Meds For Mental Health Nursing

Front 1

Symptoms of hypertensive crisis

Back 1

severe chest pain, headache, confusion, blurred vision, n/v, anxiety, SOA, seizures, change in LOC

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Clinical presentation of agranulocytosis

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fever, sore throat, malaise, granulocyte (neutro/baso/eosinophil) concentration < 100/cc in blood

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Extrapyramidal symptoms (EPS)

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muscle rigidity/contractions, tremor, twitching, restlessness, involuntary facial movements

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Presentation of oculogyric crisis

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initial: restlessness, agitation, malaise, fixed stare
later: extreme/sustained deviation of the eyes' positions
associated: back/later neck flexion, wide mouth, tongue protrusion, ocular pain

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Treatment of oculogyric crisis

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IV antimuscarinic benztropine or procyclidine (usually effective in 5-30 min), d/c causative med/agent; 25 mg diphenhydramine

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Causes of tardive dyskinesia

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Side effect of long-term use of neuroleptic drugs characterized by repetitive, involuntary, purposeless movements

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Signs/Symptoms of tardive dyskinesia

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grimacing, tongue protrusion, lip smacking, puckering, pursed lips, rapid blinking, rapid/involuntary movements of trunk/extremities/phalanges may also occur

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Treatment of tardive dyskinesia

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Tetrabenazine (only approved drug tx), reduction of neuroloptic drug use, benzo/clozapine/BoTox injections

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Signs of neuroleptic malignant syndrom (NMS)

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SE of neuroleptic/antipsychotic drugs: sudden high fever, blood pressure fluctuation, dysrhythmia, rigidity, change in LOC

Front 10

FALTER

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for NMS
F - fever
A - autonomic instability
L - leukocytosis
T - tremor
E - elevated enzymes (CPK)
R - rigidity

Front 11

Treatment for NMS

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stop antipsychotic med, monitor VS, apply cooling blanket, antipyretic, increase fluids, valium for anxiety, dantrium for muscle relaxation, postpone therapy for 2 weeks, switch to atypical agent

Front 12

Anticholinergic SE

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result from ACH antagonism; dry mouth, blurred vision, constipation, urinary retention, dizziness

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Patient teaching about minimizing anticholinergic SE

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avoid driving and hazardous activities, wear sunglasses, urinate before taking, exercise

Front 14

Dietary considerations for acticholinergic SE pt. ed.

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chew sugarless gum, eat high fiber foods, increase fluids (2-3L/day)

Front 15

Parkinsonian symptoms

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usu. caused by both types of antipsychotics, sometimes lithium
tremor, slow, movement, disturbed balance/walking, stiffness, soft voice, decrease facial expressions

Front 16

Treatment of drug-induced Parksonism

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taper medication (if possible), adjust dosage, switch to different med

Front 17

Orthostatic hypotension pt. ed.

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-stand up slowly to avoid feeling faint
-take deep breaths and flex abdomen while rising
-"dangle" at side of bed before rising to avoid dizziness
-elevate salt intake (if possible)
-maintain proper fluid intake
-eat smaller, more frequent meals
-avoid crossing legs when sitting

Front 18

Photosensitivity pt. ed.

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avoid sun exposure, wear protective clothing, apply SPF 30 to all exposed areas, avoid tanning beds
apply cool/damp cloth to rash, OTC/Rx antihistamine

Front 19

Classes which cause CNS depression

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barbiturates
anxiolytics
sedative-hypnotics
opioid narcotics

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SE of CNS depressants

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morning "hangover," blurred vision, transient orthostatic hypotension, impaired coordination, lethargy

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CNS depression pt. ed.

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take at same time every EVENING
avoid late, heavy meals
limit caffeine/alcohol
control sleep environment
reduce stress
avoid driving

Front 22

Meds that have high risk of dependency (classes)

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Benzodiazepene
SSRI
MAO-I
Stimulants

Front 23

Importance of tapering high-dependency drugs

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reducing withdrawal effects, reducing length of withdrawal, manimizing future dependency

Front 24

Serotonin syndrom

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usu. occurs 2-72 hours after starting therapeutic regimen; can be lethal; results from excess serotonin

Front 25

Signs/symptoms of serotonin syndrome

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agitation, restlessness, confusion, increased HR and BP, pupil dilation, muscle twitching, diaphoresis, diarrhea, headache, shivering, goosebumps

Front 26

Signs/symptoms of SEVERE serotonin syndrome

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High fever
Seizures
Dysrhythmia
Unconsiousness

Front 27

High potency vs Low potency drugs

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high potency drugs (morphine, alprazolam, chlorpromazine) evoke larger systemic responses at lower doses. Low potency drugs (ibuprofen, ASA) evoke small systemic responses at similar concentrations

Front 28

Role of Acetylcholine

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Peripheral NS: muscle excitation, autonomic nervous system NT
Central NS: sensory perception upon arousal from sleep, sustaining attention

Front 29

Role of Norepinephrine

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vasoconstriction, increased HR/BP/blood glucose

Front 30

Role of Serotonin

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mood, appetite, sleep, some memory/learning effects

Front 31

Role of Gamma-Aminobutiric Acid (GABA)

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regulare neuronal excitability

Front 32

Role of Dopamine

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behavior, cognition, voluntary movement, motivation, punishment/reward, sleep, mood, attention, working memory, and learning

Front 33

Tolerance

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lower therapeutic effects at same drug concentration

Front 34

Priapism

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erect penis/clitoris does not return to flaccid state despite absence of physical/psychological stimulation after 4 hours

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Retrograde ejaculation

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entry of semen into bladder instead of going out through urethra during ejaculation

Front 36

Amenorrhea

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absence of menstrual period in woman of reproductive age

Front 37

Akinesia

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absence of diminuation of voluntary motion, usu. accomp. by parallel reduction in mental activity

Front 38

Akathisia

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regualr rhythmic movements, usu. of lower limbs; constant pacing; SE of antipsychotic drug

Front 39

Dystonia

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abnormal muscle tonicity resulting in impaired voluntary movement; SE of neuroleptic meds (spasms of head/neck/face/back)

Front 40

Lag time

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time between administering drug/treatment and the manifestation of a response/result

Front 41

Blood dyscrasias

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diseased blood; presence of permanent abnormal cellular elements; abnormal structure, function, or quantity of blood componenets (leukemia, hemophilia, etc.)

Front 42

Neurotransmitter

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chemical that functions as neural messenger; released from axon terminal of presynaptic neuron when stimulated by electrical impulse

Front 43

Reuptake

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return of neurotransmitters to the presynaptic cell after communication with receptors of postsynaptic cell

Front 44

Seizure threshold

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amount of stimulus necessary to produce convulsions; present in all humans if provocation is sufficient

Front 45

Neuron

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specialized cell of the CNS; has body, axon, and dendrites

Front 46

Synapse

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gap between neurons; point at which nerve impulse transmission occurs

Front 47

Receptor site

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location on cell surface where certain molecules attach to interact with cellular components

Front 48

Antagonist

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substance that binds to receptor site without eliciting biological response and blocking other substances from binding/eliciting responses

Front 49

Agonist

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stimulates physiologic activity at receptor site; binds and elicits receptor response

Front 50

Ataxia

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failure of muscular coordination; irregularity of muscle action

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Reasons for which antipsychotics are prescribed

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treatment for symptoms of schizophrenia, schizoaffective disorder, bipolar disorder

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Alternative names for antipsychotic category

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Dopamine Receptor Agonist (DRA)
Neuroleptic

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Positive symptoms of schizophrenia

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additive; delusions, disordered thoughts/speech, hallucinations (auditory, visual, tactile, olfactory, gustatory); generally respond well to a/typical antipsychotics

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Negative symptoms of schizophrenia

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deficiency; flat/blunted affect, little/no emotional responsiveness, alogia, anhedonia, asociality, avolition; contribute to poor quality of life, functional disability, limited med response: more responsive to atypical antipsychotics

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SE of typical antipsychotics

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acute dystonia, parkinsonism, akathisia, tardive dyskinesia, NMS, anticholinergic SE, orthostatic hypotension, sedation, neuroendocrine effects, seizures, sexual dysfunction, skin pathology, agranulocytosis

Front 56

Neuroendocrine effects

Back 56

gynecomastia, galactorrhea, amenorrhea; monitor and notify provider

Front 57

SE of atypical antipsychotics

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new onset DM, anticholinergic SE, weight gain, hypercholesterolemia, ortho. hypotension, agitation, dizziness, sedation, sleep disruption, EPS

Front 58

How are antipsychotic drugs given to non-compliant clients? Why?

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IM Risperdone q 2-4 weeks: lower incidence of ADR, pt. doesn't have to take pill every day

Front 59

Typical antipsychotic effects on NTs

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block dopamine, ACh, histamine, norepinephrine receptors in CNS and PNS

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Atypical antipsychotic effects on NTs

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block serotonin, dopamine (to a lesser degree), and norepinephrine, histamine, and ACh

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Reasons for non-compliance with antipsychotic drugs

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med expense, ADRs, pregnancy, low insight, confusion, paranoia, fear of addiction, don't want to avoid alcohol

Front 62

Clozapine (Clozaril)

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atypical antipsychotic; block serotonin/dopamine receptors; expected SE; agranulocytosis

Front 63

Clozaril: common, dangerous SE and secondary prevention measure

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Agranulocytosis: weekly CBC for 6 mos, every other week for 2 yrs; WBC should be approx 3500, ANC > 2000

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Typical antipsychotic contraindications

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comatose, severe depression, Parkinson's disease, severe hypotension, dementia

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Atypical antipsychotic contraindications

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demential related psychosis, pregnancy (category C)

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Haloperidol (Haldol)

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typical antipsychotic; block dopamine receptors, EPS, anticholinergic SE; may cause seizures, NMS, agranulocytosis

Front 67

Antipsychotic that doesn't cause weight gain

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Aripiprazole (Abilify)

Front 68

Typical vs Atypical

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atypical has decreased SE, relieves neg as well as positive, less relapses, decreased affective symptoms and lowered suicidal behaviors

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Risperidone (Risperdal)

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Atypical antipsychotic; decreased symptoms of psychosis, bipolar mania, or autism; agranulocytosis, NMS, suicidal thoughts

Front 70

Why antiparkinsonian drugs are given congruently with antipsychotics

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drug serum level control; minimize EPS by trying to restore balance betw ACh and dopamine

Front 71

When you should give prn benztropine (Cogentin)

Back 71

pt. presents with dystonia, tremors, bradykinesia, rigidity, drooling, shuffling gait

Front 72

SE of diphenhydramine and benztropine

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GI upset, sedation, orthostatic, and anticholinergic; follow antipsychotic interventions

Front 73

Lithium carbonate

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Traditional Rx for mgmt/prev. of manic bipolar episodes, may stabilizes electrical activity, blocks serotonin

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% of bipolar clients helped by lithium carbonate

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60-80% or acute manic and hypomanic episodes within 10-21 days.

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Why would an antipsychotic ge given durin Lithium lag period?

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Control symptoms of mania while lithium reaches therapeutic levels.

Front 76

Relationship of lithium and salts

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Lithium similarly structure to Na and K, positive ion, SE of polyuria and edema. Risk of kidney/thyroid disease

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Lag period for lithium

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7-14 days

Front 78

Factors which raise lithium levels

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diuretics: decrease fluid increases Li concentration
NSAIDs: increased renal absorption
Renal disease: decreased excretion
Diarrhea/vomiting: low fluid
Sodium depletion

Front 79

Factors which lower lithium levels

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sodium bicarbonate, caffeine, theophylline, mannitol

Front 80

Side effects of lithium

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GI upset, fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiter, hypothyroidism, dysrhythmia, hypotension, electrolyte imbalance

Front 81

Signs of lithium toxicity

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diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, slurred speech, confusion, tremors, tinnitus, ataxia, seizures, coma

Front 82

Therapeutic serum level of lithium

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acute mania: 0.8-1.4 meq/L
maintenance: 0.4-1.3 meq/L

Front 83

How often lithium levels should be monitored

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every 2-3 days until stable, then every 1-3 mos

Front 84

Why lithium is dangerous

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potentially deady toxic effects and long-term thyroid and renal degradation

Front 85

Nursing action if lithium level is 1.7 meq/:

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instruc pt. to d/c med and notify provider, increase fluids

Front 86

Contraindications for Li therapy

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pregnancy (category D), breastfeeding, renal dysfunction, heart disease, sodium depletion, dehydration, < 12 yo

Front 87

Why clients are non-compliant

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weight gain
fear of toxicity

Front 88

Therapeutic range and SE of Carbamazepine (Tegretol)

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4-12 mcg/mL; nystagmus, double vision, vertigo, staggering gait, headache, blood dyscrasias, teratogenesis, hypo-osmolarity, dermatitis/rash

Front 89

Toxic symptoms of Carbamazepine (Tegretol)

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excessive drowsiness, staggering, slurred speech, vomiting

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Contraindications of Carbamazepine (Tegretol)

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pregnancy (category D), antibiotics, increased pepsin

Front 91

Therapeutic range and SE of Valporic Acid (Depakote)

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50-100mcg/mL, 125 in mania; GI upset, hepatotoxicity, anorexia, fatigue, pancreatitis, thrombocytopenia, teratogenesis

Front 92

Toxic symptoms of Valporic Acid (Depakote)

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nausea/vomiting followed by decreased LOC and confusion

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Contraindications of Valporic Acid (Depakote)

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pregnancy (category D), urea cycle disorders, hyperammonemic encephalopaty

Front 94

Lethal side effect of iamotrigine (Lamectal)

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life-threatening

Front 95

Selective Serotonin Reuptake Inhibitor

Back 95

Paxil (Paroxetine), Fluoxetine (Prozac), Fluvoxamine (Luvox), Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Celexa).