Pharmacology Basics: Hormones and Medications

Hormones and Medications

• Oxytocin: Produced by the pituitary gland; induces uterine contractions during delivery and postpartum to prevent hemorrhaging; common side effect includes rapid and painful contractions.
• Finasteride: Treats benign prostatic hyperplasia (BPH); alleviates nocturia symptoms; potential side effects involve sexual dysfunction and impaired fertility.
• Sulfasalazine: Used for ulcerative colitis; associated with hepatotoxicity; caution is advised for patients with severe hepatic or renal impairment.
• Orlistat: Prescribed for obesity management; inhibits fat absorption.
• Emergency Contraception: Efficacy depends on the time since unprotected intercourse.
• Methylnaltrexone: Addresses chronic constipation related to opioid use in advanced cancer; acts by blocking opioid receptors in the gut.

Acid Neutralizers and Pain Management

• Antacids: Provide temporary relief for heartburn; onset of action is 20-40 minutes; absorption may be reduced if taken within two hours of other medications.
• DMARDS (Disease Modifying Antirheumatic Drugs): Slow disease progression, often combined with NSAIDs or steroids; risks include increased infection, bone marrow suppression, and hepatic fibrosis.
• 5 Alpha Reductase Inhibitors: Prevent testosterone conversion and reduce prostate enlargement symptoms.
• Vitamin A: Safe in recommended pregnancy doses but can cause fetal malformations if overdosed.
• Alendronate: A bisphosphonate for osteoporosis; must be taken with water and requires the patient to remain upright for 30 minutes post-administration; can cause esophageal irritation.
• Magnesium Sulfate: Used in preterm labor to relax smooth muscles; requires monitoring for sedation and overdose symptoms such as confusion and decreased reflexes.

Gastrointestinal and Nutritional Considerations

• Bismuth Subsalicylate: Binds toxins to eliminate them from the body; used in gastrointestinal distress.
• Terbutaline: A tocolytic for preterm labor; black box warning for use over 48-72 hours due to fetal risks.
• Sildenafil: Treats erectile dysfunction and conditions like Raynaud’s; can cause priapism and hypotension when used with nitrates.
• Stool Softeners: Increase water and fat absorption in stools.
• Psyllium Mucilloid: First-line treatment for constipation; increases fluid intake and may take several days for effects.
• Enteral Feedings: Monitor for dry mucous membranes as a sign of insufficient hydration.

Vitamin and Hormonal Factors

• Folic Acid: Deficiency risk increased during pregnancy, alcohol abuse, and malabsorption disorders.
• H2 Receptor Antagonists: Treat and prevent duodenal ulcers without affecting acid production directly.
• Oral Contraceptives: Effectiveness can be reduced by certain antibiotics and specific medical conditions; increases risk of thrombotic events.
• Testosterone: Used in palliative care for breast cancer treatment; requires patch site rotation every 7 days.
• Conjugated Estrogen: Increases risks of blood clots and DVT; contraindicated with abnormal uterine bleeding.
• Tamsulosin: Alleviates BPH symptoms and improves nocturia.

Additional Medications and Considerations

• Norethindrone: Should be taken at the same time daily; side effects include photosensitivity; affected by St. John’s wort.
• Sucralfate: Coats and heals gastric erosions; does not affect acid production.
• Selective Estrogen Receptor Modulators: Contraindicated in patients with venous thromboembolism.
• PPIs (Proton Pump Inhibitors): Block stomach acid secretion; long-term use can increase fracture risks; delayed symptom relief.
• Medroxyprogesterone: Long-term contraceptive, administered deep IM every three months; increased thrombotic event risks; avoid smokers to reduce complications.
• Misoprostol: Prevents peptic ulcers by stimulating mucus production; inhibits gastric acid secretion.
• Ondansetron (Zofran): Administered before triggers; may prolong QT interval and cause dysrhythmias.
• TPN (Total Parenteral Nutrition): Requires central line and regular blood sugar monitoring; must be refrigerated before use.

Hormone Replacement Therapy Risks

• Risks associated with hormone replacement therapy include deep vein thrombosis (DVT), myocardial infarction (MI), and dementia.

Hormones and Medications

• Oxytocin: Produced by the pituitary gland; induces uterine contractions during delivery and postpartum to prevent hemorrhaging; common side effect includes rapid and painful contractions.
• Finasteride: Treats benign prostatic hyperplasia (BPH); alleviates nocturia symptoms; potential side effects involve sexual dysfunction and impaired fertility.
• Sulfasalazine: Used for ulcerative colitis; associated with hepatotoxicity; caution is advised for patients with severe hepatic or renal impairment.
• Orlistat: Prescribed for obesity management; inhibits fat absorption.
• Emergency Contraception: Efficacy depends on the time since unprotected intercourse.
• Methylnaltrexone: Addresses chronic constipation related to opioid use in advanced cancer; acts by blocking opioid receptors in the gut.

Acid Neutralizers and Pain Management

• Antacids: Provide temporary relief for heartburn; onset of action is 20-40 minutes; absorption may be reduced if taken within two hours of other medications.
• DMARDS (Disease Modifying Antirheumatic Drugs): Slow disease progression, often combined with NSAIDs or steroids; risks include increased infection, bone marrow suppression, and hepatic fibrosis.
• 5 Alpha Reductase Inhibitors: Prevent testosterone conversion and reduce prostate enlargement symptoms.
• Vitamin A: Safe in recommended pregnancy doses but can cause fetal malformations if overdosed.
• Alendronate: A bisphosphonate for osteoporosis; must be taken with water and requires the patient to remain upright for 30 minutes post-administration; can cause esophageal irritation.
• Magnesium Sulfate: Used in preterm labor to relax smooth muscles; requires monitoring for sedation and overdose symptoms such as confusion and decreased reflexes.

Gastrointestinal and Nutritional Considerations

• Bismuth Subsalicylate: Binds toxins to eliminate them from the body; used in gastrointestinal distress.
• Terbutaline: A tocolytic for preterm labor; black box warning for use over 48-72 hours due to fetal risks.
• Sildenafil: Treats erectile dysfunction and conditions like Raynaud’s; can cause priapism and hypotension when used with nitrates.
• Stool Softeners: Increase water and fat absorption in stools.
• Psyllium Mucilloid: First-line treatment for constipation; increases fluid intake and may take several days for effects.
• Enteral Feedings: Monitor for dry mucous membranes as a sign of insufficient hydration.

Vitamin and Hormonal Factors

• Folic Acid: Deficiency risk increased during pregnancy, alcohol abuse, and malabsorption disorders.
• H2 Receptor Antagonists: Treat and prevent duodenal ulcers without affecting acid production directly.
• Oral Contraceptives: Effectiveness can be reduced by certain antibiotics and specific medical conditions; increases risk of thrombotic events.
• Testosterone: Used in palliative care for breast cancer treatment; requires patch site rotation every 7 days.
• Conjugated Estrogen: Increases risks of blood clots and DVT; contraindicated with abnormal uterine bleeding.
• Tamsulosin: Alleviates BPH symptoms and improves nocturia.

Additional Medications and Considerations

• Norethindrone: Should be taken at the same time daily; side effects include photosensitivity; affected by St. John’s wort.
• Sucralfate: Coats and heals gastric erosions; does not affect acid production.
• Selective Estrogen Receptor Modulators: Contraindicated in patients with venous thromboembolism.
• PPIs (Proton Pump Inhibitors): Block stomach acid secretion; long-term use can increase fracture risks; delayed symptom relief.
• Medroxyprogesterone: Long-term contraceptive, administered deep IM every three months; increased thrombotic event risks; avoid smokers to reduce complications.
• Misoprostol: Prevents peptic ulcers by stimulating mucus production; inhibits gastric acid secretion.
• Ondansetron (Zofran): Administered before triggers; may prolong QT interval and cause dysrhythmias.
• TPN (Total Parenteral Nutrition): Requires central line and regular blood sugar monitoring; must be refrigerated before use.

Hormone Replacement Therapy Risks

• Risks associated with hormone replacement therapy include deep vein thrombosis (DVT), myocardial infarction (MI), and dementia.

Hormones and Contractions

• Oxytocin: Produced by the pituitary gland; stimulates uterine smooth muscle contractions during delivery; aids in regulating contractions and preventing post-delivery hemorrhaging; common side effect includes rapid and painful contractions.

Medications for Specific Conditions

• Finasteride: Treats benign prostatic hyperplasia (BPH) by decreasing symptoms like nocturia; side effects include sexual dysfunction and impaired fertility.
• Sulfasalazine: Prescribed for ulcerative colitis; carry risks of hepatotoxicity; use cautiously in patients with severe liver or kidney impairments.
• Orlistat: A medication used to manage obesity by inhibiting fat absorption.
• Emergency Contraception: Decision is based on the timing since intercourse occurred; works to prevent pregnancy post-coitus.
• Methylnaltrexone: Designed for chronic constipation relief in patients with advanced cancer on opioids.

Antacids and Gastrointestinal Medications

• Antacids: Onset of action between 20-40 minutes; neutralizes stomach acid, providing temporary relief from heartburn; absorption may be impaired if taken with other medications.
• DMARDs: Help slow disease progression in chronic conditions; often combined with NSAIDs or steroids to manage inflammation and pain; risk of infections, bone marrow suppression, and hepatic fibrosis increases.
• 5-alpha Reductase Inhibitors: Prevent conversion of testosterone, promoting prostate shrinkage; effective in treating BPH.
• Alendronate: A bisphosphonate that may cause esophageal irritation or ulceration; requires full glass of water intake and upright posture post-consumption.
• Magnesium Sulfate: Used to relax smooth muscle and delay preterm labor; monitor for overdose symptoms such as confusion and muscle weakness; avoid alcohol as it can enhance sedative effects.

Vitamins and Nutritional Considerations

• Vitamin A: Necessary for vision; safe in recommended doses during pregnancy but excess can lead to fetal malformations.
• Folic Acid: Deficiency can occur due to pregnancy, alcohol abuse, or malabsorption disorders; supplementation is vital.

Hormonal Therapies and Contraceptives

• Conjugated Estrogen: Commonly used for menopausal symptoms; increases risks of blood clots and other side effects, especially in women over 35; contraindicated in abnormal uterine bleeding.
• Norethindrone: Taken consistently daily; patients should be aware of photosensitivity; St. John's Wort can interfere with efficacy leading to breakthrough bleeding.
• Medroxyprogesterone: Long-term contraceptive administered via deep IM every three months; smoking and use of St. John's Wort can increase thrombolytic event risks.

Treatment of Ulcers and Other Conditions

• H2 Receptor Antagonists: Useful in treating duodenal ulcers and preventing recurrence; effectiveness may decrease when taken alongside antacids.
• Sucralfate: Coats and heals gastric erosions without impacting acid production; beneficial for peptic ulcer disease.
• Zofran (Ondansetron): Administered before triggers to prevent nausea; potential to lengthen QT interval and cause dysrhythmias.

IV Fluids and Electrolytes

• TPN (Total Parenteral Nutrition): Requires central line administration; monitored for blood glucose levels; remove from refrigeration 30 minutes before use.
• Crystalloids: Contain electrolytes; mimic extracellular fluid; effective for hypovolemic shock.
• Colloids: Plasma protein solutions that maintain fluid within blood vessels; rapid administration can lead to fluid overload.

Other Important Points

• Priapism: A serious condition associated with medications for erectile dysfunction; contraindicated with nitrates due to hypotension.
• Psyllium Mucilloid: First-line agent for constipation; takes several days to effect; increases water absorption in stool; essential to increase fluid intake.
• Bismuth Subsalicylate: Used for diarrhea as it binds and absorbs toxins.
• Terbutaline: Tocolytic medication for preterm labor; has a black box warning against use for more than 48-72 hours due to fetal risks.

Hormones and Contractions

• Oxytocin: Produced by the pituitary gland; stimulates uterine smooth muscle contractions during delivery; aids in regulating contractions and preventing post-delivery hemorrhaging; common side effect includes rapid and painful contractions.

Medications for Specific Conditions

• Finasteride: Treats benign prostatic hyperplasia (BPH) by decreasing symptoms like nocturia; side effects include sexual dysfunction and impaired fertility.
• Sulfasalazine: Prescribed for ulcerative colitis; carry risks of hepatotoxicity; use cautiously in patients with severe liver or kidney impairments.
• Orlistat: A medication used to manage obesity by inhibiting fat absorption.
• Emergency Contraception: Decision is based on the timing since intercourse occurred; works to prevent pregnancy post-coitus.
• Methylnaltrexone: Designed for chronic constipation relief in patients with advanced cancer on opioids.

Antacids and Gastrointestinal Medications

• Antacids: Onset of action between 20-40 minutes; neutralizes stomach acid, providing temporary relief from heartburn; absorption may be impaired if taken with other medications.
• DMARDs: Help slow disease progression in chronic conditions; often combined with NSAIDs or steroids to manage inflammation and pain; risk of infections, bone marrow suppression, and hepatic fibrosis increases.
• 5-alpha Reductase Inhibitors: Prevent conversion of testosterone, promoting prostate shrinkage; effective in treating BPH.
• Alendronate: A bisphosphonate that may cause esophageal irritation or ulceration; requires full glass of water intake and upright posture post-consumption.
• Magnesium Sulfate: Used to relax smooth muscle and delay preterm labor; monitor for overdose symptoms such as confusion and muscle weakness; avoid alcohol as it can enhance sedative effects.

Vitamins and Nutritional Considerations

• Vitamin A: Necessary for vision; safe in recommended doses during pregnancy but excess can lead to fetal malformations.
• Folic Acid: Deficiency can occur due to pregnancy, alcohol abuse, or malabsorption disorders; supplementation is vital.

Hormonal Therapies and Contraceptives

• Conjugated Estrogen: Commonly used for menopausal symptoms; increases risks of blood clots and other side effects, especially in women over 35; contraindicated in abnormal uterine bleeding.
• Norethindrone: Taken consistently daily; patients should be aware of photosensitivity; St. John's Wort can interfere with efficacy leading to breakthrough bleeding.
• Medroxyprogesterone: Long-term contraceptive administered via deep IM every three months; smoking and use of St. John's Wort can increase thrombolytic event risks.

Treatment of Ulcers and Other Conditions

• H2 Receptor Antagonists: Useful in treating duodenal ulcers and preventing recurrence; effectiveness may decrease when taken alongside antacids.
• Sucralfate: Coats and heals gastric erosions without impacting acid production; beneficial for peptic ulcer disease.
• Zofran (Ondansetron): Administered before triggers to prevent nausea; potential to lengthen QT interval and cause dysrhythmias.

IV Fluids and Electrolytes

• TPN (Total Parenteral Nutrition): Requires central line administration; monitored for blood glucose levels; remove from refrigeration 30 minutes before use.
• Crystalloids: Contain electrolytes; mimic extracellular fluid; effective for hypovolemic shock.
• Colloids: Plasma protein solutions that maintain fluid within blood vessels; rapid administration can lead to fluid overload.

Other Important Points

• Priapism: A serious condition associated with medications for erectile dysfunction; contraindicated with nitrates due to hypotension.
• Psyllium Mucilloid: First-line agent for constipation; takes several days to effect; increases water absorption in stool; essential to increase fluid intake.
• Bismuth Subsalicylate: Used for diarrhea as it binds and absorbs toxins.
• Terbutaline: Tocolytic medication for preterm labor; has a black box warning against use for more than 48-72 hours due to fetal risks.

Side Effects and Management

• Nausea and itching can be managed at home as common side effects.
• Adverse effects may include hives, severe rash, or anaphylaxis.

Medication Classifications

• Lactated Ringer's is a crystalloid fluid that is isotonic, preventing major compartment shifts.
• Ciproflaxcin is an antibiotic that can be taken with or without food; antacids reduce absorption.
• Nystatin treats fungal infections and is available in various forms such as capsules and creams.

Drug Specifics and Considerations

• Theophylline is used for asthma; it has multiple side effects including tachycardia and insomnia.
• Aspirin effectiveness can decrease with steroid use; it is classified as an NSAID.
• Allopurinol is taken with food to treat gout, requiring 1-3 weeks to affect uric acid levels.
• Omeprazole is a PPI that treats peptic ulcer disease.
• Famotidine is an OTC or prescription option for GERD treatment.

Special Drug Administration and Precautions

• Oxytocin stimulates labor and should be monitored for rapid contractions requiring intervention.
• Naloxone is used to treat opiate overdose; respiratory depression is a key sign.
• Morphine causes peripheral vasodilation leading to orthostatic hypotension and requires careful monitoring.
• Potassium IV should be delivered at a concentration of 1mEq per 10ml, with a maximum rate of 10mEq/hr; never give IV push.

Pharmacological Principles

• Absorption refers to the movement of substances across body membranes into body fluids.
• The first-pass effect is the medication metabolization in the liver bypassed by IV administration.
• A loading dose provides a large initial dose to quickly achieve therapeutic concentrations.

Drug Interactions and Effects

• Estradiol's effectiveness can be diminished by antibiotics; smoking should be questioned.
• Macrolides are bacteriostatic, inhibiting protein synthesis.
• Ibuprofen may cause gastrointestinal bleeding; monitor kidney patients for increased creatinine levels.

Treatment Modalities

• Trimethoprim-sulfamethoxazole is used to treat UTIs.
• Montelukast is a leukotriene modifier that can cause rare but serious side effects like suicidal thoughts.
• Diphendydramine is used in Parkinson's treatment and may lead to urinary retention and dry mouth.

Drug Delivery and Kinetics

• Space devices ensure that more medication is delivered into the lungs.
• Pharmacokinetics includes absorption, distribution, metabolism, and excretion—summarized as ADME.
• IV, sublingual, oral liquid, oral tablets, and oral enteric-coated represent routes from fastest to slowest effectiveness.

Additional Considerations

• Acetaminophen treats pain, especially for patients with a history of ulcers.
• Lithium is effective for manic/depressive episodes but has a narrow therapeutic window and many drug interactions.
• Use caution with medications that cannot be crushed, including extended release or enteric-coated formulations.

Side Effects and Management

• Nausea and itching can be managed at home as common side effects.
• Adverse effects may include hives, severe rash, or anaphylaxis.

Medication Classifications

• Lactated Ringer's is a crystalloid fluid that is isotonic, preventing major compartment shifts.
• Ciproflaxcin is an antibiotic that can be taken with or without food; antacids reduce absorption.
• Nystatin treats fungal infections and is available in various forms such as capsules and creams.

Drug Specifics and Considerations

• Theophylline is used for asthma; it has multiple side effects including tachycardia and insomnia.
• Aspirin effectiveness can decrease with steroid use; it is classified as an NSAID.
• Allopurinol is taken with food to treat gout, requiring 1-3 weeks to affect uric acid levels.
• Omeprazole is a PPI that treats peptic ulcer disease.
• Famotidine is an OTC or prescription option for GERD treatment.

Special Drug Administration and Precautions

• Oxytocin stimulates labor and should be monitored for rapid contractions requiring intervention.
• Naloxone is used to treat opiate overdose; respiratory depression is a key sign.
• Morphine causes peripheral vasodilation leading to orthostatic hypotension and requires careful monitoring.
• Potassium IV should be delivered at a concentration of 1mEq per 10ml, with a maximum rate of 10mEq/hr; never give IV push.

Pharmacological Principles

• Absorption refers to the movement of substances across body membranes into body fluids.
• The first-pass effect is the medication metabolization in the liver bypassed by IV administration.
• A loading dose provides a large initial dose to quickly achieve therapeutic concentrations.

Drug Interactions and Effects

• Estradiol's effectiveness can be diminished by antibiotics; smoking should be questioned.
• Macrolides are bacteriostatic, inhibiting protein synthesis.
• Ibuprofen may cause gastrointestinal bleeding; monitor kidney patients for increased creatinine levels.

Treatment Modalities

• Trimethoprim-sulfamethoxazole is used to treat UTIs.
• Montelukast is a leukotriene modifier that can cause rare but serious side effects like suicidal thoughts.
• Diphendydramine is used in Parkinson's treatment and may lead to urinary retention and dry mouth.

Drug Delivery and Kinetics

• Space devices ensure that more medication is delivered into the lungs.
• Pharmacokinetics includes absorption, distribution, metabolism, and excretion—summarized as ADME.
• IV, sublingual, oral liquid, oral tablets, and oral enteric-coated represent routes from fastest to slowest effectiveness.

Additional Considerations

• Acetaminophen treats pain, especially for patients with a history of ulcers.
• Lithium is effective for manic/depressive episodes but has a narrow therapeutic window and many drug interactions.
• Use caution with medications that cannot be crushed, including extended release or enteric-coated formulations.

Side Effects and Management

• Nausea and itching can be managed at home as a common side effect.
• Adverse effects can include hives, severe rash, and anaphylaxis.

Medications and Their Characteristics

• Lactated Ringer’s solution is an isotonic crystalloid fluid that maintains compartment stability.
• Trade names refer to the branding of medications, which may have multiple identifiers.
• Nystatin is used for fungal infections and comes in various forms: capsule, cream, oral, or powder.
• Theophylline is used for asthma management; contraindications include caffeine due to potential side effects like tachycardia and insomnia.

Renal and Drug Interaction Concerns

• End-stage renal disease (ESRD) can decrease drug excretion, increasing drug toxicity risks.
• Medications such as aspirin are affected by steroids and have NSAID classifications, impacting drug effectiveness.

Antibiotics and Their Effects

• Ciprofloxacin is an antibiotic effective for treating anthrax; it is important to take it without antacids.
• Antibiotics can lead to foul-smelling diarrhea as a side effect.
• Bactericidal antibiotics kill bacteria, while bacteriostatic antibiotics inhibit their growth.

Administration and Dosage Guidelines

• Potassium IV must be delivered at 1 mEq per 10 mL at a maximum rate of 10 mEq/hr; never administer IV push.
• Usage of a spacer ensures more effective delivery of inhaled medications.
• Oral medications should not be given if bowel sounds are absent.

Specific Drug Classifications and Effects

• Morphine causes peripheral vasodilation and may lead to orthostatic hypotension; effectiveness requires monitoring and dietary adjustments.
• Macrolides inhibit protein synthesis and display bacteriostatic activity.
• Finasteride reduces prostate size and restores urinary function, requiring 6-12 months for effectiveness.

Special Drug Uses and Considerations

• Naloxone treats opiate overdoses, with respiratory depression as an initial sign.
• Rispiridone is an atypical antipsychotic that treats both positive and negative symptoms of disorders.
• Montelukast is a leukotriene modifier for asthma but carries a risk of suicidal thoughts.

Pharmacokinetics and Body Interaction

• Pharmacokinetics involves absorption, distribution, metabolism, and excretion of drugs.
• Absorption refers to the transfer of drugs from administration site to circulating fluids.
• Distribution influences how drugs move between blood and various tissues.

Gastrointestinal and CNS Effects

• Ondansetron is an antiemetic that should be given before triggers are present.
• Diphenhydramine, a 1st generation antihistamine, can cause drowsiness and dry mouth as common effects.

Treatment for Specific Conditions

• Ibuprofen is used cautiously in patients with kidney issues and can lead to GI bleeding.
• Antiretroviral medications are vital in treating HIV, often requiring combined administration to prevent resistance.
• Loperamide serves as an antidiarrheal but is not appropriate for infectious diarrhea scenarios.

General Administration Instructions

• Extended release, delayed-release, or enteric-coated oral medications must not be crushed.
• Fastest to slowest routes of administration effectiveness are IV, sublingual, oral liquid, tablets, and enteric-coated tablets.

Mental Health and Mood Stabilizers

• Lithium is effective for manic and depressive episodes, though it has a narrow therapeutic window and numerous drug interactions.
• Tricyclic antidepressants may take 4-8 weeks to show maximum effectiveness and are not first-line treatments.

Precautions and Monitoring

• Use Ipratropium with caution in patients with allergies to soybeans, peanuts, or soy lectin.
• Tardive dyskinesia poses the most serious adverse effect for Metoclopramide, designated with a black box warning.

Autism

• Involve parents in assessments of young children as they may feel uncomfortable without parental presence.
• Consistency in routines and familiar toys is crucial for managing care at home.
• Key characteristics: inability to maintain eye contact, repetitive actions, strict adherence to routines.
• Questioning the use of electroconvulsive therapy is necessary.

ADHD

• Adolescents with ADHD may engage in risky behaviors; understanding risks is vital.
• Verbal acknowledgment of the dangers, like "not texting while driving," indicates effective teaching.
• Goal for children: recognising personal space and exhibiting less intrusive behavior.
• Stimulant medications are the first line of treatment and address all symptoms.
• Symptoms include limited attention span and frequent shifts between unfinished tasks.
• Breaking homework into smaller tasks aids in achieving completion.
• Ritalin may decrease appetite, potentially causing weight loss, but increases attention span and learning abilities.
• Plan of care: gain child’s attention before speaking and establish clear behavioral limits.

Tourette's Disorder

• Up to 50% of patients with Tourette's also have ADHD, and 40% may have OCD.
• Treatment options include antipsychotics and alpha-adrenergic agonists.
• Tics may worsen under stress; managing stress is important.
• Therapeutic relationships help clients with problem solving and coping skills.

Oppositional Defiant Disorder (ODD)

• Clients posing threats to themselves or others require additional follow-up.

Conduct Disorder

• Verbal abuse in environments carries risks for injury to others.
• Behavior contracts clarify expected behaviors and consequences.
• Childhood-onset conduct disorder is more severe than adolescent-onset, with a higher likelihood of developing antisocial personality disorder.

Separation Anxiety Disorder and Disruptive Mood Dysregulation Disorder (DMDD)

• DMDD is characterized by outbursts across multiple settings; symptoms limited to one location may not warrant a diagnosis.
• Understanding a client’s developmental level aids in tailoring family teaching materials.

Eating Disorders

• An interdisciplinary team is vital for care, with dietitians focusing on physiological needs.
• Accompanying clients with eating disorders to the bathroom after meals are crucial to prevent self-induced vomiting.
• Systolic blood pressure of 62 mm Hg indicates a need for hospitalization.
• Distorted body image is common among adolescents with eating disorders.
• Clients may have very low BMI (<17) and altered hormones, leading to extreme fear of weight gain.
• Follow-up on irregular heart rates is essential.
• SSRIs, like Fluoxetine (Prozac), take approximately two months for maximal efficacy.
• Family dynamics and conflicts can hinder recovery; families should be educated on their roles.
• Nursing interventions include encouraging clients to express feelings about family relationships.

Binge Eating Disorder

• Characterized by feelings of guilt post-eating.

Personality Disorders (Clusters A, B, C)

• Self-injury and violence require prioritized nursing actions.
• No medication cures personality disorders; interventions must focus on the patient’s understanding of the rules and consequences.
• Setting therapeutic boundaries is critical to managing manipulative behaviors.

Cluster A (Odd, Bizarre, Eccentric)

• Paranoid Personality Disorder: suspiciousness demands a non-threatening, calm approach from staff.
• Schizoid and Schizotypal disorders involve social withdrawal and eccentric behaviors.

Cluster B (Dramatic, Erratic, Emotional)

• Antisocial Personality Disorder: manipulative behavior with total disregard for societal norms.
• Borderline Personality Disorder: requires firm, consistent nursing approaches.
• Histrionic Personality Disorder: involves self-dramatization and attention-seeking.
• Narcissistic Personality Disorder: characterized by arrogance and lack of empathy.

Cluster C (Dependent, Anxious, Fearful)

• Avoidant Personality Disorder: exhibits withdrawal and fear of rejection.
• Dependent Personality Disorder: features extreme passivity and self-doubt.
• Obsessive-Compulsive Personality Disorder: marked by control and organization; clutter may indicate distress.

Additional Considerations

• Safety priority for clients reporting self-harm or harm to others necessitates immediate attention.
• Privacy is essential during assessments, but suicidal ideations must be reported.
• Electroconvulsive therapy may be warranted for cases unresponsive to other treatments.
• Nutritional support should be closely monitored, especially to prevent refeeding syndrome.

Explore essential concepts in pharmacology focusing on hormones and medications used for specific conditions. This quiz covers oxytocin, finasteride, and treatments for ulcerative colitis, including their effects and side effects. Test your knowledge in this critical area of medical science.