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95 Cards in this Set
- Front
- Back
Symptoms of hypertensive crisis
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severe chest pain, headache, confusion, blurred vision, n/v, anxiety, SOA, seizures, change in LOC
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Clinical presentation of agranulocytosis
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fever, sore throat, malaise, granulocyte (neutro/baso/eosinophil) concentration < 100/cc in blood
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Extrapyramidal symptoms (EPS)
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muscle rigidity/contractions, tremor, twitching, restlessness, involuntary facial movements
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Presentation of oculogyric crisis
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initial: restlessness, agitation, malaise, fixed stare
later: extreme/sustained deviation of the eyes' positions associated: back/later neck flexion, wide mouth, tongue protrusion, ocular pain |
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Treatment of oculogyric crisis
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IV antimuscarinic benztropine or procyclidine (usually effective in 5-30 min), d/c causative med/agent; 25 mg diphenhydramine
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Causes of tardive dyskinesia
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Side effect of long-term use of neuroleptic drugs characterized by repetitive, involuntary, purposeless movements
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Signs/Symptoms of tardive dyskinesia
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grimacing, tongue protrusion, lip smacking, puckering, pursed lips, rapid blinking, rapid/involuntary movements of trunk/extremities/phalanges may also occur
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Treatment of tardive dyskinesia
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Tetrabenazine (only approved drug tx), reduction of neuroloptic drug use, benzo/clozapine/BoTox injections
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Signs of neuroleptic malignant syndrom (NMS)
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SE of neuroleptic/antipsychotic drugs: sudden high fever, blood pressure fluctuation, dysrhythmia, rigidity, change in LOC
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FALTER
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for NMS
F - fever A - autonomic instability L - leukocytosis T - tremor E - elevated enzymes (CPK) R - rigidity |
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Treatment for NMS
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stop antipsychotic med, monitor VS, apply cooling blanket, antipyretic, increase fluids, valium for anxiety, dantrium for muscle relaxation, postpone therapy for 2 weeks, switch to atypical agent
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Anticholinergic SE
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result from ACH antagonism; dry mouth, blurred vision, constipation, urinary retention, dizziness
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Patient teaching about minimizing anticholinergic SE
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avoid driving and hazardous activities, wear sunglasses, urinate before taking, exercise
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Dietary considerations for acticholinergic SE pt. ed.
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chew sugarless gum, eat high fiber foods, increase fluids (2-3L/day)
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Parkinsonian symptoms
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usu. caused by both types of antipsychotics, sometimes lithium
tremor, slow, movement, disturbed balance/walking, stiffness, soft voice, decrease facial expressions |
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Treatment of drug-induced Parksonism
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taper medication (if possible), adjust dosage, switch to different med
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Orthostatic hypotension pt. ed.
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-stand up slowly to avoid feeling faint
-take deep breaths and flex abdomen while rising -"dangle" at side of bed before rising to avoid dizziness -elevate salt intake (if possible) -maintain proper fluid intake -eat smaller, more frequent meals -avoid crossing legs when sitting |
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Photosensitivity pt. ed.
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avoid sun exposure, wear protective clothing, apply SPF 30 to all exposed areas, avoid tanning beds
apply cool/damp cloth to rash, OTC/Rx antihistamine |
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Classes which cause CNS depression
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barbiturates
anxiolytics sedative-hypnotics opioid narcotics |
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SE of CNS depressants
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morning "hangover," blurred vision, transient orthostatic hypotension, impaired coordination, lethargy
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CNS depression pt. ed.
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take at same time every EVENING
avoid late, heavy meals limit caffeine/alcohol control sleep environment reduce stress avoid driving |
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Meds that have high risk of dependency (classes)
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Benzodiazepene
SSRI MAO-I Stimulants |
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Importance of tapering high-dependency drugs
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reducing withdrawal effects, reducing length of withdrawal, manimizing future dependency
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Serotonin syndrom
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usu. occurs 2-72 hours after starting therapeutic regimen; can be lethal; results from excess serotonin
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Signs/symptoms of serotonin syndrome
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agitation, restlessness, confusion, increased HR and BP, pupil dilation, muscle twitching, diaphoresis, diarrhea, headache, shivering, goosebumps
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Signs/symptoms of SEVERE serotonin syndrome
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High fever
Seizures Dysrhythmia Unconsiousness |
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High potency vs Low potency drugs
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high potency drugs (morphine, alprazolam, chlorpromazine) evoke larger systemic responses at lower doses. Low potency drugs (ibuprofen, ASA) evoke small systemic responses at similar concentrations
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Role of Acetylcholine
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Peripheral NS: muscle excitation, autonomic nervous system NT
Central NS: sensory perception upon arousal from sleep, sustaining attention |
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Role of Norepinephrine
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vasoconstriction, increased HR/BP/blood glucose
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Role of Serotonin
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mood, appetite, sleep, some memory/learning effects
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Role of Gamma-Aminobutiric Acid (GABA)
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regulare neuronal excitability
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Role of Dopamine
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behavior, cognition, voluntary movement, motivation, punishment/reward, sleep, mood, attention, working memory, and learning
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Tolerance
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lower therapeutic effects at same drug concentration
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Priapism
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erect penis/clitoris does not return to flaccid state despite absence of physical/psychological stimulation after 4 hours
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Retrograde ejaculation
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entry of semen into bladder instead of going out through urethra during ejaculation
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Amenorrhea
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absence of menstrual period in woman of reproductive age
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Akinesia
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absence of diminuation of voluntary motion, usu. accomp. by parallel reduction in mental activity
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Akathisia
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regualr rhythmic movements, usu. of lower limbs; constant pacing; SE of antipsychotic drug
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Dystonia
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abnormal muscle tonicity resulting in impaired voluntary movement; SE of neuroleptic meds (spasms of head/neck/face/back)
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Lag time
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time between administering drug/treatment and the manifestation of a response/result
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Blood dyscrasias
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diseased blood; presence of permanent abnormal cellular elements; abnormal structure, function, or quantity of blood componenets (leukemia, hemophilia, etc.)
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Neurotransmitter
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chemical that functions as neural messenger; released from axon terminal of presynaptic neuron when stimulated by electrical impulse
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Reuptake
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return of neurotransmitters to the presynaptic cell after communication with receptors of postsynaptic cell
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Seizure threshold
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amount of stimulus necessary to produce convulsions; present in all humans if provocation is sufficient
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Neuron
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specialized cell of the CNS; has body, axon, and dendrites
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Synapse
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gap between neurons; point at which nerve impulse transmission occurs
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Receptor site
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location on cell surface where certain molecules attach to interact with cellular components
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Antagonist
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substance that binds to receptor site without eliciting biological response and blocking other substances from binding/eliciting responses
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Agonist
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stimulates physiologic activity at receptor site; binds and elicits receptor response
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Ataxia
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failure of muscular coordination; irregularity of muscle action
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Reasons for which antipsychotics are prescribed
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treatment for symptoms of schizophrenia, schizoaffective disorder, bipolar disorder
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Alternative names for antipsychotic category
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Dopamine Receptor Agonist (DRA)
Neuroleptic |
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Positive symptoms of schizophrenia
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additive; delusions, disordered thoughts/speech, hallucinations (auditory, visual, tactile, olfactory, gustatory); generally respond well to a/typical antipsychotics
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Negative symptoms of schizophrenia
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deficiency; flat/blunted affect, little/no emotional responsiveness, alogia, anhedonia, asociality, avolition; contribute to poor quality of life, functional disability, limited med response: more responsive to atypical antipsychotics
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SE of typical antipsychotics
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acute dystonia, parkinsonism, akathisia, tardive dyskinesia, NMS, anticholinergic SE, orthostatic hypotension, sedation, neuroendocrine effects, seizures, sexual dysfunction, skin pathology, agranulocytosis
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Neuroendocrine effects
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gynecomastia, galactorrhea, amenorrhea; monitor and notify provider
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SE of atypical antipsychotics
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new onset DM, anticholinergic SE, weight gain, hypercholesterolemia, ortho. hypotension, agitation, dizziness, sedation, sleep disruption, EPS
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How are antipsychotic drugs given to non-compliant clients? Why?
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IM Risperdone q 2-4 weeks: lower incidence of ADR, pt. doesn't have to take pill every day
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Typical antipsychotic effects on NTs
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block dopamine, ACh, histamine, norepinephrine receptors in CNS and PNS
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Atypical antipsychotic effects on NTs
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block serotonin, dopamine (to a lesser degree), and norepinephrine, histamine, and ACh
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Reasons for non-compliance with antipsychotic drugs
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med expense, ADRs, pregnancy, low insight, confusion, paranoia, fear of addiction, don't want to avoid alcohol
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Clozapine (Clozaril)
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atypical antipsychotic; block serotonin/dopamine receptors; expected SE; agranulocytosis
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Clozaril: common, dangerous SE and secondary prevention measure
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Agranulocytosis: weekly CBC for 6 mos, every other week for 2 yrs; WBC should be approx 3500, ANC > 2000
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Typical antipsychotic contraindications
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comatose, severe depression, Parkinson's disease, severe hypotension, dementia
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Atypical antipsychotic contraindications
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demential related psychosis, pregnancy (category C)
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Haloperidol (Haldol)
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typical antipsychotic; block dopamine receptors, EPS, anticholinergic SE; may cause seizures, NMS, agranulocytosis
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Antipsychotic that doesn't cause weight gain
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Aripiprazole (Abilify)
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Typical vs Atypical
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atypical has decreased SE, relieves neg as well as positive, less relapses, decreased affective symptoms and lowered suicidal behaviors
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Risperidone (Risperdal)
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Atypical antipsychotic; decreased symptoms of psychosis, bipolar mania, or autism; agranulocytosis, NMS, suicidal thoughts
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Why antiparkinsonian drugs are given congruently with antipsychotics
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drug serum level control; minimize EPS by trying to restore balance betw ACh and dopamine
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When you should give prn benztropine (Cogentin)
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pt. presents with dystonia, tremors, bradykinesia, rigidity, drooling, shuffling gait
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SE of diphenhydramine and benztropine
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GI upset, sedation, orthostatic, and anticholinergic; follow antipsychotic interventions
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Lithium carbonate
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Traditional Rx for mgmt/prev. of manic bipolar episodes, may stabilizes electrical activity, blocks serotonin
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% of bipolar clients helped by lithium carbonate
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60-80% or acute manic and hypomanic episodes within 10-21 days.
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Why would an antipsychotic ge given durin Lithium lag period?
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Control symptoms of mania while lithium reaches therapeutic levels.
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Relationship of lithium and salts
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Lithium similarly structure to Na and K, positive ion, SE of polyuria and edema. Risk of kidney/thyroid disease
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Lag period for lithium
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7-14 days
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Factors which raise lithium levels
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diuretics: decrease fluid increases Li concentration
NSAIDs: increased renal absorption Renal disease: decreased excretion Diarrhea/vomiting: low fluid Sodium depletion |
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Factors which lower lithium levels
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sodium bicarbonate, caffeine, theophylline, mannitol
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Side effects of lithium
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GI upset, fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiter, hypothyroidism, dysrhythmia, hypotension, electrolyte imbalance
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Signs of lithium toxicity
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diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, slurred speech, confusion, tremors, tinnitus, ataxia, seizures, coma
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Therapeutic serum level of lithium
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acute mania: 0.8-1.4 meq/L
maintenance: 0.4-1.3 meq/L |
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How often lithium levels should be monitored
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every 2-3 days until stable, then every 1-3 mos
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Why lithium is dangerous
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potentially deady toxic effects and long-term thyroid and renal degradation
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Nursing action if lithium level is 1.7 meq/:
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instruc pt. to d/c med and notify provider, increase fluids
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Contraindications for Li therapy
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pregnancy (category D), breastfeeding, renal dysfunction, heart disease, sodium depletion, dehydration, < 12 yo
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Why clients are non-compliant
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weight gain
fear of toxicity |
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Therapeutic range and SE of Carbamazepine (Tegretol)
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4-12 mcg/mL; nystagmus, double vision, vertigo, staggering gait, headache, blood dyscrasias, teratogenesis, hypo-osmolarity, dermatitis/rash
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Toxic symptoms of Carbamazepine (Tegretol)
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excessive drowsiness, staggering, slurred speech, vomiting
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Contraindications of Carbamazepine (Tegretol)
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pregnancy (category D), antibiotics, increased pepsin
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Therapeutic range and SE of Valporic Acid (Depakote)
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50-100mcg/mL, 125 in mania; GI upset, hepatotoxicity, anorexia, fatigue, pancreatitis, thrombocytopenia, teratogenesis
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Toxic symptoms of Valporic Acid (Depakote)
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nausea/vomiting followed by decreased LOC and confusion
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Contraindications of Valporic Acid (Depakote)
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pregnancy (category D), urea cycle disorders, hyperammonemic encephalopaty
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Lethal side effect of iamotrigine (Lamectal)
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life-threatening
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Selective Serotonin Reuptake Inhibitor
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Paxil (Paroxetine), Fluoxetine (Prozac), Fluvoxamine (Luvox), Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Celexa).
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