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Psych Final
ATI
46
Nursing
Undergraduate 4
10/15/2011

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Term
ETOH Detox Meds
Definition
Benzos:Librium
Valium
Ativan
Adjunct Meds: carbamazepine(tegretol)
clonidine(catapres)
propanolol(inderal)
Term
ETOH - Benzos
Definition
Maintenance of VS WNL, decrease Sz risk, decrease Sx intensity
NOTE: monitor VS & neuro status around the clock
Term
ETOH - carbamazepine (Tegretol)
Definition
Decrease the incidence of Sz
Term
ETOH - clonidine (Catapres)
Definition
depression of the autonomic response (decrease BP & HR)
Term
ETOH - Propanolol (Inderal)
Definition
Depression of the autonomic response (decrease BP & HR)
Decreases cravings
Term
ETOH Abstinence Maintenance
MEDS
Definition
Dsulfiram (Antabuse)
Naltrexone
Acamprosate (Campral)
Term
ETOH - Disulfiram (Antabuse)
Definition
Behavioral (aversion) Therapy
If drinking ETOH:
-acetaldehyde syndrome will occur (N/V, sweating, palpitations, hypotension). Can progress to resp. & CV depression, Sz and death
Avoid ALL ETOH (cough syrup, aftershave)
Sx persist 2wks after DC
Term
ETOH - Naltrexone
Definition
Opioid antagonist that suppresses craving & pleasurable effects of ETOH (also opioid withdrawal)
-Assess Hx of opioid dependency - could initiate withdrawal syndrome
-Take w/meals to avoid GI upset
-Monthly IM if compliance poor
Term
ETOH - Acamprosate (Campral)
Definition
Decreases the unpleasant effects of withdrawal (anxiety, restlessness)
-diarrhea may result, maintain adequate fluid intake, avoid if preggo
Term
TCAs
Definition
Amitriptyline (Elavil)
Imipramine (Tofranil)
Doxepin (Sinequan)
Nortriptyline (Aventyl)
Amoxapine (Asendin)
Trimipramine (Surmontil)
Term
TSA - SE
Definition
Orhtostatic hypotension
-If significant drop, stop med & call HCP
Anticholinergic Effects
Sedation (take HS)
Toxicity resulting in cholinergic blockade & <3 toxicity
-dysrhythmias, mental confusion & agitation
Decrease Sz threshold
Diaphoresis
Term
TSAs - Contraindications/Precautions
Definition
Do not use in Sz disorders
Use Cautiously in pts w/ CAD, DM, liver, kidney * resp disorders, urinary retentions & obstruction, angle closure glaucoma, benign prostate hypertrophy, hyperthyroidism
Term
TCAs Med/Food Interactions
Definition
-w/ MAOIs ->HTN ->Severe antihistamines and other anticholinergics -concurrent use of smpathomimetics may result in ^effects of meds -ETOH, benzos, opioids, &antihistamines ->CNS DEPRESSION
Term
SSRIs
Definition
fluoxetine (Prozac)
citalopram (celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)
Term
SSRI - SE
Definition
-Sexual dysfunction (wellbutrin, nefazodone has less SE)
-CNS stim (inability to sleep, agitation, anxiety)-notify HCP, Take AC
-Weight decrease early on, then ^
-SEROTONIN SYNDROME: 2-72hrs after Tx -mental confusion, difficulty concentrating, agitation, fever, anxiety, hallucinations, hyperreflexia, incoordination, diaphoresis
-Withdrawal Sx: HA, nausea, visual disturbances, anxiety, dizziness, tremors -TAPER!
-Rash
-GI Bleed (caution in pts w/ Hx or if taking anticoag.)
-Bruxism (mouth guard)
Term
SSRI - Contraindications
Definition
-Fluoxetine & paroxetine -^ birth defect risk, use other SSRIs
-Don't take w/ MAOI's or TCAs
-Caution in renal &/or liver dysfunction, <3 disease, Sz disorders, DM, ulcers, Hx of GI bleed
Term
SSRI - Med/Food Interactions
Definition
-MAOIs, TCAs, St John's Wort -^ Serotonin Syndrome.
*DC MAOIs 14 days before SSRI use. Fluoxetine should be DC'd 5wks before MAOIs
-Warfarin (Coumadin): Monitor PTT&INR
-^ levels of TCAs & Lithium
-NSAIDs & anticoags can further suppress plt aggregation
Term
MAOIs - Med/Food Interaction
Definition
-Avoid OTC decongestants & Cold remedies
-Use w/ TCAs ->HTN crisis
-vasopressors -> HTN
-w/ SSRIs -> Serotonin Syndrome
-antiHTN meds ->hypotension
-meperidine (Demerol)-> hyperpyrexia
-tyramine ->HTN crisis (HA, nausea, ^HR, ^BP) -aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein
Term
MEDS for Bipolar Disorder
Definition
Lithium
valproic acid (Depakote)
carbamazepine (Tegretol)
lamotrigine (Lamictal)
Term
Lithium SE
Definition
-GI Distress (take w/food or milk)
-Fine hand tremors (admin beta blocker -propanolol). If ^tremors, watch for toxicity
-Polyuria, mild thirst (use k sparing diuretics)
-weight gain
-renal toxicity (monitor I&O, adjust dosage, assess BUN & Cr)
-Bradydysrhythmias, hypotension, electolyte imbalances (encourage fluid intake)
-Goiter & hypothyroidism w/ long term Tx
Term
Lithium Toxicity S/S
Definition
-early (<1.5)-diarrhea, n/v, thirst, polyuria, muscle weakness & slurred speech.
-advanced (1.5-2)-mental confusion, poor coordination, coarse tremors, & ongoing GI distress
-Severe (>2.0-2.5)-extreme polyuria, tinnitus, blurred vision, ataxia, sz, severe hypotension ->coma& poss. death
>2.5-rapid progression of sx->coma or death. Hemodialysis
Term
Lithium CONTRAINDICATIONS
Definition
-Teratogenic, esp during 1st tri.
-caution in pts w/ renal dysfxn, <3disease, hyponatremia & dehydration
Term
Lithium MED/FOOD interactions
Definition
-Diuretics -decreased Na->decreased Lithium excretion->Toxicity.
-Anticholinergics (antihistamines, TCAs)-ab. discomfort from urinary retention&polyuria. AVOID
*encourage ^Na in diet &2-3L/day of fluid
-NSAIDs (ibuprofen, celebrex)-will ^ renal absorption of lithium->toxicity (use aspirin of mild analgesic)
Term
carbamazepine (Tegretol) SE
Definition
-min cognitive effect -CNS: nystagmus, double vision, vertigo, staggering gait, H/A (lower dosage then steadily ^) -Blood dyscrasias (obtain baseline CBC & plt.) -Teratogenesis -Hypo-osmolarity-promotes ADH excretion->inhibits H2O excretion by kidneys &places HF @risk for fluid overload -Skin Disorders- dermatitis, rash (antiinflamm. or antihistamine, wear sunscreen)
Term
valproic acid (Depakote) SE
Definition
-GI (NV, indigestion): take w/food
-Hepatotoxicity aeb anorexia, N/V, fatigue, ab. pain, jaundice (Baseline LFTs & admin lowest poss. dose)
-pancreatitis aeb n/v, ab.pain (monitor amylase levels, DC med)
-Thrombocytopenia (Monitor plt)
-Teratogenesis
Term
lamotrigine (Lamictal) SE
Definition
double/blurred vision, dizziness, HA, N/V
-Serious skin rash - Stevens-Johnson
Term
MOOD STABILIZING AEDs -Contraindications
Definition
-preg risk
-carbamazepine contraindicated w/bone marrow suppression or w/bleeding disorders
-valproic acid (Depakote) - in pts w/ liver dysfxn
Term
MOOD STABILIZING AEDs - MED/FOOD INTERAXNS
Definition
-carbamazepine (Tegretol)
*birth control, coumadin: decrease in effects of these meds.
*Grapefruit juice-inhibits metabolism->^blood levels
*Phenytoin, phenobarbital: Decrease effects of Tegretol
-Valproic Acid-*Phenytoin, phenobarbital decrease effects of depakote
-Lamotrigine:*carbamazepine,phenytoin, pheobarbital: ^1/2life of lamotrigine
Term
Neuroleptic Malignant Syndrome (NMS)s/s
Definition
-sudden^ fever
-BP fluctuations
-dysrhythmias
-muscle rigidity
-LOC change -> coma
*stop med!, monitor VS, apply cooling blankets, admin antipyretics, ^fluids, dantrolene or bromocriptine -muscle relaxation. wait 2wks before resuming
Term
Mgmt of EPS Sx of antipsychotics
Definition
Acute Dystonia-anticholenergics (benzotropine or benedryl)
Parkinsonism-Tx w/ benztropine, diphenhydramine or amantadine (symmetrel)
Akathisia-Beta blockers, benzos, or anticholinergics
TD-decrease dose, switch to atypical
Term
Altruism
Definition
dealing w/ anxiety by reaching out to others
Term
Sublimation
Definition
dealing w/unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
ex: angry at boss->work out like crazy)
Term
suppression
Definition
voluntarily denying unpleasant thoughts and feelings
Term
Repression
Definition
putting unacceptable ideas, thoughts and emotions out of conscious awareness
Term
Desplacement
Definition
shifting feelings r/t an object, person, or situation to another less threatening object, person or situation
ex: person angry about losing job->destroys child's favorite toy
Term
Reaction Formation
Definition
Overcompensating or demonstrating the opposite behavior of what is felt
Term
Passive Aggression
Definition
indirectly behaving aggressively but appearing to be compliant
Term
Somatization
Definition
developing a physical symptom in place of anxiety
Term
Undoing
Definition
performing an act to make up for prior behavior
Term
Acting out behaviors
Definition
managing emotional conflicts through actions, rather than self-reflection
Term
Dissociation
Definition
temporarily blocking memories and perceptions from consciousness
Term
Devaluation
Definition
expressing negative thoughts of self and/or others
Term
Idealization
Definition
expressing extremely positive thoughts of self/others
Term
Splitting
Definition
demonstrating an inability to reconcile neg and pos attributes of self or others
Term
Projection
Definition
blaming others for unacceptable thoughts or feelings
Term
Denial
Definition
Pretending the truth is not reality to manage the anxiety of acknowledging what is real
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