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NRSG Pharm CH 16
Emotional, mood, behavioral disorders
| Question | Answer |
|---|---|
| Most common mental health disorder | Depression |
| Major Depressive Disorder req | Depressed affect + 5 of following for min 2 weeks: SIGECAPS Sleep, Interest, Guilt, Energy, Concentration, Anhedonia, Psychomotor, SI |
| Rx continuum: | 9-12month maintenance phase, learn patterns, taper off RX Dementia is long time |
| Other depressions: | Postpartum - hormonal changes Seasonal Affective Disorder SAD - enhanced release of melatonin Psychotic Depression - intense mood shifts/unusual behaviors |
| Antidepressants considerations: | Vitals, dizziness, headache, tremor, N/V, mental/emotional - anxiety/disorientation/agitation/diaphoresis, underlying psychosis? sleep/wake, renal/GI/liver/hematologic visual PT SAFETY |
| Sertraline (Zoloft) classes, mech: | P : SSRI T: antidepressant |
| sertraline (Zoloft) uses: | Depression, anxiety, OCD, PTSD max effect observed after several wk |
| sertraline (Zoloft) side/adverse: | insomnia, headache, dizziness, fatigue, nausea, wt gain sex dysfunction abrupt discontinuation -> withdrawal: nausea, sweating, agitation, tremor, insomnia, seizure |
| Serotonin syndrome: | multiple meds -> hyperreflexia |
| Serotonin discontinuation: | Rebound depression, FINISH Flu-like, Insomnia, Nausea, Imbalance, Sensory, Hyperarousal |
| NMS | Rigidity |
| sertraline black box | SI kids, adolescents, young adults with major depression and other psychiatric disorders. Not approved >6YO |
| duloxetine (Cymbalta) | SNRI, antidepressant |
| venlafaxine (Effexor) | SNRI, antidepressant -serotonin, NE, may affect dopamine, elevate mood |
| bupropion (Wellbutrin, Zyban) | Atypical (heterocyclic) antidepressant |
| imipramine (Tofranil) class, mech | T: Antidepressant, tx of nocturnal enuresis in children P: Tricyclic antidepressant (TCA) Blocks reuptake of serotonin and NE into nerve terminals |
| imipramine (Tofranil) considerations: | therapeutic effect 2+ wk |
| imipramine (Tofranil) side/adverse | sedation, drowsiness, anticholinergic: blurred vision, dry mouth, constipation, wt gain C/V - tachy, ortho hypo, extreme hypertension photosensitivity and hypersensitivity |
| phenelzine (Nardil) classes, mech, use: | MAOI T: antidepressant Irreversible inhibition of MAO = inc effects of NE in adrenergic synapse only for management of depressions that are not responsive to safer Rx. 2-3wk wash out! |
| phenelzine (Nardil) adverse: | ortho hyop, headache, insomnia, diarrhea, lots drug/food interactions Hypertensive crisis w/ foods that contain tyramine! "fancy foods" |
| Bipolar: | Bipolar I- mania. Bipolar II - depression - can have mixed DIGFAST Distracted, Indigestion, Grandiosity, Flight of ideas, Activity inc, Sleep, Talk |
| "gold standard" mood stabilizer | Lithium (Eskalith, Lithobid) - inverse relation with Na levels! |
| anti-seizure drug for bipolar | valproic acid (Depakene) |
| atypical antipsychotic drug for bipolar | risperidone (Risperdal) |
| Considerations w/ mood stabilizers: | mental/emotional status electrolyte balance, fluids, I/O Renal, C/V, GI |
| Renal metabolism mood stabilizer | Lithium (Eskalith, Lithobid) |
| Hepatic metabolism mood stabilizer | Valproic Acid (DEPAKOTE) |
| Lithium (Lithobid) classes, mech | Mood stabilizer, antimanic agent Exact action unknown, Na tx across cell membranes, also influence reuptake of neurotx |
| Lithium (Lithobid) uses: | Manic episodes of Bipolar I (treatment, maintenance, prophylaxis) |
| Lithium considerations: | Narrow therapeutic window! 0.6 - 1.5mEq/L (BLACK BOX) Inverse w/ Na levels Monitor for lithium toxicity premed labs: Electrolyte, glucose, BUN/Creatinine, UA, thyroid, preg test - Ebsteins anomaly in 1st trimester |
| Lithium inverse/interactions: | Common: N/V, anorexia, cramps, excessive thirst and urination, fine hand tremor serious adverse: lithium toxicity, food/drug interactions may increase risk |
| Mood/Emotional disorders assessment: | Pt Hx, need for therapy, med hx, labs (rx levels, liver, renal), vitals, body wt, SI! |
| ADHD | Behavioral disorder - easily distracted, failure to follow instructions, inability to focus, memory, freq loss of items, talking/interrupting, inability to sit still, impulsiveness, sleep |
| Methylphenidate (Concerta, Ritalin) classes, mech | CNS stimulant T: ADHD drug Activates RAS partially be release of NE and dopamine |
| Methylphenidate (Concerta, Ritalin) uses | ADHD - inc focus and awareness |
| CNS stim admin | SR tabs must be swallwed whole, SCH II, preg C drug-free "holidays" |
| Methylphenidate (concerta, Ritalin) side/adverse | insomnia, nervousness, anorexia, wt loss, irregular heart beat, inc BP, liver tox, risk abuse/dependance |
| methylphenidate (Concerta, Ritalin) black box | sch II drug with high abuse potential. Misuse may cause sudden death, C/V event |
Created by:
kmulla
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