NEUROTRANSMITTERS
The definition of a neurotransmitter
What is they are chemical messengers of the nerve cells.
They transmit electrical impulses in the brain and central nervous system.
The most dangerous side effect of being put on an antidepressant (mostly with SSRI's)
What is suicidal ideation until drug is at therapeutic levels.
What diagnosis does someone typically have that are placed on a mood stabilizer?
What is Bipolar disorder
The most commonly used classification of anti-anxiety medication
What are the benzodiazapines
These are the two classifications of antipsychotic medications.
What are first generation (conventionals) and second generation (atypicals)
This is what CAMP stands for
What is Cholinergics, Amino Acids, Monoamines, Peptides
Common non-life threatening side effects of the SSRI's
What is anxiety, GI disturbance, sexual dysfunction, and insomnia
Name the first line treatment for Bipolar disorder
What is Lithium
What should be avoided with the use of Benzodiazapines
What is alcohol due to potential for respiratory depression.
This is the main neurotransmitter affected with use of antipsychotic medications.
What is Dopamine. They block dopamine receptors to allow less dopamine to cross the synapse.
This is how the neurotransmitter makes electrical impulses happen.
What is they send a neurotransmitter from the pre-synaptic nerve ending to receptor sites on the post-synaptic nerve ending.
The Na+/K+ pump creates an action potential that causes the neurotransmitter to be sent.
Once it reaches the receptor site, the action potential happens.
Wines, most cheeses, ripe avocado, fermented meats, figs. smoked fish, yeast.
What part of the Bipolar disorder is Lithium thought to treat?
What is it treats both depression and mania but particularly useful in treating mania.
This drug is commonly prescribed for generalized anxiety disorder due to its less sedating effects and less potential for dependance.
What is Buspar (buspirone)
List 2 extrapyramidal side effects caused by the first generation antipsychotics.
What are Dystonia (muscle stiffness), Pseudoparkinsons, Akathisia (restlessness), Tardive dyskinesia (involuntary tongue darting, movement of eyes and lips uncontrollably)
This is what happens to the neurotransmitter after it is used.
Give at least one example
What is it gets reuptaken to the pre-synaptic nerve ending, or broken down by an enzyme that digests it, or via diffusion.
Why would a patient on a Monoamine Oxidase Inhibitor be at risk for hypertensive crisis?
What is taking another drug that also contains increased amount of epi, nor-epi, or dopamine can cause too much of these leading to a hypertensive crisis.
What is a secondary medication that can be paired with Lithium in the treatment of Bipolar disorder?
What are the Anticonvulsant drugs- these work as anti-mania agents
Most often Depakote/Depakene (valproate)
This drug is sometimes prescribed to help induce quality sleep
What is Ambien (zolpidem) "Z-hypnotics"
Not used for anxiety
We know that patients on antipsychotics do not like to take their medications. We can do this to enhance medication compliance with the antipsychotics.
Reality testing- they think we are trying to harm them with the medications. They will tell you they are "bad".
Educate that just because they feel better, does not mean they are cured.
Inpatient/outpatient medication compliance programs.
Name each of the CAMP neurotransimitters by name
C= acetylcholine
A= GABA
M= Dopamine
Serotonin
Norepinephrine
P- Substance P
Why are the Cyclic antidepressants termed "dirty drugs"
These drugs are rapidly absorbed and leads to cardiotoxicity.
Lots of negative side effects= dry mouth, blurred vision, urinary retention, constipation, confusion, orthostatic hypotension, weight gain.
Increased thirst, excessive urination, weight gain, n/v/d, tremors, hyponatremia ( in the presence of high lithium levels), kidney dysfunction, thyroid dysfunction.
These are some alternative medications to help with anxiety (non-benzos, non-hypnotics)
What are beta blockers (inderal and toprol) effective for performance anxiety. Antihistamines- due to sedative effects.
Benefit of taking a second generation over a first generation antipsychotic
Less chance for EPS but is more expensive.
What are each of the CAMP neurotransmitters responsible for?
What is- Acetylcholine- muscle movement
GABA- anxiety control
Dopamine- pleasure/mood/fine motor
Serotonin- mood/anxiety/sexual arousal/memory/sleep
Norepinephrine- fight or flight response
Substance P- pain regulation
Name one prototype drug from each of the following classifications:SSRI, MAOI, Cyclics, Atypicals
What is SSRI= Prozac (fluoxetine), Zoloft (sertraline)
MAOI- Nardil (phenelzine)
Cyclics- Elavil (amitriptyline), Pamelor (nortriptyline)
Atypical- Welbutrin (bupropion)
Things you should teach your patient who is taking Lithium
What is fluid intake of 2000-3000/day due to excessive fluid loss from urination, n/v/d.
Avoid activity that can cause excessive diaphoresis due to sodium/fluid loss.
Onset of action up to 2 weeks with therapeutic levels at 3 months, need for lithium level weekly for first several weeks then every 1-3 months.
Easy to lead to lithium toxicity due to narrow therapeutic index.
Patient teaching for use of benzodiazapines
May cause drowsiness, do not drive while taking, do not take every day, may cause dependance, do not combine with alcohol or opiates for potential for resp depression, decreases REM sleep, may lead to Alzheimers with regular long term use. Do not quit cold turkey- may lead to sz.
Nursing implications for first gen vs second gen antipsychotics.
First gen- EPS side effects to look out for. Treat with antihistamine, but TD can be permanent., orthostatic hypotension.
Second gen.- Risk of metabolic syndrome (weight gain, hypertension, blood glucose, lipids.