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188 Cards in this Set

  • Front
  • Back
What is psychosis?
break from reality
What are the 5 types of schizophrenia?
Etiologic theories of Schizophrenia?
-Genetic:vulnerability,not 100% genetic
-neurobiological:neurochemical receptors;diff drugs affect
-socio-cultural:have not proven to be true
-other theories:virus;nutrition
What is catatonic schizophrenia characterized by?
-non mvmt(motor immobility)
-or excessive motor activity
-extreme negativism
-peculiar mvmts:waxy flexibility
-echoalia or echopraxia
What is waxy flexibility?
person's body part stays in exact position you placed it
What is echolalia?
repetition of words
What is echopraxia?
repeated movements
What is paranoid schizophrenia characterized by?
What type of delusions characterize schizophrenia?
-organized around a theme
What is disorganized schizophrenia char. by?
-fragmented delusions or hallucinations
-disorganized behavior
*odd behaviors(mannerisms)
*extreme social withdrawal
-disorganzied speech
-flat,inappropriate, or silly affect
What is undifferentiated schizophrenia characterized by?
-psychotic symptoms
-mixed schizophrenic symptoms
What is residual schizophrenia characterized by?
-absence of prominent delusions/hallucinations
emotional blunting
social withdrawal
eccentric behavior
illogical thinking
loose associations
Affect characteristics of schizophrenia?
-blunt affect:reduced expression
-flat affect:emotional impoverishment
-inappropriate affect:incongruence bw emotions & situation
-ambivalent affect:opposite emotions toward the same person or situation
Other categories of characteristic r/t Schizophrenia?
4 extra pyramidal effects of antipsychotics?
-dystonic rxns:muscle spasms
-neuroleptic malignant syndrome:illness czed by these drugs:fever,rigid muscles
What is tardive dyskinesia?
-side effect of antipsychotic drugs
mvmts of the tongue,mouth,face & jaw
chewing mvmts
involuntary mvmts of the extremities
3 general side effects of antipsychotic drugs?
-weight gain
-interference w/ sexual function
Anticholinergic effects of antipsychotic drugs?
-dry mouth
-urinary retention
-blurry vision
-memory difficulties
Advantages of the Conventional antipsychotic drugs?
-well known;proven effective for pos. symptoms
-cz less weight gain & diabetes than novel drugs
-some can be inj for gradual absorption(long lasting effects)
2 antpsychotic meds that can be injected for gradual absorption?
-Haldol Decanoate
-Prolixin Decanoate
*IM every 2-6 wks
-slow release,oil based
Side effects of conventional antipsychotic meds?
-dry mouth
-blurred vision
-mvmt disorders(some have high incidence)
-little effect in neg. symptoms
What is generalized anxiety disorder(GAD)?
-persistent anxiety w/o phobias or panic attacks
-chronic disorder
When does GAD usually begin?
in childhood or adolescence
What is GAD triggered by?
by stress or nothing
What may GAD sufferers be preoccupied w/?
-may be preoccupied w/ catastrophic thoughts or visions
-sufferers worry excessively about everyday concerns
Symptoms of GAD?
-muscular tension
-difficulty concentrating
-sleep disturbance
To be dxed w/ GAD must have:
-excessive worry & anxiety occur more days than not for at least 6 mo.
-worry czs clinically significant distress,impairment in social,occupational,or other important areas of functioning
What is a panic attack?
highest level of anxiety
What is a panic attack characterized by?
-disorganized thinking
-feelings or terror or helplessness
-nonpurposeful behavior
How do ppl feel during a panic attack?
feel as if about to die,lose control, or "go crazy"
What are panic attacks usually associated w/?
-public speaking
-interpersonal conflict
-situations of high stress
When does panic disorder usually develop?
bw ages 15-24.
-affects > 1.5 million Americans
-1/3 - 1/2 also have agoraphobia
What is agoraphobia?
fear of being away 4m home and alone in public places where assistance may be needed
General Panic disorder Info?
-onset sudden & unexpected
-no specific stimulus
-intense symptoms last a few min to an hr
-involve intense fear & premonition of doom
-normal functioning suspended
Symptoms in panic disorder?
-perceptual field limited
-misinterpretation of reality
-choking sensation,palpitation
-numbness,fear of dying,fear of going crazy
What may panic disorder include?
phobic avoidance,depression,obsessions
Nocturnal panic conc. panic disorder?
-awakens person,usually w/in 1 hr of falling asleep:possibly r/t sleep apnea
Mgmt of panic disorder?
-Cognitive Behavioral Therapy
 pt told to reinterpret symptoms more realistically, learn that they are harmless
breathe into paper bag to incr CO2, decr SOB
Nursing Intervention r/t Panic Disorder?
-teach about panic attacks
-may give benzos
-teach about effects of caffeine,chocolate:could make it worse
-encourage tx
-recognize suicide risk:high suicide rate
Common features of phobic disorders?
-unreasonable behavioral response
-persistent fears
-avoidance behaviors
-disabling behavior
What is specific phobia?
-fear of only 1 object or situation
-can arise after single unpleasant experience
-common phobias:
closed spaces
What is social phobia?
-fear of most social situations
-affects 1 out of 8 ppl
-fear of humiliation or embarrassment
-victims become sick w/ fear
-ex:meeting new ppl,public bathrooms,etc.
What does person w/ agoraphobia avoid?
avoids groups of ppl
may also avoid places where they might be trapped
What is agoraphobia often triggered by?
severe stress
2 peak times of onset for agoraphobia?
15-20 yrs old
30-40 yrs old
Behavioral char. of phobic disorders?
-avoidance of object,situation
-dependent:on other ppl,
Affective char. of phobic disorders?
-fear of object
-fear of exposure
-fear of abandonment during phobic episode
Cognitive char. of phobic disorders?
-ego-dystonic:unable to rid themselves of fear although they know it is unreasonable
-consumed w/ anticipatory anxiety
-neg. expectations
-low self-esteem("failures")
-believe they need support from others
-become dependent
-may believe they are mentally ill
Social char of phobic disorders?
-severe impact on family system
-cannot leave home to work or attend family functions
-control family thru dependency & helplessness
-achieve secondary gains 4m illness
relinquish responsibility
dependency needs satisfied
power to control others
Medical mgmt of phobic disorders?
-cognitive therapy
-systematic desensitization(exposure to object or situation)
Define obsessions r/t OCD?
unwanted,repetitive thoughts,ideas,impulses or images that lead to feelings of fear,anxiety or guilt.
thoughts of violence(killing someone)
Define compulsions r/t OCD?
behaviors or thought used to decrease the fear or guilt assoc w/ obsessions
repetitive behavior performed in a particular order(hand-washing,cleaning,counting,checking,touching,hoarding)
stereotyped way
# of times
performing reduces anxiety
Req. to be dxed w/ OCD?
when obsessive-compulsive thoughts & behaviors dominate a person's life
-interference w/ life,slight to incapacitating
-usually has a lifelong course
Behavioral char. of OCD?
-abnormal doubts
-compulsion to check(alarm clock,iron)
-consuming behavior-sometimes bizarre
-behavior is forced 4m within,uncontrollable
Diff. behavioral char r/t OCD for men and women?
females:compulsive cleaning
males:compulsive checking
Affective char. of OCD?
-shame about irrational behavior
-control relieves anxiety
-feel that something terrible will happen if they don't act on compulsion
-often hopeless about improvement
-may develop phobias
Cognitive char. of OCD?
-recognize senselessness of behavior
-drive is overpowering
-feel distress about actions
-preoccupation w/ dirt,safety,violence,sexual, or blasphemous thoughts
-may include magical thinking,false beliefs,superstitions,or religious ideation
-consumed w/ doubts
Social char of OCD?
-alters lives of client & fam
-symptoms all-encompassing
-relationships strained/destroyed
-kids involve parents/siblings in rituals
Goal conc OCD?
work,play,maintain relationships
Mgmt. of OCD?
-reveal prob
-educate about disorder
-behavioral therapy
exposed to progressive degrees pf stressor
asked to respond w/ delayed or modified behavior
goal directed responses
Nursing Interventions for OCD?
-teach about meds
-should take in evening if drugs cz drowsiness
-should safeguard skin
-refer to local support groups:OCD foundation
-dont't interrupt,change schedule
What is posttraumatic stress disorder(PTSD)?
a set of maladaptive responses to an actual(real) event that has been overwhelmingly distressing
Experiences which trigger PTSD are...
outside range of usual human experience & beyond the control of the individual
-person reacts w/intense fear,terror helplessness
About PTSD symptoms?
-symptoms usually appear w/in first 3 mo. after trauma
-may be a delay of months or yrs
-sufferers are normal ppl who have experienced abnormal events
Ex of triggering experiences for PTSD?
-9-11,terrorist attacks
-fire(trapped & burned)
-catastrophic accidents
What are the 7 newer antipsychotics?
Trade name & adult dosage of aripiprazole?
trade name:Abilitat
adult dosage(mg/day):15-30
Trade name & adult dosage of clozapine?
trade name:Clozaril
adult dosage:300-900
Trade name & adult dosage of olanzapine?
trade name:Zyprexa
adult dosage:5-20
trade name & adult dosage of quetiapine?
trade name:Seroquel
adult dosage:150-750
Trade name & adult dosage for risperidone?
trade name:Risperdal
adult dose:4-16
trade name & adult dosage for sertindole?
trade name:Serlect
adult dosage:12-24
trade name & adult dosage for ziprasidone?
trade name:Geodon
adult dosage:40-160
trade name & adult dosage for acetophenazine?
trade name:Tindal
adult dosage:40-120
trade name & adult dosage for chlorpromazine?
trade name:Thorazine
adult dosage:30-800
trade name & adult dosage for fluphenazine?
trade name & adult dosage for mesoridazine?
trade name & adult dosage for perphenazine?
trade name & adult dosage for thioridazine?
trade name & adult dosage for trifluoperazine?
trade name & adult dosage of triflupromazine?
What are the 8 phenothiazines?
What are the 2 thioxanthenes?
trade name & adult dosage of chlorprothixene?
trade name & adult dosage of thiothixene?
What antipsychotic drug is in the class of butyrophenones?
What is the trade name & adult dosage of haloperidol?
What antipsychotic drug is in the class Dibenzoxazepine?
What is the trade name & adult dosage for loxapine?
What antipsychotic drug is in the class Dihydroindolone?
trade name & adult dosage for molindone?
What antipsychotic drug is in the class Diphenylbatylperidine?
trade name & adult dosage for pimozide?
Advantages of clozapine(Clozaril)?
-may be most effective;especially for neg symptoms & cognitive deficiencies
-doesn't cz mvmt disorders
-may lower the risk of drug & alcohol abuse
Side effects of clozapine(Clozaril)
-agranulocytosis(in at least 1% of pts)
-muscle weakness
-weight gain
-rapid w/dwl may lead to psychosis
Advantages of risperidone(Risperdal)
-outperforms conventional drugs
-no seizures or drooling
-mvmt disorders uncommon
Side effects of risperidone(Risperdal)?
-dry mouth
-rapid heartbeat
-some mvmt disorders at high doses
-weight gain
Advantages of olanzapine(Zyprexa)?
-outperforms conventional drugs
-overall low rate of side effects
-no seizures or drooling
-mvmt disorders uncommon
-can be injected for gradual absorption(up to 1 mo)
Side effects of olanzapine(Zyprexa)?
-dry mouth
-substantial weight gain
Advantages of quetiapine(Seroquel)?
similar to risperidone & olanzapine, but little risk of dry mouth or dizziness
Side effects of quetiapine(Seroquel)?
-substantial weight gain
-occasional mvmt disorders
-cataracts reported in animals given high doses
Advantages of ziprasidone(Geodon)?
-no mvmt disorders
-apparently little weight gain
-may be helpful for depression & anxiety
Side effects of ziprasidone(Geodon)?
-can slow electrical conduction through the heart
PTSD is characterized by?
-sudden severe loss of psychological integrity & cohesiveness
Characterized by:
re-experiencing the trauma
physiological symptoms of arousal
About re-experiencing r/t PTSD?
-intrusive thoughts,nightmares
if not present,dx of anxiety,depression, or adjustment disorder
-memories occur randomly
-obsessive thoughts about actions,lack of action
-fear of recurrence:not in person's control first time
About psychic numbing r/t PTSD?
-detached or separate 4m others
-unable to experience joy,enjoy pleasurable events
-rumination:go over & over
-aggression,fear of losing control
-unpredictable explosions of aggressive behavior
About persistent state of arousal r/t PTSD?
-exaggerated startle response
-difficult falling/staying asleep-may be assoc w/ recurring nightmares
-difficulty concentrating,completing tasks
Behavioral char. of PTSD?
-aggressive or bizzare behavior
-may behave as if event is recurring
-may resort to drugs or alcohol to decr anxiety
-react to triggers(anniversary,media)
Affective char. of PTSD?
-chronic tension
-labile affective responses
-anxiety:moderate to panic
-guilt over actions,survivor guilt
-numbing of other emotions
Cognitive char. of PTSD?
shattered sense of self
disrupted personality development
Tx for PTSD?
-integrating experience
-cognitive restructuring,learns to view behavior as reasonable & moral
-achieve new balance w/ self r/t past & present
-tx asap after event
Who is acute stress disorder experienced by?
ppl who witness or experience extreme traumatic stressor
When does acute stress disorder begin?
begins w/in a mo. of traumatic event,lasts at least 2 days, & goes away w/in 4 wks.
-If symptoms last > 4 wks, dx is PTSD.
What is dissociative disorder?
a disruption in the usually integrated functions of consciousness,memory, identity, & perception of the environment.
-physically but not mentally present
-ranges 4m daydreaming to failure to integrate thoughts,feelings, & actions
What is benzodiazepine used to tx?
What is the danger r/t using benzodiazepines to tx anxiety?
CNS depression ldg to decr. resp function & addiction and/or tolerance.
What happens when benzos taken w/ alcohol?
synergistic effect
What is buspirone(Buspar) used to tx?
General info about Buspar?
not addicting. But doesn't work rapidly, takes several weeks to take effect.
-Can use betablockers for physiological effects of anxiety such as incr RR,etc.
Cardiovascular effects that alcohol has on the body?
-direct damage to heart muscle
-czs cardiomyopathy,CHF
About blackouts as an effect of alcohol?
-early sign of alcoholism
-possibly r/t toxic effect of ETOH on glutamate transmission
What is Korsokoff's Syndrome?
*an effect of alcohol on the body(organic brain disorders)
-amnesia seen in chronic alcoholics
-short-term memory loss
-inability to learn new skills
-usually disoriented
What may a person w/ Korsokoff's syndrome present w/?
may present w/ delirium & hallucinations & confabulate to conceal condition
What is Korsokoff's syndrome czed by?
czed by degeneration of thalamus as a result of deficiency of B vitamins,especially thiamine & B12
What is Wernicke's encephalopathy?
*effect of alcohol on body
-inflammatory,hemorrhagic,degenerative cond of brain.
What is Wernicke's encephalopathy char by?
-lesions in several parts of brain:hypothalamus,mammillary bodies,tissues surrounding ventricles & aqueducts
Symptoms of Wernicke's encephalopathy?
-double vision
-involuntary & rapid eye mvmts
-lack of muscular coordination
-mild or severely decr mental function
What is Wernicke's encephalopathy czed by?
-thiamine deficiency
-seen w/ chronic alcoholism
-May coexist w/ Korsokoff's syndrome
General effects of alchohol on the body?
-peripheral neuropathies
-alcoholic dementia
-digestive system
-esophageal varices/rupture
-gastritis/ulcer/GI bleeding
-infl processes w/ malabsorption
-nutritional abnormalities
vit B deficiencies
magnesium & thiamine deficiencies
Effects of alcohol on the body after prolonged use?
-phsyical & psychological dependence
-physiological complications
Alcohol Intoxication?
slurred speech,incoordination,unsteady
gait,nystagmus,impairment in memory & attention,stupor
Alcohol Overdose?
-respiratory depression
Priority interventions for alcohol overdose?
-maintain airway/have resuscutation equip available
-monitor breathing pattern
-IV line patent
-bld alcohol levels(remember tolerance when interpreting results)
-assess & monitor LOC
-obtain history r/t abuse & recent intake(especially other drugs)
When does alcohol withdrawal syndrome(AWS) usually develop?
develops w/in hrs to a few days of last alcohol intake(usually 6-8 hrs)
S/S of alcohol withdrawal syndrome(AWS)?
-autonomic hyperactivity
increasing pulse rate & BP
-incr hand tremor
-auditory,visual,tactile hallucinations & illusions(alcohol withdrawal delirium-formerly DTs)
-psychomotor agitation
When does alcohol withdrawal delirium usually occur?
usually occurs on day 2 or 3 but may be as late as 14 days after last drink
S/S of alcohol withdrawal delirium?
-hypertension or hypotension
-extreme tremors
-death may result 4m cardiovascular collapse or hyperthermia
AWS nursing interventions?
-monitor VS
-alcohol w/dwl protocol
-maintain patent IV
-administer meds as ordered
-maintain calm environment
-avoid restraints,if possible
-stay w/ pt for safety & reassurance
-monitor & assess symptoms for worsening/improvement
-delerium or hallucinations should be reported immediately
What is the preferred drug to use in alcohol w/dwl?
What do benzos do conc AWS?
decr symptoms & prevent seizures
4 most common drugs used to decr & prevent symptoms in AWS?
-chlordiazepoxide(Librium):most common
What should be monitored when using benzos as a pharmacologic intervention for AWS?
BP & P
state of anxiety/agitation
-dosage determined by symptoms
-meds given as needed & titrated downward over 5 days
What are the adjuncts to benzos in alcohol w/dwl?
-carbamazepine(Tegretol)-reduces risk of seizures
-clonidine-reduce autonomic nervous system responses to w/dwl
-beta blockers:reduce autonomic nervous system responses & may reduce craving
-antipsychotic meds
Drugs used to maintain abstinence from alcohol?
-acetaldehyde if ETOH is ingested
-rxn occurs in 5-10 min & lasts 30 min to several hrs.
What will happen if alcohol is ingested while on disulfiram(Antabuse)?
czs very unpleasant effects.
-rxns occurs in 5-10 min & lasts 30 min to several hrs
Symptoms of alcohol/disulfiram rxn?
-copious vomiting
-chest pain
-blurred vision
Why can disulfiram be dangerous?
-marked resp. depression
-cardiovascular collapse
Gen Info about pt teaching r/t disulfiram(Antabuse)?
-Pts must be carefully chosem
-informed consent essential
-pt teaching very important
*must avoid products cont. alcohol
-cannot drink or use alcohol for 2 wks after stopping the drug
-should carry ID info conc their status
Types of things pt on disulfiram should avoid?
-sauces & other foods cooked w/ alcohol
-cologne,after shave lotion,liniments applied to the skin
-cough syrups & other OTC preps containing alcohol
What is Naltrexone(ReVia) used for?
-for alcholics
-decr cravings
-decr pleasurable effects
*Will precipitate w/dwl in someone who is dependent on opioids
-if a person taking this drug needs opioids, it will require a much higher dose
What does acamprosate(Campral) do for ppl addicted to alcohol?
-reduces unpleasant feelings brought on by abstinence
-tx should include psychosocial support
Other drugs used in the tx of alcohol abuse?
-B vitamins
☙folic acid
-fluid replacement
Name some common barbiturates that are abused.
[sedatives/hypnotics/antianxiety agents]
-tuinal(amobarbital & secobarbital)
Name some common benzodiazepines that are abused.
[sedatives/hypnotics/antianxiety agents]
Mode of administration for sedatives/hyponitcs/antianxiety agents?
-can be used IV
Site of action for sedatives/hypnotics/antianxiety agents?
-enhance action of GABA in limbic system
-may cz significant CNS depression
Effects of sedatives/hypnotics/antianxiety agents?
-sedated appearance
-lack of coordination
-labile emotions
-impaired attention
-working memory loss
Intoxication & overdose of sedatives/hypnotics/antianxiety agents?
-Same potential problems as alcohol
-synergistic(exaggerated) effect w/ other CNS depression
What are priority interventions for overdose of sedatives/hypnotics/antianxiety agents?
-manage airway
-monitor for respiratory depression/arrest
-support vital functions
-lavage/activated charcoal
-dialysis for drugs w/ longer half-lives & no antidotes
Antidotes for benzodiazepines?
☙reverses CNS depression
☙monitor for w/dwl symptoms
☙if symptoms occur,larger doses may be required bc of tolerance
Withdrawal of sedatives/hypnotics/antianxiety agents?
-symptoms same as alcohol
*Seizures can occur*
-can have delirium
-may use same drug or diff CNS depressant & taper off gradually
-monitor for same symptoms as in ETOH w/dwl
What is flunitrazapam(Rohypnol)?
[designer drugs]
"date rape" drug,sedative-hypnotic effect w/ muscle relaxatioin,blackouts,amnesia
What may Rohypnol cz?
-czs short-term memory loss
-may cz respiratory depression,aspiration or death
-may be addictive
-w/dwl seizures may occur
-klonopin(clonazepam) sold as "roofies"
What is GHB?
-clear liquid,odorless,tasteles
General GHB info?
-euphoric,sedative,& anabolic effects
-sometimes used by body builders & at gyms & fitness centers
-rapid acting CNS depressant
-occurs naturally in body
What can GHB use lead to?
can lead to unconsciousness,coma,seizures,or death esp. when combined w/ ETOH
-can cz breathing difficulties when used w/ alcohol and/or other depressants
-when combined w/ amphetamines,incr seizure risk
-may be w/dwl symptoms
Types of Opioids?
-Dilaudid(hydromorphone hcl)
-Demerol(meperidine hcl)
Mode of administration for opioids?
Site of action for opioids?
attach to same opiate receptors in brain as endorphins,enkephalins,dynorphins
Effects of opioids?
-brief,intense sensation-rush or thrill
-followed by longer-lsting high,calmness
-sedated appearance,motor retardation
-slurred speech,decr awareness
-impaired attention span
-reduction of instinctual drives
-depress respiration
-suppress coughs
-inhibit GI motility
-continued use decr prod of endorphin & enkephalin-results in low pain tolerance during w/dwl
Complications of opioid use?
-poisoning 4m heroin
-heroin more potent
-risk for hepatitis,HIV inf,AIDS
-liver probs
-malignant hypertension
-kidney failure
Symptoms of opioid overdose?
-clammy skin
-shallow respirations
-pinpoint pupils(may be dilated w/ hypoxia)
-death 4m respiratory depression or irreversible pulmonary edema
Drugs used to tx opioid overdose?
-Lasix for pulmonary edema
About Naloxone?
-an opioid antagonist
-reverses effects of opioid overdose
-usually has to be readmin bc of short half-life
-if too much given,pt may go into w/dwl
Name 3 drugs used to assist in w/dwl from opioids?
About methadone?
-modifies drug using behaviors
-very potent,long half-life
-will give for prevention of w/dwl or to replace heroin addiction
-prevents the reinforcing pleasurable effects of street drugs:so not as likely to seek out
-may also give to cancer pts for pain
-highly addicting
About buprenorphine(Subutex,Suboxone)
-used for w/dwl & maintenance of abstinence
-alleviates craving
-reduces use of illicit drugs
-low abuse potential
-safer than methadone
-can prevent opioid-induced euphoria
-w/dwl is milder
-given SL
-cannot be melted down to shoot bc then naloxone activated & will go in w/dwl
About naltrexone?
-an opioid antagonist
-prevents pleasurable effects of opioids
-pt must go thru w/dwl b4 taking this drug
-used for maintenance
-if take w/ opiates in body,will go thru w/dwl
-used for alcoholics to prevent craving
2 CNS stimulants?
Mode of admin for cocaine?
-smoking(brain delivery rate similar to IV)
-inhalation(addictive,czs erosion of nasal mm & may cz perforated septum)
Site of action for cocaine?
-CNS stimulant
-binds to DA transporters resulting in accumulation of DA
-intense feeling of euphoria
-research animals will self-administer,often overdose & die
Vasoconstriction complications of cocaine?
(sympathomimetic effects)
-severe hypertension
-elevated heart rate

*Seizures(CNS stimulation)
Gen. complications of cocaine use?
-decr glucose utilization i frontal cortex
-loss of sense of smell
-perforated nasal septum
-pulmonary damage
What is space-basing?
crack cocaine w/ PCP
*may lead to panic,terror,violent,uncontrollable behavior
What is speedballing?
cocaine mixed w/heroin & injected IV
Withdrawal symptoms of cocaine?
-severe craving
-vivid,unpleasant dreams
Overdose of cocaine?
combativeness,impaired judgment
-tachycardia,cardiac arrhythmias,elevated BP
-seizures,resp depression
Tx for cocaine overdose?
-may have to ventilate
-lidocaine or propranolol IV(dysrhythmias)
-acetominophen or Dantrium(hyperthermia)
-hydralazine or nitroprusside(HTN)
-diazepam or phenobarbital(seizures)