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Mental Health
Module 2 - Psychopharmacology
| Question | Answer |
|---|---|
| What is used to take cross sectional images (slices) layer by layer? | Computer tomography (CT) or Computed Axial Tomography (CAT) |
| CT can visualize the brain's what? What can be diagnosed by a CT? | Soft Tissue - tumors, metastases, effusions and to determine the size of the ventricles of the brain. |
| The can produce more tissue detail and contrast than a CT and can show blood flow patterns and tissue changes such as edema. | Magnetic resonance imaging (MRI) |
| This can be used to measure the size and thickness of the brain structures. | MRI |
| A person with __________ can have as much as 7% reduction in cortical thickness. | schizophrenia |
| What can prevent a person from being able to have an MRI? | pacemakers or metal implants |
| What are two type of advanced imaging process and what are they use for. | positron emission tomography (PET) and single photon emission computed tomography (SPECT) - These are used to examine the function of the brain. |
| This type of brain imaging provides better resolution with a sharper and clearer picture. It takes about 2 to 3 hours and uses 2 a single photon. | PET |
| What are the primary uses of PET and SPECT | Mainly researcher |
| What did Dorthy Dix do for mental health? | 1. Opened 32 state hospitals that offered asylum, stating that society was obligated to those who were mentally ill. 2. Advocated for shelter, nutritious food, and warm clothing |
| What Sigmund Freud do in the area of mental health? | Came up with a scientific study of psychiatry, diagnosis, and treatment of mental illnesses. |
| What person - first American psychiatric nurse that believed “the mentally sick should be at least as well cared for as the physically sick”. | Linda Richards |
| Where was site of first training for nurses to work with persons with mental illness. What did it focus on? | McLean Hospital, Belmont, MA - Focused on nutrition, hygiene, and activity |
| therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice) | H. Peplau (Hildegard) |
| What person: focus on the client’s psychosocial needs, strengths | J. Mellow |
| what person: attempted to relate mental disorders to physical disorders. His theory: imbalances of the four humors (blood, water, yellow and black bile); balance restoration via bloodletting, starving, and purging. | Aristotle |
| the first school of nursing to include psychiatric nursing course (1913) | John Hopkins |
| What people: instrumental in developing more humane methods in the custody and care of people with mental disorders using "gentler" methods, an approach that came to be known as moral treatment. | Phillipe Pinel and William Tukes |
| controls complex movements, motivation, cognition, regulation of emotional response | Dopamine - Excitatory |
| changes in attention, learning, memory, sleep, wakefulness, mood regulation | Norepinephrine - excitatroy |
| causes flight-or-fight response | Epinephrine - excitatroy |
| an excitatory amino acid that can have major neurotoxic effects at high levels | Glutamate |
| controls food intake, sleep, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions | Seratonin - Inhibitory |
| modulation of other neurotransmitters | GABA - Inhibitory |
| affects sleep-and-wakefulness cycle; signals muscles to become alert | Acetylcholine - excitatory and inhibitory |
| neuromodulator that is involved in peripheral allergic responses such as gastric secretions, cardiac stimulation, and alertness. | Histamine - excitatory and inhibitory |
| What are the limitations of Brain imaging Techniques? (3) | -Use of radioactive substances; expense of equipment; client’s inability to tolerate technique -Changes nondetectable with current techniques -Used primarily for research not for diagnosis. |
| __________________: examines the effect of psychostressors on the body immune system, and suggests a compromised immune system possibly contributes to developing illnesses, especially in at-risk populations. | Psychoimmunology: |
| Infections: particularly viruses during __________ __________, causing infection in-utero possibly plays a role in neurobiologic issues | fetal development |
| What is the nurse's role in mental health research and education (3) | 1. Ensure all clients, families are well informed. 2. Help distinguish between facts and hypotheses. 3. Explain if or how new research may affect client’s treatment or prognosis. |
| What are antipsychotic drug used for? How do they work? | - treatment of psychotic symptoms -Block dopamine receptors |
| What are the first generation/conventional/typical antipsychotic drugs? | Chlorpromazine (Thorazine), Fluphenazine (Trilafon), Thioridazine (Mellaril), Haloperidol (Haldol). - Developed in 1950’s. |
| What are the Atypical/Second Generation antipsychotic drugs? how do they work? | Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa) - Work by blocking Serotonin receptors, and act on cholinergic and histamine receptors. (est. 1990) |
| What are the third generation antipsychotic drugs? how do they work? | partial dopamine system stabilizers; e.g., Aripiprazole (Abilify) |
| How does the third generation of antipsychotic drugs work? | partial agonists can act as an agonist or antagonist, depending on the concentration of a specific neurotransmitter. Ex: at low dopamine levels will stimulate dopamine receptors- at high dopamine levels a partial agonist will inhibit dopamine receptors. |
| A side effect of antipsychotic drugs is Extrapyramidal Syndrome (EPS). What are the s/s of this (4) | - Acute dystonia (acute muscular rigidity/ cramping/stiff or thick tongue w/ difficulty swallowing) - Torticollis (twisted head or neck) - opisthotonus (tightness in the entire body w/head back & arched neck), - oculogyric crisis (eyes rolled back) |
| What are the treatments for EPS? (Extrapyramidal syndrome) | anticholinergic drugs or diphenhydramine |
| Side effect of antipsychotic drugs: Pseudoparkinsonism and Akathisia. what are these? | - Pseudoparkinsonism (stooped posture, mask-like faces, shuffling gait) - Akathisia (restlessness, anxiety, agitation, rigid posture or gait, lack of spontaneous gestures) |
| Side effect of antipsychotics: Neuroleptic malignant syndrome (NMS) - what is this? what are the s/s? | Potentially fatal idiosyncratic reaction to an antipsychotic (or neuroleptic) drug. Symptoms include: rigidity, high fever, autonomic instability such as unstable BP, diaphoresis and pallor, delirium and elevated levels of enzymes. |
| Side effect caused by antipsychotics: irreversible involuntary movements typically caused by long-term use of antipsychotic drugs | Tardive dyskinesia |
| Side effect of antipsychotic drugs: dry mouth, constipation, urinary hesitancy or retention | Anticholinergic effects |
| Other side effects of antipsychotics: - Increased_________ levels - Weight gain (second-generation agents, except Ziprasidone (Geodon)) - Prolonged ________(Thioridazine, Droperidol, Mesoridazine) -Agranulocytosis (Clozapine); decreased ____. | -prolactin -Weight gain -QT interval - WBC |
| What are the client teaching for antipsychotics? (4) | - Adherence to regimen - Side effects, management -Thirst/dry mouth, Constipation, Sedation - Actions for missed dose (dose if within 4 hours of usual time) - Weekly blood draw for CBC, ANC with Clozapine |
| What are Antidepressants used for? | major depressive illness, anxiety disorders, depressed phase of bipolar disorder, psychotic depression |
| What are the 4 group of antidepressants? | - Tricyclic and related Cycle Antidepressants (TCAs) - Selective Serotonin Reuptake Inhibitors (SSRIs) - MAO inhibitors (MAOIs) - Others (Venlafaxine (Effexor), Bupropion (Wellbutrin), Duloxetine (Cymbalta), Trazodone (Desyrel), Nefazodone (Serzone) |
| Why are Selective Serotonin Reuptake Inhibitors the preferred drugs for clients at high risk for suicide?. | Carries no risk of lethal overdose. |
| How do antidepressants work | interact with monoamine neurotransmitter systems, especially norepinephrine and serotonin |
| What are the side effects of SSRIs? | -Anxiety, agitation, akathisia, nausea, insomnia, sexual dysfunction -Weight gain |
| What are the side effects of TCAs | -Anticholinergic effects -Orthostatic hypotension, sedation, weight gain, tachycardia -Sexual dysfunction |
| What are the side effects of MAIOs | -Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction -Hypertensive crisis (with foods containing tyramine – pg. 30 red wine, cheese, aged meat, beer) |
| These are all possible side effect of what: -Sedation, headache. -Loss of appetite, nausea, agitation, insomnia (Bupropion (Wellbutrin), Venlafaxine (Effexor)) - Priapism (Trazodone) (painful lasting for hours erections) | antidepressants |
| When should SSRIs be taken? if a dose is missed how long is the grace period? | First thing in the morning - can be taken up to 8 hours after missed does |
| When should TCAs be taken? If a dose is missed how long is the grace period? | at night - Within 3 ours of missed dose |
| ____________ ________ occurs if the client is taking MAOI and ingests foods containing tyramine. | Hypertensive crisis |
| A client who takes an SSRI with an MAOI is at risk for__________ __________. | serotonin syndrome |
| Lithim is mood stabilizer for what | bipolar disorder |
| how do mood stabilizers work? | -Normalize reuptake of certain neurotransmitters (Lithium) -Increase levels of GABA (Valproic Acid (Depakote), Topiramate (Topamax)) -Kindling process (Valproic Acid (Depakote), Carbamazepine (Tegretol)) |
| What is the kindling process? | the snow-ball effect seen when a minor seizure activity seems to build up into more frequent and severe seizures. Typically occuring as a result of repeated withdrawal from alcohol or other sedative–hypnotics with related modes of action. |
| Side effects of lithium? | - Nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste, fatigue, lethargy; weight gain, acne (later in therapy) - Toxicity: severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination |
| side effects of Carbamazepine and Valproic Acid: | drowsiness, sedation, dry mouth, blurred vision |
| side effects: Carbamazepine (Tegretol): ________________ Valproic Acid (Depakote): ______________________ Topiramate (Topamax): __________________________ | - rash, orthostatic hypotension - weight gain, alopecia, hand tremor - dizziness, sedation, weight loss |
| What are the client teachings for mood stabilizers? (3) | -Periodic monitoring of blood levels -12 hours after last dose taken (peak and trough) - Drug with meals - Safety measures |
| what drug class: treatment of anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, alcohol withdrawal | antianxiety drugs |
| what is the Mechanism of action for antianxiety drugs? | Mediation of GABA (benzodiazepines) Partial agonist activity at serotonin receptors (buspirone) |
| Side effects of Benzodiazepines? (4) | Physical, psychological dependence CNS depression Hangover effect Tolerance |
| Side effects of Buspirone (4) | Dizziness, sedation, nausea, headache |
| What are the pt teaching for anti anxiety drugs | -Safety measures -Avoidance of alcohol -Avoidance of abrupt discontinuation |
| stimulant drug - Amphetamines (methylphenidate amphetamine, dextroamphetamine) - what is it used for? | treatment of ADHD in children and adolescents, residual attention-deficit disorder in adults, narcolepsy |
| stopped on 56 |
Created by:
sbertelsen
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