Anxiety + Depression Meds; Psych Quiz 1

Examples of Tricyclic Antidepressants (TCAs)

-Amitriptyline (Elavil) -Doxepin (Sinequan) -Imipramine (Tofranil)

Atypical Antidepressant examples

-Bupropion (Wellbutrin) -mirtazapine (remeron) -nefazodone

benzodiazepine complications

-CNS depression (low RR, induce coma, sedation) -educate patients to avoid operating machinery, driving, etoh, etc -amnesia -paradoxical response (everything is actually heightened) -acute toxicity -risk for withdrawal (which can be life-threatening)

what is serotonin syndrome

-Complication of SSRI -onset within first 3 days -tachycardia, hypertension, fever, hallucination -Stop the drug -rare and life-threatening event -greatest risk when SSRI is administered in combination with monoamine oxidase inhibitor (MAOI)

What do MAOIs do?

-Inhibit monoamine oxidase from breaking down neurotransmitters (serotonin, norepinephrine & dopamine) in the brain. -if you block it, these levels go up -also inhibits breakdown of tyramine in the liver (red wine, aged cheese, aged smoked meets), don't eat these or you are at high risk for hypertensive crisis -NOT first choice treatment because of the side effects -increased levels = increased mood (for depressive disorders) -increased tyramine = HTN, hypertensive crisis, CVA, possible death -People taking MAOIs must restrict intake of tyramine to prevent severe HTN

Examples of Benzodiazepines/ hypnotic anxiolytics

-Lorazepam (Ativan) -Diazepam (Valium) -Alprazolam (Xanax) -Clonazepam (Klonopin)

What does Tricyclic Antidepressants do?

-Neurotransmitter effects; inhibit reuptake of norepinephrine and serotonin -similar to SSRI but has antihistamine action -Indications; has this worked for pt/family in the past?

Medications for treating depression

-SSRIs -Tricyclic Antidepressants -MAOIs -atypical antidepressants

Medications for treating anxiety

-SSRIs (selective serotonin reuptake inhibitors) -SNRIs (serotonin norepinephrine reuptake inhibitors) -Benzodiazepines (anxiolytics) -Buspirone (buspar) -Tricyclic antidepressants -Beta Blockers

why is the selegiline transdermal system such a breakthrough MAOI

-STS inhibits MAO in the CNS -no breakdown of tyramine occurs in the liver and digestive tract -6mg over 24 hrs (tyramine restricted diet is not required) -9-12 mg over 24 hours (tyramine restricted diet is required)

Examples of SNRIs

-Venlafaxine (Effexor) -Duloxetine (Cymbalta) -Desvenlafaxine (Pristiq)

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 a low dose of buspirone is an effective measure to manage the adverse effect of paroxetine -c, using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism -d, changing to a different class of anti-anxiety medication that does not have the adverse effect of bruxism is an effective measure

Buproprion purpose

-atypical -NDRI (norepinephrine & dopamine -treatment for depression -smoking cessation

What is buspirone?

-atypical anxiolytic -exact mechanism of action is unknown -binds to serotonin & dopamine receptors -does not result in CNS depression, no risk of abuse -very slow to reach full effect (2-6 weeks) -used in panic disorder, OCD, Social Anxiety disorder, generalized anxiety

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 level of orientation c. infuse IV fluids d. prepare the client for gastric lavage

-b -when taking the nursing process approach to client care, the initial step is assessment. Identifying the client's level of orientation is the priority action

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, d, e -hallucinations are an indication of serotonin syndrome -diaphoresis is an indication -agitation is an indication -fever rather than hypothermia -muscle tremors rather than flaccidity

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 the 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 -when discontinuing fluoxetine, the client should taper the medication slowly and according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome

adverse effects of tricyclic antidepressants

-cardiac complications -anticholinergic effects (dry mouth, hypotension, dizziness) -urinary retention -constipation

contraindications of tricyclic antidepressants

-cardiovascular problems -narrow angle glaucoma -pregnant women -seizure disorders -MAOIs

Examples of SSRIs

-citalopram (celexa) -fluoxetine (prozac) -sertraline (zoloft)

contraindications of benzodiazepine

-class d risks for pregnancy -controlled substance, MASSpat -high risk for dependence can trigger relapse -use with caution in patients with liver disease (metabolized in the liver) -increased risk for overdose when taken with opioids, barbiturates, or alcohol

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 antianxiety medications d. report confusion as a potential indication of toxicity

-d -confusion is a potential indication of alprazolam toxicity that the client should report to the provider

Buspirone complications

-dizziness, nausea, HA, agitation -avoid drinking grapefruit juice (messes with s.intestine and doesn't allow body to absorb a lot of the med) -pregnancy category B -does not cause sedation

contraindications of SSRIs

-do not take with MAOIs of TCAs because they increase risk of serotonin syndrome -avoid alcohol -use caution in patients with liver or renal dysfunction -increased risk for mania with bipolar disorder

What do SNRIs do?

-inhibits the uptake of serotonin and norepinephrine, minimal inhibition of dopamine -used for major depression, panic disorders, generalized anxiety disorders-neuropathicpain -up to 4 weeks to achieve therapeutic effect

Trazadone purpose

-lower doses help sleep(insomnia) -higher dose is needed for depression

adverse effects/ complications of MAOIs

-not first choice treatment because of the side effects -orthostatic hypotension-hypertensivecrisis. -anticholinergic effects (dry mouth, blurred vision, urinary retention, tachycardia) -sedation -toxicity -decreased seizure threshold -diaphoresis -increased appetite

Examples of MAOIs

-phenelzine (Nardil) -Isocarboxazid (Marplan) -Tranylcypromine (Parnate) -Selegiline (Emsam)-transdermal MAOI

contraindications of SNRIs

-pregnancy risk C -Similar to SSRI (avoid TCA, MAOIs, St. Johns Wart, alcohol) -avoid duloxetine in patients with hepatic disease due to increased risk for bleeds -do not abruptly stop the med

contraindications of MAOIs

-pregnancy risk category C -seizure disorders -use cautiously in clients with coronary artery disease, diabetes, liver, kidney, respiratory disorders, angle closure glaucoma, benign prostatic hypertrophy, hyperthyroidism -May increase suicide risk -use with SSRIs

What do SSRIs do?

-selectively inhibit serotonin reuptake, allowing more serotonin to stay at the junction of the neurons -intensifies serotonin effects -don't block the uptake of dopamine or norepinephrine -long effective-half life; up to 4 weeks to become therapeutic (NOT PRN) -First line treatment for panic disorders, trauma, and depression

SNRI complications

-sleep disturbances, dry mouth, HA, nausea -Hyponatremia (older adults) -anorexia resulting in weight loss, sexual dysfunction

Mirtazapine (remeron) purpose

-treat depression -help with sleep and appetite-SNDI

Buspirone contraindications

-use with MAOIs -can result in a hypertensive crisis -avoid erythromycin and ketoconazole (increases the effects)

What do benzodiazepines do?

-work by enhancing the inhibitory effects of GABA in the CNS, rapid relief from anxiety -Short-acting, can be PRN -use if you can identify onset & trigger -first line treatment for panic disorder and acute anxiety -also used in seizure disorders, insomnia, etoh withdrawel

A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care? A. Risk for falls related to loss of balance and equilibrium B. Unilateral neglect related to impairments and perception C. Impaired physical mobility related to spasticity and changes in muscle tone D. Risk for impaired cerebral tissue perfusion related to obstruction secondary to infection

A. Risk for falls related to loss of balance and equilibrium rationale: the cerebellum is critical in both motor and cognitive functions. alterations may result in disturbances of coordination, balance, and gait. Safety is the number one concern

Systematic measurement of body weight, BMI, waist circumference, and glucose levels would be most important for a patient beginning a new prescription of which medication? A. Aripiprazole (Abilify) B. Olanazapine (Zyprexa) C. Ziprasidone (Geodon) D. Quetiapine (Seroquel)

B. Olanazapine (Zyprexa) rationale: this medication has metabolic side effects, particularly weight gain. Metabolic monitoring for all patients receiving atypicals is recommended.

A patient tells the community mental health nurse, "I told my healthcare provider I was having trouble sleeping and he prescribed trazodone 50 mg every night. I read on the internet that drug is an antidepressant, but I am not depressed. What should I do?" Which response from the nurse is correct? A. "I will help you contact your health care provider for clarification regarding this new prescription." B. "Insomnia and depression go hand in hand. If depression is relieved, your sleeping will improve." C. "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur." D. "Information on the internet is often misleading and incorrect. It's more important to trust the judgment of your health care provider."

C. "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur. "rationale: at lower doses, trazodone loses its antidepressant action while retaining hypnotic effects through histamine receptor antagonism, therefore useful for insomnia. High doses are required to reach the serotonergic action to relieve depression

A patient begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care? A. Monitor intake and output daily B. Educate patient about foods that contains tyramines C. Assess sitting, standing, and lying blood pressure every day D. Administer with food to reduce GI irritation

C. Assess sitting, standing, and lying blood pressure every day rationale: blocks a1 and H1 receptors. It can cause orthostatic hypotension and sedation = falls

Which patient would the nurse expect to have the most difficulty problem solving and decision making? A. an 18 year old diagnosed with bulimia nervosa t age 14, has taken oral doses of fluoxetine (Prozac) daily for 3 years B. A 46 year old diagnosed with schizophrenia at age 24,. has taken oral doses of clozapine daily for 18 years C. A 62 year old diagnosed with bipolar disorder at age 28. She has taken oral divalproex solution (Depakote) daily for 16 years. D. A 52 year old diagnosed with schizophrenia at age 21 and has taken monthly injections of hakoerudik (haladol decanoate) for 12 years

D. A 52 year old diagnosed with schizophrenia at age 21 and has taken monthly injections of hakoerudik (haladol decanoate) for 12 years rationale: executive functions occur in the cerebrum. Loss of cortical tissue has been associated with schizophrenia as well as with treatment involving haloperidol and other atypical anti-psychotics. Newer applied antipsychotics and antidepressants have been found to increase brain volume and structural synaptic/neuronal plasticity.

SSRI complications

Initially: tremor, nausea, fatigue/insomnia, drowsiness, diaphoresis Later: sexual dysfunction, weight changes, GI bleed, bruxism (teeth grinding), hyponatremia SEROTONIN SYNDROME

a charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding a. "this medication increases the release of serotonin and norepinephrine" b. "I should tell the client about the likelihood of insomnia while taking this medication" c. "this medication is contraindicated for clients who have an eating disorder" d. "sexual dysfunction is a common adverse effect of this medication"

a, Mirtazapine provides relief from depression by increasing the release of serotonin and norepinephrine

a nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following should the nurse include in the teaching? (select all that apply) 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, voiding just before taking the medication will help minimize the anticholinergic effects of urinary hesitancy or retention c, wearing sunglasses when outside will help minimize the anticholinergic effect of photophobia e, chewing sugarless gum will help minimize the anticholinergic effect of dry mouth

a nurse is assessing a client who has been taking alprazolam for several days. which of the following findings should the nurse identify as an adverse drug reaction caused by alprazolam? a. anxiety b. ringing in the ears c. increased appetite d. muscle spasms

a.

a nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. which of the following instructions should the nurse include? a. take a missed dose as soon as you remember b. take the drug as needed at the first sign of anxious feelings c. take the drug in the morning with a glass of grapefruit juice d. drink a cup of chamomile tea at night with the drug

a.

a nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past 2 weeks. which of the following findings should the nurse report to the provider as an indication of serotonin syndrome? a. hallucinations b. decreased temperature c. hypersexual behavior d. constipation

a. (SSRIs are contraindicated with St. John's wort because it can increase risk of developing serotonin syndrome)

a nurse is caring for a client who has a prescription for alprazolam. for which of the following adverse effects should the nurse monitor? SATA a. tolerance b. anxiety c. sedation d. respiratory depression e. constipation

a. (can develop with benzos) b. c. (take before bed) d.

a nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. which of the following instructions should the nurse include? SATA a. change positions slowly from sitting or lying to standing b. do not stop taking the drug abruptly c. avoid crushing the tablet d. take the drug at bedtime to prevent daytime drowsiness e. increase fiber and fluid intake

a. (orthostatic hypotension) b. d. (can cause drowsiness) e. (anticholinergic effects)

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason for the prescription modification a. renal function impairment b. cataracts c. recent weight loss d. smoking

a. renal function impairment (this dosage should be decreased for patients with renal or hepatic impairment)

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? (select all that apply) a. elevated blood glucose level b. orthostatic hypotension c. priapism d. hypomania e. bruxism

b, observe for orthostatic hypotension, which is an adverse effect of phenelzine d, observe for headache which is an adverse effect of phenelzine

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? a. motion sickness b. seasonal affective disorder c. insomnia d. nicotine addiction e. depression

b. d. e.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. which of the following instructions should the nurse include? a. weight yourself twice a month b. if you have persistent headaches, let the provider know c. reduce your daily sodium intake d. if your symptoms don't improve in 10 days, you will need a higher dosage

b. (report HA, anxiety, or insomnia)

a nurse is providing teaching for a client who has a prescription for phenelzine. the nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions? a. respiratory depression b. hypertensive crisis c. neuroleptic malignant syndrome d. serotonin syndrome

b. hypertensive crisis

a nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? a. I can expect to experience diarrhea while taking this medication b. I may feel drowsy for a few weeks after starting this medication c. I cannot eat my favorite pizza with pepperoni while taking this medication d. this medication will help me lose the weight that I have gained over the last year

b. sedation is an adverse effect of amitriptyline during the first few weeks of therapy

a nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? a. the client has a family history of seasonal pattern depression b. the client currently smokes 1.5 packs of cigarettes per day c. the client had a motor vehicle crash last year and sustained a head injury d. the client has a BMI of 25 and has gained 10 lb over the last year

c, the greatest risk to the client is development of seizures. Buproprion can lower the seizure threshold and should be avoided by clients who have a history of a head injury. This information is the highest priority to report to the provider

a nurse is providing teaching to a client who has a prescription for buspirone. which of the following instructions should the nurse include? a. take the drug with grapefruit juice to increase absorption b. use the drug as needed for anxiety c. allow 2-4 weeks for full therapeutic effects d. take the drug on an empty stomach

c.

a nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. the nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine? a. alprazolam b. phenytoin c. phenelzine d. pilocarpine

c. (should not take venlafaxine, a SNRI within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is life-threatening)

a nurse is providing teaching to a client about adverse effects of drug therapy. the nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs? a. venlafaxine b. buproprion c. imipramine d. valproic acid

c. (tricyclic antidepressant, can result in orthostatic (postural) hypotension)

a nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. the nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects? a. anterograde amnesia b. respiratory depression c. paradoxical reaction d. withdrawal symptoms

d.

a nurse is caring for a client who was admitted to the emergency department with a head injury. the nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. for which of the following adverse effects is the client at increased risk? a. ischemic stroke b. drowsiness c. respiratory depression d. seizure activity

d. (can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma)

a nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. which of the following client statements indicates an understanding of the teaching? a. it is not a big deal if I forget my pills for a couple of days b. i should limit alcohol intake to one drink daily while taking this medication c. I will avoid salt because this medication can increase my blood pressure d. if I become pregnant, it is important to let my health care provider know

d. (contraindicated)

what nervous system influences GABA

para sympathetic nervous system