1
Q
- Tricyclics
- Selective Serotonin Reuptake Inhibitors
- Monoamine Oxidase Inhibitors
A
Antidepressants
2
Q
Increase the concentration of norepinephrine, serotonin, and/or dopamine in the body - blocking the reuptake of those neurotransmitters ; also occurs when enzyme - monoamine oxidase (MAO) is inhibited at various sites in the nervous system.
A
Antidepressants - action
3
Q
Inactivate norepinephrine , serotonin and dopamine
A
MAO function
4
Q
Amitriptyline (Elavil)
A
Tricyclic antidepressant (TCA)
5
Q
Doxepin ( Tofranil)
A
Tricyclic antidepressant (TCA)
6
Q
- Blurred vision
- Constipation
- Urinary retention
- Orthostatic hypotension
- Reduction of seizure threshold
- Tachycardia , arrhytmias
- Photosensitivity
- Weight gain
A
side effects of Tricyclic antidepressant (TCA)
7
Q
Citalopram ( Celexa )
A
Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants
8
Q
Fluoxetine ( Prozac)
A
SSRI antidepressants
9
Q
Paroxentine ( Paxil )
A
SSRI antidepressants
10
Q
Sertaline ( Zoloft )
A
SSRI antidepressants
11
Q
Escitalopram ( Lexapro )
A
SSRI antidepressants
12
Q
- Insomnia, agitation
- Headache ( analgesics )
- Sexual dysfunction
- Serotonin syndrome
A
side effects of SSRI antidepressants
13
Q
- Take dose early in the day
- Avoid caffeine
- Relaxation before bed
A
Insomnia interventions
14
Q
- Changes in mental status
- Restlessness
- Hyperreflexia
- Myoclonus (muscle twitching )
- Tachycardia, labile BP
- Diaphoresis, shivering, tremors.
A
Serotonin syndrome
15
Q
Cyproheptadine
A
antihistaminic and antiserotonergic agent; treat symptoms of serotonin syndrome
16
Q
Phenelzine ( Nardil )
A
MAOI antidepressant
17
Q
Tranylcypromine sulfate ( Parnate )
A
MAOI antidepressant
18
Q
- Hypertensive crisis
- Weight gain
- Changes in cardiac rhythm
- Hypotension
- Sedation
- Insomnia
A
side effects of MAOI antidepressants
19
Q
Occurs if the individual consumes foods containing tyramine while receiving MAOI therapy
A
Hypertensive crisis
20
Q
- Severe occipital headache
- Palpitations
- Nausea/vomiting
- Nuchal rigidity (neck stiffness )
- Fever, sweating
- Increase in BP, chest pain, coma
A
Hypertensive crisis
21
Q
- Discontinue drug
- Monitor vital signs
- Short-acting antihypertensive medication
- External cooling methods to control hyperpyrexia
A
TX of hypertensive crisis
22
Q
Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.
A
Do not consume while taking MAOIs
23
Q
Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.
A
Do not consume while taking MAOIs
24
Q
- Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
- The therapeutic effect may not bee seen for as long as 4 weeks
- Not drink alcohol - potentiate the effects of each other
A
Antidepressants - teaching
25
1. Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
2. The therapeutic effect may not bee seen for as long as 4 weeks
3. Not drink alcohol - potentiate the effects of each other
Antidepressants - teaching
26
Avoid smoking - it is increases the metabolism of tricyclics
Tricyclic antidepressants - teaching
27
Avoid smoking - it is increases the metabolism of tricyclics
Tricyclic antidepressants - teaching
28
5 symptoms have been present during the same 2 -weeks period ; at least one of the symptoms is either - depressed mood or loss of interest or pleasure
Diagnostic criteria for major depressive disorder
29
1. Depressed mood
2. Loss of interest or pleasure
3. Weight loss / gain
4. Insomnia / hypersomnia
5. Fatigue/ loss of energy
6. Feelings worthlessness / excessive guilt
7. Recurrent thoughts of death
Symptoms of major depression disorder
30
Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy
Bipolar disorders
31
Lasting one week ( or more if hospitalization is necessary )
1. Grandiosity
2. Decreased need for sleep
3. Talkative
4. Racing thoughts
5. Distractibility
6. Increase in goal-directed activity
7. Involvement in pleasurable activities - painful consequences
Diagnostic criteria for manic episode
32
1. Hippocampus
2. Amygdala
3. Hypothalamus
4. Frontal cortex
5. Cerebellum
Areas of the brain affected - major depression
33
memory impairments, feeling of worthlessness , hopelessness and guilt
Hippocampus
34
anhedonia (no pleasure) , anxiety, reduced motivation
Amygdala
35
Increased/ decreased sleep and appetite, decreased energy and libido
Hypothalamus
36
depressed mood, problem concentrating
Frontal cortex
37
psychomotor retardation/agitation
Cerebellum
38
1. Risk for suicide
2. Complicated grieving
3. Low-self esteem
4. Powerlessness
5. Spiritual distress
6. Social isolation
7. Disturbed though process
8. Imbalanced nutrition
9. Insomnia
10. Self care deficit
Major Depression - nursing diagnoses
39
1. Hypomania - cheerful, ideas of great worth, increased motor activity, inappropriate behaviors (calling President )
2. Acute mania - "high" / anger; flight of ideas; hallucinations/delusions; poor impulse control ; days without sleep;
3. Delirious mania - labile mood; extremely distractible ; delusions of grandeur or persecution ; purposeless movement .
Manic states
40
1. Risk for injury
2. Risk for violence: Self - Directed or Other-Directed
3. Imbalanced nutrition less than body requirements
4. Disturbed thought process
5. Disturbed sensory perception
6. Impaired social interaction
7. Insomnia
Bipolar Mania - nursing diagnoses
41
1. High protein, high calorie finger foods
2. Juice and snacks on unit
3. I&O, calorie count, daily weight
4. Provide favorite foods
5. Supplement with vitamins and minerals
6. Sit with client during meals
Imbalanced nutrition interventions
42
The induction of a generalized seizure through the application of electrical current to the brain (6-12 treatments ; 3 times a week)
Electroconvulsive Therapy
43
1. Major depression - after meds has proved ineffective
2. Mania
3. Schizophrenia - depression or mania symptoms
Indications for ECT
44
1. Increased intracranial pressure (from brain tumor, cardiovascular accident, cerebrovascular lesion)
2. Cardiovascular problems - at risk
3. Severe osteoporosis
4. Acute and chronic pulmonary disorders
5. High-risk or complicated pregnancy
Contraindications - ECT
45
Most common:
1. Temporary memory loss
2. Confusion
Side-effects of ECT
46
2 per 100,000 treatments ; major cause - cardiovascular complications (usually in individuals with previously compromised cardiac status )
Mortality - ECT
47
1. Ensure safety
2. Manage client anxiety
3. Provide education
4. Administer Atropine - decrease secretion to prevent aspiration
Role of the nurse in ECT
48
1. Short-acting anesthetic - thiopental sodium ;
2. Muscle relaxant - succinylcholine chloride
3. Pure oxygen - resp. muscles paralyzed
4. Blood pressure cuff on the lower leg before muscle relaxant to observe seizure activity
5. Electrodes placed (bilaterally or unilaterally) on the temples to deliver electrical stimulation
ECT - implementation
49
ECT is thought to effect a therapeutic response by ...
increasing the levels of serotonin , norepinephrine , and dopamine
50
Lithium Carbonate
Antimanic -
51
1. Drowsiness, dizziness, headache
2. Dry mouth, thirst
3. GI upset, nausea/vomiting
4. Fine hand tremors (decrease dose, propranolol)
5. Hypotension, arrhythmias, pulse irregularities
6. Polyuria, dehydration
7. Weight gain
Side effects of Lithium
52
The usual ranges of therapeutic serum concentration of Lithium are :
1. 0-1.5 mEq/L - for acute mania
| 0. 6 - 1.2 mEq/L - for maintenance
53
Serum lithium should be monitored once or twice a week after initial treatment until stable ; then monthly during maintenance therapy
Lithium toxicity > 1.5
54
1. Blurred vision, ataxia , tinnitus , N&V, diarrhea
2. Excessive output of dilute urine , tremors, psychomotor retardation, mental confusion
3. Coma, MI, cardiovascular collapse
Lithium toxicity > 1.5
55
Lithium is similar in chemical structure to sodium ; if sodium intake is reduced - - lithium is reabsorbed by the kidneys - toxicity
Adequate records of intake , output, and pts weight should be kept on a daily basis
56
1. Adequate sodium intake
2. 2500-3000 mL of fluid
3. call doctor - vomiting/ diarrhea
4. Risk - pregnancy
Lithium - Teaching
57
Valproic acid (Depakote)
anticonvulsant (antiepileptic) ; used in treatment of bipolar disorder
58
1. Hypothyroidism
2. Impairment of the kidneys ability to concentrate urine
Periodic follow ups required to assess thyroid and renal function
Major long term risks of lithium therapy
59
When a patient is experiencing a severe manic episode , which bodily system is most at risk for decompensation
Cardiac - death from cardiac collapse
Psychiatric Nursing
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