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Lecture 3

NURS 3524 Lecture Notes - Lecture 3: Desvenlafaxine, 5-Ht Receptor, Psychomotor Retardation


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Lecture
3

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 3
HH/NUR 3524 6.0
Psychiatric & Mental Health Nursing For Canadian Practice
CONTENT COVERED
Mood disorders, Self-Harm (continued)
Depression Bipolar, Eating Disorders, Dementia, Children’s Mental Health
REQUIRED READINGS
Chapter 23, 25, 29 - 32
Class Objective
Discuss issues and treatment options of Bipolar Affective Disorder, Anxiety Disorders and Dementia
Discuss the current issues and treatment options for children’s mental health
Mnemonic for Assessing Possible Depression SIG E CAPS: (ON THE TESTS)
S = Sleep disturbed
I = Interest decreased
G = Guilt feelings (Inappropriate)
E = Energy lower (stay in bed)
C = Concentration poor (can’t finish their thoughts)
A = Appetite disturbed (won’t eat for days or eat soo much)
P = Psychomotor retardation (wouldn’t get out of bed)
S = Suicidal ideation (most important to assess; refer to last week)
Commonly Used Antidepressants (ON THE TEST)
SSRIs: Decrease serotonin blockers in the brain**
o Target serotonin receptor the serotonin level drops when the pt. is depressed so they block the
receptors so there will be more serotonin circulating in the brain
o sertraline (Zoloft)
o fluoxetine (Prozac)
o citalopram (Celexa)
o escitalopram (Lexapro)
o paroxetine (Paxil, Pexeva)
o fluvoxamine (Luvox)
o trazadone (Oleptro)
SE: fatigue, diarrhea, stomach upset, nausea, dry mouth, rash, weight loss/gain, insomnia,
headaches, low sex drive; hyponatremia
Serotonin syndrome: confusion, sweating, diarrhea, agitation, fever, arrhythmia,
seizures, LOC
SSRI and MOAI can’t be given together can be fault serotonin will be
dangerously high in a short time serve serotonin syndrome
**SNRI: improve serotonin and norepinephrine levels (faxine)
o desvenlafaxine (Pristiq)
o duloxetine (Cymbalta)
o venlafaxine (Effexor XR)
SE: elevated BP, loss of weight, appetite, nausea, vomiting, urinary retention, sexual
dysfunction, increase in SI
Contraindication: hypertension and CAD
Assess for sudicial indention

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 3
HH/NUR 3524 6.0
drug doesn’t reach full potential in few weeks
antidepressant can give the pt. the ability to think more clearer about their plan
the imbalances give them the energy to do it since they aren’t mentally stable
yet
TCA: used when SSRIs and others not effective
o Amitriptyline
o Clomipramine (Anafranil)
o Desipramine (Norpramin)
o Doxepin
o Imipramine (Tofranil)
o Nortrytyline (Pamelor)
SE: constipation, dry mouth, fatigue, low BP, irregular heart rate and seizures
Tetracyclic Antidepressant: maprotiline
MAOIs: breakdown of norepinephrine, dopamine and serotonin.
o isocarboxazid (Marplan)
o phenelzine (Nardil)
o selegiline (Emsam)
o tranylcypromine (Parnate)
SE: similar to other antidepressants
Contraindications: hypertensive crisis and foods that contain tyramine, St John’s Wort,
OTC with dextromethorphan, herbs containing Rhodiola
MAOI diet: no aged cheeses, deli meats, liver, fermented products, like soy sauce
chocolate, caffeine, over ripe and dried fruit, bananas, alcohol
Can cause HTN and death
Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to
neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and
autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after
dose increases.
Atypical Antidepressants (ON THE TETS)
Dopamine Reuptake Inhibitor (DRI): blocks dopamine transporter, used in ADHD, smoking
cessation, weight loss for morbid obesity, SAD
o Bupropion (Wellbutrin)
SE: increase BP, nausea, vomiting, dry mouth, sweating, sore joints, sore throat, diarrhea,
dizziness
5-HT2 Receptor Antagonists
o Specific serotonin receptor blocker
o Nefazadone
o Trazadone
SE: dizziness, drowsiness, constipation, blurred vision
5-HT3 Receptor Antagonists
o Vortioxetine (Brintellix)
Bipolar Affective Disorder
Mania/ Depression Cycles
Symptoms of Mania

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 3
HH/NUR 3524 6.0
Euphoria state of elation experienced as a heightened sense of wellbeing
Very outgoing, intrusiveness
Manipulative, and controlling if the relationship is unsatisfactory to them
May be abusive to significant others
No need for sleep, increase in nocturnal activity
Pressure of speech fast, rambling if the meds works the speech is slowed down
Delusions of Grandeur, Flight of Ideas think they can over take the world
Hyperactivity can’t stop moving
Gaudy dress and makeup
Exaggerated self-esteem
Poor judgement
Psychotic symptoms (severe cases)
Spending sprees (not to cheer oneself up) (Excessive involvement in activities that have a high potential
for painful consequences)
Increased sexual drive multiple gf/bf; sex on their mind
Abuse of substances (e.g. cocaine, alcohol)
Provocative / aggressive behavior
Denial that anything is wrong (“I feel Grrrreat!”)
o Some of them are intelligent --. Know what they are doing but can’t control themselves
Increase in goal-directed activity
Don’t have time to eat offer ensure, finger food (so they can carry)
Bipolar Affective Disorder (BAD)
Mood disorder fluctuated between expansive, elevated mood state and depression
highs (mania) or lows (depression)
Bipolar I: cycles of acute mania with or without depression “Brittany spears doll”
Bipolar II: cycles of hypomania with major depression “engineer had everything lost job killed
himself)
Bipolar III: Antidepressant Induced
Rapid-cycling at least 4+ episodes per year of depression or mania/hypomania
o In the beginning focus on the physical than the mental
Bipolar Disorder Diagnostic Clues
First symptoms can develop during childhood (often misdiagnosed) or even late in life.
Often symptoms not recognized (“just a wild guy/gal”), and people may suffer for years before it is
properly diagnosed and treated
Bipolar disorder is a chronic condition that must be carefully managed throughout a person's life.
The Mood Spectrum Bipolar Affective Disorder
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