Drugs for Mood Disorders EAQ

A new mother has been prescribed fluoxetine. What information is essential for the nurse to ask prior to therapy? "Are you feeling tired?" "Are you breast-feeding your infant?" "Do you take any other medications daily?" "Have you ever taken this medication before?"

"Are you breast-feeding your infant?"

The nurse is assessing a patient with bipolar disorder who has been prescribed sertraline. The patient asks about "feeling better." What should the nurse teach the patient? "You should feel better within a day or two." "Your symptoms should subside within a week." "Drug therapy is used for 4 to 8 weeks before evaluating successful treatment." "If you don't feel better within 2 weeks, you need to call the health care provider."

"Drug therapy is used for 4 to 8 weeks before evaluating successful treatment."

What class of drugs typically require a liver function test?

Antidepressants and specifically SSRIs and SNRIs

The nurse is caring for a patient who is receiving a selegiline transdermal patch. What medication will the patient be instructed to avoid? Fluoxetine Venlafaxine Imipramine HCl Carbamazepine

Carbamazepine

What can the atypical antidepressant Bupropion HCI increase risk of?

Increase risk of seizures

The nurse identifies which most common serious adverse effect of tricyclic antidepressant therapy? Skin rash Excitation Sexual dysfunction Orthostatic hypotension

Orthostatic hypotension

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a tricyclic antidepressant?

They have fewer side effects and are safer if an overdose occurs

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline. Which question is most important for the nurse to ask the patient? "When was your last bowel movement?" "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "Have you had any changes in your mood or anxiety level or thoughts of suicide?"

"Have you had any changes in your mood or anxiety level or thoughts of suicide?"

A patient is being switched from amitriptyline to citalopram. Which statement made by the patient reflects understanding of patient education? "I will not get as dizzy when I change positions after I switch medications." "The doctor is switching me to this medication because it is less expensive but just as effective." "I will need to limit my intake of cheese when taking citalopram to prevent a rise in my blood pressure." "I can just stop taking my amitriptyline and start taking the citalopram as ordered."

"I will not get as dizzy when I change positions after I switch medications." SSRIs such as citalopram do not cause dizzinesss while antidepressants such as amitriptyline do antidepressants = -ine SSRIs = -am

The nurse notes in the patient's chart that the health care provider has prescribed doxepin for the patient's depressive disorder. What should the nurse teach the patient? "Use this drug only as needed." "Maximal response may not occur for 12 weeks." "Do not take any other medications while on this drug." "Call if you do not have any effect from the drug in 48 hours."

"Maximal response may not occur for 12 weeks."

The nurse is caring for a patient who has been prescribed bupropion HCl for seasonal affective disorder. What should the nurse teach the patient about this medication? "Do not take this medication every day." "This medication may suppress your appetite." "Be careful of weight gain with this medication." "This medication will depress your sexual desire."

"This medication may supress your appetite."

The nurse is assessing a patient who has been prescribed isocarboxazid. The patient is having back surgery. What should the nurse teach the patient about pain control after surgery? "You cannot take meperidine for pain." "Any pain medication is contraindicated." "You will need to be tapered off the isocarboxazid." "You will need to take a different antidepressant agent."

"You cannot take meperidine for pain."

The nurse is caring for a patient who has depression and has been prescribed isocarboxazid. What will the nurse teach the patient about the reason for this therapy? Why? "This medication is used only for short-term therapy." "This medication is the only one that will treat your disorder." "You have been prescribed this medication because you did not respond to others." "This medication is being used as the risk of side effects is very low."

"You have been prescribed this medication becuase you did not respond to others." This drug is an MAOI that relieves depression and is typically last resource type drugs

The nurse knows that which statements about postpartum depression are true? Select all that apply. Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. About 80% of women experience depressive symptoms after giving birth. Once a woman has had postpartum depression, it will not recur with future deliveries. Sertraline is the drug of choice for treating postpartum depression in breast-feeding mothers. Monoamine oxidase inhibitors (MAOIs) are the first-line agents of choice for the treatment of postpartum depression.

- Thyroid insufficiency has been indicated as a contributing factor in postpartum depression - About 80% of women experience depressive symptoms after giving birth - Sertraline is the drug of choice for treating postpartum depression in breast-feeding mothers

Which instruction does the nurse include when teaching a patient about phenelzine therapy? Select all that apply. "Avoid eating avocados when taking this drug." "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." "Take the medication as needed when you are feeling depressed." "Profuse sweating is an expected side effect of this medication and will diminish with time." "If you experience a severe headache, inform your healthcare provider."

- avoid eating avocados when takingthis drug - if you experience a severe headache, inform your hcp

What foods can be included in a patient diet who taking MAOIs and what should be avoided?

- cottage cheese and white bread in diet - red wine, fava beans, and corned beef should be avoided

What common side effects do SSRIs cause? What common side effect do tricyclic antidepressants carry?

- sexual dysfunction - weight gain - risk of serotonin syndrome - risk of suicide with overdose

The nurse is teaching a patient who has a new prescription for citalopram. Which statement is appropriate to include in the teaching plan? Select all that apply. "This medication often causes drowsiness. You should take it at bedtime." "When you stop taking this medication, you should not withdraw it abruptly." "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." "This medication may cause some sexual side effects. Let your health care provider know about this if it occurs." "Let your family or your health care provider know if you experience a worsening mood, agitation, or increased anxiety."

- when you stop taking this medication, you shoul dnot withdraw it abruptly - this medication may cuase some sexual side effects, Let your healthcare provider know about this if it occurs - Let your family or your health care provider know if you expereience a worsening modd, agitation or increased anxiety

What is the safe, effective dose of duloxetine to be administered to a patient who is experiencing major depression? 35 mg/day 60 mg/day 70 mg/day 100 mg/day

60 mg/day

The nurse is assessing a patient with depression who has been prescribed nortriptyline. Following the assessment, the nurse finds that the patient has constipation and urinary retention due to interaction between the prescribed medications. Which class of medication found in the patient's prescription is responsible for these effects? Diuretics Anxiolytics Anticholinergics Antihypertensives

Anti cholinergic

The nurse is caring for a patient taking lithium. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Aspirin for mild headache Ibuprofen for muscle pain Hydrochlorothiazide for edema Diphenhydramine for cold symptoms

Aspirin for mild headache

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium. What intervention is a priority for this patient? Assessing lithium levels twice a week Monitoring the patient's intake and output Asking the patient about ringing in the ears Monitoring for the recurrence of seizure activity

Assessing lithium levels twice a week has a narrow therapeutic range. So should be monitored until therapeutic range is reached and then monitored monthly

A patient has been started on therapy with fluvoxamine. Which assessment is essential prior to and during the first few weeks of therapy? Complete blood count Blood glucose monitoring Assessment of liver enzymes Assessment of cardiac enzymes

Assessment of liver enzymes

The nurse is caring for a patient who has been administered isocarboxazid. Which instructions should the nurse provide to the patient? Select all that apply. "Avoid drinking tea." "Avoid drinking cola." "Avoid drinking wine." "Avoid eating yogurt." "Avoid eating cheese."

Avoid eating cheese and wine

Lithium is used in the treatment of bipolar disorder (BPD) and what other psychiatric disorders? Select all that apply. Bulimia Alcoholism Schizophrenia Hypertension Glucocorticoid-induced psychosis

Bulima, alcoholism, schizophrenia, glucocorticoid-induced psychosis

The nurse is caring for a patient with pre-existing cardiac disease. The patient has been prescribed citalopram. What is the nurse's priority assessment? Neurologic assessment Genitourinary assessment Cardiovascular assessment Gastrointestinal assessment

Cardiovascular assessment

When teaching a patient about the use of tricyclic antidepressants (TCAs), what will the nurse emphasize? Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for a synergistic effect. The patient should notify the health care provider if therapeutic effects are not noted within 10 days. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy.

Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy

Which food will the nurse teach the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? Select all that apply. Figs Cheese Pepperoni White bread Smoked salmon

Figs, cheese, pepperoni, and smoked salmon

The nurse notes that the health care provider is considering starting the patient on a selective serotonin reuptake inhibitor (SSRI) drug. The nurse recognizes that the health care provider will select which drug below? Doxepin Imipramine Amitriptyline Fluvoxamine

Fluvoxamine

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? Elevate mood during the severe manic episode Help control symptoms during the severe manic episode Produce sedating effects during the severe manic episode Reduce the amount of physical pain the patient experiences during the severe manic episode

Help control symptoms during the severe manic episode

The nurse is preparing to administer phenelzine to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? It increases the risk of suicide in the early phase. It is less effective than the tricyclic antidepressants. It increases the risk of psychoses and parkinsonism. It has more hazardous side effects and drug interactions

It has more hazardous side effects and drug interactions

What type of drug is sertraline and what is it used for?

It is a mood stabilizer drug used for bipolar disorder

The nurse identifies which drug(s) as the principal mood stabilizers used in the treatment of bipolar disorder? Select all that apply. Lithium Risperidone Venlafaxine Carbamazepine Divalproex sodium

Lithium, carbamazepine and divalproex sodium

A patient who has depression is prescribed duloxetine. Which tests will the nurse suggest to the provider before the therapy is started? Liver function test Renal function test Complete blood count Complete urine examination

Liver function test

The patient has been started on a treatment regimen that includes imipramine. The patient tells the nurse that he also is being treated with diazepam for a separate condition. What is the nurse's highest priority action? Notify the healthcare provider because central nervous system (CNS) depression may result. Notify the healthcare provider because the patient may experience an anaphylactic reaction. Notify the pharmacy because the dosage of the imipramine will need to be increased. Notify the pharmacy because the dosage of the imipramine will need to be decreased

Notify the health care provider because central nervous system (CNS) depression may result

What is the time period of use required to produce therapeutic effects? (what's the range)

Range of 2 to 4 weeks

The nurse is planning care for a patient taking imipramine. Which findings, if present, would most likely be side effects of this drug? Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing Blood pressure of 160/90 mm Hg

Sedation and dry mouth

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? Select all that apply. which ones are tricyclic and atypical? Sertraline Bupropion Fluoxetine Imipramine Desvenlafaxine

Sertraline and Fluoxetine Bupropion is atypical and Imipramine is tricyclic

A patient asks the nurse how long it will take for escitalopram to be completely effective. Which time frame should the nurse include in patient teaching? 1 week 2 or 3 days 2 or 3 months Several weeks

Several weeks

The nurse is caring for a patient receiving fluoxetine for depression. Which side effect is most likely associated with this drug? Dry mouth Bradycardia Sexual dysfunction Orthostatic hypotension

Sexual dysfunction

The nurse monitors the patient taking imipramine for what potential side effect? Diuresis Dry skin Seizures Hyperkalemia

Siezures Lowers seizure threshold

The nurse prepares for discharge a patient who has a prescription for sertraline. Which instruction should the nurse include in patient education? Report any increase in mania. Expect to feel better in 4 to 6 days. Avoid overheating and direct sun exposure. Take sertraline (Zoloft) at the same time each day.

Sodium level of 128 mEq/L

Which herb when mixed with duloxetine can cause symptoms of serotonin syndrome: restlessness, agitation, diaphoresis and tremors

St. Johns wort

The health care provider ordered lamotrigine for long-term maintenance therapy of bipolar disorder (BPD). The nurse anticipates which dosing schedule? Starting at a low dose and titrating up Starting at a high dose and titrating down Starting at a high dose to quickly control mania Starting with a loading dose and then a low maintenance dose

Starting at a low dose and titrating up

While assessing a patient who is being treated for post-traumatic stress disorder, the nurse finds that the patient has developed confusion, agitation, anxiety, incoordination, and excessive sweating. What is the nurse's priority action? Call the health care provider. Keep the patient cool and dry. Make certain the patient stays on bed rest. Stop administration of monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs).

Stop administration of MAOIs and SSRIs

A patient is taking tricyclic antidepressant (TCA) therapy for the treatment of insomnia. On reviewing the prescription, the nurse finds that the patient is also taking phenelzine. What is the nurse's priority action? Call a code. Assess the patient. Stop the medication. Call the health care provider.

Stop the medication due to risk of serotonin syndrome

The nurse prepares for discharge a patient who has a prescription for sertraline. Which instruction should the nurse include in patient education? Report any increase in mania. Expect to feel better in 4 to 6 days. Avoid overheating and direct sun exposure. Take sertraline (Zoloft) at the same time each day.

Take sertraline (Zoloft) at the same time each day

The primary health care provider prescribes carbamazepine to a patient who has bipolar disorder. After reviewing the medical history of the patient, the nurse requests that the primary health care provider revise the prescription. What is the reason behind this nursing action? The patient has kidney dysfunction. The patient has bone marrow depression. The patient has acute myocardial infarction. The patient is hypersensitive to the medication.

The patient has bone marrow depression Carbamazepine interferes with function of bone marrow

The primary health care provider has prescribed bupropion HCl to a patient. After reviewing the patient's medical history, the nurse requests that the primary health care provider revise the prescription. What is the reason behind this nursing action? The patient has seizures. The patient has hypovolemia. The patient has bone marrow depression. The patient has acute myocardial infarction.

The patient has seizures

The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? Why? The patient will have persistent manic symptoms. The patient may have cardiac dysrhythmia and tremors. The patient may have impaired liver and renal functioning. The patient should have effective relief from the manic symptoms.

The patient should have effective relief from the maniac symptoms bcserum lithium level should be 1 to 1.4 mEq/L for opyimum treatment of acute mania

A patient takes sertraline for depression related to chronic pain. The nurse avoids administering which analgesic agent to help prevent serotonin syndrome? Why Fentanyl Ibuprofen Tramadol Oxycodone

Tramadol bc produces an analgesic effect by blocking reuptake of norepineprhine and serotonin, thus avoiding serotonin syndrome

The nurse teaches the patient taking bupropion about which potential effect of therapy? Why? Hypersomnia Weight loss Hypertension Orthostatic hypotension

Weight loss due to the fact that bupropion supress appetite to a certain extent leading to weight loss - is also associated with increased energy and possible insomnia

How can a low sodium level lead to lithium toxicity?

When sodium levels are reduced due to diurectics, it causes more reabsorption of lithium. When lithium levels increase, they can easily lead to lithium toxicity because lithiums therapeutic index is so narrow and so close to the level needed in bloodstream for toxicity. So patients taking lithium must have their sodium/salt intake monitored closely

The nurse is caring for a patient with bruxism due to selective serotonin reuptake inhibitor (SSRI) therapy. What will the nurse teach the patient about management of this side effect? Your health care provider can prescribe pain medication. Your health care provider can prescribe low-dose buspirone. Your health care provider can increase the dose of the SSRI. Your health care provider can prescribe a monoamine oxidase inhibitor.

Your health care provider can prescribe low dose buspirone

A patient who has been prescribed duloxetine therapy states he typically drinks wine daily. What is essential for the nurse to teach the patient to do? Assess his heart rate. Monitor his blood glucose. Monitor his blood pressure. Become aware of the signs of liver toxicity, such as jaundice.

become aware of the signs of liver toxicity such as jaundice

What are two major anticholingeric side effects of TCAs (tricyclic antidepressants)

constipation and dry mouth

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram. Which is the most likely explanation for these symptoms? Cholinergic crisis Serotonin syndrome Depressive psychosis Escitalopram overdose

serotonin syndrome

What is Lithium used for?

treats manic episodes associated with bipolar disorder