Test Two Christ Hospital

Front 1

What is ETC

Back 1

Is the induction of a grand mal seizure through the application of electrical current to the brain.

Front 2

Asylums

Back 2

Where inhuman and gave lobotomies, few gave effective medications and the ones they gave had alot of side effects.

Front 3

What part of the brain is the etc going into?

Back 3

The frontal and temporal lobe

Front 4

How much is the dose for ETC?

Back 4

the dose is based on the clients seizure threshold which is variable in individuals.
**Dose of electricity in ECT maximum is 100 Jewels**

Front 5

How long do seizures last?

Back 5

only 25 seconds

Front 6

How often are ETC done?

Back 6

every other day Mon-Wed-Fri is the usual schedule

Front 7

Whats insulin coma therapy?

Back 7

Was done in the 30's and it was an injection of insulin produced a hypoglycemic coma which was believed to alleviate the symptoms of schizophrenia - too much patient can die.

Front 8

What is ECT also good for?

Back 8

ECt has been shown to be effective in the treatment of severe depression - its not the first choice done after other trials of meds are exhausted.

Front 9

What legally has to happen before ECT?

Back 9

Informed consent
Patient must be medically cleared.

Front 10

What is the contraindication of ETC?

Back 10

Increased intracranial pressure and people with heart conditions can not do ETC

Front 11

Serotonin

Back 11

Calming affect

Front 12

Norepinephrine

Back 12

concentration

Front 13

dopamine

Back 13

feel good "gotta have it"

Front 14

ETC does what?

Back 14

Fires the transmitters to wake up the brain.

Front 15

Side effect of ETC?

Back 15

Most common is memory loss and confusion lasts only 30 minutes however need to teach patients that its only short term until fog lifts and then have more memory back then before ETC

Front 16

What must happen before ETC?

Back 16

Patient must have a physical exam, WBC's and all labs and X rays

Front 17

What is administered to patient before the treatment?

Back 17

Robinul or Atropine is administered by a doctor 30 minutes before the treatment

Front 18

What is administered to the patient by the anesthesiologist?

Back 18

A short - acting anesthetic such as (thiopental sodium) Pentothal and a muscle relaxant (succinylchoine) Anectine

Front 19

What happens after patient leaves the treatment room?

Back 19

the nurse remains with the patient until they are fully awake.
*Vital signs are taken every 15 minutes for the first hour.
*Continuous O2 is administered to the client.

Front 20

Agonists

Back 20

A drug that initiates a therapeutic response by binding to a receptor

Front 21

Antagonists

Back 21

a drug that binds receptors without causing any regulatory effect.
*their binding, in turn, blocks the binding of the endogenous agonist.

Front 22

Antipsychotics

Back 22

(dopamine) Blocks dopamine

Front 23

Antidepressants

Back 23

Serotin and Norepinphrine - Blocks

Front 24

Benzodiazepines

Back 24

Faciliate transmission of the

Front 25

Convention antipsychotics blocks what receptors?

Back 25

dopamine

Front 26

Atypical antipsychotics blocks what receptors?

Back 26

blocks both dopamine and serotonin

Front 27

Antidepressants such as Zoloft, Paxil and SSRI's reuptakes what?

Back 27

Unlike antipsychotic meds these drugs bind with the serotonin transporter and inhibit the reuptake of serotonin

Front 28

Anxiolytic drugs such as Ativan enhance which transmitter?

Back 28

GABA (gamma-aminobutyric acid)

Front 29

Too much dopamine causes what?

Back 29

Dopamine is a chemical messenger that regulates thinking, emotion, behavior, and perception. Excess amount of dopamine cause nerve impulses in the brain stem to be transmitted faster than normal, resulting in strange thoughts, hallucinations and bizarre behavior.

Front 30

WHy should you block dopamine?

Back 30

it lessens or prohibits the development of biazrre thoughts and behavior Example Thorazine and Haldol

Front 31

Atypical antipsychotic meds block what?

Back 31

Both negative and postive symptoms of disorders such as schizophrenia.

Front 32

Conventional antipsychotic meds block what?

Back 32

Just the negative symptoms of disorders.

Front 33

Negative symptoms are?

Back 33

flat affect, lack of energy, decreased ADL's and apathy

Front 34

Postive symptoms are?

Back 34

hallucinations, delusions and thinking and behavior

Front 35

Which antipsychotic drug is most commonly used in an emergency?

Back 35

Haldol

Front 36

List the conventional Antipsychotic drugs

Back 36

Haloperidol (Haldol) most common
Thioridiazine (Mellaril)
Fluphenazine (Prolixin)
Trifluoperazine (Stelazine)
Chlorpromazine (Thorazine)

Front 37

List all the atypical drugs?

Back 37

Aripiprazole (Abilify) most common
Clozapine (Clozaril)
Ziprasidone (Geodon)
Paliperidone (Risperdal)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)

Front 38

EPS Extrapyramidal effects

Back 38

seen more in conventional drugs
*acute dystonia ( abnormal positioning or spasm of muscles of the head, neck, trunk or limbs)
*acute dyskinesia (any distrubance of movement)
*parkinsonism and akathisia ( motor restlessness characterized by masklike appearance, rigidity, tremors, "pill rolling" and log rolling

Front 39

When does the onset of EPS starts?

Back 39

Generally occurs after first week of treatment or before second month
(conventional meds)

Front 40

what would you give a patient experience EPS side effects?

Back 40

Anticholinergic such as cogentin or artane

Front 41

What is Tardive Dyskinesia?
(TD)

Back 41

**Seen in conventional meds.
Most frequent serious adverse effect resulting from termination of the drug, during reduction in dosage or after long-term, high-dose therapy.
*it's an involuntary rhytmic, stereotyped movements tongue protrusion, cheek puffing.
Earlier signs tongue movements and increased blinking
Later signs unusual mouth movements smacking lips
Not an emergencey
Give anticholinergic Cogentin or artane does not cure only helps the symptoms

Front 42

What is Neuroleptic Malignant syndrome (NMS)

Back 42

Rare sympton and is a medical emergency!
altered consiousness cataonia fever (up to 107 degrees) severe muscle rigidity and elevated CPK cardiac enzymes - always check for overdose.

Front 43

What are the long acting injectable meds?

Back 43

they are the conventional -
Haldol and proloxin
give an injection and can last up to 2-6 weeks great for patients who don't take their meds.

Front 44

Side effect of conventional antipsychotic meds

Back 44

orthostatic hypotension, dizzinessm tachycardia, weight gain, sleep distrubances, and EPS

Front 45

Ambilify

Back 45

"Activating" - then sedating atypical drug
lower risk for side effects

Front 46

Clozaril

Back 46

"Clinic" - given as a last resort when pt has failed two other trials with atyical drugs.
agranulocytosis (decrease of WBC<3500) occurs within first three months,
Pt must go to the clinic every week to have blood drawn if ok then is given the next week's dose.
side effect hypersalvation

Front 47

Geodon

Back 47

"Don has good heart" - Can interact with antihypertensives and other cardiac agents affects cardiac severly
monitor serum levels (K and Mg) and slowly titrate to avoid orthostatic hypotension
comes in PO and IM

Front 48

Risperdal

Back 48

"Rapid"
comes in wafer form "rapid dissolving tablet" also po and long acting IM

Front 49

Seroquel

Back 49

"Sedate" - sedating properties, reduces hostiliy ans aggression
often used with the elderly
side effects - dizziness, postural hypotension, sedating properties

Front 50

Zyprexa

Back 50

"Enzymes"
Just like Risperal comes in many forms PO, IM and the rapid acting wafer.
*Need to watch for elevated hepatic enzymes carefully use with clients with hepatic dysfunction
Can cause weight gain and increase risk of diabetes

Front 51

What are mood stablilizing agents?

Back 51

for treatment of bipolar disorder and mania
may enhance reuptake of serotonin and norepinephrine

Front 52

What is the dose for lithium?

Back 52

600-900 mg TID orally until serum levels are between 1-1.5 mEq/L

Front 53

What is the maintenance level for Lithium

Back 53

for maintenance serum levels should stay between 0.6-1.2 mEq/L must draw regular serum levels
blood is monitored at least 2 times a week once stabilized than drawn monthly.

Front 54

What is Lithium?

Back 54

Lithium is similar in chemical strucure to Na+ sodium. If Na intake is reduced (due to excessive sweating, fever, or diuresis) it is reasborbed by the kidneys, increasing he toxicity.
Therefore the client must consume a diet adequate in sodium and fliuds if Na intake is increased it causes more lithium to be excreted and may lower levels to non-therapeutic

Front 55

What are the ranges fir Lithium levels?

Back 55

Mild to Moderate 1.5-2.0 mEq
apathy,tinnitus, lethargic, drowsiness, nausea
Moderate to higher level 2.0-3.5
excessive output of urine, increasing tremors, muscular irritablity, psychomotor retardation
Higher level above 3.5
nystagmus, oliguia (little urine), anuria (no urine less than 100 ml a day)

Front 56

What does Lithium reuptake?

Back 56

norepinephrine and seroonin

Front 57

What do you teach patient taking Lithium?

Back 57

Take medication on a regular basis even when feeling well
maintain sodium intake
notify doctor of any vomitting or diarrhea or risk of being pregnant.

Front 58

What are the three mood stabilizing agents?

Back 58

Tegretol
Depakote
Lamictal
neurontin
topamax

Front 59

when do you use mood agents?

Back 59

When the pt dd not respond to lithium

Front 60

Tegretol

Back 60

Can cause life-threatening hepatic failure, sedation, nausea and vomiting
therapeutic range 50-100

Front 61

Depakote

Back 61

Often used with Lithium
therapeutic range of 50-100
side effects - prolonged bleeding time, drowisiness and sedation

Front 62

Lamictal

Back 62

not used often because associated with life threatning Stevens Johnson Syndrome

Front 63

What are antidepressants?

Back 63

For major depression, psychotic symptoms, alcoholism, schizophrenia and FDA approved for eating disorders

Front 64

What is the action of antidepressants?

Back 64

works ultimately to increase the concentration of norepinephrine, serotonin adn dopamine by inhibiting neuronal uptake of these neurotransmitters

Front 65

What are the side effects of antidepressants?

Back 65

high risk for withdrawal after abuse and tolerance
use only half the dosage in older patients with renal or hepatic dysfunction
withhold from patients with history of seizures
NOTE::BE ALERT TO SUDDEN LIFTS IN MOOD
increased energy may encourage patients to carry out suicidal ideations

Front 66

l'être (m.)

Back 66

human being

Front 67

List the SSRI's

Back 67

Celexa
Lexapro
Luvox
Paxil
Prozac
Zoloft

Front 68

What key points do you need to know about antidepressants?

Back 68

Unlike all other meds you can stop these
Results will start in 2-4 weeks
Never combine with another class of antidepressants
Be alert to sudden lifts in mood
these drugs work to increase concentration of all three transmitters - serotonin, dopamine and norepinephrine

Front 69

What is main reason people stop taking antidepressants

Back 69

weight gain
sexual dysfunction

Front 70

what are s/s of antidepressants

Back 70

mostly GI
anticholinergic - dry mouth- sedation
photosensitivy
sexual dysfunction
weight gain

Front 71

what antidepressant drug has to be tappered off

Back 71

wellbutrin

Front 72

MAOI what do you need to know

Back 72

Can not have Tyramine hypertension will occur
too much food restrictions
too much education
Nardil
Pamate
Marplan
SSRi's no restrictions that is much more used.

Front 73

TCA - Tricyclic Antidpressants

Back 73

Not first choice
Affects the cardiac system
you can overdose and have a heart attack
increased effects with halodol, SSRI's or valporic acid

Front 74

SSRI's what does it stand for?

Back 74

Selective Serotonin Reuptake Inhibitors
They increase serotonin

Front 75

SSRI's what do you need to know?

Back 75

First line of treatment for depression
Toxic reactions have occurred when use of MAOI
Never give two of the same class must taper one off first.
Weight gain and sexual dysfuction main reason pts stop

Front 76

Libruim (anti-anxiety med)

Back 76

most common for alcohol withdrawals

Front 77

Anxiolytics (Anti anxiety med)

Back 77

BuSpar
Ativan
Dalmane
Klonopin
Librium
Serax
Valium
Xanax

Front 78

which med in the anxiolytics is not a benzo?

Back 78

BuSpar
also you would give both a Buspar and a benzo and when buspar kicks in then stop benzo 10-12 days

Front 79

Benzodiazepines what do you check for before giving?

Back 79

Pt's history fop alcohol or drug abuse

Front 80

Valium

Back 80

Long lasting low dosage

Front 81

Zanax

Back 81

Short lasting high dosage

Front 82

Sedatives

Back 82

Ambien
Lunesta
Restoril
Sonata

Front 83

Barbiturates

Back 83

Amytal
Butisol
Seconal

Front 84

Sedatives, Barbiturates and anti anxiety you have to watch two things

Back 84

CNS depression
alcohol or drug use

Front 85

Meds for attention deficit disorder you would teach -

Back 85

give six hours before bedtime
and very constipating