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NURS 663 Exam 1 Questions and
Answers
Bipolar one disorder DSM five criteria - Manic episode: 1+ week of a colon elevated, expansive or irritable mood and increase energy. 3+ symptoms from B: distractibility, indiscretion, irresponsible, grandiosity, flight of ideas, activity(Increase goal-orient), decreased need for sleep, talkativeness or pressured speech. Bipolar two DSM five criteria - Hypo mania and major depressive disorder: hypo mania same as mania with decreased severity and duration and no functional impairment for episode of four or more days and no psychosis Mixed episodes (bipolar) - Manic and depressive symptoms time by side usually with comorbid substance abuse increased risk of suicide and psychosis rapid cycling - Four or more cycles per year no greater than a week well period Cyclothymia DSM-V Criteria - Two or more years of mood cycling with dysthymia and hypo mania decreased intensity than bipolar disorder meets criteria for hypo mania but does not meet criteria for major depressive disorder Dysthymia DSM five criteria - HE'S 2 SAD depressive symptoms lasting two or more years that is subsydromal characterized by hopelessness decreased energy, decrease self-esteem for two years, abnormal sleep, abnormal appetite impaired decision-making. MAOÍ Mechanism of action generally - Catalyzes the deamination of monoamines intracellularly and MAO transport Reuptake extracellular monoamines MAO-A Mechanism of action - MAO-A Oxidizes serotonin norepinephrine and epinephrine MAO-B Mechanism of action - Oxidizes phenylalanine MAO-A and MAO-B mechanism of action - Oxidizes dopamine non-preferentially
MAOs Neumonic - 2 - Date with Tyra banks with wine and cheese in Maui— can cause hypertensive crisis related to tyramine from aged food. MAWIs= my arms weight increased= effective for atypical depression MAOs adverse effects- 6 - Hypertensive crisis, diet restriction, avoid meds, five week after Prozac, two week after other antidepressants, no other medications for two weeks after discontinuing MAOs diet restriction-4 compounds - Tyrosine, high tyramine, tryptophan, phenylalanine Tyrosine foods- 10 - Aged cheese, aged wine, fava or broad bean pods, sauerkraut, soy sauce, tap or draft beer, overripe fruit, cured meat, spoiled food MAOs drugs to avoid- 6 - Antidepressants, Dextromethorphan, stimulants, sympathomimetics, meperidine, disulfiram MAOs side effects 11 - Increased weight, drowsy, dizzy, orthostatic hypotension, tremor, headache, dry mouth, constipation, change in sexual drive, peripheral Edema, sweating Tricyclic mechanism of action - Inhibit 5HT2, norepinephrine, dopamine and reuptake slows. Amino group interferes with ASP - 98 in HSERT. Causing down regulation of receptors. Tricyclic side effects - Anticholinergic effects (dry mouth, blurred vision, constipation, urine retention, impotence). Histamine effects (sedation, increased weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects (decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and decrease anxiety). Amitriptyline dosing/Class - Start at 25 to 50 mg per day, titrate 25 to 50 mg per day per week, Max dose is 300 mg per day/TCA Names of tricyclics 10 - Amitriptyline, nortriptyline, clomipramine, imipramine, protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine Tricyclics are useful- 2 - Pain, migraine
Vagal nerve stimulation side effects- 4 - Voice altered, breathlessness, neck pain, no cognitive side effects Vagus nerve stimulation is FDA approved for what in under investigation for what - FDA approved for epilepsy and under investigation for major depressive disorder and bipolar disorder What is trans cranial magnetic stimulation - Placement of rapid alternating magnets on scalp cause impulse to structures and is focused Goal of trans cranial magnetic stimulation - Firing of neurons will alter pathology Trans cranial magnetic stimulation is FDA approved for and not approved for - Approved for refractory treatment resistant depression It is not approved for bipolar disorder or schizophrenia What is cognitive therapy based on - Negative thinking increase his depression vulnerability, this therapy challenges beliefs and assumptions related to depression Cognitive therapy indications 11 - Depression, anxiety, PTSD, schizophrenia, phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders, substance abuse disorders Cognitive therapy interventions - Automatic thought restructuring, provide evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater than just antidepressants and anti- depressants are greater than just cognitive behavioral therapy in efficacy What is interpersonal therapy based on - Based on the theory that depression Arises from problematic patterns and relationships Interpersonal therapy indications 5 - Indicated for depression, grief, interpersonal dispute, role transitions, interpersonal skill deficits Interpersonal therapy interventions 3 - Increase relationship awareness, increase interpersonal skills, communication analysis What is behavioral therapy based on -
Deficits in reinforcers like present activities and positive interpersonal contacts increased depression vulnerability Behavioral therapy interventions 3 - Increase activity level, structure goalsetting, interpersonal skills training Dialectical behavioral therapy is based on - Increasing emotional regulation Dialectical behavioral therapy Indications - Borderline, bulimia, binge eating, PTSD, substance abuse Dialectical behavioral therapy interventions 4 - Increase skills, mindful practice, monitoring/responding to crisis Involuntary commitment reasons - Danger to self, danger to others, and self Neglect Are there main points of involuntary commitment -
- Mental illness/developmental disability or drug/alcohol dependence. 2. It is treatable. 3. It is related to the danger to self or others Broad categories of suicide risk factors - Psychological disorder, Nuro biological factors, social factors, psychological factors Psychological disorders related to suicide - Bipolar is greater than depression however 50% are depressed at time of suicide Neurobiological factors of suicide - Decrease serotonin, hereditary, increase reaction of H PA system Social factors of suicide - Economic recession, media reports of suicide, social isolation, decrease social belonging Psychological factors of suicide - Decrease problem-solving and life satisfaction, increase hopelessness and impulsivity Suicidal ideation safety mnemonic - DIOSMIO Detained, impatient, observe, sharp, medical clearance, injuries, or occult overdose Likelihood of attempt pneumonic - Guns & ROSES recent attempt, ongoing thoughts, self harm, ethanol, substance abuse
Other causes of SIADH - Medications, Traumatic brain injury, infections, cancer, hypothyroid SIADH dysfunction - Decreased serum osmolality equals increased urine osmolality related to vasopressin in kidney malfunction Patient health questionnaire nine scores - 0 - 4 equals minimal, 5-9 equals mild, 10-14 equals moderate, 15 or more is moderate or severe DSM five criteria for major depressive disorder - Sad mood or anhedonia for two weeks or more, Plus for the following: sleep changes, cycle motor changes, appetite or weight change, decreased energy, guilt/worthless, difficulty concentrating/thinking/decisions, recurrent thought of suicide/death Major depressive disorder mnemonic - SIGECAPs, Sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide SIGECAPs, sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide - Medical conditions that look like mania or depression 4 - Substance abuse, metabolic, infection, neurological, cerebrovascular Bipolar disorder brain structure mnemonic - Let's live outrageously forget consequences equals left lateral orbital frontal cortex Differentiating bipolar II disorder mnemonic - BP II Equals lower lows Mania often seen symptoms mnemonic - MANIA more activity not inherently affective. Increase goal directed activity is seen more than elevated mood Depression assessment across the lifespan mnemonic - Reactive PLANETS reactivity, polarity, lability, attributability, normalcy, episodic, treatment response, severity Anti-depressants adverse effects 4 - Serotonin syndrome, mania shift, suicidal ideation, bleeding Don't use anti-depression's with what disorders -
Bipolar and borderline personality disorder Negative affective biased pneumonic - NAB To nab the correct diagnosis and treatment. These patients don't see happiness like happy faces and if the treatment is working they will start to see that Atypical depression Mnemonic - ATE typical increase eating, heaviness/Leaden paralysis/hypersomnia, rejection sensitivity Depression with psychotic features requires treatment with - And anti-depressant and an antipsychotic Trazodone mnemonic - TraZoBONE Z sleep aid, bone for priapism Venlafaxine mnemonic 2 - Think fax because it is fast like a fax because it has rapid metabolism and discontinuation affects vENlafaxine Think hypertENsion like norepinephrine Duloxetine Mnemonic - DUALoxetine for its door mechanism, and DULL oxetine because it can dull pain Mirtazapine mnemonic - MEALtazipine- related to increased appetite/weight and sedation Bupropion mnemonic 4 - Bu DA NE to remember neurotransmitters. Think butane lighter because it is hot like sex related to no sexual side effects and also think to decrease smoking for smoking cessation. Think BUproprion to remember not to give to those with BUlimia or others at risk for seizures related to decreasing the seizure threshold. You don't use bupropion on with other disorders - Traumatic brain injury, seizure disorder, neurological disorder, those who have had brain surgery, disorders with electrolyte. Abnormalities (eating disorders, severe renal or gastrointestinal issues) Used cautiously in substance abusers related to abuse potential because of psychotic symptoms at high doses. Can increase anxiety irritability and agitation Bupropion dosing - The 12 hour give 100 mg daily to start then increase 100 mg daily every three weeks to a max dose of 200 mg twice a day. The 24 hour start at 150 mg then increase 150 mg each day every week to a maximum of 450 mg per day
Anti-depressants side effects 10 - Anhedonia, apathy, n/v, drowsy/dizzy, somnolence, headache, bruxism, vivid dreams, fatigue, change in sexual behavior. Antidepressant Mechanism on action - Ser-438 residue determines potency (hSERT) SSRI (unk exact mech). sertraline dose - Init 20mg/day, titrate 25-50mg/day every 1-2wk, max dose 200mg Fluoxetine indications - Depression, d/c syndrome (give 20mg tab), for activation, noncompliance, and to decrease appetite Citalopram (Celexa) and Escitalopram (Lexapro) Pneumonic - Think car seat for SEATalopram to remember to obtain an Electrocardiogram forQTC prolongation Carbamazepine treats - First line and acute mania, acute/prophylaxis mania, anti-aggressive, rapid cycling, mix patience Carbamazepine labs - Level range is 4 - 12, LFTs, CBC, EKG, multiple drug to drug interactions Carbamazepine dosing - 100 milligrams a day initially then increase 200 mg per day everyone to four days to a max dose of 1.6 g per day Carbamazepine mnemonic - CBZ Cranial nerve pain, bipolar disorder, seiZures. CarbamASIApine Do you remember that Asian dissent patients have an increased risk of Steven Johnson syndrome and are recommended to be screened Carbamazepine side effects - Water retention, ataxia, n/v/d, rash, dizzy, sedation, confusion, transaminitis Carbamazepine adverse effects - CNS, rash. Rarely SJS/toxic epidermal necrolysis. Black box warning for aplastic anemia, thrombocytopenia, leukopenia. Carbamazepine mechanism - Block voltage-dependent sodium channels, anticholinergic, antidiuretic, antimania, anticonvulsant, antineuralgic, antiarrythmic
Valproic Acid (Depakote) mnemonic - ValproATE a folate PLaTe, folate linked to neural tube defects. Pancreatitis, Liver problems (hepatotoxic), Thrombocytopenia Valproate (Depakote) indications - Mania (equal to Li), comorbid sub. Abuse/anxious, mixed patient, rapid cycling Valproate labs - LFT, HCG, CBC, steady state 4-5 days-12hr after last dose check level/CBC/LFT again, target level 50- 125 Valproate side effects - Depakote. liver toxicity, bone marrow depression, nausea, vomiting, amenorrhea (cessation of menstruation), alopecia (excessive hair loss), sedation, tremor and increased weight Valproate Dosing - Initially 500-750mg/day Titrate 250-500mg every 1-3days, Max 1500- 250 0mg/day Valproate adverse effects - Steven-Johnson syndrome, toxic epidermal necrolysis, NTD, PLT dysfunction, transaminitis, thrombocytopenia Lithium indications - manic episodes in bipolar disorder and maintenance for prevention of such episodes, decreased efficacy in depression symptoms Lithium mnemonic for SEs? - LI: Leukocytosis (increased WBCs) T: Tremors/Thirst H: Hypothyroidism IU: Increased urine output M: Muscle weakness, mental disorders, memory loss Pregnancy: LIT for Low Implanted Tricuspid (Epstein's anomaly). Side Effects: LMNOP Lithium, Movement, Nephrotoxic, hypOthyroid, Pregnancy Lithium labs to monitor - Li level- 0.6-1.2 after steady state of 5 days, 12 hr after dose, then at dose change or every 3 months, creatinine, HCG, TSH, CBC Lithium dosing - Init 300-600mg/day titrate 300mg/day every 1-5 days to max 1800 mg/day (based on labs) Lithium side effects -
