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Mental Health 2
Bioloogical Basis for Understanding Psychotropic Drugs
| Question | Answer |
|---|---|
| Drugs that affect brain function can also stimulate or depress ______ or lead to _______. | Respiration, slurred speech |
| The autonomic nervouse system and the endocrince system serve as the communication links between the ______ and the _____, _______, and _______. | brain; cardiac muscle, smooth muscle, glands of which the internal organs are composed. |
| The hypothalamic secretion (corticotropin-releasing hormone) (CRH) stimulates the piuatary to release | corticotropin. |
| Corticotropin stimulates the cortex of each adrenal gland to secrete the hormone | cortisol |
| CRH, corticotropin, and cortisol influence the functions of the | nerve cells of the brain |
| The hypothalamus - pituitary - adrenals system is overactive in both ____ and ______. | anxiety and depression |
| The fluctuation of various physiological and behavioral parameters over a 24-hour cycle | circadian rhythms |
| A jumble of unrelated words. | word salad |
| Unconnected phrases and topics | looseness of association |
| Although neurons come in a great variety of shapes and sizes, all carry out the same three types of physiological action | They respond to stimuli, they conduct electrical impulses, and they release chemicals called neurotransmitters. |
| An essential feature of the neuron is its ability to conduct an electrical impulse from | one end to the other. |
| Once an electrical impulse reaches the end of a neuron, a chemical called a ________ is released. | neurotransmitter |
| A chemical substance that functions as a neuromessenger. | neurotransmitter |
| Neurotransmitters are released from the axon terminal at the | presynaptic neuron on excitation |
| The narrow space that the neurotransmitter is diffused across is called the | synapse |
| The enzyme that destroys acetylcholine is | acetylcholinesterase |
| When a neurotransmitter is taken back into the presynaptic cell from which it was originally released by a process called | cellular reuptake |
| The destructive enzyme for monoamine transmitters such as norepinephrine, dopamine, and serotonin is | Monoamine Oxidase (MAO) |
| Proteins and even simple gases such as carbon monoxide and nitrous oxide that are released by postsynaptic cells and influence the growth, shape, and activity of presynaptic cells. | Neurotrophic factors |
| estrogen, testosterone, and cortisol are considered to be what type of hormones? | steroid hormones |
| What association with mental health does a decrease in dopamine levels have? | Parkinson's disease, depression |
| What association with mental health does an increase of dopamine levels have? | Schizophrenia, mania |
| What association with mental health does a decrease in norepinephrine levels have? | depression |
| What association with mental health does an increase in norepinephrine levels have? | Mania, anxiety states, schizophrenia |
| What association with mental health does a decrease in serotonin levels have? | depression |
| What association with mental health does an increase of serotonin levels have? | Anxiety states |
| What association with mental health does a decrease in histamin levels have? | Depression, sedation, and weight gain. |
| What association with mental health does a decrease in GABA levels have? | Anxiety disorders, schizophrenia, Huntington's chorea. |
| What association with mental health does an increase in GABA levels have? | Reduction of anxiety |
| What association with mental health does a decrease in Glutamate levels have? | Psychomimetic state that resembles schizophrenia. |
| What association with mental health does an increase in Glutamate levels have? | Improvement of cognitive performance in behavioral tasks. |
| What association with mental health does a decrease in acetylcholine levels have? | Alzeheimer's disease, Huntingtons chorea, Parkinson's disease. |
| What association with mental health does an increase in acetylchonie levels have? | Depression |
| What association with mental health does a change in Substance P (SP) levels have? | Regulation of mood and anxiety is effected, and it has a role in pain management. |
| What association with mental health does a decrease in Somatostatin levels have? | Alzheimer's disease, decreased levels of SRIF found in spinal fluid of some depressed clients. |
| What association with mental health does an increase in somatostatin levels have? | Hungington's chorea |
| What association with mental health does a decrease of neurotensin levels have? | Decreased levels found in spinal fluid of schizophrenic clients. |
| The part of the brain that is related to emotions and is referred to by some as the "emotional brain." | limbic system |
| The _____ system is involved in the mediation of fear and anxiety; anger and aggression; love, joy, and hope; and sexuality and social behavior. | limbic system |
| The mesoloimbic and mesocortical pathways use what as their neurotransmitters. | norepinephrine, serotonin, and dopamine |
| It is thought that release of dopamine from the ventral legmental pathway plays a role in | psycological reward and drug addition |
| The _____ plays a crucial role in coordinating contractions so that the movement is accomplished in a smooth and directed manner. | cerebellum |
| The ____ is primarily involved in the regulation of skeletal muscle coordination and contraction and the maintenance of equilibrium. | cerebellum |
| The ____ is responsible for mental activities and a conscious sense of being. | cerebrum |
| The _____ is responsible for our conscious perception of the external world and our own body, for emotional status, for memory, and for the control of the skeletal muscles that allow the willful direction of movement. | cerebrum |
| The _____ is also responsible for language and the ability to communicate. | cerebrum |
| Pockets of integrating gray matter deep within the cerebrum that are involved in the regulation of movement, emotions, and basic drives. | basal ganglia |
| changes as they occur in a living tissue. | PET |
| Known causes of mental dysfunction are: | Drugs, long-term use of prednisone, excess levels of hormones, infection, and phisical trauma. |
| The limbic system links the | Frontal cortex, basal ganglia, and upper brainstem. |
| The transmitters that have been most consistently linked to mental activity are: | Norepinephrine, dopamine, serotonin, GABA, and glutamate. |
| It is thought that a deficiency of norepinephrine or serotonin, or both may serve as the biological basis of | depression |
| Thought disorders such as schizophrenia are associated physiologically with excess transmission of the neurotransmitter | dopamine |
| Most antianxiety drugs act by increasing the effectiveness of this transmitter. | GABA |
| ____ is said to play a role in modulating neuronal excitability and anxiety. | GABA |
| ______ is used not only by neurons involved in thought processes but also by neurons involved in the regulation of movement. | dopamine |
| Alterations in mental status, whether arising from disease or from medication, are often accompanied by changes in | Basic drives, sleep patterns, body movements, and autonomic functions. |
| This refers to the actions of the drug on the person, and the types of changes it produces. | Pharmacodynamics |
| This refers to the actions of the person on the drug. | Pharmacokinetics |
| _____ determines the blood level of a drug and is used to guide the dosage schedule. | Pharmacokinetics |
| ______ is also used to determin the type and amount of drug used in cases of liver and kidney disease. | Pharmacokinetics |
| _____ causes greater neuron system toxicity in African Americans than it does in whites. | lithium |
| _______ have been found to be relatively ineffective in reducing hypertension in Aftrican Americans. | Beta Blockers |
| Most psychotropic drugs act by either increasing or decreasing the activity of | certain transmitter-receptor systems |
| Standard antipsychotic drugs are antagonists (blocking the action) of the recpeters for | dopamine |
| Blocking of dopamine may reduce what symptoms? | Symptoms of schizophrenia. |
| Dopamine blockage can lead to motor abnormalities such as | Parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia. |
| Blockage of dopamine transmission can lead to increased | pituitary secretion of prolactin |
| _____ is the hypothalamic factor which inhibits the release of prolactin from the anterior pituitary gland. | dopamine |
| This condition caused by blockage of prolactin from dopamine antagonists can cause amenorhea or galactorrhea in women and gynecomastia in men. | hyperprolactinemia |
| The neurotransmitter released by the postganglionic neurons of the parasympathetic nervouse system. | acetylcholine |
| The adverse effects of this type of receptor blockage are blurred vision, dry mouth, urinary retention, constipation, and tachycardia. | Muscarinic Cholinergic Blocker |
| What first generation antipsychotic medication is a muscarinic cholinergic blocker? | Phenothiazine |
| Blockage of these receptors will cause orthostatic hypotentions, dizziness, antipsychotic effect, reflux tachycardia, and failure to ejaculate. | fishy thing 1 |
| The two most significant side effects of blocking the Histamine receptors are | sedation and substantial weight gain |
| Because of the side effects of first generation antipsychotic agents, what is a major problem? | Nonadherence to the medication regimen. |
| These drugs produce few or no extrapyramidal symptoms and also target the negative as well as the positive symptoms of schizophrenia. | atypical antipsychotic drugs |
| Why are atypical antipsychotic drugs chosen as a first line treatment over first generation antipsychotic drugs. | Because of their more favorable side effect profile. |
| Olanzapine seems to be the most effective atypical antipsychotic drug for improvement of | cognition |
| An antipsychotic drug that is relatively free of the motor side effects of the phenothiazines and other first-generation antipsychotics. | Clozapine |
| Regular measurement of white blood cell count is mandatory for any client taking | Clozapine |
| The most common side effects of clozapine are | Drowsiness and sedation, hypersalivation, tachycardia, and dizziness. |
| Because of its side effects, this atypical antipsychotic drug is not a first choice drug for schizophrenia. | Clozapine |
| The adverse effect of blockage of these receptors is a lower seizure threshhold. | GABA |
| The adverse effect of blockage of these receptors are antipsychotic effects, weight gain, hypotension, ejaculatory dysfunction. | Serotonin |
| The adverse effects of blockage of these receptors are sedation, substantial weight gain, or orthostasis. | Histamine |
| it has been postulated that an overactivity of the ______ of the ______ system in certain areas of the limbic system may be responsible for at least some of the symptoms of schizophrenia. | dopamine, dopamine |
| Psychotropic drugs do not correct chemical imbalances in the brain; they do | create changes and toxic effects. |
| The brain tries to compensate for the effects of psychotropic drugs by | changing the number and output of certain receptors that are affected by the drugs. |
| Psychotropic drugs do not correct the _______ _______ that cause mental illness such as schizophrenia, depression, and anxiety. | underlying problems |
| Psychotropic drugs produce many effects which can be _____, some of which are ________. | Harmful, permanent |
| Psychotropic drugs are not specific to _______ _____. | certain diseases |
| This atypical antipsychotic drug has not been associated with extrapyramidal symptoms. | Quetiapine |
| This atypical antispsychotic drug share the the same characteristics as clozapine in it's ability to treat psychotic symptoms of delusions and hallucinations with inducing motor abnormalities. | Risperidone |
| This atypical antipsychotic drug does not seem to have the potential to cause agranulocytosis or convulsions. | Risperidone (Risperdal) |
| If a patient is given a dosage of Risperidone (Risperdal) that is slightly over the effective dose, the patient may begin to experience | motor difficulties |
| What receptors does Risperidone (Risperdal) block? | H1 and fishy thing receptors. |
| Because Risperidone blocks the H1 and fishy thing receptors, it can cause what kinds of side effects? | Orthostatic hypotension and sedation |
| Risperidone (Risperdal) can cause orthostatic hypotension in patients which can cause lead to _____ which are a serious problem among the elderly. | falls |
| Weight gain, sedation, and sexual dysfunction are adverse effects of Risperidone (Risperdal) that might lead to medication | non compliance |
| A rare but serious side effect of Resperidone (Risperdal) is an increased risk for | cerebrovascular accidents in the elderly with dementia who are being treated for agitation. |
| What atypical antipsychotic has a BROAD receptor binding profile? | Quetiapine |
| At normal dosages this atypical antipsychotic has not been associated with extra pyramidal symptoms. | Quetiapine |
| This is a derivative of clozapine and is an antagonist of serotonin, dopamine, histamine, (fishy thing and muscarinic receptors. | Olanzapine |
| Some side effects of this clozapine derivitive are sedation, weight gain, hyperglycemia, and new onset type 2 diabetes. | Olanzapine |
| This atypical antipsychotic is an SNRI and it also binds to the serotonin, dopamine, (fishy thing) and histamine receptors. | Ziprasidone |
| The main side effects of this SNRI (atypical antipsychotic) are hypotension and sedation. | ziprasidone |
| One major concern for a patient taking ziprasidone is it can be fatal if the patient has a history of _______ and the QT interval is prolonged. | Cardiac arrhythmia |
| Before administering ziprasidone,what should be done? | Baseline EKG and blood chemistry for magnesium and potassium. |
| A unique atypical known as a dopamine system stabilizer. | aripiprazole |
| This unique atypical that functions as a partial agonist at the D2 receptor. | aripiprazole |
| Side effects of aripiprazole include | sedation, hypotension, and anticholinergic effects |
| This mood stabilizers has been established for many years, but its mechanism of action is still understood. | lithium |
| This mood stabilizer is used to treat bipolar disorder. | lithium |
| Adverse effects of lithium that effect the nervous and muscular systems are | tremors, ataxia, confusion, and convulsions |
| Adverse effects of lithium that effect the digestive tract are | nausea, vomiting, diarrhea |
| An adverse effects of lithium that effect the cardiac system is | arrhythmias |
| Adverse effects of lithium that effect the fluid and electrolyte systems are | polyuria, polydipsia, and edema |
| Adverse effects of lithium that effect the endocrine system are | goiter and hypothroidism |
| Long term use of lithium increases the risk of | kidney and thyroid disease |
| This mood stabilizer has the lowest therapeutic index of all psychiatric drugs. | lithium |
| These drugs alter electrical conductivity in membranes; in particular, they reduce the firing rate of very high frequency neurons in the brain. | antiepileptic drugs |
| Antiepileptic drugs used for treatment of bipolar disorders. | Carbamazepine (Tegretol), divalproex (Depakote), and lamotrigine (Lamictal) |
| The memnrane-stabilizing effect of _____ may account for their ability to reduce the mood swings that occur in clients with bipolar disorders. | antiepileptic drugs |
| These drugs are particularly effective in reducing the excitement of the manic phase of bipolar disorders. | antiepileptic drugs |
| This antiepileptic drug shares the ability of TCA's to serve as a neurological analgesic. | carbamazepine |
| Common side effects of carbamazepine are | nausea, sedation, and ataxia |
| What recommended baseline work should be done before administering carbamazepine? | liver function tests, CBC, electrocardiogram, and electrolyte levels. |
| This medication may be used as a first line treatment for bipolar disorder, and many clients tolerate it better than lithium or carbamazepine. | divalproex |
| This anticonvulsant has been found useful for rapid cycling | divalproex |
| Occassional serious side effects fo divalproex include | thrombocytopenia, pancreatitis, hepatic failure, and birth defects. |
| What baseline levels are needed before a patient is treated with divalproex? | liver function indicators, and CBC |
| This antiepileptic medication is approved by the FDA for acute and maintenance therapy of manic depression. | lamotrigine (Lamictal) |
| This anticonvulsant is used as a mood stabilizer in patients with co-morbid bipolar disorders and chronic pain. | gabapentin (Neurontin) |
| This anticonvulsant is not classified as a mood stabilizer, but may be appropriate for some clients when weight los is desirable. | topiramate (Topamax) |
| ________ have strongly sedating properties which may account for the ability to quickly calm the manic phase of a bipolar disorder. | benzodiazepines |
| This anticonvulsant is structurally a benzodiazepine. | clonazepam (Klonopin) |
| The serious drawback of clonazepam (Klonopin) is that | patients develop tolerance and dependence to its effects |
| What baseline labs need to be gathered before starting a patient on clonazepam (Klonopin)? | CBC, liver function tests, and renal function tests |
| ______ and ____ are neurotransmitters that play a major orle in regulating mood. | norepinephrine and serotonin |
| Antidepressant medications that cause norepinephrine inhibition cause possible effects such as | reduce depression, tremors, tachycardia, erectile/ejaculatory dysfunction |
| Inhibition of the serotonin reuptake causes what possible side effects? | reduce depression, antianxiety effects, GI disturbances, sexual dysfunction |
| Blockage of the receptor binding of the serotonin causes what possible side effects? | reduces depression, reduces suicidal behavior, antipsychotic effects, hypotension and ejaculatory dysfunction. |
| Dopamine reuptake inhibition can cause what possible side effects? | decrease depression, psychomotor activation, antiparkinsonian effects. |
| Histamine blockage by antidepressants causes what possible side effects? | sdation/drowsiness, hypotension, and weight gain. |
| Acetylcholine blockage by antidepressants causes what possible side effects? | blurred vision, dry mouth, constipation, siuns tachycardia, urinary retention. |
| Typical or standard antidepressants are thought to act primariy by blocking the reuptake of _________ and to a lesser degree, _________. | norepinephrine, and serotonin |
| ______ block the reuptake and destruction of serotonin and and also increase the synaptic level of this transmitter. | TCA's |
| Blockage of tehmuscarinic receptors that normaly bind to acetylecholine leads to typical ______effects such as blurred vision, dry mouth, tachycardia, and constipation. | anticholinergic |
| Blockage of the histamine receptors by any drug causes ______ and ______. | sedation and drowsiness |
| This medication blocks the reuptake and thus the destruction of serotonin, with little or no effect on the other monoamine transmitters. | SSRI's |
| _______ have less ability to block the muscarinic and histamine receptors thna do the TCA'a. | SSRI's |
| A type of organic compound; these include the neurotransmitters, norepinephrine,m epinephrine, dopamine, and serotoning, as well as many different food substances and drugs. | monoamines |
| an enzyme that destroys monoamines. | monoamine oxidase |
| drugs that prevent the destruction of monoamines by inhibiting the action of MAO. | monoamine oxidase inhibitors (MAOIs) |
| Trazadone is ___ _____ ____ for antidepressant treatment. | not a first choice |
| An effective antidepressant an first-line agent for smoking cessation. | Bupropion |
| These are dual action Serotonin-norepinephrine reuptake inhibitors (SNRIs) 3 names | venlafaxine, duloxetine, and mirtazapine |
| The most commonly used anxiolytic agents are | benzodiazapines |
| These drugs bind to specific receptors adjacent to the GABA receptors. | benzodiazapines |
| ________ of _____ allows GABA to inhibit more forcefully thatn it would if binding alone. | binding of benzodiazapines |
| _______do not inhibit neurons in the absence of GABA. | benzodiazapines |
| Benzodiazapines such as flurazepam (Dalmane) and triazolam (Halcion) have a predominantly ____ effect. | hypnotic |
| Benzodiazapines such as lorazepam (Ativan) and alprazolam reduce anxiety with being as | soporific (sleep producing) |
| When combined with other CNS depressandt, such as alcohol, opiates, or _________ can lead to life-threatening respiratory depression. | benzodiazapines |
| In the elderly the use of benzodiazapines may cohntribute to _____ and ______ | falls and broken bones |
| A drug that reduces anxiety without having strong sedative-hypnotic properties. | Buspirone (BuSpar) |
| This drug is not a CNS depressant and thus does not have as great a danger of interaction with other CNS depressants such as alcohol. | Buspirone (BuSpar) |
| When a patient takes buspirone (BuSpar), the end result is an increased synaptic level of serotonin that presumably accounts for the beneficial action of this drug. | Buspirone (BuSpar) |
| These drugs work for ADHD by increasing the release and blocking the reuptake of monoamines . | Ritalin and Adderall |
| The side effects of ritalin and adderall are | agitation, exacerbation of psychotic thought processes, hypertensionm, and long-term growth suppression as well as the potential for abuse. |
| This is a norepinephrine uptake inhibitor that is approved for use in children 6 and older with ADHD. | Strattera |
| Common side effects of strattera are | Decreased appetite and weight loss, fatigue, and dizziness. |
| These two drugs slow the rate of memory loss and in some clients, may even improve memory. | Tacrine and donepezil (anticholinesterase drugs) |
| Inactivation of acetylcholinesterase leads to less destruction of the neurotransmitter _____. | acetylcholine |
| The first anticholinesterase approved by the FDA for the treatment of Alzheimer's disease. | Tacrine (Cognex) |
| What enzyme levels should be monitored regularly if a patient is on tacrine (Cognex)? | liver enzyme |
| This medication for alzheimers shows clinical efficacy without the liver toxicity asociated with tacrine (Cognex). | Donepezil (Aricept) |
| A new class of drug that has demonstrated effectiveness in clients with moderate to severe Alzheimer's disease. | Memantine (Namenda, Ebixa) |
| All actions of the brain - sensory, motor, intellectual - are carried out physiologically through the interactions of | nerve cells |
| Excess activity of ____ among other factors is involved in the thought disturbances of schizophrenia. | dopamine |
| Deficiencies of norepinephrine or serotonin or both underlie the mood disturbances of | depression |
| Pharmacological treatment of mental disturbances is directed a the suspected | transmitter receptor problem |
| Antipsychotic drugs block _______ receptors. | dopamine |
| Antidepressant drugs increase synaptic levels of | norepinephrine and/or serotonin |
| Antianxiety drygs increase the effectiveness of | GABA |
| Prominant side effects of pharmacologial agents used to treat mental disease include: | sedation or excitement, motor disturbances, muscarinic blockage, fishy thing antagonism, sexual dysfunction, and weight gain. |
| A nurse administering a benzodiazapines should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter _____. | GABA |
| Fluoxetine an SSRI exerts its antidepressant effect by blocking the reuptake of | serotonin |
| Fluid and electrolyte imbalance should be carefully assessed in the patient taking | lithium |
| What drug group calls for nursing assessment for development of parkinsonian movement disorders among individuals who take therapeutic dosages? | phenothiazines |
| Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women this hyperprolactinemia can result in | amenorrhea or galactorrhea |
| The basic functional unit of the nervous system is called a | neuron |
| altering brain neurochemistry | |
| The incoherent thought and speech patterns of the client with schizophrenia are related to the brain's inability to | regulate conscious mental activity |
| When the ______ cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation | brain |
| Homeostasis is promoted by interaction between the brain and internal organs mediated by | the autonomic nervous system |
| When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate | disequillibrium |
| Which organs secrete hormones that are a normal component of the body's general response to stress? | brain, pituitary gland, adrenal glands |
| The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates norms and laws demonstrates problems related to the brain's inability to | regulate social behavior |
| A client receiving a psychotropic drug reports to the nurse that he is drowsy all the time and is having difficulty focusing his attention. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate | alertness |
| A client's communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms? | cerebrum |
| A lowered ______ level is highly supported as being related to depression | serotonin |
| A nursing assistant is speaking to the nurse about a client with schizophrenia. The nurse can use knowledge of the biological basis of mental illness to facilitate appropriate interaction between the NA and the client by offering the following advice: | "His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support." |
| A client taking a medication known to block H1 should be carefully observed for | sedation, weight gain, and hypotension |
| When the nurse knows a client is taking a medication that has anticholinergic properties, the nurse would assess for | blurred vision, dry mouth, and constipation |
| The physician mentions to the nurse that the medication prescribed for a client is thought to potentiate the action of ã-aminobutyric acid. The nurse would evaluate treatment as being successful when the client demonstrates | less anxiety |
| Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. | serotonin and norepinephrine |
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