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28 Cards in this Set

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TCAs
overview
•Can be lethal in overdose
•Can have a 3-4 week delay before therapeutic response.
•No known long term adverse effects.
•Persistent side effects can often be minimized by a small decrease in dose.
•Do NOT cause physical addiction.
•Do NOT cause euphoria, so they have no abuse potential.
•Can be conveniently given once a day.
TCAs -Side effects
Most side effects are short-term.
•Sedation
•Increased appetite
•Anticholinergic side effects
•Orthostatic hypotension
•Not usually given for patients with history of heart problems, due to possibility of tachycardia, arrhythmia, or heart block.
MAO-Is
•Very effective medications
•Can be lethal in overdose
MAO-Is
•Side effects:
•anticholinergic
•cardiovascular: hypotension most common
•Careful patient teaching is absolutely necessary.
•Interaction with tyramine-containing foods or drugs can cause hypertensive crisis.
•Bad drug interactions: SSRIs, Demerol
Hypertensive Crisis
•Sudden increase in BP
•Explosive headache
•Head and face are flushed, feel “full”
•Stiff neck
•Palpitations, chest pain
•Nausea, vomiting
•Dilated pupils
•Intracranial bleeding
•Heart attack
If hypertensive crisis occurs:
•Hold next MAO-I dose.
•Do not have patient lie down.
•IM chlorpromazine (Thorazine)
•Manage fever by cooling patient externally.
MAO-I -Dietary Restrictions:
1 day before, during, and 2 weeks after taking:
Foods to avoid include:
•Cheese, sour cream, yogurt
•Pickled, dried, fermented, smoked or aged fish or meats
•Beer, wine, sherry, liqueurs, cognac
•Liver
•Overripe fruit
•Yeast
•Chocolate
•Caffeine
MAO-I: Avoid these:
•Narcotics, especially DEMEROL
•Other antidepressants!
•Cold, allergy or hay fever meds
•Weight-reducing pills or stimulants
•Cocaine, amphetamines
SSRIs
•Relatively safe in overdose
•Treatment effects comparable to other antidepressants, but withoutsignificant anticholinergic, cardiovascular or sedative side effects.
•Prozac -what’s the story
-before depression gets better, energy increased
SSRIs -Side Effects
Reported by some patients:
.
•GI symptoms:
–Nausea, diarrhea, decreased appetite
•CNS symptoms:
–Headache, dizziness, nervousness, sexual dysfunction.
–SSRIs generally do not cause sedation or weight gain
Serotonin Syndrome
•overview
Caused when combinations of serotonin-increasing meds interact to make serotonin dangerously high
–Many antidepressants
–Lithium
–Parkinson’s meds
–Demerol, some migraine meds, cold medicine
–Amphetamines, cocaine, LSD, Ecstasy
•Mortality: 11%
Serotonin Syndrome
Symptoms:
–Agitation, confusion,
–Fever, diaphoresis, nausea, diarrhea
–HR rapid, BP up & down
–Loss of coordination, muscle rigidity, seizures
Serotonin Syndrome
Treatment:
–Stop the med
–Supportive care of symptoms
•Interventions as symptoms demand
•May include ICU stay, intubation, neuromuscular paralysis to relax muscles and prevent further rhabdymyolysis
•Cooling measures for hypothermia
ECT: Nursing Considerations
Before treatment begins
Medical clearence, pre amesthia
ECT: Nursing Considerations
during
-moitor pts vs
After treatment
post anethsia, swallowing percautions
Manic Episode: DSM IV
At least 3 of the following must be present to a significant degree for at least 1 week.
•Grandiosity or inflated self esteem.
•Decreased need for sleep.
•Pressured speech
•Flight of ideas or feeling of “thoughts racing”.
•Distractibility.
•Psychomotor agitation or MUCH goal-oriented activity
•Excessive involvement in pleasurable activities with high potential for problems.
Hypomanic Episode
•Meets most of the criteria for manic episode, but the episode is notsevere enough to:
–result in significant impairment, or to
–require hospitalization
Bipolar I Disorder:
–One or more manic or mixed episodes, usually with a major depressive episode.
Bipolar II Disorder:
Includes one or two major depressive episodes and at least one hypomanic episode
Cyclothymic Disorder
.
For at least 2 years:
•The patient has had numerous periods of hypomanic symptoms and numerous periods of depressed mood.
•The patient has never experienced major depression
Etiology
•Psychodynamic theories
–Family dynamics
–Mania as defense against depression
•Biological theory
–Excessive levels or imbalance in neurotransmitters
•Genetics
Nursing Care -NPR:
•Safety
•Matter-of-fact approach
•Clear, concise directions and comments
•Interrupt if you need to -kindly.
•Set limits calmly, but don’t set unimportant limits.
•Keep assessing your countertransference! Don’t fall in.
•Reinforce reality.
Nursing Care -NPR:
Safety
•Matter-of-fact approach
•Clear, concise directions and comments
•Interrupt if you need to -kindly.
•Set limits calmly, but don’t set unimportant limits.
•Keep assessing your countertransference! Don’t fall in.
•Reinforce reality.
Milieu Management
Meet often with colleagues to defuse conflict and clarify communication.
•Consistency, consistency, consistency.
•Decrease environmental stimuli.
Lithium
A salt.
•Substitutes for sodium, changes neurons’ responses to neurotransmitters.
•1 to 2 weeks for therapeutic response
•Narrow “therapeutic window” -
•maintenance blood levels 0.6 to 1.2.
•blood levels over 1.5 toxic.
•Fluid balance very important.
Lithium -Side Effects
•ia and polydipsia
•Nausea
•Dry mouth
Polyur•Diarrhea
•Thirst
•Drowsiness
•Mild hand tremor
•Weight gain
•Bloated feeling
•Insomnia
•Dizziness
Lithium -Adverse & Toxic Effects
Diabetes insipidus
•Toxic effects depend on blood level:
–Exacerbation of side effects, increasing to:
–Extreme GI distress,
–Muscular weakness
–Ataxia
–Multiple organ failure at high levels.
•Note patient teaching needs
Diabetes insipidus
Toxic effects depend on blood level:
–Exacerbation of side effects, increasing to:
–Extreme GI distress,
–Muscular weakness
–Ataxia
–Multiple organ failure at high levels.
•Note patient teaching needs