to regulatory disorders.
83
What are the adrenal gland and what 2 parts do they contain?
Adrenal glands are an endocrine gland attached to the top of each kidney consisting of 2 parts - adrenal cortex (outer layer) and the adrenal medulla (inner layer).
84
Regarding the adrenal cortex portion of the adrenal gland, what are the 3 corticosteroids it secretes and what hormone triggers them?
The adrenal cortex secretes:
1. Glucocorticoids (stress hormones) - involved in long term response to stress, highest in morning, lowest at night, elevates blood glucose, regulates metabolism of carbohydrates, fats, proteins, some synthetics treat allergic reactions, most important- cortisol.
2. Mineralocorticoids - steroid hormones responsible for regulating fluid and electrolyte excretion by kidneys, including aldosterone (involved in sodium, water, potassium balance, blood pressure).
3. Sex hormones - androgens (stimulate male sex characteristics) and estrogens (female sex characteristics).
Adrenocorticotropic hormone (ACTH) secretion from pituitary gland during stressful times triggers release of other above hormones.
85
Regarding the adrenal medulla portion of the adrenal gland, what are the 2 catacholamine hormones it secretes?
The adrenal medulla secretes epinephrine (adrenaline) and norepinephrine.
Act on cardiovascular and CNS and involved in fight or flight. Stimulated by sympathetic nervous system, which is part of autonomic nervous system. Diverts blood to heart and muscles.
Blood vessel constriction, increased heart rate, metabolism, hearts contractile force, cardiac output, dilation of bronchioles smooth muscles, breakdown of glycogen in liver and skeletal muscles.
86
What is the band of tissue called that separates the 2 lobes of the thyroid surrounding the anterior trachea of the neck?
What 3 hormones are produced here and what do they regulate?
The isthmus.
1. Calcitonin - increases bone calcium deposits and serum calcium regulation.
2. Triiodothyronine (T3) and
3. Thyroxine (T4) - both are known as thyroid hormone, involved in protein synthesis, cellular metabolism, body's basal metabolic rate (BMR).
Iodine is important for thyroid synthesis.
Thyroid hormone is controlled by thyroid-stimulating hormone (TSH), secreted via the anterior pituitary gland in the hypothalamus.
87
What is the parathyroid gland and what does it regulate?
Parathyroid glands - 4 small endocrine glands located behind or imbedded in thyroid gland of neck. Secretes parathormone (PTH), hormone that decreases serum phosphate and potassium levels in blood, causing to be excreted in urine. PTH also regulates serum calcium levels in blood in the presence of vitamin D which is needed by intestines to absorb calcium. Calcium is essential for coagulation and neuromuscular function.
88
What is the pituitary gland?
Pituitary gland - also called the hypophysis, located on the anterior portion of brain and attached to lower portion of hypothalamus. Very small in size, plays major role in regulating growth, reproduction, and many metabolic processes, often called "master gland" of endocrine system.
Consists of 2 parts - anterior and posterior lobes.
89
Regarding the anterior pituitary lobe, what six hormones does it secrete along with their function?
Anterior pituitary lobes secretes: GFP LAT -
1. Growth hormone (GH) - also known as somatotropic hormone (STH), stimulates protein anabolism, extracting blood nutrients for cellular growth. Increases blood glucose levels, breaks down fats in the process of catabolism. Exercise and stress are primary external factors stimulating GH secretion.
2. Follicle-stimulating hormone (FSH) - stimulates estrogen secretion in women.
3. Prolactin - stimulates production of breast milk.
4. Luteinizing hormone (LH) - stimulates both estrogen secretion and ovulation in women, testosterone secretion in men.
5. Adrenocorticotropic hormone (ACTH) - stimulates secretion of cortisol by the adrenal glands.
5. Thyroid-stimulating hormone (TSH) - stimulates thyroid gland hormones.
90
Regarding the posterior pituitary gland, what 2 hormones does it secrete along with their regulatory function?
The posterior pituitary lobes secretes and stores oxytocin and antidiuretic hormone, which is originally produced in the hypothalamus.
1. Oxytocin - hormone secreted during pregnancy, stimulates milk ejection and increases muscle tone and contraction of uterus during birth.
2. Antidiuretic hormone (ADH) - also called vasopressin, is responsible for water absorption by kidneys and regulation of urine output. Also raises blood pressure by constricting blood vessels, increasing arterial resistance; vasopressin secretion increases when BP drops.
91
What do the kidneys consist of and what is their role?
Kidneys - 2 lima-bean-shaped organs located in the back of the abdominal cavity next to spinal column. Role - form urine (metabolic wast product), regulate fluids/electrolytes, maintain electrolyte and acid-base balance in blood and other body fluids along with blood pressure maintenance.
Consists of:
1. cortex -outer layer containing glomeruli, networks of capillaries involved in urine production.
2. Medulla - inner layer of kidney.
3. Renal pelvis - funnel shaped part that collects urine.
Functional unit - called the nephron.
92
What is the functional unit of the kidney called and what waste products does it make?
Nephron. Each kidney contains over 1 million nephrons that contain glomeruli involved in glomerular filtration which produces
1. urea (waste product of metabolism of proteins and amino acids).
2. creatinine (waste product of skeletal muscle metabolism).
3. uric acid (product of purine metabolism).
All processed into urine. Many other important substances are excreted in urine, such as medications and hormones.
93
What are the two adrenal hyper-secretion disorders?
Two hyper-secretion disorders of the adrenal glands:
1. Pheochromocytoma - affects adrenal medulla (increases catecholamines epi and norepi).
2. Cushing's syndrome - adrenal cortex (outer layer releases high levels of corticosteroids, especially glucocorticoids, i.e. cortisol)
94
Regarding the hyper-secretion disorder of the adrenal cortex, describe Cushing's syndrome?
Cushing's syndrome - caused by high presence of corticosteroids, especially the glucocorticoid cortisol. Can occur via long term use of steroids, pituitary lesions may cause it, most common in women between ages 20-40.
S/s - wt gain in face, back, truncal obesity, moonlike round facial features, buffalo hump - excessive fat deposits in neck/shoulders, thin arms/legs, pendulous abd, muscle weakness, hypertension, thin easily bruised skin, purple striae(stretch marks) on breasts/abd, hirsutism(excess facial hair) in women, gynecomastia(breast enlargement) in men, sleep/menstrual disturbances, osteoporosis, susceptible to frequent infections, polydipsia/polyuria/polyphagia related to inhibiting effect of glucocorticoid hormone on insulin, depression, possible psychosis, cataracts, acne.
Diagnosis- s/s, physical Hx, lab tests, CT/MRI for tumors, elevated 17-hydroxycorticosteroid/17-ketosteroids in urine, 24 hr urine for free cortisol, labs-hyperglycemia, hypokalemia, elevated cortisol.
Best test = dexamethasone suppression test- pt given 1 mg dex in evening then blood draw following morning - cortisol levels would decrease in normal people however with cushings levels will be elevated.
Treatment- diets high in protein, potassium; but low calories, sodium, carbs to avoid wt gain, tapering of corticosteroids if deemed the cause, adrenalectomy prn, meds- metyrapone(Metopirone) to supress adrenal secretion, potassium supplements, hypophysectomy prn, corticosteroids therapy prn.
95
Describe the adrenal hyper-secretion disease pheochromocytoma?
Pheochromocytoma - neuroendocrine disorder usually caused by a mostly benign tumor in adrenal medulla causing increased secretion of the catecholamines epi and norepi. More common in men.
S/s - hypertension, headache, hyperhidrosis(excessive sweating), hyper-metabolism or increased BMR with wt loss, hyperglycemia, tachycardia, palpitations, systolic BP can be over 300 with diastolic as high as 200 (malignant hypertension), hypotension can also be seen, N/V, nervousness, visual disturbances.
Diagnoses- labs, imaging, glucagon stimulation test, clonidine suppression test (antihypertensive) - if catecholamine levels do not decrease pt may be positive for pheochromocytoma, 24-hr urine specimens for positive metabolites and vanillylmandelic acid(VMA).
Treatment- decreasing stimulus for pt to limit catecholamine release, bed rest, relaxation techniques, eliminate aspirin, OTC stimulants,
Eliminate bananas, caffeine, chocolate, vanilla, alcoholic beverages, citrus fruits as they affect urine VMA levels; bed rest with head elevated, muscle relaxants, antihypertensive like sodium nitroprusside(Nipride) to lower BP, insulin if glucose levels high; adrenalectomy prn - ensure pt well hydrated prior to surgery, stabilize BP prior, alpha/beta blockers prn, phentolamine(Regitime), propanolol hydrochloride(Inderal), corticosteroid therapy.
Prednisone or glucocorticoid therapy considerations:
Physical stress, hot humid weather increases steroid need, cannot abruptly stop without possible cardiovascular collapse, morning administration, avoid infectious people, additional sodium prn, susceptible to ulcers- may take prednisone with antacids or mild, diet needed - high in carbs, sodium, protein, increase fluids.
96
What is the primary disorder related to adrenal hyposecretion?
Describe?
Addison's disease - cause by insufficient production of corticosteroid secretion; cause by autoimmune, infectious process as tuberculosis, or adrenalectomy; may mimic other diseases.
S/s - fatigue, muscle weakness, dizziness with postural hypotension, wt loss secondary to anorexia, n/v, abd pain, bronze/dark skin pigmentation, salt craving, depression, irritability.
Diagnosis - labs reveal hyponatremia, hyperkalemia, hypoglycemia, high WBC count if infection occurs as well, 24-hr urine tests indicating increased plasma ACTH, decreased cortisol levels/ 17-ketosteroid/ 17-hydroxycorticosteroids, ACTH stimulation test measuring adrenal cortisol secretion ability, CT prn.
Treatment- diet high in carbs and protein, sodium prn, shock positioning prn, saline, dextrose, hydrocortisone, aldosterone like fludrocortisone(Florinef) prn.
97
Describe Addison's crises symptoms?
Addison's crises - sodium/potassium levels become imbalanced as a result of physiological or emotional stressor causing a medical emergency.
S/s of acute emergency- back pain, severe dehydration/hypotension, tachy with weak pulse, cardiac dysrhythmias, rapid respirations, circulatory collapse if untreated.
98
What are the 3 diseases of pituitary hyper-secretion?
Three diseases of pituitary hyper-secretion:
1. Acromegaly - overproduction of growth hormone(GH) of pituitary.
2. Cushing's syndrome - hyper-secretion of corticosteroids, i.e. Cortisol.
3. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -
excess production of antidiuretic hormone(ADH) of posterior pituitary.
99
What are the two diseases pituitary hypo-secretion?
Two diseases of pituitary hypo-secretion:
1. Diabetes insipidus - insufficient secretion of ADH of posterior pituitary.
2. Hypopituitarism (pituitary insufficiency) - pituitary gland fails to secrete hormones. Causes - head trauma, infection, radiation, surgery, hypothalmic dysfunction.
