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What are positive symptoms of Schizophrenia?
- Are characterized by CNS stimulation and include agitation, delusions (imagination that someone is working w me to do something), hallucinations (perception of stimulation w/o the stimulus), insomnia, and paranoia (a fear or something).
- A-D-H-I- P = agitation-delution-hallucination-Insomnia-paranoia.
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What are negative symptom in schizophrenia?
- Are characterized by lack of pleasure, lack of motivation, blunted affect (talking make a joke and they don't laugh), poverty of speech.
- P-M-B-P
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What is psychoses?
- Psychoses is a major emotional disorder w impairment of mental functioning.
- Hallmark: loss of contact w reality.
- Schizophrenia is a type of chronic psychosis.
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what are the therapy goals in schizophrenia? How long do they take to work? what kind of medicine is it used?
- Normalize patterns of sleeping and eating.
- Increase ability to self care and socialization.
- It takes around 2 months for these therapeutic effects.
- Meds: antipsychotic meds.
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What type of antipsychotics are there? describe their functionality and side effects.
- There are two types: First generation antipsychotic (FGAs) and Second generation antipsychotic (SGSs)
- First generation antipsychotic (conventional antipscychotics): block dopamine receptors in the CNS, and cause serious movement disorders or EPS -- also 10x less expensive than SGAs.
- Second generation antipsychotics (atypical antipsychotics) : Moderate blockage of dopamine, but stronger blockage of serotonin -- Produce less extrapyramidal symptoms (EPS) but produce risk of metabolic effects.
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What are extrapyramidal symptoms (EPS)? which generation are the more associated with?
- EPS: acute dystonia, Parkinsonism, Akathisia, Tardive Dyskinesia.
- Acute dystonia: Abnormal muscle tone causing spasms of tongue, face, neck. EX: girl hyperextending the neck-- concern abt constricting the air way.
- Parkinsonism: ... concerns of falls.
- Akathisia: motor restlessness (moving a lot like Michael fox -- concern abt hitting others or themselves.
- Tardive Dyskinesia: Involuntary movement of mouth, tongue, trunk, extremities; chewing motions, sucking -- it is not like spasms, this are constant.
- EPS are associated more with first generation antipsychotics.
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What are Depot preparations drugs for schizophrenia or psychotic pts?
What are some common interaction to watch for with conventional antipsychotic drugs?
- They are injections for ppl that don't take their meds and refuse pills.
- DI: anticholinergic drugs, CNS depressants (opioids and alcohol), levodopa and direct-receptors agonist (may counteract the antipsychotic effect)
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What are some low-potency Agents antipsychotic meds? first generation.
Side effects?
- Chlorpromazine (thorazine) and Thioridazine (Mellaril)
- They are low potency but high sedative effect, hypotension, photosensitivity.
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What are conventional antipsychotic agents classes? (first generation)
- Low-potency agents.
- Medium-potency agents.
- High-Potency agents.
- Depot preparations.
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High-potency conventional drugs? side effects?
- Drugs: Haloperiodol (Haldol), Fluphenazine (prolixin), Trifluoperazine (stelazine).
- SE: Low sedative effect, low incidence of hypotension, extrapyramidal side effects (EPS)
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What are some atypical antipsychotic agents? Common characteristics of this group?
- Drugs: Clozapine (clozaril) and other atypical antipsychotic (Risperidone (Risperdal), Olanzapine (zyprexa), Quetiapine (seroquel), Ziprasidone (geodon), Aripiprazole (abilify))
- C-R-Z-S-G-A (cruze sega)
- Char: Less risk of EPS that FGAs, More is of weight gain, diabetes,and dyslipidemia.
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Clozapine (Clozaril) MA? TU? AE?
- MA: blocks dopamine and serotonin.
- TU: Schizophrenia.
- AE: agranulocytosis (knocks down the WBC, pt come to the hospital w a fever), seizures, diabetes, weight gain, myocarditis.
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Risperidone (risperdal) MA? TU? AE?
- MA: Binds to multiple receptors.
- TU: schizophrenia.
- AE: generally infrequent and mild.
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Olanzapine (zyprexa) MA? TU? AE?
- MA: blocks 5-HT2 receptros, and blocks D2 receptos.
- TU: Schizophrenia, and Bipolar disorder.
- AE: Not a lot of AE.
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Quetiapine (Seroquel) preparations, dosage and administration?
Schizophrenia dosage, and Bipolar disorder dosage.
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Ziprasidone (Geodon) MA? Preparation, dosage, and admin?
- MA: blocks multiple receptors D2, 5-HT2, H1.
- PDA: Schizophrenia IM. Bipolar disorder
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Aripiprazole (abilify) Chrs? MA?
- Contrasts w other atypical antipsychotic agents.
- MA: block multiple receptors.
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what antipsychotic drugs can be given IM?
- Haloperidol (Haldol)- 1st gen
- Fluphenazine (Prolixin) - 1st gen
- Risperidone (risperdal) - atypical
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What are some common characteristics of Tricyclic antidepressants? SE? Most dangerous SE? MOA? PK? DI?
- Drugs of first choice for many patients with major depression.
- Used for depression, angry, insomnia.
- May increase risk of suicide early in treatment.
- SE: Sedation, increased appetite, take dose at bedtime, orthostatic hypotension, and anticholinergic effects.
- MDSE: Cardiac toxicity (doesn't happen often, unless they overdose)
- MOA: Blocks neuronal reuptake of tow monoamine transmitters (Norepinephrine and Serotonin)
- PK: Usually single daily dose. Long and variable half-lives.
- DI: all other antidepressant, anticholinergic agents, and CNS depressants.
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What are the CM for toxicity of Tricyclic antidepressants? Treatment for those? to what type of pts should this drug be rx to?
- Dysrhythmias, tachycardia, IV blocks, complete atrioventricular block, ventricular tachycardia, ventricular fibrillation.
- Tx: Gastric lavage, ingestion of activated charcoal, etc.
- RX: to depressed pts that can't sleep. Pt. should take meds at night before going to sleep.
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Selective Serotonin Reuptake Inhibitors (SSRIs) characteristics? Common drug? what type of pt should this drug be rx? MA? TU? SE? DI?
- Most prescribed antidepressant bc they DO NOT cause hypotension, sedation, or anticholinergic effects.
- Drug: Fluxetine (Prozac, Sarafem); Sertraline (zoloft), escitalopram (lexapro). Paxil.
- RX: to pts that are depressed and sleepy.
- MA: Inhibits serotonin reuptake and produces CNS excitation (like overconsumption of alcohol)
- TU: Major depression, Obsessive-compulsive disorder (OCD), Bulimia nervosa, and premestrual dysphoric disorder.
- SE: take in the am to avoid insomnia, and urinary retention (only anticholinergic effect), sexual affect,
- DI: MAOIs, warfarin, Tricyclic antidepressants and lithium.
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what are S/NRIs? drugs? SE? what type of pt should this drugs be rx to? meds interactions?
- Serotonin/Norepinephrine Reuptake Inhibitors (S/NRIs)
- Drugs: Venlafaxine (effoxor), Duloxetine (cymbalta)
- SE: Diastolic HTN, hyponatremia (in elderly) -- However, if HTN is present, then HTN meds is added, the anti depression med is not taken out.
- RX: sleepy type of pt, bc we want to excite them a little.
- DI: Alcohol and MAO inhibitos, and other antidepressants.
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What are MAO inhibitors? characteristics? drugs? MOA? TU? AE? what type of pt should it be RX? at what time should pt take drug? DI? what foods contain Tyramine?
- Monoamine Oxidase inhibitors (MAOIs)
- Chs: 2nd or 3th choice for the pts -- as effective as TCAs or SSRIs, but more dangerous. -- Risk of HTN crisis when eating foods rich in Tyramine.
- Drugs: Tranylcypromine sulfate (Parnate), Phenelzine sulfate (Nardil) 2 most common used, Isocarboxazid.
- MOA: inactivates MonoAmine neurotrasmitters (NE, serotonin, and Dopamine).
- TU: Depression, Bulimia Nervosa, OCD, panic attacks.
- AE: CNS stimulation (usually ppl don't take coffee), Orthostatic Hypotension, Hypertensive crisis (tyramine).
- RX: sleepy pt, pt should take drug in the morning.
- DI: Antihypertensive drugs, Meperidine, interactions secondary to inhibition of hepatic MAO, indirect-acting sympathomimetic agents (ephedrine)
- Foods: aged cheese, fermented meat (pepperoni, salami, bologna), liver, yogurt, yeast (bread), beer, wine, sour cream, pickle products (beats, tomatoes), avocados, bananas, figs, raisins.
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What are the nursing Implications for MAOI's?
- Avoid tyramine foods.
- Avoid caffeine, antihistamines, and amphetamines.
- Avoid Triclyclics. (TCAs)
- Monitor vital signs.
- Wear sunblock (usually recommended for all the antidepressants)
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What is Selegiline (Emsam)?
It is a transdermal MAOI. Used for depression.
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What are some atypical antidepressants? Action and uses?
- Bupropion (wellbutrin): acts as stimulant and suppresses appetitte -- doesn't cause weight gain -- increases sexual desire and pleasure.
- Wellbutrin is usually a drug that is added when in other antidepressants.
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What is the drug therapy for Bipolar disorder? Characteristics?
- DT: Mood stabilizers. to relieve and prevent symptoms when in manic and depressive episodes. -- use antipsychotics (manic episodes) and antidepressants (depressive episodes).
- Chs: Ppl w BPD tend to have less gray matter.
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What is a common drug used for BPD? MOA? PK? AE therapeutic range? DI?
- Lithium.
- MOA: alters synthesis and release of norepi, serotonin, and dopamine.-- Mediates intracellular responses to neurotransmitters -- can increase total gray matter in regions known to atrophy in BPD.
- PK: excreted in the kidneys -- It is affected by the levels of sodium, therefore, pts in lithium should avoid fast food, can goods, and keep a normal level of sodium.
- AE: narrow TR (0.5 to 1.5 mEq/L) KNOW THI VALUE.
- DI: Diuretics, NSAIDs, and anticholinergic drugs.
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What are some common anti epileptic drugs?
- Valproic acid (depacon, depakene, depakote) --> targe 50-125 mcg/mL
- Carbamazepine (tegretol)--> 5 to 12
- Lamotrigine (Lamictal)--> indicated for long-term maintenance.
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What are some common Sedative-hypnotic drugs?
- Benzodiazepines
- Benzodiazepine-like drugs.
- Barbiturates.
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Benzodiazepines most common drug? drugs? chs? Benz vs Barbiturates? AE? DI? Acute toxicity (overdose)?
- Diazepam (valium)-- Most of the drugs end in -PAM (Pam helps us go to sleep).
- drugs: Diazepam (Valium), alprazlam (xanax), lorazepam (ativan).
- Chs: safer than CNS depressants -- high potential for abuse -- fewer drug interactions.
- VS: benzos are safer, but less potent than barbiturates.
- AE: CNS depression (but not like opioids), by themselves will not cause a person to stop breathing, abuse, tolerance and physical dependence.
- DI: CNS depressants, alcohol, opioids. (need to be cautious).
- AT: oral overdose use REMAZICON (Parentally). if opioids, use narcan or nalaxon.
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Benzodiazepine-like drugs?
Drugs: zolpidem (ambien), zaleplon (sonata), eszopiclone (lunesta).
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what are the classes of barbiturates? MOA? AE? TU?
- Ultrashort-acting (thiopental), short-to- intrmediate-acting (secobarbital), and long-actin (phenobarbital)
- MOA: bind to the GABA receptor-chloride channel complex.
- AE: Respiratory depression, CNS depression, cardiovascular effects, tolerance, physical dependence,
- TU: Seizures disorders, induction of anesthesia, Insomnia.
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What are some common CNS stimulants and ADHD?
Amphetamines, Methylphenidate and dexmethylphenidate, methylxanthines (caffeine), Miscellaneous stimulants.
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Amphetamines MOA? AE? toxicity? TU? Drugs?
- MOA: Release norepi (NE) and Dopamine (DA).
- AE: CNS stimulants , weight loss (be careful in kinds), Cardiovascular effects (increase HR, and BP), Psychosis (sitting in a class, not even moving).
- Toxicity: dysrhythmias, HTN, Dizziness, etc
- TU: ADHD, narcolepsy, Obesity (not recommended due to risk for abuse)
- Drugs: amphetamine/dextroamphetamine mixture (aderall and aderral-XR), Lisdexamfetamine (vyvanse), Methylphenidate (concerta/retalin)
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Methylphenidate and dexmethylphenidate drugs? Pharmacology?
- Ritalin and Focalin.
- Pharm: Almost identical to amphetamines.
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Methylxanthines derivates? drugs? MOA? PE? PK? TU? acute toxicity?
- Derivates: Xanthine.
- Drugs: Theophylline (used in asthma), Theobromine, caffeine and dietary sources (chocolate, desserts, soft drinks, cola nut).
- MOA: Reversible blockade of adenosine receptors.
- PE: CNS, Heart, Blood vessels, etc.
- PK: absorbed in the GI tract, eliminated by hepatic metabolism.
- TU: neonatal apnea, promoting wakefulness.
- AT: stimulation of the CNS, tachycardia, respiratory stimulation, sensory phenomena.
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ADHD management overview? what are the 5 most important things when assessing a pt w ADHD?
- Cognitive therapy and stimulant drug.
- Could also use Tricycle antidepressants (make the person sleepy) Bupropion (wellbutrin).
- 5 things: High and weight, HR and BP, sleep.
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types of anxiety disorders? drugs use?
- Generalized anxiety disorder (GAD): non-drug approach first -- Benzos, nonbenzos Buspirone (BuSpar) which is kind of a CNS stimulant. -- Paroxetine (paxil) or Escitalopram (lexapro) -- kava or melatonin.
- Panic Disorder: antidepressants (SSRIs, Tricyclic antidepressants, MAOIs) or Benzos.
- OCD: SSRI
- Social anxiety disorder (social phobia), post-dramatic stress disorder (PTSD): usually use SSRI first line and TCAs depends on the pts's response.
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What is the Drug of choice for older adults?
- DOC: SSRIs.
- TACs aggravate conditions in older adults (orthostatic hypotension and anticholinergic effects)
- MAOIs cause HTN crisis (tymanine)
- Older adults have higher serum levels bc of the albumin protein.
- Lithium is more toxic in older adults.
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Most important Nursing implications?
- Always assess risk of suicide.
- Monitor Vital signs and weight.
- Avoid OTCs.
- Avoid alcohol.
- Avoid driving if drowsy.
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