1. 4 levels of anxiety
    • mild
    • moderate
    • severe
    • panic
  2. neurotransmitters
    monamines, amino acids, cholinergics, peptides
  3. monamines
    dopamine, norepinephrine, seratonin, histamine
  4. amino acids
    gamma-aminobutric acid (GABA)glutamate
  5. cholinergics
  6. peptides
    substance P, somatostatin, neurotensin
  7. dopamine effects
    attention, motivation, pleasure, reward
  8. norepinepherine works on
  9. serotonin works on
    obsessions and compulsions
  10. dopanine, norepinepherine and serotonin together effect
  11. norepinepherine and serotonin together affect
  12. Pysch drug classifications (5)
    • antianxiety and hypnotic drugs
    • antidepressants
    • mood stabilizers
    • anticonvuls
    • antsantipsychotic drugs
  13. antianxiety (axiolytics) and hypnotic drug ex's (5)
    • bensodiazepines
    • short acting sedative hypnotics
    • melatonin receptor agonists
    • burspirone
    • antidepressants
  14. antidepressant ex's (6)
    • tricyclic antidepressants
    • selective serotonin reuptake
    • serotonin - norepinephrine reuptake inhibitors
    • serotonin - norepinephrine disinhibitors
    • monoamine oxidase inhibitors
    • other antidepressants
  15. what diet to be on when on MAOI's
    tiramine free
  16. mood stabilizer and anticonvulsant ex's (7)
    • lithium
    • valproate
    • carbamazepine
    • lamotrigine
    • gabapentin
    • topiramate
    • oxcarbazepine
  17. when taking lithium you must?
    monitor closely because of low lethal dose
  18. when taking mood stabilizers and anticonvulsants monitor?

    can cause?
    amount in blood levels, CBC, and liver enzymes

  19. antipsychotics ex's
    • conventional - old block dopamine
    • atypical - effects are positive and negative - cause less of the Parkinson's looking SE and EPS
  20. other psychoparmacological drugs to consider (3)
    • ADHD
    • alzhiemer's disease
    • herbal treatments
  21. effects:
    fine muscle movements
    integration of emotions and thoughts
    involved with decision making
    stimulants hypothalamus to release hormones (sex, thyroid, adrenals)
  22. a decreases in dopamine causes

    an increase causes?
    Parkinson's disease and depression

    schizoprenia and mania
  23. effects mood, stimulates sympathetic branch of ANS for "fight or flight"
    norepinephrine (NE)
  24. a decrease in norepinephrine causes?

    an increase causes?

    mania, anxiety states, schizophrenia
  25. effects sleep regulation, hunger, mood states and pain perception and plays a role in aggression and sexual behavior
  26. a decrease in serotonin causes?

    an increase?

    anxiety states
  27. plays a role in inhibition, reduces aggression, exitation and anxiety; may play a role in pain perception; effects anticonvulsant and muscle-relaxing properties
  28. a decrease in GABA causes?

    an increase?
    anxiety disorders, schizophrenia, huntington's chorea

    reduction of anxiety
  29. plays a role in learning, memory; mood regulation, manic and sexual agression; stimulates parasympathetic nervous system
  30. a decrease in acetylcholine causes

    an increase causes
    alzheimer's disease, huntington's chorea, parkinson's disease

  31. effects alertness, inflammatory response, stimulates gastric secretion
  32. decrease in histamine causes
  33. dopamine blockage can cause
    movement defects such as - parkinsonian sx, akinesia, akathasia, tardive dyskinesia

    • increased prolactin - gynecomastia in men and
    • glactorrhea-amenorrhea in women
  34. examples of atypical antipsychotic drugs
    • clozapine (clozaril)
    • resperidone (risperdal)
    • quetiapine (seroquell)
    • olanzapine (zyprexa)
  35. few or no EPS sx and target the negative as well as the positive sx or schizoprenia; no motor side effects
    atypical antipsychotics
  36. adverse effects of lithium:
    nervous system and muscle
    • tremor, ataxia, confusion, convulsions
    • N/V/D
    • arrhythimias
    • polyuria, polydipsia, edema
    • goiter and hyperthyroidism
  37. antiepileptic drugs
    • carbamazepine (tegretol)
    • valproic acid/valproate (depakote)
    • clonazepam (klonopin)
  38. negative side effects of clozapine

    most dangerous

    most common

    • possibly fatal in 1-2% of pts b/c of potential to suppress bone marrow and induce agranulocytosis
    • potential for inducing convulsions in 3% of clients

    • drowsiness, sedation, hypersalivation, tachycardia,
    • and dizziness

    WBC's weekly
  39. negative side effects of risperidone
    motor difficulties, orthostatic hypotension, sedation
  40. negative side effects of quetiapine
    sedation and weight gain
  41. negative SE with valproic acid (depakote)

    what test to monitor?
    hepatic failure, birth defects

    liver function tests
  42. typical/standard antidepressants - tricyclic antidepressants
    • amitriptyline (elavil)
    • imipramine (tofranil)
    • nortriptyline (pamelor)
  43. negative side effects from TCA's

    serious SE
    blurred vision, dry mouth, tachycardia, constipation, sedation and drowsiness, urinary retention, and esphageal reflux, postural -orthostatic hypotension

    dysrhythmias, tachycardia, myocardial infarction, heart block
  44. examples of selective serotonin reuptake inhibitors (SSRI's)
    • fluoxetine (prozac)
    • sertraline (zoloft)
    • paroxetine (paxil)
    • citalopram(celexa)
  45. MAOI's
    • Phenelzine (nardil)
    • tranylcypromine (parnate)
  46. foods containing tyramine
    aged cheeses, pickled or smoked fish, yeast, beer, wine, soy sauce, bologna, liver, lunchmeat, smoked meats, figs, bananas, avocado, sauerkraut, soybean paste
  47. atypical/novel antidepressants examples
    • trazodone (desyrel)
    • nefazodone (serzone)
    • venlafaxine (effexor)
    • mirtazapine(remeron)
    • bupropion (wellbutrin)
  48. negative side effects of atypical/novel antidepresants
    • trazodone - orthostatic hypotension, priapism in males (painful continuous erectile state unrelated to sexual desires or activity)
    • venlafaxine- heightened anxiety, N/V and dizziness, abnormal ejaculation and impotence in males
    • mirtazapine - sedation, weight gain, dry mouth and
    • constipation; antimuscarinic effects are not as strong with this
    • bupropion- headache, insomnia, nausea and restlessness and rarely causes sedation, weight gain, or sexual dysfunction
  49. antianxiety/anxiolytic drugs
    • benzodiazepines
    • buspirone (buspar)
  50. Benzodiazepines
    • diazepam (valium);
    • clonazepam (klonopin);
    • alparazolam (xanax);
    • flurazepam (dalmane);
    • triazolam (halcion);
    • lorazepam (ativan)
  51. side effects of benzodiazepines
    • flurazepam and triazolam - hypnotic (sleep inducing) effect
    • lorazepam and prazolam - not soporific (sleep producing)
  52. Benzodiazepine toxicity/overdose
    S/S: physical; psychological
    Tx: If awake; Coma
    slurred speech, incoordination, unsteady gait, drowsiness, decreased BP; disinhibition of sexual or aggressive drives, impaired judgment, impaired social or occupational function, impaired attention or memory, irritability

    cardiovascular or respiratory depression or arrest, shock, coma, convulsions, death

    keep awake, induce vomitting, give activated charcoal to aid absorption of drug, VS q 15 min; clear airway - tube, IV fluids, gastric lavage with activated charcoal, frequent VS checks for shock and cardiac arrest after client is stable, seizure precautions, possible hemodiaysis or peritoneal dialysis, flumazenil (romazicon) IV
  53. caring for a pt with mild to moderate anxiety:
    DO NOT
    nurse's presence should be..
    focus and solve problems with use of open-ended q's, give broad openings, explore and seek clarification,

    close off topics, bring up irrelevant topics

    calm, willing to listen, recognize distress of pt

    past coping mechanisms, help pt to consider alternatives to situations, offer activities that may temporarily relieve tension
  54. nursing interventions for client with mild to moderate anxiety
    • identify anxiety
    • anticipate anxiety provoking situations
    • use nonverbal language to demo interest
    • encourage pt to talk about feelings
    • avoid closing off ave of comm that are imp to pt
    • clarify
    • help pt identify thoughts or feelings before onset of anxiety
    • problem solve
    • assist in devel alt solutions to prob through role play
    • explore behaviors that worked in past
    • provide outlets for working of excess enery: walking, exercises
  55. nursing interventions for pt with severe to panic anxiety
    • use firm, short and simple statements
    • maintain calm manner
    • remain with person in acute severe to panic anxiety
    • minimize environmental stimuli; move to quieter setting and stay with client
    • use clear and simple statements and repitition
    • use low pitched voice, speak slowly
    • reinforce reality if distortions occur
    • listen for themes in communication
    • attend to physical and safety needs when necessary
    • SAFETY: physical limits may need to be set
    • when a person is constantly moving or pacing, offer high caloric fluids
    • assess person's need for meds or seclusion after all other interventions are unsuccessful
  56. client and fam teaching for SSRI's
    - inform nurse or MD if:
    - should not take within 14 days of...
    - should not take any new...
    - avoid...
    - should have what tests regularly?
    - report immediately
    - DO NOT?
    • cause sexual dysfunc, insomnia, anxiety, nervousness, let them know what meds you are on for interactions,
    • MAOI
    • OTC drugs
    • ETOH
    • liver and reval func tests and CBC's periodically
    • rash, hives, rapid HR, sore throat, diff urinating, fever, malaise, anorexia, wt loss, unusual bleeding, initiatvion of hyperactive behavior, severe HA
    • D/C abruptly
  57. client teaching for TCA's
    - effectiveness begins
    - SE that will subside
    - avoid
    -take when
    - forgotten dose
    - DO NOT
    • begin to work in 7-28 days for; may take 6-8 wks for full effect
    • drowsiness, dizziness, and hypotn; after first few weeks
    • ETOH
    • at bedtime
    • take within 3 hrs; otherwise wait for next day
    • D/C - will cause N/V, altered HR, nightmares, cold sweat in 2 to 4 days
  58. avoid tyramine when taking
  59. Hamilton Rating Scale
    - scoring
    • 0=none
    • 1=mild
    • 2=moderate
    • 3=disabling
    • 4=severe, grossly disabling
  60. aspects of hamilton rating scale
    • anxious mood
    • tension
    • fear
    • insomnia
    • intellectual (cognitive)
    • depressed mood
    • somatic (sensory)
    • somatic (muscular)
    • cardio sx
    • resp sx
    • gastro sx
    • genitourinary sx
    • autonomic sx
    • behavior at interview
  61. mature defenses
    - altruism
    - sublimation
    - humor
    - suppression
    emotional conflicts and stressors are dealt with by meeting needs of others

    unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form

    deals with emotional conflicts or stressors by emphasizing the amusing or ironic aspects of conflict or stressor through humor

    conscious denial of deisturbing situation or feeling
  62. Neurotic (intermediate) defenses
    exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness

    transfer of emotions assoc. with a perticular person, object, or situation to another person object or situation that is nonthreatening

    overcompensation - unacceptale feelings or behaviors are kep out of awareness b developing opposite behavior or emotion

    transforming anxiety on an unconscious level to physical sx that has no organic cause

    makes up for an act or communication (compulsive handwashing)

    justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations
  63. immature defenses (personality disorders)
    - passive aggression
    - acting out
    - dissociation
    - devaluation
    - idealization
    - splitting
    - projection
    deals with emotional conflict or stressors by indirectly and unassertively expressing aggression towards others.

    deals with stress with actions

    disruption in the usually integrated fx of consciousness, memory, identity, or perception of environment

    attributing neg qualities to self or others

    attributing exaggerated positive qualities to others

    inability to integrate pos and neg qualities of oneself or others

    rejects emotionally unaceptable person features and attributes them to other people
  64. psychotic (severe) defenses
    - denial
    escaping unpleasant realities by ignoring their existance
Card Set
Study Guide Psych test 2