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NRSG 220 > Neuro Starred > Flashcards

Neuro Starred Flashcards

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1
Q

Anxiety disorder symptoms

A

Apprehension
Worry, fear
palpitations
shortness of breath
heartburn
dry mouth
excess sweating

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2
Q

High levels of anxiety can be mistaken for

A

heart attack

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3
Q

If someone comes in for a heart attack, what are the steps?

A

MI first - diagnostic tests and ECG
then obtain a hx of recent events that might trigger anxiety or that might indicate drug abuse

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4
Q

What is needed to make an accurate diagnosis of anxiety

A
  1. Medications that may worsen/cause anxiety
  2. Medical conditions associated with anxiety
  3. Nonpharmalogical interventions that will reduce stressors prior to Rx intervention
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5
Q

Benzo’s cautions (5 points)

A

change dose gradually - do NOT stop abruptly
watch for suicidal ideation
may cause mania or psychosis
watch in use with dysfunctional kidneys, liver, CV or pulmonary system
use cautiously when using with the elderly

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6
Q

what is benzos last name

A

azepam

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7
Q

Lorazepam considerations (8 points)

A

aspirate prior to injection (IM)
Assess for paradoxical CNS excitement
advise pt to stop smoking
watch CBC, liver function and renal function
does the pt need anti anxiety drugs
assess for S&S of OD or abuse
teach nonpharmacologic methods of sleep/relaxation
assess for suicidal ideation

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8
Q

Phenobarbital ADEs (8 points)

A

Oversedation
“hangover” effect, lethargy
hallucinations
blood dyscrasias
hypocalcemia
hepatic disease
N/V/D/C
paradoxical excitation in children, older adults

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9
Q

Serious ADEs in phenobarbital

A

coma
SJS
angioedema
periorbital edema
thrombophlebitis

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10
Q

Phenobarbital considerations (8 points)

A

monitor for resp depression
assess patient given IV barbiturates Q 15 mins
monitor for signs of blood dyscrasias
aspirate prior to injection
monitor therapeutic serum concentrations of drug
assess baseline hepatic/renal and monitor
teach nonpharm methods of sleep/relaxation
if pt develops fever, angioedema, and body rash, hold med and call MD

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11
Q

What is depression

A

A mood disorder that is persistant disturbance in emotion that impairs ability to effectively deal with ADLs

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12
Q

What are the two primary types of mood disorders

A

depression and bipolar disorder

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13
Q

What are some causes of depression

A

environmental
situational
hereditary
no longer thought to be from parenting or unresolved childhood conflicts

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14
Q

What does depression often co exist with

A

anxiety disorder
substance abuse
HTN or arthritis

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15
Q

What kind of people are diagnosed with major depression

A

majority of the people who commit suicide

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16
Q

How many weeks may be required before patient’s mood begins to improve?

A

three or more weeks

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17
Q

How long will it take for antidepressant therapy to reach maximal benefit?

A

6-8 weeks

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18
Q

When is risk of attempted suicide the highest

A

the month before pharmacotherapy

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19
Q

What is the nurses role in care for a depressed patient

A

careful monitoring of suicide talk
weekly/dailing patient contact
careful monitoring of medications

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20
Q

Disadvantages of tricyclic antidepressants

A

withdrawal symptoms if not tapered
may take 3 weeks to see effects and 6 weeks to see optimum benefits
SE’s

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21
Q

What are SEs of tricyclic antidepressants

A

anticholinergic effects/sympathomimetic effects
orthostatic hypotension
sedation (worsened by concurrent use of other CNS depressants
high incidence of sexual dysfunction

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22
Q

Imipramine contraindications

A

Heart attack, heart block, dysrhythmias
asthma, GI disorders, alcoholism, schizophrenia, bipolar
avoid use with alcohol
seizure disorders

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23
Q

Imipramine precautions

A

suicidal tendencies
urinary retention
prostate hyperplasia
cardiac/hepatic disease
increased intraocular pressure
hyperthyroidism
Parkinson’s disease

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24
Q

Imipramine considerations (5 points)

A

monitor for suicidal ideation
be sure patient swallows each dose
encourage compliance
monitor for urinary retention or constipation
treat for dry mouth

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25
Fluoxetine ADEs
N/V/D/C anorexia cramping/flatuelence fluctuations in weight sexual dysfunction seizures poor concentration nightmares hot flashes palpitations nervousness serotonin syndrome (SES) pediatric patients (personality disorders or hyperkinesia)
26
Fluoxetine Contraindications/precautions
Bipolar disorder cardiac dysfunction diabetes seizure disorders carefully observe paediatric patients for hyperkinesia and personality changes/disorders late pregnancy
27
MAOIs
rare use high incidence of ADEs
28
What to avoid with MAOIs
foods with tyramine (aged or fermented) cheese, alcohol, condiments, certain aged meats avoid L tyrosine avoid caffeine
29
What off label uses are MAOIs used for
panic disorder social anxiety disorder migraine prophylaxis potentiates effect insulin, diabetic drugs
30
MAOIs ADEs
dizziness/orthostatic hypotension drowsiness/HA sexual dysfunction anorexia/diarrhea
31
MAOIs serious ADEs
Hypertensive crisis (foods with tyramine) dysrhythmias SIADH - like symptoms
32
MAOIs have high what
incidence of ADEs high level of NON COMPLIANCE
33
MAOIs precautions
epilepsy severe frequent headaches HTN dysrhythmias suicidal tendencies
34
MAOI considerations (5 points)
assess for suicidal ideation encourage compliance avoid tyramine foods (aged or fermented) avoid L tyrosine avoid caffeine
35
What is Bipolar disorder
alternated between extreme feelings of sadness and extreme mania significantly impacts social and occupational functioning
36
Nonpharmacologic interventions for bipolar disorder
support groups ECT
37
Pharmacologic interventions for bipolar disorder
highly individualized based on severity and predominant symptoms
38
What is a serious problem with bipolar treatment
non adherence
39
Lithium drug interactions diuretics
increase risk of lithium toxicity
40
Antithyroid drugs (drugs that contain iodine) cause what with lithium
increase in hypothyroid effect
41
Haloperidol with lithium causes what
increased neurotoxicity
42
NSAID's with lithium
increase lithium levels
43
SSRI's, MAOIs, dextramethorphan may result in what wit lithium
SES
44
Lithium considerations
monitor serum levels Q1-3 days initially and 2-3 months after assess for symptoms of bipolar disorder before and during tat monitor for symptoms of lithium toxicity assess daily for weight changes, edema, changes in skin turgor lithium is a salt so think water levels in the body monitor sodium intake (continue to take table salt to maintain osmotic hydration but dont over do it)
45
being dehydrated does what to lithium levels
increases them
46
Etiology of schizophrenia
precise ethology remains unknown genetic component of some sort
47
what is the risk of having a first degree relative with schizophrenia
5 to 10 x greater risk
48
What is another possible reason for schizophrenia
neurotransmitter imbalance - overactive dopaminergic pathways in basal nuclei - association with dopamine type 2 receptors
49
what are the drugs of choice in the tot of schizophrenia
second generation (atypical) antipsychotics have become drugs of choice for the tmt of schizophrenia
50
Managing psychoses
first dose may be higher than normal as may need to sedate an agitated, aggressive, dangerous patient
51
What is the most common drug given to relax the patient so an antipsychotic can kick in?
Benzodiazepenes (lorazepam)
52
How often do acute psychoses symptoms last
usually resolve in 3-7 days
53
What is EPS
refers to locations in the CNS associated with postural and automatic movements
54
EPS includes
acute dystonia akathisia Parkinsonism tardive dyskinesia (TD)
55
Acute dystonia
speech is heavy/not understandable
56
Akathiasis
quick repeated movements (feels like jumping out of skin)
57
Parkinsonism
parkinsons rigid movement/frozen
58
Tardive dyskinesias
repetitive movement on face or body
59
Haloperidol ADEs
anticholinergic symptoms (blurred vision, dry eyes, glaucoma) weight gain headache anemia phytotoxicity
60
Haloperidol serious ADEs
tachycardia cardiac arrest laryngospasm resp depression seizures agranulocytosis/leukopenia/leukocytosis neuroleptic malignant syndrome
61
Risperidone considerations
if medications cause drowsiness - take a bedtime watch for orthodontist hypotension assess for EPS/TD/Akathesias/NMS educate pt for S&S of above and what to watch for and when to contact HCP encourage sips of water or hard candies for dry mouth and anticholinergic like symptoms avoid alcohol and caffeine increase fluids and fibre watch liver lab results tell pt to report significant weight gain ensure pt knows that definite improvement may not be seen for 6-8 weeks
62
Drugs similar to risperidone
1. Quetiapine 2. Olanzapine 3. Clozapine
63
Second gen (atypical) antipsychotic considerations
monitor for EPS symptoms or anticholinergic effects ensure adequate nutrition/fluid monitor for signs of neuroleptic malignant syndrome (NMS) watch labs (liver)
64
Second gen (aytpical) patient education
monitor for weight gain or changes in sexual characteristics (lactation in men) no alcohol use/illegal drug use no caffeine use no smoking

NRSG 220 (8 decks)

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