withdrawal symptoms.<\/li>\n<\/ul>\n\n\n\n
QUESTION
Stimulants
Answer:
Amphetamines, cocaine or other stimulant drugs are the second most abused illicit substance in
the U.S.
QUESTION
stimulant withdrawal treatment
Answer:
Physical symptoms of chills, muscle cramps and aching make the process extremely
uncomfortable. The physical symptoms are often severe.
Depression can last for months after physical withdrawal.
Medical detox can help to make this process more tolerable.
QUESTION
Alcohol withdrawal treatments
Answer:
Prevention of alcohol withdrawal syndrome is the goal during withdrawal.
Diazepam (Valium) may be used to relieve acute agitation, tremor, impending delirium tremors
and hallucinations.
Chloradiazepoxide (Librium) may be used to reduce the danger of progress. Once the delirium
appears, intravenous lorazepam (Ativan) is used to treat severe symptoms.
QUESTION
screening tools
Answer:
Michigan Alcohol Screening Test (MAST)
CAGE- Questions to ask clients to determine how they view their substance usage
Clinical Institute Withdrawal Assessment Scale (CIWA)<\/p>\n\n\n\n
This is a scale to determine the level of detox and if additional medication is needed.
QUESTION
Typical- First Generation Antipsychotics
Answer:
haloperidol (Haldol)
loxipine (Loxitane)
perphenazine (Trilafon)
thiothixene (Navane)
chlorpromazine (Thorazine)
fluphenazine (Prolixin)
QUESTION
Both Side Effects and All EPS Side Effects are Treated with the Following
Answer:
benztropine (Cogentin)
trihexphenergdyl (Artane)
the antihistamine diphenhydramine (Benadryl)
QUESTION
meds to treat symptoms of Neuroleptic Malignant Syndrome
Answer:
bromocriptine (Parlodel)
dantrolene (Dantrium)
QUESTION
Atypical- Second Generation Antipsychotics
Answer:<\/p>\n\n\n\n
*These medications are weaker dopamine receptor antagonists, but are more potent antagonists Substance abuse disorder is characterized by What are the signs and symptoms of intoxication for opioids What are the signs and symptoms of withdrawal on opioids What is the goal for a patient going through withdrawal? What are the anticipated behaviors of a patient with addiction? What are the safety precautions for a patient with addiction going through withdrawal? The treatment for a patient going through withdrawal Naloxone isn’t usually used Neurocognitive disorders include Delirium is _ while dementia is<\/em><\/strong> Signs and symptoms of delirium How do you treat delirium what medications are used to treat delirium ? Signs and symptoms of dementia Treatment for dementia includes Medicaiton for dementia galantamine (mild to moderate) doezpeil & memantine (combo)<\/p>\n\n\n\n Psychotic disorder spectrum includes Symptoms of schizophrenia Phases of schizophrenia Positive symptoms of schizophrenia Nursing interventions for positive symptoms of hallucinations Negative symptoms Changes in speech due to schizophrenia Nursing interventions for changes in speech due to schizophrenia Medications for schizophrenia (for positive symptoms) (1st gen) EPS will not kill you but __<\/em> will Medications for schizophrenia (for positive and negative symptoms) (2nd generation) Mood disorders include Medication classes for antidepressants Main teaching for SSRIs\/ SNRIs Main teaching for Tricylycic antidepressants Main teaching for MAOis Therapy for mood disorders Biological for mood disorders Bipolar disorder is characterized by S\/S of mania in bipolar disorder Medications for bipolar disorder Nursing interventions for bipolar manic disorder lithium toxicity in treatment of manic phase of bipolar disorder important to remember Important to remember when giving mood stabilizers such as depakote to a patient with manic bipolar disorder Important to remember for lamotrogine (lamictal) mood stabilizer for manic phase of bipolar disorder With all medications it’s important to medications for delirium: medications for dementia: how do drugs given for dementia work? Confabulation Preservation Agraphia Aphasia Apraxia Agnosia Auditory agnosia Hyperorality Hypermetamorphesis Sundowning overdose treatment for opioid: Sedative, Hypnotic or Anxiolytic drugs Sedative, Hypnotic or Anxiolytic Use Disorder treatment Stimulants stimulant withdrawal treatment Alcohol withdrawal treatments screening tools Typical- First Generation Antipsychotics Both Side Effects and All EPS Side Effects are Treated with the Following meds to treat symptoms of Neuroleptic Malignant Syndrome Atypical- Second Generation Antipsychotics aripiprazole (Abilify) Advantages of Atypical Antipsychotics Psychosocial Theories Learning Theory – Those who have had numerous failures (real or perceived) abandon attempts to succeed, and thus have depressive symptoms.<\/p>\n\n\n\n Object Loss Theory – Suggests that depressive illness occurs as a result of having been abandoned by or separated from a significant other during the first 6 months of life.<\/p>\n\n\n\n Cognitive Theory – 3 cognitive distortions that are the basis for depression. Which include negative expectations of: environment, self, and the future.<\/p>\n\n\n\n Transactional Model – Recognizes combined effects of genetic, biochemical, and psychosocial influences on individual’s susceptibility to depression.<\/p>\n\n\n\n Selective Serotonin Reuptake Inhibitors (SSRI’s) important to watch in for SSRIs Serotonin syndrome symptoms Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s) Tricyclic Antidepressants (TCA’s) side effects of TCA Monoamine Oxidase Inhibitors (MAOI’s) Biological Interventions Anticonvulsants Antipsychotics are used
of serotonin receptors.
aripiprazole (Abilify)
asenapine (Saphris)
clozapine (Clozaril)- side effect-agranulocytosis-WBC, ANC count necessary- risk of infection
is serious due to this side effect.
larazidone (Latuda)
clozapine (Clzoril)- may cause agranulocytosis; must have periodic WBC\/Absolute neutrophil
blood levels
paliperidone (Invega)
quefiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)
QUESTION
Advantages of Atypical Antipsychotics
Answer:
Treat both positive and negative symptoms
Decrease in affective symptoms (depression and anxiety)
Fewer or no EPS ( less dopamine blockage)
Fewer anticholinergic side effects- (Except for clozapine)
Less relapse
QUESTION
Psychosocial Theories
Answer:
Psychoanalytic – Depression is caused by the loss of a loved object (death or rejection).
Learning Theory – Those who have had numerous failures (real or perceived) abandon attempts
to succeed, and thus have depressive symptoms.
Object Loss Theory – Suggests that depressive illness occurs as a result of having been
abandoned by or separated from a significant other during the first 6 months of life.
Cognitive Theory – 3 cognitive distortions that are the basis for depression. Which include
negative expectations of: environment, self, and the future.
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<\/a><\/figure>\n\n\n\n\n
Intoxication and withdrawal<\/p>\n\n\n\n
Opioid: decrease loc, respiration and HR<\/p>\n\n\n\n
Opioids: muscle aches, sweating, diarrhea, yawning, lacrimation<\/p>\n\n\n\n
For them to go through it safely for example with opioid you may want to use a beta blocker or benzodiazepine<\/p>\n\n\n\n
Defensive mechanisms: rationalization- “I drink because she makes me angry” denial “I don’t have a problem”<\/p>\n\n\n\n
Prevention of harm, fall\/injury, could experience hallucinations<\/p>\n\n\n\n
Individual therapy, family therapy, medications such as naloxone<\/p>\n\n\n\n
when going through withdrawal but more management for not stopping<\/p>\n\n\n\n
Delirium & dementia<\/p>\n\n\n\n
Acute\/ reversible. Slow\/ progressive<\/p>\n\n\n\n
Changes to loc, confusion, hallucinations, increased physical response, agitation<\/p>\n\n\n\n
Resolve underlying condition<\/p>\n\n\n\n
haliperidol
benzodiazepines (lorazepram and diazepam)
B1 for thiamine deficiency<\/p>\n\n\n\n
Remember “a” words: aphasia(loss of purposeful speech) , apraxia(loss of purposeful movements) , agnosia (inability to recognize familiar people)
Confabulation(false answers)\/ preservation:<\/p>\n\n\n\n
Medications increasing glutamate<\/p>\n\n\n\n
doepezil (all stages)
rivastigimine (all stages)<\/p>\n\n\n\n
mementine (moderate to severe)<\/p>\n\n\n\n
Schizoaffective: also have mood disorder symptoms
schizophrenia: has symptoms always
schizophreniform: only lasts 1-6 months (time)<\/p>\n\n\n\n
Delusions, hallucinations, disorganized speech, negative symptoms, grossly disorganized behavior.<\/p>\n\n\n\n
Prodromal phase: changes in levels of functioning but first episode hasn’t occurred.
Acute phase: active symptoms usually requires hospitalization.
Stabilization phase: medical rule out, begin medication regimen, focus on safety.
Maintenance phase: medication compliance, family education, residual symptoms, focus of relapse prevention.<\/p>\n\n\n\n
Hallucinations
delusions: fixed, false beliefs, persecution, grandeur, reference, control\/influence, somatic.<\/p>\n\n\n\n
-present reality: letting them know they are safe etc.
-safety: decreased stimuli (Mileu therapy)<\/p>\n\n\n\n
Flat affect(range of motion)
avolition(drive to do anything)
an ethos (lack of energy)
anhedonia (inability to feel pleasure)<\/p>\n\n\n\n
Loose associations, clang association, circumstantiality, preservation, neologisms, word salad, tangentiality, echolalia.<\/p>\n\n\n\n
Present reality: let them know you don’t understand them<\/p>\n\n\n\n
1st generation antis-psychotics
Focus on dopamine by decreasing it
S\/e: anticholinergic, insomnia, orthostatic hypotension.
Major considerations aka s\/e: EPS (trardive dyskinesia) NMS<\/p>\n\n\n\n
NMS (rigid, High fever and heart rate need to stop immediately and need to stop medication, give iv fluids, and administer meds to stop it)<\/p>\n\n\n\n
Impacts dopamine and serotonin
S\/E: weight gain, sexual dysfunction, sedation, GI disturbances.
Major considerations: clozapine (important to monitor wbc for argranulycytosis or low wbc count)<\/p>\n\n\n\n
Major depression: at least 2 week period with 5 or more symptoms.
Seasonal affective disorder: mood impacted by environment (changes in weather)
Persistent depressive disorder: at least 2 years
Premenstrual dysphoric disorder: prior to week of menses<\/p>\n\n\n\n
-SSRIS\/SNRIS: gold standard (sertraline, fluoxetine)
-Tricyclic antidepressants:()
-MAOI: ()<\/p>\n\n\n\n
-can cause sexual dysfunction and monitor suicidal ideation
-can cause serotonin syndrome which can kill you from too much serotonin<\/p>\n\n\n\n
They have a low overdose capability so don’t allow patient to take home too many
They are anticholinergic so they have anticholinergic effects<\/p>\n\n\n\n
They can’t be taken with tyramine containing foods which many foods have tyramine cheese etc so they are not usually given. So they need to be compliant with diet.<\/p>\n\n\n\n
Is called CBT and should be utilized along with medications<\/p>\n\n\n\n
-transcranial stimulation
-vagus nerve stimulation
-ECT (can cause seizure)**
(Rarely used but are used for last resort)<\/p>\n\n\n\n
Depression and mania<\/p>\n\n\n\n
-don’t eat, don’t sleep, Labile (mood swings), manic (think energized bunny)<\/p>\n\n\n\n
Lithium (important to prevent lithium toxicity)
Mood stabilizers (divalproex\/ depakote& lamotrigine\/ lamictal)<\/p>\n\n\n\n
-encourage finger foods
-encourage routine sleep
-encourage schedule
-reduction of stimuli (mileu therapy)
-be simple and direct when talking
-keep them safe and others bc they can be aggressive<\/p>\n\n\n\n
When sodium goes down lithium goes up so this increases risk of lithium toxicity so therefor it’s important to monitor dehydration which can be caused by (sauna, excessive exercising, stomach bug, not eating or drinking, fasting, diuretics)<\/p>\n\n\n\n
-liver function
-CBC count (platelet)
-category X pregnancy<\/p>\n\n\n\n
-rash Steven Johnson’s syndrome!<\/p>\n\n\n\n
Have medication compliance<\/p>\n\n\n\n
Antipsychotic (low-dose) haloperidol (Haldol)
Benzodiazepine-commonly used if etiology is substance withdrawal. (lorazepam (Ativan) or diazepam (Valium)
B1 IV for thiamine deficiency
Supplemental oxygen<\/p>\n\n\n\n
donepezil (Aricept) cholinesterase inhibitor-all stages
rivastigmine (Exelon) cholinesterase inhibitor-all stages
galantamine (Razadyne) cholinesterase inhibitor-mild to moderate
memantine (Namenda) blocks NMDA-moderate to severe
donepezil and nemantine (Namzaric)- (combination)<\/p>\n\n\n\n
Cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down the neurotransmitter acetylcholine.
In Alzheimer’s disease, the brain is producing less of this neurotransmitter, and this allows for more acetylcholine production.
In the brain of a client with Alzheimer’s disease (AD), there is also excessive glutamate, which leads to chronic overexposure to calcium in the brain. This process is damaging to the neurons.
Memantine blocks N-methyl-D aspartate (NMDA) receptors, thus reducing calcium.<\/p>\n\n\n\n
the creation of stories or answers in place of actual events to maintain self-esteem<\/p>\n\n\n\n
The persistent repetition of a word, phrase, or gesture.<\/p>\n\n\n\n
The diminished ability and eventual inability to read or write.<\/p>\n\n\n\n
The loss of language ability.<\/p>\n\n\n\n
The loss of purposeful movement in the absence of motor or sensory impairment.<\/p>\n\n\n\n
The loss of sensory ability to recognize objects<\/p>\n\n\n\n
The inability to recognize familiar sounds.<\/p>\n\n\n\n
The tendency to taste, chew, and put everything in the mouth.<\/p>\n\n\n\n
The urge to touch everything.<\/p>\n\n\n\n
The tendency for the mood to deteriorate and agitation to increase in the later part of the day or night.<\/p>\n\n\n\n
Breathing is promoted by aspirating secretions and inserting airway.
Naloxone (Narcan), a specific opioid antagonist, which can be administered intramuscularly, subcutaneously or intravenously.
General treatment includes is a synthetic narcotic opioid, Methadone, to decrease painful symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs such as heroin, morphine and codeine, as well as semisynthetic opioids, oxycodone and hydrocodone.<\/p>\n\n\n\n
benzodiazepines, all prescription sleeping medications, almost all antianxiety drugs.<\/p>\n\n\n\n
Gastric lavage and activated charcoal are the treatment.
If the client is awake after overdosing, prevent loss of consciousness again.<\/p>\n\n\n\n\n
Amphetamines, cocaine or other stimulant drugs are the second most abused illicit substance in the U.S.<\/p>\n\n\n\n
Physical symptoms of chills, muscle cramps and aching make the process extremely uncomfortable. The physical symptoms are often severe.
Depression can last for months after physical withdrawal.
Medical detox can help to make this process more tolerable.<\/p>\n\n\n\n
Prevention of alcohol withdrawal syndrome is the goal during withdrawal.
Diazepam (Valium) may be used to relieve acute agitation, tremor, impending delirium tremors and hallucinations.
Chloradiazepoxide (Librium) may be used to reduce the danger of progress. Once the delirium appears, intravenous lorazepam (Ativan) is used to treat severe symptoms.<\/p>\n\n\n\n
Michigan Alcohol Screening Test (MAST)
CAGE- Questions to ask clients to determine how they view their substance usage
Clinical Institute Withdrawal Assessment Scale (CIWA)
This is a scale to determine the level of detox and if additional medication is needed.<\/p>\n\n\n\n
haloperidol (Haldol)
loxipine (Loxitane)
perphenazine (Trilafon)
thiothixene (Navane)
chlorpromazine (Thorazine)
fluphenazine (Prolixin)<\/p>\n\n\n\n
benztropine (Cogentin)
trihexphenergdyl (Artane)
the antihistamine diphenhydramine (Benadryl)<\/p>\n\n\n\n
bromocriptine (Parlodel)
dantrolene (Dantrium)<\/p>\n\n\n\n
*These medications are weaker dopamine receptor antagonists, but are more potent antagonists of serotonin receptors.<\/p>\n\n\n\n
asenapine (Saphris)
clozapine (Clozaril)- side effect-agranulocytosis-WBC, ANC count necessary- risk of infection is serious due to this side effect.
larazidone (Latuda)
clozapine (Clzoril)- may cause agranulocytosis; must have periodic WBC\/Absolute neutrophil blood levels
paliperidone (Invega)
quefiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)<\/p>\n\n\n\n
Treat both positive and negative symptoms
Decrease in affective symptoms (depression and anxiety)
Fewer or no EPS ( less dopamine blockage)
Fewer anticholinergic side effects- (Except for clozapine)
Less relapse<\/p>\n\n\n\n
Psychoanalytic – Depression is caused by the loss of a loved object (death or rejection).<\/p>\n\n\n\n
SSRI’s block the neuronal uptake of serotonin. This blockage increases the availability of serotonin in the synaptic cleft.
SSRI’s include the following:
Citalopram (Celexa)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)<\/p>\n\n\n\n
serotonin syndrome<\/p>\n\n\n\n
diarrhea, sweating, fever, tachycardia, elevated BP and delirium.
Severe manifestations can induce hyperpyrexia, cardiovascular shock, or death.<\/p>\n\n\n\n
Venlafaxine (Pristiq)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)<\/p>\n\n\n\n
Amitriptyline (Elavil)
Desipramine (Norpramin)
Imipramine (Tofranil)<\/p>\n\n\n\n
These cause anticholinergic side effects:
dry mouth
blurred vision
tachycardia
urinary retention
constipation
Potential toxic effects
dysrhythmia’s
myocardial infarction
heart block<\/p>\n\n\n\n
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Eldepril)<\/p>\n\n\n\n
Electroconvulsive therapy (ECT
Transcranial Magnetic Stimulation (TMS
Deep Brain Stimulation (DBS)<\/p>\n\n\n\n
Carbamazepine (Tegretol)
Divalproex (Depakote)
Lamotrigine (Lamictal)
Topiramate (Topamax)<\/p>\n\n\n\n
in early treatment to promote sleep and decrease anxiety and agitation. Antidepressants- Selective Serotonin Reuptake Inhibitors (SSRIs) are useful during the depressive phase.
These are usually prescribed in combination with a mood stabilizer.<\/p>\n\n\n\n