mental health Module 03 Study Guide PDF

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quiz 3 mental health nursing rasmussen university...

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Sympathetic NS (Fight or Flight/Adrenergic) Adrenergic Agonist (promote/produce) a.k.a – Adrenergic, Sympathomimetic  Mimic the sympathetic neurotransmitters: - Epinephrine, Norepinephrine, Catecholamine (all the same) Actions: Vasoconstriction; increase HR, increase BP, dilates pupils, inhibits salivation, relax airways (bronchodilation), decrease GI mobility/activity, stimulates the release of glucose (increase sugar), relaxes bladder, alertness. Meds: Epinephrine – treat allergy, anaphylaxis, asthma, cardiac arrest, hypotension

Albuterol – treat bronchoconstriction associated with asthma/COPD

Sympathetic NS (Fight or Flight/Adrenergic) Adrenergic Blockers (inhibit/block) a.k.a - adrenergic antagonists, sympatholytic  Block access to the adrenergic receptor sites and inhibits the release of epinephrine and norepinephrine - Alpha and Beta Blockers I & II Alpha and Beta I = Heart/Kidneys Alpha and Beta II = Lungs Actions: Decrease HR, decrease BP, causes bronchoconstriction Meds: Atenolol, Metoprolol, labetalol – treats hypertension, angina, migraines, myocardial infarction, heart failure Side effects: depression, sexual dysfunction, cool extremities, bronchoconstriction (lowers everything – bradycardia, hypotension)

Parasympathetic NS (Rest and Digest/Cholinergic) Anticholinergics (dry, dry, dry) a.k.a - Cholinergic Antagonists, Parasympatholytics  By blocking the parasympathetic nerves, the adrenergic nervous system dominates. Actions: Decreases GI motility/peristalsis/secretions, increases bladder retention (relaxes bladder), dilates pupils, increases tremor/rigidity of muscles (can’t see, cant pee, cant spit, cant shit) Meds: Atropine – treats bradycardia, reduces salivation, dilates pupils for eye exam Benztropine – treats Parkinson’s Telterodine tartrate – decreases incontinence Sympathetic NS Adrenergic Agonist pair with Parasympathetic NS Anticholinergics Adrenergic (SNS) + Anticholinergics (PNS) = Dry secretions Parasympathetic NS (Rest and Digest/Cholinergic) Cholinergic Agonist (wet, wet, wet) a.k.a – cholinergic, parasympathomimetics  Mimic the neurotransmitter acetylcholine Actions: Increases saliva/tear production, increases GI peristalsis, stimulates urination (SLUD) Meds: Bethanechol chloride – increases urination Pilocarpine – increases salivation Sympathetic NS Adrenergic Blockers pair with Parasympathetic NS Cholinergic Agonist Adrenergic (SNS) + Cholinergic (PNS) = Wet secretions (when sympathetic is blocked, parasympathetic activates)

Antipsychotic agents/Schizophrenia – a chronic psychotic illness characterized by disordered thinking and loss of reality

Meds: *Typical* Chloropromazine – also treats hiccups & is antiemetic (prevents vomit)

S/S: Positive symptoms: exaggeration or distortion of normal function *Agitation *Disorganized speech *Hallucinations *Delusions *Paranoia Combativeness Negative symptoms: Loss of normal function *Poverty of speech *Poor self-care *Social/emotional withdrawal *Lack of motivation *Blunt affect *Poor insight/judgement

Side effects: *Sedation *Orthostatic hypotension *Anticholinergic effect *Cardiac dysrhythmias *NMS *EPS Haloperidol – contraindicated in Parkinson’s due to anticholinergic effect Education: Typical antipsychotics will be given in an emergency situation due to rapid onset

Cognitive symptoms: *Disordered thinking *Reduced ability to focus *Learning and memory disabilities

*Atypical* Clozapine – should only be given as a last resort because it can cause fatal agranulocytosis (low WBC) Takes 2 – 3 weeks for onset

Treatments: Typical antipsychotics FGAs Atypical antipsychotics SGAs

Side effects: *Drowsiness *Unsteady gait *Headache *Insomnia *Depression *Orthostatic hypotension *Weight gain *Diabetes *dyslipidemia *anticholinergic effect *Agranulocytosis

Depression (most common psychiatric disorder) – Loss of pleasure or interest in all or nearly all of one’s usual activities. Second most chronic condition after HTN

Meds:

3 Types: Reactive – triggered by life events Major – Must have lasted longer than 2 weeks Bipolar – The depressive state of bipolar disorders (opposite of manic state) S/S: Insomnia (sometimes hypersomnia) Anorexia and weight loss (sometimes weight gain) Mental slowing Loss of concentration Feelings of guilt, worthlessness, and helplessness Thoughts of suicide/death

*Atypical* Bupropion – DO NOT USE in patient with psychotic disorders. Similar to amphetamine and increases dopamine (stimulant suppression, suppresses appetite, increases sexual desire and pleasure) Education: Can be used for: Smoking cessation Relief of neuropathic pain Treats depressive episodes of bipolar Management of ADHD Side effects: *Seizures *Agitation *Headache *Weight loss *Constipation

*Tachycardia

*Dry mouth

Meds: *Monoamine Oxidase Inhibitors (MAOIs): 1st generation* Phenelzine – prevents the breakdown of dopamine, norepinephrine, and serotonin (life-threatening side effects so rarely used)

Education: *Not tolerated well and should be a last resort after all other treatments have been tried

Side effects: Orthostatic hypotension Insomnia Sexual dysfunction Hypertensive Crisis (sever increase in blood pressure that can lead to stroke) and CARDIAC ARREST Serotonin syndrome

*Without sticking to the strict diet can result in Hypertensive crisis Avoid foods containing Tyramine such as: *all cheeses *coffee *chocolate *bananas *raisins *liver *pickled food *sausage *soy *yeast *beer *red wine

Meds: *Tricyclic Anti-Depressants (TCAs): 1st generation* Imipramine Amitriptyline – Increases the levels of serotonin and norepinephrine in the brain and blocks acetylcholine (last resort)

Education: *Lethal dose is only 8 times the therapeutic dose (patients should only be given a one week supply to decrease the risk of suicide)

Side effects: Sedation Hypotension Tachycardia Anticholinergic effect Cardiotoxicity (cardiac arrest) Seizures

*When combined with MAOIs cardiovascular instability and toxic psychosis may result

*Overdose is treated with active charcoal

*Suspected overdose requires EKG and cardiac monitoring (administer sodium bicarbonate to control dysrhythmia)

Meds: *Selective Serotonin Reuptake inhibitor (SSRIs): 2nd Generation* Fluoxetine Sertraline

Meds: Seretonin Norepiniephrine reuptake inhibitors (SNRIs): 2nd Generation Venlafaxine Duloxetine

Side effects: Nausea Weight gain Headache Insomnia Sexual dysfunction CNS stimulation

Side effects: Anorexia Hypertension Nausea Headache Insomnia Sexual dysfunction Risk of Serotonin Syndrome

Education: *Limit grapefruit juice *Has fewer side effects *Greater risk for serotonin syndrome (2-72 hrs. after tx onset) *Do not stop abruptly *Takes 1-4 weeks for max effectiveness Bipolar Disorders – (chronic condition lifelong treatment) a brain disorder that causes an unusual shift in mood, energy, activity levels, and the ability to carry out tasks *Characterized by manic and depressive phases, separated by period in which mood is normal – repeated episodes of one or the other are possible. Not everyone alternates between the two Bipolar I: Manic or mixed episodes Bipolar II: Hypomanic or depressive episodes Treatments: Mood stabilizers (Lithium Gold Standard) Antidepressants Antipsychotics Anticonvulsants

Education: Duloxetine - Can cause hepatotoxicity and is contraindicated in those that drink heavily or have liver disease

Meds: Lithium – used for mania (drug of choice and will not cause sedation) or depression Therapeutic range: 0.4 – 1 mEq/L Education: Pt. should have neurological, renal, and hepatic checked reg. Hyponatremia cause toxicity (avoid sodium-free diets, diuretics, and dehydra Avoid HCTZ and ACE inhibitors Do not use with NSAIDs or anticholinergic drugs Report palpitations or cardiac dysryhtmias immediately Side effects (WNL): N/V & Diarrhea Polyuria Thirst Muscle weakness (N/V & Diarrhea will decrease over time)

When levels are high Confusion EKG changes Seizures Course hand tremors Death (> 2.5 mEq/L)

When levels are low Convulsions Olguria Death

Meds: (Antiepileptic) Divalpoex sodium/Valproate (traditional) – used for manic and depressive episodes. Helps prevent relapse of mania.Works faster than lithuim

Meds: (Antiepileptic) Carbamazepine – treatment and prevention of mania (less effective on depression) Therapeutic range: 4 - 12 mcg/mL

Therapeutic range: 50 - 100 mcg/mL (always check blood levels first if there is a therapeutic range) Education:  Teach patient that they must have a live enzyme and blood test first.  Can be taken with or without food but with food to reduce nausea.  Decreases effectiveness of birth control Side effects: Can cause hepatotoxicity Teratogenic Thrombocytopenia Diarrhea Insomnia – Define as the inability to sleep well (transient for some and chronic for others) Education:  Usually self-limiting and drug therapy should be short term  Can be caused by psychiatric disorders, pain, odd work hours, excessive noise, stress S/S   

Daytime drowsiness Impairment of mood, memory, coordination, concentration, and decision making skills Increased risk for accidents, marriage problems, depression, CAD, Metabolic and endocrine dysregulation

Education:  Can accelerate metabolism of itself and other drugs such as oral contraceptives and warfarin Side effects: Visual disturbance Vertigo Headache Anemia Thrombocytopenia

Meds: Non-pharmacological treatment  Determine underlying cause  Caffeine reduction  Psychotherapy  Cognitive behavioral therapy (sleep therapy and strategies) Meds: Sedatives/Hypnotic Classes 3 major groups: *Barbiturates (schedule III drug) *Benzodiazepines (drug of choice for anxiety and insomnia) *Benzodiazepine-like drugs Education: *Typically, sedative-hypnotics relieve anxiety in low doses and induce sleep at higher doses *The differences between antianxiety effects and hypnotics effects is often a matter of dosage. *Agents given to promote sleep are called: hypnotics *Agents given to reduce anxiety are called: anxiolytics

Meds: Benzodiazepine – Intensifies the effects of the inhibitory neurotransmitter GABA Used to :  General anesthesia  Treat seizures  Muscle spasms  Alcohol withdrawal  Anxiety and sleep disorders Education: *Reduce anxiety *Promote Sleep *Induce muscle relaxation *When taken orally have no effect on the heart and blood vessels *When IV can produce profound hypotension and cardiac arrest *Little to moderate respiratory depression Meds: Barbiturates – No longer the first line drug for insomnia. Cause CNS depression Used for – Daytime sedation, induction of sleep, seizure suppression, and general anesthesia Side effects: Tolerance Dependence Abuse Multiple drug interactions Respiratory failure Death Secobarbital – has a rapid onset of 10 – 15 minutes which helps induce sleep Side effects: CNS depression Acute toxicity

Meds: Lorazapam – treats anxiety, insomnia, & seizures Diazepam – treats anxiety, muscle relaxers, ETOH Alprazolam – treats anxiety and panic disorders Education: Taper off slowly Increased fall risk Pregnancy class D and X Side effects: *Drowsiness *Lethargy *Memory impairment *Dizziness *Decreased Libio *Depression *impaired coordination *Sleep-related behaviors *Respiratory depression *Hypotension *Coma *Death Reversal agent = Flumazenil Meds: Benzo-like Drugs – used for short term management of insomnia, not used for anxiety  Schedule IV drug (low potential for abuse) Zolpidem Side effects: Drowsiness Dizziness Tolerance Dependence Sleep-related behavior Hypotension Angioedema

Anxiety Disorder – An uncomfortable state that has both psychological and physical components (GAD last > months)

Meds: Anxiety (Azopirones) Buspirone: 1st line

Panic Disorder – Reccuretn, intensly uncomfortable episodes known as panic attacks (feels like a heart attack) OCD - A potentially disabling condition characterized by persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day, and significantly interfere with daily living

Education: *Non-sedating (no CNS effect) *Delayed onset *May take up to 2 weeks to become effective (maintenance) *Grapefruit juice and Erythromycin (antibiotic) can lead to toxicity. *No abuse potential

Social Anxiety Disorder - Characterized by an intense, irrational fear of situations in which one might be: • Scrutinized by others • Might do something that is embarrassing or humiliating

Side effects: Dizziness Nausea Headache Light-headedness

Post-Traumatic Stress Disorder (PTSD) - Develops following a traumatic event that elicited an immediate reaction of fear, helplessness, or horror. Panic Disorder Treatments: Drugs or Cognitive Behavior Therapy. • Avoid sympathomimetics, caffeine, and sleep deprivation. • SSRI – 1st line • SNRI – 1st line • TCAs – 2nd line • MAOIs – 2nd line • Benzos – 2nd line Participate in regular aerobic exercise

OCD Treatments - Optimal treatment consists of both meds and behavioral therapy. Deep Brain Stimulation: • Blocks nerve traffic • Must fail tx with at least 3 meds and behavioral therapy Behavioral therapy: • Patients are exposed to sources of theirs fears, while being encouraged to refrain from acting out their compulsive rituals. • Causes anxiety • High success rate

Social Anxiety Disorder:

PTSD Treatment:

Generalized: person fears nearly all social and performance situations.

Trauma-focused therapy  Exposure therapy: in which patients repeatedly reimagine the traumatic event as a way to make those events lose their power.

Performance-only: fear is limited to speaking or performing in public. Treatments: Psychotherapy Drug Therapy SSRI – 1st line

Stress inoculation training  Helps patients identify cues that can trigger fear and anxiety, and then teaches them techniques to cope with those disturbing reactions. Drug Therapy  SSRI – 1st line  SNRI – 1st line  TCAs – 2nd line  MAOIs – 2nd line...