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98 Cards in this Set

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  • Back
what is psychosis
severe emotional disorder that often impairs mental function to the point of significant disability regarding ADLs. A hallmark of psychosis is a loss of contact with reality.
what are affective disorders
mood disorders) are characterized by changes in mood and range from mania to depression. Bipolar disorder.
what is anxiety
unpleasant state of mind chiefly characterized by a sense of dread and fear.
common symptoms of depression
feelings worthless, losing interest in most normal daily activities, increase or decrease in appetite, insomnia
what is OCD
what a person does the same thing over and over again loke washing hands
what is posttramatic stree syndrome
when they have a bad life altering experience like going to war, polio, raped
what is generalized anxiety disorder
people experience more than normal anxiety day to day
what is panic disorder
intense fear of something which makes you have physcial effects
what is social phobia
dont want to be around people
what is simple phobia
any phobia a person may have
what is the biochemical concept of mental illness
Abnormal levels of endogenous chemicals in the brain known as neurotransmitters
Catecholamines – dopamine, norepinephrine
Indolamines – serotonin and histamine
GABA – gamma-aminobutyric acid
and various inorganic ions-K,Na, and Mg
what are benzodiazepines?
anxiolytic effect by depressing activity in the brainstem and limbic system. Increase the GABA Action and have specific receptor binding sites.
what are antihitamines
sedating effects (Atarax and Vistaril). benedryl
what are misc antianxiety drugs
BuSpar (non-sedating and non-habiting forming).
waht do benzodiazepines govern the release of
GABA which causes sedation and muscle relaxation
what is the anthistamine hydroxyzine most commonly used for
what are the 2 salt forms of antihistamines
hydrochloride-atarax adn hydroxyzine pamoate-vistaril
side effects of anti-anxiety drugs
sedative, hypnotic, appetite stimulation, analgesic, and anti convulsion effects
what else do anti-anxiety drugs treat
sedation, muscle relaxation, contol seizures, depression, alcohol withdrawl
what else to midazolam used for
sedative and anestheic during invasive painful medical procedures, also used in the ICU to control anxiety and agitation
side effects of anti-anxiety
hypotension, in pedi/adolescent hyper activity and aggressive behavior, increase seizure frequency, and haibit forming and addictive
extreme cases of OD use what drug for TX
physostigmine in normal toxicity use syrup of ipacac, gastic lavage, activated charcoal, saline cathartic.
what are S/S of OD on anti-anxiety drugs
somnolence, confusion, coma, respiratory depression
most common, used for anxiety, alcohol withdrawl, and seizure disorders, sedation, muscle spasms, liver dysfunctions bc it is metabolized in the liver
short-term releif of anxiety, perop medication, chemothearpy-related nausea and vomitting and acute alcohol withdrawl
depression, panic, and aniexty
seizures and panic
alcohol withdrawl, anxiety, preop sedative drug
only IV for moderate sedation, gives amnesia is minor surgery
what is physostigmine - cholinergic
Used for overdose of antihistamines
Used for overdose of tricyclic antidepressants
IV – 0.5 – 3mgs (do not give faster than 1mg/min)
what is romazicon
used for benzodiazepine overdose
0.2 mg over 15 seconds and may repeat 0.2 mg every 60 seconds for 4 additional doses or a cumulative dose of 1 mg.
what is elavial
given IV goes sright to brain, give in small doese, narrow thearpeutic range
what is effected in a person with mania
dopamine, notepinephrine, serotonin
narrow range of therapeutic index
Very Toxic – must have lab work
Maintenance ranges are 0.6 – 1.2 mEq/L
Mania – levels can be 1.0 to 1.5 mEq/L
Half-life is 18-24 hours
Many medications used in conjunction to lithium (valporic acid, ACE inhibitors).
Recommend po dose of lithium is 600-1200 mg/day.
Difficult for compliance because do not like the “down” feeling.
what are s/s of OD on lithium
GI discomfort, tremor, confusion, somnolence, seizures, death, drowiness, slurred speach, epileptic-type seizures, wavelike muscle movements, disturbed muscle coordination, hypothyroidism
what is an alternative to lithium usually in elderly
valproic acid bc it has a narrow therapeutic index
anti-depressants are useful in treating
dysthymia, schizophrenia, eating disorders, personality disorders, and bipolar disoder
what is biogenic amine hypothesis
that depression results from a deficiency or neuronal and synaptic catecholamines and mania from an excess of amines at the adrenergic receptor sites in the brain
what is premissive hypothesis
reduces concentrations of serotonin as the predisposing factor in patients with affective disorders
what is dysregualtion hypothesis
views depression and affective disorders
if you have a nonresponse to atleast to trails you are
treatment resistant depression and you made need to add a second drug
black box warning
In 2005 – Regular monitoring for worsening depressive symptoms
Monitoring of suicide ideations
what are the first SSRI's
Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, & Cymbalta
what are the second generation antidepressants
Desyrel and Wellbutrin
what is the third generation antidepressants
Effexor, Remeron
what is good about SSRIs
Less side effects than tricyclic drugs and MAOIs. SSRIs have little or no effect on the Cardiovascular system.
Inhibit serotonin reuptake and have weak effects on norepinephrine and dopamine reuptake
sertaline inhibit what
inhibits serotonin
nefazodone and trazodone inhibit what
serotonin and norepinephrine reuptake
how does mirtazapine work
promoting presynaptic release of norepinephrine and serotonin
The three classed of new generation antidepressants treat what
depresssion, BPD, obesity, eating disorders, PTSD, panic attacks, social aniexty disorder, and neurological disorder, alcohol dependance
what are side effects
Weight gain
Sexual dysfunction
chest pain
on EKG prolong QT
what is serotonin syndrome signs
delirium, agitation, tachycardia, sweating, muscle spasms, hyperreflexia, shivering, coarse tremors, and extensor plantar muscle spasms.
fluoxetine-prozac, sarafem
150-450mg bid or tid
10-80mg qd bid
depression, OCD, bulimia, prementral dysphoric disorder
25-200mg qd
depression, OCD, panic disorder, PTSD
10-50mg qd
depression, OCD, panic disorder, social anxiety disorder, GAD
20-40mg qd
10-20mg qd
depression, general anxiety disorder
depression, and pain from diabetic neuropathy
what are tricyclic antidepressants
correct the imbalance in the neurotransmitter concentrations or serotonin and norepinephrine at nerve endings by blocking reuptake of neurotransmitters
what do TCAs inhibit and block
norepinephrine and serotonin and block muscarinic, histaminergic, adrenergic, dopaminergic, and serotonergic receptors
what are TCAs good for treating
bedwetting in children, OCD, pain syndromes,
side effects of TCAs
sedation, impotence, orthostatic hypotension, cardiac conduction, alter seizure threshold, elderly suffer more from dizziness, postural hypotension, constipation, delayed micturation, edema, and muscla tremors
they are highly lethal, multiple doses of activated charcoal, sodium bicarbonate speeds up elimination, antidysrhythmics
elavil and endep
effect heart and cause lethal dysrhythmias and seizures
15-300mg divided
elderly 100-150mg divided
what are MAOIs
1st generation of antidepressants but have move to the last of the line
Very toxic and many side effects
Nardil and Parnate
Interact with food containing tyramine and cause hypertensive crisis
Can not use Demerol with MAOIs – hypertensive crisis long half life remains in body 2wks
MAO-A metabolizes
serotonin, norepinephrine, and tyramine
MAO-B metabolizes
inital does 45-90mg tid, followed by dose reduction
depression and panic disorders
20-60mg divided bid
s/s of OD of MAOIs
tachycardia, circulatory callapse, seizures, coma, hyperthermia annd miosis
TX of OD of MAOIs
gastric lavage, urine acidification, and hemodialysos
what antipsychotic drugs
treat serious mental illness such as depressice and druf induced psychoses, schizophrenia, and autism,extreme mania, BPD, certain movement disorders
what are phenothiazine
Phenothiazines are the largest group of antipsychotic drugs.
Block dopamine receptors in the brain, thus decreasing the dopamine concentration in the CNS.
side effects of phenothiazines
agranlocytosis and hemolytic anemia, exfoliative dermatitis, drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, tardive dyskinsea.
what three groups are phenothiazines divided into
aliphatic, peperidine, adn piperazine
what are phenothiazine used to treat
thioxanthenes, butyrophenones, dihydroindolones, and dibenzoxazepines
second generation antipsychotic
have different mechanisms than first gen. block dopamine 2 and serotonin 2 receptors
first generation antipsychotic disadvantage
cause extrapyrmidal symptoms rigidity, tremor, bradykinesia and bradyphrenia
what is neuroleptic malignant syndrome
life-threatening adverse effect that may include high fever, unstable blood pressure, and myoglobienmia.
what is extrapyramidal symptoms
involuntary motor symptoms similar to pseudoparkinsonsism
what is tardive dyskinesia
late onset of contractions of oral and facial muscles, involuntary tongue thrusting and wave like movement of the extremities. Usually after long term therapy.
what are ocular effects of antipsychotic
blurred vision. corneal leans changes, epithelial keratopathy, pigment retinopathy
what are other side effects of antipsychotic
postural hypotension, EEC changes long QT waves
what are the antipsychotic drug interactions
Antacids decrease absorption
Antihypertensive have an added effect
CNS depressants have an added effect
Tannic acids (tea, grapes, wine) decrease absorption
what are the antipsychotic drugs
alipatic phenothiazine
adult 25-500mg
pedi IV or IM 0.5-1mg q6-8hrs
piperidine phenothiazine
adult only PO 0.5-20mg IM 1.25-10mg
xadult PO IM 0.5-5mg
pedi PO 25-50mg IM 2-5mg q1h
PO 10mg bid up to 250mg
IM 12.5-50mg q4-6h
PO 50-225mg divide doses
2mg tid to 60mg
atypical antipsychotic drugs
25-900mg divide larger doses
psychotic disorder
PO 1-8mg IM 25-50 every two weeks
psychotic disorder
schizophrenia, bipolar mania
25-800mg divide large doses
10-30mg once daily
schizophrenia, bipolar mania