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113 Cards in this Set
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Acetylcholine
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decreased in Alzheimer's
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dopamine
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increased in schizophrenia (psychosis)
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norepinephrine
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decreased in depression, increased in mania
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serotonin
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decreased in depression
increased in mania also a part of OCD, anxiety, pain |
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Glutamate
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increases cause anxiety
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GABA- Gamma-Aminobutyric
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increases cause relaxation
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not enough GABA to keep the neuron calm
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neurons in anxiety
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Schizophrenia
Mania or Depression with psychotic features Schizoaffective Disorder |
Psychosis
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Haloperidol
Fluphenazine Thioridazine Chlorpromazine |
Typical Antipsychotic
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Clozaril
Olanzapine Risperidone Quetiapine |
Atypical Antipsychotic
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Ziprasidone
Aripiprazole Asenapine Iloperidone |
Atypical Antipscyhotic
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Atypical Antipsychotic- dissolves on the tongue like a listerine strip
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Olanzapine and Risperidone
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atypical antipsychotic- used sublingual
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Asenapine
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Atypical Antipsychotic act on....
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block dopamine and decrease serotonin
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Typical Antipsychotic act on...
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block dopamine
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Drowsiness
Orthostatic hypotension Weight gain Photosensitivity Parkinsonism Dystonias, akathisias Neuroleptic malignant syndrome Tardive dyskinesia Dry mouth blurred vision |
typical antipsychotic s/e
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muscle spasms
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dystonias- typical antipsychotic s/e
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inablilty to sit still or restlessness and is more common in middle aged adults- typical antipsychotic s/e
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akathisias
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life threatening, extremely high fever, muscle rigidity, cognitive changes like delirium- typical antipsychotic s/e
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Neuroleptic malignant syndrome
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long term effects of blocking dopamine for so long; abnormal involuntary movement; starts with chewing on their mouths, sticking their tongue out, spasms, chorea like movements typical antipsychotic s/e
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Tardive dysinesia
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agranulocytosis> neutrophils are granulocytes; look at neutrophil count every week while; s/e of atypical antipsychotic
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Clozaril (clozapine)
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agranulocytosis weight gain-
diabetes drowsiness drooling , seizures akathisia; s/e of atypical antipsychotic |
Clozaril (clozpine)
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no agranulocytosis weight gain
Diabetes s/e of atypical antipsychotic |
olanzapine (zyprexa)
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associated with QTc prolongation aka Torsade de pointes
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Ziprasidone (Geodon) atypical
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May be movements on the tongue (wormy movements on the tongue), chewing, tongue protrusions; no effective treatment maybe irreversible
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Tardive dyskinesia
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abnormal involuntary muscle scale/ ask patient to do various movements with mouth and arms; used to check for Tardive dyskinesia
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AIMS EXAM
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Lorazepam (ativan)
Clonazepam (klonopin) Chlordiazepoxide (librium) Diazepam (valium) Oxazepam (serax) Alprazolam (xanax |
benzodiazepines (anti anxiety meds)
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Buspirone (buspar)
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Non-benzodiazepines (anti anxiety)
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Actions of benzodiazepines
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Increase or mimic the action of gaba
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Sedation
Dizziness Tolerance, addiction and withdrawal phenomena |
Side effects of bzp’s
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Not addictive
Not fast acting More similar to antidepressant May increase dig levels |
Buspirone
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Methylphenidate (Ritalin)
Dexmethylphenidate (Focalin) Pemoline (Cylert) Amphetamine sulfate (Adderall) Lisdexamfetamine dimesylate (Vyvanze) Atomoxetine- (Strattera) |
meds for ADHD (stimulants)
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Slow growth
Decrease appetite Tics Anorexia, tremors, increased hyperactivity, tachycardia, exfoliative dermatitis, hepatotoxicity |
Stimulant Side Effects
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meds that increase dopamine
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Stimulants
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Citalopram (Celexa) , escitalopram (Lexapro) , fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), Sertraline (zoloft)
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Selective serotonin reuptake inhibitors- anti depressants
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Amitriptyline (Elavil), clompipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor),
protriptyline (Vivactil), trimipramine |
Tricyclic/ heterocyclic
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Isocarboxazid ,Phenelzine (nardil) ,Tranylcypromine (parnate), eldepryl (transdermal)
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MAO inhibitors
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Amoxapine, bupropion, trazodone, maprotiline, venlafaxine, desvenlafaxine
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Atypical antidepressants
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First line for treatment of depression
Also used in anxiety, pain, panic, OCD, Inhibits reuptake of serotonin so that more is available to act on the post synaptic neuron |
SSRI’s action
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Increase risk of suicide in teens- 25
Nausea, headache, insomnia, nervousness Grapefruit juice can increase level of many SSRI’s |
SSRI side effects
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Confusion, hypomania
Restlessness agitation Myoclonus (a twitch), hyperreflexia Sweating, shivering Tremor |
Serotonin syndrome
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F- FLU LIKE SYMPTOMS
I - INSOMNIA N- NAUSEA I IMBALANCE S- SENSORY DISTURBANCES H- HYPERAROUSAL |
Abrupt discontinuation of SSRI's
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Increases available norepinephrine, serotonin (and possibly dopamine)
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Tricyclic/ heterocyclic
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Lethal in relatively low doses (cardiac toxicity)
Orthostatic hypotension Constipation, blurred vision, urinary retention Sedation (this can be a good thing) |
Tricyclic Side Effects
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potential for cardio toxicity
symptoms include prolongation of cardiac conduction problems Contraindicated with second degree atrioventricular block and should be cautiously used in patients who have heart problems |
Tricyclic Side Effects
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Phenelzine (Nardil)
Tranylcypromine (Parnate) Selegiline (Emsam)* |
Monoamine oxidase inhibitors
* does not need to follow MAOI diet |
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inhibits the enzyme which metabolizes norepinephrine, serotonin, and dopamine.
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monoamine oxidase inhibitor
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Potential for hypertensive crisis (can be fatal) if food high in tyramine ingested
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MAOI DIET
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Pounding occipital headache
Palpitations symptoms of hypertensive crisis if a patient ingests tyramine |
MAOI s/e
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Do not ingest:
Beer, chianti, non-alcoholic beer, brewer’s yeast Cheeses that are aged Fava beans Aged, preserved, pickled foods Avoid caffeine (includes chocolate) |
MAOI diet
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Stimulants
Decongestants Narcotic sedatives or analgesics Anesthetics Saint John’s Wort |
Medications to avoid when on MAOI
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Nifedipine
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ordered as treatment for hypertensive crisis of MAOI
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Lithium
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Mood stabilizing medications
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Inhibits release of norepinephrine and serotonin
Enhances reuptake of serotonin and norepinephrine |
action of lithium
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Increased urination
Shakiness Weight gain Decreased renal and thyroid function (long term) |
lithium s/e
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Therapeutic
.6-1.2 meq per liter Trough level (8-12 hours after last dose) Over 1.5 is toxic |
Blood levels for lithium
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Vomiting
Diarrhea Ataxia, incoordination Confusion, tinnitus Coma Death |
Signs of lithium toxicity
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Depakote
Tegretol Topomax Neurontin |
Anticonvulsants as Mood Stabilizers
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An objective description about the patient's emotional state.
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Affect
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absence of all or most affect
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Flat
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moderately reduced range of affect
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Blunted or restricted
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generally appropriate; mobile
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Full or wide range of affect
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multiple abrupt changes in affect
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Labile
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Internal emotional tone of the patient - largely ascertained from the patient's subjective report
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Mood
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normal mood
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Euthymic
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prevailing state of sadness and depression
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Dysphoric
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exaggerated feeling of well being or elation
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Euphoric
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rapid movement from one emotional state to another
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Labile
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Whether the affect you observe is consistent with the mood expressed by the patient and his thought content.
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Affect/Mood Congruence
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The way in which ideas are linked, not the ideas themselves. Does the patient's thinking make sense? Normally thought processes are goal directed and logically associated.
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Thought Processes
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rapid speech, typical in manic disorder
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1. Pressured speech
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sudden cessation of speech, often in the middle of a statement; losing the train of thought
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2. Blocking
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thoughts are connected but occur so rapidly that it is difficult for the listener to keep up and understand. - typical of manic disorder.
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3. Flight of ideas
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connections between the thoughts are not apparent to the listener.
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4. Loosening of associations
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the patient gets side tracked and never gets to the point.
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5. Tangentiality
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automatic repetition of a verbal response despite changing the question.
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6. Preservation
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taking forever but ultimately gets to the point; many irrelevant details.
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7. Circumstantiality
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the patient makes up his own words, for example, "wonderphenom"
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8. Neologisms
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the "invention of stories" to fill in memory gaps. Done to avoid calling attention to their cognitive deficits
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9. Confabulation
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no apparent connection between thoughts, even within a sentence.
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10. Word salad or incoherence
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false sensory perceptions, which may be auditory, visual, tactile, gustatory or olfactory. Always determine if hallucinations are accusatory, threatening. or command
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1. Hallucinations
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Describes the content of what is on the patient's mind.
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Thought Content
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fixed false beliefs firmly held in spite of contradictory evidence.
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2. Delusions
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false belief that others are trying to cause harm or are spying with intent to cause harm.
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a. Persecutory
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false belief that the patient has a physical disorder or defect.
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b. Somatic
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- false belief of an inflated sense of self worth, power, knowledge, or wea1th.
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c. Grandiose
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false belief that a person, usually of higher status, is in love with the patient
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d. Erotomanic
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believes others can hear one's thought.
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e. Thought broadcasting
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believes others are placing thoughts in one's mind.
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f. Thought insertion
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thoughts or ideas about suicide or homicide. If present, discuss intent, plan, and means.
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Suicidal or homicidal ideation
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recurrent thought. images or impulses that are intrusive and unwanted) and compulsions (behaviors that the person feels driven to perform - usually repeatedly).
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Obsessions
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few ideas or topics about which the patient converses (may be seen in cognitive deficit or depressive disorders.)
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Poverty of content
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exaggerated or irrational fear of an event or object.
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Phobias
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misinterpretations of reality.
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Illusions
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misinterpreting unrelated events as being directly related to the patient, such as believing that the television is talking directly to them.
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Ideas of reference
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a. Alertness or level of consciousness (lethargic, sleepy, alert)
b. orientation to person, place, time, and situation |
1. Sensorium.
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ability to focus on a task such as repeating a series of digits forward and backward
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2. Attention
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ability to maintain focus on a task such as spelling the word “world” forward and backward.
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Concentration
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ability to repeat the names of several items that the examiner has just recited. Example: Name 3 objects to remember and immediately ask what they are.
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a. Immediate recall
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ask to repeat three objects after 5 minutes.
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b. Short term or recent recall
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memory of events of past hours or days and sometimes weeks.
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Recent memory
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long term memory is usually assessed by asking for historical or autobiographical information
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c. Remote memory
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• Refers to the patient's recognition of having a disorder, the symptoms related to it, and the need for treatment
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Insight
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• The ability to plan or act wisely and to act in socially acceptable ways. Can assess by asking, “What would you do if you ran out of medication?” or “What would you do if the electricity in your apartment were turned off?”
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Judgment
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mental disorder or the focus of treatment
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axis 1
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personality disorder and mental retardation
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axis 2
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ad
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additional medical problems
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axis 3
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psychosocial stressors like occupational, economic, relationship stressors
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axis 4
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global assessment function
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axis 5
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being honest when dealing with clients
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veracity
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faithfulness or loyalty; a nurse that stays beyond her shift to help a patient who has just heard stressing news
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fidelity
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fair and equal treatment
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justice
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do good cause no harm; most of the care that is provided
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beneficence
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