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Chapter 15 - Nsg. 118

The treatment of emotional and mental disorders. Psychotherapeutics
What are the three main emotional & mental disorders. Psychosis, Affective Disorders, Anxiety
A severe emotional disorder that impairs the mental function of the affected individual to the point that individual can't particpate in activities of daily living. Psychosis EX: Schizophrenia Depression & Drug-Induced Psychosis
What are the six major anxiety disorders. 1. Obsessivecompulsive disorder (OCD) 2. Posttraumatic stress disorder (PTSD) 3. Generalized anxiety disorder (GAD) 4. Panic Disorder 5. Social Phobia 6. Simple Phobia
Neurotransmitters that play an important role in maintaining mental health are: Catecholamines (Dopamine & norepinephrine) & Indolamines (Serotonin & Histamine) also biochemicals such as GABA, ACh, Sodium, Potassium, and Magnessium play apart as well
Antianxiety Drugs 1. Benzodiazepines (drepress activity in the brainstem) 2. Antihistamines (depress CNS by sedation and primarily used in allergic conditions) 3. Misc. Drugs: buspirone(BuSpar) - which is non-sedating & non-habit forming
Benzodiazepine Anxiolytics diazepam (Valium) lorazepam (Ativan) alprazolam (Xanax) clonazepam (Klonopin) chlordiazepoxide (Librium) mdazolam (Versed)
Benzodiazepine: Adverse Effects 1. decreased CNS activity 2. Hypotension 3. Drowsiness 4. N/V or consitpation 5. Loss of coordination
Benzodiazepines: Contraindications 1. other sedatives 2. alcohol
Drug used to reverse benzodiazepine effects: flumazenil
Antimanic Drugs Lithium
Drug of choice for mania that has potentiate serotonergic neurotransmission and a narrow therapeutic range (0.6-1.2 mEq/L) Lithium
Etiology of Depression: 1. Biogenic amine hypothesis(alteration of neuronal & synaptic catecholamine concentration) 2. Permissive hypothesis (decreased concentrations of serotonin) 3. Dysregulation hypothesis (failure in regulation of catecholamine activity)
Three categories of Antidepressants 1. Newer-Generation (SSRIs & 2nd / 3rd Generation) 2. Tricyclic 3. MAOIs
Newer-Generation Antidepressants - 2nd Generation trazodone (Desyrel) burpropion (Wellbutrin)
Newer-Generation Antidepressants - SSRIs fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) fluvoxamine (Luvox) citalopram (Celexa) escitalopram (Lexapro)
Indications for Newer-Generation Antidepressants: depression Bipolar disorder Obesity & Eating Disorders Obsessive-Compulsive Disorder Panic Attacks or Disorders Social Anxiety Disorders Posttraumatic Stress Disorders (PTSD) Myoclonus Tx of various substance abuse problems
Adverse Effects of Newer Generation Antidepressants HA, Dizziness, Tremors, nervousness, insomnia, FATIGUE, nausea, diarrhea, constipation, dry mouth, sexual dysfunction, WEIGHT GAIN, weight loss, sweating
Interactions for Newer-Generation Antidepressants highly bound to plasma proteins, inhibition of cytochrome P-450, MAOIs
Tricyclics amitriptyline (Elavil, Endep); doxepin (Sinequan); imipramine (Tofranil); desipramine (Norpramin); nortriptyline (Aventyl, Pamelor)
Method of Action : Tricyclics Blocks norepinephrine uptake (tremors, tachycardia); & Blocks serotonin reuptake (Nausea, HA, anxiety, sexual dysfunction
Indications : Tricyclics Drepression; Childhood enuresis Tx: imipramine (Tofranil); Obsessive-compulsive disorders Tx: clomipramine ; Adjunctive for chronic pain (neuralgia)
Adverse Effects : Tricyclics Sedation; Impotence; Orthostatic Hypotension; edema,muscle tremors,delayed micturation in elder
Tricyclics : Overdose usually LETHAL (affects CNS (sz) & Cardio(dysrhythmias) - NO ANTIDOTE (use charcoal, BLS, Manage Sz & Dysrhythmias
MAOIs phenelzine (Nardil) & tranycypromine (Parnate)
Method of Action : MAOIs Inhibits MAO enzyme in CNS; Does not breakdown Amines (dopamine, serotonin, norepinephrine) = alleviation of depression symptoms
Indictions : MAOIs Depression (increased sleep & appetite) and for depression not responding to tricyclics
Adverse Effects : MAOIs Fewer - Orthostatic Hypotension most common
Overdose : MAOIs symptoms appear 12 hours after ingestion and then include (tacycardia, circulatory collapse, sz, coma) Tx: to protect brain & heart and eliminate toxin (gastric lavage, urine acidificaiton, hemodialysis)
Interactions : MAOIs Foods/Drinks with amino acid tyramine leads to hypertensive crisis which can lead to cerebral hemorrhage, stroke, coma, or death ~This includes: aged cheese, smoked/pickled meats, fish, poultry, yeast extracts, red wines, italian broad beans(fava beans)
Concurrent use of MAOIs and SSRIs may lead to Serotonin Syndrom "wash-out" between switch
Drugs used to treat seroius mental illness, behavioral problems or psychotic disorders Antipsychotics
Antipsychotics Thioxanthenes: thiothixene (Navane)
Antipsychotics Butyrophennes: haloperidol (Haldol)
Antipsychotics Dihydroindolones: molindone (Moban)
Antipsychotics Dibenzoxazepine: loxapine (Loxitane)
Antipsychotics Phenothiazines: three structural groups
Antipsychotics Atypical antipsychotics: New Class
Method of Action : Antipsychotics Blocks dopamine receptors giving a tranquilizing effect
Atypical Antipsychotics clozapine (Clozaril); risperidone (Risperdal); olanzapine (Zyprexa); quetiapine (Seroquel); ziprasidone (Geodon); aripiprazole (Abilify)
Atypical Antipsychotics : Method of Action Blocks dopamine receptors (D2) and blocks specific serotonin receptors (5HT2)
Atypical Antipsychotics : Interactions Bipolar, Depressive/Drug Induced psychosis, Schizophrenia, Autism, Tourette's, Nausea, Intractable hiccups
Adverse Effects : Antipsychotics CNS Sedation, delirium, Orhtostatic hyptension, syncope, dermatologic, photosensitivity, rash, dry mouth, urinary hesitancy, impaired erection, leukopenia, Galactorrhea (milk from nipples), irregular menses, polydipsia (thirst)
Other Adverse Effects of Antipsychotics Neuroleptic malignant syndrom (NMS), Extrapyramidal symptoms (EPS) - Tx with benztropine (cogentin) & trihexyphenidyl (Artane); Tardive dyskinesia (TD)
Nursing Implications for Psychotherapeutics Assess Physical & Emotional status, baseline VS, LFT, Renal Test, Contraindications & Interactions, LOC, Mental Alertness, Potentional for injury to self/others, check mouth to be sure they can swallow, simple explanations, DONT abrupt withdrawal
Nurisng Implications Continued - Psychotherapeutics Coping skills, No alcohol or other CNS depressants
Antianxiety - Nurisng Implications elderly monitor for oversedation
Antidepressants - Nursing Implicaitons May take several weeks to see therapeutic effects, monitor for suicide & provide support, assist elderly with ambulation, Tricyclics need weened before surgery, monitor for effects, encourage pt to wear ID, avoid caffeine & cigarettes & tyramine foods
Phenothiazines - Nursing Implications wear sunscreen, avoid antacids within 1 hour, no alcohol, long-term haloperidol may result in tremors,N/V, take orals with meds to prevent GI upset, fall precautions (orthstatics)
Therapeutic Effects - Psychotherapeutics Mental alertness, cognition, affect, mood, ability of ADLs, appetite, sleep patterns, potential for injury
Therapeutic Effects for Anxiolytics are improved mental alertness, cognition, and mood; fewer anxiety & panic attacks; improved sleep patterns & appetite, less tension and irritability; fewer feelings of fear & doom, more interest in others
Therapeutic Effects for Antidepressants are improved sleep patterns & nutrition, increased feelings of self-esteem, decreased feeling of hopelessness, increased interest in self and appearance, increased interest in ADLs, fewer depressive manifestations or suicidal thoughts
Therapeutic Effects for antipsychotics are improved mood & affect, alleviation of psychotic symptoms and episodes, decrease in hallucintaions, paranoia, delusions, garbled speech, ability to cope
Theraputic Effecst for Lithium Less mania and levels of 0.6-1.2 mEq/L
Created by: LILES
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