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Mental Health

Module 2 - Psychopharmacology

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
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Created by: sbertelsen



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