Psychobiology and psychopharmacology
ADHD drug management
Monitor: - BP, weight and height. - May consider drug holidays during summer months to allow catch up from growth suppression. - CBC, platelets, liver function periodically - appetite - give doses with or right after meals to minimize appetite suppression.
medications for Bipolar Disorder
Mood stabilizer: Lithium carbonate Anticonvulsants: Valproate (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal) Benzodiazepines (sedative to help manic calm down): Clonazepam (Klonopin) Lorazepam (Ativan) Atypical antipsychotics: Olanzapine (Zyprexa), Risperidone (Risperdal)
Second-generation atypical/antipsychotic medications: ex. Olanzapine (Zyprexa)
Side effects: prolactinemia (high prolactin in the blood) Teach about weight gain, sedative effects, high prolactin levels advanced practice: assess men's nipples, ask women about their period or if they have nipple discharge
A nurse is performing an admission assessment. The patient complains that it has been taking larger and larger amounts of medication to get the desired effect. Based on this information, the nurse interprets this as
Tolerance
An older adult is complaining of anxiety is prescribed diazepam (Valium) by a family physician. The physician asks the office nurse to explain the problematic side effects of this medication to the patient. Which instruction would be most important for the nurse to emphasize about this drug?
You may feel dizzy and be prone to falls after taking this medication.
A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells the nurse that he or she has been constipated. Which instruction would the nurse give the patient?
You need to eat more fruits and vegetables and drink more water.
a charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? auditory hallucinations withdrawal from social situations delusions of grandeur severe agitation anhedonia
auditory hallucinations delusions of grandeur severe agitation
Foods with tyramine
avocados, bananas, bologna, pepperoni, salami, smoked fish, aged cheese (cottage cheese is not aged), yeast extract, beer, wine, soy sauce, pickles, caffeine, chocolate
A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? a. I will take this medication at bedtime b. I will follow a low-sodium diet while taking this medication c. I will need to discontinue this medication slowly d. I will be at risk for weight loss with long-term use of this medication
c. I will need to discontinue this medication slowly
a nurse is assessing a client who is currently taking perphenazine. which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? decreased LOC drooling involuntary arm movements urinary retention continued pacing
drooling involuntary arm movements continued pacing
frontal lobe
for executive function; associated with reasoning, planning, parts of speech, movement, emotions, and problem solving
Mood Stabilizers: Anticonvulsant drugs
help pts who have bipolar: - Valproate (Depakote, Depakene) - Carbamazepine (Tegretol) - Lamotrigine (Lamictal) - Gabapentin (Neurontin) - Topiramate (Topamax) - Oxcarbazepine (Trileptal)
Anticonvulsant Mood Stabilizers Side Effects: Trileptal (Oxcarbazepine)
hyponatremia, somnolence, can interfere with Birth Control Pills - tell them to use other contraceptive methods
Hyperprolactinemia
increased prolactin in the blood due to atypical antipsychotics women: lactation as if pregnant or amenorrhea men:gynecomastia
melatonin imbalance
insomnia
Tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs; objective ex: tongue moving in and out
Neuroleptic Malignant Syndrome (NMS)
is a life-threatening reaction that can occur in response to antipsychotic medication. symptoms include high fever, confusion, rigid muscles, variable blood pressures (can be malignantly high), sweating (will not see this in anticholinergic toxicity), and fast heart rate
Serotonin syndrome (excess serotonin)
medical emergency: diarrhea, restlessness, extreme agitation, seizure, hyperthermia, rigidity, myoclonus, cardiovascular instability, coma and possible death - With any drug that increases 5-HT (SSRIs MAO inhibitors, SNRIs, TCAs)
Alzheimer's disease Drugs: Cholinesterase inhibitors
mild to moderate - Cognex/Tacrine - not first line, hepatotoxic, liver toxic - Aricept/Donepezil - first line, can increase LFTs - Razadyne/Galantamaine - Exelon/ Revastigmine - also available as patch CARE
limbic system
neural system (including the hippocampus, amygdala, and hypothalamus) located below the cerebral hemispheres; associated with emotions and drives.
Cellular Composition of the Brain
neurons: respond to stimuli, conduct electrical impulses, release chemicals - neurotransmitters
medications for Generalized Anxiety Disorder
o Antidepressants o Antianxiety agent
anticholinergic toxicity
symptoms of fever, confusion, tachycardia, and potentially decreased bowel sounds, differ from NMS by the presentation of mydriasis (the dilation of the pupil) and decreased secretions (very dry mouth, will not have tears when cry) - can be fatal
a nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. what is a priority for the nurse to report to the provider?
the client had a motor vehicle crash last year and sustained a head injury - increased risk for seizure
corpus callosum
the large band of neural fibers connecting the two brain hemispheres and carrying messages between them
hemispheres separated by
the longitudinal fissure and joined by the corpus callosum
a charge nurse is discussing mirtazapine with a newly licensed nurse. what statement by the newly licensed nurse indicated understanding?
this medication increases the release of serotonin and norepinephrine.
SSRI: Paroxetine (Paxil)
used to treat depression seen in many clients who have psychotic disorder - monitor the client for suicidal ideation because this medication can increase thoughts of self harm, especially when first taking it - avoid abrupt cessation to avoid withdrawal effect - notify the provider of adverse affects (deepened depression)
After teaching a patient who is prescribed imipramine about the drug, the nurse determines that the teaching was effective when the patient states
I need to be careful because the drug can make me sleepy.
Akathisia
subjective feeling of muscular discomfort and restlessness ex: restless leg syndrome, they feel like they have to move their muscles
A nurse is providing teaching to a client who has a new prescription for amitriptyline. What statement by the client indicates an understanding of the treatment?
I may feel drowsy for a few weeks after starting this medication.
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?
Diphenhydramine (Benadryl)
a nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. which of the following client statements abdicated understanding of the teaching?
"I will be careful not to gain too much weight while taking this medication."
anti anxiety drugs: Short-acting sedative-hypnotic sleep agents
"Z-hypnotics": - Zolpidem (Ambien)- if pt does not like Temazepam/Restoril bc of metal taste, will change to Ambien - main s/e of Ambien is sleep walking - Zaleplon (Sonata) - Eszopiclone (Lunesta)
Mood Stabilizers: Lithium
- 0.6-1.2 - Normal range very narrow - 1.5 or more - Lithium toxicity: Stop the medication, then call the provider - must monitor blood work - must check BUN and Creatinine - Common side effects: Tremor, weight gain, sedation, stomach upset, polyuria, thirst, edema of lower legs, hypothyroidism, acne - Lithium toxicity: medical emergency
Commonly studied neurotransmitters
- Acetylcholine (Ach) - Dopamine (DA) - Norepinephrine(NE) - Epinephrine (E) - Serotonin (5-HT or 5-hydroxytriptamine) - Histamine - Glutamate - Gamma-Aminobutyric Acid (GABA)
classes of psychotropic drugs
- Antianxiety/anxiolytics/sedative (anxiety/sleep) - Antidepressants (depression and anxiety) - the neurotransmitters responsible for anxiety and depression occupy the same receptors - Bipolar-Mood Stabilizer and antiseizure meds - Stimulant (attention deficit hyperactive disorders) - Cognitive Enhancers (Dementia) - Addiction Pharmacology - Antipsychotics (treat psychotics and mood disorders) schizophrenia and mood disorders like bipolar and depression
antidepressant drugs: Monoamine oxidase inhibitors (MAOIs)
- Block enzymes so they do not destroy neurotransmitters - adverse/toxic effects: orthostatic hypotension, weight gain, edema, intracranial hemorrhage, and hypertensive crisis if ingested food with tyramine - other side effects: insomnia, sexual dysfunction - for unconventional depression: panic disorder, social phobia
second generation antipsychotics
- Clozapine (Clozaril): agranulocytosis - decreased WBCs; very good medication for not only psychotic disorders but depression - prevents people from committing suicide, increased risk for seizure (ex. good for someone with schizophrenia [or related disorder] and depression) - Risperidone (Risperdal): weight gain - Quetiapine (Seroquel) very good, helps with sleep, but gives you big appetite - Olanzapine (Zyprexa, Zyprexa Relprevv) pill and sublingual - Ziprasidone (Geodon) causes QT interval enlargement - must check EKG - Paliperidone (Invega) - Iloperidone (Fanapt) - Lurasidone (Latuda): very effective for bipolar depression. Low effect on metabolism - doesn't cause much weight gain. But still need to exercise. - Asenapine (Saphris)
Administering and Monitoring Medication for Insomnia
- Commonly used in all settings - Rebound insomnia - Assess for confusion, memory problems, excessive sedation, risk of falls o Monitoring for Drug-to-Drug Interactions: - CNS depressants: increased depressive effects - Interact with: oral contraceptives, isoniazid, fluvoxamine, verapamil - Grapefruit juice medication interactions
Structured imaging techniques
- Computed tomography (CT) - can detect aneurism, area of infarct, lesion - Magnetic resonance imaging (MRI) - can detect edema, neoplasm, ischemia
Benzodiazepines
- Diazepam (Valium) - Clonazepam (Klonopin) - Alprazolam (Xanax) - Lorazepam (Ativan)
The four major neurotransmitters that regulate mood are:
- Dopamine - Serotonin - Norepinephrine - GABA
Disturbances of Mental Function
- Environment - Genes - Altered neurotransmitters
antidepressant drugs: Selective serotonin reuptake inhibitors (SSRIs)
- First line for anxiety and depression - Common side effects - anxiety, agitation, GI upset (there are serotonin receptors in the GI tract - tell them to give it time and it will go down) SEXUAL DYSFUNCTION male patients are hesitant to use, esp. young adults - offer them zinc, a mineral - Serotonin syndrome (excess serotonin) - Serotonin discontinuation - Take 4-6 weeks to have full effect
Selective serotonin reuptake inhibitors (SSRIs)
- Fluoxetine (Prozac) - Sertraline (Zoloft) - Paroxetine (Paxil) - Citalopram (Celexa) - Escitalopram (Lexapro) - Fluvoxamine (Luvox) - Vortioxetine (Trintellix)
anti anxiety drugs: Benzodiazepines for Sleep
- Flurazepam (Dalmane) - Temazepam (Restoril) used a lot, main complaint is a metal taste - Triazolam (Halcion) - Estazolam (ProSom) - Quazepam (Doral)
first generation antipsychotics
- Haloperidol (Haldol) - high potency - Fluphenazine (Prolixin) - high potency - Perphenazine (Trilafon) - medium potency - Thioridazine (Mellaril) - low potency - Trifluoperazine (Stelline) - high potency
Monoamine oxidase inhibitors (MAOIs)
- Isocarboxazid (Marplan) - Phenelzine (Nardil) - Selegiline (EMSAM) - Tranylcypromine (Parnate)
mood stabilizers
- Lithium - gold standard for Bipolar - Anticonvulsant drugs
For attention deficit hyperactivity disorder (ADHD)
- Methylphenidate (Ritalin, also Daytrana, a transdermal system) - check BP. Can cause insomnia - Dextroamphetamine (Adderall, Vyvanse) - also for binge eating and watch for addictive behavior. Also check for family history of sudden death. - Atomoxetine (Strattera) - good for pt with ADHD and depression - Intuniv (guanfacine) - good for pt with HTN and tics - Kapvay (clonidine) - good for pt with HTN and tics - check BP if heart rate is below 60 do not give
treatment of restless leg syndrome
- Mild and intermittent: behavioral therapy, sleep hygiene, lifestyle interventions; supplementation with ferrous sulfate if indicated - Moderate to severe: pramipexole, rotigotine, cabergoline, gabapentin enacarbil; ropinirole, pregabalin, IV FCM
antidepressant drugs: Serotonin-2 antagonist/reuptake inhibitors (SARIs)
- Nefazodone (Serzone) - FDA black box warning for hepatotoxicity - not a first line med - Trazodone (Desyrel) - Priapism in males: painful, long lasting erection. If this does not happen, this is the SARI of choice.
antidepressant drugs: Tricyclic antidepressants (TCAs)
- Pamelor/Nortriptyline - Elavil/Amitriptyline - Tofranil/Imipramine - Anafranil/Clomipramine Pneumonic: PETA
Functional imaging techniques
- Positron emission tomography (PET) - can detect oxygen utilization, glucose metabolism, blood - Single photon emission computed tomography (SPECT) - can detect circulation of cerebrospinal fluid
Antipsychotic Drugs: Second-Generation, AKA: Atypical
- Produce fewer extrapyramidal side effects (EPS) - Target both the negative and positive symptoms - Often chosen as first-line treatment - Dopamine and serotonin blockers - disadvantage: tendency to cause significant weight gain
anti anxiety drugs: Melatonin receptor agonists
- Ramelteon (Rozerem) - Doxepin (Silenor) - Buspirone (BuSpar)-commonly used - takes 4 to 6 weeks to be fully effective. Not addictive. •Inpatient - tx with benzo regardless of addiction hx, when send them home - give Xanax PRN and BuSpar to be used daily
Alzheimer's Disease Drugs
- Side effects: nausea, diarrhea, vomiting, appetite loss, increased gastric acid secretion (like GERD) - NMDA glutamate receptor antagonist: severe dementia - Cholinesterase inhibitors: mild to moderate
Antipsychotic drugs: First-generation, AKA: conventional, typical of standard antipsychotic drugs
- Target ONLY positive -symptoms. - Blocks only dopamine - Greater risk for Extrapyramidal Symptoms (EPS) - Dystonia - Tardive dyskinesia - Akathisia - Pseudo Parkinsonism
Anticonvulsant Mood Stabilizers
- Therapeutic effects on reducing mania begin after days (will be able to sleep, function, etc), but mood stabilization may take weeks to months (full mania will be stopped) - Common transient side effects are nausea, diarrhea and sedation - Common maintained side effects are: Weight gain (lower with lamotrigine [watch for SJS] and topamax), tremor
anti anxiety drugs: benzodiazepines
- Used for acute anxiety and agitation - Side effects: drowsiness, fatigue, depression, dizziness, ataxia, slurred speech, weakness and forgetfulness - increased risk for addiction: if pt has severe anxiety but has an addiction hx - make sure the meds are taken properly - as needed and only give them certain amounts
antidepressant drugs: Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Venlafaxine (Effexor) - Desvenlafaxine (Pristiq) - Duloxetine (Cymbalta) - also for nerve pain like fibromyalgia
medications used for Tourettes
- antipsychotics: aripiprazole (Abilify) - alpha adrenergic receptor agonists
treatment of hypersomnolence
- dextroamphetamine and amphetamine mixtures - modafinil - methylphenidate - pemoline - May self medicate with caffeine
antidepressant drugs
- drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters - Side effects: dry mouth, blurred vision, constipation, memory effects, orthostatic hypotension, sedation and weight gain
Serotonin Discontinuation Syndrome
- occurs with SSRIs and SNRIs when stopped abruptly, taper to avoid: - agitation, nausea, disequilibrium and flu like symptoms
other side effects of antipsychotics
- orthostatic hypotension - monitor BP lying, sitting and standing - sedation - fall risk with elderly - weight gain - diet and exercise - new onset of diabetes mellitus - fasting blood glucose tests and hemoglobin A1C monitoring - cardiac arrhythmias - prolonged QT interval - especially with Ziprasidone (Geodon)
Lithium Patient Teaching
1. give after meals to decrease gastric upset and prolong absorption 2. avoid changes in dietary sodium - excess sodium results in decreased lithium levels (stay in the bloodstream - cause toxicity and kidney failure); low sodium results in toxic lithium level 3. take medication consistently 4. Avoid fluid excess: intake should be 2500-3000mL and avoid fluid depletion (critical)
A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the client's blood level for this drug, which level would alert the nurse to the need to change the dosage? 30 ng/mL 55 ng/mL 75 ng/mL 115 ng/mL
30 ng/mL
A nurse administers a prescribed dose of lithium at 8 PM. The nurse would schedule a specimen to be obtained for a blood level at which time?
8 AM (12 hours)
A client diagnosed with major depression was prescribed imipramine (Tofranil) and has been taking this medication for 1 week. The client took his last dose of imipramine (Tofranil) at 9:00 PM. The client is scheduled to have blood drawn to monitor the medication level the next morning. The nurse should instruct the client to have his blood drawn as close as possible to which time?
9:00 AM
A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local café for lunch with a friend. Which of the following items on the menu would be least appropriate for the client to order? Roast beef, mashed potatoes, and gravy A Cobb salad with blue cheese and Roquefort salad dressing Scrambled eggs, toast, and grape jelly Medium-well steak, French fries, and broccoli
A Cobb salad with blue cheese and Roquefort salad dressing
agranulocytosis
A life-threatening drop in white blood cells caused by some antipsychotics - check WBCs - Clozapine (Clozaril) - Carbamazepine (Tegretol) and Valproate (Depakote)
amygdala
A limbic system structure involved in memory and emotion, particularly fear and aggression.
occipital lobe
A region of the cerebral cortex that processes visual information
A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? Select all that apply. A) Clomipramine B) Lithium C) Sertraline D) Fluvoxamine E) Paroxetine F) Alprazolam
A) Clomipramine C) Sertraline D) Fluvoxamine E) Paroxetine
a nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. the nurse should inform the client of the need for routine monitoring of what?
AST/ALT and LDH
A patient who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the patient's physician because the nurse suspects what?
Agranulocytosis
A hospitalized patient who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he cannot sit still. The nurse documents this finding as
Akathisia
A client is diagnosed with generalized anxiety disorder and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the quickest relief from anxiety symptoms? Buspirone Venlafaxine Alprazolam Imipramine
Alprazolam
temporal lobe
An area on each hemisphere of the cerebral cortex near the temples that is the primary receiving area for auditory information; balance
medications for eating disorders
Anorexia nervosa: SSRIs for depression (tell them about sexual dysfunction) Bulimia nervosa: benzodiazepines and atypical antipsychotic (Zyprexa) for anger and irritability, SSRIs for depression Binge-eating disorder: SSRIs for depression, atypical antipsychotic (Zyprexa) - tell them about high prolactin
Potentially Dangerous Responses to Antipsychotics
Anticholinergic toxicity Neuroleptic malignant syndrome (NMS) Agranulocytosis
A patient is experiencing hallucinations and delusions. The nurse would expect the physician to order which class of drug?
Antipsychotic
medications for phobias
Anxiolytics for short-term relief of anxiety
cerebrum
Area of the brain responsible for all voluntary activities of the body. There are two hemisphere. Each hemisphere has four major lobes: frontal, temporal, parietal, occipital
A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe?
Aripiprazole
third generation antipsychotic
Aripiprazole (Abilify) - Dopamine system stabilizer - Improves positive and negative symptoms and cognitive function - Little risk of EPS or tardive dyskinesia - lower risk for weight gain and anticholinergic effects - only one in its class
During the stabilization phase of drug therapy for a patient who is hospitalized with a psychiatric disorder, which action would be most appropriate?
Assessing the patient for target symptoms and side effects
A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate? Immediately obtain a specimen to determine the client's blood drug level. Suggest that the client take the medication with meals or snacks. Assist the client in minimizing exposure to stressors. Encourage the client to elevate the affected hand on a pillow.
Assist the client in minimizing exposure to stressors.
The history of a child newly diagnosed with ADHD reveals that the child is experiencing sleeping difficulties. Which agent would the nurse most likely use?
Atomoxetine
A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time? A) When did you last have blood drawn to check your drug level? B) What have you had to eat or drink today? C) Are you having any chest pain? D) Do you use any herbal remedies?
B) What have you had to eat or drink today?
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A. administer flumazenil B. identify the client's LOC C. infuse IV fluids D. prepare the client for gastric lavage
B. identify the client's LOC
The nurse is caring for a 70-year-old psychiatric patient who has been prescribed a number of medications. When teaching the patient about the medications, which explanation would be most appropriate?
Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic.
A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse identifies this as?
Bioavailability
After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. Dilated reactive pupils Blurred vision Ataxia Coherent speech Facial pallor Disorientation
Blurred vision Ataxia Disorientation
atypical antidepressant drugs: Norepinephrine dopamine reuptake inhibitor (NDRI)
Bupropion (Wellbutrin; Zyban) • Seizure risk: Contraindicated in individual with seizure history and bulimia • Useful for pts who want to stop smoking
The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?
Clozapine
The nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed mirtazapine. The nurse interprets this information, identifying this agent as which type?
D) Alpha-2 antagonist
medication for enuresis
Desmopressin - DDAVP (a nasal spray)
A client's blood level of carbamazepine is increased. When reviewing the client's medication history, which of the following would alert the nurse to a possible interaction? Phenobarbital Primidone Phenytoin Diltiazem
Diltiazem the others decrease it
The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. patient is smacking her lips and blinking her eyes rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?
Document the patient's symptoms of tardive dyskinesia.
After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which neurotransmitter as being implicated? Dopamine Serotonin Norepinephrine Gamma-aminobutyric acid (GABA)
Dopamine
A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately?
Elevated temperature
A nurse is preparing a patient for electroconvulsive therapy. What would the nurse include in the patient's plan of care?
Ensuring that there is a signed informed consent on the patient's chart Alerting the patient to the possibility of confusion after the treatment Ensuring that the patient is closely supervised for at least the first 12 hours afterward
A nurse is preparing a continuing education presentation for a group of psychiatricmental health nurses about various psychopharmacologic agents. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply. Fluoxetine Duloxetine Sertraline Venlafaxine Bupropion Amoxapine
Fluoxetine Sertraline
A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following? GABA Serotonin Dopamine Norepinephrine
GABA
A nurse is caring for a psychiatric patient who is receiving an antacid that contains aluminum salts. Which action by the nurse would be most appropriate?
Give the antacid 1 hour before the antipsychotic medication.
A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer? Lithium carbonate (Lithium) Haloperidol lactate (Haldol) Fluoxetine (Prozac) Paroxetine (Paxil)
Haloperidol lactate (Haldol)
The nurse is reviewing the medical records of several patients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a patient at greater risk for tardive dyskinesia?
History of depression
A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following? Select all that apply. Tachypnea Bradycardia Hypotension Nystagmus Vomiting
Hypotension Nystagmus Vomiting
antidepressant drugs: Serotonin-norepinephrine disinhibitors (SNDIs) also called noradrenaline and specific serotonergic agent (NaSSA) and alpha-2 antagonist
Mirtazapine (Remeron) - give at bedtime •Highly sedating and can cause weight gain, less sexual dysfunction •Care plan: exercise and low fat, high fiber diet •Increases the release of serotonin and norepinephrine
A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? Keep a record of how often and how long you experience the side effect of dry mouth. Monitor your urinary output and notify your doctor if your urine changes color. Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. If you experience any drowsiness, discontinue taking this medication.
Keep an eye on your weight, and if you gain weight rapidly, notify your doctor.
A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client's medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply. Lisinopril Hydrochlorothiazide Indomethacin Caffeine Aspirin
Lisinopril Hydrochlorothiazide Indomethacin
A group of nursing students are reviewing information related to drug therapy for mood disorders. The students demonstrate understanding of the information when they identify which agent as the gold standard for treating bipolar disorder?
Lithium
A group of nursing students are reviewing the various drug classes used to treat psychiatric disorders. The students demonstrate understanding when they identify which of the following as examples of antianxiety medications? Select all that apply. Selegiline Lorazepam Buspirone Zolpidem Methylphenidate
Lorazepam Buspirone Zolpidem?-sedative hypnotic can be used for anxiety
Lithium contraindications
Low sodium intake Cardiovascular disease Brain damage Renal disease Liver disease Thyroid disease Myasthenia gravis Pregnancy- category D Breastfeeding mothers Children younger than 12 years hypovolemia schizophrenia
herbal medicine
Major concerns: - Potential long-term effects: •Nerve damage •Kidney damage •Liver damage - Possibility of adverse chemical reactions: •With other substances •With conventional medications - not fully studied by the FDA - Ex. St. John's Wort -Tell pts not to take their teas at the same time as their conventional medications
Alzheimer's disease Drugs: NMDA glutamate receptor antagonist
Memantine (Namenda) for severe dementia
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply. Metallic taste Ataxia Diarrhea Slurred speech Fasciculations Muscle weakness
Metallic taste Diarrhea Muscle weakness
A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the following would alert the nurse to suspect possible withdrawal? Select all that apply. Metallic taste Irritability Dry, flushed skin Tremor Muscle flaccidity
Metallic taste Irritability
Anticonvulsant Mood Stabilizers Side Effects: Carbamazepine (Tegretol)
Neural tube defect, Steven Johnson's Syndrome, aplastic anemia, agranulocytosis, liver problems, hyponatremia Monitor plasma level: CBC and platelets (observe for bruising and bleeding of gums) Avoid concurrent use of oral contraception and warfarin (coumadin) CNS effects: Nystagmus, double vision, vertigo, staggering gait, headache - Blood levels 6-12 - Prone to infections
Tricyclic antidepressants (TCAs)
Neurotransmitter effects - sedative effects are attributed to the blockade of histamine receptors, effect usually diminishes over time Adverse effects - CNS stimulation (anxiety, agitation, hypomania, mania); advise client to change positions slowly to minimize dizziness due to orthostatic changes; anticholinergic effects Toxic effects - urinary retention and severe constipation warrant immediate medical attention Contraindications - H/O MI, narrow-angle glaucoma, and seizures; pregnancy
A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the students identify which of the following as a site of action? Receptor Ion channels Neurotransmitters Enzymes
Neurotransmitters
The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as which of the following?
Oculogyric crisis
A nurse is working as part of a team involved with the testing of a new psychiatric medication. The drug is currently being used in multiple clinical trials at various different sites. The nurse is engaged in which phase of testing?
Phase III
A group of nurses is reviewing medications used to treat attention deficit hyperactivity disorder. The students demonstrate understanding of the information when they identify methylphenidate as which of the following?
Psychostimulant
medications used for ADHD
Psychostimulants: methylphenidate (ritalin), amphetamine-dextroamphetamine (adderall) - has potential for abuse Noradrenergic reuptake inhibitor: atomoxetine (Strattera) - little risk for abuse
After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent? Fluphenazine (Prolixin) Thiothixene (Navane) Quetiapine (Seroquel) Chlorpromazine (Thorazine)
Quetiapine (Seroquel)
A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist? Trazodone Estazolam Mirtazapine Ramelteon
Ramelteon
A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication? Closely monitor your fluid intake while taking this medication. Stop taking this medication if it causes weight gain. Expect menstrual irregularities, particularly if they've occurred previously. Report any weight changes that occur during the first few weeks this medication is taken.
Report any weight changes that occur during the first few weeks this medication is taken.
medications for separation anxiety disorder
SSRIs
medication for PTSD
SSRIs, SNRIs, benzodiazepines, and β-blockers, off-label use of prazosin (used for HTN), an alpha1 inhibitor - effective treatment for preventing nightmares and improving sleep
Anticonvulsant Mood Stabilizers Side Effects: Gabapentin (Neurontin)
Sedation, joint pain, ataxia and decreased coordination - not used anymore by itself, may be adjunct with something else
A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which of the following would the nurse most likely expect to administer? Benzodiazepine Selective serotonin reuptake inhibitor (SSRI) Monoamine oxidase inhibitor (MAOI) Tricyclic antidepressant (TCA)
Selective serotonin reuptake inhibitor (SSRI)
A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. John's wort to feel better. The nurse assesses the client for which of the following? Water intoxication Increased depressive symptoms Serotonin syndrome Hypertensive crisis
Serotonin syndrome
A patient is brought to the emergency department by her brother, who reports that the patient became very agitated and started hallucinating. Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The brother states that the patient is taking paroxetine for depression. What would the nurse most likely suspect?
Serotonin syndrome
A 10-year-old child with Tourette's disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child would lead the nurse to suspect that he is experiencing a side effect of the drug?
Sometimes I feel like I'm so sleepy.
Anticonvulsant Mood Stabilizers Side Effects: Valproate (Depakote)
Spinal bifida, alopecia, weight gain, diarrhea, agranulocytosis, thrombocytopenia; liver toxicity, jaundice - liver panel before starting meds - blood level 50-125
A patient with depression asks the nurse about possible herbal supplements. Which of the following would the nurse identify as being commonly used?
St. John's wort
Anticonvulsant Mood Stabilizers Side Effects: Lamotrigine (Lamictal)
Steven Johnson syndrome, insomnia, headache and dizziness SJS: must assess for rashes. Usually starts as a sandy rash on abdomen - STOP med, call the provider. It is fatal Adolescent patients gain less weight with this than other anticonvulsant drugs. Double or blurred vision: caution the client about performing activities that require concentration or visual acuity.
The nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant, assessment for which of the following would be most important? Suicide Hypersomnia Cardiac arrhythmia Erectile dysfunction
Suicide
The parents of a child with ADHD bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives his first dose of methylphenidate (Ritalin) at about 7:30 AM every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 noon. Which of the following might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively?
Switching to a longer acting preparation.
After teaching a patient who is receiving phenelzine, the nurse determines that the teaching was successful when the patient states the need to avoid which of the following? Fresh cottage cheese Cooked sliced ham Tap beers Soy milk
Tap beers
The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following?
Tardive dyskinesia
A patient receiving an antipsychotic agent develops acute extrapyramidal symptoms. What response by the nurse would be most appropriate?
These are the results of the drug that can be treated; your illness is not getting worse.
A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, These pills are making me sick. I think I'm getting a brain tumor because of the headaches. Which response by the nurse would be most appropriate? A) Let's talk about how often you have been performing the rituals lately. B) Tell me how many times you have washed your hands today. C) Have you been practicing your deep breathing and relaxation exercises? D) These medications have side effects that can cause increased headaches.
These medications have side effects that can cause increased headaches.
The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?
WBC count
A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? He needs to have an electrocardiogram periodically when taking this drug. We'll need to make sure that he has his blood count checked at least weekly. He might develop toxic levels of the drug if he smokes cigarettes.We need to watch to make sure that he doesn't lose too much weight.
We'll need to make sure that he has his blood count checked at least weekly.
The nurse is developing a teaching plan for a client who is prescribed escitalopram. Which of the following side effects would the nurse include in this plan? Select all that apply. Weight gain Decreased sexual interest Sedation Blurred vision Urinary retention Dry mouth
Weight gain Decreased sexual interest
A patient has been prescribed clozapine for treatment of schizophrenia. What would the nurse include in the teaching plan for this patient and family?
You may experience noticeable weight gain while taking this medication.
A client with a panic disorder has been prescribed a benzodiazepine medication. Which of the following would the nurse emphasize as a risk associated with using this medication? Dietary restrictions Withdrawal symptoms Agitation Fecal impaction
Withdrawal symptoms
Dystonia
a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement; slow muscle spasm in the neck, face
Neurotransmitters
attach to receptors to either stimulate or inhibit the postsynaptic cells.
a nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder. the client states, "I grind my teeth during the night which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? a. concurrent administration of buspirone b. administration of a different SSRI c. use of a mouth guard d. changing to a different class of anti anxiety medication e. increasing the dose of paroxetine
a. concurrent administration of buspirone c. use of a mouth guard d. changing to a different class of anti anxiety medication
a nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. which of the following instructions should the nurse include in the teaching? a. void just before taking the medication b. increase the dietary intake of potassium c. wear sunglasses when outside d. change positions slowly when getting up e. chew sugarless gum
a. void just before taking the medication c. wear sunglasses when outside e. chew sugarless gum
a nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. what action should the nurse take?
administer the next dose of lithium carbonate as scheduled
γ(gamma)-aminobutyric acid (GABA)
an increase causes: a decrease of anxiety a decrease causes: anxiety disorders, schizophrenia, mania and Huntington's disease, seizures (involuntary movement)
Serotonin
an increase causes: anxiety states a decrease causes: depression
Norepinephrine
an increase causes: mania, anxiety states and schizophrenia. a decrease causes: depression
Glutamate
an increase causes: prolonged increased state neurotoxic and neurodegeneration in Alzheimer's disease a decrease causes: psychosis receptors: NMDA:N-methyl-d- aspartate
Dopamine
an increase causes: schizophrenia and mania a decrease causes: Parkinson's disease and depression
The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe?
anticholinergic
a nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. which of the following findings should the nurse report to the provider as indications of serotonin syndrome? a. hypothermia b. hallucinations c. muscular flaccidity d. diaphoresis e. agitation
b. hallucinations d. diaphoresis e. agitation
a nurse is caring for a client who is taking phenelzine. for which of the following manifestations should the nurse monitor as an adverse effect of this medication? a. elevated blood glucose level b. orthostatic hypotension c. priapism d. hypomania e. bruxism
b. orthostatic hypotension d. hypomania
a nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. the nurse should include which of the following manifestations in the teaching? a. constipation b. polyuria c. rash d. muscle weakness e. tinnitus
b. polyuria d. muscle weakness
treatment of sleep terrors
benzodiazepines
neurotransmitter destruction
can be done by: - Enzymes - chemicals that break down substances - Reuptake - where they take back to the presynaptic cell from which they were originally process, where they can be reused or destroyed - destruction results in mental problems
Anticonvulsant Mood Stabilizers Side Effects: Topiramate (Topamax)
short term memory loss, nephrolithiasis, paresthesias, cognitive slowing
a nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. when collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? a. current medical conditions include diabetes that is controlled by diet. b. recent medications include a course of prednisone for acute bronchitis c. current vaccinations include a flu vaccine last month d. current medications include furosemide for congestive heart failure
d. current medications include furosemide for congestive heart failure
A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? a. three to six weeks of treatment is required to achieve therapeutic benefit b. combining alcohol with alprazolam will produce a paradoxical response c. alprazolam has a lower risk for dependence than other anti anxiety medications d. report confusion as a potential indication of toxicity
d. report confusion as a potential indication of toxicity
A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following?
diabetes
Lithium toxicity
diarrhea, nausea, vomiting, drowsiness, tremor, muscle weakness, tinnitus • Medical emergency: Stop meds immediatelyand call provider, give emesis or lavage, check labs and EKG; dialysis may be required
Autism Spectrum Disorder (ASD)
some atypical antipsychotics are used for irritability - risperidone (risperdol) and aripiprasole (abilify) - and mood stabilizer
treatment for insomnia
o Benzodiazepine receptor agonists (BzRAs) - triazolam, temazepam, estazolam, quazepam, flurazepam o Nonbenzodiazepines: GABA agonists: zolpidem, zolpidem extended release, zaleplon, eszopiclone ("Z-hypnotics") - Common side effects: headache, dizziness, residual sleepiness o Melatonin Receptor Agonist - Melatonin - hormone that aids in regulation of sleep-wake cycle - Ramelteon: Low-abuse potential; not a controlled substance o Orexin receptor antagonist, Also known as hypocretins - Suvorexant: approved for treatment of insomnia - May trigger signs of narcolepsy/cataplexy - Relatively new medication, long half-life o OTC Medications and Dietary Supplements - usually contain antihistamines: Doxylamine, diphenhydramine - Produce anticholinergic side effects - Exogenous melatonin - Valerian
types of neurotransmitters
o Cholinergic o Biogenic amines o Amino acids o Neuropeptides
Amino acid: Histamine
o Derived from amino acid histadine o Function not well known
Opioid neuropeptides
o Endorphins, enkephalins, and dynorphins o Endocrine functioning and pain suppression
Biogenic amine: Dopamine
o Excitatory o Cognition o Motor o Neuroendocrine function
Biogenic amine: Serotonin (5-HT)
o Excitatory o Emotions o Cognition o Sensory perceptions o Sleep o Appetite
Biogenic amine: Norepinephrine
o Excitatory o Mood states o Fight-or-flight o Sleep and wakefulness
Amino Acid: Glutamate
o Excitatory o Most widely distributed o May have role in learning and memory o Too much glutamate is neurotoxic
Cholinergic: Acetylcholine (ACh)
o Primary excitatory neurotransmitter o Greatest concentration in the peripheral nervous system o Possibly involved in higher intellectual functioning and memory
Amino Acid: Gamma-aminobutyric acid (GABA)
o Primary inhibitory o Exists in CNS o Controls neuronal excitability through brain o Interconnections with other neurotransmitters
medication for panic disorder
o SSRIs in conjunction with CBT o SNRIs o Benzodiazepine
medications for Generalized Social Anxiety Disorder
o SSRIs to reduce social anxiety and phobic avoidance o Benzodiazepines to reduce anxiety caused by phobias
treatment of narcolepsy
o Sleepiness: CNS stimulants (methylphenidate, dextroamphetamine, modafinil, pemoline) o Cataplexy: tricyclic antidepressants o Excessive sleepiness and cataplexy: sodium oxybate (Schedule II drug)
Nonopioid neuropeptides
o Substance P and somatostatin o Pain transmission and endocrine functioning
a nurse is caring for a client who takes ziprasidone. the client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. the nurse should contact the provider to discuss a change to which of the following medications? olanzapine quetiapine aripiprazole clozapine asenapine
olanzapine - orally disintegrating tablet available aripiprazole - orally disintegrating tablet available clozapine - orally disintegrating tablet available asenapine - sublingual tablet available
treatment of nightmares associated with PTSD
prazosin
parietal lobe
receives sensory input for touch and body position. certain areas are central in calculating and processing of numbers
a nurse is caring for a client who is prescribed lithium therapy. the client tells of the plan to take ibuprofen for osteoarthritis pain relief. which statement should the nurse make?
regular aspirin would be a better choice than ibuprofen
Pseudo parkinsonism
rigidity, tremors, pill rolling, shuffling gait
a nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. the nurse should expect a prescription for which of the following medication? chlorpromazine thiothixene risperidone haloperidol
risperidone
A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following? I need to notify my physician if I develop a skin rash. I need to have my blood tested about once a month. I have to watch how much salt I use every day. This drug can affect my liver function.
I need to notify my physician if I develop a skin rash.
A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate? Increase your salt intake if an activity causes you to perspire heavily. Wear sunscreen when you are going to be outdoors in the summer time. Drink less fluid than usual now because you are taking this drug. No changes are necessary for strenuous activities you do outdoors.
Increase your salt intake if an activity causes you to perspire heavily.
medications for OCD
•SSRI: Sertraline (Zoloft), Fluvoxamine (Luvox), Fluoxetine (Prozac) and Paroxetine (Paxil). •Anti-anxiety: Buspar - not addictive but takes 4-6 weeks (all of the meds do) •TCA: Clomipramine (Anafranil)- If meds don't help consider ECT
