WCU Mental Health Final Focused Review 2023

Medications that help with Alcohol Addiction - Answer- Benzodiazepines: Valium, Ativan and Librium for withdrawal symptoms Disulfiram (Antabuse): inhibits Acetaldehyde Dehydrogenase Alcohol-disulfiram reaction causes unpleasant physical effects Naltrexone (ReVia, Trexan): block the need to ingest alcohol. Vivitrol-IM (monthly) Opiate antagonist. Blocks euphoric reinforcement produced by substance and prevents craving Acamprosate (Campral): Stabilizes N-Methyl-D-Aspartate (NMDA) receptor causing decrease of glutamatergic/excitatory system SSRI's: may decrease drinking in late onset alcoholism Ondanstron (Zofran): 5HT3 Blocker, effective for early onset Topiramate (Topamax): actions on glutamatergic system to decrease alcohol cravings Medications to help with Cocaine/Crack Addiction - Answer- Diazepan (Valium) Phenobarbital Imipramine hydrochloride (Tofranil) Propranolol (Inderal) Bromocriptine (Parlodel) Amantadine (Symmetrel) Medications to help with Opiate Addiction - Answer- • Methadone (Dolophine) - Synthetic opiate blocks craving for and effects of heroin • LAAM (l-α-acetylmethadol) - An alternative to methadone • Naltrexone (ReVia) - Antagonist that blocks euphoric effects of opioids • Clonidine (Catapres) - Effective somatic treatment when combined with naltrexone • Buprenorphine (Subutex) - Blocks signs and symptoms of opioid withdrawal Tacrine (Cognex) - Answer- * Used for mild to moderate Alzheimer's * Slows down progression of Alzheimer's at Stage 4 -Cholinesterase Inhibitor -Action: Prevent breakdown of acetylcholamine, thereby increasing availability for synapses -Side Effects: Nausea, vomiting, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope. o HIGH RISK FOR HEPATOXICITY (liver damage)! No longer widely used Types of Legal Holds (7) - Answer- 5150 - 72 hour-hold (DTS, DTO, GD) 5250 - 14 day hold (DTS, DTO, GD) 5260 - Consecutive 14 day hold for DTS 5270 - 30 day hold (GD) 5300 - 180 day hold for (DTO) * Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment- unless they have gone through a legal competency hearing and have been judged incompetent. o Riese Petition * Patients forced to take medication against will * Court ordered, for benefit of patient * The client who has been judged incompetent has a temporary or permanent guardian, usually a family member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if he were still competent. Temporary Conservatorship (30 days) - GD LPS Conservatorship - GD * DTS- Danger to Self, DTO-Danger to Others, GD- Gravely Disabled Medications for Insomnia (Benzodiazepines & Benzo-like drugs; HABIT FORMING) - Answer- * Benzodiazepines - FDA approved, HABIT FORMING, SCHEDULE IV Generic (Brand) Onset of action (min) Duration of action Estazolam 15-60 Intermediate Flurazepam 20-60 Long Quazepam (Doral) 20-45 Long Temazepam ( Restoril) 45-60 Intermediate Triazolam (Halcion) 15-30 short * Benzodiazepine like drugs - FDA approved, HABIT FORMING, SCHD IV Generic (Brand) Onset of action (min) Duration of action Eszopiclone (Lunesta) 60 Intermediate Zaleplon (Sonata) 15-30 Ultra short Zolpidem (Ambien) 30 short Meds for Insomnia (Melatonin Receptor Agonist, Antidepressant, and Antihistimines; NON HABIT FORMING) - Answer- * Melatonin Receptor Agonist - FDA approved, NOT HABIT FORMING Generic (Brand) Onset of action (min) Duration of action Ramelteon (Rozerem) 30 Short * Antidepressant - NOT HABIT FORMING Generic (Brand) Onset of action (min) Duration of action Trazadone (desyrel) 60-120 long * Antihistamines - FDA approved as sleep aid, tolerance to hypnotic effects may develop in 1-2 weeks Generic (Brand) Onset of action (min) Duration of action Diphendydramine (Nytol, Sominex) 60-180 Long Doxylamine (Unisom) 60-120 long ****INSTRUCTIONS FOR PPL W/ INSOMNIA OR TAKING MEDS FOR INSOMNIA o SET LIMITS o NO HEAVY MACHINARY o NO ALCOHOL o RISK FOR SLEEP APNEA o WITHDRAWAL FOR --- EXHAUSTED RITALIN What Effect Does Cocaine Have on the Body? - Answer- * Smoking cocaine takes immediate effect (4-6 seconds) lasting for 5-7 minutes followed by deep depression that strengthens addiction * Schedule II substance * Increased productivity * Decreases appetite * Pupils dilated and deviated septum * Develop tolerance * Two main effects on body: o Anesthetic -Blocks primarily pain transmission o Stimulant - acts as a stimulant for both sexual arousal and violent behavior * Cocaine blocks the reuptake of norepinephrine, dopamine, and serotonin o Believed to causes symptoms of withdrawal o Symptoms take an hour to several days of stop What are the 3 Levels of Cocaine Toxicity and Withdrawal? - Answer- * Normal: * Depression, Paranoia, Fatigue, Anxiety, Insomnia, night terrors, psychomotor retardation, agitation, nausea, vomiting, sweating, craving * Mild toxicity: * Dizziness, irritable, tremor, blurry vision * Severe Toxicity: * Hallucinations, seizure, hyperpyrexia, tachycardia, hypotension, chest pain, HF, death * Withdrawal is classified as having 3 distinct phases o Phase one or the crash phase, which lasts up to 4 days: * Depression, Anergia, and acute onset of agitated depression. Craving peaks during this phase, along with anxiety and paranoia. ( Inpatient care to prevent access to the drug is important during the 1st and 2nd phases) o Second phase: * Prolonged dysphoria, anhedonia, and a lack of motivation, along with intense cravings that lasts up to 10 weeks ( Relapse is most likely during this phase) o Third phase: * Characterized by intermittent cravings and can last indefinitely Haldol: What does it do/how is it used Therapeutically? - Answer- Conventional antipsychotic block dopamine, acetylcholine, histamine, and norepinephrine receptors in brain and periphery. Inhibits of psychotic symptoms is result of dopamine bloackade in brain * Therapeutic uses o Tx of acute or chronic psychosis o Schizophrenia o Bipolar disoder - primary manic phase o Tourette's syndrome o Delusional and schizoaffective disorders o Dementia o Prevention of nausea/vomiting through block of dopamine in chemoreceptor trigger zone of medulla Haldol: Side Effects (BIG, complex symptoms) - Answer- * Side Effects o Acute dystonia - monitor for s/s 5 hours to 5 days after start of tx * Spasms of tongue, neck, face, and back * Requires rapid tx * Treat with anticholinergic agents such as benzotropine (cogentin), or diphenhydramine (benadryl) o Pseudoparkinsonism - Monitor for first month from beginning tx * Bradykinesia, * rigidty, * shuffling gait, *"pill rolling" * drooling, * tremors * Treat with anticholinergics benzotropine (cogentin), diphenhydramine (benadryl) or amantadine (symmetrel) o Akathisia - observe signs and symptoms in first 2 months of tx * Inability to sit or stand still * Continual pacing and agitation * Manage symptoms with beta-blockers, benzodiazepines, or anticholinergic meds o Late extrapyramidal SE Tardive Dyskinesia: * Involuntary movements of tongue and face, LIP SMACKING * Involuntary movements of arms lets and trunk o Administer low dosage possible to control symptom o Evaluate after 12 months of therapy then every 3 months. If sign of TD appear, dosage should be lowered, or client should be switched to Atypical antipsychotic o Use Abnormal involuntary Movement Scale (AIMS) to screen for presence of EPS. o Neuroleptic Malignant syndrome (NMS) - occurs usually 2 weeks into tx or when medication increaed * Sudden high fever * BP fluctuations * Dysrthymias * Muscle rigidity * Change in LOC * Coma * Stop antipsychotic immediately * Monitor client VS * Apply cooling blanket * Administer antipyretic, aspirin or acetaminophen * Increase client fluid intake * Administer Danrolene (Dantrium) and Bromocriptine (Parlodel) to induce muscle relaxation * Wait 2 weeks before resuming therapy. Consider switching to atypical antipsychotic Haldol: Side Effects Part 2 - Answer- o Anticholinergic effects * Dry mouth * Blurred vision * Photophobia * Urinary retention * Constipation * Tachycardia * Interventions o Chew sugarless gum o Sipping on water o Avoiding hazardous activities o Wearing sunglasses o Eating foods high in fiber o Participating in regular exercise o Maintaining fluid intake of 2 to 3 L per day o Voiding before taking medication Orthostatic hypotension * Tolerance developed in 2 to 3 months * Monitor BP and HR for changes. Hold medication until provider notified of significant change * Instruct client about signs of postural hypotension (lightheadedness, dizziness) * If occurred, tell client to sit or lay down. * Orthostatic hypotension can be minimized by getting up and changing positions slowly o Sedation * Inform client effects should diminish within few weeks * Instruct client to take medication at bedtime to avoid daytime sleepiness * Advise client not to drive or operate heavy machinery until sedation subsides o Seizures * Greatest risk in clients who have pre-existing seizure disorders * Advised to report any seizure activity * Increase of antiseizure medication may be necessary o Skin Effect * Photosensitivity may result in severe sunburn * Contact dermatitis from handling medication o Agranulocytosis * Low WBC, higher risk for infection o Severe Dysrhythmias * Associated with conventional antipsychotic agents Haldol: Contraindications/Precautions - Answer- * Contraindications/precautions o Contraindicated in clients who are in coma, have severe depression, Parkinson's disease, prolactindependent cancer of breast and severe hypotension o Contraindicated with adults with dementia o Assess client to differentiate between EPS and worsening psychotic disorder * Aminister anticholinergics, beta-blockers, and benzodiazepines to control early EPS * If symptoms intolerable, switch to low potency or atypical anti-psychotic agent * Antipsychotic medication is not addicting * Take medication as prescribed, on regular schedule, do not skip doses, do not double dose if medication missed * Therapeutic effects will be noticeable witin few days, improvements may take up to 2 to 4 weeks, and months for full effects * Consider depot preparations, administered IM once every 2 to 4 weeks, for clients having difficulty maintaining med regimen. Lower doses can be used in depot preparations, decreases risk of adverse effects and TD * Start with 2x day dosing, but switch to 1x a day at bedtime to decrease daytime drowsiness and promote sleep