Unit 4

mental state characterized by depressed mood - mild to severe that interferes w activities of daily living for a period of 2 weeks

SYMPTOMS - change in appetite, insomnia, loss of interest/pleasure, fatigue, feeling of worthlessness/hopelessness, decerease sex drive, decrease ability to concentrate, feeling sad, withdrawal from society, irritability, thoughts of death/suicide

Exogenous - environment causing the depression (loss of loved one, loss of job) - self limiting

Endogenous - chemical imbalance within brain

Counseling 1st, psychotherapy, support groups, church groups, then drug therapy

Depression - decrease (low  NE & 5HT)

Mania        - increase (high NE & 5HT)

GOAL: increase NE & 5HT for depression, decrease NE & 5HT for mania

Tri-cyclic Antidepressants                      (TCA)

Monoamine Oxidase Inhibitors              (MAO)

Selectic Serotonin Reuptake Inhibitors (SSRI)

Misc Anti-depressants

1st Week

improved sleep, appetite

1-3 weeks

increase sex drive

self care improves

concentration, thinking normalizes

4-6 weeks

increase mood

less hopelessness

decrease suicidal thoughts

Sedation

Anti-cholinergic effects

dry mouth

constipation

urinary retention

blurred vision

Increased CNS activity

restlessness

tremors

convulsions

mania

High doses of TCA's can lead to lethal arrhythmias, seizures

increase NE & 5HT levels in the brain

RESULTS:

upon admin, results within a few hours

full therapeutic effect 4-6 wks

effects 2 wks after D/C of the drug

like the TCS, increase NE & 5HT levels in the brain

AVOID: foods that contain thyramine

wine

beer

cheese

over-riped avocado

chicken or beef liver

sausages

bananas

raisins

Selective only to 5HT

SIDE EFFECTS

anxiety

insomnia

sexual dysfunction

GI-distress (nausea/diarrhea)

BIG ADVANTAGE: less side effects than other tradition anti-depressants such as anti-cholinergic effects

takes up to 2 weeks for drug to show anti-depressant effects

side effects should subside w/ continued therapy

after mood improved, continue treatment for at least 6-9 months to prevent recurrence

some patientss require indefinite treatment

Symptoms

hyperactivity

unrealistic thoughts

talkative

apartment examples: bedroom bigger, tear down wall without consent, feel by connecting to another room, sleep 1 hour in 24 hour period.

Lithium MOA:

decreases excitability of nerve tissues (for the mania phase)

decreases release of NE at nerve ending (for the mania phase)

resulting in increase NE & 5HT for depression phase (depression phase)

Normal levels: 0.6-0.8 Meq/L  narrow therapeutic window

Side Effects:  0.9-1.5 Meq/L  fine hand tremors, GI upset, polydipsia, muscle weakness

  1.5-2.5 Meq/L  slurred speech, confusion, sedation, dizziness 

  >2.5 Meq/L    seizures, coma, cardiovascaular collapse, DEATH

Lithium equally effective in preventing BOTH manic/depressive recurrences in bipolar pat.

NO advantage to using combination of Lithium & antidepressants in prophylaxis over lithium alone in Bipolar patients.

monitor toxicity associated w lithium

tremors may interfere w/ oral hygiene

Naprosyn, Ibuprofin & other NSAIDS can produce lithium toxicity

Psychoses - mental disorder that involves a breakdown of the personality

Schizophrenia - a psychotic condition; increase in DA (dopamine) in the basal ganglia & Limbic System

All classes of typicals produce the same effect

Takes 1-2 weeks to see a full therapeutic effects

SYMPTOMS:

have for 1 month

bizarre delusions - false beliefs, stomach (snakes)

hallucinations - visual/auditory imaginary people

agitation - being watched

loose assoc - burger is candy

social withdrawn

GOAL: to decrease the DA in the brain / Limbic system. This resuls in increase in ACH (acetocholene) which produces EPS (extra pyramidal symptoms)

- All classes of typicals produce same effect

- takes 1-2 weeks to see full effect

1st line of therapy; SIDE EFFECTS:

A. Sedation

B. Anti-cholinergic effects - blurred vision, dry mouth, constipation, urinary retention

C. Orthostatic hypotension - decrease BP, rise slowly

D. Extra Pyramidal Symptom (EPS) increase in DA levels

  -Dystonic Reactions (Torticollis) - involuntary muscle twitching, spasms

- Akathisia - restlessness, pacing, fidgeting (1st mo)

- Parkinsonism - fine hand tremors (1st mo)

- Tardive Dyskinesia - invol mvmt of extremeties (tongue,jaw,lips)

Anti-cholinergic drug class (blurred vision, dry mouth, constipation, urinary retention)

MOA: decrease ACH levels, which decrease EPS side effects

- help calm patient down to function normally

- be able to communicate more rationally

- perform routine daily activity

- control!!!

- Use caution w patient interactions (patient may misinterpret your verbal & nonverbal actions (tools going toward mouth misread intent to harm)

- Check for Xerostomia & its managment (dry mouth)

- Check for TMJ EPS (mouth may be difficult to open, do not force)

- Encourage patient to rise slowly from dental chair to minimize

- progressive disorder of the basal ganglia in the brain

- decrease of DA in basal ganglia, resulting in increase in ACH

- DA    (dopamine)  - inhbitory NT: decrease muscle tone & activity

- ACH (acetacoline) - excitatory NT: increase muscle tone & activity

SYMPTOMS:

resting tremors - fine hand tremors

cogwheel muscular rigidity - flex muscles back & forth, away & toward not working

postural balance disturbances

sweating

salivation

bradykinesia - slow movement

Levodopa - increases DA

**Levodopa + Caridopa (Sinemet) increases DA to higher levels

Armantadine      (Symmetrel)  Anti-viral  - increases DA

Bromocriptine      (Parlodel)      DA Agonist - increases DA

Selegeline          (Eldepryl)      DA Conserver - keeps DA from being lost

Diphenydramine (Benadryl)      Anti-histamines - decreases ACH

Benztropine        (Cogentin)    Anti-cholinergic agents - decreases ACH

Trihexphenidyl    (Artane)            "          "

A condition in which there are chronic or recurrent seizures with the primary defect originating in the brain. This may lead to convulsions.

This uncontrolled neuron discharging (actual seizure) occurs in the cerebral cortex (right to left, left to right).

hypoxia - low oxygen to brain

bacterial/viral meningitis - inflammation of meninges

high fever

head trauma

stroke

brain tumor

genetics - linkage

intense emotional stress

hypoglycemia - low blood sugar

PSYCHOMOTOR EPILEPSY

*hallucinations

*bizarre behavior - chew food as though they are eating when nothing is in mouth

*an aura is present

SIGNS OF AN AURA

nauseated/stomach upset

smelling an unplesant odor

visual disturbances

numbness

dizziness

GRAND MAL SEIZURES

*tonic convulsions

*clonic convulsions

*AURA is present

STATUS EPILEPTICUS **LIFE THREATENING** DOC: IV Diazepam (Valium)

*SE's can lead to hypotension, hypoxia, brain damage, DEATH

*AURA is present

PETIT MAL SEIZURES

*absence seizures

*NO AURA

SIDE EFFECTS:

dizziness

BMC- (bone marrow depression) RBC, platelets, WBC, thrombocytopenia, anemia

Arrhythmias

Lupus

visual disturbances

Gingival hyperplasia - enlargement of the gums

* brand names only, too new for other

Anti-Epileptics - drugs are used to prevent occurerence of seizures by decreasing the excitability of brain cells (CNS activity)

Primadone (Mysoline): controlled substance

doses are low, psychological/physical dependence, tolerance, withdrawal symptoms, enzyme induction occurs

SIDE EFFECTS: Sedation, dizziness, rash, N/V

Sedative - used to reduce desire for physical activity, causes drowsiness, not "natural sleep"

Hypnotic - used to induce & maintain sleep

Barbituates - these drugs depress brain cell activity, pre-anesthetic

Nonbarbituates - no advantage over barbituates (still controlled substances)

TAKE ON AN 'AS NEEDED' BASIS

Anxiety - has to do with our nerves (neuroses) feelings of fear/anxiety. Anxious.

Sympathetic System increases

untreated, behavioral/emotional changes

GAD - excessive anxiety/worry of 2+ life circumstances for 6 months & symptoms as well

Anti-Anxiety Drugs - target & calm individuals

reduce unpleasant aspects of anxiety

reduce stress / anxiety

Non-Drug Therapy (Anxiety) - resting, gardening, movies, relaxing, TV, support groups, join counseling groups, listen to music

SYMPTOMS

trembling

increase BP, HR

loss of appetite/trouble swallowing

sweating

nervousness/feeling on edge

muscle tension

SOB

mind going blank

irritable

difficulty sleeping

dry mouth

less side effects are produced

MOA: increase inhibitory action of GABA, a NT in the CNS, which results in depression of specific areas of the CNS

- Reticular Formation - alertness / wakefulness

- Limbic System - emotional/behavioral responses

- Cerebral Cortex/Cerebral Medulla (higher learning & motor function)

- Spinal Cord-muscle activity

SIDE EFFECTS:

drowsiness

dizziness

dry mouth

physical / physiological dependence

long-term effects: memory loss

TAKE ON AN 'AS NEEDED' BASIS

DOC: IV Diazepam (Valium) - Static Eplilepticus (Anti-Epileptic)

NO ALCOHOL WHILE ON CNS DRUGS

TAKE ON AN 'AS NEEDED' BASIS

similar in efficacy to Benzo's

Advantages

no abuse potential

not affected by alcohol

no sedation

Disadvantages

slow onset of action

needs to be taken continuously on a routine regimen, not as needed

has no anti-convulsant & skeletal muscle relaxant properties

full therapeutic effect in 3-4 weeks

What CNS disorder is she manifesting? NOT experiencing parkinson, bipolar, or other CN

What are the symptoms she is experiencing? anxiety

What non-drug therapy do you recommend? in laws come in for 1 week, exercise, support group, other people, music, gardening

What medication might be of benefit for her? benzo's, not busbar as it takes 3-4 wks to take action, needs help now

Drug class and a particular drug - any of them, xanax, valium...other

Pain - a protective signal to warn us of a possible internal disease or tissue injury (tumor or appendicitis)

Local irritation - stimulation of peripheral nerves

Recognition of pain (CNS) - this increases CNS: anxiety and apprehension

Narcotic - treats moderate to sever acute pain

Non-narcotic - treats less intense pain

Treat:

Post surgical trauma pain

pre-operative pain

labor pain

cramps

pain from any peripheral vascular origin

terminal illness

HA/Migraine

Uses

Pain - to reduce awareness & perception of pain

suppress the cough reflexes

Best Results

take on a scheduled basis & give before intense pain is present for an effective dose

Bad Side Effects

1 decrease mental alertness/judgement

2 change in mood

3 stimulates chemoreceptor trigger zone-causing emesis (vomiting)

4 respiratory depression: HA, hypoventalation, carbon dioxide retention in blood, DEATH

5 decrease peristalsis: constipation

6 anticholinergic effects (dry mouth, blurred vision, urinary

7 spasmogenic activity

8 increase histamine release - bronchoconstriction

9 ortho-static hypotension

10 miosis

11 tolerance & physical dependency

12 NO ALCOHOL

overdosing on codeine or morphine, street drugs, respiratory depression, given Naloxone (Narcan), reversing this

agonist - treat pain

antagonist -reverse respiratory depression

Signs and Symptoms of inflammation

Redness (erythema)

Swelling (edema)

warmth

pain

Drugs help ease symptoms of inflammation

Mediator of the inflammatory response. this response is needed for healing to occur.

When response becomes exaggerated or prolonged - the inflammation becomes a disease itself (arthritis)

Protects stomach by secretion of mucus, bicarbonate

MOA: inhibits prostaglandin synthesis to decrease the inflammation signs / symptoms

USES

analgesic - HA

antipyretic

anti-inflammatory activity - R.A. rheumatoid arthritis

anti-coagulation activity

ALLERGIES:

skin rash, redness, swelling

trouble breathing

OVERDOSE:

nausea, vomiting, tinnitus, HA, hyperventalation, respiratory depression-acidosis occurs, Reyes Syndrome in children

TREATMENT

D/C drug

administer sodium bicarbonate, fluid and electrolytes

Treats inflammation by inhibiting the pathway of prostaglandin synthesis, delaying healing process

antipyretic - against fever

analgesia - HA

Conditions: arthritis, Dysmenorrhea (painful menses, cramps)

**Disrupts the stomach lining --GI irritation, bleeding

NO ALCOHOL (ulcers may form)

No anti-inflammatory properties

used for fever and pain

metabolized by the liver

Side Effects

hepatotoxicity

NO ALCOHOL (liver issue)

antidote: acetylcysteine to reverse toxicity

APAP - tylenol

ASA - aspirin

caffeine/butalbital -