Chapter 27 Psychiatric Problems

generalized anxiety disorder (GAD)

Excessive anxiety daily for 6 months

tyramine rich foods

Include aged cheese, pepperoni, salami, avocado, figs, banana, soy sauce, smoked fish

amitriptyline

TCA drug is _______________ (elavil) all end in -mine or -line

weight, bowel, constipation, extra, mental, sedation, food

check after giving antipsychotic drugs - monitor I&O - daily ________ - monitor ________ function report _______________ and encourage patient to drink ________ fluids - reassess __________ status and watch for ___________ - give with _________

blurred, dry, mouth, hypo, constipation

common side effects of TCAs -lethargy -sedation -drowsiness, -fatigue -___________ vision -_______ eyes -dry _________ -________tension -_____________ (difficulty pooping)

tyramine

hypertensive crisis can occur with MAOIs if patient eats a diet containing ____________, which could lead to a CVA

TCA, SSRI, serotonin, 10, 14, neurotransmitters

interactions of MAOIs - use of ______s can lead hypertensive crisis - use of _______s can lead to __________ syndrome - advise clients to that MAOIs shouldn't be used within ____ to _____ days before or after surgery - Indirect-acting sympathomimetic medications (ephedrine, amphetamine) promote the release of ________________ (Avoid decongestant meds)

2, 8

antidepressant drugs take ____ to ____ weeks to work

B. Coarse tremors

A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication? A. Sever hypertension B. Coarse tremors C. Constipation D. Muscle spasms

A. Cough B. Dizziness C. Decreased libido

A nurse is caring for a client who has depression and a new prescription for venlafaxine. For which of the following adverse effects should the nurse monitor this client? (Select all that apply) A. Cough B. Dizziness C. Decreased libido D. Alopecia E. Hypotension

BP, heart, dizziness, mental

After: Monitor ____ abnormal __________ rhythms Monitor for _____________, drowsiness Reassess _________ status

obsessive-compulsive disorder (OCD)

Compulsive actions

psychiatric

Moderate-to-severe anxiety is a symptom of ___________ disorders

phobic disorders

Persistent/recurrent fears of certain objects/situations

C. Chlorpromazine can cause dizziness, so be sure to change positions slowly

What precautions will you teach an older adult who is prescribed chlorpromazine (thorazine)? A. Chlorpromazine can cause an increase in thirst, so the older adult should drink more fluids B. Chlorpromazine can cause excessive urination, which can lead to dehydration, so drink more fluids C. Chlorpromazine can cause dizziness, so be sure to change positions slowly D. Chlorpromazine can cause kidney function to decrease, so a diuretic drug may also be prescribed

depression, bowel, fluid, diet, St. John's wort

What to do before giving antidepressants - ask about family history of _____________ - ask about usual ________ patterns - ________ intake and ________ - notify the prescriber if the patient takes ___ __________ __________

mild, treatment

______ anxiety is common and requires no _________________

benzodiazepine

because of their abuse potential, __________________________ drugs are contraindicated for patients with a substance abuse disorder

body temperature regulation

patients taking quetiapine may experience an alteration in ______________ _________________ _________________

antipsychotic

side effects of ____________ drugs Sedation, drowsiness, dizziness, lethargy restlessness, insomnia, GI upset

meals, immediately, not, short, anxiety, year

when taking ____________(buspar) Take with ________ Effect does not occur ____________ tolerance, dependence, or withdrawal effects are ______ an issue with this medication. Labeled for ________-term treatment of __________, but has shown therapeutic benefit for as long as a _________.

SSRIs

work by increasing the amount of serotonin in the brain

D. "If things don't improve, I'll have no reason to live anymore."

A group of individuals are participating in a support session to help with depression. Which patient statement would warrant an immediate notification to his or her health care provider? A. "I still have feelings of extreme sadness every single day." B. "When will this medication start to work? I still cry a lot." C. "My mouth is so dry, I wish I never started taking my medication." D. "If things don't improve, I'll have no reason to live anymore."

B. Neck spasms

A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider? A. Shuffling gait B. Neck spasms C. Drowsiness D. Impotence

D. Limit aerobic activity in hot weather

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches B. Restrict intake of foods rich in sodium C. Decrease fluid intake to less than 1,500 mL daily D. Limit aerobic activity in hot weather

A. Orthostatic hypotension

A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication? A. Orthostatic hypotension B. Hearing loss C. Gastrointestinal bleeding D. Weight loss

A. Thrombocyte count C. Amylase D. Liver function test

A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have which of the following laboratory tests completed periodically? (Select all that apply) A. Thrombocyte count B. Hematocrit C. Amylase D. Liver function test E. Potassium

B. Fever

A nurse is caring for a client who has been taking sertraline for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? A. Bruising B. Fever C. Abdominal pain D. Rash

A. Concurrent administration of buspirone C. Use of mouthgaurd D. Changing to a different class of antidepressants

A nurse is caring for a client who take paroxetine to treat posttraumatic stress disorder and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of mouthgaurd D. Changing to a different class of antidepressants E. Increasing the dose of paroxetine

B. "Eliminate grapefruit juice from your diet." C. "You will need to have a complete blood count and carbamazepine levels drawn periodically." D. "Notify your provider if you develop a rash." E. "Avoid driving for the first few days after starting this medication."

A nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. "This medication can safely be taken during pregnancy." B. "Eliminate grapefruit juice from your diet." C. "You will need to have a complete blood count and carbamazepine levels drawn periodically." D. "Notify your provider if you develop a rash." E. "Avoid driving for the first few days after starting this medication."

A. Disorganized speech B. Bizarre behavior D. Hallucinations

A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply) A. Disorganized speech B. Bizarre behavior C. Impaired social interactions D. Hallucinations E. Decreased motivation

D. "You should have your white blood cell count monitored every week."

A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching? A. "You should have a high-carbohydrate snack between meals and at bedtime." B. "You are likely to develop hand tremors if you take this medication for a long period of time." C. "You may experience temporary numbness of your mouth after each dose." D. "You should have your white blood cell count monitored every week."

A. "You may have a decreased desire for intimacy while taking this medication."

A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for posttraumatic stress disorder. Which of the following statements should the nurse include in the teaching? A. "You may have a decreased desire for intimacy while taking this medication." B. "You should take this medication at bedtime to help promote sleep." C. "You will have fewer urinary adverse effects if you urinate just before taking this medication." D. "You'll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication."

B. "Notify the provider if you develop breast enlargement."

A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching? A. "Add extra snacks to your diet to prevent weight loss." B. "Notify the provider if you develop breast enlargement." C. "You may begin to have mild seizures while taking this medication." D. "This medication is likely to increase your libido"

C. Change positions slowly to minimize dizziness E. Chew sugarless gum to prevent dry mouth

A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply) A. Expect therapeutic effects in 24 to 48 hours B. Discontinue the medication after a week of improved mood C. Change positions slowly to minimize dizziness D. Decrease dietary fiber intake to control diarrhea E. Chew sugarless gum to prevent dry mouth

D. "This medication has a low risk for dependency."

A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A. "Take this medication on an empty stomach." B. "Expect optimal therapeutic effecting within 24 hr." C. "Take this medication when needed for anxiety." D. "This medication has a low risk for dependency."

A. Perform immediate gastric levage

A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A. Perform immediate gastric levage B. Prepare the client for hemodialysis C. Administer an additional oral dose of lithium D. Request a stat repeat of the laboratory test

C. "I need to discontinue this medication slowly."

A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A. "I should take the medication on an empty stomach." B. "I will follow a low-sodium diet while taking this medication." C. "I need to discontinue this medication slowly." D. "I should not crush this medication before swallowing."

A. "It can take several weeks before you feel like the medication is helping."

A nurse is teaching a client who has obsessive-compulsive disorder and has a new prescription for paroxetine. Which of the following instruction should the nurse include? A. "It can take several weeks before you feel like the medication is helping." B. "Take the medication just before bedtime to promote sleep." C. "You should take the medication when needed for obsessive urges." D. "Monitor for weight gain while taking this medication."

B. Chew sugarless gum to moisten the mouth

A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects? A. Take the medication in the morning to prevent insomina B. Chew sugarless gum to moisten the mouth C. Use cooling measures to decrease fever D. Take an antacid to relieve nausea

B. Identify the client's level of orientation

A nurse working in the emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. 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

C. Change positions and get up slowly

A patient has begun treatment with 25 mg of chlorpromazine (thorazine) BID. You should instruct the patient to be sure to practice which precaution? A. Do not take the medication with grapefruit juice B. Record daily weights to monitor for retained fluid C. Change positions and get up slowly D. Check fasting blood sugar daily

A. Insomnia B. Anorexia E. Increased sweating

A patient has recently begun taking citalopram (celexa) for symptoms of depression. You should monitor the patient for which common side effects? (Select all that apply) A. Insomnia B. Anorexia C. Dry mouth D. Facial grimacing E. Increased sweating

D. The patient tells you that he smokes cigarettes

A patient prescribed olanzapine (Zyprexa) for treatment of psychosis. What information from the patient must you report to the prescriber? A. The patient tells you that he uses St. John's wort B. The patient tells you that he exercises every day C. The patient tells you that he eats a lot of fast foods D. The patient tells you that he smokes cigarettes

C. "Paroxetine can take from 1 to 8 weeks for symptoms of depression to improve."

A patient prescribed the SSRI paroxetine (paxil) 4 weeks ago tells you that it is not working and asks if she can have diazepam (valium) instead? What is your best response? A. "Paroxetine has fewer side effects than diazepam." B. "Paroxetine is less likely to cause dependence than diazepam." C. "Paroxetine can take from 1 to 8 weeks for symptoms of depression to improve." D. "Diazepam interacts with other drugs and food whereas paroxetine can be taken without regard to other drugs or food."

C. Have the patient get up slowly and sit on the side of the bed before standing

A patient who has been taking amitriptyline (elavil) to treat depression has developed dizziness with a blood pressure of 94/60. The patient tells the unlicensed assistive personal (UAP) that he needs to get up to use the bathroom. What are your best instructions for the UAP? A. Keep the patient on bedrest and offer him a bedpan B. Have the patient take slow deep breaths and keep the head of his bed in supine position C. Have the patient get up slowly and sit on the side of the bed before standing D. Keep the patient in bed until we can get an order for a bedside commode

D. "You must give the drug more time because it usually takes several weeks to be effective."

A patient who has been taking sertraline (zoloft) daily for 10 days reports that the medication has not helped with anxiety. What should the nurse tell the patient? A. "This is a low dose and the prescriber will be contacted to request an increase." B. "You should probably be taking a benzodiazepine for your condition." C. "Another medication should be added to your regimen to get good results." D. "You must give the drug more time because it usually takes several weeks to be effective."

B. Gamma-aminobutyric acid

A patient who has been taking the benzodiazepine chlordiazepoxide (librium) for anxiety reports after 2 weeks of therapy that she is feeling much calmer. This is a result of the enhanced inhibitory effects of which neurotransmitter? A. Serotonin B. Gamma-aminobutyric acid C. Dopamine D. Norepinephrine

C. Neuroleptic malignant syndrome

A patient who has taken chlorpromazine (thorazine) has developed symptoms of muscle rigidity, elevated temperature, increased respiratory rate, and elevated pulse and blood pressure. In addition, the patient has become less responsive to verbal stimuli. Which adverse reaction has this patient developed? A. Tardive dyskinesia B. Neutropenia C. Neuroleptic malignant syndrome D. Myocarditis

A. It can cause birth defects B. The fetus can become dependent on the drug

A patient who is in her second trimester of pregnancy is experience emotional difficulty at home and asks her health care provider for a prescription for lorazepam (ativan) to help her cope. Why is this drug contraindicated for this patient? (Select all that apply) A. It can cause birth defects B. The fetus can become dependent on the drug C. The risk of preeclampsia is increased D. It might make the patient miscarry

C. Seizures

A patient who was prescribed lorazepam (ativan) for 2 months suddenly stopped taking it because she "felt so much better." Now she reports restlessness, weakness, and insomnia. You should instruct her to call the prescriber and make an appointment immediately because of what risk associated with benzodiazepine withdrawal. A. Sedation B. Hypotension C. Seizures D. Stevens-Johnson syndrome

D. Provide the patient with food when giving this drug

After giving a patient risperidone (risperdal) she tells you that she feels nauseated. What is your best action? A. Notify the prescriber immediately B. Check the patient of signs of an allergic reaction C. Give the drug on an empty stomach D. Provide the patient with food when giving this drug

D. Instruct the patient about ways to restrict sodium intake

An older adult has been taking lithium and develops nausea and vomiting. Which intervention is most appropriate? A. Contact the prescriber for possible parenteral fluids B. Remind the patient to restrict fluid intake C. Hold the lithium until the nausea subsides D. Instruct the patient about ways to restrict sodium intake

C. Smoking may decrease the effectiveness of clozapine

Before giving clozapine (clozaril) to a patient, you assess the patient's smoking history. What is the reason for this assessment? A. Hand tremors may cause self-injury while smoking B. Smoking increases the risk of tardive dyskinesia C. Smoking may decrease the effectiveness of clozapine D. Smoking increases the risk of dementia

current, baseline, falls, patency, mental, suicidal

Before: Complete list of patient's _________ drugs Establish __________ vital signs Assess risk for ________ Assess IV site for _________ Assess __________ status, ___________ thoughts

Monoamine Oxidase Inhibitors (MAOIs)

Block Monoamine Oxidase in the brain (Increase in Norepi, dopamine, serotonin and tyramine available for transmission of impulse THESE ARE LAST RESORT MEDS

major, several, dysthymia, bipolar, psychosis

Depressive disorders ________ depression: May occur once/________ times ___________: Symptoms aren't disabling Bipolar disorder: Untreated can progress to __________ Treatment: Counseling, psychotherapy, antidepressants

post-traumatic stress disorder (PTSD)

Exposure to death or near-death experiences

C. By increasing the amount of the neurotransmitter serotonin in the brain

How do selective serotonin reuptake inhibitors (SSRIs) work to treat depression? A. By inhibiting the reuptake of the neurotransmitters norepinephrine, dopamine, or serotonin by nerve cells B. By inhibiting the actions of gamma-aminobutyric acid (GABA) in the brain C. By increasing the amount of the neurotransmitter serotonin in the brain D. By inhibiting the activity of monoamine oxidase preventing the breakdown of monoamine neurotransmitters

A. TCA drugs inhibit the reuptake of neurotransmitters

How do tricyclic antidepressants (TCAs) work in the treatment of depression? A. TCA drugs inhibit the reuptake of neurotransmitters B. TCA drugs decrease the amount of serotonin in the brain C. TCA drugs lower the levels of neurotransmitters D. TCA drugs work very slowly to correct chemical imbalances in the brain

panic disorder

Intense feelings of fear or doom

illusions

Mistaken perceptions of reality For example, a child who perceives tree branches at night as if they are goblins

exactly, side, keep, avoid, alertness, slowly, alcohol, surgery, medical

Patient teaching: Take drugs __________ as prescribed, immediately report _______ effects _______ follow-up appointments ________ activities requiring ____________ Change positions _________ Avoid ___________ Tell about drugs before __________ Wear a ___________ alert bracelet

somnia, upset, potence, blurred, eyes, gain, bruxism

SSRIs Side effects Drowsiness dizziness fatigue in_________ GI ________ im__________ lethargy sedation ____________ vision dry ________ weight _______ tremors ___________ (grinding of teeth at night)

A. Notify the prescriber D. Initiate suicide precautions E. Ask the patient if he or she has a suicide plan

The patient prescribed a benzodiazepine drug tells you that he is considering suicide. What must you do? (Select all that apply) A. Notify the prescriber B. Hold the benzodiazepine drug C. Ask for an order for leather restraints D. Initiate suicide precautions E. Ask the patient if he or she has a suicide plan

B. Instruct the patient to drink extra fluids every day

The patient prescribed chlorpromazine (thorazine) is at risk for constipation. What is your best action? A. Call the prescriber and ask for an order for stool softeners B. Instruct the patient to drink extra fluids every day C. Teach the patient about foods that are low in fiber D. Tell the patient about the importance of exercise in preventing constipation

A. "Be sure to wear protective clothing when you are outside."

The patient prescribed chlorpromazine (thorazine) tells you that he is very active and spends a lot of time outdoors What best advice do you teach this patient? A. "Be sure to wear protective clothing when you are outside." B. "There is no need to change the amount of time you spend outside." C. "You may need to get a membership to a gym and stay indoors." D. "Be sure to drink more fluids whenever you spend time outdoors."

TCA

Therapeutic Uses for _______s Depression Depressive episodes of bipolar disorders Other Uses Fibromyalgia Anxiety disorders Insomnia Neuropathic pain

MAOI, bulimia, panic, social

Therapeutic Uses for _______s Depression/_________ nervosa/_________ disorder/GAD/PTSD/________ anxiety disorder

A. Fluoxetine (Prozac)

Which antidepressant drug may cause unusual excitement, irritability, and trouble sleeping when prescribed for children? A. Fluoxetine (Prozac) B. Sertraline (Zoloft) C. Venlafaxine (Effexor) D. Duloxetine (Cymbalta)

C. Benzodiazepines

Which class of drugs is most likely to lead to dependence when prescribed? A. TCAs B. SSRIs C. Benzodiazepines D. Antipsychotic drugs

B. "I won't take this drug with grapefruit juice to avoid excessive blood levels."

Which statement made by a patient best indicates that the patient correctly understands the correct use of olanzapine (zyprexa)? A. "I won't worry if this drug causes my urine to turn pinkish-brown." B. "I won't take this drug with grapefruit juice to avoid excessive blood levels." C. "I can drink a glass of wine at night to help me relax and sleep better." D. "Suntanning is acceptable, as long as I don not use a tanning bed."

B. SSRI drugs have fewer side effects than TCA drugs

Why are SSRI drugs prescribed more often the TCA drugs for the treatment of depression? A. TCA drugs are more likely to lead to dependence B. SSRI drugs have fewer side effects than TCA drugs C. TCA drugs lead to more adverse effects D. SSRI drugs work more rapidly than TCA drugs

SSRI, paroxetine, sertraline, escitalopram, fluoxetine, fluvoxamine,

______ meds - _________ (Paxil) - ____________ (Zoloft) - _________________ ( Lexapro) - _______________ (Prozac) - ___________________ (Luvox)

fluoxetine, panic, OCD, PTSD

________ (prozac) is used for: - ________ disorder - obsessive compulsive disorder (________) - post traumatic stress disorder (________)

diuretics

_________ and lithium don't go well because sodium is excreted with the use of them. and reduced sodium decreases lithium excretion which can lead to toxicity

buspirone

__________ (buspar) is an atypical /non barbiturate anxiolytic

paroxetine, generalized, panic, obsessive, social, trauma, stressor, dissociative, depressive, adjustment

__________ (paxil) used for: - _______________ anxiety disorder (GAD) - ________ disorder - ___________ compulsive disorder (OCD) - __________ anxiety disorder - _________ and __________ related disorders - _____________ disorders - _____________ disorders - _____________ disorders

escitalopram, GAD, OCD

___________ (lexapro) is used for: - generalized anxiety disorder (_______) - obsessive compulsive disorder (______)

fluvoxamine, OCD, social

___________ (luvox) is used for: - obsessive compulsive disorder (______) - _________ anxiety

fluoxetine, tricyclic, lithium

___________ (prozac) can increase the levels of __________ antidepressants and ___________

sertraline, panic, obsessive, social, taumatic

___________ (zoloft) used for: - _________ disorders - ____________ compulse disorder (OCD) - __________ anxiety disorder - post ______________ stress disorder (PTSD)

antipsychotic, dementia, agitated, psychotic, dangerous

___________ drugs should no longer be prescribed for patients with _____________ unless they are ___________, aggressive, or showing ___________ behavior that is distressing to patients or ______________ to others.

erythromycin, ketoconazole, buspirone, increased

____________, _____________, St. John's wort, and grapefruit juice can increase the effect of ____________ ______________ risk for serotonin syndrome with SSRIs

tricyclic antidepressants (TCAs), 4, 8

______________ ____________ work by blocking reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitter Take ___ to ____ weeks to reach max effect

serotonin syndrome

_______________ _______________ is a rare adverse effect that occurs when levels of serotonin are very high. s/s of this include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination, and rapid heart rate resolves after meds are discontinued

antipsychotic, tranquilizing, dopamine, whim

________________ drugs Produce ___________________ effect, help relax CNS All antipsychotic drugs tend to block ____________ receptors in the pathways in the brain Major tranquillizers, lithium carbonate, thiothixene Should not be used on a _______ Intended responses: Signs/symptoms of psychosis decreased, behavior and schizophrenic behavior are improved, suicidal thoughts decreased

NSAID

_________s and lithium don't go well because they increase renal reabsorption of lithium leading to toxicity

NDRI, seizure, neutropenia, failure, increased

________s adverse reactions ___________ (uncontrollable movements), ____________ (low WBC), liver _________/toxicity, _____________ suicidal thoughts in children/adolescents/young adults

TCA, cardiac, ventricular asystole

________s may cause serious adverse ________ effects including unstable _____________ dysrhythmias or _________

TCA, seizure, MI, CAD, retention, glaucoma, thyroidism, suicide, week, overdose

_______s are contraindicated in patient's with; - _____________ disorders - recently experienced a ______ - use cautiously if elderly if they have: coronary artery disease (______), diabetes, liver, kidney or respiratory disorders, urinary retention, BPH, angle-closure ____________ and hyper____________ - patients at an increased risk for __________ should receive a 1 _______ supply of medication at a time due to the lethality of an ____________

serotonin, receptors

a selective serotonin reuptake inhibitor blocks the reuptake of ________________, making it more available to act on _______________ in the brain

antipsychotic, tardive dyskinesia, neuroleptic, neutropenia, death, dementia

adverse effects of ___________ drugs: - ___________ _______________, a disorder characterized by involuntary movements most often affecting the mouth (much more common with first generation drugs) - __________________ malignant syndrome is a rare, potentially life-threatening disorder involving the ANS - _________________ can result form taking clozapine or prochlorperazine - quetiapine and risperidone cause increased risk of _________ in older adults with __________

Benzodiazepines, 30, PRN, 3, 5, alcohol, delirium, increase GABA

all end in -pam - the major benefit of these is that they act within _____ minutes and may be given _____, whereas it may take SSRIs ___ to ___ weeks to control anxiety. They also decrease symptoms of __________ withdrawal and prevent __________ tremens - they _________ the inhibitory actions of ______ in the brain

antipsychotic, fluid, urine, weight, psychosis, orientation, behavior, suicidal

before giving ___________ drugs: - monitor _______ intake and _______ output - obtain baseline _________ - assess baseline level of ____________ - check ____________ thoughts

MAOI, stimulation, orthostatic, crisis, rash, toxicity, 12

complications of Monoamine Oxidase Inhibitors (______s) - CNS _____________ - ____________ hypotension - hypertensive __________ - local ________ with transdermal preparation * ___________ not evident until ___ hours after ingestion*

TCA, orthostatic, anticholingric, antidote, cardiac, seizure, excessive

complications of _______s _______________ hypotension _______________ effects (dry mouth, blurred vision, tachy, photophobia) Sedation Toxicity with no ____________ for toxicity Cholinergic blockade and __________ toxicity (Evidence by cardiac dysrhythmias, mental confusion , agitation, seizures coma and possible death) Decreased ___________ threshold ___________ sweating

delusions

false ideas about what is occurring or personal identity For example, a person with schizophrenia might believe a billboard or a celebrity is sending a message meant specifically for them

TCA, smoking, decrease

if a patient is taking a ______, ask about __________ because may _____________ the effectiveness of the drug

2.5

if lithium level is greater than _____ mEq/L this is when it can rapidly progress to coma and death

TCAs

inhibit reuptake of norepinephrine, dopamine, and serotonin

stabilizer, bipolar, acute, mania, depression

lithium is a mood _____________ and is used to treat _____________ disorders. it controls the episodes of _______ mania, and helps prevent the return of _________ or __________

kidneys, I&O

lithium is really harsh on the __________ so get baseline of their function and monitor __________

0.8, 1.4

normal lithium level should between ______ and _______ mEq/L

major tranquilizer, neuroleptics

other terms for an antipsychotic drug are _____________________ _________________ and _____________________

alcohol, sleeping, pain, depression, wean, withdrawal, dependence, antacids

patient teaching for benzodiazepines - take drugs exactly as prescribed - avoid drinking _________, taking ______________ pills, or taking prescription _____ drugs at the same time because of the danger of more severe CNS ____________ - prescriber may want to _______ them off of these drugs gradually because stopping suddenly can cause ______________ symptoms - immediately report signs of ________________ to prescriber - don't take ____________ with these

neutropenia

patients on mirtazapine are at increased risk for infection because of _______________

seizures

patients taking venlafaxine, duloxetine, bupropion are at risk for ____________________

hallucinations

seeing or hearing things that are not there For example, hearing the voice of or briefly seeing a loved one who recently died

allergic, pain, increased, heart, shortness, breathing, swallowing, coordination, hands, hurting

signs and symptoms of ______________ reactions chest _________ _______________ or irregular ________ rhythm ___________ of breath fever hives rash itiching difficulty ______________ or ______________ swelling decreased _____________ shaking _________ dizziness light-headedness thoughts of __________ oneself

buspirone, panic, social, renal, liver, MAOI, 14

therapeutic uses for __________ (buspar) - _______ disorders - ________ anxiety disorders - OCD - PTSD Caution with ________/_________ dysfunction Hypertensive crisis: concurrent use with ________ antidepressants/ ____ days after

suicide, children, young, warning, black

thoughts of _________ may increase in __________, adolescents, and young ___________ when taking antidepressants; a ___________ appears on all labels for these drugs (_________ box warning)

norepinephrine, serotonin

tricyclic antidepressants act by blocking the reuptake of _______________ and ________________, making more of these substances available to act on receptors in the brain

paroxetine, stimulation, insomnia

unlike the other SSRIs _____________ (paxil) causes CNS ___________, which can cause _____________

reassess, mental

what to do after giving antidepressants - ____________ the patient's ___________ status to determine his/her response to drugs - monitor for any side effects, adverse reactions, etc

low, gradually, therapeutic, control, cure, 1, 8, gradually, adverse

what to teach patients taking antidepressants - explain that their prescriber may start with a ______ drug dose and _____________ increase it until _______________ antidepressant effects are achieved - remind patients that antidepressants can ___________ the symptoms of depression but will not _________ it - teach them that it may take __ to ___ weeks before symptoms are improved - take meds even when feeling "better" - antidepressants may need to be discontinued _____________ to avoid ___________ effects

frequent, rinses, hygiene, dry, SSRI, once, morning, MAOI, 14, serotonin

what to teach patients taking antidepressants (con't) - tell patients that __________ mouth ________ and good oral __________ can minimize the effects of _____ mouth - instruct patients taking an ________ to take the dose _______ a day in the __________ - caution patients taking a ________ and transitioning to an SSRI, TCA, or other antidepressant that these drugs should not be used for at least ___ days after discontinuing because of a life-threatening drug interaction called ___________ syndrome

throat, bleeding, tremors, alcohol, bowel, food, sunscreen, dry,

what to teach patients taking antipsychotic drugs: - Prescriber may start dose low and gradually increase - Report sore _________, unusual __________ or bruising, rash, or ________ - Importance of psychotherapy - Avoid ___________ and other CNS depressants - Monitor _________ function and increase activity - Take drugs with ________ if GI upset occurs - Use __________ and wear protective clothing/hats - frequent mouth rinses and oral care can help minimize ______ mouth (alcohol free mouthwash)

morning, food, sexual, MAOI, sodium, diuretics

when giving SSRIs and SNRIs - give in the __________ to minimize sleep disturbances - take with _______ to minimize GI upset - advise about potential _________ side effects - avoid use of _______s - obtain baseline ________ levels for older adult clients taking ___________, and monitor periodically

buspirone, less, sedation, 2, 6, PRN

when taking __________ (buspar) dependency is much ______ likely than with other anxiolytics, and use of buspirone does not result in ______________ or potentiate the effects of other CNS depressants. the major disadvantage is that it takes ___ to ___ weeks for it to reach its full effects. Therefore should not be scheduled ___________