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Pharmacology 17-20

Obsession Unwanted thought, idea, image, or urge that the person recognizes as time-consuming and senseless but repeatedly intrudes into the consciousness, despite attempts to ignore, prevent, or counteract it (recurrent thoughts of dirt or germ contamination, fear
Simple phobia Irrational fear of a specific object or situation (heights, closed spaces, air travel, animals)If exposed to the object, there is an immediate feeling of panic, sweating, and tachycardia. People avoid the feared object
Obsessive-compulsive disorder recurrent obsessions or compulsions that cause significant distress and interfere with normal occupational responsibilities, social activities, and relationships complex condition requiring behavioral, pharmacologic, and psychosocial components; can becom
Antianxiety medications are also known as anxiolytics or tranquilizers are prescribed
Treat anxiety 3 classes: Benzodiazepines Azaspirones Selective Serotonin Reuptake Inhibitors (SSRI)
To assess mental status look for General appearance (is person clean and neat?) Posture stooped, erect, or slumped? Oriented to date, time, place, and person?
To assess mood/affect look for Tearful, angry, hostile? Facial expression tense, fearful, sad, angry, or blank?
To assess clarity of thought look for Ask specific questions regarding their ability to make judgments and decisions. Memory impairment?
The objective of an assessment is to Obtain history of precipitating factors that may have triggered or contributed to the anxiety
Precipitating factors that can trigger or contribute to anxiety Drugs or alcohol use; Recent loss of job, loved one. Medical problems that attribute to the symptoms? Specific fears?
Detailed history of all meds taken
To assess psychomotor functions look for What activity level has person maintained? Are they able to go to school or to work? Have normal responses to daily activities been altered?
To assess obsessions or compulsions determine Are there repetitive physical or mental behaviors and if so, how often do they occur?
To assess a patients's sleep pattern determine What is their normal sleep pattern and has it varied? Insomnia present? Describe amount and quality of sleep?
Dietary history weight gains or losses
Benzodiazepines Reduce anxiety by stimulating the action of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA)
Benefits of Benzodiazepines Most commonly used – more consistently effective and less likely toLess likely to cause overdose; Have less potential for abuse
Using Benzodiazepines in elderly or pt with reduced hepatic function: Xanax, Ativan, Serax are more appropriate because of their short duration of action & no active metabolites
Benzodiazepines should not be administered during the first trimester of pregnancy because of increased incidence of birth defects and (cross the placenta) in mothers who are breastfeeding
Symptoms of side effect of Benzodiazepines : Blood dyscrasias sore throat, fever, jaundice, excessive/progressive weakness
Symptoms of side effect of Benzodiazepines: Hepatotoxicity Anorexia, N/V, jaundice, abnormal liver function tests
Azaspirones Used in treatment of anxiety disorders and for short-term relief of symptoms of anxiety
Benefits of Azaspirones Anxiety agent unrelated to barbiturates, benzodiazepines, or other anxiolytic agents; Has lower sedative properties. Has no antipsychotic activity; Is not a controlled substance; Therapeutic outcome is decrease in level of anxiety to a manageable level
Side Effects Azaspirones Sedation Lethargy CNS disturbances (most common), dizziness, insomnia, nervousness, drowsiness, lightheadness REPORT: slurred speech & dizziness
Selective Serotonin Reuptake Inhibitors(SSRIs) Drug of choice used to treat obsessive-compulsive disorder(OCD) when causing marked distress, time-consuming, or interfere with responsibilities
what is hydroxyzine Is an antihistamine which acts within the CNS to produce sedation, antiemetic, anticholinergic, antihistaminic, antianxiety, and antispasmodic activity
How is hydroxyzine used Multipurpose agent Used as a mild tranquilizer in psychiatric conditions characterized by anxiety, tension, and agitation
Hydroxyzine is routinely used as a preoperative or postoperative sedative to control vomiting, diminish anxiety, and reduce amount of narcotics needed for analgesia
Hydroxyzine may be used as an antipruritic to relieve itching associated with allergic reactions
Side Effects from hydroxyzine (Vistaril), (Atarax) Blurred vision, Constipation, Dryness of mucosa of mouth, throat, nose, REPORT – slurred speech, dizziness
Mood sustained, emotional feeling perceived along a normal continuum of sad to happy
Mood disorder when certain symptoms impair the person’s ability to function for a duration of time (abnormal feelings of depression or euphoria)
Depression persistent, reduced ability to experience pleasure in life’s usual activities such as hobbies, family, and work
Cognitive symptoms inability to concentrate, slowed thinking, confusion, and poor memory of recent events
Psychomotor symptoms slowed or retarded movements, thought processes, and speech, restless motion
Bipolar disorder “manic depression”, distinct episodes of mania (elation, euphoria) and depression separated by intervals without mood disturbances
Mania usually begin abruptly and escalate over several days. Heightened mood (euphoria), quicker thoughts, fast speech, increased energy, increased physical and mental activities, decreased need for sleep, irritability
Labile mood rapid shifts toward anger and irritability with short attention span and inability to concentrate
Grandiose delusions become paranoid
Drug Therapy for Mood Disorders Antidepressants subdivided into: MAOIs;Tricyclic; SSRIs; Misc group
What are MAOIs Drug Class: Monoamine Oxidase Inhibitors
What is the normal dosage of MAOIs GN: phenelzine, BN: _____________ Initial dose 15 mg TID up to 60 mg/day GN: tranylcypromine, BN: ___________ Initial dose 10 mg BID up to 30 mg/day
pheneizine (Nardil) Remains in body for up to two weeks after last dose. Need to avoid foods high in _________ for that period of time!!
Actions of MAOIs Block the metabolic destruction of norepinephrine, dopamine, and serotonin neurotransmitters. Require ___ to ___ weeks to become evident!!
MAOIs are most effective in atypical depression, panic disorder, obsessive-compulsive disorder, and some phobia disorders
What is the expected therapeutic outcome of MAOIs Elevated mood and reduction of symptoms of depression
What to do when acting as a nurse to a MAOI using patient Obtain B/P and pulse; Monitor blood glucose if patient is diabetic; Tyramine foods (could cause life-threatening hypertensive crisis)
Tyramine foods include Well-ripened cheeses, red wines, overripe bananas, figs, avocados, chicken livers, beer, yeast extract!!
Side Effects of MAOIs Orthostatic hypotension (monitor B/P in supine and standing position) Drowsiness Sedation Restlessness Agitation Blurred vision Constipation, urinary retention
Serotonin Reuptake Inhibitors treat what depression, obsessive-compulsive disorder, obesity, eating disorders, bipolar disorders, panic disorders
Serotonin Reuptake Inhibitors take how long to take full effect 2 to 4 weeks
Serotonin Reuptake Inhibitors do not have what medical consequences Anticholinergic and cardiovascular side effects
what is the therapeutic outcome of Serotonin Reuptake Inhibitors Elevated mood and reduction of symptoms of depression
Drug interaction with SSRI Tricyclic antidepressants arrhythmias, seizure activity
Drug interaction with SSRI Lithium lithium toxicity(nausea, anorexia, tremors, persistent vomiting, profuse diarrhea)
Drug interaction with SSRI MAOIs excitement, diaphoresis, rigidity, convulsions, death
Drug interaction with SSRI Warfarin enhances anticoagulant effects (bleeding gums, dark tarry stools, bright-red, coffee-ground emesis)
Created by: astroshag