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					                                      NURS 355
                                      Dr. Brown
                             STUDY GUIDE for Med Test
                              50 multiple choice questions
   Identify how impairment in the following areas of the brain are associated with
    psychological problems - HPA axis, limbic system, frontal cortex
    (e.g. anxiety is associated with hypersensitivity of HPA axis)
     What tests are available to identify etiological basis for mental illnesses (structural &
    functional tests) ct/mri; pet/spect
    (e.g. a CT scan shows the structural abnormality of enlarged ventricles in the brain of a
    person who suffers schizophrenia)
   Know the sets of symptoms that each class of psychotropics is meant to target:
    antidepressants, anxiolytics, mood stabilizers, antipsychotics, cognitive enhancers
    (e.g. anxiolytics target symptoms of anxiety – SOB, restlessness, worry)
   Neurotransmitters – what are they? Which neurotransmitter assoc. with which illness
    (e.g. schizophrenia is associated with excess dopamine) ANXIETY LITTLE GABA;
    DEPRESSION TOO LITTLE 5HT, MOOD STABILIZER/BIPOLAR: VARIES GAGA,
    LITHIUM CHANGES IONS
   Common side effects and teaching points for each drug subgroup (i.e. benzos likely to
    cause drowsiness, warn about potential dependence and not to drink alcohol)
           o Know the difference in side effect profiles for the subclasses of antidepressants:
               TCAs,
                     SSRIs (SEXUAL),
                     SNRIs ANTICHOLINERGIC NAUSEA, SEDATING WT. GAIN
                        (REMERON LOW DOSE MORE SEDATING THAN HIGHER
                        DOSE),
                     MAOIs (ORTHOSTATIC HYPOTENSION, HT CRISIS IN
                        OVERDOSE, ANTICHOLINERGIC
                     TCAs have anticholinergic side effects and are lethal in overdose)
           o Lithium – range, toxicity, monitoring
           o When would benzodiazepines be chosen over nonbenzodiazepines for treatment
               of anxiety (and vice versa) PANIC
           o Mood stabilizers - Lithium versus anticonvulsants (EFFECTIVNESS FOR
               RAPID CYCLING MANIA, – what are the concerns/nursing considerations with
               each – what are lab draws for? Lithium – know the therapeutic range, typical side
               effects versus symptoms of toxicity, teaching points for patients
           o Antipsychotics – typicals versus atypicals – what neurotransmitters are targeted
               with each subclass, what is the side effect profile of high versus low potency
               antipsychotics, which drugs/subclass treat negative sx versus positive sx or both
               – know the difference between negative & positive sx
   Nursing management of medications (treatment of side effects, prevention of probs)
           o TCA MONITOR SUICIDE RISK,
   drugs used in substance withdrawal: ANTABUSE, NARCAN ATAVAN, LIBRIUM,
    ATIVAN, PHENOBARBITOL, METHADONE
   Extrapyramidal side effects: acute dystonia (HEAD/NECK RIGIDITY, akathisia
    (TAPPING), parkinsonism (MASKFACE, SHUFFLING, tardive dyskinesia (MOUTH
    MVMT)– recognize the signs of each and what medications are used to treat these side
    effects SINEMET, SYMMETREL, LEVADOPA, COGENTIN, BENADRYL
   What are the indications for when you should use the various forms of medications - PO
    versus IM (CRAZY ACTING FOLKS) & sublingual (fast-acting) (COMPLIANT BUT
      NEED IT FAST versus decanoate (long-acting/slow-release) (IRRESPONSIBLE AND
      HOMELESS
      (e.g. if patient is forgetful about taking daily medication, a decanoate might be useful)

Sample questions:
1. A schizophrenic client has recently begun a new medication, clozapine (Clozaril). The nurse
is aware that a potentially fatal side effect of this medication is:
A) Agranulocytosis.
B) Akathisia.
C) Dystonia.
D) Akinesia.

2. Carol has made an appointment to see her primary care provider because of increased anxiety.
She sees a nurse practitioner, who performs a physical examination and takes a detailed history.
The psychiatrist diagnoses Carol with anxiety disorder. Which of the following medications is
prescribed for anxiety?
A) Chlorpromazine (Thorazine)
B) Clozapine (Clozaril)
C) Diazepam (Valium)
D) Methylphenidate (Ritalin)

3. Which of the following medications would the nurse expect to administer when observing that
a patient seems to be fidgety, demonstrates motor restlessness, and jiggles his legs when asked to
sit down?
A) Olanzapine (Zyprexa)
B) Molindone (Moban)
C) Benztropine (Cogentin) EPS
D) Thioridazine (Mellaril)

4. The nurse is assessing a patient who recently started taking a low-potency typical
antipsychotic medication. Which of the following side effects could the nurse expect to observe?
A) Constipation, decreased sweating, and decreased moisture around the eyes
B) Slurred speech, hand tremors, and severe occipital headache
C) Sleeplessness, irritability, and muscle weakness
D) Lead-pipe rigidity, vomiting, and severe frontal headache

5. A depressed patient is experiencing the following symptoms: nausea, palpitations, and "a
terrible headache and chest pain", elevated blood pressure and temperature, dilated pupils, flushed
head and face, and diaphoresis. What is the likely cause of these symptoms?
A) a food or drug interaction with the patient’s prescribed MAOI
B) an anxiety attack
C) extrapyramidal side effects from the patient’s prescribed antipsychotic
D) toxicity from the patient’s mood stabilizer Tegretol (carbamazepine)


ANSWERS:
1. A
2. C
3. C
4. A
5. A
Be able to recognize all drugs on list below as to what category they are in (group and subgroup –
i.e. antidepressant, SSRI)

                                      BRAND                            GENERIC
  Antianxiety Agents
                                       Xanax                          alprazolam
                                       Ativan                          lorazepam
   Benzodiazepines                    Klonopin                        clonazepam
                                      Librium                      chlordiazepoxide
                                      Valium                            diazepam
                                      BuSpar                            buspirone
 Non Benzodiazepines                  Catepres                          clonidine
   Antidepressants
                                     Pamelor                          nortriptyline
         TCAs                          Elavil                         amitriptyline
                                    Norpramine                         desipramine
                                     Tofranil                          imipramine
                                      Nardil                            phenelzine
        MAOIs                         Parnate                       tranylcypromine
                                      Prozac                            fluoxetine
                                      Paxil*                            paroxetine
         SSRIs                        Zoloft*                            sertraline
                                     Luvox*                           fluvoxamine
                                  Lexapro/ Celexa                       citalopram
         SNRI                         Effexor                          venlafaxine
                                    Cymbalta*                       Duloxetine HCL
                                     Remeron                           mirtazepine
         Other                       Desyrel                            trazadone
                                    Wellbutrin                          bupropion
   Mood stabilizers
                                 Eskalith/ Lithobid                lithium carbonate
                                Depakene/Depakote               valproic acid/valproates
                                    Neurontin                           gabapentin
                                     Lamictal                          lamotrigine
                                    Topomax                             topiramate
                                     Tegretol                        carbamazepine
                                     Trileptal                         oxcarbazine
       EPS meds
                                     Benadryl                      diphenhydramine
                                     Cogentin                         benztropine
                                  Dopar/ Laradopa                      levadopa
                                     Sinemet                      carbidopa/ levidopa
                                    Symmetrel                         amantadine
    Antipsychotics
                                       Haldol                         haloperidol
                                       Moban                          molindone
                                     Mellaril                       thioridazine
                                     Prolixin                      fluphenazine
        Typical                     Stelazine                      trifluperazine
                                    Thorazine                     chlorpromazine
                                     Trilafon                      perphenazine
                                     Navane                          thiothixene
                                     Clozaril                         clozapine
        Atypical                    Risperidal                       risperidone
                                     Zyprexa                         olanzapine
                                    Seroquel                         quetiapine
                                     Geodon                         ziprasidone
                                     Abilify                        aripiprazole
 Cognitive enhancers
                                     Namenda                        memantine
                                      Aricept                        donepezil
                                     Cognex                            tacrine
                                     Reminyl                      galantamine hbr
                                                                     Vitamin E
                                                                   Ginko balboa
   Psychostimulants
                                     Cylert                          pemoline
                                    Dexedrine                   dextroamphetamine
                                     Ritalin                     methylphenidate
                                    Strattera                      atomoxetine
                                     Adderal                  amphetamine saccharate
         Other
 Drugs for substance                 Antabuse                       disulfuram
     intoxication,                   Librium                     chlordiazepoxide
withdrawal, deterrence                Ativan                        lorazepam
                                      Narcan                       naloxone hcl
                                      ReVia                       naltrexone hcl
                                                                    methadone
                                                                  phenobarbital
* also used to treat anxiety

Review session
Brain
Brain stem/cerebellum> instinctual and survival behavior; muscles, balance breathing, HR

Limbic system- anxiety/depression; emotions and instinct

Cebral cortex
        Associated w/ alzheimers/dementia, schizophrenia

Maslows hierarchy: Alice Even Likes Sleeping Pigs
      Actual
      Esteem
      Love
      Safety
      Phyical
Neurotransmitters          Psych condition                              med function
Acetylcholine:             Alzheimer’s/dementia                enzymes to adjust acetylcholine
Dopamine:                   schizophrenia                      parital/complete blockage dopamine
Serotonin:                 depression                          increase available amt of serotonin
Norepinephrine:            anxiety/depression                  depression (2 little NE) anxiety(2 much)
Histamine:                 anxiety                             anti-histamine to sedate
GABA:                      anxiety                                      increase GABA

CT (structure), PET (function), MRI (functional), SPECT (functional)
Know typicals vs atypical
        Typical address dopamines:
                 Low potency- increase sedation, dry mouth (cholinergic effects), decrease EPS
                 High potency- opposite of low; low anticholinergic, increase EPS
        Atypical address Serotonin, norepi, and dopamine
Know which ones can be depot
        Haldol, thorazine, prolixin
Which drugs to use for cholinergic vs EPS
        Cholinergic SE: dry eyes, constipation, dry
        EPS: parkinsonian
                 TD- mouth mvmts
                 Akathisia- foot tapping
                 Acute dystonia- looking up

Typicals:
Low Potency (bigger dose) more anticholinergic, fewer EPS; more sedating
High potency (low dose) less sedating, fewer EPS, less anticholinergic
EPS sy mptoms
         Acute dystonia- acute cxt tongue face neck back, eyes locked upward
         Pseudo-Parkinsonism- “mask-like faces”, stiff/stooped posture, shuffling gait, droo ling
         Akathesia(foot tapping…not still)
         Tardive dyskinesia (irreversib le, tongue smacking) (dysfunctional mv mt)
         Neuroleptic Malignancy Syndrome (“leadpipe”)drooling, muscle rigidity
         Drugs tx EPS: Benadryl, cogentin, Dopar, Sinemet, Sy mmetrel
Typicals
         D/T antagonist for D Prolactin levels increase antipsychotics except fo r abilify
         Decanoate/depot: haldol, prolixin
         Low: thorazine, mellaril
         High: haldol, prolixin, stellazine, navane; more assoc w/ NMS
         Medium potency:
Atypicals increase 5ht
         Zyprexa, clozaril (agranulocytosis; need weekly CBCs),
         Zyprexa, seroquel, risperodol (increase weight gain) NOT abilify or geodone
         Risperidol: decanoate/depot

         PG 404 Atypical NT effect

				
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