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59 Cards in this Set
- Front
- Back
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What is the primary neurotransmitter related to thought process? |
Dopamine |
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Dopamine helps with __________, _________, & voluntary decision making. |
coordination, emotion |
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Reductions in the amount of _____ cause cognitive changes. |
ACh |
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What functions do ACh help with? |
arousal, coordination of movement, memory acquisition, and memory retention |
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What is schizophrenia? |
serious persistent mental illness (SPMI) - significant disturbances of perception, thought, feeling, behaviors, attention, & motivation |
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Dementia v Delirium |
Delirium - onset abrupt - brief/acute - fluctuating alertness - delusions/hallucinations - physical change in body (drugs) - impaired short term memory - slurred speech - fluctuating LOC; sleep erratic |
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Dementia v Delirium |
Dementia - onset insidious - long term/chronic - generally alert - delusions/hallucinations - primary disorder - impaired short term memory initially, then long term fails slowly - normal speech - no change in LOC (level of consciousness) |
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What is Dementia? |
clinical syndrome of progressive, degenerative loss of memory can also affect - language skills, judgement, problem solving, object recognition, motor skills, mood, agitation, insomnia, & loss of inhibitions |
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What is Alzheimer disease? |
It is a form of progressive dementia - most common disorder > 65 - plaques with beta-amyloid protein deposits & neurofibrillary tangles in the cortical neurons |
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What is vascular dementia? |
damage to brain tissue, from CVA or TIA |
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What are possible causes of dementia? |
AIDS, Parkinson Disease, Huntington Chorea |
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What is haloperidol (Haldol)? |
a typical antipsychotic drug used to treat psychotic disorders |
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What are the pharmacokinetics of haloperidol (Haldol)? |
Protein bound, delayed onset of action |
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What are the pharmacodynamics of haloperidol (Haldol)? |
- blocks dopamine, alpha, and serotonin receptors - effective when decrease in tics, hallucinations, delusions, and psychosis - promotes calm |
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What are the contraindications and precautions of haloperidol (Haldol)? |
Hypersensitivity & Parkinson disease |
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What are some adverse effects of haloperidol (Haldol)? |
extrapyramidal symtoms (EPS), drowsiness, sedation, somnolence, lethargy, & dysphoria |
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What drugs interact with haloperidol (Haldol)? |
few drug interactions - smoking decreases serum levels |
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What are some nursing considerations of haloperidol (Haldol)? |
- assess past medical history - category C - document occupation and activities - assess environment where drug will be given - asians have a 50% higher serum levels than whites |
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What are some nursing diagnoses with haloperidol (Haldol)? |
- risk for injury - altered thought process - risk for ineffective management of therapeutic regimen |
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Ways to maximize therapeutic effects of haloperidol (Haldol)? |
Encourage to take drug routinely |
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Ways to minimize therapeutic effects of haloperidol (Haldol)? |
- find a dose that effectively control symptoms, but produces minimal adverse effects - EPS are more likely to occur if the patient repeatedly stops and restarts therapy |
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What is the difference between atypical & typical antipsychotics? |
atypical target only specific dopamine receptors - lower adverse effects - treat negative and positive symptoms of schizophrenia |
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What is olanzapine (Zyprexa)? |
An atypical antipsychotic used to treat psychotic symptoms in schizophrenia & short-term treatment of acute bipolar disorder |
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What are the pharmacokinetics of olanzapine (Zyprexa)? |
Highly protein bound Half-life= 21-54 hours |
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What are the pharmacodynamics of olanzapine (Zyprexa)? |
Blocks several neuroreceptor sites - serotonin, dopamine, muscarinic, H1, & alpha 1 |
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What are some contraindications and precautions of olanzapine (Zyprexa)? |
Hypersensitivity |
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What are some adverse effects of olanzapine (Zyprexa)? |
Drowsiness, insomnia, agitation, nervousness, weight gain, hostility, hyperglycemia, orthostatic hypotension, tardive dyskinesia, and neuroleptic malignant syndrome |
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What drugs interact with olanzapine (Zyprexa)?? |
centrally acting drugs, alcohol, omeprazole, rifampin, & carbamazepine |
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What are some nursing considerations of olanzapine (Zyprexa)? |
- category C - evaluate caffeine intake and diet - assess climate where drug is given - therapeutic response may not be immediate - assess weight - low carb diet - assess for EPS/sedation |
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What are some nursing diagnoses of olanzapine (Zyprexa)? |
- imbalanced nutrition - risk for injury - risk for fluid and electrolyte imbalance - risk for sedation |
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What are ways to maximize effects of olanzapine (Zyprexa)? |
- don't stop med or symptoms will return |
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What are ways to minimize adverse effects of olanzapine (Zyprexa)? |
- FBS (fasting blood sugar) prior to start - single daily dosing at bedtime; prevent sedation |
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What is the advantage of olanzapine (Zyprexa) over other atypical antipsychotic drugs? |
No risk for agranulocytosis which is common in atypical antipsychotic drugs |
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What is acetylcholine? |
a neurotransmitter for several CNS circuits in the brain.
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What do acetylcholinesterase enzyme inhibitors do? |
inhibit action of AChE prolong activity of ACh on cortical cholinergic receptors and in the synapse increases concentrations of acetylcholine by inhibiting the enzyme cholinesterase |
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What is rivastigmine (Exelon)? |
An acetylcholinesterase enzyme inhibitor that treats mild-moderate dementia |
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What are the pharmacokinetics of rivastigmine (Exelon)? |
administered orally distributed throughout body metabolized by liver excreted through urine peaks at 1 hour |
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What are the pharmacodynamics of rivastigmine (Exelon)? |
carbamate derivative that enhances cholinergic function |
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What are some contraindications and precautions with rivastigmine (Exelon)? |
hypersensitivity |
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What are some adverse effects of rivastigmine (Exelon)? |
GI effects, dizziness, headache, chest pain, peripheral edema, vertigo, joint pain, agitation, and coughing |
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What drugs interact with rivastigmine (Exelon)? |
succinylcholine, similar neuromuscular blocking agents, or cholinergic agonists |
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What are some nursing considerations of rivastigmine (Exelon)? |
- assess for cardiac dysfunction - assess age - assess for tobacco use - discuss disease & its progression - discuss side effects - assess cognitive function |
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What are some nursing diagnoses for rivastigmine (Exelon)? |
- imbalanced nutrition - risk for injury |
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What are ways to maximize therapeutic effects of rivastigmine (Exelon)? |
- keep routines similar - avoid frustrating the patient with memory questions |
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What are ways to minimize adverse effects? |
- offer small frequent meals, or give drug with food - monitor weight throughout therapy |
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Has rivastigmine (Exelon) been shown to alter the course of dementia? |
No, it is anticipated that disease effects will lessen as the disease process advances and fewer cholinergic neurons remain intact |
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What is a TBI (traumatic brain injury)? |
head injury caused by blunt trauma or acceleration/deceleration blast causes air pressure changes loss of consciousness tissue damage |
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Signs and symptoms of TBI? |
- memory disturbance, decrease attention span, language problems, MH, executive function problems, lack of self awareness, alcohol/drug abuse, PTSD, pain, fatigue, weight change, seizures, vertigo, sleep problems, incontinence, light sensitivity, visual/hearing impairment, and decrease libido |
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How would you treat a TBI? |
Meds -start low, go slow - hypersensitivity and resistance are common - treatment is symptom based - antipsychotics, anti anxieties, and antiepileptics |
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Loss of consciousness with muscle twitching and mild alterations in consciousness with repetitive blinking are signs of? |
Seizures |
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What are some actions of antiepiletics? |
- decrease rate of Na influx into cells - inhibit Ca flow rate into specific channels - increasing GABA |
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What are some causes of seizures? |
head trauma tumor growth hypoxia inherited birth defects - diagnose by EEG |
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What are some types of seizures? |
generalized: tonic clonic seizure lasting 2-5 mins both hemisphere affected Focal/Partial/Local: focus activity limited to one area. loss of muscle tone lasting seconds. may have LOC Unclassified/Idiopathic: don't fit into other categories. cause unknown
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Drug that decrease Na+ influx? |
dilantin, tegretol, felbatol, cerebyx, trileptal, depakote (#1) - don't stop these abruptly - increases risk of self injury with antiepileptics - cause sedation/confusion |
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What are some adverse side effects of dilantin (Phenytoin)? |
- causes blood dyscrasias - dysarthria - dizziness - gingival hyperplasia - GI upset * dilantin requires blood levels |
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What drug decreases Ca+ influx? |
Ethosuximide - used for absence seizures - interacts with other drugs = monotherapy |
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What is status epilepticus? |
One seizure follows another without recovery of consciousness |
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What drugs are used for status epilepticus? |
IV Ativan (lorazepam) or IV Valium (diazepam) - these increase GABA - Benzos are also used |
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What are some other causes of seizures? |
high fevers, electrolyte imbalance, brain injury, hypoglycemia, meningitis, eclampsia, toxemia of pregnancy, drug/alcohol abuse/withdrawal |
