Chapter 23
what is the therapeutic range for Lithium?
0.6 to 1.2 mEq/L
what are possible side effects of using fluvoxamine (Luvox)?
dizziness drowsiness headache insomnia dry mouth asthenia anorexia nausea diarrhea sexual dysfunction SJS
what can occur if you intake tyramine with MAOIs?
hypertensive crisis
what is imipramine used for?
depression
which drug has the longest half-life, thus can be taken weekly?
Prozac
12. When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? A. Yogurt B. Avocado C. Grapefruit D. Potato chips
Answer: A Rationale: When taking monamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.
what are possible side effects related to imipramine?
dizziness drowsiness fatigue headache blurred vision dry mouth orthostatic hypotension tremor urinary retention seizures SI
what is lithium metabolized by?
liver
what is amitriptyline used for?
depression
when should you use caution with fluvoxamine (Luvox)?
hepatic disorders
when should you use caution with venlafaxine (Effexor)?
with MAOIs CNS depression SIADH anticoagulant pregnancy breastfeeding children sI renal impairment hepatic disease bleeding narrow angle glaucoma seizures malnourishemnet hypovolemia hypokalemia hyponatremia hyperthyroidism MI heart failure
what can increase lithium levels?
caffeine loop dieuretics
what is trazodone used for?
depression
what is paroxetine (Paxil) used for?
depression GAD SAD PTSD OCD
what is sertraline (Zoloft) used for?
depression OCD PTSD panic disorder SAD
what is a possible adverse reaction with nefazodone (Serzone)?
hepatotoxicity
when should you avoid using bupropion (Welbutrin)?
history of seizures
what can lithium levels great than 1.5 mEq/L indicate?
toxicity
what can happen to serum sodium levels with intake of lithium?
can deplete sodium
what is the most serious side effect with tricyclic antidepressants?
cardio toxicity
what is the drug class for venlafaxine (Effexor)?
antidepressant: serotonin norepinephrine reuptake inhibitor
what are the therapeutic effects of fluoxetine (Prozac)?
treat depression, bipolar disorder, bulimia disorder, OCD, panic disorder, and premenstrual dysphoric disorder
what are possible side effects of carbamazepine (Tegretol)?
dizziness drowsiness headache blurred vision ataxia pruritus nasuea vominting weakness anemia agranulcocystosis SI
what are possible side effects of using divalproex (Depakote)
dizziness drowsiness insomnia asthenia blurred visison nasuea vomiting diarrhea thrombocytopenia SI
20. When a patient is taking an antidepressant, what should the nurse do? (Select all that apply). A. Monitor the patient for suicidal tendencies. B. Observe the patient for orthostatic hypotension. C. Teach the patient to take the drug with food if GI distress occurs. D. Tell the patient that the drug may not have full effectiveness for 1 to 2 weeks. E. Advise the patient to maintain adequate fluid intake of 2 L/d
A, B, C, D
21. A patient is taking lithium. The nurse should be aware of the importance of which nursing intervention(s)? (Select all that apply). A. Observe the patient for motor tremors. B. Monitor the patient for orthostatic hypotension. C. Draw lithium blood levels immediately after a dose. D. Advise the patient to drink 750 L/d of fluid in hot weather. E. Advise patient to avoid caffeinated foods and beverages. F. Teach the patient to take lithium with meals to decrease GI irritation
A, B, E, F
8. A patient with major depression has been prescribed fluoxetine (Prozac). What nursing diagnosis would be most appropriate? A. Social isolation B. Impaired physical mobility C. Impaired urinary elimination D. Disturbed sensory perception
Answer: A Rationale: The most appropriate nursing diagnosis for the patient taking fluoxetine is social isolation. Impaired physical mobility, impaired urinary elimination, and disturbed sensory perception are not associated with fluoxetine.
14. Which statement about amitriptyline (Elavil) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.
Answer: B Rationale: When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).
10. Before administering an MAO inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.
C, Answer: C Rationale: Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.
15. A patient is admitted with bipolar affective disorder. The nurse acknowledges which medication as one used to treat this disorder for some patients in place of Lithium? A. Thiopental B. Gingko biloba C. Fluvoxamine (Luvox) D. Divalproex (Depakote)
D
19. Which statement is true concerning lithium? A. The maximum dose is 3.4 g/d B. The therapeutic drug range is 2.5 to 3.5 mEq/L. C. Lithium increases receptor sensitivity to GABA. D. Concurrent NSAIDs may increase lithium levels.
D
13. Which advice will the nurse include when teaching the patient about lithium therapy? A. Take the drug on an empty stomach. B. Eliminate all sodium from your diet. C. Stop taking the lithium when you feel better. D. It may take 1 to 2 weeks before you have any benefits from taking the medication.
D, Answer: D Rationale: The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.
NCLEX questions When a patient is taking an antidepressant, what should the nurse do? Select all that apply a. Monitor the patient for suicidal tendencies. b. Observe the patient for orthostatic hypotension. c. Teach the patient to take the drug with food if gastrointestinal distress occurs. d. Tell the patient that the drug may not have full effectiveness for 1 to 2 weeks. e. Advise the patient to maintain adequate fluid intake of 2 L/day
a. Monitor the patient for suicidal tendencies. b. Observe the patient for orthostatic hypotension. c. Teach the patient to take the drug with food if gastrointestinal distress occurs. d. Tell the patient that the drug may not have full effectiveness for 1 to 2 weeks.
NCLEX questions A patient is taking lithium. The nurse should be aware of the importance of which nursing interventions. Select all that apply a. Observe the patient for motor tremors. b. Monitor the patient for hypotension. c. Draw lithium blood levels immediately after a dose d. Advise the patient to drink 750mL/day of fluid in hot weather. e. Advise the patient to avoid caffeinated foods and beverages. f. Teach the patient to take lithium with meals to decrease gastric irritation.
a. Observe the patient for motor tremors. b. Monitor the patient for hypotension. e. Advise the patient to avoid caffeinated foods and beverages. f. Teach the patient to take lithium with meals to decrease gastric irritation.
what is the mode of action for lithium?
alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin
what are two of the drugs included in the tricyclics antidepressants group?
amitriptyline imipramine
what drug class is fluoxetine (Prozac)?
antidepressant: selective serotonin reuptake inhibitor
NCLEX questions A patient is taking tranylcypromine sulfate for depression. What advice should the nurse include in the teaching plan for this medication? a. Warn the patient about severe hypotension. b. Instruct the patient to avoid beer and cheddar cheese. c. Encourage the patient to take ginseng and ephedra. d. Encourage the patient to eat fruit such as bananas.
b. Instruct the patient to avoid beer and cheddar cheese.
what is lamotrigine (Lamictal) used for?
bipolar disoer, seizures, Lennox-Gastaut syndrome
what are therapeutic effects of lithium?
bipolar disorder and manic episodes
what is divalproex (Depakote) used for?
bipolar disorder, seizures, migraine prophylaxis
what is carbamazepine (Tegretol) used for?
bipolar disorder, seizures, neuropathic pain, trigeminal neuralgia
what is the action of tricyclic antidepressants (TCA)?
block the uptake of the neurotransmitters norepinephrine and serotonin in the brain
when is carbamazepine (Tegretol) contraindicated?
bone marrow depression
NCLEX questions The nurse realizes that some complementary and alternative therapies interact with selective serotonin reuptake inhibitors. Which complementary and alternative therapy interaction may cause serotonin syndrome? a. Feverfew b. Ma-haung c. St. John's wort d. Gingko biloba
c. St. John's wort
NCLEX questions Which statement is true concerning lithium? a. The maximum dose is 3.4g/day b. The therapeutic drug range is 2.5 to 3.5 mEq/L c. Lithium increases receptor sensitivity to gamma-aminobutyric acid. d. Concurrent nonsteroidal antiinflammatory drugs (NSAIDs) may increase lithium levels.
d. Concurrent nonsteroidal antiinflammatory drugs (NSAIDs) may increase lithium levels.
NCLEX questions A patient is admitted with bipolar affective disorder. The nurse acknowledges which medication as one used to treat this disorder for some patients in place of lithium? a. Thipental b. Ginko biloba c. Fluvoxamine d. Divalproex
d. Divalproex
what is desvenlafaxine (Prestiq) used for?
depression
what is mirtazpine (Remeron) used for?
depression
what is nefazodone (Serzone) used for?
depression
what is escitalopram (Lexapro) used for?
depression and generalized anxiety disorder
what are the therapeutic effects of venlafaxine (Effexor)?
depression, GAD, SAD, panic disorder
what is bupropion (Welbutrin) used for?
depression, seasonal affective disorder, and nicotine withdrawal
what are possible side effects of using lamotrigine (Lamictal)?
dizziness drowsiness blurred vision pharyngitis nausea vomiting ataxia SJS
what are possible side effects of fluoxetine (Cymbalta)?
dizziness drowsiness headache insomnia anxiety asthenia dry mouth anorexia nausea constiaption si
what are possible side effects of sertraline (Zoloft)
dizziness drowsiness headache insomnia nausea diarrhea orthostatic hypotension SJS
what are possible side effects of using desvenlafaxine (Prestiq)?
dizziness drowsiness insomnia dry mouth nausea excess weating fatigue withdrawal SI
what are possible side effects of bupropion (Welbutrin)?
dizziness insomnia lethargy headache blurred vision dry mouth diaphoresis agitation tachycardia weight loss SI
what are possible side effects of nefazodone (Serzone)
headache drowsiness diziness insomnia blurred vision dry mouth weakness infection nausea diarrhea constiaption SI
what drug class is lithium?
mood stabilizer
what are possible side effects of using trazodone?
drowsiness dizziness blurred vision headache insomnia fatigue dry mouth orthostatic hypotension tachycardia nausea vomiting SI
what are some side effects relate to TCAs?
orthostatic hypotension, cardiotoxicity, sexual dysfunction, and blood dyscrasias
what is the mode of action for venlafaxine (Effexor)
serotonin and norepinephrine are increased in nerve cells because of blockage from nerve fibers
what are side effects of amitriptyline?
drowsiness dizziness blurred vision memory impairment headache insomnia orthostatic hypotension dysrhythmias dry mouth excess sweating constipation weight gain/loss lethargy tremor paraesthesia seizures SI
11. Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium (Lithobid)? A. Urinalysis B. Serum glucose C. Serum electrolytes D. Complete blood count
Answer: C Rationale: Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.
18. A patient is taking tranylcypromine sulfate (Partite) for depression. What advise should the nurse include in the teaching plan for this medication? A. Warn the patient about severe hypotension. B. Instruct the patient to avoid beer and cheddar cheese. C. Encourage the patient to take ginseng and ephedra. D. Encourage the patient to eat fresh fruits= such as bananas.
B
2. A nurse works in an assisted living setting. The nurse is administering a selective serotonin reuptake inhibitor to an 84-year-old client. The nurse is aware that the daily dose of this medication for the older adult client would be _____ the adult dose. A. Double B. Half C. Triple D. Quadriple
B
1. A client is ordered a tricyclic antidepressant. In monitoring this client, the nurse would assess for: A. Orthostatic hypotension B. Loss of hair C. Extreme depression D. Maniac disorder
A
17. A selective serotonin reuptake inhibitor is prescribed for a patient. The nurse know that which drug is an SSRI? A. paroxetine (Paxil) B. amitriptyline (Elavil) C. divalproex sodium (Depakote) D. bupropion HCl (Wellbutrin)
A
4.. A client is on maintenance lithium therapy for bipolar disorder. The client enters the emergency department complaining of tremors. The client appears to be giddy and confused. A serum lithium level is drawn and is found to be 2 mEq/L. The nurse would anticipate: A. Holding the next dose B. Giving the dose C. Contact the health care provider D. Administer more
A
5. The client has been treated with antidepressants for mild depression for 3 years. The client says her medication is no longer working, and she states that she has heard that MAO inhibitors are effective medications in treating depression. The nurse would respond based on the knowledge that: A. This medication requires strict dietary restrictions. B. This medication is rad. C. This medication will have a lot of side effects. D. This medication will make you feel great and like you can fly.
A
7. A patient with major depression has been prescribed fluoxetine (Prozac). What appropriate dosing regimen would the nurse expect? A. 20 mg every morning B. 40 mg 3 times per day C. 50 mg at bedtime D. 100 mg 4 times per day
A Rationale: Fluoxetine (Prozac) is usually initially ordered at 20 mg every morning and may be increased every 2 weeks with a maximum dose of 80 mg/day. The other answers do not fit these guidelines.
3. Serum lithium level is important to monitor because it has a narrow therapeutic range. What is the reference (therapeutic) range? A. 2.0-3.0 meq/L B. 0.5 - 1.5 meq/L C. 1.0-2.0 meq/L D. 4.5-6 meq/L
B
what are the side effects of venlafaxine (Effexor)?
drowsiness dizziness insomnia headache euphoria amnesia blurred vision mydriasis dry mouth and eyes excess sweating weakness diarrhea weight loss nausea anorexia constipation
what are possible side effect of escitalopram (Lexapro)?
drowsiness headache insomnia nausea orthosttaic hypotension ejaculation dysfunction agranulocytosis SJS
what are examples of SSRI's?
fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram
9. A patient with reactive depression is ordered to receive fluoxetine (Prozac). Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 week. B. The medication increases libido. C. The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.
Answer: D Rationale: Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.
16. The nurse realizes that some herbs interact with selective serotonin reuptake inhibitors. Which her interaction may cause serotonin syndrome? A. feverfew B. ma-huang C. St. John's wort D. gingko biloba
C
what are side effects related to fluoxetine (Prozac)?
headache dizziness drowsiness insomnia anxiety asthenia memory impairment mydriasis tremors dry mouth akathisia anorexia nauseas diarrhea weight loss erectile dysfunction
6. Name 5 dietary restrictions for MAO inhibitors.
Foods that contain tyramine Some cheeses, cream, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines, can cause a hypertensive crisis.
what are side effects related of lithium?
headache memory impariment blurred vision metallic taste thirst dry mouth dental caries drowsiness dizziness ataxia tremors anorexia nausea vomiting diarrhea polyuria dehydration hypotension abdominal pain restlessness erectile dysfunction weight gain/loss abnormally dry skin
when should you use caution with fluoxetine (Prozac)?
Myocardial infarction with MAOI's dehydration breast feeding SI liver disease osteoporosis glaucoma seizure disorder diabetes mellitus malnourished anticoagulant therapy diarrhea
what is fluvoxamine (Luvox) used for?
OCD and social anxiety disorder
what are possible side effects of paroxetine (Paxil)?
dizziness drowsiness insomnia headache asthenia dry mouth nausea constipation diarrhea tremors orthostatic hypotension sexual dysfunciton SI
what are side effects of mirtazapine (Remeron)?
dizziness drowsiness restlessness increased appetite dry mouth constipation weight gain hypercholesterolemia SI
NCLEX questions A selective serotonin reuptake inhibitor is prescribed for a patient. The nurse knows that which drug is a selective serotonin reuptake inhibitor? a. Paroxetine b. Amitripptyline c. Divalproex sodium d. Bupropion Hydrochloride
a. Paroxetine
when should you use caution with lithium?
hepatic/renal disease pregnancy lactation breastfeeding cardiac disease dehydration hyponatremia hypokalemia children older adults hypertension infection bradycardia thyroid disease seizure disorder alcoholism
when is fluoxetine (Prozac) contraindicated?
hypersensitivity
when is lithium contraindicated?
hypersensitivity
when is venlafaxine (Effexor) contraindicated?
hypersensitivity
what is fluoxetine (Cymbalta) used for?
major depression, diabetic neuropathy, fibromyalgia, GAD, musculoskeletal pain, and osteoarthritis
why might someone using SSRI's exhibit GI issues?
most receptors are in the gut
what do atypical antidepressants affect?
one/two of the three serotonin, norepinephrine, and dopamine
what are possible adverse reactions related to fluoxetine (Prozac)?
seizures angioedema hyponatremia hypokalemia hyperkalemia hypoglycemia dehydration bleeding osteoporosis *LIFE THREATENING:* SJS hepatic dyfunciton SI
what is the mode of action for fluoxetine (Prozac)?
serotonin is increased in nerve cells because of blockage from nerve fibers
what can happen if st john's worts is combined with other SSRI's?
serotonin syndrome
what are possible adverse reactions related to venlafaxine (Effexor)?
tachycardia seizure hypertension serotonin syndrome *LIFE THREATENING:* SI NMS SIADH renal failure SJS
what are adverse reaction related to lithium?
urinary and fecal incontinence hyperglycemia preteinurea leukocytosis nephrotoxicity *LIFE THREATENING:* cardiac dysrthythmias seizures angioedema cardiac arrest serotonin syndrome neuroleptic malignant syndrome
what is citalopram (Celexa) used for and what are possible side effects?
used for depression drowsiness insomnia dry mouth excess sweating nausea ejaculation dysfunciton seizures prolonged QT angioedema
