Week 6 Depressive, Bipolar, Substance Related & Addictive Disorders

Question 1

Remember Monamines are neurotransmitters that include:

Answer 1

Serotonin (5HT), Norepinephrine (NE), and Dopamine (DA).

Question 2

Thinking about the adrenal glands (atop of the kidneys:

Answer 2

Think about when these stressors remain high for long periods of time:

Question 3

Bipolar depression:

Answer 3

Childhood 5-6 up to age 50 with a mean onset of 21-30

Question 4

Disruptive Mood Disorder Dysregulation

Answer 4

can occur at any age, but generally is seen btwn 20-50 with a mean of 40

Question 5

We can use the SIGECAPS mnemonic to help guide our questioning:

Answer 5

sleep, interest, guilt energy, concentration, appetite, psychomotor, suicidality

Question 6

Remember Antidepressants can activate

Answer 6

manic episodes in people suffering from Bipolar and mania sometimes expresses itself as loss of impulse control

Question 7

Antidepressants

Answer 7

Citalopram (Celexa)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Escitalopram (Lexapro)

Question 8

Paroxetine (Paxil):

Answer 8

be very careful and do not take with herbal supplements due to adverse effects:
Sertraline (Zoloft)

Question 9

SNRIs:

Answer 9

Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)
Venlafaxine (Effexor)

Question 10

MAOIs:

Answer 10

Isocarboxiazid (Marplan)
Phenelzine (Nardil)
Selegiline (EMSAM) transdermal patch
Tranylcypromine (Parnate)

Question 11

Tricyclic Antidepressants:

Answer 11

Amitryptyline (Elavil)
Amoxapine (Ascendin)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)

Question 12

Bipolar 1 and 2

Answer 12

Looking at Bipolar 1 (severe mood swings from mania to depression and Bipolar 2 a milder form, characterized by milder episodes of hypomania that alternate with depression:

Question 13

Patient who is Bipolar has mania remember the following mnemonic DIGFAST

Answer 13

What should I think about to help guide my questioning? distractibility, indiscretion, grandiosity or inflated self esteem, flight of ideas or racing thoughts, activity increase, sleep deficit, talkativeness or pressured speech.

Question 14

Can bipolar 1 and 2 (mania) occur in children?

Answer 14

Both mood disorders can occur in children and adolescents.

Question 15

What meds could we give to treat Bipolar Disorder?

Answer 15

1st choice: Lithium:

Question 16

NOW if my client doesn’t respond to lithium:

Answer 16

the next choice is anticonvulsants which are incorrectly called mood stabilizers but are not

Question 17

Anticonvulsants include:

Answer 17

Valproic acid (Depakene) and Divalproex (Depakote):
Carbamazepine (Tegretol
Lamotrigine (Lamictal):
Oxcarbazepine (Trileptal):

Question 18

Alcohol withdrawal description S/S

Answer 18

S/S develop within few hours after cessation of alcohol intake
These S/S peak after 24 hours and then rapidly disappear UNLESS WD

Question 19

DTS

Answer 19

6-12 hrs after the last drink the relatively mild symptoms of early withdrawal may begin to be felt, including

Question 20

DTS (Delerium Tremens)

Answer 20

6-12 hrs after the last drink the relatively mild symptoms of early withdrawal may begin to be felt, including

Question 21

Interventions for alcohol withdrawal

Answer 21

monitor serum electrolytes, including glucose and magnesium
orient frequently
monitor I&O
Administer vitamins (MVI, vitamin B, folic acid, thiamine, and Vit c)

Question 22

Medication therapy for alcohol misuse and alcohol dependence

Answer 22

Meds only prescribed for clients who STOPPED drinking
Naltrexone
Acamprosate (Campral)
Disulfiram (Antabuse): Important med!!

Question 23

Disulfiram adverse effects

Answer 23

fatigue, facial flushing, sweating, throbbing headache, neck pain, N/V, hypotension , tachycardia, Resp distress

Question 24

Managing the client who misuses alcohol & managing the client who has substance misused disorder

Answer 24

Set limits on manipulative behavior and verbal and physical abuse
Hold the client accountable for all behaviors

Question 25

Managing the client who has substance misused disorder

Answer 25

Behavior therapy including CBT

Question 26

Drug dependency CNS depressants

Answer 26

include alcohol, benzodiazepines, and barbiturates and act as a depressant, hypnotic or sedative.

Question 27

What are the S/S of cocaine use?

Answer 27

dilated pupils

Question 28

Opiods intoxication

Answer 28

include opium, heroin, meperidine, morphine, codeine sulfate, methadone, hydromorphone

Question 29

What are S/S of withdrawal?

Answer 29

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Question 30

There are 4 formulations of buprenorphine

Answer 30

Suboxone sublingual film- like methadone

Subutex

Question 31

Naltrexone

Answer 31

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Question 32

Naloxone

Answer 32

reverse opiod overdose

Question 33

Methamphetamine: highly addictive stimulant

Answer 33

meth molecule is structurally similar to amphetamine

Question 34

Intoxication Hallucinogens

Answer 34

h

Question 35

Inhalants

Answer 35

h

Question 36

Marijuana

Answer 36

h

Question 37

Other recreational and club drugs

Answer 37

h

Question 38

Interventions: Withdrawal

Answer 38

Initiate seizure precautions
hydrate the client
Monitor v/s every hour, include cardiac monitoring and diagnostic tests such as ECG and cardiac markers.