mental health nursing exam #1

limbic system

emotional portion of the brain

parasympathetic

slows you down

what neurotransmitter is associated with the sympathetic nervous system?

norepinephrine

acetylcholine

excitatory memory thinking muscle contraction

dopamine

excitatory neurotransmitter

increased dopamine [seen in]

schizophrenia; mania

decreased dopamine [seen in]

parkinson's disease; depression

norepinephrine decrease [seen in]

depression

norepinephrine increase [seen in]

mania; anxiety; schizophrenia

norepinephrine is responsible for

fight or flight response

serotonin decrease [seen in]

depression

serotonin increase [seen in]

mania; panic; anxiety disorders

GABA function

slow things down

decreased GABA [seen in]

anxiety; schizophrenia

increased glutamate [seen in]

anxiety; depression

decreased glutamate [seen in]

schizophrenia

reuptake

natural process of neurotransmitter; inactivation by which the neurotransmitter is reabsorbed into presynaptic neuron from which it had been released

breakdown

neurotransmitter inactivation by breakdown of the transmitter and then no longer available

what are the three anxiety meds?

1. diazepam
2. lorazepam
3. alprazolam

what do benzos do to GABA?

increase

what do benzos do to the CNS?

depress

other uses for benzos

- alcohol withdrawal
- insomnia
- anticonvulsant

what duration are you supposed to use benzos?

short term (because of high abuse potential)

what happens when you take benzos for too long?

physical dependence

side effects of benzos

- mental slowing
- sedation
- depression
- unsteady gait
- slurred speech

what increases the effects of benzos?

- alcohol
- pain meds

what decreases the effects of benzos?

- caffeine
- cigarette smoke

antidepressants

increase serotonin and norepinephrine

antipsychotics

decrease dopamine

psychostimulants

increase dopamine and norepinephrine

non-benzo anxiolytic

buspirone

when is buspirone taken?

on a regular basis

beta blocker (example and administration)

propranolol; taken PRN one hour before

antihistamine (example and administration)

hydroxyzine; taken PRN for drowsiness

sleep aids that have risk for dependence

sedative hypnotic - zolpidem
benzodiazepines - diazepam

antidepressant used for sleep

trazadone

melatonin agonist used for sleep

ramelteon

effexor can cause

NMS (neuroleptic malignant syndrome); potentially deadly

SSRI mode of action

antidepressant; block reabsorption of serotonin = more serotonin

side effects of SSRIs

- nausea
- headache
- dry mouth
- nervousness (?)
- sexual problems
- insomnia

3 SSRIs

- fluoxetine: prozac
- paxil: paroxetine
- sertraline: zoloft

SNRI stands for

serotonin and norepinephrine reuptake inhibitor

SNRI mode of action

blocks reuptake of serotonin and norepinephrine --> increased serotonin and norepinephrine
antidepressant with anxiety and chronic pain management

SNRI side effects

- nausea
- headache
- dry mouth
- dizziness
- sweating
- insomnia
- sexual side effects

1 SNRI drug

venlafaxine (effexor)

TCA mode of action

- block reuptake of serotonin and norepinephrine
- alpha1 adrenergic agonist
- blocks acetylcholine receptors
- blocks histamine H1 receptors

TCA side effects

- anticholinergic: dry mouth, blurry vision, confusion, constipation
- antihistamine: drowsiness, weight gain
- alpha1 adrenergic agonist: orthostatic hypotension and increased risk of arrhythmias/cardiac side effects

2 TCA drugs

- imipramine (tofranil)
- amitriptyline (elavil)

MAOI mode of action

inhibits MAO from removing norepinephrine, serotonin, and dopamine form the brain

you can not eat food high in ____ which on MAOIs

tyramine

what drugs should you avoid on MAOIs?

other antidepressants (because of serotonin syndrome)

1 MAOI drug

phenelzine (nardil)

MAOI "no-no" foods

- cheeses
- beer and red wine
- processed/fermented meats
- bananas, avocados
- soy sauce

bupropion mode of action

norepinephrine - dopamine reuptake inhibitor

trazadone mode of action

blocks reuptake of serotonin

atypical antidepressant side effects

- nausea
- insomnia
- weight loss
*trazodone may cause priapism (painful, long-lasting erection)

2 atypical drugs

bupropion (wellbutrin)
trazodone (desyrel)

who do you NOT want to give bupropion to?

patients with seizures

bupropion is also used for

smoking cessation

what do antidepressants increase?

suicidal tendencies in those

how long does it take for an antidepressant to reach its full effectiveness?

4-6 weeks

most people will begin to feel effects of antidepressants after

2 weeks

what vitamin can cause serotonin syndrome?

st. johns wart

EARLY signs of serotonin syndrome

- restlessness
- anxiety
- tachycardia
- diaphoresis
- muscle twitching
- shivering

LATE signs of serotonin syndrome

- diarrhea
- dramatic swings in BP
- severe hyperthermia
- muscle rigidity

discontinuation syndrome symptoms

- anxiety
- insomnia
- vivid dreams
- nausea
- tiredness
- flu-like symptoms

what does lithium require

regular bloodwork

maintenance lithium level

0.6-1.2

labs for lithium

- CBC
- TFT
- kidney function

side effects of lithium

- hand tremors
- nausea
- GI upset
- hypotension
- weight gain
- polyuria
- dehydration
- dry mouth

early/mild reactions of lithium toxicity

- diarrhea
- vomiting
- drowsiness
- fatigue

moderate manifestations of lithium toxicity

- ataxia
- failure/irregularity of muscle action
- tinnitus
- blurred vision

lithium toxicity late/severe manifestations

- confusion
- seizure
- coma
- death

what do you need while on lithium?

- consistent intake of sodium
- adequate hydration

what causes decreased effectiveness of lithium levels?

caffeine

anticonvulsant mode of action

- some increase GABA
- some inhibit Na and Ca channels
- some inhibit glutamate

anticonvulsants adverse effects

- steven johnson syndrome (lamotrigine and carbamazepine)
- agranulocytosis (carbamazepine)

4 anticonvulsant drugs

- carbamazepine (tegretol)
- divalproex sodium (depakote)
- lamotrigine (lamictal)
- gabapentin (neurotin)

typical antipsychotic mode of action

- dopamine (D2) antagonists
- decrease delusions and hallucinations
- increase risk of EPS

2 typical antipsychotic drugs

- chlorpromazine (thorazine)
- haloperidol (haldol)

2nd gen. atypical antipsychotic mode of action

- dopamin (D2) and serotonin (5-HTZA) antagonist (????)
- decreased delusions and hallucinations
- treat bipolar mania
- increase risk of metabolic syndrome
- decrease risk of EPS

3rd gen. atypical antipsychotic mode of action

- partial agonist at dopamin and serotonin antagonist at serotonin
- dec. delusions and hallucinations
- treat bipolar mania

2nd gen. atypical antipsychotic drug

clozapine (clozaril)

3rd gen. atypical antipsychotic drug

aripiprazole (abilify)

typical antipsychotic side effects

- EPS
- NMS
- photosensitivity
- sedation
- prolonged QT interval
- hypotension
- anticholinergic

extrapyramidal side effects (EPS)

- dystonia: involuntary muscle contractions
- torticollis: head twists to one side
- oculogyric crisis: spasmodic eye movements
- akinesia: loss of ability to move muscles
- akathisia: restlessness
- pseudo-parkinsons: slowed movements
- tradive dyskinesia: repetitive movements

NMS

- parkinsonian muscle rigidity
- hyperthermia
- autonomic instability
- confusion

side effects of atypical antipsychotics

- hypersalivation (clozapine)
- agranulocytosis (clozapine)
- metabolic syndrome
- reduction of seizure
- threshold

metabolic syndrome

- inc. risk of heart disease/stroke
- elevated blood glucose
- elevated cholesterol
- excessive abdominal fal (?)
- increased bp

main side effect of clozapine

- agranulocytosis
- low WBC
- s/s sore throat

what increases risk for lithium toxicity?

- kidney problems
- liver problems
- alcohol (dehydrates you)
- intense exercise
- anorexia

side effect for lamotrigine

steven johnson syndrome

clozapine can cause hyper_____

salivation

anticholinergic side effects

- mad as a hatter
- hot as hell
- red as a beet
- dry as a bone
- blind as a bat

antiparkinson agents use

parkinsonian effects or dystonia from antipsychotic meds

antiparkinson agents drug

benztropine (cogentin)

education for antipsychotics

- avoid hot tubs or showers
- avoid abrupt drug withdrawal
- use sunscreen
- report sore throat

what do ADHD agents do to the CNS?

stimulate it

ADHD drugs mode of action

- activates D4 receptors in the basal ganglia and thalamus to depress motor activity to treat hyperactivity
- increase levels of dopamine and norepinephrine

2 ADHD drugs

- amphetamine (adderall)
- concerta (methylphenidate)