Question | Answer |
Obsession | Unwanted thought, idea, image, or urge that the person recognizes as time-consuming and senseless but repeatedly intrudes into the consciousness, despite attempts to ignore, prevent, or counteract it (recurrent thoughts of dirt or germ contamination, fear |
Simple phobia | Irrational fear of a specific object or situation (heights, closed spaces, air travel, animals)If exposed to the object, there is an immediate feeling of panic, sweating, and tachycardia. People avoid the feared object |
Obsessive-compulsive disorder | recurrent obsessions or compulsions that cause significant distress and interfere with normal occupational responsibilities, social activities, and relationships complex condition requiring behavioral, pharmacologic, and psychosocial components; can becom |
Antianxiety medications are also known as | anxiolytics or tranquilizers are prescribed |
Treat anxiety 3 classes: | Benzodiazepines Azaspirones Selective Serotonin Reuptake Inhibitors (SSRI) |
To assess mental status look for | General appearance (is person clean and neat?) Posture stooped, erect, or slumped? Oriented to date, time, place, and person? |
To assess mood/affect look for | Tearful, angry, hostile? Facial expression tense, fearful, sad, angry, or blank? |
To assess clarity of thought look for | Ask specific questions regarding their ability to make judgments and decisions. Memory impairment? |
The objective of an assessment is to | Obtain history of precipitating factors that may have triggered or contributed to the anxiety |
Precipitating factors that can trigger or contribute to anxiety | Drugs or alcohol use; Recent loss of job, loved one. Medical problems that attribute to the symptoms? Specific fears? |
Detailed history of all meds taken | |
To assess psychomotor functions look for | What activity level has person maintained? Are they able to go to school or to work? Have normal responses to daily activities been altered? |
To assess obsessions or compulsions determine | Are there repetitive physical or mental behaviors and if so, how often do they occur? |
To assess a patients's sleep pattern determine | What is their normal sleep pattern and has it varied? Insomnia present? Describe amount and quality of sleep? |
Dietary history | weight gains or losses |
Benzodiazepines | Reduce anxiety by stimulating the action of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA) |
Benefits of Benzodiazepines | Most commonly used – more consistently effective and less likely toLess likely to cause overdose; Have less potential for abuse |
Using Benzodiazepines in elderly or pt with reduced hepatic function: Xanax, Ativan, Serax are | more appropriate because of their short duration of action & no active metabolites |
Benzodiazepines should not be administered during the first trimester of pregnancy because | of increased incidence of birth defects and (cross the placenta) in mothers who are breastfeeding |
Symptoms of side effect of Benzodiazepines : Blood dyscrasias | sore throat, fever, jaundice, excessive/progressive weakness |
Symptoms of side effect of Benzodiazepines: Hepatotoxicity | Anorexia, N/V, jaundice, abnormal liver function tests |
Azaspirones | Used in treatment of anxiety disorders and for short-term relief of symptoms of anxiety |
Benefits of Azaspirones | Anxiety agent unrelated to barbiturates, benzodiazepines, or other anxiolytic agents; Has lower sedative properties. Has no antipsychotic activity; Is not a controlled substance; Therapeutic outcome is decrease in level of anxiety to a manageable level |
Side Effects Azaspirones | Sedation Lethargy CNS disturbances (most common), dizziness, insomnia, nervousness, drowsiness, lightheadness REPORT: slurred speech & dizziness |
Selective Serotonin Reuptake Inhibitors(SSRIs) | Drug of choice used to treat obsessive-compulsive disorder(OCD) when causing marked distress, time-consuming, or interfere with responsibilities |
what is hydroxyzine | Is an antihistamine which acts within the CNS to produce sedation, antiemetic, anticholinergic, antihistaminic, antianxiety, and antispasmodic activity |
How is hydroxyzine used | Multipurpose agent Used as a mild tranquilizer in psychiatric conditions characterized by anxiety, tension, and agitation |
Hydroxyzine is routinely used as a preoperative or postoperative sedative to | control vomiting, diminish anxiety, and reduce amount of narcotics needed for analgesia |
Hydroxyzine may be used as an antipruritic to | relieve itching associated with allergic reactions |
Side Effects from hydroxyzine (Vistaril), (Atarax) | Blurred vision, Constipation, Dryness of mucosa of mouth, throat, nose, REPORT – slurred speech, dizziness |
Mood | sustained, emotional feeling perceived along a normal continuum of sad to happy |
Mood disorder | when certain symptoms impair the person’s ability to function for a duration of time (abnormal feelings of depression or euphoria) |
Depression | persistent, reduced ability to experience pleasure in life’s usual activities such as hobbies, family, and work |
Cognitive symptoms | inability to concentrate, slowed thinking, confusion, and poor memory of recent events |
Psychomotor symptoms | slowed or retarded movements, thought processes, and speech, restless motion |
Bipolar disorder | “manic depression”, distinct episodes of mania (elation, euphoria) and depression separated by intervals without mood disturbances |
Mania | usually begin abruptly and escalate over several days. Heightened mood (euphoria), quicker thoughts, fast speech, increased energy, increased physical and mental activities, decreased need for sleep, irritability |
Labile mood | rapid shifts toward anger and irritability with short attention span and inability to concentrate |
Grandiose delusions | become paranoid |
Drug Therapy for Mood Disorders | Antidepressants subdivided into: MAOIs;Tricyclic; SSRIs; Misc group |
What are MAOIs | Drug Class: Monoamine Oxidase Inhibitors |
What is the normal dosage of MAOIs | GN: phenelzine, BN: _____________ Initial dose 15 mg TID up to 60 mg/day GN: tranylcypromine, BN: ___________ Initial dose 10 mg BID up to 30 mg/day |
pheneizine (Nardil) | Remains in body for up to two weeks after last dose. Need to avoid foods high in _________ for that period of time!! |
Actions of MAOIs | Block the metabolic destruction of norepinephrine, dopamine, and serotonin neurotransmitters. Require ___ to ___ weeks to become evident!! |
MAOIs are most effective in | atypical depression, panic disorder, obsessive-compulsive disorder, and some phobia disorders |
What is the expected therapeutic outcome of MAOIs | Elevated mood and reduction of symptoms of depression |
What to do when acting as a nurse to a MAOI using patient | Obtain B/P and pulse; Monitor blood glucose if patient is diabetic; Tyramine foods (could cause life-threatening hypertensive crisis) |
Tyramine foods include | Well-ripened cheeses, red wines, overripe bananas, figs, avocados, chicken livers, beer, yeast extract!! |
Side Effects of MAOIs | Orthostatic hypotension (monitor B/P in supine and standing position) Drowsiness Sedation Restlessness Agitation Blurred vision Constipation, urinary retention |
Serotonin Reuptake Inhibitors treat what | depression, obsessive-compulsive disorder, obesity, eating disorders, bipolar disorders, panic disorders |
Serotonin Reuptake Inhibitors take how long to take full effect | 2 to 4 weeks |
Serotonin Reuptake Inhibitors do not have what medical consequences | Anticholinergic and cardiovascular side effects |
what is the therapeutic outcome of Serotonin Reuptake Inhibitors | Elevated mood and reduction of symptoms of depression |
Drug interaction with SSRI Tricyclic antidepressants | arrhythmias, seizure activity |
Drug interaction with SSRI Lithium | lithium toxicity(nausea, anorexia, tremors, persistent vomiting, profuse diarrhea) |
Drug interaction with SSRI MAOIs | excitement, diaphoresis, rigidity, convulsions, death |
Drug interaction with SSRI Warfarin | enhances anticoagulant effects (bleeding gums, dark tarry stools, bright-red, coffee-ground emesis) |