Ch. 21 Antidepressant Agents

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?

Phenelzine (Nardil)

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives.

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?

14 days

When a client is started on an antidepressant, it is important for the nurse to explain to the client that it may take time to see a change in mood. How long can it take for the client to see the beneficial effects of an antidepressant?

4 weeks

The client has been perscribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?

Selective serotonin reuptake inhibitor

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors

The nurse is caring for a 12-year-old child who has been hospitalized with depression, and the health care provider has elected to treat the child with a TCA. The nurse understands that what laboratory test will be routinely ordered by the provider?

Blood pressure, ECG, and plasma drug levels

A 30-year-old client is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

Dizziness

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension

A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe?

Hypertensive crisis

What medication is effective in treating enuresis in children older than 6 years of age?

Imipramine

A client is prescribed a tricyclic antidepressant. The nurse would anticipate administering this drug by which route?

Oral

A patient newly diagnosed with depression has been prescribed fluoxetene, a selective serotonin reuptake inhibitor (SSRI). Why would the physician order an SSRI for a newly diagnosed patient?

SSRIs usually produce fewer and milder adverse effects than other antidepressants.

When assessing a client's medication history, the use of which herb would alert the nurse to the potential for adverse reactions when taken with antidepressants?

St. John's wort

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

Which laboratory value would prevent a client from being prescribed duloxetine?

increased alanine aminotransferase level (ALT)

The adverse effects of selective serotonin reuptake inhibitors are less than other antidepressants.

true

Tricyclic antidepressants reduce the reuptake of serotonin and norepinephrine.

true

A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status?

"Have you felt hopeless anytime lately?"

After teaching a client who is to receive transdermal selegiline, which client statement would indicate to the nurse that the client has understood the instructions?

"I can apply a new patch to my upper arm, thigh, or torso."

The nurse is interviewing the client who is to receive a tricyclic antidepressant. Which client statement should alert the nurse to a likely contraindication?

"I had a myelogram yesterday."

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective."

A 33-year-old woman has been diagnosed with major depression and has recently begun treatment with citalopram (Celexa). What teaching point should the nurse emphasize when providing health education for this patient?

"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning."

A client has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse?

"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?

"There may be an increased risk of suicide while taking this drug."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth."

A client is at the clinic for a follow-up appointment related to treatment for depression. The client had began taking fluoxetine 2 weeks ago. The client states, "This medication must not be working, because I don't feel better at all." What would be the nurse's best response?

"You may have to take this drug for a few more days before you feel its effects."

The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?

1.8 mEq/L

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?

A 45-year-old man with angina pectoris

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment

A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?

A client has dysphagia

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?

A lower dose of the antidepressant

A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone (Risperdal). What assessment should the nurse prioritize in the care of this client?

Assessment of the client's behaviors and thought processes

A nurse is preparing to administer an antidepressant that affects the neurotransmission of norepinephrine, serotonin, and dopamine. Which drug would the nurse be most likely to administer?

Bupropion

A client has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which food should the client be instructed to avoid eating?

Cheddar cheese and bratwurst

A nurse is preparing to administer selective serotonin reuptake inhibitors (SSRIs) to a group of clients. The nurse would administer the drug cautiously to which clients?

Clients with diabetes mellitus

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness

A client who ingests foods high in tyramine while taking a selective serotonin reuptake inhibitor is at risk for developing severe hypertensive crisis.

False

Which agent would a nurse identify as a selective serotonin reuptake inhibitor?

Fluvoxamine

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

In 4 to 6 weeks after stopping the paroxetine

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?

It may take up to two more weeks before the client feels better

A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?

Onset of suicidal ideation

A client has been diagnosed with depression and prescribed fluoxetine (Prozac) 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?

Question the prescriber about the dose

The normal function of which neurotransmitter is most likely impaired when a client expresses feelings of gloom and the inability to perform activities of daily living?

Serotonin

A nurse caring for a client starting treatment with paroxetine (Paxil) should be educated on which adverse effects? (Select all that apply.)

Sexual dysfunction Insomnia Somnolence Diarrhea Constipation

A client is receiving a selective serotonin reuptake inhibitor (SSRI) and is being switched to a monoamine oxidase inhibitor (MAOI) due to lack of response. When would the nurse teach the client to begin the MAOI?

The MAOI would be started 2 to 4 weeks after stopping the SSRI.

What fact should underlie the nurse's response to the client who asks to be prescribed a monoamine oxidase (MAO) inhibitors for their long-standing depression?

The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used.

Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin?

Tricyclic antidepressants

A deficiency of a biogenic amine in key brain areas is believed to result in depression.

True

A client with depression began taking fluoxetine 10 days ago. The nurse should monitor the client for what adverse effect?

Urinary incontinence

The nurse is caring for a group of clients in a long-term care facility. The nurse is aware that SSRIs are associated with what side effect that is especially undesirable in older adults?

Weight loss

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

Yogurt