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50 Cards in this Set
- Front
- Back
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Extrapyramidal side effects
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-D2 receptor blockade in brain stem
-risk higher in conventional meds -dystonia= rigidity/cramping, stiff/thick tongue, dysphagia, laryngospasms, respiratory difficulty TX= IM Cogentin (anticholinergic) or IM/IV Benadryl -psuedoparkinsonism/EPS= stiff stooped posture, mask-like facies, decreased arm swing, shuffling gait, cogwheel rigidity, droolong, tremor, bradycardia, pill-rolling movements TX= PO anticholinergic or amantadine -akathisia=intense need to move TX=PO anticholinergic, beta-blocker, or benzodiazepine |
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Geodon
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-atypical antipsychotic
-rarely causes EPS -contraindicated in pt with a known history of QT prolongation, recent MI, or uncompensated heart failure -not used with other QT prolonging drugs |
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Neuroleptic Malignant Syndrome
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-potentially fatal reaction to an antipsychotic or neuroleptic drug
-rigidity, high fever, autonomic instability (BP/ diaphoresis/ pallor), delerium, elevated levels of enzymes (esp creatine phosphokinase) -usually confused and mute -may go from agitation to stupor TX= STOP ALL ANTIPSYCHOTICS |
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Tardive Dyskinesia
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-syndrome of permanent involuntary movements
-often d/t long term use of atypical antipsychotics -tongue thrusting, lip smacking, blinking, etc -higher doses may mask effects -assess for development |
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Antipsychotic drugs
- common side effects -take missed dose if less than 4 hours have passed |
-NMS
-EPS -elevated prolactin (breast size) -decreased libido -erectile/orgasmic dysfunction -irregular periods -weight gain -increased risk of breast cancer -dry mouth -constipation -PHOTOSENSITIVITY -minor cardio effects: postural hypotension palpitations tachycardia |
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Clozapine
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-atypical antipsychotic
-fewer side effects but..... -potentially fatal side effect of agranulocytosis= acute fever, maliase, ulcerative sore throat, leukopenia up to 24 wks after start -weekly WBC count above 3,500 per mm3 and absolute neutrophil count above 2,00 for 6 months -labs also checked q weekly for 4 weeks if drug is stopped |
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Droperidol
Thioridazine Mesoridazine |
-may lengthen QT interval may lead to fatal dysrythmia or cardiac arrest
-torsade de pointes= heart rate of 150-250 bpm resulting in "twisted" ECG -QT interval longer than 500 ms is BAD |
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Anticholonergic side effects
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-often occur with 1st use of antipsychotics and include
-orthostatic hypotension -dry mouth -constipation -urinary hesitance or retention -blurred near vision -dry eyes -photophobia -decreased memory -nasal congestion -often go away in 4 weeks or so |
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MAOIs
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Phenelzine (Nardil)
Tranylcypromine (Parnate) Isocarboxazid (Marplan) -low sedation and anticholinergic -lots of DRUG INTERACTIONS -FATAL IN OVER DOSE -TYRAMINE FOODS -AVOID -all cheese but cottage/ricotta/cream/fake slices -aged meats -fava beans -tofu or soy -banana peel -overripe fruit -avocado -all tap and microbrewed beers -sauerkraut -marmite or Brewer's yeast -yogurt or sour cream -peanuts -MSG |
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Antidepressents for suicide risk pt
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-SSRIs
-venlafaxine, nefazodone,bupropion =NO RISK of Over Dose -SSRIs = increased suicide risk in children and adolescents -SSRIs=only effective for mild to moderate depression |
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SSRI side effects
-take in the AM -take missed dose w/in 8 hours |
-fewer than the cyclics
-anxiety -agitation -akathisia -nausea -insomnia -sexual dysfunction -weight gain |
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Nefazodone (Serzone)
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-novel antidepressant
-rare/possibly fatal liver damage -headache -dry mouth -nausea |
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Bupropion (Wellbutrin)
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-novel antidepressant
-SEIZURE RISK x4 dose more than 450mg/day sudden or large increase hx of seizures/cranial trauma xs use or withdrawal of alcohol addiction to opiates or stims diabetes medications |
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Serotonin Syndrome/ OD
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-agitation
-sweating -fever -tachycardia -hypotension -rigidity -hypoflexia -coma and death |
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Cyclic antidepressants
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-take up to 3 weeks to work
-take in the PM -take missed dose w/in 3 hours |
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Lithium
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-mood stabilizer
- levels 0.5 and 1.5mEq/L -1st line for bipolar disorder -monitored q 2-3 days at start -then weekly then less -side effects -nausea or diarrhea -fine hand tremor -polydipsia and polyuria -metallic taste in the mouth -lethargy or fatigue -weight gain -toxic effects -severe diarrhea and vomiting -drowsiess -muscle weakness -lack of coordination -renal failure, coma, DEATH -dialysis if over 3.0mEq/L |
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Valporic acid (Depakote)
-side effects |
-heaptic failure
-liver function tests for 6 months -teratogenic effects-neural tube -pancreatitis -alopecia -weight gain -hand tremor |
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Lamotrigine
-side effects |
-mood stabilizer
-serious rashes -Stevens-Johnson syndrome -toxic epidermal necrolysis -risk for rashes greater under 16yrs |
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Carbamazepine
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-mood stabilizer
-aplastic anemia -agranulocytosis -look for low WBCs or platlets |
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Buspirone
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-benzo that does not cause physical dependence
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Disulfiram
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-Antabuse
-avoid alcohol of course -interferes w/dilantin, coumadin, barbs, and long acting benzos -given 12+ hours after alcohol |
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Acamprosate (Campral)
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-sometimes used for alcohol withdrawal and dependence
-reduces discomfort -contraindicated in renal impaired |
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Isolation
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separating unacceptable feeling from one's thoughts. Ex caring for a terminally ill and focusing on Tx and not outcome
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Sublimation
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re-channeling unacceptable impulses into activities that are socially acceptable. Ex: a kid who is always fighting joins the wrestling team
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Repression
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'burying alive'. unable to recall painful or unpleasant thoughts. Ex.: person who had a serious accident is unable to recall the accident
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Identification
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The 'imitator', Ex: to dress, act, and talk like someone else
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intellectualization
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Txfr emotional concerns into intellectual shpere.
Ex: using reasoning & logic to make sense of an emotional decision. |
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Regression
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retreating to past levels of behaviors that reduce anxiety.
Ex: a 5 y/o starts wetting his pant because of his father hospitalization |
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Displacement
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To transfer feeling such as frustration, hostility, anxiety, from one idea/person to another that is less threatening.
Ex: slamming door when angry or yelling a 1 person when actually mad at another. |
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Denial
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Unconscious refusal to face thoughts, feelings, needs or reality by refusing to acknowledge it's existance.
Ex: someone who is termanilly ill denies the Dx, and tells family its 'only a small tumor' and the Dr took it out. |
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Introjection
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Attributing to oneself the good qualities of another
Ex: claiming to be Jesus and refusing to participate until called by that name |
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Compensation
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The act of 'making up', by overcoming an inability by becoming proficient in another.
Ex: short girl cant play basketball, so becomes the team manager |
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Projection
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'scape-goat'
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Rationalization
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unconsiously justify ideas, actions, or feelings with good reasons, explanations.
Ex: girl not asked to prom to the prom say it was because the boy felt sorry for another girl & asked her instead |
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Reaction Formation
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Over compensation, exaggeration to prevent painful or unacceptable attitudes towards others.
Ex: man who dislikes in law act very polit and loving towards her |
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Undoing
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The negation of a consciously intolerable action to reduce feeling of guilt.
Ex: sending flowers to someone after embarrasing them at a party. |
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Suppression
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Putting unacceptable thoughts/feelings out of one's mind with the ability to recall it at will.
Ex: lets talk about it later or i dont want to talk about it right now |
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Bipolar Disorder
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Manic Phase
-decrease stimuli -provide safe environment -set limits -monitor drug levels Depressive Phase -safe environment -assess drug compliance -suicide risk |
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OCD
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-allow time for rituals
-encourage pt to ID stress/feelings |
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Alzheimer's Stages
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Stage 1-mild
-confusion and memory loss -disorientation -problems with sleep -hard to perform tasks -changes in personality Stage 2-moderate -hard to perform ADLs -suspiciousness -agitation -wandering and/or pacing -repetitive behaviors -may not recognize family Stage 3-severe symptoms -loss of speech -anorexia -weight loss -incontinence -total dependence TX=Cognex/Aricept/Exelon/Razadyne -roll with the confusion -provide for safety |
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Antisocial Personality Disorder
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-don't care about others
-lack empathy -destructive tendency -may abuse animals/people -LOVE THEMSELVES -are MANIPULATIVE -more often MEN -set limits -do not bargain or rationalize -praise truth -help them express anger verbally |
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Borderline Personality Disorder
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-SELF MUTILATION
-not able to from a sense of self -cannot maintain relationships -moody -dissociation -also MANIPULATIVE |
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Dependent Personality Disorder
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-clingy and demanding
-fear/ anxiety over losing people -hypersensitive -LOW SELF ESTEEM -also manipulative -assertiveness training -decision making activities |
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Schizophrenia
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-must have symptoms 6+ months
-more common in Asians/AA -TOO MUCH DOPAMINE Positive Symptoms -distortion of normal function Negative symptoms -focus on loss of normal function -auditory hallucinations most common= see if they are command -MRI=enlarged ventricles/sulci, cortical atrophy, decreased cerebral blood flow |
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Schizophrenic pt care
-SDS |
S-structure
D-diversion S-stress relief |
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Malingering
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medically unproven symptom that is caused by the persons thoughts
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Alcohol Disorder
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-CAGE or Michigan Alcohol Screen
-Korsakoff's syndrome -Benzos and Disulfiram -Naltrexone (Revia) -relapse -SSRIs |
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Cocaine Abuse -meds
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bromocriptine(Parlodel)-dopamine
-Benzos/SSRIs/propranolol |
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CAGE questionnaire
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have u ever felt the need to CUT down
-have people ANNOYED u by criticizing your drinking -have you ever felt GUILT -have you ever had an EYE-OPENER (hair of the dog) |
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Opiate abuse-meds
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-Clonidine (Catapres)-withdrawal
-Methadone-addiction -Levo-alpha-acetylmethadol-H -Buprenorphine (Suleoxone) |
