bipolar disorder, schizophrenia, drug abuse, depression, and cardiovascular
Quiz yourself by thinking what should be in
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on it to display the answer.
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| Name the clot busters. | TNKase, Streptase, Retavase, and Activase
give within 6 hours of AMI onset
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| What are side effects of clot busters? | bleeding, hypotension, allergic reaction
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| What are clot busters used to treat? | AMI, PE, DVT
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| Name the clot busters. | TNKase, Streptase, Retavase, and Activase
give within 6 hours of AMI onset
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| What is unstable angina? | unpredictible CP, worsening pattern that occurs at rest, can progress to MI or return to stable lesion
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| What are side effects of clot busters? | bleeding, hypotension, allergic reaction
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| What are side effects of clot busters? | bleeding, hypotension, allergic reaction
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| What are clot busters used to treat? | AMI, PE, DVT
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| What are the contraindications for clot busters? | recent CVA, cerebral neoplasm, active bleeding, severe HTN, UC, anticoagulant therapy, advanced age, recent CPR
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| What are clot busters used to treat? | AMI, PE, DVT
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| What are the s/s of a MI? | sudden prolonged severe CP, radiating, not relieved by rest or nitrates, diaphoresis, n/v, decreased CO, ST elevation
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| What is unstable angina? | unpredictible CP, worsening pattern that occurs at rest, can progress to MI or return to stable lesion
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| What are the contraindications for clot busters? | recent CVA, cerebral neoplasm, active bleeding, severe HTN, UC, anticoagulant therapy, advanced age, recent CPR
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| What individuals will have different pain with a MI/ACS? | DM, women, HTN, elderly
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| How long should the pt. wear oxygen after an MI? | 24-48 hours
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| What is unstable angina? | unpredictible CP, worsening pattern that occurs at rest, can progress to MI or return to stable lesion
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| What individuals will have different pain with a MI/ACS? | DM, women, HTN, elderly
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| How long should the pt. wear oxygen after an MI? | 24-48 hours
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| What are the s/s of a MI? | sudden prolonged severe CP, radiating, not relieved by rest or nitrates, diaphoresis, n/v, decreased CO, ST elevation
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| Aspirin | thrombus prevention before, during, or after a MI, 81 mg x 4= 324 mg, s/e: GI upset, bleeding, tinnitus
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| Morphine Sulfate | decreases myocardial O2 demands and relieves pain, titrate to pain, s/e: respiratory depression, sedation; antidote: narcan
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| Magnesium IV | given for torsades de pointes
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| How long should the pt. wear oxygen after an MI? | 24-48 hours
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| Calcium Chloride | given for acute hyperkalemia or hypocalcemia
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| Aspirin | thrombus prevention before, during, or after a MI, 81 mg x 4= 324 mg, s/e: GI upset, bleeding, tinnitus
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| Sodium Bicarbonate | given for metabolic acidosis with prolonged CPR
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| Magnesium IV | given for torsades de pointes
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| Angiogram | PCI, images of blood vessels using contrast, complications: damage to arterial wall, PLT aggregation, MI, death, stent failure
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| Calcium Chloride | given for acute hyperkalemia or hypocalcemia
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| Chantix (varenicline) | for smoking cessation, PO, after meals, x 12 weeks, can smoke while on it
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| stent placement | wire mesh treats abrupt or threatened closure of vessel, antiplatelet angents given, complications same as angiogram
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| Sodium Bicarbonate | given for metabolic acidosis with prolonged CPR
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| PTCA (percutaneous transluminal coronary angioplasty) | balloon catheter inflated to enlarge diameter of vessel, same complications as angiogram
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| Questran (cholestyramine) | bile acid sequestrant, ACHS, gritty powder mixed in 120-240 mL of juice, s/e: GI distress, may interfere with coumadin (increase bleeding), reduced absorption of Vit ADEK, monitor PT, other meds 1 hr before or 6 hr after
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| Angiogram | PCI, images of blood vessels using contrast, complications: damage to arterial wall, PLT aggregation, MI, death, stent failure
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| Questran (cholestyramine) | bile acid sequestrant, ACHS, gritty powder mixed in 120-240 mL of juice, s/e: GI distress, may interfere with coumadin (increase bleeding), reduced absorption of Vit ADEK, monitor PT, other meds 1 hr before or 6 hr after
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| Chantix (varenicline) | for smoking cessation, PO, after meals, x 12 weeks, can smoke while on it
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| Integrilin (eptifibatide) | prevents aggregation of clotting factors, short term prevention of ischemic complications of AMI and during PCI, IVPB in combo with ASA and low dose heparin; tx time: 24-72 hrs, super aspirin, expensive
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| PTCA (percutaneous transluminal coronary angioplasty) | balloon catheter inflated to enlarge diameter of vessel, same complications as angiogram
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| Coronary Artery Bypass Graft | MVD or severe occlusions that cannot be corrected with PCI, leg vein used to reroute blood flow around the coronary occlusion and restore blood flow to the heart tissue
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| stent placement | wire mesh treats abrupt or threatened closure of vessel, antiplatelet angents given, complications same as angiogram
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| Cardiac Tamponade | accumulation of blood, pus, or fluid in pericardial sac (120-150 mL), heart compressed,
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| Questran (cholestyramine) | bile acid sequestrant, ACHS, gritty powder mixed in 120-240 mL of juice, s/e: GI distress, may interfere with coumadin (increase bleeding), reduced absorption of Vit ADEK, monitor PT, other meds 1 hr before or 6 hr after
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| Integrilin (eptifibatide) | prevents aggregation of clotting factors, short term prevention of ischemic complications of AMI and during PCI, IVPB in combo with ASA and low dose heparin; tx time: 24-72 hrs, super aspirin, expensive
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| Coronary Artery Bypass Graft | MVD or severe occlusions that cannot be corrected with PCI, leg vein used to reroute blood flow around the coronary occlusion and restore blood flow to the heart tissue
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| Pericarditis | 2-4 days after MI, swollen heart muscle rubs agains pericardial surface and causes it to lose it's lubricating fluid=friction rub,pt will have pain worsens when supine, fever, palpitations, SOB; TX: abx and antiinflammatories
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| Cardiac Tamponade | accumulation of blood, pus, or fluid in pericardial sac (120-150 mL), heart compressed, leads to cardiac failure and cardiogenic shock, tx: pericardiocentesis
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| Cardiogenic Shock | failure of heart to pump effectively (decreased CO and tissue perfusion), EF severely decreased, death most likely
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| Epinephrine (adrenaline) | increased BP, HR, and CO; tx cardiac arrest, IV/IO push, ETT in 10 mL of NS, S/E: tachycardia, HTN, toxicity with CRI
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| Amiodarone (cordarone) | decreases excitability (ectopic foci); tx: pvcs, vt, a.fib/flutter; Emergency: IV/IO push; maintenance with drip, s/e: decreased HR and BP, photophobia, skin discoloration
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| Digoxin (lanoxin) | decreased HR, increased ventricle contraction, increased CO; tx: CHF, a.fib/flutter; dose: IVP slow diluted; toxicity: halos, yellow vision, AMS, n/v; MUST HAVE NORMAL K AND MG LEVELS!!!!
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| Digoxin serum level | 0.5-2.0
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| Lidocaine (xylocaine) | decreased excitability, suppresses numbs ectopic beats ONLY IN THE VENTRICLE; tx: pvcs, vt, vf; IV/IO push then drip, ETT in 10 ml NS, s/e: neurotoxicity
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| Adenocard (adenosine) | decreased conduction through AV node (stops heart); tx: svt; short half life; s/e: asystole, CP, flushing
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| Atropine Sulfate | stimulates SA node (atrium), tx: bradycardia (symptomatic); IV/IO push, ETT in 10 mL NS, s/e: anticholinergic, increased hr
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| Cardizem (diltiazem) | calcium channel blocker, decreased AV node conduciton, tx: svt, a.fib/flutter; iv bolus then drip; s/e: hypotension, myocardial depression
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| Zelta (ezetimibe) | decreases cholesterol absorption/fat in GI tract; QD without regard to meals; s/e myalgias, arthralgias, diarrhea, assess LFT
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| Statin Drugs-Atorvastatin (Lipitor), lovastatin (mevacor), simvastatin (zocor), rosuvastatin (crestor) | increases HDL, decreases LDL, PO qHS, no GF juice, s/e: increased LFT, rhabdomyalysis; report muscle pain, LFT q3-6 months
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| Lovaza (fish oil/omega 3 acid ethyl esters) | lowers cholesterol, take at night, s/e: burping, flu symptoms, GI distress, change in taste; can not take if allergic to fish
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| Nicotinic Acid (Niacin, vitamin B12) | lowers lipids, give with food, MOST PEOPLE DO NOT TOLERATE, s/e: GI distress, facial flushing, increased LFT
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| Gemfibrozil (lopid) | lowers lipids, take 30 min before meals, s/e: increased bleeding, GI distress, not take at same time as anticoagulants
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| fenofibrate (tricor) | lowers lipids, take with meals, s/e : increased bleeding, GI distress; do not take with anticoagulants
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| Stable Angina | predictable intermittent CP, only 3-5 minutes, no pain at rest, relieved by nitrates, pain is never sharp or stabbing and never changes with position changes
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| Nitroglycerin (NTG) | potent vasodilator, s/e: hypotension, HA; check BP, light sensitive, replace tabs q3-5 months
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| ACE inhibitors | lowers bp, decreases vascular resistance; tx: CHF, protects kidneys
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| CCB | lowers bp, decreases sa/av conduction, vascular relaxation; tx: angina, atrial tachydysrhythmias, pvd (#1 drug for pvd)
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| BB | lowers hr,bp, and heart's o2 need; tx: angina, MI, irregular hr, tremors, chf
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| dopamine | controls movements
decreased levels= resting muscle tremors
increased levels= schizophrenia
cocaine and amphetamines increase levels
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| s/s of addiction | dilated or constricted pupils, abnormal vs, track marks, tremors, etoh on breath, drug paraphenalia, bal, uds
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| What do antiepileptics do? | decrease mania and stabilizes mood
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| What are the s/e of antiepileptics? | rash, decreased wbc, hepatic/renal damage
monitor therapeutic serum levels
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| Antiepileptic drugs | Depakene, Depakote, Tegretol, Lamictal
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| Lithium Carbonate | mood stabilizer for acute and recurrent tx of BPD, 7-14 days before effective, taper to d/c, BID or TID dosing, expected s/e: nausea, thirst, polyuria, fine hand tremors; other s/ewt gain, hypothyroidism; ci: renal, cv, thyroid
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| Serum lithium levels | 0.5-1.5
draw levels 12 hours after last dose
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| What are the s/s of toxicity of lithium? | diarrhea, vomiting, drowsiness, decreased coordination, convulsions, muscle weakness, coma, death
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| Bipolar disorder | swings in mood, energy, and ability to fx
rapid cycling: mania, normal activity, depression
just dont know the cause
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| cyclothymia | hypomania alternating with minor depression
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| Bipolar II Disorder | hypomania alternating with major depression
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| Bipolar I Disorder | mania alternating with major depression
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| Mania | unstable elevated mood with delusions, poor judgement, and impaired reality
does not sleep or eat
hospitalization if unsafe
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| Electroconvulsive therapy (ECT) | shock therapy, electrical current to brain = seizures; tx: suicidal, severe depression, bpd; used when meds not successful; need consent, give anticholinergic with muscle relaxer, crash cart; complaints sfter: HA, muscle soreness, nausea; lie on side, vs
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| Serotonin Syndrome | excessive serotonin levels
s/e: AMS, agitation, increased hr, htn, muscle rigidity, fever, sweating, tremor
untreated: cv collapse, death
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| tyramine | biproduct of tyrosine in processed foods
need to decrease in diet with maois or htn, cva, or htn crisis can occur
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| MAOIs | increase serotonin, dopamine, and tyramine; tx: depression, phobias, anxiety; go to er if severe ha, bp x 6 wks when starting drug; not compatible with most drugs
NARDIL, PARNATE, MARPLAN
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| TCAs | increase serotonin
ELAVIL, PAMELOR, TOFRANIL
start low and go slow, no alcohol!
s/e anticholinergic effects, sedation, lethal in OD
toxic effects: avb, increased hr, MI
ci: cv hx, glaucoma, pregnancy
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| SNRIs | increase serotonin
tx: depression, anxiety, ocd, fibromyalgia
CYMBALTA, EFFEXOR, PRISTIQ
s/e: insomnia, suicidal thoughts, sexual dysfx
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| Atypical (Novel) antidepressants | increase serotonin
tx: depression, smoking cessation
WELLBUTRIN, ZYBAN, REMERON, SERZONE
s/e: sedation, increased suicidal ideations
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| SSRIs | increases serotonin=mood
tx: depression, anxiety, ocd
PROZAC, ZOLOFT, PAXIL, CELEXA, LEXAPRO
faster onset (max 2 wks)
less dangerous c/ od
s/e: drowsiness, insomnia, sexual dysfx, gi symptoms early, ha
effective in 2-4 wks
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| Clozpine (clozaril) | dopamine and serotonin antagonist (decreases)
agranulocytosis (bone marrow supression) risk-bleeding, infection
weekly cbc, w/draw med if agranulocytosis occurs
one week rx at a time
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| 2nd Generation Antipsychotics (atypical) | dopamine and serotonin angtagonist (decreases)
CLOZAPINE, RISPERDAL, GEODON, SEROQUEL, ZYPREXA, ABILIFY
tx: positive and negative sx
s/e: decreased eps, decreased relapse, sedation, increased chance of dm (increased bs)
1st line drugs for schizophren
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| Congentin (benzotropine) | anticholinergic, antiparkinson
1st generation antipsychotic
tx: eps tx/prevention
po, im, iv (rare)
s/e: r/t everything dries up, photosensitivity, orthostatic hypotension
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| Tardive Dyskinesia | with long term therapy
IRREVERSIBLE, may decrease w/ dosage reduction
INVOLUNTARY TWISTING/WRITHING MOVEMENTS OF TONGUE AND FACE, LIPS, LIMBS, TOES, FINGERS, AND TRUNK
prevention: decrease effective dose of antipsychotic + congentin, AIMS scale
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| Clozpine (clozaril) | dopamine and serotonin antagonist (decreases)
agranulocytosis (bone marrow supression) risk-bleeding, infection
weekly cbc, w/draw med if agranulocytosis occurs
one week rx at a time
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| 2nd Generation Antipsychotics (atypical) | dopamine and serotonin angtagonist (decreases)
CLOZAPINE, RISPERDAL, GEODON, SEROQUEL, ZYPREXA, ABILIFY
tx: positive and negative sx
s/e: decreased eps, decreased relapse, sedation, increased chance of dm (increased bs)
1st line drugs for schizophren
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| Clozpine (clozaril) | dopamine and serotonin antagonist (decreases)
agranulocytosis (bone marrow supression) risk-bleeding, infection
weekly cbc, w/draw med if agranulocytosis occurs
one week rx at a time
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| 2nd Generation Antipsychotics (atypical) | dopamine and serotonin angtagonist (decreases)
CLOZAPINE, RISPERDAL, GEODON, SEROQUEL, ZYPREXA, ABILIFY
tx: positive and negative sx
s/e: decreased eps, decreased relapse, sedation, increased chance of dm (increased bs)
1st line drugs for schizophren
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| Congentin (benzotropine) | anticholinergic, antiparkinson
1st generation antipsychotic
tx: eps tx/prevention
po, im, iv (rare)
s/e: r/t everything dries up, photosensitivity, orthostatic hypotension
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| Tardive Dyskinesia | with long term therapy
IRREVERSIBLE, may decrease w/ dosage reduction
INVOLUNTARY TWISTING/WRITHING MOVEMENTS OF TONGUE AND FACE, LIPS, LIMBS, TOES, FINGERS, AND TRUNK
prevention: decrease effective dose of antipsychotic + congentin, AIMS scale
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| Congentin (benzotropine) | anticholinergic, antiparkinson
1st generation antipsychotic
tx: eps tx/prevention
po, im, iv (rare)
s/e: r/t everything dries up, photosensitivity, orthostatic hypotension
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| Akathisia | uncontrolled urge to be in constant motion
reversible
1st 6 wks of tx
give low does of bb, benzos, anticholinergics (congentin)
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| Parkinsonism | bradykinesia, mask-like face, drooling, tremor, rigidity, shuffling gait, stooped posture
reversible
develops 1st month of therapy
give low dose with congenting or benadryl
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| Tardive Dyskinesia | with long term therapy
IRREVERSIBLE, may decrease w/ dosage reduction
INVOLUNTARY TWISTING/WRITHING MOVEMENTS OF TONGUE AND FACE, LIPS, LIMBS, TOES, FINGERS, AND TRUNK
prevention: decrease effective dose of antipsychotic + congentin, AIMS scale
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| Acute Dystonia | min/hrs/days of 1st dose
severe muscle spasms/cramping of tongue, neck, back, face, eye deviation
also possible with phenergan & reglan
immediate reversal with iv or im congentin or benadryl
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| Akathisia | uncontrolled urge to be in constant motion
reversible
1st 6 wks of tx
give low does of bb, benzos, anticholinergics (congentin)
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| Flat Affect | negative sx
no facial expression/blank look
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| Parkinsonism | bradykinesia, mask-like face, drooling, tremor, rigidity, shuffling gait, stooped posture
reversible
develops 1st month of therapy
give low dose with congenting or benadryl
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| Inappropriate Affect | negative sx
emotional response does not match situation
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| Acute Dystonia | min/hrs/days of 1st dose
severe muscle spasms/cramping of tongue, neck, back, face, eye deviation
also possible with phenergan & reglan
immediate reversal with iv or im congentin or benadryl
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| Bizarre Affect | negative sx
grimacing, giggling, mumbling to oneself
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| 1st Generation Antipsychotics (conventional) | decrease dopamine levels
HALDOL, PROLIXIN, THORAZINE, LOXITANE
tx: positive sx, relapse prevention, acute agitation
nasty s/e: eps, full effects 2-4 wks/months, intial effects in 2-4 days
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| Stupor | positive sx
motionless for long periods of time
may appear to be in coma
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| Flat Affect | negative sx
no facial expression/blank look
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| Wavy Flexibility | positive sx
excessive maintenance of abnormal posture
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| Inappropriate Affect | negative sx
emotional response does not match situation
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| Automatic Obedience | positive sx
follows simple commands robot-like fashion
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| Bizarre Affect | negative sx
grimacing, giggling, mumbling to oneself
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| Stereotyped Behaviors | positive sx
motor patterns that had meaning now lack purpose
folding towels-mill worker
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| Stupor | positive sx
motionless for long periods of time
may appear to be in coma
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| Extreme Motor Agitation | positive sx
increased physical behavior
risks: exhaustion, collapse, death
constant running
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| Wavy Flexibility | positive sx
excessive maintenance of abnormal posture
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| Derealization | positive sx
false perception environment has changed
going home, asking where am i?
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| Automatic Obedience | positive sx
follows simple commands robot-like fashion
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| Depersonalization | personal boundary difficulties
lost identity, self different or unreal
fingers are snakes, arms rotting wood
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| Stereotyped Behaviors | positive sx
motor patterns that had meaning now lack purpose
folding towels-mill worker
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| Illusion | something is there but what they describe isn't what is there
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| Extreme Motor Agitation | positive sx
increased physical behavior
risks: exhaustion, collapse, death
constant running
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| Command Hallucinations | can be dangerous
signify psychiatric emergency
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| Derealization | positive sx
false perception environment has changed
going home, asking where am i?
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| Auditory Hallucinations | turning head
frequent blinking
grimacing
responding to unseen others
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| Depersonalization | personal boundary difficulties
lost identity, self different or unreal
fingers are snakes, arms rotting wood
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| Benzodiazepines | for withdrawal delerium
LIBRIUM, VALIUM, SERAX, ATIVAN
po tapered over 5-7 days
anticonvulsant effects,sedates
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| Illusion | something is there but what they describe isn't what is there
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| Vivitrol, ReVia (naltrexone) | im q month
decrease alcohol cravings, helps abstain from alcohol
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| Auditory Hallucinations | turning head
frequent blinking
grimacing
responding to unseen others
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| Command Hallucinations | can be dangerous
signify psychiatric emergency
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| Benzodiazepines | for withdrawal delerium
LIBRIUM, VALIUM, SERAX, ATIVAN
po tapered over 5-7 days
anticonvulsant effects,sedates
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| Auditory Hallucinations | turning head
frequent blinking
grimacing
responding to unseen others
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| Vivitrol, ReVia (naltrexone) | im q month
decrease alcohol cravings, helps abstain from alcohol
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| Benzodiazepines | for withdrawal delerium
LIBRIUM, VALIUM, SERAX, ATIVAN
po tapered over 5-7 days
anticonvulsant effects,sedates
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| s/s of cns stimulant addiction |
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| Vivitrol, ReVia (naltrexone) | im q month
decrease alcohol cravings, helps abstain from alcohol
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| s/s of cns stimulant intoxication | crack cocaine, amphetamines
dilation of pupils, dry mouth, increased motor activity, increased bp, insomnia, hallucinations, paranoia
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| cns stimulant od | resp depression, hyperpyrexia, mi, coma, death
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| opiate intoxication | opium, morphine, heroin, codeine, fentanyl, methadone, demerol, dilaudid
everything slows down, constricted pupils, impaired judgement and memory, slurred speech
abcs, supportive, narcan ivp
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| marijuana (cannabis sativa) | smoked, ingested po
s/s: euphoria, detachment, relaxation, talkativeness, slowed perception of time, increased sensitivity to stimuli, mellows
med indications (13 states) chemo induced nausea, decrease iop, increase appetite
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| Hallucinogens | LSD, peyote, PCP
po, sniffed, smoked
intoxication s/s: same as stimulant + synesthesia (speeds everything up)
od: psychosis, brain damage, death, hyperthermia
tx: abcs, low stimuli, speak slowly in low voice, valium, haldol
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| inhalants | intoxication: excitation followed by drowsiness, disinhibition, staggering, light-headedness, agitation, euphoria
od- damage to cns
tx support affected systems
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| amphetamines s/e | euphoria, increased energy, increased self-confidence, increase sociability, increased temp, hf, rf, dehydration
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| GHB (rohypnol) | benzodiazepine
ruffie
mixed easily in drinks (colorless, odorless, tasteless)
unconscious in min + retrograde amnesia
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| Hallucinations | positive sx
sensory perceptions where no external stimuli exists
auditory, visual, olfactory (smell), gustatory (taste), tactile (feel)
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| Word Salad | positive sx
jumble of words meaningless to listener and speaker (neologisms, similar to associative looseness)
i am fine, apple pie, no sale, furniture stor, take it slow, cellar door
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| Clang Association | positive sx
meaningless rhyming of words, forceful manner
rhyming more important than content
lil wayne
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| Echopraxia | positive sx
mimicking anothers movements
catatonic state
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| Echolalia | positive sx
repitition of anothers words
catatonic states
rainman
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| Neologism | positive sx
word that a person makes up that has a special meaning to them
children and creative writers
= disruption in thought processes
norks?
🗑
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| Associative looseness | positive sx
threads linking thoughts together are absent
thinking illogical, haphazard, confused
can't go to the zoo, no money, oh... i have a hat, these rumors make no sense, man... what's the problem
🗑
|
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| Concrete Thinking | positive sx
overemphasis on specific details
literal, abstract thinking missing, normal for children
What brings you to the er? ambulance
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| Delusions | positive sx
false beliefs that cannot be corrected by reasoning, loosely organized and bizarre
persecutory (out to get me)
grandoise (i am cleopatra)
religious, hypochondrial, controlled
leads to increased anxiety, thoughts w/drawn, broadcasted, inse
🗑
|
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| Serotonin | regulates sleep and emotional states
decreased levels= depression, anxiety
increased levels c/ exercise and balanced diet
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| Alcohol W/drawal | signs of delirium develop hrs after last drink
hallucinations and illusions common
peak @24-48 hrs, rapidly and dramatically disappear
🗑
|
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| Delirium | disturbance of cognition, manifested by confusion, excitement, disorientation, and clouding of conciousness
etoh induced delirium tremens (DTs) lasts 3-6 days
🗑
|
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| Anticonvulsants for DTs | w/ drawal delirium med
phenoobarbital
mg sulfate
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|
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| Antabuse (disulfiram) | motivated clients/voluntary alcoholics
po, qday
unpleasant reaction when mixed with etoh
30 min. after drink
in system 2 weeks after last dose
🗑
|
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| CNS depressants | etoh, benzos, barbituatates
s/s: slows down (sedation, ataxia, vomiting, resp depression, hypotension, rf, shock, coma, death
tx abcs, gastric lavage, dialysis, romazicon, ivp reverses benzos
🗑
|
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