week 6 cns and pns

action potential

cause release of neurotransmitter

release, reuptake, elimination of neurotransmitter

3 faulty events that mental illness happen

ach- both, da-e, ne-e, sht-both, mainly i, glutamate-both, gaba-i

6 neurotransmitters

movement/muscular control

acetylcholine function

movement, thinking, pleasure, euphoric effects, psychotics

5 function of dopamine

psychosis, schizophrenia

loss of sense of reality

hallucinations, delusions, thought disturbances, bizarre behavior

4 ss of schizophrenia

cognition, emotion, behavior

psychosis affects 3

dec in serotonin

if there is depression, there is

dec in gaba

if anxious, there is

anti-psychotics, anxiolytics, anti-depressants, mood stabilizer, anticholinergics

5 psychotropic/psychopharmacologic drugs

anti-psychotic drugs/neuroleptics

major tranquilizer

blocks dopamine receptors d1-d5

MOA of anti-psychotics drugs

Chlorpromazine

first anti-psychotic drug made

d2, EPS

all anti psychotics drug target which dopamine receptor and its consequence

older, does not reduce - ss, potent to reduce psychotic ss, ok in managing A ss, high EPS

typical AP 5

not much affect d2 but d4, lesser EPS, ok in HDTB, ok in schitz ss, more expensive

atypical AP 5

hdtb

positive ss in schizo

lack of motivation and pleasure

2 negative ss of schizo

Fluphenazine, haloperidol

2 typical drugs

tablet,syrup, im, iv

4 adm of typical drugs

long acting injection

slow effect but sustained duration

2-4

how many weeks does typical drugs effect

g21 needle, deep im, shud not massage the site after, shud not surpass 15 mins in syringe

4 nsg consideration for typical drugs

Aripiprazole(abilify)

atypical drug ex

liver, excretion in stool and urine

atypical drugs metabolized in

lab for liver function test, bun creatinine, monitor reg labs

nsg consideration and responsibility for atypical 3

drowsy/sedation, hypotensive, anticholinergic, cardiac, gi, low libido, hyperprolactinemia, weight gain, inc lipid level, photosensitivity

side effect of anti-psychotic drugs 10

breast enlarge in males, breast pain in fem

hyperprolactinemia

metabolic syndrome, Olanzapine- insulin resistant

one distinct side effect for atypical drugs and which drug

dont come contact in skin- contact dermatitis

for liquid prep in antipsychotics nsg cons

allergy rxn

common se of antipsychotics

akathisia, dystonia, Pseudoparkinsonism, Tardive dyskinesia, neuroleptic malignant syndrome, agranulocytosis-atyp, blood dyscrasia

7 eps

akathisia

restlessness

oro-laryngopharyngeal spasm (breathing probs), oculogyric crisis, Opisthotonus(arching of back), torticollis(stiff neck), writers hand(stiff hand)

5 ss of dystonia(movement disorder that causes the muscles to contract)

anticholinergic

med to give in pseudoparkinsonism

tremors, muscle rigid, bradykinesia, mask like face

4 ss pseudoparkinsonism

lip smacking, teeth and jaw clenching, tongue protusion

tardive dyskinesia 3 ss

Abnormal Involuntary Movement Scale

used to measure involuntary movements, particularly tardive dyskinesia, which is a potential side effect of antipsychotic medications.

fever, autonomic dysreg, muscle rigid, dehydration

4 ss for neuroleptic malignant syndrome

Dantrolene, bromocriptine

muscle relaxant drug

agranulocytosis

dec leukocytes, low immune

Clozapine

first atypical drug to treat agranulocytosis

monitor cbc, wbc, watch out fever and sore throat

2 nsg cons when there is agranulocytosis

blood dyscrasia

blood disorder, clotting prob

depleted so give dopamine agent

in true parkisonism, dopamine are

anxiolytics- minor tranqulizer

if there is dec gaba, inc gaba by

barbiturates/non benzo, benzodiazepine-common rx

2 anxiolytic drugs

sedation, muscle relax, dependency issues

3 major effects of benzodiazepines

anxiety/alc withdrawal, pre op anxiety relief, seizure(diazepam), insomnia, hyperexcitability, muscle spasm, epilepsy, tetanus

benzo indications

3-4 mo

u can only give benzo for how many mo

allergy, psychosis, acute narrow angle glaucoma, shock/coma/acute alc intox, preg

5 ci for benzo

sedation, light headedness, anticholinergic ss, hypotension, cns depression

5 adverse e for benzo

risk for injury/falls, taper meds

2 nsg cons for benzo

Flumazenil

drug for benzo toxicity

barbiturates, buspirone-longer effect

2 non benzos drugs

pre anesthetics, seizures, dont for preg/lac, lead to respi depression-taper

4 for barbiturates

sweating, fast hr, rapid breathing, elevated bp

anxiety ss

mild, mod, severe, panic

levels of anxity

adls, chronic stimulation of sns

severe anxiety to panic can interfere

muscle spasms, convulsion/epileptic prob

other use for anxiolytics

inc the effect of gaba

moa of benzodiazepine

assess allergy, monitor liver and kidney integ, assess for ci, PO, iv when needed, reduce dose of narcotic analgesics, bed in 3hrs, taper dose, pt void b4 taking, give w/ food if gi upset

nsg cons for benzodiazepine

diff breathing, confusion, dizzy, weakness, tremors

5 ss for benzo toxicity

o2 therapy

therapy to help w/ breathing for benzo toxicity

activated charcoal

to absorb remaining meds for benzo toxicity

alprazolam(xanax), diazepam(valium)

guve 2 ex for benzos

inhibits neuronal impulse conduction in ras, depressing the cebral cortex, alter cerebral function, depress motor output

barbiturates action

allergy, latent or manifest porphyria, hepatic/renal impair, respi distress, preg

ci for barbiturates

porphyria

group of genetic disorder that affects the body to reproduce heme, component of hgb and rbc

paradoxical excitement, serious hypoven, laryngospasm, steven johnson syndrome

barbi adverse effects 4

dont mix iv drugs w/ others, oral prefer, life support faci, taper, assess respi rate, paradoxical stimulation for children

nsg cons for barbi 6

amobarbital(amytal sodium), pentobarbital(nembutal)

2 ex for babri

buspirone hypochloride

less sedation, no inc in cns dep, lowe abuse potential, slow onset, not ideal for panic attacks

depression

ab state by exag feeling of sadness, melancholoy, worthelessnes, emptiness, hopelessness

norep, sht,da

antidepressant affect 3 neurotransmitters

monoamine oxidase break them down, rapid fire of neurons lead to depletion, no. of sensitivity of post synaptic receptors may inc

deficiencies of neurotransmitters may develop bc of 3

tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors

3 antidepressant classifications

inhibit reuptake of neurotransmitters norep and sht

tricyclic antidepressants moa

depression, enuresis older than 6, ocd-clomipramine

3 indication for tricyclic

allergy, mi, maoi use, cv disorders, angle closure glaucoma, gi surgery, psychotic pt, manic depressive pt, seizure hx, renal/hepatic d

tcs ci

sedation, orthostatic hypo, hypertension, mi, angina, stroke, palpitations

tca adverse effect

cimetidine, ranitidine

be careful when administering tca with histamine 2 blockers use to gastric hyperacidity

fluoxetine

be careful when administering tca with ssri

mao inhibitors

tca with - can lead to hypertensive crisis

dont give maois within 2 weeks of imipramine, assess adverse rxn 1st 2 hrs, 2-3 weeks mood elevation, taper, major portion at bedtime

tca cons

inhibiting the mao enzyme

maoi moa

allergy, pheocromocytoma, hypertension

ci for maoi

pheocromocytoma

turmor forms in middle of adrenal gland- high bp, irreg hr

same wt tca

maoi adverse rxn

occipital headache, vomit

maoi hypertensive crisis

tyramine rich food

maoi hypertensive crisis caused by

6

a period of — weeks shud elapse after stopping an ssri befor begi to maoi