PSYCH NUR EXAM 3 BP- DETAILED SOLUTIONS LATEST UPDATES

1) Mood: 11 questions Depression: SSRI - Selective Serotonin Reuptake Inhibitor. (first line med treatment for depression) ● Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram) ● Mechanism of action ○ Block reuptake of serotonin back into the nerve endings, making more serotonin available in the neuronal synapse ● Side Effects ○ Weight gain, sexual dysfunction, nausea, headache, anxiety and nervousness. SNRI - Serotonin Norepinephrine Reuptake Inhibitor. Serotonin antagonist ● Duloxetine, Desvenlafaxine ● Mechanism of action ○ Inhibit the uptake of serotonin and norepinephrine: minimal inhibition of dopamine ● Side Effects ○ Headache, nausea, anxiety, agitation, dry mouth and sleep disturbances. SSRI & SNRI: takes 3-4 weeks to kick in ● Both: weight loss initially then weight gain, insomnia, sexual dysfunction, headache TCA - Tricyclic Antidepressants ● Amitriptyline (Elavil) ● Mechanism of action ○ Blocks uptake of serotonin and norepinephrine in the neural synapse. ● Side Effects ○ Photosensitivity, constipation, blurred vision, orthostatic hypotension, dizziness, tachycardia and urinary hesitancy, palpitations, weight gain MAOI - Monoamine Oxidase Inhibitor ● Phenelzine(Nardil) ● Mechanism of action ○ Removes norepinephrine, serotonin and dopamine from the brain. ● Side Effects ○ Weight gain, muscle twitching, increased sweating, orthostatic hypotension, dizziness ● Avoid food high in tyramine diet ○ High tyramine diet can cause HYPERTENSIVE CRISIS (high BP) ○ Avoid aged cheese, cheddar, smoked/aged/fermented meat, fish, poultry, such as sausage, pepperoni, salami, corned beef ○ Brewer’s yeast ○ Fava beans, red wine, soy sauce Suicidal ideation (suicidal thoughts): ● Assessment ○ Screenings for depression and other mental disorders, history of past attempts ○ History of trauma (loss of loved ones, unemployment, rape and subtance abuse) ○ Risk factors: LGBTQ members, family history of suicide. ○ Pt w high lethality (serious overdose, gunshot wounds, jumping from heights) or near lethality (attempt made w/o notifying others and discovered accidentally) is at high risk for suicide ○ Those who live alone, experienced multiple losses, limited social skills/resources, unsatisfactory or no relationships ● Treatment planning ○ Suicide prevention (one on one supervsion)(room checks) ○ Medications ■ Antidepressants (Fluoxetine) (Citalopram) (Sertraline) ■ Benzodiazepine (Lorazepam) (Diazepam) ■ Mood stabilizers (Lithium) ■ 2nd gen antipsychotic (Risperidone) (Olanzapine) Warning signs of suicide potential: IS PATH WARM ● Ideation ● Substance abuse ● Purposelessness ● Anxiety ● Trapped ● Hopelessness ● Withdrawal ● Anger ● Recklessness ● Mood change Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) tool, Evaluation of Suicide Risk Tool for Clinicians, Beck Depression Inventory, SAD PERSONS screening tool SAD PERSONS tool ● Sex (male) ● Age less than 19 or greater than 45 years ● Depression (client admits to depression or decreased concentration, sleep, appetite and/or libido) ● Previous suicide attempt or psychiatric care ● Excessive alcohol or drug use ● Rational thinking loss: psychosis or organic brain syndrome ● Separated, divorced or widowed ● Organized plan or serious attempt ● No social support ● Sickness, chronic disease A score of 1-2 points = low risk 3-5 points = moderate risk 7-10 points = high risk for suicide Bipolar Disorder: table 17.8, 17.10. Pg 424/425 Medications: ○ Mood stabilizers ○ Anticonvulsants ○ Antipsychotics ○ Antidepressants ○ Benzodiazepines- to help alleviate anxiety, insomnia, restlessness, especially in the lag time before any three main drugs to work Mood stabilizers ○ Lithium (lithium carbonate, Lithobid) ○ Take 2-3 weeks to work Levels of lithium toxicity: ● Mechanism of action ○ Altering the distribution of calcium, sodium, magnesium ions for nerve function ○ Affects the synthesis and release of norepinephrine,serotonin and dopamine ○ Normal range: 0.6-1.2 mEq/L Symptoms: ● Side effects increase as level of lithium in blood increases ● Mild (blood level of 1.5mEq/L): Tremor, mild stomach irritation, abdominal bloating,mild thirst, polyuria, muscle weakness, tiredness, headache, weight gain, vomit ● Moderate (blood level of 1.5-2.0mEq/L): nausea, vomiting, diarrhea, coarse hand tremor, loss of coordination, sedation, EKG changes, muscle twitch, ○ withheld lithium and draw blood work ● Severe (blood level of 2.0-2.5mEq/L): tinnitus, high output of dilute urine, serious EKG changes, severe hypotension, stupor, seizures ● Intentional overdose (Above 2.5): urine output ceases, cardiac arrhythmia, peripheral circulatory collapse, seizure, coma, death Treatment: ● Maintain normal salt or sodium intake (↓ sodium = ↑ lithium levels) ● Maintain adequate fluid; 8-12 glasses of water ● Take with food or milk ● Frequent blood samples: every 2-3 days ● After stabilization - blood work every 1-3 months ● Draw blood in morning - 12 hrs after evening dose ● Avoid taking during pregnancy or breastfeeding ● Avoid NSAID and diuretics- increase lithium level