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MH 2013 Exam 3
anxiety/mood disorders
| Question | Answer |
|---|---|
| what classification of drug is Prozac? | SSRI |
| what classification of drug is Paxil? | SSRI |
| What classification of drug is Lexapro? | SSRI |
| What classification of drug is Zoloft? | SSRI |
| What classification of drug is Celexa? | SSRI |
| what classification of drug is Luvox? | SSRI |
| what classification of drug is Pamelor? | Tricyclic |
| what classification of drug is tofranil? | tricyclic |
| what classification of drug is Norpramin? | tricyclic |
| what classification of drug is Elavil? | tricyclic |
| what classification of drug is Anafranil? | tricyclic |
| what classification of drug is Adapin/Sinequan? | tricyclic |
| what classification of drug is Nardil? | MAOI |
| what classification of drug is Parnate? | MAOI |
| what classification of drug is Xanax? | benzo |
| what classification of drug is clonazepam? | benzo |
| what classification of drug is Ativan? | benzo |
| what classification of drug is librium? | benzo |
| what classification of drug is Valium? | benzo |
| what classification of drug is Serax? | benzo |
| which classification of drug can become habit forming? | benzo |
| which classification of drug causes sedation, ataxia and decreased cognitive functioning? | benzo |
| which drug classification of drug has immediate action (20 min) | benzo |
| which classification of drug decreases anxiety fast so you can focus on other problems | benzo |
| avoid taking antacids with what drugs? | benzo |
| always taper off what drug class? | benzo |
| older adults are at risk for broken bones with falls in which drug category? | benzo |
| what do MAOI patients need to avoid? | tyramine foods |
| what are tyramine foods | aged cheese, pickled or smoked fish, wine, avocados, soybean, figs, bananas, liver, bologna, pepperoni, salami, imported beers, soy sauce |
| MAOI patients need to avoid this ethnic food? | Chinese |
| MAOI patients need to be aware of what symptom of severe hypotensive crisis | headache, patient to go to ER |
| MAOI patients need to monitor blood pressure for how long | 6 weeks |
| after MAOIs are discontinued how long must patient follow diet | 14 days |
| MAOI patients need to avoid what other meds? | OTC especially oral decongestants |
| can pregnant woman have TCAs | not unless absolutely necessary |
| patients must have cardiac workup before taking what class of drugs? | TCAs |
| TCAs can not be given to these types of patients? | narrow angle glaucoma, myocardial infarct, and seizure patients |
| take full dose of what medications at bedtime? | TCAs |
| no alcohol with what drugs? | any and all |
| drowsiness, dizziness and hypotension are all side effects of what drug class? | TCAs |
| drug effect may not be seen for 4-6 weeks in what drugs? | MAOIs, TCAs and SSRIs |
| weight gain is common in what drug class? | TCAs |
| TCAs do what? | they really work!! |
| sweating, nausea, vomiting and diarrhea are the mild side effects associated with what drug class? | SSRIs |
| Agitation and anxiety are possible side effects of what drug class? | SSRIs |
| Serotonin syndrome is possible with what drugs? | SSRIs |
| what are signs and symptoms of serotonin syndrome? | tachycardia, hyperactivity, fever, hypertension, altered mental status, mood swings, seizures, abdominal pain, bloating, diarrhea and incoordiation |
| what are interventions for serotonin syndrome? | remove offending agent, propranol, cooling blankets, dantrolene, diazepam, paralysis and anti convulsants |
| SSRIs can not be taken with what other drug class? | MAOIs |
| what is the first line of treatment for major depression? | SSRIs |
| potential toxic side effect of SSRIs | serotonin syndrome |
| a patient should discontinue SSRIs 2-5 weeks before starting what? | MAOIs |
| what drug class can worsen many cardiac and other medical conditions? | TCAs |
| what are the side effects of TCAs | dry mouth, constipation, urinary retention, blurred vision, orthostatic hypotension, cardiac toxicity and sedation |
| TCAs can be what if overdosed | lethal |
| initial dose of TCA is what | low and gradually increased |
| potential toxic effect of TCAs | cardiovascular; arrhythmia, myocardial infarction, heart block |
| potential toxic effect of MAOIs | increase in blood pressure, headache, stiff or sore neck indicating severe hypertensive crisis |
| drug given in situation of hypertensive crisis? | nifedipine to vasodilate |
| ECT may be primary treatment for these patients? | suicidal, previous medications failed, marked agitation, marked vegetative state, catatonia, major depression with psychotic features |
| usual course of ECT is what? | 2-3 treatments per week for a total of 6-12 treatments |
| what is the patient given before ECT | general anesthetic, Brevital and succinylcholine (muscle paralyzing agent) |
| after waking from ECT patients are generally what? | confused and disorientated, with memory defects for the first few weeks afterward |
| signs and symptoms of major depressive disorder | weight gain or weight loss, insomnia, increased or decreased motor activity, anergia (fatigue or loss of energy), feelings of worthlessness, suicide thoughts |
| symptoms of dysthymic disorder | decreased or increased appetite, insomnia, low energy, chronic fatigue, decreased self esteem, poor concentration, hopelessness or despair |
| the symptoms interfere with persons social or occupational functioning and in some cases include psychotic features in what disorder? | major depressive disorder |
| psychotic features of major depressive disorder include? | delusions or hallucinations |
| melancholic features of major depressive disorder include? | severe apathy, weight loss, profound guilt, symptoms worse in early morning and suicide thoughts |
| atypical features of major depressive disorder | dominant veggie symptoms (overeating or oversleeping) onset is younger |
| catatonic features of major depressive disorder? | non-responsive, extreme psychomotor retardation (patient may seem paralyzed) or withdrawal |
| postpartum onset of major depressive disorder | onset within 4 weeks of delivery with psychotic features |
| seasonal affective disorder symptoms in major depressive disorder | lack of energy, increased sleep, weight gain, craving carbs and responds to light therapy |
| age of onset for dysthymic disorder? | early childhood, teen to early adulthood |
| primary risk factors for depression include these? | female gender, unmarried, low socioeconomical status, early childhood trauma, negative life event, family history, postpartum, medical illness, absence of social support and alcohol and drug abuse |
| assessment findings with depression | anergia, anxiety, pacing or wringing of hands, headaches, backaches, changes in BMs, sleep and sex disturbances, posture is poor, look older that stated age, facial expressions |
| feelings of hopelessness are represented by... | no eye contact, speak in monotone, little or no facial expression, yes or no responses only and frequent sighing is common |
| thought processes are affected how in depression | ability to problem solve is decreased, judgement is poor, memory is poor, concentration is poor |
| mood is affected how in depression | anxiety, worthlessness, guilt, helplessness, hopelessness and anger |
| physical behavior is affected how in depression? | lethargy,patients constantly pace, smoke, bite fingernails, fidgety and restless, grooming and dress is neglected, changes in eating pattern, sleep pattern, sex pattern and bowel pattern |
| priority assessment in depression is what? | risk for suicide |
| what are the three phases in treatment of depression? | phase 1 (acute phase 6-12 weeks), phase 2 (continuation phase 4-9 months)and phase 3 (maintenance phase 1 year or more) |
| acute phase of depression is geared towards what? | reduction of symptoms and restoration of social and work functions |
| phase 2 of depression is geared towards what? | prevention of relapse, drug therapy and education |
| phase three of depression is geared towards what? | treatment directed at prevention of further episodes |
| if a benzo is taken with alcohol what happens? | respiratory depression |
| SSRIs are good for PTSD, why? | they block sertonin receptors and stay in the blood longer which increases levels |
| if you take a high dose of benzo what side effect would you likely see? | sedation |
| general adaption syndrome of stress occurs in three stages name them. | alarm stage (acute stress (fight or flight), resistance stage (sustained and optimal resistance to stress occurs), exhaustion stage (attempts to resist stress are proven futile) |
| what are distress and eustress | distress - negative and eustress is positive |
| what are examples of physical stressors? | environmental (trauma or excessive cold), physical conditions (infection, hunger, pain) |
| what are physiological stressors? | divorce, loss of job, death of loved one, terrorist attack |
| how do North Americans define stress? | feelings of guilt, shame and sinfulness |
| how do Puerto Ricans and Hispanics define stress? | irritability, rage and nervousness |
| what are some effective stress busters? | sleep, exercise, reduction of caffeine, music, pets and massage |
| list the positive responses to stress | problem solving, social support and reframing |
| list the negative responses to stress. | avoidance, self blame and wishful thinking |
| what is progressive muscle relaxation? | tensing a group of muscles starting with feet and working towards head |
| what is guided imagery? | process in which a person is led to envision images that are both calming and health enhancing |
| what is biofeedback? | provides immediate and exact information regarding muscle activity, brain activity, skin temp, heart rate and blood pressure |
| what is cognitive reframing? The statements generally include "he always, i'll never and should" | the goal is to change the individuals perception of stress by reassessing a situation with irrational thoughts to more positive ones "i can't pass this course" to "if i study more i can pass this class" |
| what is mindfulness? | changing negative interpretations "mowing the lawn is a hot and dirty job" to "mowing the lawn is wonderful exercise" |
| what two every day activities can simple methods of identifying stressors? | humor and journaling |
| what is anxiety? | feelings of apprehension, uneasiness, uncertainty or dread |
| what is fear? | the reaction to specific danger |
| dysfunctional behavior is often what? | a defense against anxiety |
| name the levels of anxiety? | mild, moderate, severe and panic |
| describe mild anxiety | slight discomfort, restlessness, irritability or mild tension relieving behaviors (nail biting, foot taping or fidgeting) |
| describe moderate anxiety | tension, pounding heart, increased pulse, increased resp rate and sweating, gastric discomfort, headache and urinary urgency, voice tremors and shakiness |
| describe severe anxiety | difficulty knowing what is going on in the environment, learning and problem solving not an option, dazed and confused, headache, nausea, dizziness insomnia often increase, trembling and pounding heart and hyperventilation and impending doom sensation |
| describe panic state of anxiety | unable to process what is going on and lost touch with reality, pacing, running, shouting, screaming, hallucinations and may lead to exhaustion |
| what is compensation defense mechanism? | making up for perceived deficiencies and coverup short comings |
| what is conversion defense mechanism? | unconscious transformation of of anxiety to physical symptom with no organic cause |
| what is denial defense mechanism? | escaping unpleasant, anxiety causing thoughts, feelings, wishes or needs by ignoring their existence |
| what is displacement defense mechanism? | transference of emotions associated with particular person, object, or situation |
| what is dissociation defense mechanism? | separation between feeling and thought |
| what is identification defense mechanism? | attributing to oneself the characteristics of another person or group |
| what is intellectual defense mechanism? | events are analyzed based on remote cold facts without passion |
| what is introjection defense mechanism? | process by which the outside world is incorporated into or absorbed into a persons view of self |
| what is projection defense mechanism? | "what you say is what you are" |
| what is rationalization defense mechanism? | justifying illogical or unreasonable ideas, actions, or feelings |
| what is reaction formation defense mechanism? | unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite reaction |
| what is regression defense mechanism? | reverting to an earlier more primitive childlike behavior |
| what is repression defense mechanism? | first line psychological defense against anxiety, happens unconsciously, man forgets wifes b-day after fight with her |
| what is splitting defense mechanism? | inability to integrate positive and negative qualities of oneself or others into cohesive image |
| what is sublimation defense mechanism? | unconscious, impulses are often sexual or aggressive "a woman angry with her boss writes a short story about a heroic woman" |
| what is supression defense mechanism? | conscious denial of disturbing feeling or situation |
| what is undoing defense mechanism? | most commonly seen in children, it is when a person makes up for an act or communication |
| what is a panic attack? | sudden onset of extreme apprehension or fear usually associated with impending doom, the person may feel as if they are having a heart attack |
| what are the signs and symptoms of panic attack? | palpitations, chest pain, breathing difficulties, nausea, choking, chills and hot flashes |
| what is agorphobia? | excessive anxiety of fear, about being in places in which escape is imposible |
| what are obsessions? | defined as thoughts, impulses or images that persist and reoccur so that they can not be dismissed from the mind |
| what are compulsions? | rituals a person feels driven to perform in an attempt to reduce anxiety |
| what is generalized anxiety disorder? | excessive anxiety or worry about numerous things that lasts 6 months or longer |
| signs and symptoms of generalized anxiety disorder. | restlessness, fatigue, poor concentration, irritability, tension and sleep disturbances |
| what is PTSD | post traumatic stress disorder is characterized by persistent reexperiencing of a highly traumatic event that involved actual death or threatened death or serious injury to others, the patient responds with intense fear, helplessness and horror |
| PTSD symptoms can occur 3 months to years after event and include | flashbacks, avoidance of stimuli, difficulty sleeping, concentrating and numbing of general responses, chemical abuse may be an attempt to self medicate |
| what is acute stress disorder? | occurs one month after event (PTSD), will resolve four weeks after event |
| anxiety due to a medical condition... | hyperthyroidism, pulmonary embolism, or cardiac event |
| describe a panic attack in latin americans and northern Europeans. | chocking, smothering, numbness, tingling and fear of dying |
| what is ataque de nervios? | seen in hispanic culture, a response to stress evidenced by, trembling, fainting, palpitations, out of control shouting, seizure like activities and heat that moves from chest to head |
| interventions with mild and moderate level anxiety. | asking open ended questions, giving broad openings, exploring and seeking clarification,provide a calm presence, recognize distress, willingness to listen, encourage problem solving, explore behaviors that have worked in the past |
| nursing interventions for severe and panic level anxiety | provide safety, meet physical needs, prevent exhaustion, removing person to quiet environment, firm short simple statements, low pitched voice speaking slowly, reinforce reality, provide exercise, high calorie food/fluids |
| buspar is used to treat what? | generalized anxiety disorder |
| describe benzo withdrawal symptoms. | insomnia, irritability, nervousness, dry mouth, tremors, convulsions and confusion |
| differences in men and woman with bipolar disorder | woman will develop alcohol abuse, commit suicide, develop thyroid disease and men are more likely to have legal problems and commit acts of violence |
| define bipolar one disorder | one episode of mania alternating with one episode of major depression |
| define bipolar two disorder | hypomanic episodes alternate with major depression |
| define cyclothymia | hypomanic episodes alternate with minor depression |
| define rapid cycling | four or more episodes in 12 month period |
| what is the first line therapy for bipolar disorder? | lithium |
| bipolar disorders are more prevalent in what socioeconomic status? | upper class |
| what is the euphoric state of bipolar disorder? | intense feeling of well being |
| what is the manic state of bipolar disorder? | laugh, joke, talk in continuous stream, boundless energy and self confidence, excessive phone calls and e-mails to famous and influential people, stay busy all day long |
| in the manic state people often give away what? | money, prized possessions and expensive gifts |
| during hypomania emergencies can occur, name them | nonstop physical activity, lack of sleep and food can lead to physical exhaustion |
| manic patients can appear like so during manic bipolar phase | dress is outlandish, bizarre, colorful, noticeably inappropriate, make up garnish and overdone, concentration is poor and manic people go from one activity to another without finishing one |
| flight of ideas is what? | continuous flow of accelerated speech with abrupt changes in topic, speech is rapid and disorganized |
| what are clang associations? | stringing of words together because of their rhyming... boat, throat, goat, moat |
| nursing staffing considerations with manic patients.. | consistency among staff is imperative if limit setting is to be carried out, limit setting would include lights out after 11pm |
| describe the nursing intervention acute phase of bipolar disorder | injury prevention, patient will be well hydrated, maintain stable cardiac status, maintain tissue integrity, get sufficient sleep, demonstrate thought self control and make no attempt at self harm |
| describe the nursing continuation phase of bipolar disorder | lasts 4-9 months, outcome is relapse prevention, psychoeducational classes, support groups, and communication and problem solving skills |
| describe the nursing maintenance phase of bipolar disorder | prevention of relapse, and limitation of the severity and duration of future episodes |
| during the acute phase of bipolar disorder the nursing care is geared towards what? | managing meds, decreasing physical activity, increasing food and fluid intake, ensuring at least 4-6 hours of sleep per night, ensuring that ADLs are met and bowel and bladder problems are under control |
| during the continuation phase nursing care is geared towards what? | family problems, financial problems and social problems. communication training can be done at this time |
| medication treatment for the acute phase of bipolar disorder | lithium and atypical antipsychotics (zyprexa and risperodone) |
| lithium is particularly effective in reducing what? | elation, grandiosity, expansiveness, flight of ideas, irritability and manipulation as well as anxiety |
| lithium must reach therapeutic levels to be effective, how long does this take? | 7-14 days |
| what is the therapeutic level of lithium? | 0.8-1.4mEq/L |
| when should blood be drawn for lithium levels? | 8-12 hours after last dose and every months for 6 months then every three months |
| list the side effects of lithium therapy | hand tremor, polyuria and mild thirst, mild nausea and weight gain |
| list the early signs of lithium toxicity greater than 1.5mEq/L | N/V/D, thirst, lethargy, slurred speech, muscle weakness, fine hand tremor |
| list the advanced signs of lithium toxicity 1.5-2.0mEq/L | mental confusion, persistent GI upset, muscle hyperactivity, EEG changes, incoordination and sedation |
| list the signs of severe lithium toxicity greater than 2.0mEq/L | ataxia, confusion, dilute urine, blurred vision, clonic movements, seizures, stupor, coma,severe hypotension, pulmonary complications |
| name the two major long term complications of lithium therapy? | hypothyroidism and impairment of kidney function |
| tell patients to inform physician if any of the following occur... | excessive diarrhea, vomiting or sweating, this can lead to dehydration which can then lead to lithium toxicity |
| do NOT take diuretics with this medication | lithium |
| a low sodium intake leads to relative increase in lithium retention so the patient needs to do what? | normal diet with normal salt and fluid intake |
| risk factors for suicide include... | male gender, increasing age (men over 45 and woman over 55), white, protestants and jewish people, divorced men, professionals (physicians, architects and engineers), previous physical illness |
| examples of overt statements | "I can't take it anymore", "life isn't worth living anymore", "I wish I was dead", "everyone would be better off if I was dead" |
| examples of covert statements | "It's okay now soon everything will be fine", "things will never work out", "I won't be a problem much longer", "nothing feels good to me anymore", "how do i give my body to science" |
| what are the common feelings of people who are suicidal? | hopelessness, anger, frustration, abandonment and rejection |
| what is the primary suicide intervention? | provide support, information and education to prevent suicide |
| what is secondary suicide intervention? | treatment of the actual suicidal crisis |
| what is tertiary suicidal intervention? | interventions with family and friends of a person who committed suicide |
Created by:
bkgrota
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