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Pharmacology 17-20

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Question
Answer
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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