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How many stages of sleep is there?
4 phases
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What are the characteristics for phase 1 sleep? (6)
- 1. begins soon as the suns sets
- 2. pineal gland begins to produce melatonin (hormone released in the absence of light)
- 3. muscles relax
- 4. heart rate and breathing slow down
- 5. body temperature drops
- 6. the brain relaxes but is still alert
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What is the characetriatic for stage 2 sleep?
layer stays still for about 10-15 minutes
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What are the 2 characetristics for phase 3 sleep?
- 1. a deeper sleep
- 2. lasts about 5-15 minutes
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What is phase 4 sleep also called?
REM sleep
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What are the characteristics for phase 4 sleep?
- 1. lasts a half hour or so
- 2. REM occurs
- 3. dreams occur
- 4. when dreams end, starts back at phase 2 and the process over again (abotu 5 times repeated through the night)
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The average sleeper will sleep how long uninterrupted?
8 hours and 15 mins
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What are barbiturates? (3)
- Drugs which exert a depressant effect, often prescribed to:
- 1. promote sleep
- 2. prevent seizures
- 3. induce anesthesia
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What does a barbiturates often end with?
-barbital
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What do barbiturates interfere with?
the sleep cycle
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barbiturates are quite toxic, so?
there is a high risk of death with overdose.
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What are the two types of barbiturates that deal with how fast the drug works?
- 1. short-acting
- 2. long-acting
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With barbiturates, dependence is possible, and a rapid withdrawal leads to?
seizures, death (should wean off instead)
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What are Benzodiazepines?
drugs which exert a depressant effect in the CNS
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Benzodiazepines are often used to reduce what? and promote what?
- reduce anxiety
- promote sleep
- EX: VALIUM
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(Benzodiazepines) little interference with REM causes what?
little drowsiness
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(Benzodiazepines) little interactions with other what?
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(Benzodiazepines) can accumulate in body and cause what? leading to what?
- serious withdrawls (taper off gradually)
- leading to seizures
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(Benzodiazepines) may cause what? (4)
- 1. excitement
- 2. oversedation
- 3. respitatory suppression
- 4. decrease BP
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Benzodiazepine drug names end in what?
"-am"
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What is the antidote/antagonist for benzodiazepines?
flumazenol (Rumazicon)
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What are non-benzodiazepines?
newer drugs to promote sleep (EX:LUNESTA, AMBIEN)
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Clients taking ambien may get dependent on it?
yes (non-benzodiazpines may still cause dependence)
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What are 2 other names for alcohol?
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What are psychotropic drugs?(3)
- agents which are used to treat emotional or psychiatric conditions such as:
- 1. anxiety
- 2. psychoses
- 3. affective disorders
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What is another name for antianxiety agents?
anxiolytics
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What are the 4 classes of antianxiety agents?
- 1. barbiturates
- 2. carbamates
- 3. antihistamines
- 4. benzodiazepines
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What are anxiolytics?
drugs to treat affective disorders, usually by affecting neurotransmitter levels in the brain
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What are 2 facts about antidepressants?
- 1. may take weeks to show improvement
- 2. often interfere with libido
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What are the side effects of tricyclic antidepressants? (4)
- 1. sedation
- 2. irregular heart rate
- 3. increased P
- 4. anticholinergic effects (dry mouth, trouble voiding)
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What are tricyclic antidepressants used to treat?
OCD
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What does MAO inhibitors stand for?
monoamine oxidase inhibitors
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What are MAO inhibitors?
drugs that inhibit the enzyme MAO that destroys neurotransmitters
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MAO inhibitors have many side effects and drug/food interactions, so?
are not used if other options are available
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What kind of food should clients on MAO inhibitors avoid? (1) why? (2)
- foods high in tyramine because it can interact and cause:
- 1. high BP
- 2. CVA
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What does SSRI stand for?
selective serotonin reuptake inhibitors
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What are SSRI's?
drugs that allow levels of seratonin to rise, thus improving depression (EX:lexapro, prozac, and paxil)
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What are antipsychotic agents? (3)
- drugs that are used mainly to treat psychiatric conditions such as:
- 1. schizophrenia
- 2. bi-polar disorder
- 3. psychoses
- probably by reducing the levels or effects of dopamine on the brain.
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What do antipsychotic agents usually end with?
-azine
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What kind of symptoms do antipsychotic agents cause?
extrapyramidal symptoms (EPS)
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What are extrapyramidal symptoms? (4)
- 1. uncontrollable, involuntary muscle jerking
- 2. spasms
- 3. uncoordinated gait (leg movements)
- 4. lip smacking, chewing movements
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What is a type of extrapyramidal symptom?
tardive dyskenesia movements
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When do tardive dyskenesia movements occur?
with long term use of antipsychotics. MAY BE IRREVERSIBLE
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What is lithium?
drug for treating bi-polar disorders, unknown method of action
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Clients on lithium need?
regular blood work to assess lithium levels
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Cleints should not take lithium if?
they are pregnat or nursing
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What are 2 S&S of lithium?
- 1. DOES NOT cause sedation
- 2. metallic taste
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What are the S&S of lithium for levels between 1.0 MEQ/L and 2.0 MEQ/L? (5)
- 1. nausea
- 2. vomiting
- 3. muscle weakness
- 4. drowsiness
- 5. loss of coordination
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What are the S&S of lithium for levels between 2.0 and 3.0 MEQ/L? (12)
- 1. agitation
- 2. ataxia
- 3. blurred vision
- 4. confusion
- 5. dizziness/vertigo
- 6. increased loss of muscle coordination
- 7. myoclonic twitching
- 8. hyperreflexia
- 9. hypertonia
- 10.slurred speech
- 11. tinnitus
- 12. urinary or bowel incontinence
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What are the S&S for lithium levels greater than 3 MEQ/L? (6)
- 1. arrhythmias/dysrhythmias
- 2. coma
- 3. hypotension
- 4. peripheral vascular collapse
- 5. seizures
- 6. stupor
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What are the general considerations for antianxiety agents and sedatives and hypnotics? (7)
- WATCH:
- 1. vital signs
- 2. levels of consciousness/sedation
- 3. dizziness
- 4. mood/suicide ideations
- 5. side effects reported by patients
- 6. stop only with physcian approval & often gradually wean off
- 7. no alcohol, or similar drugs
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What does A+Ox3 mean?
alert and oriented to person, place, and time
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What is ADD?
does not show hyperactiivity behaviors, but causes interference with ability to focus and may benefit with medication
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What is ADHD?
has problems with focusing along with hyperactivity, impulsive, constantly "wired" behavior
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What do peoople with ADD and ADHD respond well to?
CNS stimulants (withdraw gradually)
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What are the main side effects of CNS stimulants? (4)
- 1. slowed growth
- 2. GI upset
- 3. dry mouth
- 4. cardiac problems
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What should be avoided when a person is on CNS stimulants?
caffeine
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Many CNS stimulants are sustained release so?
DO NOT crush
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what is very helpful when a person is on CNS stimulants?
feedback from teacher
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CNS stimulants are contraindicated in those with?
substance abuse history
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What is alzheimer's disease?
Chronic, progressive neurological disorder
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What is alzheimer's disease characterized by? (4)
- 1. decline in cognitive function
- 2. neurofibrillary tangles
- 3. plaques in brain
- 4. decrease Ach levels
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IS Alzheimer's curable?
no, but there are drugs to slow its progression.
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Most Alzheimer's drugs work to?
increase Ach levels in brain
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In later stages, (Alzheimer's) sedative may be required to? (2)
- 1. reduce agitation
- 2. assist caregivers
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What are the drugs used for musculoskeletal disorders? (3)
- 1. Neuromuscular blocking agents
- 2. Skeletal muscle relaxants
- 3. skeletal muscle sitmulants
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What are neuromuscular blocking agents?
drugs which cause paralysis skeletal muscles (but not smooth or cardiac muscle) by interfering with normal Ach binding (drug blocks the receptors to Ach)
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What route are neuromuscular blocking agents usually given?
IV
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What is the precaution for neuromuscular blocking agents?
may interact with certain antibiotics which enhance the effects of the blocking drug
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What are skeletal muscle relaxants?
drugs which reduce skeletal muscle contraction (unknown method of action) to help with muscle spasms.
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What are the 3 precautions for skeletal muscle relaxants?
- 1. may cause sedation
- 2. many interactions with other drugs
- 3. may cause hepatoxicity
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What are skeletal muscle stimulants?
drugs which raise Ach levels by interfering with the enzyme that breaks down Ach.
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skeletal muscle stimulants are mainly used to treat?
myasthenia gravis
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What causes Atropine Sulfate?
too much anticholine
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