Pharmacology 17-20
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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
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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
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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
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Antianxiety medications are also known as | anxiolytics or tranquilizers are prescribed
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Treat anxiety 3 classes: | Benzodiazepines Azaspirones Selective Serotonin Reuptake Inhibitors (SSRI)
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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?
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To assess mood/affect look for | Tearful, angry, hostile? Facial expression tense, fearful, sad, angry, or blank?
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To assess clarity of thought look for | Ask specific questions regarding their ability to make judgments and decisions. Memory impairment?
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The objective of an assessment is to | Obtain history of precipitating factors that may have triggered or contributed to the anxiety
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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?
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Detailed history of all meds taken |
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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?
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To assess obsessions or compulsions determine | Are there repetitive physical or mental behaviors and if so, how often do they occur?
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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?
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Dietary history | weight gains or losses
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Benzodiazepines | Reduce anxiety by stimulating the action of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA)
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Benefits of Benzodiazepines | Most commonly used – more consistently effective and less likely toLess likely to cause overdose; Have less potential for abuse
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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
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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
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Symptoms of side effect of Benzodiazepines : Blood dyscrasias | sore throat, fever, jaundice, excessive/progressive weakness
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Symptoms of side effect of Benzodiazepines: Hepatotoxicity | Anorexia, N/V, jaundice, abnormal liver function tests
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Azaspirones | Used in treatment of anxiety disorders and for short-term relief of symptoms of anxiety
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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
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Side Effects Azaspirones | Sedation Lethargy CNS disturbances (most common), dizziness, insomnia, nervousness, drowsiness, lightheadness REPORT: slurred speech & dizziness
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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
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what is hydroxyzine | Is an antihistamine which acts within the CNS to produce sedation, antiemetic, anticholinergic, antihistaminic, antianxiety, and antispasmodic activity
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How is hydroxyzine used | Multipurpose agent Used as a mild tranquilizer in psychiatric conditions characterized by anxiety, tension, and agitation
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Hydroxyzine is routinely used as a preoperative or postoperative sedative to | control vomiting, diminish anxiety, and reduce amount of narcotics needed for analgesia
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Hydroxyzine may be used as an antipruritic to | relieve itching associated with allergic reactions
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Side Effects from hydroxyzine (Vistaril), (Atarax) | Blurred vision, Constipation, Dryness of mucosa of mouth, throat, nose, REPORT – slurred speech, dizziness
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Mood | sustained, emotional feeling perceived along a normal continuum of sad to happy
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Mood disorder | when certain symptoms impair the person’s ability to function for a duration of time (abnormal feelings of depression or euphoria)
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Depression | persistent, reduced ability to experience pleasure in life’s usual activities such as hobbies, family, and work
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Cognitive symptoms | inability to concentrate, slowed thinking, confusion, and poor memory of recent events
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Psychomotor symptoms | slowed or retarded movements, thought processes, and speech, restless motion
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Bipolar disorder | “manic depression”, distinct episodes of mania (elation, euphoria) and depression separated by intervals without mood disturbances
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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
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Labile mood | rapid shifts toward anger and irritability with short attention span and inability to concentrate
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Grandiose delusions | become paranoid
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Drug Therapy for Mood Disorders | Antidepressants subdivided into: MAOIs;Tricyclic; SSRIs; Misc group
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What are MAOIs | Drug Class: Monoamine Oxidase Inhibitors
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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
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pheneizine (Nardil) | Remains in body for up to two weeks after last dose. Need to avoid foods high in _________ for that period of time!!
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Actions of MAOIs | Block the metabolic destruction of norepinephrine, dopamine, and serotonin neurotransmitters. Require ___ to ___ weeks to become evident!!
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MAOIs are most effective in | atypical depression, panic disorder, obsessive-compulsive disorder, and some phobia disorders
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What is the expected therapeutic outcome of MAOIs | Elevated mood and reduction of symptoms of depression
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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)
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Tyramine foods include | Well-ripened cheeses, red wines, overripe bananas, figs, avocados, chicken livers, beer, yeast extract!!
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Side Effects of MAOIs | Orthostatic hypotension (monitor B/P in supine and standing position) Drowsiness Sedation Restlessness Agitation Blurred vision Constipation, urinary retention
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Serotonin Reuptake Inhibitors treat what | depression, obsessive-compulsive disorder, obesity, eating disorders, bipolar disorders, panic disorders
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Serotonin Reuptake Inhibitors take how long to take full effect | 2 to 4 weeks
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Serotonin Reuptake Inhibitors do not have what medical consequences | Anticholinergic and cardiovascular side effects
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what is the therapeutic outcome of Serotonin Reuptake Inhibitors | Elevated mood and reduction of symptoms of depression
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Drug interaction with SSRI Tricyclic antidepressants | arrhythmias, seizure activity
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Drug interaction with SSRI Lithium | lithium toxicity(nausea, anorexia, tremors, persistent vomiting, profuse diarrhea)
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Drug interaction with SSRI MAOIs | excitement, diaphoresis, rigidity, convulsions, death
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Drug interaction with SSRI Warfarin | enhances anticoagulant effects (bleeding gums, dark tarry stools, bright-red, coffee-ground emesis)
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