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115 Cards in this Set
- Front
- Back
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positive symptoms are ______
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observable
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major drug categories for depression therapy
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TCA
SSRI SNRI MAOI ATYPICALS |
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suidice risks increase ______ with medications
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initially
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the test will contain what about drugs?
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what is the action of drug categories
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TCA's
action ae other use |
blocks neuronal reuptake of noreepi/serotonin
intensify NE/serotonin long half life AE: cariotoxcity, sedation, hypotension, anticholinergiic effects other uses: neuropathic pain insomnia adhd ocd |
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explain TCA's cardiotoxic effects
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may cause bradycardia/tachycardia
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if TCA mix with MAOI
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HTN ensues
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if TCA mix with other NE reputake inhibitor
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tachycardia
manic epidsode htn |
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SSRI
action half life AE |
action
-intensifies transmission at synapses -prolonged half life (one month to become effective) AE: sex dysfunction weight gain withdrawal serotonin syndrome EPS bruxism platelet dysfunction hyponatremia fatigue |
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serotonin syndrome:
clincal manifestations |
highly agiated
sever hallucinations hypothalmus over drive -high fevers -brain damage -death |
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bruxism
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ssri ae
grinding teeth can lead to migraines treat with mouth gaurds |
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EPS
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extra pyramidal side effectts
ae of ssri |
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platelet dysfunction
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ae of ssri
if going for sx, tell someone |
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weight gain for ssri tx
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exercise and watch diet
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ssri drug interactions
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warfarin
maoi tca lithium |
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how ssri effects warfarin
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probly have to increase dose
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maoi+ssri= ______
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serotonin syndrom
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ssri+tca=______
what to do? |
could increase tca level
decrease the tca dose |
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ssri+lithium=______
what to do? |
higher lithium levels
decrease lithium dosage |
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lithium effect ______ and ______ levels
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electrolyte and ion levels
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why are ssri better than tca
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they dont have carditoxic side effects
considered safer |
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S/NRI
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effexof/cymbalta
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S/NRI
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deals with the aching of depression
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why does depression hurt?
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depression is a stressor. stress response kicks in and inflammatory phase happens
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S/NRI
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effexor/cymbalta
powerful blockade of norepinephrine and serotonin |
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MAOI
indications |
atypical depression
bulimia ocd panic |
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MAOI
ae |
cns stimulation
orthostatic hypotension HTN crisis |
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MAO is
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an enzyme in the liver that activates norepinephrine
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MAOI effect are reverssible/irreversible
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irreversible
monitor for htn crisis |
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MAOI pateints cant process this yogurt element
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tyramine - protein
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anxiety disorders
define |
intense fear disproportionate to event
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five subcategories of anxiety disorders
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panic disorders
PTSD gen anxiety disorder social phobia OCD |
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bipoolar disease
what is it? |
diagnosis is made by level of mania a patient achieves
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tx goals of bipolar
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prevent mania
maintain stable emotion control mania |
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how do we tx bipolar
3 categories |
antidepresants
antipsychotics mood stabilizers (lithium) |
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why give antipsychocits for bipolar
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short term mood stabilizers
given when escalating to mania |
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what is a widely used mood stablizer
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lithium
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lithium you must maintain ______
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levels
do regular checks |
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what could happen if li levels go to high
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catatonic state
sit drooling dont eat dont move |
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who do we want on lithium?
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someone who is compliant
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lithium is good why?
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because it does not sedate
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usual antipsychotics for bipolar disease
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seroquil (inexpensive)
geodon abilify respiradone |
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antiseizure meds can be used at ______ stabilizers
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mood
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antiseizure meds for mood stabalizers
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valproic acid
lamictal depakote |
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heres the issue with antiseizure meds
what to do |
a lot can cause SJS
go easy and do good teaching |
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panic disorder
define |
deblitating condition with multiple symptoms
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parts of body where panic disorders manifest
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neurologic
cardiac resp diaphoresis nause/abd pain psychological |
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why is GI effected by panic
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^acid
decreased blood flow=cramps |
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etiology of panic disorders
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genetic and major life stressor
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panic diosrder interventions
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behavioral therapy-extended time
psycholocal therapy-extended time meds -antidepressants -ssri |
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one drug you wont see with panic disorders is______
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wellbutrin
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generalized anxiety disorder
define ss meds |
excessive worry >6months
muscle tension autonomic hyperactivity exaggerated startle concentration issues benzo buspirone SSRI b adrenergic blockers |
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what is excessive worry?
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worry about real deal situations but you just give it more thought than it should be
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obession is a ________
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thought.
someons says "i cant get this thought out of my head" |
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compusions are ________
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acts
i have to wash my hands 3 times before i can walk out the door |
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ocd is often confused with ________ or ________
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adhd or defiance
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s/s ocd
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contiuous repitition of acts or thoughts regardless of environment
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interventions for ocd
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behavioral and cognitive therapy
SSRIs and TCAs |
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social phobias are aka
define |
social anxiety disorder
irrational and persistent fear of negative reception by other people |
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outcomes of social phobias
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interferes with routine activities like school, jobs, appts
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social phobia interventions
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behavior and cognitive therpies
ssris benzo mao b adrenergic blockers |
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PTSD
define |
result of a traumatic event causing immediate fear helplessness or horror
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PTSD marker
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re experiencing event
avoidacne of reminders persistent hypervigilance |
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PTSD interventions
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psychotherapy
SSRI (paxil/zoloft) |
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benzos
mech action indications long term AE |
potential gaba
fast to cross BBB metab is liver dont depress CNS sever anxiety attack alcohol/drugs withdraw ICU environment good to help maintain sleep (however, it is drug induced sleep) used to get people through colonoscopies long term use can insight quiet delrium |
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dosing with benzos
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start low
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common benzos
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valium-longest acting
xanax ativan versed all have amnesic properties |
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________ has the best anterograde amnesia properites
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versed
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how do you reverse benzo?
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romazecon
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cognition
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processing of sensory input
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rem sleep
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rapid eye movement
vivid dreams loss of muscle movement hard to arouse these people |
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circadian rhythms
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light levels
suprachiasmatic nucleus -hypothalamus anterior ptuitary |
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non 24 hour sleep wake syndrome
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circadian disorder
those who cant tell light from dark blind brain tumors sbi |
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jet lag syndrom
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circadian disorder
no synchrondy |
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shift work sleep disorder
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cicadian disorder
might achieve rm sleep but wont stay in it long |
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how to manage shift worker syndrome
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control the environment you sleep in
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delayed sleep phase cycle
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circadian disorder
inability to go to bed at night but cant wake up in the morning |
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advanced sleep phase syndrome
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circadian disorder
cant keep awake at 7pm but wake up at 3am |
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insomnias
dx |
sleep diary
environment chem/meds actigraphy polysomnography |
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insomnia
interventions |
treat cause
psychotherapy meds |
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night terrors
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nightmares with children
happens first part of the night |
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elderly pt loose _____
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rem sleep and all kinds of things cause it
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what percent of sleep is stage one?
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5%
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what percent of sleep is stage two?
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50%
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sleep stage two
eeg/wakeability |
eeg spikes
easy to wake them |
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what percent is stage 3 of sleep
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10-20%
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what percent is REM sleep?
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1/4th
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how long do most benzodiazapine last
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about 4 hours
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what is the first choice of drugs for sleep issues
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benzodiazepines
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talk about benzodiazepines and tolerance
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occurs after 2 weeks
may cause rebound insomnia |
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non benzo hypnotics
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zolpidem
zaleplon eszopiclone ramelteon |
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triazolam
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drug for sleep
rapid onset short duration |
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zaleplon
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drug good for middle of night waking as duration is short
no am drowsiness |
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ramelteon
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melatonin agonist
rapid onset short duration |
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trazodone
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sedating antidepressant
good for pt using stimulating antidepressant meds AE: hypotension, impotence |
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antihistamines AE
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tolerance
am drowsiness |
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narcolepsy definition
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abnormal sleep issues related to neurotransmitters in the hypothalamus
hypocretin 1 and hypocretin 2 |
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narcolepsy s/s
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daytime sleepiness
disturbed nocturnal sleep muscle weakness hallucinations sleep paralysis |
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how to dx narcolepsy
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sleep lab studies
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narcolepsy interventions
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stimulats:
methylphenidate methamphetamine modafini TCAs environmental controls |
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movement disorders define
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occur in non rem sleep and are disruptive
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two types of movement related sleep disorders
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periodic limb movement disorder
relsteless leg syndrome |
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PLMD
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periodic limb movement disorder
repetitive movment of big two with flexion of ankle, knee, hip unknown etiology |
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RLS
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urgency to move limbs w/ or w/out sensation
etiology: genetics, spinal cord lesions, meds, iron defic meds: levadopa, dopamine agonists, antiseizure meds, benzos, opiods |
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sleep apnea s/s
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snoring
insomnia morning headaches excessive sleepiness polycythemia sexual disfuction congitive changes systemic htn |
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how is polycythemia r/t sleep apnea
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polycythemia is over production of RBC
sleep apnea causes chronic low levels of oxygen, body responds with more RBC could cause clots |
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how to dx sleep apnea
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sleep studies and history
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interventions for sleep apnea
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weight loss
med change dental appliance cpap bipap ncpap |
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difference between cpap/bipap
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continuous positive airway pressure to blow past obstruction
bipap has two settings, and works on ventilation |
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nightmares define
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dreams that activate the sympathetic nervous system
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when do night terrors and sleep walking happen?
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stage two
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parasomnia interventions
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control sleep environment
meds benzos -diazepam -clonazepam TCA |
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sleep disorders in children
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sleep terror
confusional arousal sleep walking |
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discuss sleep terrors
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happens in first half of night sleep
effect 2-4yr they cant tell you they had a bad dream their eyes are open sympathetic nervous system activated |
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how to treat kids and sleep disorders
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make sure they get their naps
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