Pharmacology Chapter 22 Psychotherapeutic Agents

Pharmacokinetics Lithium

- slowly crosses the blood-brain barrier - 80% is reabsorbed

A client refuses to take his oral antipsychotic medication. What should the nurse do?

Attempt to reason with the client. If he still refuses, contact the provider for further instructions.

A patient is seen in the ambulatory care clinic with a complaint of insomnia. What should the nurse assess in regard to the complaint of insomnia?

Daily intake of caffeine-containing products

After reviewing information about antipsychotic agents, the students demonstrate understanding of the information when they identify which agent as an example of a typical antipsychotic?

Haloperidol

A patient has been prescribed an amphetamine as part of obesity treatment. Which of the following interventions should the nurse perform before the dosage regimen starts?

Record the patient's weight.

A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience?

Tardive dyskinesia

A 10-year-old child is being administered CNS stimulants for ADHD. Which of the following should the nurse instruct the parents to record periodically?

Weight and growth

Neuroleptic

a drug with many associated neurological adverse effects that is used to treat disorders that involve thought processes (e.g., schizophrenia)

Haloperidol is frequently used to treat

acute psychiatric situations and is available for intravenous (IV)

CNS stimulants are used clinically to treat

attention-deficit disorders and narcolepsy

Bipolar Disorder

behavioral disorder that involves extremes of depression alternating with hyperactivity and excitement

Attention-Deficit Disorder:

behavioral syndrome characterized by an inability to concentrate for longer than a few minutes and excessive activity

Attention-deficit disorders (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of

central nervous system stimulants

Antipsychotic drugs are basically

dopamine-receptor blockers

Antipsychotic

drug used to treat disorders involving thought processes; dopamine-receptor blocker that helps affected people to organize their thoughts and respond appropriately to stimuli

Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include

dry mouth, hypotension, and glaucoma

A nurse is caring for a patient who is taking haloperidol. He has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on which of the following?

An increased risk for toxic effects of haloperidol therapy

A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?

Antipsychotic

A nurse is caring for a patient who has been prescribed an analeptic drug for respiratory depression. What ongoing assessments should the nurse perform for this patient? Select all that apply.

• Monitor the level of consciousness • Observe patient for adverse drug reactions • Draw blood for arterial blood gas analysis at intervals as ordered

A nursing student learning about different types of drugs that affect the central nervous system knows that drugs given to a patient with schizophrenia are known as which of the following? (Select all that apply.)

• antipsychotic drugs • neuroleptics

A nurse has just administered a first dose of didrex to a patient taking it for weight loss. For what side effects should the nurse be monitoring? (Select all that apply.)

• headache • nervousness • apprehension • disorientation • excessive CNS stimulation

A client asks the nurse dopamine is. What is a correct response by the nurse?

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."

A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man's lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?

"Take this drug once each day on an empty stomach."

After teaching the parents of a child diagnosed with ADHD about the disorder and its treatment, the nurse determines that the teaching has been effective when the parents state which of the following?

"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention."

The nursing student learned in anatomy and physiology class that the nervous system has how many divisions?

2

A dose of 60 mg Doxapram HCL has been prescribed for a patient to be administered intravenously. The drug is available in 20-mL vials containing 400 mg of the drug. How many ml of the available solution should be administered to the patient?

3

A patient has been prescribed Didrex. Which of the following precautions should the nurse take while administering the drug?

Avoid administering antidepressants.

A 75-year-old male client is given an order for a CNS stimulant secondary to a new diagnosis of narcolepsy. He begins to experience signs and symptoms of excessive CNS stimulation. The nurse knows that the client is likely to also experience an exacerbation of which preexisting condition?

Cardiac dysrhythmias

Antipsychotic Protoype

Chlorpromazine Clozapine

The nurse expects to monitor a client's white blood count weekly when the client is prescribed which of the following?

Clozapine

Which of the following effects can be noticed in a patient who has been administered amphetamines?

Decreased appetite

A patient is undergoing lithium therapy at a health care facility. The patient informs the nurse that he is taking antacids for heartburn. Which of the following is a possible effect of the interaction of lithium with antacids?

Decreased effectiveness of lithium

Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication?

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task.

A patient has been treated with amphetamines for ADHD. At the age of 16 years, she is diagnosed with hyperthyroidism. What intervention should be implemented with this patient?

Discontinue the amphetamines

The nurse would monitor a patient closely for lithium toxicity if the patient is also receiving which of the following?

Indomethacin

A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The plan is to stop the drug. Which of the following best reflects the rationale for this plan?

It needs to be determined if the child still has symptoms that require treatment.

A client calls the clinic complaining that she is only able to get a 1-month supply of pills for her son who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?

It reduces the likelihood of drug dependence or diversion

Which of the following would lead the nurse to suspect that a patient receiving antipsychotic therapy is developing tardive dyskinesia?

Lip smacking

Antimanic Prototype

Lithium

Serotonin abnormalities are thought to be involved in the following disorders

Mental depression and sleep disorders

A male client's physician orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.

Central Nervous System Stimulants Prototype

Methylphenidate

A patient with narcolepsy is placed on a central nervous system stimulant for treatment of his narcolepsy. What is the central nervous system stimulant of choice to treat narcolepsy?

Modafinil (Provigil)

John is a 45-year-old man who is obese. He is coming to see the physician today about diet and medications to help him lose weight. He wants to be prescribed dextroamphetamine. Based on John's history, what would contraindicate the use of this medication?

Myocardial infarction 2 months previously

Which of the following would a nurse assess as an anticholinergic effect of antipsychotics?

Nasal congestion

Due to excessive stimulation, caffeine is not recommended for

People with cardiac dysrhythmias, a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia

A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, complains of constant thirst, frequent urination, and feeling nauseous. The nurse knows that which of the following is most likely his problem?

The client may have undiagnosed diabetes.

Your patient, a 6-year-old boy, is starting a regimen of Ritalin (methylphenidate) to control an attention-deficit disorder. Family teaching should include which of the following?

This drug may cause insomnia, weight loss, and gastrointestinal upset.

The main goal of therapy when using CNS stimulants is:

To relieve the symptoms for which they were prescribed

Major Tranquilizer

former name of antipsychotic drugs; the name is no longer used because it implies that the primary effect of these drugs is sedation, which is no longer thought to be the desired therapeutic action

Haloperidol (Haldol) is a potent antipsychotic that is associated with

severe extrapyramidal effects

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse's priority assessment would be

height and weight.

Patients being treated with lithium should be encouraged not to use

herbal therapy psyllium

Patients receiving lithium should be encouraged to maintain

hydration and salt intake

The antipsychotics are widely distributed

in the tissues and are often stored there, being released for up to 6 months after the drug is stopped

Risperidone is used frequently to treat

irritability and aggression associated with autistic disorders in children and adolescents

The therapeutically effective serum level

is 0.6 to 1.2 mEq/L.

Patients in Asian countries receive

lower doses of neuroleptics and lithium

A lithium-haloperidol combination

may result in an encephalopathic syndrome, consisting of weakness, lethargy, confusion, tremors, extrapyramidal symptoms, leukocytosis, and irreversible brain damage

Narcolepsy

mental disorder characterized by daytime sleepiness and periods of sudden loss of wakefulness

Prochlorperazine available in

oral, rectal, and parenteral forms

Chlorpromazine is also used to decrease

preoperative restlessness and apprehension, to treat intermittent porphyria, as an adjunct in the treatment of tetanus, and to control nausea, vomiting, and intractable hiccups

Mania

state of hyperexcitability; one phase of bipolar disorders, which alternate between periods of severe depression and mania

Schizophrenia

the most common type of psychosis; characteristics include hallucinations, paranoia, delusions, speech abnormalities, and affective problems

A client taking a CNS stimulant may experience altered sleep patterns. What can the nurse instruct the client to do to help with altered sleep patterns? Select all that apply

• Be active during the day. • Avoid other caffeine. • Administer the drug early in the day.

Which of the following represent the parts of the central nervous system (CNS)? (Select all that apply)

• Brain • Spinal cord

The phenothiazines

often turn the urine pink to reddish-brown as a result of their excretion

Before administering lithium to a client, the nurse should check for the concomitant use of which of the following drugs, which could cause serious adverse effects?

- Ibuprofen - Haloperidol - Thiazide diuretics - Antacids

Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which of the following?

- Positioning to decrease discomfort of dyskinesias - Implementing safety measures to prevent injury - Careful teaching to alert the patient and family about this adverse effect

African Americans respond more rapidly to antipsychotic medications and have a greater risk

- tardive dyskinesia - higher red blood cell plasma lithium ratio

A client comes into the emergency department and is agitated, swiping his arms at "the bugs" and screaming that Harry Potter sent the bugs to take him away. After two security officers help to restrain the client, the doctor orders 5 mg of Haldol STAT. How would the nurse administer this drug?

5 mg IM in the client's gluteus maximus

A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?

A 48-year-old Caucasian man who has adult-onset diabetes

Which of the following is usually administered before, during, and after CNS stimulant administration to a patient with respiratory depression?

Oxygen

Which of the following CNS stimulants is used in the treatment of obesity?

Phentermine (Adipex-P)

Your client relates that she is taking Valium for a muscle relaxant and Provigil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of your client education, you would include which of the following?

Provigil may decrease the effects of her contraceptive, and she may need to use other protection

Pediatric patients given atomoxetine (Strattera) should be monitored closely for which of the following?

Suicidal ideation

A patient is receiving clozapine. Which of the following would the nurse expect to monitor weekly?

White blood cell count

Established pediatric regimens

chlorpromazine haloperidol pimozide prochlorperazine risperidone thioridazine trifluoperazine

Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include

schizophrenia

Lithium toxicity can be dangerous. Patient assessment to evaluate for appropriate lithium levels would look for

serum lithium levels <1.5 mEq/L

Prochlorperazine is also frequently used to control

severe nausea and vomiting associated with surgery and chemotherapy

Antipsychotic drugs are also known as neuroleptic drugs because

they cause numerous neurological effects.

Antipsychotics are classified as

typical or atypical

The nurse should suspect lithium toxicity in a client that experiences which of the following symptoms? Select all that apply

• Diarrhea • Lack of coordination • Muscle weakness

Which of the following are true in regards to the effect of caffeine on the body? Select all that apply:

• Diuresis • Respiratory stimulation • Central nervous system (CNS) stimulation

The use of CNS stimulants is contraindicated in clients with which of the following conditions? Select all that apply:

• Epilepsy • COPD • Glaucoma

A nurse recommends a client avoid other CNS stimulants while taking dexmethylphenidate (Focalin) which include which of the following? Select all that apply:

• Tea • Chocolate • Coffee • Cola drinks

Which of the following statements should be included in the teaching plan for a patient receiving methylphenidate (Ritalin)?

"Adverse effects include hypertension and nervousness."