week 3 Flashcards
1
Q
Are men or women more likely to self medicate? (ex: substance abuse etc)
A
men
2
Q
Is depression considered a normal part of aging?
A
No
3
Q
What causes depression?
A
triggers
genetics
biochemical
learned helplessness
cultural
4
Q
Explain the “learned helplessness” phenomena
A
anxiousness or so many overwhelming factors that eventually turns into “well, I don’t even care anymore”.
5
Q
What are the two kinds of depressive disorders learned in class?
A
- major depressive disorder
- persistent depressive disorder
6
Q
What “state” is someone in when they have major depressive disorder?
A
constant state of unhappiness
7
Q
What is a KEY feature of someone with Major depressive disorder?
A
loss of pleasure or not interested in things they used to enjoy
8
Q
What are symptoms of Major Depressive Disorder?
A
- guilt
- appetite changes
- suicidal thoughts
- psychomotor retardation
- interest lost
concentration diminished - energy decreased
- Sleep disturbance (includes insomnia or hypersomnia)
9
Q
What are symptoms of persistent depressive disorder?
A
- Hard to distinguish between person’s usual pattern of functioning
- daytime fatigue
- irritable
- able to function but not optimally
- eating too much or too little
- pessimistic thinking
- low self-esteem
10
Q
What are two medical diagnoses that can mimic depression symptoms?
A
- vitamin D deficiency
- HYPOthyroidism
11
Q
What are things you will look for in an assessment on a pt with depression?
A
- physical exam
- recognizing the common symptoms
- depression scale
- hx of previous episodes and coping skills
- support systems
- cultural factors
12
Q
what are common symptoms to look for in a pt with depression?
A
- mood and affect
- cognition and thought content
- physical changes
- suicide and homicide assessment
13
Q
What 3 questions do you ask in a suicide assessment?
A
- Do you have thoughts on harming yourself?
- what is your plan
- determine if they have the means to carry out that plan
14
Q
what is the main difference between a suicide assessment and a homicide assessment?
A
Is there is a specific target they want to harm or anyone who walks into the room
15
Q
What is the depression scale called?
A
PHQ-9
16
Q
How is the PHQ-9 useful?
A
is not used to diagnose someone with depression but refer the pt to somewhere else for further eval
17
Q
What is ALWAYS the priority for someone with depression?
A
safety safety safety
18
Q
what therapeutic technique works BEST for someone who is depressed?
A
therapeutic silence
19
Q
What are the interdisciplinary treatments for depression?
A
- milieu therapy
- psychotherapy
- mindefullness-based cognitive therapy
- group therapy
20
Q
What is the first line of treatment?
A
CBT: cognitive behavior therapy
modifies any dysfunctional thoughts
21
Q
what is mindfulness-based cognitive therapy
A
a form of CBT that is basically meditation
22
Q
What are the different types of antidepressants?
A
SSRIs
SNRIs
Trazadone
TCAs
MAOIs
Buproprion
23
Q
When it comes to antidepressants, they have black box warning that there is an increased risk of suicide when taking the medication, why?
A
antidepressants target mood symptoms and do not target suicidal ideation. SO if the pt has a changed mood and they have more energy they will have the energy to carry out that suicide.
INCREASED RISK OF SUICIDE
you want to make sure that when someone starts an antidepressant that you’re checking up on them
24
Q
List the 5 SSRIs
A
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
25
What are SSRIs useful for treatment in?
1. Depression with anxiety
2. Panic disorder
3. PTSD
4. OCD
5. Bulimia
26
What are the side effects of SSRIs?
1. Sleep disturbance
2. **Sexual dysfunction**
3. Tension headaches
4. Reduced appetite
5. hyponatremia (Headache is a sign of hyponatremia)
6. Rash/SJS
27
How long does it take SSRIs to take FULL effect?
2-3 WEEKS for full effect
28
What does SSRI stand for and how does it work?
Selective Serotonin Re-uptake inhibitor
Prohibits the re-uptake of serotonin so there's more serotonin available in the brain
**the higher the dose the higher risk there are for Serotonin Syndrome **
29
Signs of Serotonin Syndrome
hint *SHIVERS*
1. S shivering
2. H hyperreflexia
3. I increased temp
4. VS vital sign instability
5. E Encephalopathy
6. R restlessness
7. S Sweating
8. Abdominal pain
30
Why would you NOT want to give two antidepressants at the same time?
increased risk for serotonin syndrome
31
If a pt with ulcers or a GI bleed is taking antidepressants what are they at risk for?
higher risk for another GI bleed
32
What medication do you NOT want to give SSRIs with?
warfarin!
because of the increased bleeding tendencies
33
What are the 4 SNRIs?
1. Venlafaxine
2. Desvenlafaxine
3. Duloxetine
4. Levomilnacipran
34
What do SNRIs inhibit?
serotonin and norepinephrine
35
SNRIs are useful in treatment of what disorders?
Major depressive disorder and anxiety disorder
36
What is trazodone usually prescribed for?
Trazodone is usually prescribed for sleep, but it is classified as an anti-depressant.
37
Can trazodone be given with SSRIs?
yes but mostly targets sleep
38
What does trazodone block? What should be be mindful of when giving someone trazodone?
it blocks serotonin so we want to be mindful in looking for symptoms of serotonin syndrome
39
What is an adverse effect of trazodone?
Priaprism
painful erect dickkkkk
40
What are the 4 Tricyclics? (TCAs)
1. Amitriptyline
2. Doxepin
3. Imipramine
4. Nortriptyline
41
How long does it take for TCAs to take FULL effect?
4-8 weeks
42
What anticholinergic side effects do TCAs have?
1. Dry mouth
2. Blurred vision
3. Tachycardia
4. Constipation
5. Urinary retention
6. Esophageal reflux
7. Photophobia
8. Sexual dysfunction
43
What anticholinergic effects of TCAs is considered a medical emergency while taking this medication?
Constipation
Urinary retention
44
Which medication is known to be very cardiotoxic?
Tricyclics (TCAs)
45
Is it easy to overdose on Tricyclics (TCAs)?
YUH
46
What medication is given for someone going through physician assisted suicide? Why?
Amitriptyline
This medication causes those dysrhythmias , that's why its easy to overdose on
47
What are adverse effects of Tricyclics? (TCAs)
1. Orthostatic hypotension
2. Dysrhythmias
3. Myocardial infarction
4. Heart block
48
If someone has a seizure disorder and given TCAs, would you want to increase or decrease their dosage of their seizure medication? Why?
Increase because they are at higher risk for seizures when using TCAs
49
What are the contraindications for TCAs?
1. Recent MI
2. Narrow-angle glaucoma
3. BPH
4. Seizures
5. Preggo
50
What are MAOIs?
Monamine Oxidase Inhibitors
51
What are the 4 kinds of MAOIs?
1. Phenelzine
2. Tranylcypromine
3. Isocarboxazid
4. Selegiline
52
What is one known side effect of MAOIs?
HTN Crisis
53
What are the sign of a HTN crisis?
1. Severe HA or blurry vision
2. Chest pain
3. Tachycardia
4. SOB
5. Diaphoresis
6. Anxiety
7. Mental status change
8. Confusion
9. N/V
54
If someone is taking an SSRI and the doctor wants to switch them to an MAOI, what should the nurse be mindful of? Why?
There needs to be a 2-5 week wash out period before they can take a MAOI because of the increased risk of serotonin syndrome and HTN crisis
55
What antidepressant medication class inhibits the breakdown of Tyramine?
MAOIs
56
What are some tyramine foods to avoid?
1. Avocados, figs
2. Fermented, smoked, cured meats and fish
3. bologna, pepperoni, salami
4. almost all cheeses
5. Yeast extract
6. Some beers (No tap just can)
7. Protein supps
8. shrimp paste, soy sauce
no Chinese food, no red wine but they can have white wine, and no ripe bananas :)
57
Why should pts avoid tyramine rich foods when taking a MAOI?
It can cause HTN crisis so always check their BP
58
What are some contraindications of MAOIs
1. CVD
2. HTN
3. CHF
4. Liver disease
5. recurrent or severe headaches
6. Recent surgery
59
What is Buproprion given for?
1. Depression
2. Smoking cessation
3. Prevention of seasonal pattern depression
**mostly just smoking cessation**
60
What are some adverse effects of Buproprion?
1. Appetite suppression
2. Seizures
61
Why would you not want to give Buproprion to someone with an eating disorder?
Because one of the adverse effects is appetite suppression.
62
What are two differences between antidepressants and ketamine?
Anti-depressants DO NOT target suicidal ideation buuuuut Ketamine DOES!
Ketamine is quick acting and antidepressants take a few weeks
63
What specifically does ketamine target?
Suicidal Ideation
64
How can Ketamine be given? Is it just one treatment or multiple?
IV or Nasal spray
It wears off after a couple of days so pts have to go in for regular treatments
65
What are some side effects of Ketamine?
1. Increased BP/HR
2. Dissociation
Pts will experience withdrawal symptoms
66
What are some alternative treatments for depression?
Light therapy
St. Johns Wort
67
If someone is prescribed an SSRI, what herbal substance would you want to assess for? Why?
St Johns Wort
this interacts with SSRIs and can lead to serotonin syndrome
68
What is electroconvulsive therapy used for?
1. Major Depressive disorder
2. Schizo
3. Acute mania
69
At what point would you use electroconvulsive therapy?
Last resort, when all medication options have been exhausted
70
What medications are given when someone is receiving ECT? Why?
1. Atropine: To prevent aspiration. when seizing
2. Propophal: to sedate
3. Succinylcholine: muscle relaxant
71
What are some known side effects of ECT?
1. Confusion
2. ***Memory loss***
72
Why is ECT not an option for someone with a CVD or hx of stroke?
it puts a lot of strain on the heart
73
What are some examples of Brain stimulation therapies?
1. Vagus nerve stimulation
2. Transcranial Magnetic stimulation
3. Deep brain stimulation
74
What would be considered a big outcome in a evaluation?
Safety!!!!
Absence of suicidal thoughts
75
A client is prescribed an SSRI for depression. The client asks the nurse when should they expect to notice an improvement of their symptoms?
A.You should notice a significant improvement in 1-2 weeks of starting your medication.
B. It may take up to 6 weeks of consistent use for it to reach its full effect.
C. You should feel better after just a few days of taking the medication.
D. The improvement usually varies from person to person but it usually happens within 24 hours.
B. It may take up to 6 weeks of consistent use for it to reach its full effect.
76
What can anxiety increase the risk for?
1. Cardiovascular complications
2. reduced immunity
3. IBS
4. increased risk of cancer
77
What is behavioral theory?
Anxiety is learned but can also be unlearned
if we see someone is afraid of spiders, were going to be afraid of them too
78
What is cognitive theory?
where we tend to have assumptions of the world and they lead to cognitive distortions or negative perceptions and these distortions lead to anxiety
79
What is the difference between fear and anxiety?
Same feeling of uneasiness or uncertainty BUT for fear there is an actual danger in front of you
80
What are the three types of anxiety
Normal
Acute
Pathological
81
Why is normal anxiety necessary for survival?
It's this energy force that makes us carry out tasks MOTIVATION
82
What is acute anxiety?
Something that threatens your sense of security
usually something that's triggered by a stressor
83
what is pathological anxiety?
an emotional response that is out of proportion to a threat.
Some thing happens and their response is veryyyyy overdramatic
84
What are the four different LEVELS of anxiety?
mild
moderate
severe
panic
85
What does each level of anxiety have a difference in?
1. Perceptual field (How can they view the world around them)
2. Ability to learn (Can they follow directions
3. Physical charactersitics
86
What are specific characteristics of mild anxiety?
They can take in all the information that's going on around them BUT
they may be restless. mildly irritable, nail biting
87
What are some specific characteristics of moderate anxiety?
They have selective attention, can learn but altered ability
88
What are the Physical characteristics of moderate anxiety?
1. tension
2. pounding heart
3. increased RR,HR
4. Somatic symptoms
5. voice tremors
89
What are some characteristics of severe anxiety?
They are unable to learn, feel threatened, and can't take in any information from their external environment
90
what are some physical characteristics of severe anxiety?
1. Automatic behavior: they randomly start taking their clothes off (irrational behavior)
2. Severe somatic symptoms: they feel like their having a heart attack
3. sense of dread
91
Why is panic considered an extension of severe anxiety?
They experience the same characteristics as severe, however they experience more PSYCHOTIC type of behavior.
Psycho form of severe anxiety
**completely out of touch of reality**
92
As the levels of anxiety go UP...
Cognition goes DOWNNN
can't think straight
93
Describe a panic disorder
Unexpected and come out of no where (no trigger)
can last up to 30 min
94
What are some physical symptoms of a panic disorder?
heart palpitations
hyperventilation
hot flashes
**ALWAYS RULE OUT MEDICAL BEFORE ASSUMING ITS A PANIC ATTACK**
95
What medication class would be great for acute anxiety attacks?
Benzodiazepines
96
Are medications effective for phobias?
NAUR
97
What is someone afraid of when they have social anxiety disorder?
being evaluated or humiliated
98
In order to have agoraphobia you have to have at least TWO of these phobias
1. fear of using public transport
2. Fear of being in open/closed spaces
3. standing in line
99
What are those with OCD at high risk for?
suicide
100
Define sublimation
ex: somebody who has an urge to kill people becomes a butcher
They do something that is acceptable to hide unacceptable feelings
101
Define displacement
when a person transfers emotions from one person to another person
Take you anger out on someone else
102
Define undoing
performing an action to makeup for something
103
Specificities of antidepressants
1. increase risk for suicide
2. must be tapered down
3. long term tx
104
What are 3 benzodiazepines?
Lorazepam
Clonazepam
Alprazolam
105
What are the specificities of benzos?
1. short term tx
2. highly addictive
3. PRN BASIS
4. withdrawal symptoms
106
What are the side effects of benzos?
1. Amnesia
2. Impaired judgment don't drive
3. ANTIDOTE: FLUMAZENIL
4. long term use can lead to dementia
5. has a paradoxical effect (its supposed to calm pt but instead it makes them agitated)
107
What are the two antihistamines?
1. Diphenhydramine
2. Hydroxyzine
108
What disorder benefits the best with usage of antihistamines?
substance use disorder because its the alternative for benzos
109
Specificities of Busprione
1. Non addictive
2. long term tx
3. 2-4 weeks for it to be effective
4. **not for acute anxiety**
5. Risk for serotonin syndrome
6. High risk for falls due to orthostatic hypotension
7. Can cause delirium in older adults
110
What are three anticonvulsants?
Valproic acid
Gabapentin
Pregabalin
111
What are anticonvulsants used for?
1. GAD
2. Social anxiety
3. Panic attacks
112
What are some examples of easily accessible meds?
1. Kava kava: causes hepatotoxicity
2. Valerian: effective on insomnia
3. Lavender oil
4. St. Johns Wort: not effective for anxiety
