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188 Cards in this Set
- Front
- Back
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What is psychosis?
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break from reality
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What are the 5 types of schizophrenia?
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-catatonic
-paranoid -disorganized -undifferentiated -residual |
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Etiologic theories of Schizophrenia?
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-Genetic:vulnerability,not 100% genetic
-neurobiological:neurochemical receptors;diff drugs affect -socio-cultural:have not proven to be true -other theories:virus;nutrition |
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What is catatonic schizophrenia characterized by?
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-non mvmt(motor immobility)
-or excessive motor activity -extreme negativism -peculiar mvmts:waxy flexibility -echoalia or echopraxia |
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What is waxy flexibility?
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person's body part stays in exact position you placed it
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What is echolalia?
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repetition of words
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What is echopraxia?
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repeated movements
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What is paranoid schizophrenia characterized by?
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-delusions
-hallucinations -anger -argumentativeness -violence |
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What type of delusions characterize schizophrenia?
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-organized around a theme
-persecutory -grandiose |
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What is disorganized schizophrenia char. by?
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-fragmented delusions or hallucinations
-disorganized behavior *odd behaviors(mannerisms) *extreme social withdrawal -disorganzied speech -flat,inappropriate, or silly affect |
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What is undifferentiated schizophrenia characterized by?
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-psychotic symptoms
-mixed schizophrenic symptoms |
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What is residual schizophrenia characterized by?
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-absence of prominent delusions/hallucinations
emotional blunting social withdrawal eccentric behavior illogical thinking loose associations |
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Affect characteristics of schizophrenia?
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-blunt affect:reduced expression
-flat affect:emotional impoverishment -inappropriate affect:incongruence bw emotions & situation -ambivalent affect:opposite emotions toward the same person or situation |
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Other categories of characteristic r/t Schizophrenia?
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-behavioral
-perceptual -cognitive -social -culture -age -physiological |
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4 extra pyramidal effects of antipsychotics?
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-dystonic rxns:muscle spasms
-akathisia:restless -parkinsonism:shuffling,drool- ing -neuroleptic malignant syndrome:illness czed by these drugs:fever,rigid muscles |
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What is tardive dyskinesia?
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-side effect of antipsychotic drugs
mvmts of the tongue,mouth,face & jaw puckering chewing mvmts involuntary mvmts of the extremities |
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3 general side effects of antipsychotic drugs?
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-photosensitivity
-weight gain -interference w/ sexual function |
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Anticholinergic effects of antipsychotic drugs?
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-dry mouth
-constipation -urinary retention -blurry vision -memory difficulties -confusion |
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Advantages of the Conventional antipsychotic drugs?
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-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) |
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2 antpsychotic meds that can be injected for gradual absorption?
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-Haldol Decanoate
-Prolixin Decanoate *IM every 2-6 wks -slow release,oil based |
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Side effects of conventional antipsychotic meds?
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-constipation
-dry mouth -blurred vision -dizziness -mvmt disorders(some have high incidence) -little effect in neg. symptoms |
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What is generalized anxiety disorder(GAD)?
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-persistent anxiety w/o phobias or panic attacks
-chronic disorder |
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When does GAD usually begin?
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in childhood or adolescence
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What is GAD triggered by?
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by stress or nothing
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What may GAD sufferers be preoccupied w/?
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-may be preoccupied w/ catastrophic thoughts or visions
-sufferers worry excessively about everyday concerns |
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Symptoms of GAD?
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-fatigue
-muscular tension -restlessness -irritability -difficulty concentrating -sleep disturbance |
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To be dxed w/ GAD must have:
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-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 |
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What is a panic attack?
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highest level of anxiety
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What is a panic attack characterized by?
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-disorganized thinking
-feelings or terror or helplessness -nonpurposeful behavior |
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How do ppl feel during a panic attack?
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feel as if about to die,lose control, or "go crazy"
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What are panic attacks usually associated w/?
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-public speaking
-interpersonal conflict -exams -situations of high stress |
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When does panic disorder usually develop?
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bw ages 15-24.
-affects > 1.5 million Americans -1/3 - 1/2 also have agoraphobia |
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What is agoraphobia?
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fear of being away 4m home and alone in public places where assistance may be needed
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General Panic disorder Info?
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-onset sudden & unexpected
-no specific stimulus -intense symptoms last a few min to an hr -involve intense fear & premonition of doom -normal functioning suspended |
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Symptoms in panic disorder?
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-perceptual field limited
-misinterpretation of reality -dizziness,unsteadiness,faint-ness -choking sensation,palpitation -trembling,sweating,depersona- lization -numbness,fear of dying,fear of going crazy |
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What may panic disorder include?
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phobic avoidance,depression,obsessions
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Nocturnal panic conc. panic disorder?
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-awakens person,usually w/in 1 hr of falling asleep:possibly r/t sleep apnea
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Mgmt of panic disorder?
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-meds
-Cognitive Behavioral Therapy pt told to reinterpret symptoms more realistically, learn that they are harmless breathe into paper bag to incr CO2, decr SOB |
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Nursing Intervention r/t Panic Disorder?
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-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 |
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Common features of phobic disorders?
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-unreasonable behavioral response
-persistent fears -avoidance behaviors -disabling behavior |
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What is specific phobia?
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-fear of only 1 object or situation
-can arise after single unpleasant experience -common phobias: heights snakes closed spaces spiders |
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What is social phobia?
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-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. |
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What does person w/ agoraphobia avoid?
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avoids groups of ppl
may also avoid places where they might be trapped |
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What is agoraphobia often triggered by?
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severe stress
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2 peak times of onset for agoraphobia?
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15-20 yrs old
30-40 yrs old |
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Behavioral char. of phobic disorders?
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-avoidance of object,situation
-dependent:on other ppl, |
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Affective char. of phobic disorders?
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-fear of object
-fear of exposure -fear of abandonment during phobic episode |
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Cognitive char. of phobic disorders?
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-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 |
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Social char of phobic disorders?
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-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 |
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Medical mgmt of phobic disorders?
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-anxiolytics
-relaxation -education -cognitive therapy -systematic desensitization(exposure to object or situation) |
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Define obsessions r/t OCD?
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unwanted,repetitive thoughts,ideas,impulses or images that lead to feelings of fear,anxiety or guilt.
thoughts of violence(killing someone) contamination sexual |
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Define compulsions r/t OCD?
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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 |
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Req. to be dxed w/ OCD?
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when obsessive-compulsive thoughts & behaviors dominate a person's life
-interference w/ life,slight to incapacitating -usually has a lifelong course |
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Behavioral char. of OCD?
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Common
-abnormal doubts -compulsion to check(alarm clock,iron) -consuming behavior-sometimes bizarre -behavior is forced 4m within,uncontrollable |
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Diff. behavioral char r/t OCD for men and women?
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females:compulsive cleaning
males:compulsive checking |
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Affective char. of OCD?
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-shame about irrational behavior
-tense,inadequate,ineffective -control relieves anxiety -feel that something terrible will happen if they don't act on compulsion -often hopeless about improvement -may develop phobias |
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Cognitive char. of OCD?
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-ego-dystonic
-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 |
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Social char of OCD?
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-devastating
-alters lives of client & fam -symptoms all-encompassing -relationships strained/destroyed -kids involve parents/siblings in rituals |
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Goal conc OCD?
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work,play,maintain relationships
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Mgmt. of OCD?
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-reveal prob
-educate about disorder -behavioral therapy exposed to progressive degrees pf stressor asked to respond w/ delayed or modified behavior goal directed responses |
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Nursing Interventions for OCD?
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-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 |
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What is posttraumatic stress disorder(PTSD)?
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a set of maladaptive responses to an actual(real) event that has been overwhelmingly distressing
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Experiences which trigger PTSD are...
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outside range of usual human experience & beyond the control of the individual
-person reacts w/intense fear,terror helplessness |
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About PTSD symptoms?
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-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 |
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Ex of triggering experiences for PTSD?
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-9-11,terrorist attacks
-war -hurricanes,floods,tornadoes -fire(trapped & burned) -catastrophic accidents |
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What are the 7 newer antipsychotics?
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-aripiprazole(Abilitat)
-clozapine(Clozaril) -olanzapine(Zyprexa) -quetiapine(Seroquel) -risperidone(Risperdal) -sertindole(Serlect) -ziprasidone(Geodon) |
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Trade name & adult dosage of aripiprazole?
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trade name:Abilitat
adult dosage(mg/day):15-30 |
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Trade name & adult dosage of clozapine?
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trade name:Clozaril
adult dosage:300-900 |
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Trade name & adult dosage of olanzapine?
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trade name:Zyprexa
adult dosage:5-20 |
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trade name & adult dosage of quetiapine?
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trade name:Seroquel
adult dosage:150-750 |
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Trade name & adult dosage for risperidone?
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trade name:Risperdal
adult dose:4-16 |
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trade name & adult dosage for sertindole?
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trade name:Serlect
adult dosage:12-24 |
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trade name & adult dosage for ziprasidone?
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trade name:Geodon
adult dosage:40-160 |
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trade name & adult dosage for acetophenazine?
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trade name:Tindal
adult dosage:40-120 |
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trade name & adult dosage for chlorpromazine?
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trade name:Thorazine
adult dosage:30-800 |
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trade name & adult dosage for fluphenazine?
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-Prolixin,Permitil
-1-40 |
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trade name & adult dosage for mesoridazine?
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-Serentil
-75-300 |
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trade name & adult dosage for perphenazine?
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-Trilafon
-8-64 |
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trade name & adult dosage for thioridazine?
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-Mellaril
-150-800 |
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trade name & adult dosage for trifluoperazine?
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-Stelazine,Suptazine
-15-20 |
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trade name & adult dosage of triflupromazine?
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-Vesprin
-60-150 |
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What are the 8 phenothiazines?
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-acetophenazine(Tindal)
-chlorpromazine(Thorazine) -fluphenazine(Prolixin,Permitil) -mesoridazine(Serentil) -perphenazine(Trilafon) -thioridazine(Mellaril) -trifluoperazine(Stelazine,Suptazine) -triflupromazine(Vesprin) |
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What are the 2 thioxanthenes?
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-chlorprothixene(Taractan)
-thiothixene(Navane) |
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trade name & adult dosage of chlorprothixene?
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-Taractan
-75-600 |
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trade name & adult dosage of thiothixene?
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-Navane
-6-120 |
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What antipsychotic drug is in the class of butyrophenones?
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haloperidol(Haldol)
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What is the trade name & adult dosage of haloperidol?
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-haldol
-1-50 |
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What antipsychotic drug is in the class Dibenzoxazepine?
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Loxapine(loxitane)
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What is the trade name & adult dosage for loxapine?
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-Loxitane
-10-160 |
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What antipsychotic drug is in the class Dihydroindolone?
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molindone(Moban)
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trade name & adult dosage for molindone?
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-Moban
-15-225 |
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What antipsychotic drug is in the class Diphenylbatylperidine?
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pimozide(Orap)
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trade name & adult dosage for pimozide?
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-Orap
-1-10 |
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Advantages of clozapine(Clozaril)?
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-may be most effective;especially for neg symptoms & cognitive deficiencies
-doesn't cz mvmt disorders -may lower the risk of drug & alcohol abuse |
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Side effects of clozapine(Clozaril)
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-agranulocytosis(in at least 1% of pts)
-drowsiness,dizziness,drooling -muscle weakness -weight gain -diabetes -rapid w/dwl may lead to psychosis |
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Advantages of risperidone(Risperdal)
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-outperforms conventional drugs
-no seizures or drooling -mvmt disorders uncommon |
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Side effects of risperidone(Risperdal)?
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-dizziness
-drowsiness -dry mouth -rapid heartbeat -some mvmt disorders at high doses -weight gain -diabetes |
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Advantages of olanzapine(Zyprexa)?
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-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) |
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Side effects of olanzapine(Zyprexa)?
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-dizziness
-drowsiness -dry mouth -substantial weight gain -diabetes |
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Advantages of quetiapine(Seroquel)?
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similar to risperidone & olanzapine, but little risk of dry mouth or dizziness
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Side effects of quetiapine(Seroquel)?
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-drowsiness
-substantial weight gain -diabetes -occasional mvmt disorders -cataracts reported in animals given high doses |
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Advantages of ziprasidone(Geodon)?
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-no mvmt disorders
-apparently little weight gain -may be helpful for depression & anxiety |
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Side effects of ziprasidone(Geodon)?
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-headaches
-nausea -drowsiness -dizziness -rash -can slow electrical conduction through the heart |
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PTSD is characterized by?
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-sudden severe loss of psychological integrity & cohesiveness
Characterized by: re-experiencing the trauma numbing physiological symptoms of arousal |
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About re-experiencing r/t PTSD?
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-intrusive thoughts,nightmares
if not present,dx of anxiety,depression, or adjustment disorder -preoccupation -memories occur randomly -obsessive thoughts about actions,lack of action -fear of recurrence:not in person's control first time |
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About psychic numbing r/t PTSD?
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-detached or separate 4m others
-unable to experience joy,enjoy pleasurable events -rumination:go over & over -anger,sadness,rage,stoicism -aggression,fear of losing control -unpredictable explosions of aggressive behavior |
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About persistent state of arousal r/t PTSD?
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-hypervigilant
-exaggerated startle response -difficult falling/staying asleep-may be assoc w/ recurring nightmares -difficulty concentrating,completing tasks |
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Behavioral char. of PTSD?
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-hypervigilance
-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) -avoidance |
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Affective char. of PTSD?
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-chronic tension
-edgy,jittery,tense,restless -labile affective responses -anxiety:moderate to panic -guilt over actions,survivor guilt -numbing of other emotions |
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Cognitive char. of PTSD?
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-Memory:
amnesia flashbacks -Self-devaluation shattered sense of self disrupted personality development |
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Tx for PTSD?
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-med
-integrating experience -time -cognitive restructuring,learns to view behavior as reasonable & moral -therapy -achieve new balance w/ self r/t past & present -tx asap after event |
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Who is acute stress disorder experienced by?
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ppl who witness or experience extreme traumatic stressor
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When does acute stress disorder begin?
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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. |
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What is dissociative disorder?
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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 |
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What is benzodiazepine used to tx?
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Anxiety
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What is the danger r/t using benzodiazepines to tx anxiety?
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CNS depression ldg to decr. resp function & addiction and/or tolerance.
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What happens when benzos taken w/ alcohol?
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synergistic effect
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What is buspirone(Buspar) used to tx?
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-anxiety
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General info about Buspar?
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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. |
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Cardiovascular effects that alcohol has on the body?
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-direct damage to heart muscle
-czs cardiomyopathy,CHF |
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About blackouts as an effect of alcohol?
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-early sign of alcoholism
-possibly r/t toxic effect of ETOH on glutamate transmission |
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What is Korsokoff's Syndrome?
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*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 |
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What may a person w/ Korsokoff's syndrome present w/?
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may present w/ delirium & hallucinations & confabulate to conceal condition
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What is Korsokoff's syndrome czed by?
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czed by degeneration of thalamus as a result of deficiency of B vitamins,especially thiamine & B12
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What is Wernicke's encephalopathy?
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*effect of alcohol on body
-inflammatory,hemorrhagic,degenerative cond of brain. |
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What is Wernicke's encephalopathy char by?
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-lesions in several parts of brain:hypothalamus,mammillary bodies,tissues surrounding ventricles & aqueducts
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Symptoms of Wernicke's encephalopathy?
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-double vision
-involuntary & rapid eye mvmts -lack of muscular coordination -mild or severely decr mental function |
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What is Wernicke's encephalopathy czed by?
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-thiamine deficiency
-seen w/ chronic alcoholism -May coexist w/ Korsokoff's syndrome |
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General effects of alchohol on the body?
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-peripheral neuropathies
-alcoholic dementia -digestive system -cirrhosis -esophageal varices/rupture -pancreatitis -gastritis/ulcer/GI bleeding -infl processes w/ malabsorption -nutritional abnormalities vit B deficiencies magnesium & thiamine deficiencies |
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Effects of alcohol on the body after prolonged use?
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-tolerance
-phsyical & psychological dependence -physiological complications |
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Alcohol Intoxication?
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slurred speech,incoordination,unsteady
gait,nystagmus,impairment in memory & attention,stupor |
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Alcohol Overdose?
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-coma
-respiratory depression -aspiration |
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Priority interventions for alcohol overdose?
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-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) |
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When does alcohol withdrawal syndrome(AWS) usually develop?
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develops w/in hrs to a few days of last alcohol intake(usually 6-8 hrs)
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S/S of alcohol withdrawal syndrome(AWS)?
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-autonomic hyperactivity
sweating increasing pulse rate & BP -incr hand tremor -insomnia -N/V -auditory,visual,tactile hallucinations & illusions(alcohol withdrawal delirium-formerly DTs) -psychomotor agitation -anxiety -seizures |
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When does alcohol withdrawal delirium usually occur?
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usually occurs on day 2 or 3 but may be as late as 14 days after last drink
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S/S of alcohol withdrawal delirium?
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-confusion,disorientation,hal-
lucinations -tachycardia -hypertension or hypotension -extreme tremors -agitation -diaphoresis -fever -death may result 4m cardiovascular collapse or hyperthermia |
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AWS nursing interventions?
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-monitor VS
-alcohol w/dwl protocol -maintain patent IV -administer meds as ordered -rehydrate,reorient,reassure -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 |
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What is the preferred drug to use in alcohol w/dwl?
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benzodiazepines
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What do benzos do conc AWS?
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decr symptoms & prevent seizures
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4 most common drugs used to decr & prevent symptoms in AWS?
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-chlordiazepoxide(Librium):most common
-diazepam(Valium) -ozazepam(Serax) -lorazepam(Ativan) |
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What should be monitored when using benzos as a pharmacologic intervention for AWS?
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-Monitor:
BP & P tremors state of anxiety/agitation -dosage determined by symptoms -meds given as needed & titrated downward over 5 days |
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What are the adjuncts to benzos in alcohol w/dwl?
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-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 |
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Drugs used to maintain abstinence from alcohol?
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-disulfiram(Antabuse)
-naltrexone(ReVia) -acamprosate(Campral) -acetaldehyde if ETOH is ingested -rxn occurs in 5-10 min & lasts 30 min to several hrs. |
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What will happen if alcohol is ingested while on disulfiram(Antabuse)?
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czs very unpleasant effects.
-rxns occurs in 5-10 min & lasts 30 min to several hrs |
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Symptoms of alcohol/disulfiram rxn?
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-nausea
-copious vomiting -flushing -palpitations -h/a -sweating -thirst -chest pain -hypotension -weakness -blurred vision |
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Why can disulfiram be dangerous?
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-marked resp. depression
-cardiovascular collapse -dysrhythmias -MI -CHF -convulsions -Death |
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Gen Info about pt teaching r/t disulfiram(Antabuse)?
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-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 |
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Types of things pt on disulfiram should avoid?
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-sauces & other foods cooked w/ alcohol
-cologne,after shave lotion,liniments applied to the skin -cough syrups & other OTC preps containing alcohol |
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What is Naltrexone(ReVia) used for?
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-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 |
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What does acamprosate(Campral) do for ppl addicted to alcohol?
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-reduces unpleasant feelings brought on by abstinence
-tx should include psychosocial support |
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Other drugs used in the tx of alcohol abuse?
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-B vitamins
☙thiamine ☙folic acid ☙B12 -multivitamins -fluid replacement -antibiotics |
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Name some common barbiturates that are abused.
[sedatives/hypnotics/antianxiety agents] |
-seconal(secobarbital)
-nembutal(pentobarbital) -amytal(amobarbital) -tuinal(amobarbital & secobarbital) -phenobarbital -quaaludes |
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Name some common benzodiazepines that are abused.
[sedatives/hypnotics/antianxiety agents] |
-valium(diazepam)
-librium(chlordiazepoxide) -xanax(alprazolam) -halcion(triazolam) -ativan(lorazepam) |
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Mode of administration for sedatives/hyponitcs/antianxiety agents?
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-oral
-can be used IV |
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Site of action for sedatives/hypnotics/antianxiety agents?
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-enhance action of GABA in limbic system
-may cz significant CNS depression |
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Effects of sedatives/hypnotics/antianxiety agents?
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-drowsiness
-sedated appearance -lack of coordination -euphoria -labile emotions -irritability,anxiety -impaired attention -working memory loss |
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Intoxication & overdose of sedatives/hypnotics/antianxiety agents?
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-Same potential problems as alcohol
-synergistic(exaggerated) effect w/ other CNS depression |
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What are priority interventions for overdose of sedatives/hypnotics/antianxiety agents?
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-manage airway
-monitor for respiratory depression/arrest -support vital functions -lavage/activated charcoal -dialysis for drugs w/ longer half-lives & no antidotes |
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Antidotes for benzodiazepines?
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-Anexate
-Romazicon(flumazenil) ☙reverses CNS depression ☙monitor for w/dwl symptoms ☙if symptoms occur,larger doses may be required bc of tolerance |
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Withdrawal of sedatives/hypnotics/antianxiety agents?
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-dangerous
-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 |
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What is flunitrazapam(Rohypnol)?
[designer drugs] |
"date rape" drug,sedative-hypnotic effect w/ muscle relaxatioin,blackouts,amnesia
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What may Rohypnol cz?
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-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" |
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What is GHB?
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-gamma-hydroxybutyrate
-clear liquid,odorless,tasteles |
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General GHB info?
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-euphoric,sedative,& anabolic effects
-sometimes used by body builders & at gyms & fitness centers -rapid acting CNS depressant -occurs naturally in body - |
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What can GHB use lead to?
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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 |
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Types of Opioids?
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-morphine
-heroin -codeine -Dilaudid(hydromorphone hcl) -Percodan(oxycodonex2/asa) -Demerol(meperidine hcl) -methadone -oxycodone -Percocet(oxycodone/apap) -Vicodin(hydrocodone/apap) |
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Mode of administration for opioids?
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-oral,inj,IV
-smoking,inhalation |
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Site of action for opioids?
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attach to same opiate receptors in brain as endorphins,enkephalins,dynorphins
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Effects of opioids?
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-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 -euphoria,pleasure,relaxation -depress respiration -suppress coughs -inhibit GI motility -continued use decr prod of endorphin & enkephalin-results in low pain tolerance during w/dwl |
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Complications of opioid use?
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-poisoning 4m heroin
-heroin more potent -risk for hepatitis,HIV inf,AIDS -liver probs -malignant hypertension -strokes -kidney failure |
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Symptoms of opioid overdose?
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-clammy skin
-shallow respirations -pinpoint pupils(may be dilated w/ hypoxia) -death 4m respiratory depression or irreversible pulmonary edema |
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Drugs used to tx opioid overdose?
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-Lasix for pulmonary edema
-Naloxone(Narcan) |
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About Naloxone?
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-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 |
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Name 3 drugs used to assist in w/dwl from opioids?
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-methadone
-buprenorphine -clonidine |
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About methadone?
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-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 |
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About buprenorphine(Subutex,Suboxone)
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-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 |
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About naltrexone?
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-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 |
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2 CNS stimulants?
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-cocaine
-amphetamines |
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Mode of admin for cocaine?
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-smoking(brain delivery rate similar to IV)
-inhalation(addictive,czs erosion of nasal mm & may cz perforated septum) -inj -IV |
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Site of action for cocaine?
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-CNS stimulant
-binds to DA transporters resulting in accumulation of DA -intense feeling of euphoria -research animals will self-administer,often overdose & die |
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Vasoconstriction complications of cocaine?
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(sympathomimetic effects)
-severe hypertension -elevated heart rate -stroke -MI -dysrhythmias ______________________________ *Seizures(CNS stimulation) -hypertension -stroke -MI |
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Gen. complications of cocaine use?
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-decr glucose utilization i frontal cortex
-loss of sense of smell -perforated nasal septum -pulmonary damage -hepatitis |
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What is space-basing?
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crack cocaine w/ PCP
*may lead to panic,terror,violent,uncontrollable behavior |
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What is speedballing?
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cocaine mixed w/heroin & injected IV
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Withdrawal symptoms of cocaine?
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-severe craving
-depression -fatigue,irritability -vivid,unpleasant dreams |
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Overdose of cocaine?
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-euphoria,grandiosity,anger,
combativeness,impaired judgment -tachycardia,cardiac arrhythmias,elevated BP -perspiration,chills -N/V -seizures,resp depression -hyperpyrexia -death |
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Tx for cocaine overdose?
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-may have to ventilate
-lidocaine or propranolol IV(dysrhythmias) -acetominophen or Dantrium(hyperthermia) -hydralazine or nitroprusside(HTN) -diazepam or phenobarbital(seizures) |
