NURS660/ NURS 660 Exam 2 Complete guide with Questions and Verified Answers (NEW 2026/ 2027) Psychopharmacology and Advanced Mental Health Exam | 100% Accurate | - Maryville

NURS660/ NURS 660 Exam 2 Complete guide with Questions and Verified Answers (NEW 2026/ 2027) Psychopharmacology and Advanced Mental Health Exam | 100% Accurate | - Maryville Q. H1 blockade causes? ANSWERS sedation and weight gain Q. M1 blockade causes? ANSWERS anticholinergic side effects (dry mouth, blurred vision, urinary retention, constipation) Q. Alpha 1 blockade causes? ANSWERS ortho hypotension, dizziness Q. Voltage-sensitive sodium channel blockade side effects? ANSWERS coma, seizures, card. arrhythmias, card. arrest, death, OD RISK Q. Amitriptyline can also be used for? ANSWERS can help w/ neuropathic type pain Q. Nortriptyline dosing? ANSWERS 50-150mg. At least 12 hours post dose lab draw Q. TCA OD toxicity can cause? ANSWERS wide QRS 100ms - give bicarb and supportive care Q. Tertiary TCAs block? ANSWERS blocks more serotonin than NE Q. secondary TCA block? ANSWERS blocks more NE than Serotonin Q. Tertiary TCA metabolism? ANSWERS Liver makes more secondary and has a more anticholinergic effect Q. How do you transition from SSRI/SNRI to MAOI? ANSWERS Depends on half life - wait 5 half lives (5-7 days) and start MAOI - except prozac (wait 5 weeks!!) Q. How do you transition from MAOI to SSRI/SNRI? ANSWERS wait 2 weeks and then start body needs to make more MAO WASHOUT period Q. History questions for determining bipolar dx? Suicide? ANSWERS mood disorder? psych hospitalizations? anyone take Li or mood stabliizers, antidepress, antipsych? ECT? Q. Collateral history information for bipolar? ANSWERS Information gathered from friends/family about behaviors Q. Hypothalamus controls? ANSWERS Sleep and appetite Q. Prefrontal cortex controls? ANSWERS Cognition: psychomotor fatigue concentration (interest/pleasure) guilt, suicidal, worthlessness, mood Q. Amygdala controls? ANSWERS guilt, suicidal, worthless, mood Q. Neucleus Accumbens controls? ANSWERS pleasure, fatigue, anxiety Q. Depression & Remission : least difficult symptoms to control? ANSWERS depressed mood SI psychomotor retardation Q. Depression & Remission : most difficult (common) symptoms to control? ANSWERS Residual symptoms: insomnia, fatigue, pain Q. Reduced Positive Affect of depression is? ANSWERS DA and NE dysfunction -mood, loss of happiness, loss of interest/pleasure, loss of energy, decreased alertness, decreased self-confidence YOU NEED TO INCREASE DA AND NE Q. Increased Negative Affect of depression is? ANSWERS NE and 5HT dysfunction - depressed mood, guilt, hostility, aggression, anxiety, irritability, lonliness. YOU NEED TO INCREASE SEROTONIN AND NE Q. SSRIs work by? ANSWERS Stoping serotonin from being increased back into the presynaptic neuron Q. SSRI 4 SSSS (side effects)? ANSWERS Stomach upset Sexual Dysfunction Serotonin Syndrome Suicidal Ideation Q. Side effects of SSRIs? ANSWERS insomnia, GI, sexual, Serotonin syndrome Q. Side effects of TCAs? ANSWERS sedation, anticholinergic (dry), cardio toxic Q. Side effects of MAOIs? ANSWERS Insomnia, wt gain, HTN, DRI, tyramine effet Q. Fluoxetine (Prozac) works how? ANSWERS 5HT2C antagonism (increases release of NE and DA) energizing, activating, improves concentration/motivation Long half life! 2 weeks! Q. Sertraline (Zoloft) works how? ANSWERS Dopamine and Sigma 1 receptor binding may be helpful for atypical depression: Q. Sigma - 1 impacts? ANSWERS anxiolytic effects and addressing psychotic/delusional depression Q. Paroxetine (Paxil) works how? ANSWERS Weak NET inhibition Inhibits NOS - sexual side effects Mild anticholingeric (M1) - sedation and wt. gain Q. Paroxetine (Paxil) impacts what CYP enzyme? ANSWERS POTENT 2D6 inhibitor - DDI! Withdrawal symptoms - serotonin w/d Q. SSRI discontinuation syndrome symptoms? FINISH: ANSWERS flu-like insomnia nausea imbalance sensory disturbance hyperarousal Q. Fluvoxamine (Luvox) works how? ANSWERS NO FDA indication for depression Sigma 1 - (anxiolytic) FDA - Anxiety No dopamine Q. Fluvoxamine (Luvox) impacts which CYP enzymes? ANSWERS 1A2 and 3A4 inhibition - DDI, caffeine can be increased due to decreased metabolism of caffeine. Q. Citalopram (Celexa) works how? ANSWERS SERT R and S with H1 - sedation Weak inhibitor of 2D6 - less DDI Higher doses more effective BBW for Citalopram (Celexa)? QTC prolongation with doses 40mg. cardiac arrhythmias in 60+ patients only use 20mg. Citalopram (Celexa) dose compared to Lexapro? Lexapro is half the dose of Celexa Celexa 40mg = Lexapro 20mg. Escitalopram (Lexapro) works how? CLEAN DRUG no QTC issues Works purely on SERT, and only SERT - S No histamine activity Antidepressant discontinuation syndrome symptoms? -2-4 days after; sensory hypersensitivity, somatic, anxiety, nausea, flu-like symptoms, insomnia, hyperarousal -About 20% of patients who abruptly discontinue meds -Lasts 1-2 weeks Paxil, Effexor, Pristiq Restart or new similar med to feel better SNRI side effects? Increased BP urinary retention sweating SNRI mechanism of action? Inhibit (prohibit) SERT Inhibit (prohibit) NET Blocking NE increases DA in the PFC Venalfaxine (Effexor) works how? dose dependent of 5Ht and NET Lower dose - 5HT Higher dose - NET (225mg) Met. by 2D6 Desvenalfaxine (Pristiq) works how? NET 5HT Active met of Venlafaxine Not met. through liver Less DDI Duloxetine (Cymbalta) works how? SERT NET Inhibits reuptake of Serotonin/NE Inhibits 2D6 Duloxetine (Cymbalta) - can cause? liver problems Avoid in: - hepatitis - alcoholism Levomilnacipran (Fetzima) works how? Inhibits reuptake of SERT/ NET NET SERT Improves cognition, fatigue, anergia, anhedonia efficacious on painful physical symptoms. Levomilnacipran (Fetzima) side effects? sweating, urinary hesitancy, HTN not for highly anxious/high strung patients. Vilazodone (Viibryd) works how? 5HT1A partial agonist Decreased sexual side effects More GI issues - take with food (rapid increase in 5HT) Inhibits serotonin Bupropion (Wellbutrin) works how? Inhibits (prohibits) NE and DA reuptake No sexual s/e, no weight gain Stimulating Smoking cessation Bupropion (Wellbutrin) BBW? seizure risk with IR Avoid with patients who have lower seizure threshold Mirtazapine (Remeron) works how? does not block Serotonin Alpha- 2 antagonism increase NE and DA Mirtazapine (Remeron) H1 activity causes? sedation Mirtazapine (Remeron) 2C antagonism and H1 action cause? wt gain Mirtazapine (Remeron) 5HT3 activity causes? CTZ - Nausea, vomiting, diarrhea, decreased GI side effects, increase in appetite. Trazodone (Desyrel) works how? Blocks 5HT2A and 2C. Higher doses are antidepressive Lower doses used for sedation priapism is a side effect of which drug? Trazodone (Desyrel) Vortioxetine (Trintellix) works how? inhibits (prohibits) SERT weight neutral decreased sex. side effects procognitive effect Max dose of 10mg with Wellbutrin d/t nausea MAOIs work how? Inhibit MAO - A and B which increases 5HT, NE, and DA MAOI S/E? OH WISE orthostatic hypotension weight gain insomnia sexual side effects edema HTN crisis is caused by? build up of NE and DA Serotonin Syndrome Menmonic SHIVERS shivering hyperreflexia increased temp vital sign instability encephalopathy restless sweating Gabapentin (Neurontin) uses? PTSD, anxiety, neuropathy, sleep , Not a mood stabilizer Lamotrigine (Lamictal) use in bipolar? Better with depression than mania. Has very little effect on mania Lamotrigine (Lamictal) MOA? blocking alpha subunit of voltage-sensitive sodium channels, decrease the release of excitatory NT glutamate Lamotrigine (Lamictal) interaction w/ Depakote? Decrease in lamictal clearance ( decrease dose by 1/2 even if they take a med to increase clearance) Lamotrigine (Lamictal) interaction with birth control? BC increases Lamictal clearance - need to dose Lamictal higher Lamotrigine (Lamictal) interaction with Carbamazepine? Increase lamictal clearance (double lamictal dose if using together) SJ Rash is what? Fever, rash, sore throat, cough, malaise, lyphyadenopathy, facial, mucosal membranes, skin tenderness, purpura, redness What do you do with 5 days missed with Lamotrigine (Lamictal)? Start over with titration Bipolar Brain Neuroanatomy in bipolar? Excess NT happening. Bipolar: mania symptoms? racing thoughts goal directed grandiose Bipolar PFC controls? racing thoughts grandiose pressured speech distracted Bipolar: Amygdala controls? Mood Bipolar: thalamus controls? increased sleep/arousal D2 in mania causes? psychotic symptoms Bipolar: 5HT2A and 1A activity causes? decrease non-psychotic mania and delusions Decrease glutamate hyperactivity Lithium is? "classic mood stabilizer" Decreases suicide Treats acute mania 0.6-1.2 therapeutic level Lithium S/E? tertatogenic - cardiac structure defect L - levels I - increased urination - QD can decrease polyuria T - thirst/tremors - dehydration =tox (monitor creatinine) H - hair thinning/ hypothyroidism I - interactions (decreased clearance = toxicity U - Upset stomach M - Muscle weakness (symp of tox) S - skin effects (acne, psoriasis) - adol. males Lithium toxicity? confusion, weakness, lightheaded, seizures, coma, slurred speech, MEDICAL EMERGENCY Lithium dosing? Give all at HS - when it peaks, more S/E- if sleeping, less issues Valproate (Depakote) MOA? Acts on voltage-sensitive sodium channels - enhance inhibitory action on GABA Blocks glutamate actions Carbamazepine (Tegretol) MOA? acts on the alpha subunit of voltage-sensitive sodium channels and augments GABA transmission Lamotrigine (Lamictal) MOA? Decreases the release of glutamate Depakote Toxicity? n/v, sedation, resp depression, tremor, cardiac arrest, hyperammoniemia, hypotnatremia tertaogenic - neural tube defects (cleft lip/ palate) Increases lamictal levels by 50% Depakote IR monitoring? 12 hours post dose - after 3 days Depakote ER monitoring? 15 hours 8-9 days later 25% error if 12 hours post dose Levels of Depakote should be? 50-125 Carbamazepine (Tegretol) interactions? Interacts with EVERYTHING induces metabolism of many drugs including itself (autoinduction) Carbamazepine (Tegretol) MOA? enhance inhibitory actions of GABA binds to alpha subunit of voltage-sensitive sodium channels Inducer of CYP450 Carbamazepine (Tegretol) SE? CARBA MEAN C - confusion A - ataxia R - rashes B - Blurred vision A - Aplastic anemia M - bone Marrow suppression E - eosinophilia A - Agranulocytosis N - neutropenia Depakote additional monitoring? Monitor platelets Depakote side effects? VALPROATE V- vomiting A - anorexia L - liver tox P - Pancreatitis. R - Retention of weight O - Oedema A - Alopecia T - teratogenic./ tremor E - enzyme inhibition Sertraline (Zoloft) side effects? hypersomnia, anergia, mood reactivity Lamicatal (lamotrigine) dose when given with Depakote? Depakote increases lamicatal dose by double, so need to give half the dose Carbamazepine (Tegretol) can cause what electrolyte issue? Hyponatremia Carbamazepine (Tegretol) does what to Lamicatal? It decreases the dose by half so need to double the dose What is the impact of BCP and mood stabilizers? Lamicatal (lamotrigine) is reduced by birth control pills whereas all other mood stabilizers decrease the efficacy of BCPs Lamicatal (lamotrigine) major side effect to watch for? SJS. If any rash develops, stop the med Which statement would indicate the need for further teaching? A. If skin area gets red but red goas away after turning, I should report it to the nurse B. Putting foam pads under the heels or other bony prominences can help decrease pressure C. If a person cannot turn himself in bed, someone should help them change position every 4 hours D. Skin should be washed with only warm water (not hot) and lotion put on wile it is still little whet C. If a person cannot turn himself in bed, someone should help them change position every 4 hours Rationale: This should happen every 2 hrs. Wound draining thick yellow material. What type of drainage? Purulent Client enters ED after motor cycle accident, resulting in skidding across pavement. Client wearing shorts, so large areas skin ripped off. Best describe this wound as: A. Abrasion B. Approximated C. Laceration D. Eschar C. Laceration Key word: Ripped Laceration because large amounts of skin ripped off. Although abrasion is usually related to road rash, the large amount of skin damaged is why it is considered a laceration Nurse caring for patients with variety of wounds. Which wound will most likely heal by primary intention? A. Cut in skin from kitchen knife B. Excoriated perineal area C. Abrasion of the skin D. Pressure ulcer A. Cut in skin from kitchen knife 3 other options will heal by secondary intention Nurse preparing to measure depth of client's tunneled wound. Which of the following tools should nurse use to measure depth accurately? A. Otic curette B. Sterile tongue blade lubricated with water soluble gel C. Sterile flexible applicator moistened with saline D. Small ruler C. Sterile flexible applicator moistened with saline Older patient is most likely to experience which of the following changes with aging? A. Thinning of epidermis B. Thickening of epidermis C. Oiliness of skin D. Increased elasticity of skin A. Thinning of epidermis Age causes thinning, decreased elasticity, and increased dryness. Caring for client and notice a superficial ulcer on left hip that appears shallow crater, red pink wound bed and no slough or eschar. Which stage would best describe the break in skin integrity? A. Stage I B. Stage II C. Stage III D. Stage IV E. Unstageable B. Stage II Stage I = no skin loss Minimal skin loss/shallow depth = stage II Caring for client at high risk for developing pressure ulcers. Which of the following are intrinsic factors that increase risk of pressure ulcers? Select All that Apply: A. Friction B. Impaired sensation d/t spinal cord injury C. Poor nutrition D. Shearing E. Edema F. Compression B. impaired sensation d/t spinal cord injury C. Poor nutrition - specifically protein E. Edema Friction, Shearing, and Compression are extrinsic factors associated with risk of pressure injury. Applying saline-moistened dressing to clients wound. Client asks, "Wouldn't it be better to let wound dry out so scab can form?" Which is the most appropriate response? A. Wounds heal better when moist wound bed is maintained B. you may be correct, I will check with your primary HCP C. Allowing a scab to form would prevent from observing wound for signs of infection D. Wound too large for scab to form over it, so a moist dressing is the best alternative A. Wounds heal better when moist wound bed is maintained Which of the following factors contribute to impaired wound healing? Select all that apply A. Diabetes B. Poor nutrition C. Surgery requiring multiple incisions D. Smoking E. Obesity A. Diabetes B. Poor nutrition D. Smoking E. Obesity Older adult client admitted to hospital with dehydration, and nurse has inserted peripheral IV to forearm. Which type of dressing should be applied over clients venous access site? A. Dressing with nonadherent coating B. Gauze dressing precut halfway to fit around IV line C. Gauze dressing pre-medicated with antibiotics D. Transparent film D. Transparent film Need to be able to clearly assess skin Cleaning wound of gunshot victim. Which of the following is recommended guideline for this procedure? A. Clean wound from bottom to top, outside to center B. Clean wound top to bottom, center to outside C. Once wound cleaned, dry area with absorbent cloth D. use clean technique to clean the wound B. Clean wound top to bottom, center to outside Always want to clean wound from inside to outside to avoid introducing infectious agents into center of wound. Often must use sterile technique rather than clean technique Clean top to bottom to avoid dripping into wound. Med-surge nurse is assisting wound care nurse with debridement of client's coccyx wound. What is primary goal of this action? A. Stimulating wound bed to promote growth of granulation tissue B. Removing dead/infected tissue to promote wound healing C. Removing excess drainage and wet tissue to prevent maceration of surrounding skin D. Removing purulent drainage from wound bed in order to accurately assess it B. Removing dead/infected tissue to promote wound healing Nurse caring for client who has surgical wound following C-section notes dehiscence of wound and contacts surgeon. Which of the following finding is related to this condition? A. Accumulation of fluid in interstitial tissue B. Edges of the wound lightly pulled together C. redness or inflammation of an area as result of dilation D. Accidental separation of the wound D. Accidental separation of the wound patient who has large abdominal wound calls out for help because she feels as though something is falling out of incision. Inspection reveals gaping open wound with tissue bulging outward. In which order should nurse perform following interventions? A. Notify physician immediately of situation B. Cover exposed tissue with sterile towels moistened with sterile NSS C. Place patient in the low Fowler's position (1) C. Place patient in the low Fowler's position (2) B. Cover exposed tissue with sterile towels moistened with sterile NS (3) A. Notify physician immediately Low Fowler's position helps to decrease abdominal pressure. Abdominal pressure would increase risk of further complications, should best to minimize first. Important to keep wound covered, moist. then immediately notify provider after providing immediate patient care. Patient, 16, in MVA and sustained wound across nose and cheek. After surgery to repair wound the patient says, "I am so ugly now." Based on this statement, what nursing diagnosis would be most appropriate? A. Pain B. Impaired skin integrity C. Disturbed body image D. Disturbed through processes C. Disturbed body image Patient admitted with nonhealing surgical wound. Which nursing action most effective in preventing wound infection? A. Using a sterile dressing supply B. Suggesting dietary supplements C. Applying antibiotic ointment D. Performing careful hand hygiene. D. Performing careful hand hygiene. All choices impact wound healing/infection, but MOST effective is hand hygiene. Nurse who is changing dressings of postoperative patients documents various phases of wound healing on patient charts. Which statement accurately describes these stages? (select all apply) A. Hemostasis occurs immediately after initial injury B. Liquid called exudate formed during proliferation phase C. WBCs move to wound in inflammatory response D. Granulation tissue forms in inflammatory phase E. During inflammatory process, patient has generalized body response F. Scar forms during proliferation phase A. Hemostasis occurs immediately after initial injury C. WBCs move to wound in inflammatory response E. During inflammatory process, patient has generalized body response Rationale: B. Occurs during hemostasis phase (immediate), not proliferation phase. D. Occurs during proliferation phase, not inflammatory phase F. Scar forms during maturation phase not proliferation phase What is a major indicator of fluid volume deficit? A. Full, bounding pulse B. Drop in postural BP C. Elevated Temperature D. Pitting edema in lower extremities B. Drop in postural BP A and D are found in fluid volume overload Physician orders isotonic IV solution. Which solution should nurse plan to administer? A. 5% dextrose and normal saline solution B. Lactated Ringer's solution C. Half-normal saline solution D. 10% dextrose in water B. Lactated Ringer's solution Rationale: D10W - hypertonic half normal saline - hypotonic D5W with NS - hypertonic solution Just D5W - hypotonic (isotonic - body digests dextrose - becomes hypotonic) A Patient is diagnosed with severe hyponatremia. Nurse realizes the patient will most likely need which of the following precautions implemented? A. Seizure B. Infection C. Neutropenic D. High-risk fall A. Seizure Looking for mental changes with changes in sodium. Fall may accompany, but seizure/mental changes more pressing concern. Elderly patient with history of sodium retention arrives to clinic with complaint of, "heart skipping beats and leg tremors" which of the following should nurse ask patient regarding these symptoms? A. Have you stopped taking your digoxin medication? B. When was the last time you had a BM? C. Were you ding any unusual physical activity? D. Are you using a salt substitute? D. Are you using a salt substitute? Rationale: Heart tremors = most pressing regarding hypernatremia. What is nurses primary concern regarding fluid and electrolytes when caring for elderly patient who is intermittently confused? A. Risk dehydration B. Risk kidney damage C. Risk stroke D. Risk bleeding A. Risk dehydration Elderly patient who is confused will not be able to ask for water/ get own water/ share that they are thirsty. Patient receiving IV fluids postoperatively following cardiac surgery. Nursing assessments should focus on which postoperative complication? A. Fluid volume excess B. Fluid volume deficit C. Seizure activity D. Liver failure A. Fluid volume excess Nurse planning care for Patient with fluid volume overload and hyponatremia. Which of following should be including in plan of care? A. Restrict fluids B. Administer IV fluids C. Provide Kayexalate D. Administer IV NS with furosemide A. Restrict fluids Rationale: More fluid than needed in body - causing dilution. - restrict fluids to balance out fluid overload/dilution When analyzing arterial blood gas report of a patient with COPD and respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? A. kidneys retain bicarbonate B. kidneys excrete bicarbonate C. Lungs will retain CO2 D. Lungs will excrete CO2 A. kidneys retain bicarbonate Lungs can not compensate for themselves. Bicarbonate is a base, so kidneys will retain to counter acidity in lungs Nurse is caring for patient who is anxious and dizzy following traumatic experience. AGB findings include: Ph 7.48 PaO2 110 PaCO2 25 HCO3 24 Nurse would anticipate which initial intervention? A. Encourage patient to breathe in-out slowly into paper bag B Immediately administer oxygen via a mask and monitor O2 sat C. Prepare to start IV fluid bolus using isotonic fluids D. Anticipate administration of IV sodium bicarbonate A. Encourage patient to breathe in-out slowly into paper bag Patient is hyperventilating, causing low CO2 (Respiratory alkalosis) - raise CO2 levels to reduce alkalosis and bring back to baseline. By breathing into paper bag, breathing in more CO2. Elderly patient does not complain of thirst. What should nurse do to assess that the patient is not dehydrated? A. Ask physician for order to begin IV fluid replacement B. Ask physician to order chest x-ray C. Assess urine D. C. Assess urine Dark yellow, concentrated, small volume urine -- sign of dehydration. If urine is pale yellow, moderate volume -- not dehydrated. Nurse admitting patient diagnosed with acute renal failure. Which of following electrolytes will be most affected by this disorder? A. Calcium B. Magnesium C. Phosphorus D. Potassium D. Potassium Potassium will be affected first. potassium issues most often related to renal failure. potassium = greater effects with smaller changes. Calcium = parathyroid Magnesium = rare, with kidney impairment but potassium changes first, medicine issues Phosphorus = parathyroid (regulates CA, CA and P are inversely related) A Patients ABG levels: pH greater than 7.53 Bicarb levels of 36 Nurse realizes that acid-base disorder this patient is demonstrating is which of the following? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis D. Metabolic alkalosis Patient with metastatic bone cancer, whose calcium levels are 12.1 mg/dL. Which initial manifestations would nurse notice in patient? Select All A. Weakness B. Paresthesia C. Facial spasms D. Muscle tremors E. Depressed reflexes A. Weakness E. Depressed reflexes This is hypercalcemia B, C, D all specific to hypocalcemia. Staff educator teaching ED nurses about hypertensive crisis. Nurse educator should explain that hypertensive urgency differs from hypertensive crisis in what way? A. BP always higher in hypertensive emergency B. Vigilant hemodynamic monitoring required C. D. Hypertensive emergencies associated with target organ damage D. Hypertensive emergencies are associated with target organ damage Patient has decreased cardiac output related to heart failure. What should nurse recognize about cardiac output? A. It is calculated by multiplying SV by HR B. Average amount of blood ejected during one complete cardiac cycle C. determined by measuring electrical activity of heart and HR D. patients average resting HR multiplied by patients mean arteriole BP. A. It is calculated by multiplying SV by HR RN observing student nurse doing PA on patient. RN need to intervene immediately if student nurse: A. presses on skin over tibia for 10 seconds to check for edema B. Palpates both carotid arteries simultaneously to compare pulse quality C. D. B. Palpates both carotid arteries simultaneously to compare pulse quality Rationale: This cuts off blood flow to the brain. NEVER palpate both carotids simultaneously Which patient with HTN should nurse asses first: A. 52 yo with BP 212/90 with intermittent claudication B. 43 yo with BP of 190/102 complaining of chest pain C. 50 yo with BP 210/110 with creatine of 1.5 D. 48yo with BP 200/98 whose urine shows microalbuminuria B. 43 yo with BP of 190/102 complaining of chest pain Because of chest pain. Patient with elevated BP. Which finding most important to discuss with patient? A. Low dietary fiber intake B. No regular aerobic exercise C. Weight 5lbs above ideal weight D. Drinks wine with dinner once a week B. No regular aerobic exercise Which information should nurse include when teaching patient with newly diagnosed HTN: A. dietary sodium restriction will control BP for most patients B. Most patients able to control BP through lifestyle changes C. HTN usually asymptomatic until significant organ damage occurs D. Annual BP checks needed to monitor treatment effectiveness C. HTN usually asymptomatic until significant organ damage occurs Most true statement regarding HTN Think "Silent Killer" can maintain BP with lifestyle changes, but many are also on BP medications. BP checks should be checked more often than every year . Nurse assessing patient admitted to ICU with hypertensive emergency. Which finding most important to report to HCP? A. Urine output over 8 hours 200 ml less than fluid intake B. Patient unable to move left arm and leg when asked to do so C. Tremors noted in fingers when patient extends arms D. Patient complains of severe headache with pain 8/10 B. Patient unable to move left arm and leg when asked to do so Rationale: Sign of stroke - stroke is complication of HTN emergency. Nurse observes client for signs of stage 1 pressure injury development, which most likely will include which finding? A. Visible subcutaneous fat B. Exposed bone with eschar C. Nonblanchable redness D. Shallow open injury C. Nonblanchable redness Nurse just completed dressing change and returned client to comfortable position. What should the nurse do next? A. Massage healthy tissue surrounding the wound B. Document color, odor, amount, and type of wound drainage C. Measure length, width, depth, of wound D. Determine the extent of wound undermining. B. Document color, odor, amount, and type of wound drainage Nurse is admitting client to a long-term care facility. What should nurse plan to use to assess client for risk of pressure injury development? A. FLACC scale B. Morse scale C. Braden scale 4. Glasgow scale C. Braden scale Which activity should nurse implement to decrease shearing force on a clients stage II pressure injury? A. Preventing client from sliding in bed B. Lubricating area with skin oil C. Pulling client up from under the arms D. Improving client's hydration A. Preventing client from sliding in bed A 77-year-old client has experienced an ischemic stroke and is now dependent for all activities of daily living. What components of nursing care will the nurse initiate to prevent skin breakdown? A. Perform passive ROM exercises B. Implement 2-hr repositioning schedule C. Massage skin surfaces daily, especially areas under pressure and bony prominences D. Frequently orient client to place and situation B. Implement 2-hr repositioning schedule Of the many topics that may be taught to clients or caregivers about home wound care, which one is the most significant in preventing wound infections? A. Taking medications as prescribed B. Proper intake of foods and fluids C. Adequate sleep and rest D. Thorough hand hygiene D. Thorough hand hygiene A medical-surgical nurse is assisting a wound care nurse with the debridement of a client's coccyx wound. What is the primary goal of this action? A. Removing purulent drainage from the wound bed in order to accurately assess it B. Stimulating the wound bed to promote the growth of granulation tissue C. Removing dead or infected tissue to promote wound healing D. Removing excess drainage and wet tissue to prevent maceration of surrounding skin C. Removing dead or infected tissue to promote wound healing What nursing diagnosis would be a priority for a client who has a large wound from colon surgery, is obese, and is taking corticosteroid medications? A. Anxiety B. Risk for infection C. Risk for imbalanced nutrition D. Self-care deficit B. Risk for infection A nurse assessing a client's wound documents the finding of purulent drainage. What is the composition of this type of drainage? A. WBCs, debris, bacteria B. Clear, watery blood C. Large number RBCs D. Mixture of serum and RBCs A. WBCs, debris, bacteria The nurse is preparing to measure the depth of a client's tunneled wound. Which implement should the nurse use to measure the depth accurately? A. Small plastic ruler B. Sterile, flexible applicator moistened with saline C. Sterile tongue blade lubricated with water soluble gel D. Otic curette B. Sterile, flexible applicator moistened with saline When caring for a patient with essential hypertension what instruction should the nurse provide to the patient to normalize blood pressure? A. Increase intake of fluids B. Avoid intake low-fat diet C. Reduce sodium intake D. Increase iodine intake C. Reduce sodium intake A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see? A. Occupational therapist B. Social worker C. Pharmacist D. Dietician D. Dietician The nurse is caring for a patient newly diagnosed with hypertension. Which statement by the patient indicates the need for further teaching? A. "I will consult a dietician to help get my weight under control." B. "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." C. "When getting up from bed, I will sit for a short period before standing up." D. "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." D. "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." A community health nurse is screening for hypertension. Which patient would the nurse focus on most intensively? A. A postmenopausal Caucasian woman B. Hispanic teenager C. Middle-aged African-American man D. 45 y/o Asian Woman C. Middle-aged African-American man The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? A. Results will be falsely elevated B. Results will be falsely decreased C. Significantly different with each reading D. Give accurate reading A. Results will be falsely elevated Which statements are true when nurse is measuring BP? (Select all that apply) A. Clients BP should be measured 1 hr before consuming alcohol B. Client's arm should be positioned at level of heart C. Using BP cuff too large will give higher BP measurement D. Client should sit quietly while BP is being measured E. Using BP cuff too small will give higher BP measurement B. Client's arm should be positioned at level of heart D. Client should sit quietly while BP is being measured E. Using BP cuff too small will give higher BP measurement A blood pressure (BP) of 140/90 mm Hg is considered to be: A. Hypertension B. Normal C. Prehypertension D. Hypertensive emergency A. Hypertension The nurse is teaching a patient about chronic untreated hypertension. What complication will the nurse explain to the patient? A. Pulmonary insufficiency B. Stroke C. Right-sided HF D. Peripheral edema B. Stroke What is the most important lifestyle changes a patient can make to improve cardiovascular health? A. Live more sedentary lifestyle B. Quit smoking C. Less exercise, more rest D. Eating diet high in fat B. Quit smoking What is considered a modifiable risk factor for hypertension? A. Obesity B. Age C. Gender D. Race A. Obesity What are the risk factors that contribute to pressure ulcer/injury formation? Intrinsic: Extrinsic: Intrinsic: Immobility (position + mechanical pressure on bony prominences), moisture (pyrexia, diaphoresis), age, immune system function, nutrition, edema Extrinsic: Shear, friction, compression Describe pressure ulcer/injury staging system Stage I: nonblanchable erythema, closed blister Stage II: Partial thickness, through epidermis. Open bister. Serous exudate Stage III: Full thickness skin loss. subcutaneous fat loss Stage IV: Full thickness tissue loss. Bone and muscle visible. Risk for spontaneous amputation. Unstageable: Depth unknown. Black/necrotic. Escher Discuss normal process of wound healing (Steps/stages) Hemostasis: Blood clot formation Inflammatory response: scab produced. Palpation (5 cardinal signs of inflammation) Proliferative: Fibroblasts proliferate, granulation begins. Wound becomes smaller Remodeling: Freshly healed dermis and epidermis. Scar formation Differences in wound healing by primary and secondary intention. Tertiary? Primary: Clean incision, able to suture. Hairline scar. use dressing to protect area. Secondary: Requires granulation to close wound, can not be pulled shut by sutures. Remains open to air. Tertiary: can be from either primary or secondary, mixture of 2. Delayed primary closure. What are complications of wound healing? Risk for infection/tissue loss (necrosis), tunneling, undermining, lack of blood flow Factors that impede or promote wound healing: Impede: Health status, age, nutrition, medications, wound stress, tissue perfusion (low) Promote: Debridement, moisture, tissue perfusion (high), wound vacs/drainage, nutrition, rest, hygiene Complete assessment for patient with impaired skin integrity. Inspect: measure borders/edge/shape/size of wound, measure depth of wound (sterile NS Q-tip) Assess: color, exudate, tunneling/undermining Document appropriately and in detail. Regular gloves fine - don't need to be sterile. Red: protect, Yellow: clean, Black: Debride List nursing diagnoses associated with impaired skin integrity. Risk for infection, infection Risk for impaired skin integrity, Impaired skin integrity Impaired BF, risk for impaired BF List appropriate interventinos for patients with impaired skin integrity. Dependent on patients condition/etiology. Adequate hygiene repositioning every 2hrs ambulation as tolerated hydration + nutrition status Dressing changes Describe body fluid distribution and the process involved in regulating fluid balance homeostasis. Distribution: ECF: 1/3 total body water. Water outside cell - Intravascular, transcellular, interstitial. ICF: 2/3 total body water. Water inside cell. Process: Osmosis and filtration Thirst regulation (hypothalamus), hormonal regulation (ADH/vaso, RAAS) Interpret basic fluid and electrolyte lab values: Na+ K+ Cl- Ca+ Mg+ P+ Urine specific gravity Hematocrit Osmolality Na+: 136-145 K+: 3.5-5.5 Cl-: 98-106 Ca+: 8.6-10.5 Mg++: 1.5-2.5 P+: 2.7-4.5 Urine specific gravity: 1.005-1.030 Hematocrit: (M)42-52% (W)37-47% Osmolality: 280-300 ECF volume deficit: Causes S/S Labs Causes: severely decreased PO intake, Increased GI output, increased renal output, hemorrhage, burns, massive sweating (diaphoresis) S/S: Overnight weight loss, postural hypotension, tachycardia, dry mucous membranes, poor skin turgor, Flat neck veins, dark yellow urine Labs: Increased hematocrit, increased BUN, increased urine specific gravity ECF Volume Excess Causes S/S Labs Causes: Too much Na+ containing isotonic IV fluids, renal retention of Na+ and water, HF, cirrhosis S/S: Overnight weight gain, edema, full neck veins, bounding pulses, crackles in lungs (pulmonary edema) Labs: Decreased hematocrit Hypernatremia Causes S/S Labs Causes: Loss more water than salt, gain more salt than water S/S: Decreased LOC, confusion, seizure Labs: Na+ 145, serum osmolality 300 Hyponatremia Causes S/S Labs Causes: Gain more water than salt, loss more salt than water S/S: Decreased LOC, confusion, seizure Labs: Na+ 135, serum osmolality 280 Clinical dehydration Causes S/S Labs Causes: Sodium and water intake output AND loss of relatively more water than salt. S/S: Combines ECF volume deficit + hypernatremia s/s Labs: Increased hematocrit, increased BUN, increased urine specific gravity, NA+ 145, Serum osmolality 300 Describe processes involved in regulating plasma concentrations of K, Ca, Mg, P ions. (3) Intake/absorption: Diet K= fruit, potatoes, Ca= dairy, req. vit D for absorption, Mg= dark leafy greens, P= milk Electrolyte Output: Excretions in urine, feces, sweat Abnormal losses in vomiting, drainage, fistulas Electrolyte Distribution: K+ (High ICF, low ECF) Alkalosis brings more K+ into cell. Acidosis excretes K+ Ca++ (low ECF, high bones and ICF). Inverse relationship with Phosphate. Mg++ (low ECF, high bones) Phosphate (low ECF, high bones). Inverse relationship with calcium. Hypokalemia Etiology Defining characteristics/ nursing implications Etiology: GI loss, K+ wasting diuretics, alkalosis Defining characteristics: Decreased NM excitation (Muscle weakness), ECG Changes: U waves, flattened T waves, ST depression, dysrhythmias Hyperkalemia Etiology Defining characteristics/ nursing implications Etiology: Salt substitutes, kidney dysfunction, acidosis, K+ sparing diuretics Defining Characteristics: Increased NM excitability, peaked T waves, widened QRS, PR prolongation, dysrhythmias, CA, Diarrhea, abdominal cramping Hypocalcemia: Etiology Defining characteristics/ nursing implications Etiology: Vit D deficiency, Low CA diet, increased Phosphorus levels (kidney dysfunction), hypoparathyroidism, pancreatitis, hyperphosphatemia Defining Characteristics: Paresthesia, numbness/tingling fingers/toes/around mouth, laryngospasms, Chvostek's sign, Trousseau's sign, tetany, dysrhythmias, hyperactive reflexes. Hypercalcemia: Etiology Defining characteristics/ nursing implications Etiology: Prolonged immobilization, bone tumors, hyperparathyroidism Defining Characteristics: N/V, constipation, anorexia, decreased reflexes, lethal arrhythmias/CA, lethargy, confusion Hypomagnesemia Etiology Defining characteristics/ nursing implications Etiology: Chronic alcoholism, chronic diarrhea Defining Characteristics: Increased NM excitation + DTR, muscle cramping, twitching, dysrhythmias, dysphagia, tachycardia, tetany, seizures, hypertension Hypermagnesemia Etiology Defining characteristics/ nursing implications Etiology: End stage renal disease, antacids + laxatives Defining Characteristics: Decreased NM excitability + DTR, hypotension, bradycardia, flushing Describe processes involved in regulating acid-base balance (3) Acid buffering: H3O buffer in the ECF Acid production: Cells produce CO2, other metabolic acids include lactic acid Acid excretion: Lungs exhale CO2, kidneys excrete everything except carbonic acid Apply nursing process when caring for patients with fluid, electrolyte, acid-base imbalances. Assess: Vitals, daily weights, 24hr I+Os, lab values (baselines and trends) Diagnose: Deficient fluid volume, acute confusion, impaired gas exchange, excess fluid volume, risk for electrolyte imbalance, deficient knowledge regarding disease management, risk for injury, decreased CO. Each Dx should only include 1 problem. Planning: Goals + outcomes (SMART), individual plan of care for each nursing Dx, plan for potential interventions + required material/equipment. Intervention: Health promotion (education), risk reduction, acute care - PO fluid replacement, fluid restriction, IV therapy (fluid, electrolytes, blood products) Evaluate: Assess effects of intervention (reassess labs, etc). Check in w/ patient. Identify tonicity of types of IV fluids and discuss impact on cell, therapeutic uses, and contraindications to use. Isotonic: 0.9% sodium chloride (NS) [NS is only solution that cane be used with blood products] Lactated ringers Dextrose 5% water (D5W) - enters as isotonic - metabolize dextrose - free H2O - becomes hypotonic. Isotonic solutions expand ECF volume (vascular + interstitial), no fluid shifts, cells same size. *watch for s/s fluid overload Hypotonic: 0.45% NS "half normal" Less solutes than intracellular fluid, Cell wall swells used for hydration Hypertonic: 3.5% sodium chloride, Dextrose 5% in 0.45% sodium chloride, D5 in 0.9%, D5 in lactated ringers More solutes than intracellular fluid, fluid shifts out of cell - cell shrinks Used for hypovolemia, vascular expansion Describe potential complication of vascular access devices: Phlebitis Infiltration Extravasation Assess IV every 4hrs, 2hrs if critical/coma Phlebitis: Infection, red, warmth, tender - chemical, bacterial, mechanical Infiltration: Leak of fluid around puncture site. Cool, pale, swollen skin - dislodging of IV (mechanical) Extravasation: Deep wound. Cool, pale, swollen skin Identify types of vascular access devices (3) Central line/CVAD: long-term use. Catheter tip and superior vena cava. Some require surgical insertion. Concerns for CLABSIs PICC line: Peripherally inserted central catheter. Peripheral arm vein, terminates at superior vena cava. 3 lines in 1 site. Peripheral IV: short term use. 18 gauge (blood transfusion), large IV. Describe different blood transfusion reactions and interventions to manage them. Hemolytic: ABO compatibility error (antibodies attack donor antigens). Chills, fever, tachycardia, hypotension, flushing Nonhemolytic: Febrile. Antibodies attack donor WBCs. rigors, headache, flushing Minor allergic: Uticaria (hives) Anaphylactic: Lethal reaction. Within 10mL/first 15 min of infusion STOP infusion, administer NS in NEW line, notify provider, stay with patient. Appropriate techniques for physical assessment of cardiovascular system. Manual BP, Palpate: for peripheral edema, JVD Inspect: coloring (cyanosis), pulse pressure symmetry Auscultate: APE to MAN, normal heart sounds, s3, s4, murmurs, symmetry Need multiple BP readings for hypertension Dx. Wait 30 min. No caffeine or smoking Identify age-related changes of CV system Decreased elasticity in veins, increased vascular resistance, increased plaques Define normal BP and categories of abnormal pressures Normal: SBP 120 and DBP 80 Elevated: SBP 120-129 and DBP 80 HTN Stage 1: SBP 130-139 or DBP 80-89 HTN Stage 2: SBP =140 or DBP =90 Identify risk factors, pathophysiology, clinical manifestations, medical and nursing management of patients with HTN Describe treatment approaches for HTN, including lifestyle modifications and medication therapy. DASH diet, decrease Na, smoking cessation, decrease caffeine, weight loss, stress management Periodic monitoring (3-6 months) Describe hypertensive crisis and treatment Urgency vs emergency Urgency: Asymptomatic, BP in hypertensive crisis Emergency: Symptomatic, headache, confusion. Evidence of target organ damage/failure Treatment: IV antihypertensives, monitor BP frequently, assess neuro status: PEERLA, LOC, muscle strength/motor coordination, ECG to assess cardiac status. Quetiapine (Seroquel) Serotonin-Dopamine Antagonist Atypical antipsychotic 3 multiple choice options How long does it take for quetiapine (Seroquel) to work Psychotic and manic symptoms can improve within one week. It will take several week to have full effect on behavior. Recommended to wait 4-6 weeks to determine efficacy. May take 16-20 weeks to show good response on cognitive symptoms What does quetiapine do? Decrease positive symptoms of schizophrenia 3 multiple choice options What should be monitored closely before patients are on atypical antipsychotics? BMI Waist circumference Blood glucose levels (fasting blood glucose between 100-125) How are side effects of quetiapine caused? Sedation (by blocking H1 receptors) Dizziness, sedation, hypotension (by blocking alpha 1 adrenergic receptors Dry mouth, constipation, sedation (by blocking muscarinic 1 receptors) Weight gain, increased incidence of diabetes, dislipidemia, (reason for cause unknown) What are the side effects of quetiapine? Weight gain based on dose Increased risk for diabetes and dyslipidemia Dizziness Sedation Constipation Dry mouth Dyspepsia Orthostatic hypotension (in the beginning trial period) Potentially tardive dyskinesia What are adverse effects of quetiapine (potentially life threatening) 1. Hyperglycemia causing ketoacidosis or Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. (resulting in coma) 2. NMS 3. Seizures 4. Increased risk of death and cerebral vascular incident Aripiprazole (Abilify, Aristada) atypical antipsychotic (sometimes second generation) 2 multiple choice options Aripiprazole is commonly prescribed for Schizophrenia Maintaining stability in schizophrenia Depression Autism related irritability How does aripiprazole work? 1. Partial agonism at dopamine 2 receptors 2. Reduces dopamine output when dopamine is high thus improving positive symptoms and mediating antipsychotic actions. 3. Increases dopamine output when dopamine levels are low thus improving cognition, negative, and mood symptoms 4. Also acts on dopamine 3 receptors 5. Blocks serotonin 2A receptors thus increasing dopamine How long does it take aripiprazole to work? May begin working in one week. It is best to wait 4-6 weeks to see full efficacy. How does aripiprazole cause side effects 1. Blocking alpha 1 adrenergic receptors causing dizziness, sedation, and hypertension 2. Partial agonist at dopamine 2 receptors in the striatum can cause motor side effects such as akathisia 3. Partial agonist at dopamine 2 receptor causing nausea, vomiting, and activation side effects Notable side effects of aripiprazole? 1.Dizziness 2. Insomnia 3. Akathisia 4. Activation 5. Nausea and vomiting 6. Orthostatic hypotension 7. Constipation 8. Headache, asthenia (muscle weakness) 9. Theoretical risk of tardive dyskinisia What are the adverse effects (life threatening) of aripiprazole Impulse control problems NMS Seizures Cerebral vascular events Sedation and vomiting in overdose (not reported fatal) What is the dosage for aripiprazole? 15-30 mg daily for schizophrenia What is Brexpiprazole (Rexulti)? Atypical antipsychotic Dopamine partial agonist Third generation antipsychotic What is brexpiprazole (Rexulti) prescribed for? Schizophrenia Treatment resistant depression Acute mania-(Mixed mania) How does brexpiprazole (Rexulti) work? 1.Partial dopamine 2 receptor agonist (reduces dopamine output where dopamine is high, thus reducing positive symptoms of schizophrenia). 2. Increases dopamine output where dopamine concentrations are low thus decreasing cognitive, negative and mood symptoms by blocking serotonin 2A receptors. 3. Partial agonism of 5HT1A receptor which can help mood anxiety and cognition. 4. Block alpha 1B receptors reducing akathisia 5. Block alpha 2C receptors reducing depression symptoms How long until brexpiprazole (Rexulti) works? Some effects in 1 week and optimal results in 4-6 weeks. Most schizophrenics will have 1/3 decease in symptoms. Super responders will have decrease of 50-60%. How does brexpiprazole (Rexulti) cause side effects? 1. By blocking alpha 1 adrenergic receptors the medication can cause sedation, dizziness, and hypotension. 2. Partial agonist actions at the dopamine 2 receptors in the striatum causes akathisia 3. Partial agonist actions at the dopamine 2 receptors and 5HT1A receptors causes nausea and vomiting What are the side effects of brexpiprazole (Rexulti)? 1. Weight gain 2. Akathisia 3. Sedation 4. Theoretical risk of tardive dyskinisia What are the adverse effects of brexpiprazole (Rexulti) LIfe threatening? Extreme hyperglycemia, ketoacidosis, hyperosmolar coma, death, rare NMS, increased risk of cardiovascular disease. What is clozapine? 50. Clozapine: a. Atypical antipsychotics. b. Clozapine and olanzapine belong to MARTA=Multi Acting Receptor Targeted Agents. (mult-ireceptor D antagonist) c. Treatment of Acute and Chronic Schizophrenia. d. Contraindications: i. Highly effective but can cause AGRANULOCYTOSIS!! Sometimes even lethal! So very restricted use. e. It does Not cause as much sedation as do the conventional antipsychotics. f. Do NOT use if: i. Hepatic insufficiency. ii. Pt has Parkinsonian symptoms. iii. Phaeochromocytoma. iv. Pregnancy. What is the dosage for brexpiprazole (Rexulti) 2-4 mg daily What is the dosing schedule for brexpiprazole (Rexulti) 1 mg daily for 1-4 days increase to 2 mg daily for 5-7 days Day 8 maximum dose 4 mg daily What is clozaril used for Treatment resistant schizophrenia Reduction in risk of recurrent suicidal behaviors in patients with schizophrenia or schizoaffective disorder How does clozaril work 1.Blocks dopamine 2 receptors blocking positive and stabilizing affective symptoms 2. Blocks serotonin 2A receptors increasing cognition and affective symptoms 3. Interactions at the 5HT2C and 5HT1A receptors may contribute to efficacy for cognitive and affective symptoms How long until clozaril works? Patients must reach a trough level of 350 ng/ml 2. median time to reach this level is about 3 weeks 3. In refractory schizophrenia, 50-60% of patients will respond. 4. The response of refractory schizophrenia to other atypical antipsychotics is 0-9% 5. Levels greater than 700 ng/ml is not well tolerated. 6. The most refractory of all of the patients will need augmentation with valproate and lamotrigine. What are the side effects of clozaril 1. Sialorrhea 2. Orthostasis 3. Constipation (psyllium will make condition worse, use miralax) 4. Sedation 5. Tachycardia 6. Weight Gain 7. Dyslipidemia & hyperglycemia 8. Benign fever 9. Tardive dyskinesia What are the adverse effects (lifethreatening) of clozaril? 1. Severe neutropeina 2. Myocarditis (only in the first 6 weeks of administration) 3. Paralytic ileus 4. Seizures (risk increases with dose) 5. Hyperglycemia 6. Pulmonary embolism 7. Dilated cardiomyopathy 8. Increased risk of CVA death 9. NMS Dosing of clozaril 25 mg at night to begin with Increase by 25-50 mg daily every 48-72 hours as tolerated. Dose above 500 mg daily may need to be spit into two doses Chlorpromazine (Thorazine) conventional antipsychotic. phenothiazine. D2 receptor blocker. tx agitation, + symptoms (delusion, hallucination) of schizophrenia. PO 25-100 mg tid or qid, 1 g/day MAX. IM/IV 25-50mg for breakthru. adverse: EPS. anticholinergic (dry mouth, retention, ortho HoTN) Chlorpromazine (Thorazine) is commonly prescribed for Schizophrenia Nausea and Vomiting Restlessness and apprehension before surgery Combativeness and hyperexcitability in children Long term use of chlorpromazine (Thorazine) can cause what disorder? Tardive Dyskenisia tardive dyskinesia A side effect of long-term use of traditional antipsychotic drugs (neuroleptics) causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue. What are some of the hypotheses about the cause of tardive dyskinesia? 1. Upregulation of dopamine receptors due to long term dopamine blockage by dopamine receptor agonists (first-generation antipsychotics) resulting in exaggerated response to the post-synaptic receptors to dopamine. 2. Long-term use of anticholinergic medicaitons. 3. 5-hydroxytryptophan receptors that are found in the striatum. These receptors interact with dopaminergic neurons and considered to be involved in regulating motor activity. 4. the resulting oxidative stress due to antidepressants blocking dopamine receptors which cause an increase in dopamine metabolism and this subsequently results in free radical production. The consequential oxidative stress on the basal ganglia, striatum and substantia nigra results in the manifestation of tardive dyskinesia. What is the upregulation of dopamine receptors? Upregulation of dopamine receptors occurs with long term blockage of dopamine receptors by medications such as antipsychotics. Because all of the receptors are blocked (or a significant number of them are blocked) the body produces more receptors (upregulating the number of receptors). This can cause a relapse of psychotic symptoms if it is a upregulation of dopamine receptors. What is the down regulation of dopamine receptors? Down regulation of dopamine receptors occurs with long-term exposure to high concentrations of an agonist.. This causes the reduction in the number of receptors available for activation. Haloperidol (Haldol) An antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia. (Positive symptoms of schizophrenia). How does haloperidol (Haldol) work? 1. Blocks dopamine 2 receptors thus reducing the positive symptoms of psychosis and possibly combative and hyperactive behaviors. 2. Blocks dopamine 2 receptors in the niagrostriatal pathways thus reducing tics and other symptoms in tourette's syndrome How to switch from oral antipsychotics to clozapine 1. If switching from amisulpride, aripiprazole (Abilify), and paliperidone ER (Invega), an immediate stop is possible and begin clozapine at middle dose. 2. If switching from risperidone (Risperdal), ziprasidone (Geodon), iloperidone (Fanept), and lurasidone (Latuda) begin clozapine gradually, titrating over at least two weeks to allow patients to become tolerant to the sedating effects. 3. Pt can be given benzodiazepines or an anticholinergic medication during cross-titration to help alleviate side effects such as insomnia, agitation, and /or psychosis. Lurasidone (Latuda) -Dopamine serotonin receptor antagonist (DS-RAn) -Atypical antipsychotic; also a potential mood stabilizer What is lurasidone commonly prescribed for? -Schizophrenia -Bipolar Depression -Acute mixed mania How does lurasidone work? -Blocks dopamine 2 receptors, blocking positive symptoms of psychosis and stabilizing affective symptoms. -Blocks serotonin 2A receptors causing the enhancement of dopamine release in certain brain regions reducing motor side effects and improving cognitive ability -Potentially blocks serotonin 7 receptors that may be beneficial for mood, sleep, cognitive impairments, and negative symptoms in schizophrenia. -Partial agonist of 5HTA receptors -Not a potent D1, M1 H1 receptor so it may not cause cognitive impairment, weight gain, or sedation like other medications. -Long-term use may aid in slight weight reduction. What are the side effets of lurasidone? -Dose-dependent sedation -Akathisia -Nausea -Dose-Dependent hyperprolactinemia -Increased risk for diabetes and hyperlipidemia -Tardive dyskinesia (risk much lower than other antipsychotics). -Anticholinergic medication (for motor side effects) or dose reduction (for akathisia) may reduce some side effects. -Giving benzos or trihexyphenidyl can reduce motor side effects -Beta-blockers and benzos can help reduce akathisia What are the adverse effects of lurasidone (Latuda) -Tachycardia and first degree AV block -Extreme hyperglycemia -Increased risk of CVA and death in elderly patients with dementia -NMS (although the risk is low compared to other antipsychotic medications) -Rare seizures What is the dosing schedule for lurasidone (Latuda)? -40-80 mg once daily for schizophrenia. (should be taken with a minimum of 350 calories. Taking on an empty stomach can reduce effectiveness by 50%) -patient may have symptom reduction within one week but it will take 4-6 weeks to determine the efficacy of the medication - Contraindications of lurasidone (Latuda) -angioedema -pt's predisposed to hypotension -taking a CYP3A4 inhibitor (ketoconazole or rifampin) -Patients with renal and/or hepatic impairment Ziprasidone (Geodon) Atypical antipsychotic. Serotonin-norepinephrine reuptake inhibitor. Side effects: dizzy, sedation. Contraindicated with QT Prolongation, recent MI, or uncompinsated Heart Failure How does Ziprasidone work? -Blocks dopamine 2 receptors, blocking positive symptoms of psychosis and stabilizing affective symptoms. -Blocks serotonin 2A receptors causing the enhancement of dopamine release in certain brain regions reducing motor side effects and improving cognitive ability -Specifically interactions with 5HT2C and 5HT1A may contribute to efficacy of cognitive and affective symptoms in some patients -Specifically interactions with 5HT1D and 5HT7 and at serotonin and norepinepherine transporters (especially at high doses) may contribute to efficacy of affective symptoms in some patients. What is ziprazidone (Geodon) commonly prescribed for? -Schizophrenia -Delaying relapse in schizophrenia -Acute agitation in schizophrenia -Acute mania/mixed mania What are the side effects of ziprazidone (Geodon)? -Activation at very low doses -Dizziness -EPS (benztropine or trihexyphenidyl for motor-related symptoms) -Sedation -Dystonia -Dry mouth -Asthesia -Skin rash -Orthostatic hypotension What are the adverse effects of ziprasidone (Geodon) -Drug reaction with eosinophilia (DRES) (seen more in people of African descent) -NMS -Tardive dyskinesia -Seizures -Increased risk of death and CVA in elderly patients with dementia-related psychosis What is the dosing schedule and range for ziprasidone (Geodon) -40-200 mg in divided doses daily (must take with food up to 500 calories or effectiveness of the medication is cut in 1/2) for schizophrenia. Start with 20 mg twice daily. Patients may tolerate 60 mg twice daily better to prevent activation. -80-160 mg daily for bipolar disorder -10-20 mg IM as rescue medication -Rarely lethal in monotherapy overdose Risperidone (Risperdal) Antipsychotic (atypical). What is risperidone used to treat? schizophrenia, bipolar disorders (oral) delaying relapse in schizophrenia Acute mixed mania Autism How does risperidone (Risperdal) work? -Blocks dopamine 2A receptors decreasing positive symptoms of psychosis and stabilizing affective symptoms -Blocks serotonin 2A receptors causing enhancement of dopamine release in certain brain regions thus reducing motor side effects and possibly improving cognitive and affective symptoms -Specifically 5HT7 antagonist properties may contribute to antidepressant actions What are the side effects of risperidone (Risperdal) -Increased risk for diabetes and dyslipidemia -Dose-dependent EPS symptoms (benztropine or trihexyphenidyl for motor-related symptoms) -Dose-related hyperprolactinemia -Dose-dependent dizziness, insomnia, sedation, anxiety -Nausea, constipation, abdominal pain, weight gain -Tachycardia, dose-dependent sexual dysfunction -Rare tardive dyskinesia -Rare orthostatic hypotension during initial titration What are the adverse effects of risperadone? -Hyperglycemia that can cause ketoacidosis or hyperosmolar coma or death -increased risk of death and CVA in elderly patients with dementia-related psychosis -Rare NMS -Rare seizures What is the dose range for risperadone? 2-8 mg daily orally for acute psychosis Learn More You can also click the terms or definitions to blur or reveal them