MH ch 2

what can too much dopamine do

schizophrenia, psychotic disorders, and Parkinson’s disease

what do u give for too much dopamine

antipsychotic

mostly involved in regulating emotions, mood, and food intake.sexual

serotonin

chemical substances that help transmit information throughout the body 

neurotransmitters

controls movement, motivation, cognition, and regulates emotions

dopamine

implications of serotonin

mood disorders, depression, anxiety, and schizophrenia.

how does giving antidepressant for serotonin disorder work

increase serotonin availability in the brain—they block reuptake;

ex if person has low serotonin it helps serotonin stay in brain longer

affects the sleep-wake cycle and signals muscles to become active.

Acetylcholine

 Decreased amounts of acetylcholine have been implicated in

and can trigger

Alzheimer’s Disease.

involuntary movement, extrapyramidal symptoms (eps).

: arrousal, plays a role in attention, learning, memory, sleep, wakefulness, and mood regulation.

Norepinephrine

implicated in anxiety disorder, memory loss, social withdrawal, and depression. 

epinephrine

 Excites brain activity. This neurotransmitter can become toxic if levels are too high. Can cause brian damage

Opposite of gaba,

accelerator in car

Glutamate

ex of Glutamate

When an alcoholic stops drinking and begins to go through withdrawals. 

 It is the opposite of Glutamate.

is an inhibitory neurotransmitter

calms the brain.

Break in car

Gamm-aminobutyric Acid (GABA)

ex med that increases gaba in brain

benzodiazepines

in mental healht what do we treat

symptoms, not just diagnosis

many med can require a long time (4-6 weeks) before reaching its full potential

Delayed therapeutic effect

Many psychotropic meds should be tapered bc of:

withdrawal and rebound

symptoms come back quickly and worsen than befroe they started taking meds)

Rebound

pt doesn't adhere to med anf they dont take med- simpler the regimen the better

adherence/compliance

what to do if pt says antidepressants are not working

Tell the pt to continue 4-6 weeks

Also do a suicide assessment because theyre at risk for doing attempt( when they first start, their mood dosent lift but they get more energy so they can carry out the plan)

Block dopamine receptors and are used in the treatment of schizophrenia, psychotic disorders, and the manic phase of bipolar disorder.

Antipsychotics

primary use of antipsychotics

reduce psychotic sympotmes such as delusions and hallucinations

what is first gen antipschyotics

came first, have a strong dopamine block 

-when pt takes them they are susceptible to extraparamidal symptoms

what is 2nd gen antipsychotics

not as strong of dopamine block

- pt dosent get EPS symptoms as much.

ex clozapine,

some risks of taking clozapine- antipsychotic

neutropenia, which causes WBC to go down, susceptible to getting infections

painful muscle, rigged neck muscle, tense, thick tongue, neck muscle spasm 

EPS- Acute dystonia

treatment of acute dystonia

Notify the provider—they will order anticholinergic or benadryl,

lower the dose of the med

impromat thing to know about acute dystonia

likely to happen early—first week—airway threatened

is an emergency

Shuffling gait 

Mask-like face

Rigid

 Drooling 

Muscle (arms) "catch/glitch" as it goes down

EPS- pseudoparksinsims

Pacing, looking agitated or anxious, and restlessness can be mistaken for anxiety and can be the reason someone stops taking their meds.

EPS-akathisia-

EPS-akathisia- treatment

 Pt changed the med and put on a beta blocker, cholinergic, or benzo in the beginning to calm them

Can be fatal - rare 

 Caused by adverse reaction to antipsychotic med

Causes high fever, labile blood pressure (swing high and low), tachycardia, diaphoresis, altered mental state ("catch/glitch their arm"), inability to think or pay attention, elevated CPK, and severe muscle rigidity isn't

Normally it occurs early when they take meds or the provider increases the dose.

Neuroleptic malignant syndrome

age-related

Can happen late onset—after taking a med for a long time 

Involuntary movements that affect the face and neck—lip smacking, tongue protrusion, chewing, grimacing, and abnormal limb movement— 

Risk for , or choking

Can be irreversible—prevention by early recognition is important. 

Tardive dyskinesia

Test someone for TKD by the

abnormal involuntary movement scale.

Nursing priority for antipsychotic meds 

Can have an anticholinergic effect—dries them up—dry mouth, constipation, urinary retention, blurred vision 

- orthostatic hypotension slowly. low BP when standing up suddenly 

Sedation

Tell the pt to stand up slowly.

2nd-gen meds antipsychotics cause

metabolic syndrome, increase appetite, change the way the body stores fat, and change insulin secretion

What to monitor for 2nd gen antipsychotics

weight gain and BP, and do glucose and lipid tests.

2nd gen antipsychotic can cause and contraindications in

Hyperprolactinemia: cause erectile dysfunction; men can develop breast,

Qt prolongation— if the patient had this—heart not fully and efficiently pumping blood

(geodone-) - avoid if the patient had a recent heart attack

Clozapine—safety facts

Can affect pt wbc—severe neutropenia—need to get baseline ANC (absolute neutrophil count) and then monitor them

Don't give this if something else available it is a last option choice

Have a slow release—get immunity every 2-4 weeks. 

Usually for patients who do not adhere to meds 

Ex-haloparidol, fufenazine

Long-acting injectable antipsychotics

Safety issue of Zyprexia

always aspirate with this medication. If it hits the vein and enters rapidly into the bloodstream, it can cause post-injection delirium syndrome, which can cause loss of consciousness, delirium, and confusion 

Monitor the pt for 3 hrs 

antipsychotic patient teaching—

Never stop meds because of side effects without telling the provider 

Can have anticholinergic effects—which cause dry mouth—treated with sugar-free gums and fluids (prevent weight gain).

Constipation—encourage activity, fluid, and fiber 

Risk from photoseverity—wear sunscreen 

Drowsy in begininy- avoid driving 

Purchase pill organizer 

block the reuptake of serotonin- keeps serotonin in the synapses longer

. They are used in the treatment of major depression, anxiety disorders, and the depressive phase of bipolar disorder. Depression and mood disorder 

If there is a delay, it is one to 4-6 weeks.

Suicide assessment is priority at first 

Antidepressants

works by blocking serotonin reuptake— 

If serotonin is being taken away too quickly from the brain, this will keep serotonin in the brain longer. 

ssri-selective serotonin reuptake inhibitor

Can cause insomnia, agitation, weight gain, and sexual dysfunction.

Moitnor has a suicide risk because of delayed onset—the pt can act on suicide thoughts 

SSRI

means picking something up and taking it away

reuptake

blocks norepinephrine reuptake and blocks some serotonin reuptake—has an anticholinergic effect—orthostatic hypotension 

Trycilcic—2nd kind— antipsychotivc

 happens when too much serotonin builds up in the brain.

if they're taking too many or more drugs that prevent serotonin reuptake.

It can be life-threatening because of an overloaded body's nervous system,

or it can be an adverse reaction from taking too many drugs or a drug overdose. 

serotonin syndrome

Symptoms serotonin syndrome

: agitation, fever, hypotension, tachycardia, rigid muscles, hyperflexia (repetitive jerking movements), confusion, and severe cases—progress from coma to death 

Oldest antidepressant 

Never prescribed this until they exhausted everything else—because this medication mixed with foods with tyramine can cause hypertensive crisis. 

Make sure the patient knows what food and OTC they can't have

maoi

What can’t you have with MAOI

 Cannot have aged cheese. smoked, cured meat, no soy, no fermented food. Can't have fermented yeast—beer and red wine 

Check with the provider before taking OTC meds.

 Can't have cough syrups 

These drugs work on serotonin, dopamine, norepinephrine, acetylcholine, and GABA. They are used to treat bipolar disorders. The goal is to stabilize the mood and prevent the highs and lows. Mood disorder 

For BPD and acute mania 

mood stablizers

Major side effects of mood stabilizers especially in the beginning, include ,

Nausea, diarrhea, polydipsia, polyuria, metallic taste in the mouth, and fatigue when first starting to take the med; after being on the med for a while, 

Tell the patient to take it as prescribed and sign off for toxicity so they can report it. If they feel nauseous, take it with meals.

Therapeutic level of lithium serum—

0.6 to 1.2

Toxicity signs of mood stabilizers —. 

Severe diarrhea, vomiting, drowsiness, muscle weakness, poor coordination, and having routine blood draws to check lithium levels—if not, it can cause renal failure or colon death

Ex of a classic mood stabilizer—this is a salt that can build up in the body. 

Lithium

Activates GABA receptor channels. These drugs are used to treat anxiety disorders, obsessive-compulsive disorders (OCD), depression, post-traumatic stress disorder, and alcohol disorders. 

Can give for insomnia, as a muscle relaxer, or if someone has a seizure 

anti anxiety meds

are the most prescribed anti anxiety med in us 

and how long should they be taken

Benzodiazepines

Only short-term use can be addictive

Nusirng priority of anti anxiety med

can cause CNS depression, sedation, poor coordination, and memory impairment; can cause falls—because of sedative; physical dependence—don't abruptly stop—withdrawal syndrome

Nonbenzodiazepine 

Not additive can be used long-term. 

Don't take them with alcohol because they're both CNS depressants 

Don't stop abruptly—you can go through a dangerous withdrawal

Buspirone

 These drugs release norepinephrine, dopamine, and serotonin and are used to treat attention deficit hyperactivity disorder (ADHD). 

Stimulants (Amphetamines)

Mechanism of Stimulants (Amphetamines)

reduce reuptake of norepinephrine, dopamine, and serotonin—improve pt ability to filter distraction and manage behavior 

Side effects/ what to monitor for Stimulants (Amphetamines)

decreased appetite, nausea, irritability, heart palpitations, 

Monitor pt weight; encourage giving after meals, not before 

Miususe issue - can cause addiction when not used as prescribed

Avoid doses too late in the day when insomnia is a concern 

Sustained release—take in morning 

Used in the treatment of alcoholism and causes an adverse reaction if the patient drinks alcohol. It is used as a deterrent to consume alcohol.

Disulfiram (Antabuse):

works by blocking the enzyme that metabolizes alcohol, resulting in an alcohol reaction, which includes throbbing headache, nausea and vomiting, chest pain, low blood pressure, confusion, and even death.  Reactions can last 30 minutes to 2 hours. 

Antabuse

an antabuse 

Alcohol isn't metabolized.

Stop alcohol—tell the pt to sign informed consent 

Severe headache, flushed face, drop BP, painful breathing 

 Be careful with lotions/makeup with alcohol. 

No nyquil 

Disulfiram