Unit 5 Patho2
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Questions and Answers

What role do neurotransmitters play in synaptic transmission?

  • They solely inhibit nerve activity.
  • They are responsible for muscle coordination.
  • They exclusively excite nerve impulses.
  • They communicate signals between presynaptic nerves and postsynaptic effector cells. (correct)

    • Which class of medications is NOT typically recommended for individuals with cardiac issues?

  • Tricyclic Antidepressants (TCA’s) (correct)
  • Antidepressants
  • Benzodiazepines
  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • What is the potential effect of MAO inhibitors when combined with foods containing tyramine?

  • They can lead to hypertensive crises. (correct)
  • They can cause hyperglycemia.
  • They have no significant interaction.
  • They decrease the effects of anxiety.

    • Which of the following neurotransmitters is primarily associated with impulse coordination?

    <p>Dopamine</p> Signup and view all the answers

    Which anxiety disorder is characterized by experiencing panic attacks lasting less than 10 minutes?

    <p>Panic Disorder</p> Signup and view all the answers

    In the context of non-pharmacological management of anxiety, which approach is emphasized as a first-line treatment?

    <p>Counseling</p> Signup and view all the answers

    What is a key feature of long-term insomnia?

    <p>It can be linked to chronic medical issues.</p> Signup and view all the answers

    What is the primary action of SSRIs in treating depression?

    <p>They increase serotonin availability at neuronal junctions.</p> Signup and view all the answers

    What is a common complication associated with SSRIs after several weeks of treatment?

    <p>Bruxism</p> Signup and view all the answers

    Which of the following is NOT a characteristic of serotonin syndrome?

    <p>Respiratory depression</p> Signup and view all the answers

    Which medication class enhances the action of GABA and is widely used for anxiety?

    <p>Benzodiazepines</p> Signup and view all the answers

    What is a critical nursing consideration when administering Lorazepam intravenously?

    <p>Monitor respiratory rate frequently</p> Signup and view all the answers

    What condition does Buspirone primarily target?

    <p>Panic disorder</p> Signup and view all the answers

    Which of the following medications is considered a first-line treatment for major depressive disorder?

    <p>Fluoxetine</p> Signup and view all the answers

    What is the main reason for tapering off benzodiazepines?

    <p>To prevent dependence</p> Signup and view all the answers

    Which interaction poses a risk of serotonin syndrome when using SSRIs?

    <p>MAOIs</p> Signup and view all the answers

    What is a significant black box warning associated with antidepressants?

    <p>Suicidal thoughts</p> Signup and view all the answers

    What should be monitored closely in a patient receiving high doses of Lorazepam?

    <p>Blood pressure changes</p> Signup and view all the answers

    What effect can occur with high doses of Diazepam?

    <p>Amnesia</p> Signup and view all the answers

    What is a potential complication of taking Zolpidem?

    <p>Sedation while awake</p> Signup and view all the answers

    For which condition is Melatonin typically used as treatment?

    <p>Insomnia related to circadian rhythm disruption</p> Signup and view all the answers

    What type of medication class is Duloxetine categorized under?

    <p>Serotonin norepinephrine reuptake inhibitor</p> Signup and view all the answers

    Which of the following is a contraindication for Bupropion?

    <p>Seizure disorders</p> Signup and view all the answers

    What is the primary complication associated with the use of MAOIs like Phenelzine?

    <p>Hypertensive crisis</p> Signup and view all the answers

    What is a significant risk associated with Duloxetine in pediatric patients?

    <p>Heightened risk for suicide</p> Signup and view all the answers

    Which medication is known as a norepinephrine-dopamine reuptake inhibitor (NDRI)?

    <p>Bupropion</p> Signup and view all the answers

    Which of the following is a common adverse effect of using atypical antipsychotics like Risperidone?

    <p>Weight gain</p> Signup and view all the answers

    What symptom is considered a positive symptom of schizophrenia?

    <p>Hallucination</p> Signup and view all the answers

    What is the primary mechanism of action for Lithium Carbonate?

    <p>Stabilizes mood by affecting sodium levels</p> Signup and view all the answers

    Which of the following complications is associated with Trazodone?

    <p>Sedation</p> Signup and view all the answers

    What withdrawal symptom might occur with abrupt discontinuation of antidepressants?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is an important nursing consideration when administering Methylphenidate for ADHD?

    <p>Prevent mealtime disturbances</p> Signup and view all the answers

    Which tricyclic antidepressant primarily acts by blocking the reuptake of serotonin and norepinephrine?

    <p>Amitriptyline</p> Signup and view all the answers

    What is a significant interaction concern with Phenelzine regarding diet?

    <p>Tyramine-containing foods</p> Signup and view all the answers

    Which of the following complications is most commonly associated with the use of SSRIs after several weeks of treatment?

    <p>Bruxism</p> Signup and view all the answers

    Which medication class is primarily indicated for the treatment of generalized anxiety disorder and is a Schedule IV drug?

    <p>Benzodiazepines</p> Signup and view all the answers

    In the context of antidepressants, which of the following should be monitored closely due to the risk of potentially serious adverse effects?

    <p>GI bleeding</p> Signup and view all the answers

    What is the primary advantage of using Buspirone for anxiety treatment compared to benzodiazepines?

    <p>It has a lower risk of dependency</p> Signup and view all the answers

    Which of the following is a critical nursing consideration when administering Diazepam?

    <p>Taper off gradually to avoid withdrawal</p> Signup and view all the answers

    Which of the following interactions poses a high risk for serotonin syndrome when using Sertraline?

    <p>MAOIs</p> Signup and view all the answers

    Which symptom is a defining criterion for major depressive disorder?

    <p>Abnormal eating patterns</p> Signup and view all the answers

    What significant warning is associated with all antidepressants regardless of class?

    <p>Black box warning for suicide</p> Signup and view all the answers

    Which minor side effect is commonly experienced with the use of Zolpidem?

    <p>Sleepwalking</p> Signup and view all the answers

    Which type of depression is typically triggered by an identifiable event?

    <p>Situational depression</p> Signup and view all the answers

    Which medication requires close monitoring of respiratory rate during IV administration?

    <p>Lorazepam</p> Signup and view all the answers

    What is the primary function of atypical antidepressants like SNRIs?

    <p>Enhance mood through norepinephrine and serotonin</p> Signup and view all the answers

    Which of the following complications can arise from high-dose use of benzodiazepines like Diazepam?

    <p>Paradoxical responses</p> Signup and view all the answers

    What is the primary role of norepinephrine in neurotransmission?

    <p>Coordinates impulses</p> Signup and view all the answers

    Which of the following describes a primary characteristic of panic disorders?

    <p>Less than 10 minutes with anticipatory symptoms</p> Signup and view all the answers

    Which neurotransmitter is associated with inhibiting nerve activity?

    <p>GABA</p> Signup and view all the answers

    What is a major concern associated with the use of antidepressants?

    <p>Suicidal ideations during treatment</p> Signup and view all the answers

    What is a key point regarding long-term insomnia treatment?

    <p>Underlying conditions must be addressed as a priority</p> Signup and view all the answers

    What is a significant interaction concern with Monamine Oxidase Inhibitors (MAOIs)?

    <p>Interactions with tyramine-rich foods can lead to hypertensive crisis</p> Signup and view all the answers

    Which type of counseling is emphasized for treating anxiety disorders?

    <p>Cognitive Behavioral Therapy (CBT)</p> Signup and view all the answers

    What is a recommended precaution when taking SSRIs?

    <p>Being alert for suicidal thoughts or behaviors</p> Signup and view all the answers

    What is a common complication associated with the use of Bupropion?

    <p>Seizures</p> Signup and view all the answers

    Which of the following nursing considerations is most important when administering Duloxetine?

    <p>Monitor for withdrawal syndrome</p> Signup and view all the answers

    What dietary restriction is essential for patients taking Phenelzine?

    <p>Avoidance of tyramine-containing foods</p> Signup and view all the answers

    Which of the following symptoms is considered a negative symptom of schizophrenia?

    <p>Lack of motivation</p> Signup and view all the answers

    Which medication can lead to serotonin syndrome if used concurrently with St. John’s Wort?

    <p>Duloxetine</p> Signup and view all the answers

    What is the primary mechanism of action for tricyclic antidepressants like Amitriptyline?

    <p>Combination of serotonin and norepinephrine reuptake inhibition</p> Signup and view all the answers

    Which potential side effect is unique to atypical antipsychotic medications compared to typical antipsychotics?

    <p>Weight gain</p> Signup and view all the answers

    What is the recommended administration frequency for Lithium Carbonate monitoring?

    <p>Every two weeks initially, then monthly</p> Signup and view all the answers

    What common complication is associated with the use of Methylphenidate for ADHD?

    <p>Decreased appetite</p> Signup and view all the answers

    Which symptom is an indication of Lithium toxicity?

    <p>Severe confusion</p> Signup and view all the answers

    Which type of antidepressant primarily targets norepinephrine and dopamine reuptake?

    <p>NDRIs</p> Signup and view all the answers

    What complication should be looked for in patients treated with Haloperidol?

    <p>EPS (Extrapyramidal Symptoms)</p> Signup and view all the answers

    What is an important nursing consideration for patients on atomoxetine for ADHD?

    <p>Assess for liver damage</p> Signup and view all the answers

    Which medication would NOT be safe for a patient with a history of eating disorders?

    <p>Bupropion</p> Signup and view all the answers

    In a patient experiencing hypertensive crisis due to Phenelzine, which food group should be avoided?

    <p>Fermented or aged foods</p> Signup and view all the answers

    Study Notes

    Nervous System

    • Chemical transmission allows neurons to communicate with other nerves and effectors.
    • Neurotransmitters (NTs) are released from the presynaptic nerve and bind to receptors on the postsynaptic effector cell.
    • NTs can excite or inhibit the postsynaptic cell.

    Important NTs

    • Norepinephrine: Plays a role in mood, alertness, and attention.
    • Acetylcholine: Important for nerve and muscle coordination.
    • Dopamine: Involved in impulse coordination, reward, and motivation.
    • GABA: Inhibits nerve activity, reducing anxiety and promoting relaxation.
    • Serotonin: Plays a role in mood, sleep, appetite, and cognition.

    Anxiety Disorders

    • Generalized Anxiety Disorder (GAD): Characterized by excessive worry and anxiety for at least 6 months.
    • Panic Disorders: Involve sudden episodes of intense fear and physical symptoms, lasting less than 10 minutes.
    • Phobias: Irrational fears of specific objects or situations.
    • Social Anxiety Disorder: Fear and anxiety in social situations.
    • Obsessive-Compulsive Disorder (OCD): Characterized by obsessions (unwanted thoughts) and compulsions (repetitive behaviors).
    • Post-Traumatic Stress Disorder (PTSD): Develops after experiencing or witnessing a traumatic event.

    Neural Systems Involved in Anxiety and Wakefulness

    • The limbic system is involved in emotional expression, learning, and memory.
    • The hypothalamus receives signals from the limbic system and triggers unconscious responses to extreme stress, such as the "fight or flight" response.
    • The reticular formation, located in the brainstem, regulates arousal and wakefulness.
    • The reticular activating system (RAS) is involved in sleep and wakefulness.

    Non-Pharmacological Management of Anxiety

    • Addressing the underlying cause of anxiety is essential.
    • Counseling, cognitive-behavioral therapy (CBT), meditation, and herbal remedies can be helpful.

    Pharmacological Management of Anxiety and Insomnia

    • Anxiolytic drugs: Alter norepinephrine and serotonin levels to restore balance.
    • Major classes of anxiolytics:
      • Antidepressants
      • Benzodiazepines
      • Barbiturates
      • Non-barbiturate anxiolytics
    • Concerns about anxiolytics: Potential for physical dependence.

    Antidepressants

    • Selective serotonin reuptake inhibitors (SSRIs): Generally have fewer side effects than other antidepressants.
      • Black box warning: Monitor for suicidal ideations.
    • Tricyclic antidepressants (TCAs): Not recommended for patients with cardiac issues.
      • Pregnancy categories C and D.
    • Monoamine oxidase inhibitors (MAOIs): Strictly avoid foods containing tyramine (aged cheeses, cured meats).
      • Potentiate the effects of insulin and diabetic drugs.
      • Rarely used due to potential interactions.
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs): Carefully monitor for suicidal ideations.

    Escitalopram (Lexapro)

    • Class: Antidepressant
    • Subclass: SSRI
    • Mechanism of Action: Inhibits serotonin reuptake, allowing more serotonin to remain at the synapse.
    • Complications: Serotonin syndrome, neuroleptic malignant syndrome.
    • Interactions: MAOIs (serotonin syndrome), alcohol, St. John's wort (serotonin syndrome).
    • Nursing Considerations: Avoid within 14 days of MAOIs, reduce dose for renal/hepatic impairment, increment doses by at least one week. Not safe for children under 12 years old.

    Paroxetine (Paxil)

    • Class: Antidepressant
    • Subclass: SSRI
    • Mechanism of Action: Selectively inhibits serotonin uptake.
    • Complications: Nausea, diaphoresis, tremor, fatigue, drowsiness (early side effects). Sexual dysfunction, weight gain, GI bleeding, serotonin syndrome, bruxism, postural hypotension (later side effects).
    • Nursing Considerations: Report sexual dysfunction, monitor for bleeding, use mouth guard during sleep, exercise regularly, sit before standing, do not stop abruptly. Pregnancy category D. Requires up to 4 weeks for therapeutic effect.

    Benzodiazepines

    • Preferred drugs for anxiety and insomnia.
    • Schedule IV drugs, offering greater safety than barbiturates.
    • Primarily administered orally (PO).
    • Parenteral forms (diazepam, lorazepam) require close monitoring.
    • Do not produce life-threatening respiratory depression.

    Lorazepam (Ativan)

    • Class: Sedative-hypnotic
    • Subclass: Benzodiazepine
    • Mechanism of Action: Potentiates the effects of GABA; can be used as a pre-anesthetic.
    • Complications: Drowsiness, sedation, amnesia, weakness, disorientation, sleep disturbances, blood pressure changes, blurred vision, nausea, vomiting (high doses).
    • Interactions: CNS depressants, sedation-producing herbs (kava, valerian).
    • Nursing Considerations: Monitor respiratory rate every 5-25 minutes for IV administration. Have airway and resuscitative equipment available. Pregnancy category D. Flumazenil is used to treat overdoses.

    Diazepam (Valium)

    • Class: Sedative-hypnotic
    • Subclass: Benzodiazepine
    • Mechanism of Action: Enhances the action of GABA; used for alcohol withdrawal, seizure disorders, and muscle spasms.
    • Complications: Paradoxical response (opposite of intended effects), CNS depression, respiratory depression, nausea, vomiting, anorexia, toxicity, physical dependence.
    • Interactions: CNS depressants.
    • Nursing Considerations: Take with food, avoid hazardous activities, discontinue gradually over weeks to months, pregnancy category D. Flumazenil is used to treat overdoses.

    Barbiturates

    • Low doses: Reduce anxiety, cause drowsiness.
    • Moderate doses: Inhibit seizure activity, promote sleep.
    • High doses: Used for anesthesia.
    • Schedule II drugs with significant adverse effects.
    • Rarely prescribed for anxiety or insomnia due to potential for severe withdrawal.

    Buspirone (BuSpar)

    • Class: Atypical anxiolytic
    • Subclass: Non-barbiturate anxiolytic
    • Mechanism of Action: Binds to serotonin receptors; used for panic disorders, OCD, and PTSD.
    • Complications: Dizziness, nausea, suicidal ideation, headache, lightheadedness.
    • Interactions: MAOIs should be discontinued for 14 days before starting buspirone. St. John's wort, grapefruit juice.
    • Nursing Considerations: Effects are not immediate. Dependency is less likely. Does not cause sedation or potentiate other CNS depressants. Monitor for suicidal ideation. Increase fluids and fiber to prevent constipation.

    Zolipidem (Ambien)

    • Class: Sedative-hypnotic
    • Subclass: Non-benzodiazepine, non-barbiturate CNS depressant
    • Mechanism of Action: Facilitates GABA; used for short-term insomnia management (7-10 days).
    • Complications: Daytime sedation, dizziness, depression with suicidal ideation, adverse neuropsychiatric reactions (hallucinations, sensory distortion, sleepwalking, nocturnal eating).
    • Contraindications: None listed in the text.
    • Interactions: CNS depressants.
    • Nursing Considerations: Rapid onset, administer immediately before bedtime.

    Melatonin

    • Mechanism of Action: Helps with falling asleep faster, especially for insomnia related to disrupted circadian rhythm cycles.
    • Complications: Nausea, headache, dizziness.

    10/17 Lecture - Mood Disorders

    • Many classes of medications can be used for both depression and anxiety.

    Depression

    • Major Depressive Disorder: Characterized by an imbalance of neurotransmitters in brain regions associated with cognition and emotion.
    • Diagnostic criteria: Depressive symptoms for at least two weeks.
    • Symptoms: Sleeping too much or not enough, lack of energy, abnormal eating patterns, vague physical symptoms, inability to concentrate, feelings of despair, obsessive thoughts of death, social withdrawal, lack of interest, delusions, and hallucinations.
    • Situational Depression: Triggered by specific events.
    • Postpartum Depression (PP Depression): Can be undetected.
    • Seasonal Affective Disorder (SAD): "Seasonal depression".
    • Psychotic Depression: Involves psychotic symptoms (hallucinations, delusions).

    Assessment and Treatment of Depression

    • Assess for physical and psychological factors contributing to depression.
    • Assess for self-treatment with alcohol or drugs.
    • Assess for suicidal ideation and symptoms.
    • Treatment includes:
      • Medications (antidepressants)
      • Psychotherapy
      • Electroconvulsive therapy
      • Repetitive transcranial magnetic stimulation

    Antidepressants - Used to Treat Depression by Enhancing Mood

    • Black box warning: Increased risk of suicide.
    • Mechanism of Action: Antidepressants work on norepinephrine, serotonin, and dopamine by blocking or slowing reabsorption.
    • Primary classes of antidepressants:
      • SSRIs
      • SNRIs
      • TCAs
      • MAOIs

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Slow the reuptake of serotonin.
    • Generally considered safe and have fewer side effects.
    • Selective targeting: Primarily target serotonin.
    • Most common side effects: Sexual dysfunction, weight gain.
    • Serotonin Syndrome: Hyperpyrexia, hypertension, confusion, diaphoresis. Can occur due to overdose or interactions.

    Sertraline (Zoloft)

    • Class: Antidepressant
    • Subclass: SSRI
    • Mechanism of Action: Inhibits serotonin uptake in the brain, improving mood.
    • Complications: Serotonin syndrome, agitation, insomnia, headache, dizziness, fatigue.
    • Interactions: MAOIs, St. John's wort (can cause serotonin syndrome).
    • Nursing Considerations: Black box warning for suicide.

    Fluoxetine (Prozac)

    • Class: Antidepressant
    • Subclass: SSRI
    • Mechanism of Action: Blocks serotonin reuptake in the synaptic space; first-line treatment for depression.
    • Complications: Sexual dysfunction, serotonin syndrome, sleepiness, faintness.
    • Interactions: MAOIs, TCAs, St. John's wort, NSAIDs, anticoagulants (increased risk of bleeding).
    • Nursing Considerations: May take up to 3 weeks for therapeutic effects. Administer in the morning. Taper dose gradually.

    Atypical Antidepressants (SNRIs, NDRIs)

    • Targets serotonin, norepinephrine, and dopamine.
    • Examples:
      • Duloxetine (Cymbalta)
      • Bupropion (Wellbutrin)
      • Trazodone

    Duloxetine (Cymbalta)

    • Class: Atypical antidepressant
    • Subclass: SNRI
    • Mechanism of Action: Treats major depression by blocking reuptake of norepinephrine and serotonin.
    • Complications: Risk of suicide in children and adolescents, sexual dysfunction, serotonin syndrome, withdrawal syndrome, nausea, vomiting, anorexia, hypertension, tachycardia, dizziness, blurred vision, bronchitis.
    • Interactions: MAOIs, NSAIDs, alcohol and other CNS medications, St. John's wort.
    • Nursing Considerations: Monitor weight, food intake, vital signs, and taper dose gradually.

    Bupropion (Wellbutrin)

    • Class: Atypical antidepressant
    • Subclass: Norepinephrine-dopamine reuptake inhibitor (NDRI)
    • Mechanism of Action: Treats depression and aids in smoking cessation.
    • Complications: Nausea, vomiting, anorexia, weight loss, seizures, headaches, dry mouth, GI distress, constipation, increased heart rate, hypertension, restlessness, insomnia.
    • Contraindications: Seizure disorders, eating disorders.
    • Nursing Considerations: Alternative to SSRIs and SNRIs for patients who experience sexual dysfunction. Monitor weight and food intake. Avoid administering to clients at risk for seizures.

    Tricyclic Antidepressants (TCAs)

    • Treats major depressive disorder.
    • Common side effects: Nausea, vomiting, orthostatic hypotension, cardiac dysrhythmias.
    • Significant interactions: CNS depressants, MAOIs.

    Imipramine (Tofranil)

    • Class: Antidepressant
    • Subclass: Tricyclic antidepressant
    • Mechanism of Action: Blocks reuptake of serotonin and norepinephrine; treats major depression.
    • Complications: Sedation, drowsiness, blurred vision.
    • Interactions: CNS depressants, St. John's wort.
    • Nursing Considerations: Compliance is crucial for therapeutic effects (2-3 weeks). Do not discontinue abruptly.

    Amitriptyline (Elavil)

    • Class: Antidepressant
    • Subclass: Tricyclic antidepressant
    • Mechanism of Action: Blocks norepinephrine and serotonin reuptake.
    • Complications: Orthostatic hypotension, decreased seizure threshold, sedation.
    • Nursing Considerations: Change positions slowly, avoid hazardous activities, monitor patients with seizure disorders.

    Monoamine Oxidase Inhibitors (MAOIs)

    • Targets norepinephrine, serotonin, and dopamine.
    • Used when other antidepressants are ineffective.
    • Avoid foods containing tyramine (aged cheese, cured meats): Can cause a hypertensive crisis.
    • Low safety margin: Monitor closely for interactions.
    • Common side effects: Orthostatic hypotension.

    Phenelzine (Nardil)

    • Class: Antidepressant
    • Subclass: MAOI
    • Mechanism of Action: Irreversible inhibition of MAO; treats depression.
    • Complications: Constipation, dry mouth, hypertensive crisis.
    • Contraindications: Foods containing tyramine (causes hypertensive crisis).
    • Nursing Considerations: Requires a washout period of 2-3 weeks before introducing other drugs. Abrupt discontinuation can cause rebound hypertension. Avoid tyramine-containing foods (including wine).

    Complementary and Alternative Therapies for Depression

    • St. John's Wort: Inhibits serotonin reuptake, similar to SSRIs.
    • Risk of serotonin syndrome: Monitor for interactions with other antidepressants.

    Bipolar Disorder

    • Characterized by episodes of depression and mania.
    • Mania: High psychomotor activity, distractibility, elevated mood.
    • Diagnosis: Manic symptoms lasting at least one week.
    • Mood stabilizers: Lithium is a primary treatment.
    • Monitor sodium levels closely: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L).

    Lithium Carbonate (Lithobid, Eskalith)

    • Class: Mood stabilizer
    • Mechanism of Action: Treats acute mania and manages depression.
    • Complications: Lithium toxicity, renal toxicity (BUN, creatinine), polyuria, slight thirst.
    • Contraindications: Renal dysfunction, sodium depletion, dehydration.
    • Interactions: Diuretics.
    • Nursing Considerations: Maintain adequate fluid intake, monitor for toxicity, closely monitor sodium levels, daily weights (for fluid balance).

    Attention-Deficit/Hyperactivity Disorder (ADHD)

    • Prevalence: Common.
    • Diagnosis: Typically made by age 12.
    • Symptoms: Poor attention span, behavioral control issues, inability to sit still.
    • Etiology: High lead levels, genetics, alcohol or drug exposure in utero.
    • Treatment: Stimulants (methylphenidate) are often prescribed to improve focus and reduce impulsivity.

    Methylphenidate (Ritalin)

    • Class: ADHD drug
    • Subclass: CNS stimulant
    • Mechanism of Action: Activates the reticular activating system, reducing impulsivity and improving focus.
    • Complications: Nervousness, insomnia, irregular heartbeat, high blood pressure, diminished appetite, anorexia, liver toxicity, dependence.
    • Nursing Considerations: Schedule II drug. Monitor weight weekly. Administer early in the day (before 4 pm). Assess the need for continuous medication or "drug holidays". Do not discontinue abruptly.

    Atomoxetine (Strattera)

    • Class: Non-CNS stimulant
    • Mechanism of Action: Treats ADHD.
    • Complications: Appetite suppression, weight loss, hepatotoxicity (liver damage).
    • Nursing Considerations: Structure meals to prevent weight loss. May take up to 3 weeks to work. Monitor for liver damage.

    10/22 Lecture - Psychoses

    Schizophrenia

    • Neurobiology: Overactive dopamine pathways in the basal nuclei.
    • High risk for suicide: Monitor closely for suicidal ideations.
    • Types of symptoms:
      • Positive symptoms: Exaggerations of normal behaviors (delusions, hallucinations, paranoia)
      • Negative symptoms: Reduction or absence of normal behaviors (lack of interest, motivation, responsiveness, pleasure in activities).
    • Challenges with adherence: High non-compliance rate.
    • Pharmacotherapy: Drugs do not cure but can help manage symptoms. Symptoms remain in remission as long as medication is taken.
    • Adverse effects: Extrapyramidal symptoms (EPS), typical and atypical antipsychotics.

    Phenothiazines

    • Mechanism of Action: Block dopamine and serotonin from occupying receptors.
    • Effectiveness: Most effective for positive symptoms.
    • Safety margin: Wide safety margin.
    • Extrapyramidal symptoms: Acute dystonia, akathisia, secondary Parkinsonism, tardive dyskinesia.

    Chlorpromazine (Thorazine)

    • Class: Antipsychotic drug
    • Subclass: Phenothiazine
    • Mechanism of Action: Blocks dopamine and serotonin from occupying receptors.
    • Complications: EPS, neuroleptic malignant syndrome (high fever, confusion, rigidity), sedation, sexual dysfunction.
    • Nursing Considerations: May take 8 weeks for results. Parenteral forms available for extreme agitation. Withdraw gradually.

    Haloperidol (Haldol)

    • Class: Conventional antipsychotic
    • Subclass: Non-phenothiazine
    • Mechanism of Action: Blocks postsynaptic dopamine receptors. EPS is common in older adults. 50 times more potent than chlorpromazine.
    • Complications: Less sedative, EPS, neuroleptic malignant syndrome.
    • Nursing Considerations: Do not discontinue abruptly. Injectable form is considered if oral therapy is not tolerated.

    Atypical Antipsychotic Drugs

    • Fewer EPS effects: Treat both positive and negative symptoms.
    • Complications: Weight gain, diabetes, increased risk of cerebrovascular events, hypertriglycerides.

    Risperidone (Risperdal)

    • Class: Atypical antipsychotic drug
    • Mechanism of Action: Blocks dopamine, serotonin, and alpha-adrenergic receptors.
    • Complications: Weight gain, hyperglycemia, hypertriglycerides, EPS.
    • Nursing Considerations: Compliance is essential.

    Substance Use Disorder

    • Addiction: Overwhelming compulsion despite negative consequences.
    • Contributing factors: Multiple variables.
    • Physical Dependence: Alcohol, sedatives, nicotine.
    • Psychological Dependence: Cannabinoids.
    • Withdrawal Syndrome: Occurs when a physically dependent individual abruptly discontinues a substance.
    • Medications to support withdrawal: Benzodiazepines.
    • Delirium Tremens (DTs) from alcohol withdrawal: Shaking, vomiting, tachycardia, high temperature, high blood pressure, aversion to therapy.
    • Cocaine withdrawal: Dilated pupils, nosebleeds, sniffing, tachycardia, seizures, high blood pressure, respiratory rate, and temperature, hallucinations, anxiety/agitation, anorexia.
    • Opioid withdrawal: Agitation, insomnia, flu-like symptoms, yawning, sweating.
    • Treatment: Methadone substitution, clonidine, buprenorphine.
    • Nicotine treatment: Varenicline (Chantix).

    Nervous System Overview

    • Synaptic transmission involves chemical communication between nerves and effectors using neurotransmitters.
    • Important neurotransmitters include:
      • Norepinephrine: contributes to alertness and mood regulation.
      • Acetylcholine: facilitates nerve/muscle coordination.
      • Dopamine: involved in impulse coordination.
      • GABA: inhibits nerve activity.
      • Serotonin: influences arousal and cognition.

    Anxiety Disorders

    • Types of anxiety disorders:
      • Generalized Anxiety Disorder (GAD): characterized by excessive worry for at least 6 months.
      • Panic Disorder: intense fear episodes lasting less than 10 minutes and occurring in two stages: anticipatory anxiety and physical symptoms.
      • Phobias: intense fears of specific objects or situations.
      • Social Anxiety Disorder: excessive fear of social situations.
      • Obsessive-Compulsive Disorder: recurrent intrusive thoughts and rituals to alleviate anxiety.
      • Post-Traumatic Stress Disorder: develops after experiencing a traumatic event.

    Neural Systems for Anxiety and Wakefulness

    • The limbic system plays a role in emotional expression, learning, and memory.
    • The hypothalamus receives signals from the limbic system and triggers unconscious responses to extreme stress, leading to the "fight or flight" response.
    • The reticular formation connects with the hypothalamus and regulates stimulation and inhibition.
    • The Reticular Activating System (RAS) is involved in sleep and wakefulness.

    Management of Anxiety

    • Non-pharmacological Management:
      • Addressing the root cause.
      • Counseling and Cognitive Behavioral Therapy (CBT).
      • Meditation and herbal remedies.
    • Pharmacological Management:
      • Use of anxiolytics.

    Insomnia

    • Insomnia refers to difficulty falling asleep.
    • Short-term insomnia is often caused by stress, food, or beverages.
    • Long-term insomnia (lasting over 30 days) can be associated with depression, manic disorders, and chronic pain.
    • Non-pharmacological interventions are recommended first.

    Anxiolytic Drugs

    • Anxiolytic drugs work by altering norepinephrine and serotonin levels to restore normal balance.
    • Major classes of anxiolytics:
      • Antidepressants: inhibit the reuptake of neurotransmitters.
      • Benzodiazepines: potentiate GABA neurotransmission.
      • Barbiturates: depress the central nervous system.
      • Non-barbituate anxiolytics: target various receptors.
    • Concerns: Potential for physical dependence.

    Antidepressants

    • Selective Serotonin Reuptake Inhibitors (SSRIs):
      • Fewer side effects compared to other antidepressants.
      • Black Box Warning: Monitor for suicidal ideations.
    • Tricyclic Antidepressants (TCAs):
      • Not recommended for patients with cardiac issues.
      • Pregnancy category C or D.
    • Monoamine Oxidase Inhibitors (MAOIs):
      • Strictly avoid foods containing tyramine.
      • Potentiate effects of insulin and diabetic medications, leading to hypoglycemia.
      • Rarely used.
    • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):
      • Monitor for suicidal ideations.

    Benzodiazepines

    • Preferred medications for anxiety and insomnia.
    • Classified as Schedule IV drugs.
    • Offer a greater margin of safety than barbiturates.
    • Available in oral and parenteral forms.
    • Monitor closely when administering parenteral forms (e.g., diazepam, lorazepam).
    • Do not produce life-threatening respiratory depression.

    Barbituates

    • Low doses: Reduce anxiety and cause drowsiness.
    • Moderate doses: Inhibits seizure activity and promotes sleep.
    • High doses: Used for anesthesia.
    • Classified as Schedule II drugs.
    • Significant adverse effects: Rarely prescribed for anxiety and insomnia.
    • Withdrawal symptoms: can be severe.

    Non-Benzodiazepine, Non-Barbituate CNS Depressants

    • Insomnia Therapy:
      • Buspirone:
        • Mechanism of Action: Binds to serotonin receptors.
        • Indications: Panic disorders, OCD, PTSD.
        • Interactions: Avoid MAOIs, St. John's Wort, and grapefruit juice.
      • Zolipidem:
        • Mechanism of Action: Facilitates GABA neurotransmission.
        • Indications: Short-term insomnia management (7-10 days).
        • Contraindications: CNS depressants.
      • Melatonin:
        • Mechanism of Action: Regulates sleep-wake cycles.
        • Indications: Insomnia related to disrupted circadian rhythms.

    Mood Disorders

    • Depression is characterized by an imbalance of neurotransmitters in regions associated with cognitive focus and emotion.
    • Major Depressive Disorder: Depressive symptoms persist for at least two weeks.
    • Situational Depression: Triggered by a specific event.
    • Postpartum Depression: May go undetected.
    • Seasonal Affective Disorder: "Seasonal depression."
    • Psychotic Depression: Involves delusions and hallucinations.
    • Assessment and Treatment:
      • Evaluate: Physical and psychological factors, and self-treatments (e.g., alcohol, drugs).
      • Assess for suicidal ideations.
      • Treatment: Medications, psychotherapy, electroconvulsive therapy, repetitive transcranial magnetic stimulation.

    Antidepressants (for Depression Treatment)

    • Enhance mood by influencing neurotransmitter levels.
    • Black Box Warning: Risk of suicide.
    • Classes of Antidepressants:
      • SSRIs: Inhibit serotonin reuptake. (e.g., Sertraline, Fluoxetine)
      • SNRIs: Block reuptake of both serotonin and norepinephrine (e.g., Duloxetine)
      • NDRIs: Target norepinephrine and dopamine (e.g., Bupropion)
      • TCAs: Block reuptake of serotonin and norepinephrine, leading to common side effects (e.g., Imipramine, Amitriptyline)
      • MAOIs: Inhibit the enzyme MAO, leading to potential interactions with foods containing tyramine (e.g., Phenelzine)

    Bipolar Disorder

    • Characterized by alternating episodes of depression and mania.
    • Mania: Excessive psychomotor activity, distractibility.
    • Diagnosis: Manic symptoms for at least one week.
    • Treatment: Mood stabilizers (e.g., Lithium)
    • Lithium Monitoring: Sodium levels need to be carefully monitored.

    ADHD

    • Common neurodevelopmental disorder.
    • Diagnosed by age 12.
    • Symptoms include inattention, behavioral control issues, and restlessness.
    • Possible causes: High lead levels, genetics, alcohol or drug exposure in utero.
    • Treatment: Stimulants to help with focus.

    Psychoses

    • Schizophrenia: Associated with overactive dopamine pathways.
    • Symptoms:
      • Positive: Delusions, hallucinations, paranoia.
      • Negative: Lack of interest, motivation, responsiveness, and pleasure in daily activities.
    • Treatment: Pharmacotherapy (doesn't cure but manages symptoms).
    • Challenges: Adherence can be difficult, with high non-compliance rates.
    • Pharmacological Side Effects: Extrapyramidal Symptoms (EPS)

    Antipsychotic Drugs

    • Typical Antipsychotics (Phenothiazines):
      • Mechanism of Action: Block dopamine and serotonin receptors.
      • Effectiveness: Most effective for positive symptoms.
      • Wide Safety Margin: EPS can occur (acute dystonia, akathisia, secondary parkinsonism, tardive dyskinesia).
    • Nonphenothiazines: (e.g., Haloperidol)
    • Atypical Antipsychotics:
      • Mechanism of Action: Block dopamine and serotonin receptors.
      • Effectiveness: Treat both positive and negative symptoms.
      • Fewer EPS effects: Weight gain, diabetes, increased risk of cerebrovascular events, hypertriglycerides.

    Substance Use Disorder

    • Addiction: Overwhelming compulsion to use substances despite negative consequences.

    • Physical Dependence: Alcohol, sedatives, nicotine.

    • Psychological Dependence: Cannabinoids.

    • Withdrawal Syndrome: Symptoms experienced after abrupt discontinuation of a substance.

      • Alcohol Withdrawal: Delirium tremens (shaking, vomiting, tachycardia, high temperature, high blood pressure).
      • Cocaine Withdrawal: Dilated pupils, nosebleeds, tachycardia, seizures, hallucinations.
      • Opioid Withdrawal: Agitation, insomnia, flu-like symptoms, yawning, sweating.

    • Treatment: Meds to support withdrawal: benzodiazepines, methadone, clonidine, buprenorphine.

    • Nicotine Treatment: Varenicline.

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    Description

    Test your knowledge on the nervous system, neurotransmitters, and their roles in various functions. Explore important neurotransmitters such as norepinephrine and serotonin, and understand anxiety disorders including generalized anxiety disorder and phobias. This quiz is designed for students studying neuroscience or psychology.

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