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181 Cards in this Set
- Front
- Back
What is the oldest antianxiety drug in history?
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Alcohol
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Biological factors
Genetics Psychological and Behavioral |
Etiology in substance abuse.
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A substance disorder plus a major psychiatric disorder. (e.g. paranoid schizophrenia and cocaine abuse)
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Dual Dx.
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What percentage of substance abuse patients have a dual dx?
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30-40% out pts.
60-80% in pts. |
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Do substance abuse patients with dual dx have difficulty with tx?
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Yes, duh.
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CNS Depressant
Crosses Placenta Crosses BBB Not digested; metabolized by liver, absorbed directly into bloodstream? |
Alcohol
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Increase in vital signs
Anxiety,agitation, irritability Nausea and vomiting, diarrhea Tremors, headache, sweating |
Alcohol Withdrawal
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ANS hyperactivity
Mental status changes, hallucinations Increase in Sx within 48 hours of stopping or decreasing the abused substance? |
Alcohol Delirium (Delirium Tremens)
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Blackouts
Fetal Alcohol Syndrome |
Complications of Alcohol Abuse
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Newborn babies can be born with withdrawal from?
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Marijuana, cocaine, heroine, and methadone.
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Fetal Alcohol Syndrome (FAS), causes what?
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MR
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Small head, low nasal bridge, small eyes, short nose, thin upper lip, and underdeveloped jaw?
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Physical signs of FAS.
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What did Coca Cola originaly contain?
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Cocaine
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What is more dangerous, substance abuse or substance dependency?
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Substance dependency because the body craves it.
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Some people metabolize alcohol into what addictive type of substance, which turns them into an alcoholic?
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Morphine
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If one parent is an alcoholic?
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Child has a 50% chance of being an alcoholic.
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If both parents are alcoholics?
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The child has an 85-100% chance of being an alcoholic.
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Biological factors
Genetics Psychological and behavioral |
Substance Abuse Etiology
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Can alcoholism be a learned behavior?
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Yes
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In women, what does alcoholism usually start with?
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Depression
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Substance disorder plus a major psychiatric disorder is called, what?
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Dual Dx
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CNS Depressant
Crosses Placenta Crosses BBB Not Digested; metabolized by liver; absorbed directly into bloodstream? |
Alcohol
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Alcohol is deadly when combined with?
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Benzo's, Barbituates, Phenobarbital and narcotics.
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If a mother drinks two glasses of wine, how much does her unborn baby drink?
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Two glasses of wine.
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Increase in vital signs
Anxiety, agitation, irritability Nausea and vomiting, diarrhea Tremors, headache, sweating? |
Alcohol Withdrawal
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ANS Hyperactivity
Mental status changes, hallucinations Increase in Sx Within 48 hours of stopping or decrease? |
Alcohol Delirium (delirium tremens)
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Delerium Tremens are very?
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Rare
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When dealing with alcohol withdrawal, push what?
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Fluids
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When a patient is in alcohol withdrawal they may be prescribed what to decrease, increased vital signs.
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Librium taper or
Ativan taper, benzo. |
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Once vital signs increase to a certain level because of alcohol withdrawal, e.g. 130/100 BP or respirations greater than 100.
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Patient will be placed on a taper.
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Dehydration in normal alcohol withdrawal increases the risk for?
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Delerium Tremens
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Alcohol delirium is a very serious situation with a mortality of, what?
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15-20%
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DT's will either be cared for in a or a ?
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ICU or Step Down Unit.
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People who have DT's need to be on, what?
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A heart monitor.
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DT is a life threatening situation where you have to monitor what, and have what?
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Vitals and have a vein open.
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In DT, all vital signs spike, including temperatures of?
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106, 107
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Hypertensive, prone to stroke, prone to heart attack, arythmyias, pneumonia, change in mental status.
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What DT's commonly have.
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If a patient is in DT and they become mentally confused, what do you do?
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Get their vitals and call the doctor.
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An alcoholic blackout is when?
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The patient cannot remember what they did while under the influence.
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Alcoholics who often have blackouts will use what as a defense mechanism?
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Confabulation
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Do children with FAS always have the Tell Tale facial features of the Dx?
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No.
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Mental status changes, gait, coordination, ataxia?
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Wernicke's
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Psychotic features, impaired memory, confabulation, disorientation, delerium, dimentia, neuropathy, alcohol and lack of thiamine?
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Korsakoff's
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Korsakoff's is caused by?
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The damaging effects of alcohol use on the brain and the lack of Thiamine.
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Thiamine is what vitamin?
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B1
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A condition of nerve damage in the arms and legs due to alcohol and vitamin defficiency.
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Peripheral Polyneuritis
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Korsakoff's, Wernicke's, Alcohol Dementia, Peripheral Polyneuritis cannot be reversed but can be stopped by?
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Large doses of Thiamine and DC'd alcohol use.
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Cardiovascular problems - hypertension, arrthymias, cardiomyopathy, enlarged heart with decreased pumping action?
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Caused by alcohol abuse.
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Cancers - mouth, larynx, esophagus, pancreas, stomach, colon, liver?
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Caused by alcohol abuse.
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Decreased WBC, Thrombocytopenia, Compromised Immune Function, Elevated GGT, ALT, AST, Elevated MCV/MCH?
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Hematopoietic Complications of Alcohol Abuse
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Cirrhosis, Most Common Cause of Acute Pancreatitis, Gastric Ulcers and Hemorrhage, Esophageal Varices, 20% of heavy drinkers have fatty liver; is reversible?
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Complications of Alcohol Abuse
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DSM-IV - abuse, dependency, tolerance.
MAST - 25 questions/weighted. CAGE - Cut down? Annoyed? Guilty? Eye-Opener? WART - What is in the red wagon behind you? |
Diagnosis and Screening for Alcohol Abuse
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What does CAGE stand for?
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Cut down? Annoyed? Guilty? Eye-Opener?
Part of the Diagnosis and Screening for Alcohol Abuse |
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What does WART stand for?
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When Alcohol (drugs), Repeated, Trouble
Part of the Diagnosis and Screening for Alcohol Abuse |
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3-5 days, safety, stabilizations, use benzodiazepines; Serax and Ativan for impaired livers; vital signs; mental status; Nutrition/Fluids?
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Medical Detoxification in treatmet of Alcohol Abuse.
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Restore emotional and physical stability; denial, acceptance, education, hope, resocialization, self-esteem/self-worth, develop routine; 12-step programs?
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Rehabilitation in Alcohol Abuse.
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1935; Broad Spiritual Concepts; higher power; sponsor; altruism; AL-ANON, ALA-TEEN; ALA-TOT; ALCOA, NA, CA?
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12-STEP PROGRAMS for Alcohol Abuse.
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Confront Denial, Rationalization, projection-point out the red wagon; disease education; family needs (endabling and co-dependency); exercise, meditation, new hobbies; stress 12-step programs and sponsor; identify and deal with anger/grief; Terapeutic communication, open-ended questions, provide support (force them to talk about the problem), do not enable?
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Nurse's Role and Interventions for Alcohol Abuse.
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Denial, Rationalization, Projection-point out the red wagon?
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The Big 3 to confront. (Nurse's Role in Alcohol Abuse).
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Medications used for Alcohol Abuse
antabuse |
Medications used for Alcohol Abuse
Disulfiram |
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Medications used for Alcohol Abuse
revia |
Medications used for Alcohol Abuse
Naltrexone |
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Medications used for Alcohol Abuse
prevents breakdown of ETOH; must avoid all alcohol; with ETOH = n/v; hypotension; arrythmias? |
Medications used for Alcohol Abuse
antabuse/Disulfiram |
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Medications used for Alcohol Abuse
May help with the craving? |
Medications used for Alcohol Abuse
revia/Naltrexone |
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Medications used for Alcohol Abuse
synthetic narcotic; replaces the heroin; not as debilitating? |
Medications used for Alcohol Abuse
Methadone |
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CNS Depressants, narcotics, benzodiazepines, barbituates, marijuana, nicotine, alcohol; CNS Stimulants, cocaine (crack, etc.), amphetamines (ice, crank, meth, ecstasy), inhalants, nicotine, marijuana, caffeine; Hallucinogens, LSD, PCP, mescaline, peyote?
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Drugs that can be abused.
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Which two drugs can be a depressant and a stimulant?
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Nicotine and Marijuana.
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Disturbance in reality, orientation, thinking, and social involvement.
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Definition for Thought Disorders
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Mood episode (depression or mania) plus active symptoms of schizophrenia?
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Shizoaffective Disorder
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Two or more of:
Delusions, Hallucinations, Disorganized Speech, Disorganized/Catatonic Behavior, Negative Symptoms? |
Indications of Schizophrenia.
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Indications that Schizophrenia is an old illness?
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1400BC drawings.
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Excess or distortion of normal functions, delusions, hallucinations, disorganized speech, disorganized or catatonic behavior?
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Positive Symptoms of Schizophrenia.
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Diminished or loss of normal functioning.
flat affect alogia decreased fluency decreased production of speech and thought avolition? |
Negative Symptoms of Schizophrenia.
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Twin studies, etc.?
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Genetic Etiology of Schizophrenia.
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Prenatal and birth complications, flu, maternal malnutrition?
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Environmental Risks in Etiology of Schizophrenia.
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Neurochemical imbalances, irregular patterns of neurons, ????? difficulties (norepinephrine and dopamine)?
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Neurochemical Etiology of Schizophrenia.
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Environmental stresses + vulnerability including substance abuse and interpersonal stresses?
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Psychosocial Etiology of Schizophrenia
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Perseveration, distractibility, clanging, neologisms, tangentiality, echolalia, thought blocking, disorganized speech, loose associations, word salad?
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Disordered Functioning of Speech. "Schizo"
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Withdrawn, poor hygiene, hoarding, inappropriate and bizarre behavior, paranoia, avolition, ambivalence, affective changes?
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Disordered Functioning of Behavior. Schizo.
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Delusions, firm, fixed false idea; Ideas or reference and persecution; often sexual, religious, grandiose; Hallucinations, sensory experience WITHOUT stimulation; Memory impairment, poor judgment and insight, concrete thinking?
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Disordered Functioning of Thought.
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50% suicide attempt rate, substance abuse (alcohol, THC, cocaine, etc.), water intoxication (polyuria and hyponatremia)?
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Complications of Schizophrenia.
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Paranoid
Disorganized Catatonic Undifferentiated Residual |
Subtypes of Schizophrenia.
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Delusions of grandeur, reference, and persecution; hallucinations?
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Paranoid (subtype of Schizophrenia)
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Regressed, silly, inappropriate, poor grooming, disorganized?
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Disorganized (subtype of Schizophrenia)
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Psychomotor changes from stupor to excitement; waxy flexibility; posturing, mutism, extreme negativism?
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Catatonic (subtype of Schizophrenia)
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Symptoms of several other subtypes?
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Undifferentiated (subtype of Schizophrenia)
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Lacks positive symptoms but demonstrates negative symptoms such as flat affect and withdrawal?
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Residual (subtype of Schizophrenia)
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Safety, Medication stabilization, careful assessment, patient/family education, physical care, communication techniques, discharge planning?
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Nursing Care for Schizophrenia.
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Traditional/Conventional antipsychotics; Mechanism: Block dopamine receptors; Thorazine, Stelazine, Mellaril, Prolixin, Haldol, Navane?
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Medications used for Schizophrenia.
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Sedation; EPS; Tardive Dyskinesia; NMS; Hormonal (weight gain, gynecomastia, glactorrhea, amenorrhea, sexual dysfunction; Photosensitivity; anticholinergic?
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Side effects of antipsychotics.
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NMS is?
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Neuroleptic Malignant Syndrome
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Mental Status Changes, 30% mortality rate, increased vital signs, lead pipe rigidity (cannot bend), increased CPK, hold drug, move to medical unit?
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NMS (Neuroleptic Malignant Syndrome)
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Blocks dopamine and serotonin receptors; relieves both positive and negative sypmtoms; blocking serotonin releases dopamine in cortex; all antipsychotic side effects and WEIGHT GAIN?
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Atypical/Novel Medications
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Thought Disorder Medications
Lower seizure threshold; must watch WBC's? |
Thought Disorder Medications
clozapine/Clozaril |
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Thought Disorder Medications
resperidone? |
Thought Disorder Medications
Resperdal |
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Thought Disorder Medications
olanzapine? |
Thought Disorder Medications
Zyprexa |
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Thought Disorder Medications
Also for depression, watch EKG? |
Thought Disorder Medications
ziprasidone/Geodon |
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Thought Disorder Medications
Dopamine agonist and antagonist? |
Thought Disorder Medications
aripiprazole/Abilify |
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Thought Disorder Medications
clozapine? |
Thought Disorder Medications
Clozaril |
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Thought Disorder Medications
ziprasidone |
Thought Disorder Medications
Geodon |
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Thought Disorder Medications
aripiprazole? |
Thought Disorder Medications
Abilify |
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Education about meds and condition.
Expected medication side effects. Plan for follow-up? |
Compliance in Thought Disorders
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What greatly increases the risk factors of DT's?
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Dehydration
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What crucial sign differentiates alcohol withdrawal from DT's?
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Increased vital signs, not responding to librium and benzo tapers, and they have mental status changes.
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Aspiration, pneumonia, stroke, heart attack, temperatures of 106 or 107, very serious ER situation?
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DT
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Alcohol damages the brain and loss of thiamine.
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Alcoholic Dementia.
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Peripheral polyneuritis?
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Thiamine deficiency.
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Lab values, decreased WBC, thrombocytopenia (bleeding disorder), compromised immune function (prone to infections of all kind), elevated GGT, AST, ALT, and normal hemotacrit, hemoglobin, with an elevevated MCV, MCH?
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Common lab values and findings in alcoholics.
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Can a fatty liver be reversed?
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Yes, if they stop drinking.
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Can cirrhosis be reversed?
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No, they must have a liver transplant.
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Gastric ulcers, hemorrhaging, esophageal varices (like hemmorhoids in the throat that can cause you to blead out)?
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Complications of Alcoholism.
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What percentage of alcoholics have a fatty liver?
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20%
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Detoxification means what?
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Withdrawal with medical and nursing care.
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What anxiety drugs will you use in patients with impaired livers?
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Ativan and Serax.
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How often do you check the vital signs of a patient in withdrawal?
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Every 4 hours.
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Alcoholics are said to have many whats, which cause them to drink?
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Losses and griefs.
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Do not allow an alcoholic to talk about their depression. Force them to talk about, what?
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Their problem.
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Prevents the breakdown of ETOH (alcohol); must avoid all alcohol; if alcohol is taken, may caues n/v, hypotension and arrthymias; side effects are bad taste, fatigue, and impotence; but will not stop the craving for alcohol?
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Anatabuse (Disulfiram)
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May help with the craving for alcohol?
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Revia (Naltrexone)
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Synthetic narcotic that replaces heroine but is not as debilitating. It must be regulated, it has street value, and if it is DC'd it must be done with a valium taper; also used as pain med?
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Methadone
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Benzodiazepines, barbituates, and boose are the three B's that, what?
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You cannot withdraw from without medical help.
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What type of "schizo" has a higher level of function?
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A Schizoaffective. (Shizophrenia plus one of the mood disorders)
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How do "schizo's" think?
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Concrete thinking. No abstract.
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Normal behaviors become bizarre?
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Positive Sx of Schizo.
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Sx's of schizo that indicates loss or regression?
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Negative Sx of Schizo.
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Schizofrenia is more frequent in what group?
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Males 15-25.
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Schizophrenia in females is "usually" found between what ages?
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25-35.
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What is the main neurotransmitter involved in Schizo?
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Dopamine
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The lack of logical relationship between thought and ideas may be manifested by vague, diffuse, or unfocused speech.
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Loose Association.
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What is the definition for Disorganized Speech?
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Bizarre and convoluted speech. Primary characteristic of Schizophrenia.
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What is the definition for Perseveration?
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When the client repeats their own statments repeatedly.
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What is the definition for Alogia?
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Poverty of thinking.
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What is the definition for Clanging?
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Rhyming and sound association.
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What is the definition for Neologisms?
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Made up words.
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Paranoid Schizo have mostly what kind of symptoms?
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Positive. (Hallucinations and delusions)
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What is the definition for Echolalia?
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When the patient echoes what you are saying.
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What is the definition for Thought Blocking?
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When the patient looses their thought in mid-sentence.
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Disorganized Schizos have mostly what kind of symptoms?
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Negative (regressed, loss, silly, inapropriate, child-like)
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Catatonic Schizo symptoms can range from stupor, waxy, posturing, mutism, extreme negativisms?
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Catatonic excitement which is sometimes confused with mania.
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Schizo's that have both negative and positive symptoms are refered to as?
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Undifferentiated.
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People who have left over schizo symptoms, but can function at a low level, are refered to as, they lack positive symptoms but demonstrate negative symptoms such as flat affect and withdrawal?
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Residual
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Don't agree with a patient having a delusion, say?
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"I find that hard to believe." and redirect to a concrete subject.
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Don't buy into hallucinations, say?
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"I know that you see, hear, feel, or taste that, but I do not." Redirect into a more concrete subject.
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How do traditional (typical) antipsychotics, such as Thorazine, Stelazine, Mellaril, Prolixin, Haldol, and Navane, work?
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They block dopamine receptors througout the CNS.
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Used to treat Parkinsonism and dystonia, may reduce akathisia?
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benztropine (Cogentin). This is an anticholinergic.
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Used to treat akathisia; contraindicated in clients with diabetes and asthma?
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propranolol (Inderal). Beta blocker.
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Used to relieve acute dystonia; to treat akathisia, when sedation is needed?
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diphenhydramine (Benadryl). Antihistamine
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fluphenazine (Prolixin)
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Typical (Traditional) antipsychotic. Blocks dopamine receptor, works on positive symptoms of Schizo.
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chlorpromazine (Thorazine)
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Typical (Traditional) antipsychotic. Blocks dopamine in the CNS, works on positive symptoms of schizo.
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thioridazine (Mellaril)
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Typical (Traditional) antipsychotic. Blocks dopamine in the CNS, works on positive symptoms of schizo.
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trifluoperazine (Stelazine)
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Typical (Traditional) antipsychotic. Blocks dopamine in the CNS, works on positive symptoms of schizo.
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haloperidol (Haldol)
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Typical (Traditional) antipsychotic. Blocks dopamine in the CNS, works on positive symptoms of schizo.
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thiothixene (Navane)
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Typical (Traditional) antipsychotic. Blocks dopamine in the CNS, works on positive symptoms of schizo.
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clozapine (Clozaril)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors in the limbic systme which traps dopamine in the cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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risperidone (Risperdal; Consta; depot; Invega, long acting)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors which traps dopamine in the limbic/cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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olanzapine (Zyprexa)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors which traps dopamine in the limbic/cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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quetiapine (dibenzothiazine, Seroquel, Seroquel XR)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors which traps dopamine in the limbic/cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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ziprasidone (Geodon)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors which traps dopamine in the limbic/cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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aripiprazole (Abilify)
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Atypical antipsychotic (new). Works on positive and negative symptoms of schizo. Blocks dopamine and serotonin receptors which traps dopamine in the limbic/cortex area. Has all of the traditional side effects but the greatest side effect is weight gain.
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Lowers the seizure threshold, must watch for decreased white blood counts, agranulocytosis, must have lab work every week to two weeks?
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Atypical antipsychotic, clozaril (Clozapine)
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Increases appetite, decreases blood pressure?
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Atypical antipsychotic, resperdal (Resperidone)
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Terrible weight gain?
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Atypical antipsychotic, olanzapine (Zyprexa) and quetiapine (Seroquel)
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Also used in depression, must watch the patient's EKG, <500, must be administered in fat for IM?
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Atypical antipsychotic, ziprasidone (Geodon)
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The perfect drug, is a dopamine agonist and antagonist, it balances dopamine whichever way it is needed, it is also used for depression?
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Atypical antipsychotic, apiprazole (Abilify)
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Belief that the TV is talking to you?
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Delusion of reference.
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Belief's such as, "We are living in a police state."?
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Paranoid delusions
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Traditional antipsychotics block what?
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Dopamine
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Atypical antipsychotics block what?
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Dopamine and Serotonin.
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What drugs are used to treat EPS's?
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Benadryl, Artane, Cogentin.
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What is the most common side effects of atypicals?
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Weight gain.
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What would be most important for the nurse to monitor in a patient receiving clozaril (Clozapine)?
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Decreased WBC.
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Muscle rigidity and an increase in vital signs?
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Sx of NMS.
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Which lab test is important in the diagnosis of NMS?
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CPK
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What would you give a patient who has a pseudoparkinsonism of drooling?
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Cogentin.
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Low potency antipsychotics have a higher incidence of, what?
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anticholinergic effects.
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High potency antipsychotics have a high rate of?
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EPS effect.
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The patient has developed problems sitting still and is obviously agitated. You recognize this to be?
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Akathisia
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Which two drugs can be given in long acting depot form?
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Prolixin and Haldol.
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Patients on traditional antipsychotics are encouraged to wear, what?
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Sun block due to photosensitivity.
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Not responding to Tx?
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Refractory.
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Which atypical can cause QT elongation?
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Geodon
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Tongue movements and "smacking"?
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TD
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