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MH 2013 Exam 3

anxiety/mood disorders

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