test 1 module 3 new.docx

Module 3: Psychiatric Mental Health 19\. Neurotransmitters in Psych a\. Dopamine: influences how we interact with the world. Found in all areas of the brain. Involved in psychosis. (Schizophrenia, bipolar, Alzheimer's) b\. Norepinephrine: excitatory impact (fight or flight); major role in mediat...

Module 3: Psychiatric Mental Health 19\. Neurotransmitters in Psych a\. Dopamine: influences how we interact with the world. Found in all areas of the brain. Involved in psychosis. (Schizophrenia, bipolar, Alzheimer's) b\. Norepinephrine: excitatory impact (fight or flight); major role in mediating mood and anxiety; regulation of NE is generally used in treating mood and anxiety disorders. (Major depression, bipolar, Alzheimer's, anxiety) c\. Serotonin: influence temperature, sensory, sleep, and assertiveness areas of the brain. Serves as chemical mediator in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions. (Major depression, bipolar, Alzheimer's, anxiety) d\. GABA: chemical made in the brain. It is an inhibitory NT that reduces a nerve cells' ability to send and receive chemical messages through CNS. Linked with anxiety, autism, and Parkinson's (bipolar, anxiety) e\. Acetylcholine: first NT; plays a major role in encoding memory and cognition. (Alzheimer's, bipolar) 20\. Classic adverse reactions associated with first generation antipsychotic medications: a\. Orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders (agranulocytosis), neuroleptic malignant syndrome (NMS), photosensitivity, lowered seizure threshold, medication-related movement disorders 21\. Education the NP should provide to the patient and family regarding possible side effects and patient monitoring when prescribing clozapine. a\. Blocks receptors for serotonin and dopamine. b\. Used for schizophrenia and reducing suicidal behavior when other drugs have failed. Monitor CBC, cardiovascular exam, and blood glucose. c\. Adverse effects include sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, and seizures d\. BBW: agranulocytosis and myocarditis e\. Rare effects: NMS, photosensitivity, and a lowered seizure threshold. 22\. Explain how the NP manage sexual dysfunction caused by antidepressant medications. a\. Reducing the dosage of the medication of witching to a high potency FGA may reduce adverse effects. Examples include Haldol, 23\. Why should MAOIs and SSRIs not be taken together? How would you prevent complications from changing psychiatric medications when discontinuing one and starting another? a\. Combining MAOIs and SSRIs leaves a patient vulnerable to serotonin syndrome. b\. The original antipsychotic should be tapered off to nothing, followed by a washout period (will be based on the half life of the medication the person had originally been on), and then begin a slow and tapered start dose of the second medication. 24\. What patient education should be covered when starting an MAOI and why? a\. The greatest risk for these patients is hypertensive crisis (headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating) due to eating foods high in tyramine. MAOI does not allow the body to process tyramine correctly, leading to an excess build up of it in the body. Tyramine releases norepinephrine from sympathetic neurons. This in turn causes massive vasoconstriction and intense stimulation of the heart. 25\. What conditions does Risperidone treat? a\. BPD manic episodes 26\. What does Lithium treat? a\. Mania and depressive episodes of bipolar illness 27\. Are Risperidone and Lithium ever used in combination? a\. Lithium is used as a mood stabilizer and is combined with risperidone to help control symptoms during an acute manic episode. Lithium helps stabilize the mood itself with risperidone helps control the symptoms of mania. 28\. Signs and symptoms of serotonin syndrome a\. Mental status changes (hallucinations, agitation), autonomic instability (tachycardia, hyperthermia, BP changes), neuromuscular problems (hyperreflexia, incoordination), Gi disturbances (N/V/D); can be life-threatening. 29\. Signs and symptoms of drug withdrawal a\. Dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, diarrhea, anxiety, irritability, and depression. 30\. Conditions that may develop as a result of taking lithium and their treatments a\. Tremors: use divided doses, sustained release doses, or a beta blocker b\. Polyuria: take amiloride, a potassium sparring diuretic, and make sure to stay hydrated. c\. Goiter and hypothyroidism: measure levels, adjust dosing, take Synthroid d\. Lithium toxicity: hemodialysis if necessary 31\. Durg of choice for different types of mania a\. Pure manic episode (Euphoria mania): mood stabilizers, seven second generation antipsychotics, and a benzodiazepine if needed. b\. Hypomanic Episode (hypomania): no required treatment c\. Major depressive episode (Depression): mood stabilizers, atypical antipsychotic, or a mood stabilizer/antipsychotic plus an antidepressant d\. Mixed Episode: significant risk for suicide 32\. Drug of choice for depression a\. SSRI: Fluoxetine (Prozac): anticholinergic effects 33\. Drug of choice for panic attacks a\. SSRI (Prozac) or SNRI (venlafaxine): nausea, diarrhea, fatigue, and drowsiness b\. Benzodiazepines are also a first choice treatment for anxiety disorders. Examples include Xanax, Valium, and Ativan as well as Temazepam and Triazolam. 34\. Which psychiatric medications potentiate asthma? a\. Typical antipsychotics (clozapine) as well as anticholinergics (amitriptyline) and imipramine can worsen the symptoms of asthma. 35\. What health information should be monitored in patients receiving methylphenidate? a\. Considered to be an amphetamine. b\. Release of norepinephrine and dopamine. c\. Increase wakefulness, alertness, mood, stimulate respiration, decrease appetite, increase heart rate, and have high potential for tolerance as well as abuse. d\. Can cause insomnia and restlessness, weight loss, and increased HR and BP, which can cause issues in patients with previous cardiac disorders. e\. Excessive use can cause paranoid psychosis. 36\. What labs should be monitored in a patient taking lithium? a\. Blood levels for toxicity (0.8-1.2 mEq/L), creatinine concentrations, thyroid hormones, and BCB every 6 months 37\. What is substance abuse disorder? a\. A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related issues. Although physical dependence can contribute to addictive behavior, it is neither necessary not sufficient for addiction to occur. 38\. What medications should patients with alcohol abuse disorder not take? a\. CNS Depressants: CNS depression b\. NSAIDs: injury to GI mucosa resulting in significant gastric bleeding c\. Acetaminophen: potential for fatal liver injury. d\. Disulfiram (Antabuse): effects used to help maintain abstinence e\. Antihypertensive drugs: alcohol raises BP, and so it counteracts the effects of antihypertensive medications 39\. What are the sequelae of long-term alcohol abuse? What body system does alcohol adversely affect? a\. Wernicke's encephalopathy: lack of thiamine. Causes confusion, nystagmus, and abnormal ocular movements. Readily reversible with thiamin. b\. Korsakoff psychosis: polyneuropathy, inability to convert short term to long term memory, and confabulation. Is not reversible. c\. Most dramatic long term effect: enlargement of cerebral ventricles, in response to atrophy of cerebellum itself. Impairment of memory and intellectual function. Only partially reversible. 40\. What are the physical manifestations of cocaine abuse, ecstasy abuse, marijuana abuse, and methamphetamine abuse? What about S/S of overdose in each of these agents? a\. Cocaine abuse: euphoria similar to amphetamines through uptake of dopamine. i\. Toxicity: agitation, dizziness, tremor, blurred vision. Hyperpyrexia, convulsions, ventricular dysrhythmias, and hemorrhagic stroke. Anxiety, paranoia, and hallucinations. b\. Ecstasy abuse: euphoria, psychedelic effects in low dose and amphetamine-like effects in high doses i\. Toxicity: neurotoxicity, seizures, excessive cardiac stimulation, and hyperthermia c\. Marijuana abuse: euphoria, sedation, and hallucinations. Increased sensitivity and humor, delusions. i\. Toxicity: antimotivation syndrome, cannabinoid hyperemesis syndrome, increased HR, orthostatic hypotension and reddening of conjunctiva, bronchodilation, but constriction of airway with chronic use, decreased sperm count, reduction in size of hippocampus and amygdala. d\. Methamphetamine abuse: increases norepinephrine and dopamine uptake. Produces arousal and elevation of mood, euphoria, and talkativeness. Increased physical strength and mental capacity. i\. Toxicity: delusions, paranoia, hallucinations, psychosis, vasoconstriction, angina, hypertension, weight