Term
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Definition
Pathophysiology- Chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality
S/S – Flat affect, apathy, Hallucinations, social withdrawal, poor self-care, reduced ability to focus attention, & memory deficit
Treatment
FGA’s – First Generation (conventional) Antipsychotics or Neuroleptics 1950’s IE: Haldol or Thorazine.
SGA’s – 1990’s Second-Generation(atypical) Antipsychotics (Serotonin & dopamine antagonists). IE: Clozapine, Zyprexa, Geodon.
SGA’s have fewer EPS side effects than FGA’s but cost 10 times as much! |
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Term
| Olanzapine (zyprexa) & Ziprasidone (geodon) |
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Definition
MOA: Serotonin & Dopamine receptor blocker (Antagonist). Serotonin > Dopamine = less incidence of EPS and TD. *Also blocks Norepinephrine, histamine (H1) & acetylcholine.
Adverse Effects- Sedation, orthostatic hypotension, dry mouth, blurred vision, constipation (Muscarinic blockade).
Metabolic Effects: wt. Gain (H1), Diabetes, Dyslipidemia.
Clozapine specific side effect = Agranulocytosis (Monitor WBC and for FLU like symptoms) |
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Term
Nursing Implications
Olanzapine (zyprexa) & Ziprasidone (geodon) |
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Definition
Warn pt. about Agranulocytosis – Monitor WBC, they need to report fever, sore throat, fatigue
Report wt. Gain > 30 lbs. – Exercise and eat right
Report signs of chest pain, dyspnea, tachycardia. |
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Term
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Definition
30% of population suffer from Depression at some point in lifetime
Monoamine Neurotransmitters = serotonin, norepinephrine & dopamine which are used to relay messages throughout the body.
Monoamine deficiency = Depression.
s/s:
Depressed mood
Loss of pleasure
Insomnia
Wt. Loss/wt. Gain
Worthlessness & helplessness
Diagnosis: symptoms present most of the day, everyday, for at least 2 weeks. |
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Term
| Antidepressant Induced SUICIDE |
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Definition
The risk of suicide may actually increase early in treatment – WHY?
Mainly in children and adolescents under the age of 25.
Requires close observation during the 1st few months of therapy.
What to watch for? Worsening mood and changes in behavior.
Because ANTI depressant drugs can be used for SUICIDE:
RX for smallest amount of pills
DOT – watch for cheeking |
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Term
Fluoxetine (Prozac), Sertraline (Zoloft), & Escitalopram (Lexapro)
SSRI’s
(antidepressants) |
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Definition
Selective Serotonin Reuptake Inhibitors
MOA: Increases circulating serotonin in the synapse by blocking the reuptake of serotonin in the neuron.
Adverse Effects- Sexual dysfunction, wt. Gain, sleepiness.
Special Teaching- Effects in 10-20 days, wean off slowly, & Take with food and monitor for hyponatremia |
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Term
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Definition
Begins 2-72 hours after starting treatment
Sweating
Mental Confusion
Agitation
Anxiety
Hallucinations
Hyperreflexia
Tremors
Autonomic instability = Life Threatening
Stop the Med
Call the Doctor
*MAOI’s increase the risk* |
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Term
Desvenlafaxine (pristiq) 2008
SNRI
(antidepressant) |
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Definition
MOA: Serotonin & Norepinephrine Reuptake Inhibitor
Used when SSRI’s don’t work
Adverse Effects- Nausea, Headache, anorexia
Special Teaching- 2-4 weeks to see results, wean slowly, and do not take with MAOIs |
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Term
Bupropion (Welbutrin)
NDRI
(antidepressant) |
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Definition
MOA : Norepinephrine Dopamine Reuptake Inhibitor. Stimulant action and suppresses appetite.
Therapeutic uses:
Used when SSRI’s don’t work
SAD (Seasonal affective Disorder) & smoking cessation therapy.
Adverse Effects: Most serious = Seizures. Most common = Agitation, Headache, dry mouth. |
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Term
Phenelzine (Nardil)
MAOI’s
(antidepressants) |
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Definition
Monoamine Oxidase Inhibitors – 2nd or 3rd choice due to dangerous S/E.
Atypical depression only
Foods to Avoid containing Tyramine
Some Beers & Chianti wine
Yeast Extracts
Most Cheeses
Fermented sausages
salami
Pepperoni
Bologna
Aged Fish or meat (smoked)
Avocados
Figs & Bananas
Be careful with Caffeine & chocolate.
MOA: Block MAO-A in the brain, thereby increasing Norepinephrine (NE) and serotonin available for impulse transmission = bye-bye depression.
Adverse Effects: CNS stimulation (anxiety, agitation, mania) Orthostatic hypotension, MOST Dangerous = Hypertensive Crisis (from eating tyramine) |
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Term
Nursing Implications
Antidepressants |
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Definition
Take medication Daily as prescribed
Therapeutic effects in 1-3 weeks
Continue to take the meds even after feeling better.
Therapy usually continues 6 months after resolution of symptoms
Warn patient & family of increased suicide risks. |
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Term
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Definition
Patho: Disruption of neuronal growth and survivial.
Otherwise known as Manic-depressive illness – Chronic disorder requiring lifelong treatment. Typically 4 episodes during 1st 10 years.
Occurrence: Adolescence – early adulthood
S/S: Episodes of Mania followed by depression.
Treatment: Mood Stabilizers ie: Lithium or aripirazole (abilify) |
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Term
Aripirazole (abilify)
Mood Stabilizer |
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Definition
Antipsychotic typically used for manic phase while waiting for therapeutic levels of Lithium.
MOA: Dopamine2 and Serotonin agonist.
Adverse effects: Suicidal thoughts, drowsiness, Extrapyramidal reactions, akathisia, confusion, depression, etc…. |
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Term
Lithium Carbonate
( Mood Stabilizer) |
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Definition
MOA: Blocks Serotonin receptors & Protect against neuronal atrophy &/or promote neuronal growth
Fun Fact – Simple inorganic ion with a single positive charge. Similar to generic salt!
Other uses: Alcoholism & Bulimia.
Adverse effects: N/V, diarrhea, thirst, Polyuria (3L/day) lethargy, slurred speech, muscle weakness and hand tremors.
Category D. |
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Term
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Definition
Therapeutic Range:
Initial 0.8 -1.4 meq/L
Maint. 0.4-1.0 meq/L
Toxic level > 1.5 meq/L.
Dialysis for toxic levels above 2.5 meq/L
Low serum Sodium increases risk of toxicity?
SEVERE S/E:
Inc. Hand tremors
confusion
hyperirritability of muscles
ECG changes
Renal injury
DEATH |
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Term
Nursing Implications
(Mood Stabilizers) |
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Definition
Encourage strict adherence to med regimen – Most patients enjoy their manic phase.
Antimanic effects begin 5-7 days after treatment onset with full benefits 3 weeks.
Lithium specific:
Monitor blood levels regulary
Drink 2-3 liters of fluid/ day
Take with food and maintain a normal SODIUM intake.
Do NOT Breastfeed while taking |
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Term
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Definition
Patho – ???
Types:
GAD – Generalized Anxiety Disorder
OCD- Obsessive Compulsive Disorder
PTSD- Post Traumatic Stress Disorder
Social Anxiety Disorder
S/S: Restlessness, tachycardia, apprehension, poor concentration, nervousness >6 months
Occurs in Childhood or early adolescence.
Treatment: Sedative Hypnotic - Benzodiazepines |
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Term
Sedatives
(CNS depressant for anxiety) |
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Definition
Drugs that have an inhibitory effect on the CNS to the degree that they reduce:
Nervousness
Excitability
Irritability
without causing sleep |
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Term
Hypnotics
(CNS depressant for anxiety) |
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Definition
| Calm or soothe the CNS to the point that they cause sleep |
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Term
Sedative-Hypnotics
(CNS depressant for anxiety) |
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Definition
dose dependent:
At low doses, calm or soothe the CNS without inducing sleep
At high doses, calm or soothe the CNS to the point of causing sleep.
Therapeutic Uses
Hypnotics
Sedatives
Anticonvulsants
Surgical procedures |
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Term
Benzodiazepines (Nonbarbiturate sedative-hypnotic)
Alprazolam (xanax), Lorazepam (ativan) Diazepam (Valium). |
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Definition
MOA: Enhances the action of gamma-amino butyric acid (GABA) in the CNS (BRAIN)
Depress CNS activity
Affect hypothalamic, thalamic, and limbic systems of the brain
Benzodiazepine receptors
Drug Effects
Calming effect on the CNS
Useful in controlling agitation and anxiety
Not used long term due to rebound insomnia.
Therapeutic Uses
Sedation
Sleep induction
Skeletal muscle relaxation
Anxiety relief
Treatment of alcohol withdrawal
Agitation
Depression
Epilepsy
Balanced anesthesia |
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Term
Benzodiazepines
Side Effects |
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Definition
Drowsiness
Dizziness
Vertigo
Lethargy
Paradoxical excitement – insomnia, excitation, euphoria, anxiety, rage.
“Hangover effect” |
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Term
CNS Depressants: Nursing Implications
Benzodiazipines |
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Definition
Thorough history regarding allergies, use of other medications,health history, and medical history.
Obtain baseline vital signs
Give 15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep.
Most benzodiazepines (except flurazepam) cause REM rebound and a tired feeling the next day; use with caution in the elderly.
Patients should be instructed to avoid alcohol and other CNS depressants.
2-3 weeks before noticing the effects
Do not stop abruptly…WEAN and watch for rebound insomnia.
Xanax info: Less Anxiety, More sleep |
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Term
CNS Depressants: Nursing Implications
Safety
Benzodiazipines |
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Definition
Keep side rails up
Do not permit smoking
Assist patient with ambulation (especially the elderly)
Keep call light within reach
Monitor for side effects |
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Term
CNS Depressants: Nursing Implications
Therapeutic Effects
Benzodiazipines |
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Definition
Fewer panic episodes
Increased ability to sleep at night
Fewer awakenings
Shorter sleep induction time
Few side effects, such as hangover effects
Improved sense of well-being because of improved sleep |
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Term
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Definition
| Methylphenidate (Ritalin, Concerta), Amphetamine (adderall XR), & Atomoxetine (strattera) |
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Term
| Methylphenidate (Ritalin, Concerta), Amphetamine (adderall XR), & Atomoxetine (strattera) |
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Definition
MOA: Release Norepinephrine (NE) and dopamine in the Brain and inhibit the reuptake.
Adverse Effects: CNS Stimulation (insomnia & restlessness), wt. loss, dysrhythmias, angina. Most severe – paranoid psychosis |
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Term
Nursing Implications
ADHD Meds |
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Definition
Use smallest dose required and avoid giving late at night.
Minimize dietary caffeine
Take AM dose after breakfast & PM early afternoon to minimize interference with eating.
Monitor for Therapeutic response- reduced impulsiveness, hyperactivity, inattention and improved cognitive function. |
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