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Test 2 Nur 185
Flashcards for Psychopharmacology, Anxiety D/O, Personality D/O
| Question | Answer |
|---|---|
| What was the first class of antipsychotics used? | Phenothiazine (Thorazine) |
| When was Thorazine first used? | 1950's |
| What was Thorazine primarily used for? | Thorazine was first used as a sedative |
| What do psychotropic drugs affect? | Psychological function, behavior and/or experience |
| Will antipsychotic meds cure mental illness? | No, they only help pts manage their behavior. Get off the meds, illness will come back |
| Name three neurotransmitters that work by reuptake? | Serotonin, Norepinephrine, & Dopamine |
| What is another name for antianxiety meds? | Anxiolytics |
| What are antianxiety meds used to treat? | Acute alcohol withdrawal, skeletal muscle spasms, convulsive disorder, status epilepticus, pre-op sedation |
| When should antianxiety meds NOT be used? | Antianxiety meds SHOULD NOT be used with other CNS suppressants, during lactation, glaucoma & shock |
| What are 4 antianxiety meds? | Antihistamines, Benzodiazepines, Carbamate derivative, Azaspirondeconediiones |
| Does Benzodiazepines have a physical and psychological dependency? | Yes |
| Do Antihistamines have a physical and psychological dependency? | No |
| What is the delayed onset with Buspirone (Buspar)? | There is a lag time of 10 days to 2 weeks between onset of therapy with Buspirone and subsiding of anxiety symptoms |
| Can antianxiety meds be stopped abruptly? | No, they need to be weaned |
| What are antidepressants used to treat? | Depression, Bipolar, Depression due to Alzheimer's, Schizophrenia, MR, Alcoholics, Bulimia Nervosa |
| How do antidepressants work? | By reuptake |
| Antidepressants increase the concentration of what 3 neurotransmitters? | Serotonin, Norepinephrine & Dopamine |
| What health problems would antidepressants be contraindicated for? | Acute MI, narrow-angled glaucoma, and pts with renal disease, hepatic disease or CAD |
| Name 5 types of antidepressants? | Tricyclics, Monoamine Oxidase Inhibitors (MAOI), Selective Serotnoin Reuptake Inhibitors (SSRI), Atypical or Others, Combinations |
| What interactions can occur with tricyclics and MAOIs? | Hyperpyretic crisis, convulsions and death |
| What are s/e of tricyclics? | Orthostatic hypotension, sedation, anticholinergic effects, urinary retention, cardiac toxicity and seizures |
| What effect to tricyclic antidepressants have on seizure meds? | They lower the seizure med's effectiveness |
| With ALL antidepressants, why is it important that you be aware if a formerly depressed pt feels better with more energy? | Because that is when the risk for suicide is very high. |
| What are the 3 MAOIs? | Marplan, Nardil, Parnate |
| MAOIs are very effective buy why aren't they used often? | Because they have very adverse reactions |
| What 'hyper' crisis can occur with MAOIs? | Hypertensive crisis |
| What are the s/s of a hypertensive crisis? | Fever, neck rigidity, severe headache at the top of the head, palpitations, n/v, sweating, chest pain, coma and possibly death if nothing done |
| With MAOI's, when combine with 'what', will a hypertensive crisis occur? | When taken with amphetamines such as Stretera & Wellbutrin |
| What are frequent s/e of MAOIs? | Orthostataic hypotension & anticholinergic effects |
| What are Selective Serotonin Reuptake Inhibitors (SSRI) used to treat? | Anxiety disorders such as obsessive-compulsive, panic, & post-traumatic disorders |
| What are some s/e of SSRIs? | Dry mouth, blurred vision, insomnia, headache, nervousness, anorexia, nausea, diarrhea, suicidal ideation, urinary retention (big thing), decreased sexual arousal |
| What is a high risk s/e for every single antidepressant? | Suicidal ideation |
| What is Serotonin Syndrome? | A potentially life-threatening adverse drug reaction that raises the level of Serotonin in the body, characterized by changes in mental status, restlessness, hyperreflexia, tachycardia, labile bp, diaphoresis, shivering & tremors |
| With what drugs/herbs can an SSRI have an adverse reaction with leading to Serotonin Syndrome? | Tricyclics, Thorazine, St. John's Wart, Coumadin, Reglan |
| Name a few atypical antidepressants? | Ludiomil, Trazodone, Cymbalta |
| Do atypical antidepressants decrease or increase Coumadin? | Increases |
| Is the chance for liver toxicity increased or decreased with atypical antidepressants? | Increased |
| How should atypical antidepressants be taken with MAOIs? | They shouldn't! NEVER take with MAOIs or even within 14 days after they have been discontinued |
| What are some s/e of atypical antidepressants? | Blurred vision, constipation, urinary retention, reduction of seizure threshold, arrhythmias, photosensitivity |
| Name 4 types of mood stabilizing agents. | Calcium Channel Blockers, Anticonvulsants, Antimanics, & Antipsychotics (I think of CAAA) |
| What is an example of an anticonvulsant? | Depakote |
| What is lithium carbonate given to treat? | Bipolar affective disorder |
| What was the first drug given to bipolar pts? | Lithium carbonate |
| Why is lithium carbonate good to treat bipolar disorder? | Because it controls flight of ideas, hyperactivity and calms a pt down without affecting their cognition |
| What is the therapeutic range for lithium carbonate? | 0.5- 1.5 mEq/L |
| When is lithium carbonate considered to be toxic? | When the levels are above 1.5 mEq/L |
| What is the easiest way to reverse lithium toxicity if caught early enough? | Hydration |
| What are the s/e of lithium carbonate? | Dry mouth, thirst, increased urination, weight gain, metallic taste, dependent edema of feet and ankles, and a tetratogenic affect on a fetus |
| What is the relationship between lithium carbonate and sodium? | They have an inverse relationship. Intake of lithium carbonate causes a pt to diurese, resulting in a loss of sodium. As sodium is depleted, lithium levels rise and can reach a toxic level |
| What classification is Tegretol? | An anticonvulsant |
| What does Tegretol do to lithium levels? | Increases them |
| What are early s/s of lithium toxicity? | Hand tremors from fine to coarse, difficulty walking, and very confused |
| What happens when Tegretol and MAOIs are combined? | Hypertensive reaction |
| What does Valproic Acid do to the effects of tricyclic antidepressants? | Increases their effects |
| When on mood stabilizing agents, what labs are drawn to look at their therapeutic windows? | Tegretol, Valproic Acid & Lithium |
| Why shouldn't a pt take mood stabilizing meds with grapefruit juice? | Grapefruit juice negates the actions and effectiveness of most drugs |
| Name a Calcium Channel Blocker used as a mood stabilizing agent. | Verapamil |
| Why are calcium channel blockers used as a mood stabilizing agent? | Because when taken with lithium, it may reduce the lithium levels |
| What do antipsychotics do in conjunction with CNS depression? | Potentiates it |
| What are late s/s of lithium toxicity? | N/V, diarrhea, ataxia, blurred vision, tinnitus, & excessive urination |
| If pt is taking lithium, what should you educate them about in regards to F&E? | To stay hydrated!! Lithium will cause diuresis so drink plenty of water and stay away from caffeine (coffee,colas, etc) since it's a diuretic |
| What is the action of antipsychotics? | The action is unknown |
| In what situations should you NOT use antipsychotics? | In comas, CNS depressions, pts with blood dyscrasias or Parkinson's or narrow-angle glaucoma |
| What are the common s/e of all antipsychotics? | Anticholinergic effect, blurred vision, constipation, urinary retention, nausea, skin rash, sedation, photosensitivity |
| What are the unusual s/e of all antipsychotics (We should know these)? | Hormonal effects, ECG changes, decreased seizure threshold, agranulocytosis, hypersalivation, EPS, tardive dyskinesia, Neuroleptic Malignant Syndrome |
| What is EPS? | Extrapyramidal Side Effects |
| What are the s/s of EPS? | Tremors (aka pseudoparkinsonism effect), muscle rigidity, shuffling gait, muscle weakness (Akinezea), fidgeting movements (Akathisia), dystonia (involuntary movement of arms & legs) |
| What is tardive dyskinesia? | A typical s/e of antipsychotics, most of the time irreversible. Presents as stiff neck & difficulty swallowing. |
| What is neuroleptic malignant syndrome? | Rare but life-threatening neurological disorder that is caused by an adverse reaction of antipsychotic meds; can happen as early as a few hours or take years. |
| What are the s/s of neuroleptic malignant syndrome? | Severe Parkinson's syndrome with fine to coarse tremors, hyperpyrexia (107+), muscle rigor, tachycardia, tachypnea, very diaphoretic, labile bp, extreme confusion (late sign) |
| What will an MD order to counteract the effects of NMS (Neuroleptic Malignant Syndrome)? | Parlodel or Dantrium |
| What is the biggest problem with psychopharmacology? | Non-compliance with pts not taking their meds as they should if at all. |
| What are Sedative-Hypnotics used to treat? | Sedative-hypnotics are used for short-term management of anxiety and for insomnia |
| What is another use for anticonvulsants? | They can also be used for sedation. |
| Is there a low or high tolerance for dependency with sedative-hypnotics? | High tendency |
| Name a sedative-hypnotic that doesn't have dependency issues? | Roz |
| What are 3 classes of sedative-hypnotics? | Barbiturates, Benzodiazepines & Miscellaneous |
| Why aren't barbiturates hardly used anymore? | Because of their high risk of physical and psychological dependence; they can also cause severe CNS depression or distress |
| Are Benzodiazepines for long-term or short-term use? | Short-term use ONLY |
| Which class of sedative-hypnotics are safer, barbiturates or benzodiazepines? | Benzodiasepines |
| Name a miscellaneously classified sedative-hypnotic? | Ambien |
| Are ADHD drugs used on children or adults? | They are used on both |
| Is there an age that is not allowed to use ADHD drugs? | Yes, they are not permitted for children under the age of 3 |
| What do ADHD drugs do to the CNS? | They are considered CNS stimulants except for Stattera and Wellbutrin |
| What three conditions are there when taking ADHD drugs? | Take with food, take about 6 hrs before bedtime and never combine with MAOIs |
| What sort of warnings come with Strattera and Wellbutrin? | Black box warnings |
| Name 3 classes of ADHD agents. | Amphetamines, Amphetamine Mixtures & Miscellaneous |
| When is the use of CNS stimulants contraindicated? | With children who have psychotic disorders & Tourette's disorder |
| What can happen with a prolonged use of ADHD drugs? | There may be development of tolerance, and physical/psychological dependence |
| What is anxiety? | It is an emotional response to anticipation of danger or threatening situations (perception) |
| What is the difference between anxiety and fear? | Anxiety- we don't know the source of the anxiety; Fear- we know the source of our fear |
| What is the most common of mental illness disorders? | Anxiety disorders |
| Which gender is more affected by anxiety disorders? | Women |
| What are some s/s of panic disorder? | Sudden, overwhelming, intense feeling as if they are going to die; most severe; causes HR & Resp to go up; unpredictable feeling of doom |
| How is one diagnosed with panic disorder? | There are several symptoms and a pt must be diagnosed with at least 4 of those symptoms for it to be classified as panic disorder; any less and it's considered limited-symptom attack |
| What are 3 characteristics of panic disorder? | The attacks last minutes, they are separated by weeks to months and you can multiple episodes over a long period of time |
| When is panic disorder usually appear? | Usually by late 20's |
| What is agoraphobia? | Fear of places or situations that you can't get out of; can limit your travel and leave you housebound. |
| What disorder is considered chronic, unrealistic with excessive anxiety & worry with symptoms lasting at least 6 months? | Generalized anxiety disorder |
| What did Freud believe was the cause of generalized anxiety disorder? | A conflict between the id, ego & superego |
| With the cognitive theory, what is believed to be the cause of generalized anxiety disorder? | A though process; ppl have negative patterns of distorted thinking and an MD believes that changing this thought pattern will help manage the disorder |
| What does the Transactional Model of Stress/Adaptation say about generalized anxiety disorder? | There isn't one single theory that can explain generalized anxiety disorder, rather a generalized anxiety disorder can be explain by all theories in it's etiology |
| What is a social phobia? | A fear of doing something embarrassing in public |
| What is a phobia? | A fear cued by presence or anticipation of a specific object or situation usually causes immediate anxiety; pt knows their reaction is unreasonable and excessive |
| How does the learning theory explain phobias? | It believes that the client is presented by a stimulus that causes a certain type of response that is learned based on other ppl's responses such as a parent |
| How does life experiences theory explain phobias? | A phobia could develop due to a situation that happened in the pts life; the contribution of a past experience such as a child being locked in the closet as punishment |
| What is the definition of OCD? | Recurrent compulsions, so severe & time consuming that it may cause significant distress and/or impairment in function socially, emotionally occupationally |
| Even though a pt with OCD understands that the rituals are unreasonable, why do they go through with them? | Because it provides relief from the distress/anxiety |
| What are some meds that can help OCD pts? | Tricyclic antidepressants such as Anafranil and SSRIs |
| What is the definition of Posttraumatic Stress Disorder? | This disorder develops specific symptoms that follow exposure to extreme stressors that cause a major personal threat to the body or even death |
| How does the cognitive theory view PTSD? | That a pt has distorted thinking as a playback of negative tapes playing in their head; pt has very frightening nightmares that reoccur |
| With an anxiety disorder that is due to a general medical condition, how are those anxiety symptoms alleviated? | By treating the general medical condition; a lot of pts are given TSH tests to see if pt is about to experience a thyroid storm |
| With a substance-abuse anxiety disorder, how are symptoms alleviated? | By treating the substance being abused such as cocaine, heroine, marijuana, etc. |
| How does psychotherapy treat anxiety disorders? | By talking about the problem and helping the pt understand the unconscious meaning of anxiety, repressed impulses & any symbolism of avoided situations |
| How does cognitive therapy treat anxiety disorders? | Therapists believe in cognitive distortions that hold negative appraisals; therapists use questions to encourage pt to correct anxiety-producing thoughts |
| How does behavior therapy treat anxiety disorders? | By using systematic desensitization and implosion therapy; the first gets the pt used to the source of their anxiety a little at a time, the latter totally immerses them with the source of their anxiety |
| How does group/family therapy treat anxiety disorders? | By talking and sharing, teaching social adaptation and managing aggression; very beneficial for PTSD pts |
| What sort of psychopharmacology is used to treat phobic disorders? | Tricyclics, SSRIs, Bensodiaxepenes, Valporic acid (for PTSD) |
| Which anxiety disorders are usually treated with meds? | Phobic disorders, OCD & PTSD |
| Define personality? | The emotional and behavioral characteristics that everyone possesses and is unique to that individual; is usually stable and predictable |
| At what point does the personality develop a disorder? | When certain traits become inflexible and maladaptive accompanied by emotional and functional distress |
| What is the biological and psychological etiology of a personality disorder? | It is believed that heredity, temperament, experiential learning and social interaction play a part in personality disorders |
| How many clusters of disorders are there? | 3; A, B & C |
| How does a paranoid personality present itself? | A general distrust and suspiciousness of ppl; thinks everyone is out to get them; difficult to manage because they know how to read and manipulate ppl; rarely ask for assistance |
| Among which gender is a paranoid personality disorder more common? | Men |
| What is the treatment goal for a paranoid personality disorder? | To get the pt to live in the community managing their mental illness |
| What are some of the clinical manifestations of a paranoid personality disorder? | They are on guard, hypervigilant for any perceived threat; tense, irritable, defensive, cold, insensitive towards others, difficult to criticize, very sensitive, can be intimidating |
| What defense mechanism does a paranoid personality use? | Projection- blame everyone else, they don't accept responsibility for their own actions |
| With a paranoid personality, does it run in families or just 'occur'? | It runs in families |
| How does a schizoid personality present itself? | they cannot make friends or have social/personal relationships; there just isn't any meaning to one; what relationships they do have are shallow, they are very withdrawn & feel uncomfortable around ppl enjoying each other; they are also tense & irritable |
| What are the clinical manifestations of a schizoid personality? | Cold & insensitive to others, work in isolation, unsociable, no emotional ties and always serious |
| How does a schizoid personality differ from a schizophrenic? | A schizoid personality disorder doesn't hinder daily functioning to the extent of a schizophrenic |
| How is a schizoid personality usually formed? | By early interactions with ppl who were cold and didn't meet their needs when they were younger; lack of empathy and nurturing |
| With a schizoid personality, what runs in the family? | Introversion; a withdrawing from reality, all negative energy is turned towards themselves |
| What is a criteria from the textbook about schizoid personality disorder? | A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings |
| What is another name for a schizotypal personality disorder? | Latent schizophrenics |
| What is the description of a schizotypal personality disorder? | The behavior is odd and eccentric but kept under control, it's more grave and serious than a schizoid personality disorder, they are closer to schizophrenics than a schizoid and they have a bland, cold affect |
| What are some clinical manifestations for a schizotypal personality? | Bland, apathetic affect, Magical thinking, Acute discomfort in social and interpersonal situations, ideas of reference, illusional thinking, bizarre speech patterns, and very brief bouts of psychosis |
| What are some predisposing factors for schizotypal personalities? | First-degree biological relatives of schizophrenic parents, anatomical deficits or neurochemical changes, & from early childhood relationships where impassivity, indifference, personal affection and closeness are uncomfortable |
| How does an antisocial personality present itself? | They have total disregard for the rights and feelings of others; they are guiltless, exploitative, and socially irresponsible; can be extremely charming and open |
| What can be another name for antisocial personality disorder? | Sociopath |
| What are some clinical manifestations of an antisocial personality disorder? | They are usually in prisons or rehab services, cold, callous, intimidating, argumentative, cruel and malicious, low toleration for frustration, act impetuoulsy and unable to delay gratification, restless, easily bored, seek thrills |
| What happens if an antisocial personality disorder feels challenged? | They become furious and vindictive and want to attack, demean and dominate |
| What defense mechanism do antisocial personality disorders use? | Projection |
| What are some pre-disposing factors of antisocial personality disorders? | They have first-degree biological relatives of parents with same disorder, genetics, ADHD and conduct disorder, parental deprivation, severely physically abused as children, very limited or no insight at all; they aren't the problem, it's everyone else |
| How does a borderline personality present itself? | Catch-all disorder, patterns of intense & chaotic relationships, labile attitudes towards ppl, impulsivity, self-destructive, no understanding of who they are & how they fit in society; simple, small events are exaggerated, close to histrionic disorder |
| Is borderline personality disorder easily diagnosed? | No, it's hard for psychiatrists to define |
| What are some clinical manifestations of borderline personality disorder? | A perpetual state of turmoil or crisis mode, changeability, extreme, intense behavior, chronic depression, cannot be alone, & self-destructive behaviors |
| What are some specific patterns of interaction with a borderline personality disorder? | Cling & distance, splitting and manipulation |
| Are the suicide attempts of a borderline personality common and fatal? | Yes they are common but mostly done for attention, they don't really want to harm themselves |
| What happens with a borderline personality disorder in regards to their impulsivity? | Since they are in poor control, they commonly end up having problems with substance-abuse, gambling, promiscuity, reckless driving, &drinking and driving |
| What are some pre-disposing factors of borderline personality disorder? | Serotonergic defect (need meds that enhance serotonin reuptake), more relatives with mood disorders like bipolar and depression, perhaps some childhood trauma and developmental factors (like developing as an individual early in life) |
| How does a histrionic personality present itself? | As dramatic, extroverted, excitable and emotional; need constant affirmation, approval & acceptance |
| Is histrionic personality disorder more common in men or women? | Women |
| What are some pre-disposing factors of histrionic personality disorders? | A neurobiological association with high sensitivity to environmental stimuli; decreased serotonin levels & heredity |
| How does a narcissistic personality disorder present itself? | Exaggerated sense of self-worth, very self centered, very fragile due to low self-esteem; they think they are the best but know that they aren't, no empathy and don't criticize these pts |
| What are some clinical manifestations of narcissistic personality disorder? | Self centered, exploit others, optimistic, cheerful; due to fragile self-esteem, if they don't get approval they show rage, shame, humiliation or rejection; impaired social relationships |
| What are some pre-disposing factors of a narcissistic personality disorder? | Child has fears, failures and needs that were met with criticism, disdain or neglect; parents have same disorder; perfectionistic parents with unreal expectations; parents how live virciously through their child |
| How does an avoidant personality disorder present itself? | Extremely sensitive to rejection; become withdrawn because of this sensitivity; want relationships but extreme shyness and fear of rejections prevents this; equally common in men & women |
| What are some pre-disposing factors of an avoidant personality disorder? | Hereditary, temperamental disposition such as infants with traits of hyperirritability, crankiness, tension & withdrawal & parental rejection |
| How does a dependent personality present itself? | Need to be taken care of and turn into clinging with a fear of separation; lets others make decisions, submissive, tolerate mistreatment by others, will demean themselves; fear of being separated by primary ppl in their lives; more common in women |
| What are some clinical manifestations of dependent personalities? | Lack of self-confidence, low self-worth, passive, too optimistic view of the world; rose-colored glasses |
| What are some pre-disposing factors of dependent personalities? | Starts in infancy when all the stimulation and nurturing comes from one person; overprotective parents and discouragement of independent behaviors; prevention of child from gaining autonomy |
| What defense mechanisms are used by obsessive-compulsive personalities? | Undoing, Isolation, Rationalization & Intellectualization |
| What are some pre-disposing factors for obsessive-compulsive personalities? | Parenting style is over-controlling, less praise for good behavior, emphasizing on the bad behavior; these pts learn to avoid punishment, learn to abide by rigid rules |
| How does a passive-aggressive personality present itself? | Negative attitudes/passive resistance against adequate standards in social/occupational situations; undermine things; will figure out a plan to get away w/it & make it your fault; appear agreeable but pushing against standard performance; obstructive |
| What are some clinical manifestations of a passive-aggressive personality? | They feel cheated and no one cares about them or their feelings; vindictive; behave like a martyr, the offended, misunderstood, guilt-ridden, overworked one; allows for venting of anger |
| What are some pre-disposing factors of passive-aggressive behavior? | Parental attitudes, feelings and behavior are often contradictory; parental responses are unpredictable, double-bind communication- say one thing but feel another |
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