35 - 38

Drug Interactions of Tricyclics

MAOIs Direct-acting sympathomimetic drugs Indirect-acting sympathomimetic drugs Anticholinergic agents- intensified. CNS depressants- augments CNS depression.

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching?

-"I will reduce my salt intake while taking this medication."

A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching?

-"It may take 3 to 4 weeks before my mood is elevated."

The nurse is caring for a patient who is receiving pramipexole [Mirapex]. The nurse is most concerned if the patient makes which statement?

-"Sometimes I just fall asleep without warning."

A patient with mild symptoms of AD is prescribed donepezil [Aricept]. Which statement made by the patient indicates the need for further teaching?

-"The drug will stop damage to the neurons in my brain."

A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring?

-"The medication does not seem to be working as well."

The nurse cares for a patient with depression who has been prescribed an antidepressant. When would the nurse expect the medication to reach its full therapeutic effect?

-In 2 to 3 weeks

A patient taking levodopa/carbidopa [Sinemet] for Parkinson's disease experiences frequent "on-off" episodes (i.e., the abrupt loss of effect). Which action by the nurse is best?

-Instruct the patient to avoid high-protein foods.

The nurse prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what?

-The orthostatic blood pressure measurements

Barbiturate adverse effects

-Thiopental -Secobarbital -Phenobarbital can cuase Respiratory depression Suicide Abuse Use in pregnancy Exacerbation of intermittent porphyria Hangover Paradoxical excitement Hyperalgesia

Which manifestations does the nurse associate with tardive dyskinesia?

-Twisting, worm-like movements of the tongue and face

what is Doxepin used for

-antidepressant with strong sedative effects - used to treat patients who have trouble staying asleep

1st gen antipsychs

-block dopamine -cause movement disorders (EPS)

3 types of meds for bipolar

-mood stabalizer (lithium) -antipsych -antidepressant

2nd gen antipsychs

-produce only moderate blockade of dopamine -stronger blockade of serotonin -Fewer EPS -Clozapine

Classes of Sedative-Hypnotic Drugs include:

-Benzodiazepines -Benzodiazepine-like drugs -Ramelteon: a melatonin agonist -Barbiturates

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient?

-Flumazenil [Romazicon]

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question?

-Furosemide [Lasix]

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food?

-Grapefruit juice

antidote for opioid OD

narcan

What is the most common side effect of venlafaxine (Effexor XR)?

nausea

the nurse prepares to administer lithium to a patient. which laboratory result should first be assessed? a. urinary creatinine clearance b. serum toponin I and T levels c. fasting blood glucose level d. serum lipid profile

urinary creatinine clearance

First line antidepressant approved for generalized anxiety disorder

venlafaxine (Effexor XR)

For clients taking clozapine, it is necessary to regularly monitor what lab test during the initial months of therapy and periodically thereafter?

white blood cell (WBC) count

risperidone

2nd gen antiphyschotic

Treatment plan for PTSD

psychotherapy and drugs

Treatment for serotonin syndrome

Cyproheptadine

Drug therapy for OCD

SSRIs

Anxiolytic

a drug that lessens anxiety

Anxiety is characterized by

fear, apprehension, dread, and uneasiness

best med for neuropathic pain

gabapentin

1st gen antihistamine

hydroxyzine

They are okay to take

while breastfeeding and in the elderly.

Lithium adverse

•Gastrointestinal effects •Tremors •Polyuria •Renal toxicity •Goiter and hypothyroidism Teratogenesis

Lithium

-0.8-1.4 -Mechanism of action: Neurotrophic, Neuroprotective -short half-life

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action?

Inform the prescriber and monitor for GI and CNS effects

drug class that should NOT be used for allergic rhinitis

bronchodilators

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

B. Neck spasms Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding.

Parkinsonism adverse

Bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cogwheeling, and stooped posture

What drug to treatm neuroleptic malignant syndrome?(2)

Dantrolene and bromocriptine

Benozos interact with

Other CNS depressants

A client with diagnoses of Parkinson's disease and hepatic disease is to begin tolcapone therapy. What monitoring intervention should be included in the client's plan of care?

a baseline liver function test

The students are learning about medications to treat ADHD. The pharmacology instructor discusses the medication methylphenidate, used to treat attention deficit hyperactivity disorder. According to the instructor, methylphenidate is which?

a central CNS stimulant

TCA

amitriptyline (elavil)

Panic disorder

an anxiety disorder that consists of sudden, overwhelming attacks of terror

The nurse prepares to administer a cholinesterase inhibitor to a patient with AD. Which medication, if ordered by the health care provider, should the nurse question?

-Amitriptyline [Elavil]

Which drugs are considered neuroleptics? Asenapine Lurasidone Aripiprazole Thioridazine Chlorpromazine

Thioridazine Chlorpromazine

What are SGA's(atypical) and mechanism of action?

Second generation antipsychotics Moderately block dopamine type 2 but stronger blocker of SERATONIN

An older patient with skin cancer and hypertension is prescribed levodopa/carbidopa [Sinemet] to treat Parkinson's disease. Which action by the nurse is best?

-Ask the patient about the type of skin cancer.

A patient is prescribed isocarboxazid [Marplan] for the treatment of depression. Which foods should the patient be taught to avoid?

-Bananas, smoked fish, and cheese

A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia?

-Clozapine [Clozaril]

What are SEDATIVE HYPNO TONIC DRUGS used for?

-Depress CNS function -Primarily used to treat anxiety and insomnia -Antianxiety agents or anxiolytics -Distinction between antianxiety effects and hypnotic effects is often a matter of dosage

A client has been prescribed alprazolam 0.5 mg PO t. i. d. for the treatment of anxiety. What statement by the client demonstrates an accurate understanding of the drug regimen?

"I will make sure not to stop the drug abruptly."

Which statements about zaleplon [Sonata] does the nurse identify as true? (Select all that apply.)

- Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. Correct - Zaleplon [Sonata] interacts with the neurotransmitter GABA explanation:

other drugs used for treatment of insomnia

- antihistamines -Diphenhydramine-benedryl - Doxylamine -melatonin

Patient should be cautioned to avoid which when taking skeletal muscle relaxants?

Alcohol

what are the sleep phases

1. REM ( Rapid Eye movement) 2. NREM ( Non rapid Eye movement)

A patient has an infection affecting a central nervous system (CNS) component. Which structure makes the delivery of antibiotic therapy more difficult? Blood-brain barrier Chemotherapeutic trigger zone Neuropeptide receptors Thalamic synapses

Blood brain barrier The blood-brain barrier normally is protective, but it can also interfere with the delivery of some therapeutic agents. This is one reason CNS infections are critical.

A patient who experiences panic attacks in social situations has been prescribed an antianxiety medication. What should the nurse check before administering the drug?

Blood pressure

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action? Affect short-term memory Permit a healthier lifestyle Allow the client to tolerate small amounts of alcohol Cause a severe adverse reaction if alcohol is consumed

Cause a severe adverse reaction if alcohol is consumed

What are FGA's and what is there mechanism of action?

First generation antipsychotic- block dopamine type 2 receptors

The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include?

Informing the client and family that seizure control is not gained immediately

A male client's physician orders levodopa for the treatment of the client's Parkinson's disease. The client asks the nurse whether the levodopa will cure his condition. Which is a correct statement about the effects of levodopa?

It does not alter the underlying disease process, but it may improve a client's quality of life.

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential?

Phenobarbital [Luminal Sodium] explanation: Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.

A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms?

Polydipsia, slurred speech, and fine hand tremors

A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?

Reduction of muscle spasm

Monoamine Oxidase Inhibitors

Second or third choice antidepressants for most patients As effective as TCAs and SSRIs but more hazardous Risk of triggering hypertensive crisis if patient eats foods rich in tyramine Drug of choice for atypical depression Isocarboxazid [Marplan] Phenelzine [Nardil] Tranylcypromine [Parnate]

If you're barbiutatue toxic then

Symptoms -Respiratory depression -Coma -Pinpoint pupils Treatment Removal of barbiturate from the body Maintenance of an adequate oxygen supply to the brain Administration Oral, Intravenous, Intramuscular

gastric lavage activated charcoal IV Na+ bicarb

TCA toxicity treatment

The nurse teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective?

The drug may leave a bitter taste in my mouth

Basic Considerations

Time course of response Symptoms resolve slowly Initial responses develop after 1 to 3 weeks Maximal responses may not be seen for 12 weeks Failure when taken 1 month without success- may increase, dosage, change drug, or add a drug. Drug selection Antidepressants have nearly equal efficacy- different side effects.

Respiratory distress is a contraindication for the use of barbiturates.

True

Obsessive-compulsive disorder (OCD)

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

Generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal

What is the most common psychiatric illness?

anxiety

Which manifestations does the nurse associate with tardive dyskinesia?

Twisting, worm-like movements of the tongue and face

SGA's(4)

Clozapine, olanzapine, repiridone, apripiprazole

Lorazepam antidote

Fuemazenil (Romazicon)

medication for HYPOthyroidism

levothuroxine

Cymbalta drug interactions:

Alcohol and MAOIs. Cimetidine, Cipro, Prozac, and Quinidine can cause toxicity. Taper with cymbalta.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? Tonic-clonic Absence Simple partial Complex partial

B. Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

What do barbiturates do?

Binds to the GABA receptor-chloride channel complex

The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?

Improving

Which adverse effect is least likely to occur in a client who is prescribed clozapine? Seizures Sedation Akathisia Myocarditis

Myocarditis

which med has antipyretic, anti-inflammatory, and analgesic properties

aspirin

A client who has schizophrenia is receiving a phenothiazine antipsychotic medication. Which serious client responses to the medication will the nurse immediately report to the primary healthcare provider? Akathisia Shuffling gait Yellow sclerae Photosensitivity Involuntary tongue movements

Yellow sclerae Involuntary tongue movements

A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse's best response?

"Long-term use of benzodiazepines can result in dependency."

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? "With proper treatment, we can completely eliminate your seizures." "Our goal is to reduce your seizures to an extent that helps you live a normal life." "Epilepsy medication does not reduce seizures in most patients." "These drugs will help control your seizures until you have surgery."

"Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

what are sedative hypnotic drugs

- benzoiazepines - benzodiazepine like drugs - barbituates

Treatment for social anxiety disorder (social phobia)

psychotherapy, SSRIs, paroxetine (Paxil, and sertraline (Zoloft)

A client is admitted to the emergency department for an opioid overdose. What would the nurse expect to administer to this client?

Naloxone

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam?

Flumazenil [Romazicon] Correct explanation: Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol]

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) Bupropion [Wellbutrin] Imipramine [Tofranil] Fluoxetine [Prozac] Desvenlafaxine [Pristiq] Sertraline [Zoloft]

Fluoxetine Sertraline Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

How long does uncontrollable worrying occur before it is considered generalized anxiety disorder?

6 months or longer

Mechanism of Action in Tricyclics

Block neuronal reuptake of two monoamine transmitters: NE and serotonin.

Physical dependence

Can cause physical dependence, but the incidence of substantial dependence is low

A patient is brought to the emergency department for treatment of an overdose of alprazolam (Xanax). Which medication should the nurse prepare to administer to this patient?

Flumazenil (Romazicon)

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient?

Flumazenil [Romazicon]

Nurse teaches a pt about bupropion (wellbutrin) which statement by patient indicates that more teaching is indicated? a. i can take the drug w food to reduce nausea b. drug will increase my interest in sex c. i may experience decreased appetite and weigh loss d. i had a serious head injury 3 years ago

I had a serious head injury 3 years ago

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching?

I will reduce my salt intake while taking this medication

Tolorance of benzos

Tolorance with benzos build up with some effects but not others

A client is receiving a monoamine oxidase inhibitor (MAOI). What does the nurse teach the client? It is necessary to avoid the sun. Drowsiness is an expected side effect of this medication. The therapeutic and toxic levels of the drug are very close. Many prescribed and over-the-counter drugs cannot be taken with this medication.

Many prescribed and over-the-counter drugs cannot be taken with this medication.

Lorazapam and me!

Maximizing therapeutic effects Give at scheduled intervals throughout the day. Administer in PM if insomnia is a problem - BEFORE BED Minimizing adverse effects If GI distress occurs, administer lorazepam WITH FOOD Monitor for paradoxical reactions and stop the drug if they occur. Prevent Falls Never stop abruptly (tapered off over 6-8 weeks) Give cautiously to elderly Do not give if the client is pregnant

Suicide Risk With Antidepressants

May increase suicidal tendencies during early treatment esp w adolescents. Teach pts to watch for worsening mood, suicidality, and changes in bx. Prescriptions should start as low as possible. Dosing of inpatients should be directly observed

The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? Morning sedation A respiratory rate of 30 breaths per minute Constipation A blood pressure of 160/88 mm Hg

Morning sedation The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).

Prozac: mechanism of action

Produce selective inhibition of serotonin reuptake Produce central nervous system (CNS) excitation

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?

Provide respiratory assistance

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?

Pyridoxine (vitamin B6)

Antidepressant classes used for treatment of panic disorder

SSRIs, TCAs, MAOIs

6. A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?

Suspect a possible paradoxical reaction to the clorazepate. explanation: Patients taking benzodiazepines for anxiety sometimes develop paradoxical responses to the drug, which include insomnia, excitation, euphoria, heightened anxiety, and rage. A missed dose would trigger withdrawal symptoms, which would include anxiety, insomnia, sweating, tremors, and dizziness. Because this is a paradoxical reaction to the drug, a longer-acting drug would make the symptoms worse. This is not caused by overdose, which would manifest as drowsiness, lethargy, and confusion, so a drug level is not warranted.

albuterol drug class

beta 2 agonist

Before administering ramelteon [Rozerem] to a patient on the medical unit, which action by the nurse is best?

•Rationale: Ramelteon should be used with caution by patients with moderate hepatic impairment, and it should be avoided by those with severe hepatic impairment. For patients with hepatic impairment, elimination is delayed, and drug levels can rise. Food can reduce both the rate and extent of the absorption of ramelteon; the medication should not be taken with a high-fat meal. No evidence suggests that taking ramelteon leads to physical dependence or abuse.

The nurse prepares to administer lithium to a patient. Which laboratory result should first be assessed?

•Rationale: Renal function (eg, serum creatinine level, creatinine clearance, urinalysis) should be evaluated before the administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include a complete blood count with differential, serum electrolyte levels, renal function, and thyroid function.

The nurse teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective?

•Rationale: The most common adverse effect of eszopiclone is a bitter aftertaste. Eszopiclone should be taken just before bedtime. Amnesia is not an adverse effect of eszopiclone. Studies of eszopiclone have not indicated the presence of tolerance.

A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? "Amantadine was developed as an antiviral agent but is now used for treatment of PD." "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." "Amantadine works rapidly and does not lose its effectiveness." "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."

"Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications." Amantadine was developed as an antiviral agent, but this response is not helpful to explain the use of the medication to the family member. Medication effects develop rapidly—often within 2 to 3 days—but are much less profound than with levodopa or the dopamine agonists. Furthermore, effects may begin to diminish within 3 to 6 months. Amantadine is not considered a first-line agent. However, the drug may be helpful for managing dyskinesias caused by levodopa.

A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? "Have you noticed any swelling in your feet?" "Are you having vivid dreams or hallucinations?" "Have you noticed any changes in your stool?" "Have you had your flu vaccine?"

"Are you having vivid dreams or hallucinations?" Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?

"Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia."

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

"Have you had any changes in your mood or anxiety level?" In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

A patient is prescribed ergotamine tartrate [Ergomar] for migraine headaches. Which statement made by the patient indicates a need for further teaching?

"I am not at risk for physical dependence with this drug."

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? "The medication should not make me feel sleepy." "I should take the medication on an empty stomach." "I'll need to discuss a reliable form of birth control with my gynecologist." "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

"I should take the medication on an empty stomach." Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

10. A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?

"Phenobarbital doses for seizures are nonsedating."

A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect? "Rasagiline may cause insomnia, so monitor your sleeping habits." "It is important to avoid tyramine-containing foods." "You may be at increased risk for malignant melanoma, so have regular skin checks." "You may experience side effects, such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."

"Rasagiline may cause insomnia, so monitor your sleeping habits." Unlike selegiline, rasagiline does not cause insomnia. Rasagiline may pose a risk of hypertensive crisis and hence patients should be instructed to avoid tyramine-containing foods. Rasagiline may increase the risk of malignant melanoma, a potentially deadly cancer of the skin. Periodic monitoring of the skin is recommended. Side effects are headache, arthralgia, dyspepsia, depression, and flu-like symptoms.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? "Take the medication with a glass of grapefruit juice each morning." "Notify the physician if you are gaining weight or your legs are swollen." "Nausea, vomiting, and indigestion are common side effects of carbamazepine." "Have liver function tests performed on a routine basis."

"Take the medication with a glass of grapefruit juice each morning." Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug?

"Take this drug as soon as you feel the first signs of a migraine."

A client has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse?

"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective."

A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?

"There may be an increased risk of suicide while taking this drug."

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? "You have apparently developed resistance to your current medication and will have to change to another drug." "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." "You should try to keep taking your medication at the current dose. These effects will go away with time."

"This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

A patient is prescribed venlafaxine [Effexor XR] and requests information about the medication. Which response by the nurse is most appropriate?

"Venlafaxine [Effexor XR] is used to treat anxiety and depression."

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan?

"When it is time to discontinue this drug, you will need to taper it off slowly." Correct

3. A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?

"When this drug is metabolized, the resulting compound has longer-lasting effects." explanation: Flurazepam has a half-life of 2 to 3 hours; however, its metabolite has a long half-life, so giving the drug results in long-lasting effects. Barbiturates, not benzodiazepines, are commonly associated with residual, or hangover, effects. A paradoxical reaction to a sedative would manifest as insomnia, euphoria, and excitation, not drowsiness. Tolerance means that the patient would need increased amounts of a drug to get the desired effects and would not have prolonged effects of the medication.

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct?

"Yes, there is a medication that works with your body's melatonin and is not a controlled substance." Correct

When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.)

- Benzodiazepines have a high safety profile. Correct - Benzodiazepines have a low ability to cause tolerance. Correct - Benzodiazepines have a low abuse potential. Correct

what is a side effect from benzo

- CNS depression - anterograde amnesia -sleep driving - paradoxical effects ( opposite effect of what the medicine is suppose to do) - respiratory depression

benzodiazepines drugs

- Diazepam ( Valium) / Lorazepam and alprazolam (most prescribed drug)

what are the other drugs used for treatment of insomnia

- antidepressant ( Trazodone- Oleptro) - is used a lot for alchoholics

what is the mechanism of action for barbituates

- binds to the GABA receptor chloride channel complez

what are sedative-hypnotic drugs

- drugs that depress the CNS function - treats anxiety/ insomnia - are antianxiety agents/ anxiolytics -antianxiety and hypnotic effects are often a matter of dosage

what are benzodiazepines and benzodiazepine receptor agonists

- drugs to treat insomnia and anxiety - is used to induce general anesthesia - manages seizure disorders, muscle spasms, panic disorders and withdrawal from alcohol - safer then general CNS depressant -low potential for abuse -fewer drug interactions

ramelteonL metalonin agonist

- for patients who dont wake up - rapid onset - 30 minutes

benzo like drugs: Zaleplon (Sonata)

- new class of hypnotics, pyrazolopyridimines - shrt term management of insomnia - side effects: headache, nausea, drowsiness, dizziness, myalgia, and abdominal pain

benzo like drugs: Zolpidem ( Ambien)

- sedative hypnotic - shrt term management of insomnia - side eff: daytime drowsiness and dizziness

benzo like drugs: Eszoplicone (lunesta)

- the S-isomer of zopliclone - trtment of insomnia

the nurse teaches a patient about eszopliclone ( lunesta). which statement by the patient indicates the teaching has been effective

- the drug may leave a bitter taste in my mouth

what is the ultrashort acting barbituate

- thiopental

what are barbituates

- used for sedation. anti seizure - causes tolerance and dependance - high abuse potential - powerful respiratory depressant that can be fatal with overdose - are used much less now due to new and safer drugs like benzo

The nurse teaches a 16-year-old female patient about methylphenidate (Ritalin). Which statement by the patient indicates that more teaching is needed?

-"I can have an unlimited number of noncola soft drinks."

The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated?

-"I had a serious head injury 3 years ago."

The nurse provides teaching for a patient with obsessive-compulsive disorder who has been prescribed Sertraline [Zoloft]. Which statement by the patient indicates that more teaching is necessary?

-"I will feel better in 3 weeks."

The nurse teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective?

-"The drug may leave a bitter taste in my mouth."

A nurse instructs a parent about the administration schedule for Adderall XR (amphetamine/dextroamphetamine mixture) to treat the child's ADHD. The nurse determines that teaching is successful if the parent makes which statement?

-"The drug should be given in the morning, before school."

The nurse instructs a young adult patient about triazolam [Halcion] for the short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of the instructions?

-"The medication will not affect my breathing."

The nurse receives a phone call from a patient who has been taking a CNS drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best?

-"The nausea will most likely decrease over time."

A patient is prescribed the dopamine agonist pramipexole [Mirapex]. Which statement made by the patient indicates a need for further teaching?

-"This drug will stop the progression of Parkinson's disease."

Serotonin Syndrone

-2-72 hours after treament -altered mental status -incoordination, myoclonus, hyperflexion -increased risk w/ MAOIs

Other benzodiazepines short acting AL-LO FL-OX-ES-T FET us used for sleep

-Alprazolam (Xanax) anxiety, panic disorder Lorazepam (Ativan) anxiety, anesthesia, Alcohol withdrawal Flurazepam (Dalmane) insomnia Oxazepam (Serax) anxiety, Alcohol withdrawal Estazolam (ProSom) insomnia Temazepam (Restoril) insomnia

What are benzos used for?

-Anxiety disorders -Insomnia, seizures -Muscle spasms and tension -Acute alcohol withdrawal symptoms -Panic disorder -Induction of general anesthesia -IV doses used in conscious sedation and preanesthesia

Miscellaneous Sedative-Hypnotics

-Basic pharmacologic profile -Nonselective CNS depressants Actions much like those of barbiturates Acute overdose resembles poisoning with barbiturates ----Avoid during pregnancy and lactation -Chloral hydrate -Meprobamate -Paraldehyde

The nurse prepares to administer memantine [Namenda] to a patient with severe AD. The nurse should assess what before administering of the medication?

-Blood urea nitrogen and serum creatinine

Adverese effects

-CNS depression Mild drowsiness, ataxia, confusion, respiratory disturbances, bradycardia, and hypotension Tolerance possible if used long term

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question?

-Cimetidine [Tagamet]

The nurse is caring for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety?

-Clonazepam [Klonopin]

Before administering ramelteon [Rozerem] to a patient on the medical unit, which action by the nurse is best?

-Consult the prescriber if the patient has chronic hepatitis.

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid?

-Diphenhydramine [Benadryl]

Lorazepam Contraindications and precautions

-Hypersensitivity, - psychoses, -acute narrow-angle glaucoma, and ----use in children younger than 6 months

A patient is concerned about developing AD. What should the nurse include in the teaching plan?

-No solid evidence supports the use of drugs to prevent AD.

A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms?

-Polydipsia, slurred speech, and fine hand tremors

Benzodiazepine function

-Potentiate the effect of gamma-aminobutyric acid (GABA), an inhibitory CNS neurotransmitter = resulting in CNS depression -First choice for anxiety and insomnia -selection depends on short of long half-life -High margin of safty

A child with ADHD has been prescribed Daytrana (a transdermal methylphenidate patch). When teaching the child's caregiver how to administer the medication, which instruction should the nurse include in the teaching?

-Remove the patch within 9 hours of application.

Fluoxetine (Prozac)

-SSRI -bipolar -panic -bulimic -Off label: PTSD, social phobia, alcoholism, adhd, touretts -produce CNS excitation

Manging insomia

-Sleep physiology -Sleep phases -Basic management principles -Cause-specific therapy -Nondrug therapy -Drugs used for treatment Hypnotic drugs

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching?

-Teach the patient to avoid the abrupt cessation of treatment.

The nurse prepares to administer lithium to a patient. Which laboratory result should first be assessed?

-Urinary creatinine clearance

A child takes Adderall XR (amphetamine/dextroamphetamine mixture) for ADHD. The nurse should assess the child for which adverse effects?

-Weight loss, restlessness, and chest pain

what is the treatment for barbituate overdose

-removal with activated charcoal - maintenence with O2 supply to the brain

The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer? 0.25 0.5 1 4

0.25 The available medication is 2 mg/mL. Divide 2 mg/mL by 4/4 to equal 0.5 mg/0.25 mL. This is the same as recognizing that 2 mg/mL equals 1 mg/0.5 mL, which equals 0.5 mg/0.25 mL. Continue dividing the top and bottom numbers in half.

Adverse effects of FGA's? EPA(4)

1. Acute dystonic reaction (muscles of face, neck upper back, larynx all spasm, eyes roll upward) 2. Akathisia (restless movement) 3. Parkinsonism (slowed movement, mask like face) 4. Tardive dyskinesia (wormlike movements of tongue and face) can be permanent

The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer? 1 mL 10 mL 100 mL 0.1 mL

10 mL The available concentration of amantadine is 10 mg/mL. The ordered dose of 100 mg would equal 10 mL of syrup. 100 mg/10 = 10 mL.

ID: 3772720636 The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? 800 mg 1400 mg 1600 mg 3200 mg

1600 24 hours divided by every-6-hour doses equals 4 doses of 400 mg. 400 mg times 4 doses equals 1600 mg.

haloperidol class

1st gen antipsychotic

Drugs used to treat PTSD

3 SSRIs- fluoxetine, paroxetine, and sertraline; and one serotonin/norepinephrine reuptake inhibitor (venlafaxine)

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? 250 mg 500 mg 750 mg 1000 mg

750 The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid? Glucosamine sulfate Omeprazole [Prilosec] Fish oil (omega-3 fatty acids) Diphenhydramine [Benadryl]

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid? Glucosamine sulfate Omeprazole [Prilosec] Fish oil (omega-3 fatty acids) Diphenhydramine [Benadryl]

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? (Select all that apply.) A. Depression B. Panic disorder C. Social anxiety disorder D. Post-traumatic stress disorder E. Obsessive-compulsive disorder

A, B, C, and E Rationale: Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful? A. "The primary treatment is therapy, but there are some medications that have been somewhat effective." B. "The primary treatment is monotherapy with an SSRI." C. "The primary treatment is a combination of multiple medications." D. "The primary treatment is benzodiazepine for anxiety."

A. Rationale: Post-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved for PTSD. If none of the first-line drugs are effective, the guidelines suggest several alternatives: mirtazapine, a TCA (amitriptyline or imipramine), or an MAOI (phenelzine). Current evidence does not support the use of monotherapy with either bupropion, buspirone, trazodone, or a benzodiazepine.

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful? "The primary treatment is therapy, but there are some medications that have been somewhat effective." "The primary treatment is monotherapy with an SSRI." "The primary treatment is a combination of multiple medications." "The primary treatment is benzodiazepine for anxiety."

A. Post-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved for PTSD. If none of the first-line drugs are effective, the guidelines suggest several alternatives: mirtazapine, a TCA (amitriptyline or imipramine), or an MAOI (phenelzine). Current evidence does not support the use of monotherapy with either bupropion, buspirone, trazodone, or a benzodiazepine.

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." "No, all of the sleep medications are controlled substances." "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." "Yes, but it is not for chronic insomnia."

A. Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long-term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance.

The nurse is working with a group of patients receiving drugs that work in the central nervous system (CNS). Nursing care of these patients is based on which facts? (Select all that apply.) a. Overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. c. Animal studies in progress will greatly enhance knowledge of CNS medications. d. When CNS drugs are taken long term, their effects differ from initial use. e. The blood-brain barrier is permeable to water-soluble drugs.

A. overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. d. When CNS drugs are taken long term, their effects differ from initial use. Even though CNS medications are widely used, much about them remains unclear. The CNS is known to have many more active neurotransmitters than the peripheral nervous system. Animal studies are not particularly helpful in studying CNS drugs, because adequate animal models of mental illness are lacking. Adaptive changes occur in the brain when CNS agents are taken over time. This can increase the therapeutic effects, decrease the side effects, and contribute to tolerance and physical dependence. The blood-brain barrier is permeable to lipid-soluble agents.

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis, therefore, is most likely? A. Panic disorder B. Bipolar disorder C. Generalized anxiety disorder D. Clinical depression

A. panic disorder Rationale: Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? Tonic-clonic Absence Atonic Myoclonic

Absence. This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? Increased risk of infection Reddened, swollen gums Nausea, vomiting, and indigestion Central nervous system depression

According to Evolve: Nausea, vomiting, indigestion Rationale: Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation. According to quizlet questions: D) Central nervous system depression Valproic acid is generally well tolerated. It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia. It causes minimal sedation. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.

The nurse is caring for a patient with depression who takes citalopram [Celexa], an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process? Adaptive changes in the brain Drug tolerance and dependence A wide therapeutic index Improved neuronal transmission

Adaptive changes in the brain The brain adapts to CNS agents over time. The beneficial effects of antidepressants are believed to be delayed because they result from adaptive changes.

A client with mild Alzheimer disease has been taking galantamine, and the primary healthcare provider prescribes paroxetine for depression. For what effect will a nurse assess the client when these medications are taken concurrently? Allergic Dystonic Additive Extrapyramidal

Additive

A client is prescribed a monoamine oxidase inhibitor. What foods does nurse teach the client to avoid when taking this medication? Fresh fish Citrus fruits Aged cheese Ripe avocados Delicatessen meats

Aged cheese Ripe avocados Delicatessen meats

Biggest side effects of clozapine?

Agranulocytosis (Low neutrophil count)

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? Venlafaxine [Effexor] Buspirone [BuSpar] Paroxetine [Paxil] Alprazolam [Xanax]

Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.

The nurse prepares to administer lithium to a patient. The nurse should assess what before administration of the medication? Urinary creatinine clearance Serum troponin I and T Fasting blood glucose Serum lipid profile

Answer: A Rationale: Renal function (e.g., serum creatinine, creatinine clearance, urinalysis) should be evaluated before administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy, and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include complete blood count with differential, serum electrolytes, renal function, and thyroid function.

Which individual would be more sensitive to the effects of central nervous system drugs? 2-week-old infant who has pyloric stenosis 16-year-old adolescent who has a spinal cord injury 58-year-old adult who has venous insufficiency 74-year-old adult who has Parkinson's disease

Answer: A Rationale: The blood-brain barrier is not fully developed at birth. Accordingly, infants are much more sensitive to central nervous system drugs than are older children and adults.

A patient with obsessive-compulsive disorder is prescribed sertraline. The nurse should intervene if the patient makes which statement? A. "I may develop headaches and trouble sleeping." B. "I will feel better in approximately 3 weeks." C. "I need to take this medication for at least a year." D. "I should watch my diet so that I don't gain weight."

Answer: B Rationale: Beneficial effects of sertraline develop slowly over several months to become maximal. Common side effects include nausea, headache, insomnia, and sexual dysfunction. Weight gain can also occur. Treatment lasts for at least a year, and a trial discontinuation is conducted.

A patient taking levodopa/carbidopa for Parkinson's disease experiences frequent "on-off" episodes (or abrupt loss of effect). Which action by the nurse is best? A. Administer the medication on an empty stomach. B. Instruct the patient to avoid high-protein foods. C. Have the patient increase intake of vitamin B6. D. Discontinue the drug for 10 days (for a "drug holiday").

Answer: B Rationale: Meals high in protein can reduce therapeutic responses to levodopa and may trigger an abrupt loss of effect.

The nurse cares for a patient receiving pramipexole. The nurse is most concerned if the patient makes which statement? "I now use a patch instead of taking birth control pills." "Sometimes I just fall asleep without warning." "The pills make me sleepy, so I take a nap in the afternoon." "I have noticed that this medicine makes me constipated."

Answer: B Rationale: Pramipexole may cause sleep attacks; patients should inform the prescriber and should avoid potentially hazardous activities.

The nurse cares for a patient receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question? Levothyroxine Sulindac Furosemide Propranolol

Answer: C Rationale: Diuretics (e.g., furosemide) promote sodium loss. If sodium is low, renal excretion of lithium is reduced; lithium levels are increased, which may result in toxicity. No steroidal anti-inflammatory drugs (NSAIDs) can increase lithium levels by suppressing prostaglandin synthesis in the kidney and increasing renal reabsorption of lithium. NSAIDs known to increase lithium levels include ibuprofen, naproxen, piroxicam, indomethacin, and celecoxib. However, sulindac does not increase lithium levels. Anticholinergics can cause urinary hesitancy; lithium-induced polyuria may result in considerable discomfort. Patients should avoid drugs with prominent anticholinergic actions (e.g., antihistamines, phenothiazine antipsychotics, tricyclic antidepressants). Levothyroxine is safe to administer with lithium; lithium may cause hypothyroidism. Propranolol should be administered with caution because lithium toxicity can cause hypotension; propranolol may also cause hypotension.

A patient is prescribed isocarboxazid for treatment of depression. Which foods should the patient be taught to avoid? A. Broccoli, shrimp, and yogurt B. Tomatoes, chicken, and milk C. Bananas, smoked fish, and cheese D. Apples, steak, and cottage cheese

Answer: C Rationale: Foods high in tyramine should be avoided if a patient is taking monoamine oxidase inhibitors (MAOIs) such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine, causing massive vasoconstriction and excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

Rationale: The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (for example, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (for example, dizziness, headache, nausea, tremor, anxiety, and dysphoria).

Answer: C Rationale: Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

An elderly patient with skin cancer and hypertension is prescribed levodopa/carbidopa to treat Parkinson's disease. Which action by the nurse is best? Give the medication if the blood pressure is normal. Administer the medication as prescribed. Ask the patient about the type of skin cancer. Hold the medication if the patient is older than 65 years.

Answer: C Rationale: Levodopa can activate malignant melanoma and consequently should be avoided in patients with undiagnosed skin lesions.

The nurse instructs a patient taking paroxetine for post-traumatic stress disorder (PTSD). Which statement, if made by the patient to the nurse, indicates understanding about the instructions? "This drug is effective only if PTSD is related to combat." "The drug must be effective because it is approved for PTSD." "It is not clear whether this drug is an effective treatment for PTSD." "This drug is more effective than any other type of therapy."

Answer: C Rationale: Optimal treatment for post-traumatic stress disorder (PTSD) with psychotherapy and/or drugs has not been established. Exposure therapy is a type of psychotherapy that has sufficient proof of efficacy to recommend its use. Regarding drugs used for PTSD, there is no proof that any of them help, including paroxetine and sertraline, the only agents approved for PTSD by the Food and Drug Administration (FDA). Events that can lead to PTSD include physical or sexual assault, rape, torture, combat, industrial explosions, serious accidents, natural disasters, being taken hostage, displacement as a refugee, and terrorist attacks. Combat carries a high risk of PTSD, but the use of paroxetine is not limited to combat-related PTSD.

A patient who is diagnosed with bipolar disorder is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms? A. Insomnia, increased appetite, and abdominal distention B. Dry cough, hyperactive reflexes, and hypertension C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema

Answer: C Rationale: Signs and symptoms of lithium toxicity include polydipsia, slurred speech, and fine hand tremors. They also include nausea, vomiting, persistent GI upset, diarrhea, clonic movements, hyperirritability of muscles, muscle weakness, and hypotension.

A patient with depression is prescribed fluoxetine. Which statement made by the patient indicates an understanding of the medication teaching? A. "Disorientation and hallucinations are common." B. "The drug may enhance my interest in sex." C. "It may take 3 to 4 weeks before my mood is elevated." D. "I can stop this medication when I feel less depressed."

Answer: C Rationale: The half-life is prolonged; therefore approximately 4 weeks is required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop in 1 to 3 weeks. Maximal responses develop over 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor (MAOI) or ritonavir. Abrupt discontinuation of fluoxetine can cause withdrawal syndrome (dizziness, headache, nausea, tremor, anxiety, and dysphoria).

A patient is prescribed venlafaxine and requests information about the medication. Which response by the nurse is most appropriate? A. Ask the patient to talk to the prescribing healthcare provider. B. Refer the patient to the pharmacist for detailed instructions. C. Tell the patient the medication treats anxiety and depression. D. Give the patient a pamphlet about drugs used to treat anxiety.

Answer: C Rationale: The nurse should respond to the patient's concerns or questions honestly. Venlafaxine treats both anxiety and depression.

The nurse receives a phone call from a patient who has been taking a central nervous system drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best? "Nausea is not a common side effect of this drug." "You should stop the medication immediately." "The nausea will most likely decrease over time." "Try taking the medication on an empty stomach."

Answer: C Rationale: When central nervous system drugs are taken on a long-term basis, the intensity of side effects may decrease (while therapeutic effects remain undiminished). Adaptations within the brain are believed to underlie these phenomena.

The nurse cares for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. Which medication should the nurse administer to provide immediate relief of anxiety? Fluvoxamine Paroxetine Sertraline Clonazepam

Answer: D Rationale: Benzodiazepines (e.g., clonazepam, alprazolam) provide immediate relief of anxiety and can be used as needed for intense anxiety. Selective serotonin reuptake inhibitors (SSRIs) are first-line drugs for most patients with social anxiety disorder and are especially well suited for patients who fear multiple situations and are obliged to face those situations on a regular basis. Currently, only three SSRIs (fluvoxamine, paroxetine, and sertraline) are approved for social anxiety disorder. Initial effects take about 4 weeks to develop; optimal effects are seen in 8 to 12 weeks.

The nurse teaches a patient about bupropion. Which statement by the patient requires an intervention by the nurse? "I can take the drug with food to reduce nausea." "This drug will increase my interest in sex." "I may experience decreased appetite and weight loss." "I had a serious head injury 3 years ago."

Answer: D Rationale: Bupropion is generally well tolerated but can cause seizures; bupropion should be avoided in patients with past head trauma because their risk for seizures is increased. Bupropion does not cause weight gain or sexual dysfunction; it appears to increase sexual desire and pleasure. Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset.

A patient is prescribed a dopamine agonist, pramipexole. Which statement made by the patient indicates a need for further teaching? A. "The drug should be taken with food to prevent nausea." B. "I may experience hallucinations while taking this drug." C. "I should rise slowly to prevent dizziness and fainting." D. "This drug will stop the progression of Parkinson's disease."

Answer: D Rationale: Dopamine agonists will improve patients' abilities to complete activities of daily living but are not a cure and will not delay progression of Parkinson's disease.

A patient is brought to the emergency department for treatment of an overdose of alprazolam. Which medication should the nurse prepare to administer to this patient? Protamine sulfate Acetylcysteine Naloxone Flumazenil

Answer: D Rationale: Flumazenil, a benzodiazepine receptor antagonist, can be used to treat benzodiazepine overdose. Protamine sulfate is the antidote for heparin overdose, acetylcysteine is the antidote for acetaminophen overdose, and naloxone is the antidote for an opioid overdose.

A patient with bipolar disorder is prescribed lithium. Which statement if made by the patient indicates a need for further teaching? A. "I can take the medication with milk or a snack." B. "I will call my doctor if I feel hyperactive." C. "I should drink at least 8 to 10 glasses of water every day." D. "I will reduce my salt intake while taking this medication."

Answer: D Rationale: Lithium may be taken with milk or food to decrease gastric upset. Feelings of mania should be reported promptly; patients may need a mood stabilizer in addition to lithium. Patients taking lithium often experience polyuria and should drink 8 to 10 glasses of water each day. Lithium will accumulate if sodium is restricted in the diet.

A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring? A. "The medication seems to be working better than at first." B. "I feel really sick if I do not take the medication every day." C. "The side effects are not bothering me anymore." D. "The medication does not seem to be working as well."

Answer: D Rationale: Tolerance is defined as a decreased response occurring in the course of prolonged drug use.

Treatment of EPS? What type of med and what are the two?

Anticholinergics like diphenhydramine or benztropine(benadryl)

A client who has been taking valproic acid (sodium valproate) for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?

Antiepilepsy drugs are teratogenic

SSRIs

As effective as tricylic but dont cause hypotensiom, sedation, or anticholinergic -OD doesn't cause cardiac toxicity -OD death is rare

5. A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?

Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Aspirin (ASA) for mild headache Diphenhydramine [Benadryl] for cold symptoms

Aspirin Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time?

At the onset of migraine symptoms

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?

Avoid alcohol or other CNS depressants.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? (Select all that apply.) A. Fluoxetine [Prozac] B. Venlafaxine [Effexor XR] C. Paroxetine [Paxil] D. Escitalopram [Lexapro] E. Duloxetine [Cymbalta]

B, C, D, and E Rationale: Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.

The nurse provides teaching for a pt with OCD who has been prescribed Sertraline (Zoloft). Which statement by the pt indicates that more teaching is necessary? A. "I may develop headaches and trouble sleeping." B. "I will feel better in 3 weeks." C. "I need to take this medication for at least a year." D. "I should watch my diet so that I don't gain weight."

B. Rationale: Beneficial effects of sertraline develop slowly over several months to become maximal. Common side effects include nausea, headache, insomnia, and sexual dysfunction. Weight gain can also occur. Tx lasts for at least a year.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? (Select all that apply.) a. Fluoxetine [Prozac] b. Venlafaxine [Effexor XR] c. Paroxetine [Paxil] d. Escitalopram [Lexapro] e. Duloxetine [Cymbalta]

B. C. D. E. Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? Naloxone [Narcan] Flumazenil [Romazicon] Acetylcysteine [Mucomyst] Vitamin K

B. Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

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

B. severe headache - inform E. Avoid avocado Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis--severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and manic-like reactions have occurred.

Mild EPS treatments

Benzos, anticholinergics, and beta blockers

SSRIs (Prozac)

Bipolar disorder Obsessive-compulsive disorder Panic disorder Bulimia nervosa Premenstrual dysphoric disorder Off-label uses: Post-traumatic stress disorder, social phobia, alcoholism, attention-deficit/hyperactivity disorder, Tourette's syndrome, and obesity

An adolescent with a major depressive disorder is prescribed venlafaxine. What signs or symptoms related to the medication will the nurse communicate immediately to the prescribing provider? Blurred vision Suicidal ideation Difficult urination Tardive dyskinesia Transient hypoglycemia

Blurred vision Suicidal ideation Difficult urination

A client with schizophrenia is started on a regimen of chlorpromazine. After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate 2 mg by mouth daily is prescribed. What does the nurse remember when administering these medications together? Both medications are cholinesterase inhibitors. Both medications have a cholinergic-blocking action. The antipsychotic effects of chlorpromazine will be decreased. The synergistic effect of these medications will cause drooling.

Both medications have a cholinergic-blocking action.

Ramelteon: Melatonin Agonist

Brand name: Rozerem Relatively new hypnotic Activation of melatonin receptors which are mediators for sleep Approved for chronic insomnia: difficulty with sleep onset Rapid onset (about 30 minutes) Use with caution in hepatic impairment Do not take with high fat diet Not recommended in pregnancy & lactation Common adverse effects: headache, daytime sleepiness, dizziness, tiredness, nausea, worsening insomnia, and colds.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? A. "This medication should not make me feel drowsy." B. "This medication should help me feel less anxious." C. "I will drink grapefruit juice instead of coffee with breakfast." D. "I will take my medication three times per day."

C. Rationale: Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

A pt is prescribed venlafaxine (Effexor XR) and requests information about the medication. Which response by the nurse is most appropriate? A. "You will need to talk with your doctor about that." B. "Call your pharmacist, because he/she will know the most about this drug." C. "Venlafaxine (Effexor XR) is used to treat anxiety and depression." D. "I will get you a pamphlet so that you can read about the drug."

C. Rationale: Venlafaxine (Effexor XR) is used to treat anxiety and depression.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? "This medication should not make me feel drowsy." "This medication should help me feel less anxious." "I will drink grapefruit juice instead of coffee with breakfast." "I will take my medication three times per day."

C. Grapefruit juice - Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? A. Diarrhea B. Risk for abuse C. Dizziness D. Weight gain

C. dizziness Rationale: Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

Barbituates physiological effects

CNS depression Cardiovascular effects Induction of hepatic drug-metabolizing enzymes

The nurse instructs a patient about eszopiclone (Lunesta). Which statement by the patient to the nurse indicates understanding about the instructions?

Causes bitter tastes

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? Take the medication on a full stomach. Change positions slowly. The drug may cause the urine to be very dilute. Carbidopa has many adverse effects.

Change positions slowly Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

A client has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which food should the client be instructed to avoid eating?

Cheddar cheese and bratwurst

Tardive dyskinesia

Choreoathetoid movements of the tongue and face; lip-smacking movements; tongue flicks out in a "fly-catching" motion; slow, worm-like movement of the tongue; and involuntary movements of the limbs, toes, fingers, and trunk

Prototype second generation antipsychotic

Clozapine

Pathogenesis

Complex and incomplete Possible contributing factors Genetic heritage Difficult childhood Chronic low self-esteem Monoamine hypothesis of depression Depression is caused by the functional insufficiency of monoamine neurotransmitters

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect?

Constipation

The physician orders ramelteon (Rozerem) for a patient on the medical unit. Which action by the nurse is best?

Consult physican of patient has chronic hepatitis Ramelteon should be used with caution by patients with moderate hepatic impairment, and should be avoided by those with severe hepatic impairment. In patients with hepatic impairment, elimination is delayed and drug levels can rise. Food can reduce both the rate and extent of absorption of ramelteon; the medication should not be taken with a high-fat meal. No evidence suggests that taking ramelteon leads to physical dependence or abuse.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? Continue as planned, because the level is within normal limits. Tell the patient to hold today's dose and return to the clinic. Consult the prescriber to recommend an increased dose. Have the patient call 911 and meet the patient in the emergency department.

Continue as planned, because the level is within normal limits The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

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 in the treatment of severe manic episodes to do what? Help control symptoms during the severe manic episode Elevate mood 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

Control symptoms Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

Mechanism of Action in MAOIs.

Convert monoamine neurotransmitters (NE, serotonin, and dopamine) into inactive products Inactivate tyramine and other biogenic amines Two forms of MAO in the body: MAO-A MAO-B Affected by antidepressants Act on MAO in two ways: reversible and irreversible Reversible: Lasts 3 to 5 days Irreversible: Lasts about 2 weeks All of the MAOIs in current use cause irreversible inhibition

The nurse is caring for a pt with social anxiety disorder. The pt is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety? A. fluvoxamine (Luvox) B. paroxetine (Paxil) C. sertraline (Zoloft) D. clonazepam (Klonopin)

D. Rationale: Benzodiazepines provide immediate relief of anxiety and can be used as needed for intense anxiety. SSRIs are first line drugs for most pts with social anxiety disorder, and they are especially well suited for pts who fear multiple situations and face them on a regular basis.

Which statements about zaleplon [Sonata] does the nurse identify as true? (Select all that apply.) a. Zaleplon [Sonata] is a benzodiazepine. b. Zaleplon [Sonata] is indicated for long-term management of insomnia. c. Zaleplon [Sonata] is used to maintain sleep throughout the night. d. Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. e. Zaleplon [Sonata] interacts with the neurotransmitter GABA.

D. E. Zaleplon [Sonata] belongs to a new class of drugs called the pyrazolopyrimidines. It is indicated for short-term management of insomnia. Zaleplon has a rapid onset and short duration of action and therefore is beneficial for initiating sleep but not for maintaining it throughout the night. Zaleplon and cimetidine should not be administered together. Zaleplon interacts with the neurotransmitter GABA.

Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20? Primidone [Mysoline] Lamotrigine [Lamictal] Lacosamide [Vimpat] Topiramate [Topamax]

D. Topiramate The arterial blood gas results reflect metabolic acidosis with partial respiratory compensation. Topiramate can cause metabolic acidosis, because it inhibits carbonic anhydrase; this increases renal excretion of bicarbonate, causing the plasma pH to fall. Hyperventilation is the most characteristic symptom. Primidone, lamotrigine, and lacosamide do not cause metabolic acidosis.

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? A. Venlafaxine [Effexor] B. Buspirone [BuSpar] C. Paroxetine [Paxil] D. Alprazolam [Xanax]

D. alprazolam (Xanax) Rationale: Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.

The client is scheduled for surgery. The nurse administers diazepam (Valium) preoperatively for what purpose?

Decreased anxiety

Therapeutic Uses of Tricyclics

Depression Bipolar disorder Fibromyalgia syndrome Other uses Neuropathic pain Chronic insomnia Attention-deficit/hyperactivity disorder Panic disorder Obsessive-compulsive disorder

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? (Select all that apply.) Depression Panic disorder Social anxiety disorder Post-traumatic stress disorder Obsessive-compulsive disorder

Depression, Panic disorder, social anxiety, OCD Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

What is the prototype for the classification of drugs referred to as benzodiazepines?

Diazepam

Long actings benzos

Diazepam (Valium) Anxiety, seizures, muscle spasm, ETOH- Withradawal, induction of anesthesia Clonazepam (Klonopin) Seizures, panic disorder Chlorazepate (Tranxene) Anxiety, seizures, ETOH-W Chlordiazepoxide (Librium) Anxiety, ETOH-W

Pt. prescribed doxepin (sinequan) for depression. Which over-the-counter med should nurse teach patient to avoid? a. glucosamine sulfate b. omeprazole (prilosec) c. fish oil (omega3) d. diphenhydramine (benedryl)

Diphenhydramine (Benedryl)

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? "When it is time to discontinue this drug, you will need to taper it off slowly." "Protect your skin from the sun to prevent rash and exaggerated sunburn." "Increase your intake of fluid and high-fiber foods to prevent constipation." "Take this medication on an empty stomach at least 2 hours after meals."

Discontinue- taper. Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? Diarrhea Risk for abuse Dizziness Weight gain

Dizziness - Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

Dosages and Routes of Administration

Dosage Initial doses should be low Routes of administration All can be administered by mouth and preferrably at bedtime. Imipramine can be given IM.

Tricyclic Antidepressants: Imipramine

Drugs of first choice for many patients with major depression Most common adverse effects: Sedation, orthostatic hypotension, and anticholinergic effects Similar to phenothiazine antipsychotics Most dangerous adverse effect: Cardiac toxicity May increase risk of suicide during early treatment Single daily dose, but know that there is interpatient individualization.

Anticholinergic effects

Dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, and tachycardia

Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? Trazodone Bupropion Duloxetine Mirtazapine

Duloxetine

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? Diarrhea Dyskinesia Wheezing Headache

Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention? Warn her not to withdraw this drug abruptly. Recommend that she take this medication at bedtime with meals. Teach her family to assist with maintaining a seizure frequency chart. Ensure that genetic testing for HLA-B*1502 is performed.

Ensure genetic testing - Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B*1502. The FDA now recommends that before taking carbamazepine, patients of Asian descent undergo genetic testing.

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient?

Flumazenil [Romazicon]

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? Aged cheese and sherry Grapefruit and other citrus juices Coffee, colas, and tea Potato and corn chips

Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? Norepinephrine Acetylcholine Serotonin (5-HT) Gamma-aminobutyric acid (GABA)

GABA Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter?

Gamma-aminobutyric acid (GABA) Correct

A patient who was on benzodiazepine antianxiety drug therapy intends to discontinue the treatment. What should the nurse suggest regarding continuation of the medication?

Gradually decrease dosage schedule.

more about Lorazepam

Health status Asses for renal and hepatic impairment Life span and gender Pregnancy Category D NEVER GIVE Lifestyle, diet, and habits Assess the patient for the use of other CNS depressants. Environment Oral formulation can be given in any environment. Give at betime Culture and inherited traits Longer T½ in Asians

Hypertensive Crisis

Hypertensive crisis/dietary tyramine Tyramine: Promotes the release of NE from sympathetic neurons Hypertensive crisis Severe headache Tachycardia Hypertension Nausea and vomiting Confusion Profuse sweating Stroke Death

The nurse teaches a 16-year-old female patient about methylphenidate (Ritalin). Which statement by the patient indicates that more teaching is needed?

I can have an unlimited number of noncola soft drinks

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching? a. i can take the medication with milk or a snack b. i will call my doctor if i feel hyperactive c. i should drink at least 8-10 glasses of water every day d. i will reduce my salt intake while taking this medication

I will reduce my salt intake while taking this medication

The nurse cares for a patient with depression who has been prescribed an antidepressant. When would the nurse expect the medication to reach its full therapeutic effect?

In 2 to 3 weeks

Drug Interactions of MAOIs

Indirect-acting sympathomimetic agents Interactions secondary to the inhibition of hepatic MAO Antidepressants: TCAs and SSRIs Antihypertensive drugs Meperidine Preparations, dosage, and administration All MAOIs administered orally

The nurse is preparing to administer phenelzine [Nardil] 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 side effects and drug interactions.

It has more side effects and drug interactions. Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

A patient w depression has been prescribed fluoxetine(Prozac) Which statement by pt. indicates an understanding of the medication teaching? a. Disorientation/hallucinations are common b. the drug may enhance my interest in sex c. it may take 3-4 weeks before my mood is elevated d. I can stop this medication when I feel less depressed

It may take 3-4 weeks before my mood is elevated

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block? Lacosamide [Vimpat] Felbamate [Felbatol] Tiagabine [Gabitril] Levetiracetam [Keppra]

Lacosamide can prolong the PR interval and should be used with caution in patients with cardiac conduction problems and in those taking other drugs that prolong the PR interval, such as calcium channel and beta blockers. Felbamate, tiagabine, and levetiracetam do not affect the PR interval.

The most effective drug to treat major symptoms associated with Parkinson's is:

Levodopa.

Which characteristic improves a drug's ability to reach the central nervous system (CNS)? Protein binding Lipid solubility Electrical charge Ionization

Lipid solubility Because drugs must cross the blood-brain barrier to enter the CNS, only lipid-soluble agents and those that have a specialized transport system are able to cross. Protein binding and ionization (electrical charge) reduce a drug's ability to cross the blood-brain barrier.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? Consumed some foods high in tyramine Not taken the lithium as directed Developed tolerance to the lithium Developed lithium toxicity

Lithium toxicity Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

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

Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

Short acting benzo prototype

Loarazpam (ativan) -for anxeity and insomia -short half life, more than once a day -highly protien bound It increases the effect of GABA givin parenternally or P.O.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? Phenytoin [Dilantin] 200 mg IV over 4 minutes Phenobarbital 30 mg IM Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min. Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

IV vasodilator sodium nitroprusside phentolamine labetulol

MAOI tyramine crisis treatment

SNRIs: Venlafaxine

Major depression Generalized anxiety disorder Social anxiety disorder (social phobia) Blocks NE and serotonin uptake Does not block cholinergic, histaminergic, or alpha1-adrenergic receptors Serious reactions if combined with MAOIs

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? Decaffeinated tea, gelatin cubes, and ginger ale when alert Docusate 100 mg orally daily Meperidine 50 mg IM every 4 hours as needed for pain Acetaminophen 650 mg every 6 hours as needed for temperature

Meperidine 50 mg IM every 4 hours as needed for pain. Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

The nurse is providing care for a 72-year-old female client whose diagnosis of bipolar disorder is treated with lithium. What nursing responsibility should be prioritized?

Monitor the client's fluid balance and sodium intake

More adverse effects of SSRIs

Monoamine oxidase inhibitors --> Antiplatelet drugs and anticoagulants Aspirin and nonsteroidal anti-inflammatory drugs Warfarin-- Increases the level of warfarin. TCAs and lithium Can elevate levels of these drugs

Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) a. Mood stabilizers are used to prevent recurrent manic-depressive episodes. b. Antipsychotics are used to treat depressive episodes. c. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. d. Lithium and valproate are the preferred mood stabilizers for BPD. e. A lithium level of 2.0 mEq/L is considered therapeutic.

Mood stabilizers prevent recurrent manic depressive episodes antidepressants should be used w. mood stabilizer for bipolar pt's Lithium and valproate are preferred for BPD The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

Tricylic Antidepressants (TCAs)

Most common adverse effects: Sedation, orthostatic hypotension, and anticholinergic effects Most dangerous adverse effect: Cardiac toxicity May increase risk of suicide during early treatment

antidote for acetaminophin overdose

Mucomyst (acetylcysteine)

Adverse effects of SNRIs

Nausea Headache Anorexia Nervousness Sweating Somnolence Insomnia Weight loss/anorexia Diastolic hypertension Sexual dysfunction Hyponatremia (in older adult patients) Neonatal withdrawal syndrome

Which neurotransmitter is active in both the peripheral and central nervous systems (CNS)? Norepinephrine Serotonin Substance P Dynorphins

Norepi All of these agents are active in the CNS. The only known neurotransmitters in the peripheral nervous system are acetylcholine, epinephrine, and norepinephrine.

A client needs to be administered topical anesthesia. The nurse would administer the anesthetic at which location?

On the surface of the skin

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

Ortho hypo - Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

An elderly patient is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

Adverse effects of Tricyclics

Orthostatic hypotension Anticholinergic effects Diaphoresis Sedation Cardiac toxicity Seizures Hypomania

Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?

Oxygen

Akathisia adverse

Pacing and squirming brought on by an uncontrollable need to be in motion

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely? Panic disorder Bipolar disorder Generalized anxiety disorder Clinical depression

Panic disorder Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

After teaching an in-service program about nervous system conditions, the nurse determines that the teaching was successful when the group identifies which condition or disease as a group of symptoms involving motor movement characterized by tremors, rigidity, and bradykinesia?

Parkinsonism

Lorazepam teaching

Patient and family education Caution against use of alcohol with this drug. Discuss side effects of medication. Professional Counseling Nonpharmacological measures to reduce anxiety Ongoing assessment and evaluation Lorazepam therapy is effective if the patient reports a reduction in feelings of anxiety. Throughout therapy, assess for therapeutic response and onset of adverse effects.

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? Diazepam [Valium] Triazolam [Halcion] Zolpidem [Ambien] Phenobarbital [Luminal Sodium]

Phenobarbital Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.

A client who is being treated for schizophrenia, paranoid type, arrives at the clinic demonstrating a shuffling gait and tilting the head toward one shoulder. What does the nurse conclude about these clinical manifestations? Expected characteristics of this illness Consistent with an acute exacerbation of the illness Possible side effects of the antipsychotic medication Life threatening and requiring immediate intervention

Possible side effects of the antipsychotic medication

Barbituates stimulate which going form left to right?

Precursors? Stimulate here #### Porphyrin? Heme? Cytochrome P450

Antidepressants.

Primarily used to relieve symptoms of depression Can also help patients with anxiety disorders Not indicated for uncomplicated bereavement

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? Clonazepam [Klonopin] Alprazolam [Xanax] Propranolol [Inderal] Sertraline [Zoloft]

Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, palpitations). Doses are relatively small (eg, only 10 to 80 mg for propranolol).

A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching? A. "Disorientation and hallucinations are common." B. "The drug may enhance my interest in sex." C. "It may take 3 to 4 weeks before my mood is elevated." D. "I can stop this medication when I feel less depressed."

Rationale: The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (for example, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (for example, dizziness, headache, nausea, tremor, anxiety, and dysphoria).

The nurse is administering opioid analgesics to a client for postoperative pain. What is the nurse's most important assessment prior to administering the medication?

Respiratory rate

A nurse is caring for a group of clients on the psychiatric unit. What clinical findings will alert the nurse that serotonin syndrome has developed in one of the clients? Continuous involuntary movement of the tongue and jaw Extremely high blood pressure with headache and flushing Blurred vision, urine retention, dry mouth, and constipation Restlessness, tachycardia, fever, diarrhea, and altered mental status

Restlessness, tachycardia, fever, diarrhea, and altered mental status

A pediatric client with a history of chickenpox is undergoing treatment for mental illness with psychotherapeutic drugs. Which is the expected adverse effect of the psychotherapeutic drug in the pediatric client? Reye's syndrome Serotonin syndrome Orthostatic hypotension Extrapyramidal symptoms

Reye's syndrome

A patient newly diagnosed with depression has been prescribed fluoxetene, a selective serotonin reuptake inhibitor (SSRI). Why would the physician order an SSRI for a newly diagnosed patient?

SSRIs usually produce fewer and milder adverse effects than other antidepressants.

A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?

Safety precautions

The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures? Nausea Sedation Fatigue Dry mouth

Sedation - Side effects of phenobarbital include sedation during the initial phase of therapy; however, with continued treatment, sedation declines while full protection from seizures is retained. This is thought to be related to adaptive change within the brain during prolonged phenobarbital drug exposure.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? Blood pressure of 160/90 mm Hg Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing

Sedation and dry mouth Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

Barbitutatre helpful managing

Seizure disorders Induction of anesthesia Insomnia Other uses Lipid solubility has a significant impact Rapid onset and brief duration

Wellbutrin side effects

Seizures Agitation Tremor Tachycardia Blurred vision Dizziness Headache Insomnia GI upset Dry Mouth COnstipation Weight loss

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors

Atypical Antidepressants

Selegiline [Emsam] First transdermal treatment for depression Much lower risk of hypertensive crisis with transdermal route as compared with oral route Enters the system without going through the gastrointestinal tract Adverse effects still occur when used with sympathomimetic drugs Avoid carbamazepine [Tegretol] and oxcarbazepine [Trileptal]

Transdermal MAOI

Selegiline [Emsam] First transdermal treatment for depression Much lower risk of hypertensive crisis with transdermal route as compared with oral route Enters the system without going through the gastrointestinal tract Adverse effects still occur when used with sympathomimetic drugs Avoid carbamazepine [Tegretol] and oxcarbazepine [Trileptal]

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 [Lexapro]. Which is the most likely explanation for these symptoms? Depressive psychosis Serotonin syndrome Escitalopram overdose Cholinergic crisis

Serotonin syndrome Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

Major Adverse effect of SSRIs

Serotonin syndrome- begins 2 to 72 hours after treatment. Altered mental status (for example, agitation, confusion, disorientation, anxiety, hallucinations, and poor concentration) Incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever Deaths have occurred. Syndrome resolves spontaneously after discontinuing the drug Risk increased by concurrent use of MAOIs and other drugs

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

Sexual dysfunction Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

Toxicity of Tricyclics

Small therapeutic Index: Primarily from anticholinergic and cardiotoxic actions Dysrhythmias Tachycardia Intraventricular blocks Complete atrioventricular block Ventricular tachycardia Ventricular fibrillation

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? Sodium level of 128 mEq/L Prothrombin time of 8 seconds Blood urea nitrogen level of 25 mg/dL Potassium level of 5.6 mEq/L

Sodium 128 The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule? Starting at a high dose to quickly control mania Starting at a low dose and titrating up Starting at a high dose and titrating down Starting with a loading dose and then a low maintenance dose

Start low- titrate up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.

When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.) Benzodiazepines have a high safety profile. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. Benzodiazepines are associated with a high suicide potential. Benzodiazepines have a low ability to cause tolerance. Benzodiazepines have a low abuse potential.

Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) Swollen, tender gums Measles-like rash Productive cough Unusual hair growth Nausea and vomiting

Swollen, tender gums Measles-like rash Unusual hair growth Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

A healthcare provider prescribes lithium carbonate for a client with bipolar disorder, depressive episode. What instructions will the nurse include when teaching the client about lithium? Take the medication with food. Adjust the dosage if your mood improves. Have a snack with milk before going to bed. It may take several weeks for beneficial results to occur. You do not have to restrict your intake of dietary sodium.

Take the medication with food. It may take several weeks for beneficial results to occur. You do not have to restrict your intake of dietary sodium.

A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?

Tardive dyskinesia

A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?

The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.

A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring?

The medication does not seem to be working as well

The nurse receives a phone call from a patient who has been taking a CNS drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best?

The nausea will most likely decrease over time

The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated? "I can take the drug with food to reduce nausea." "This drug will increase my interest in sex." "I may experience decreased appetite and weight loss." "I had a serious head injury 3 years ago."

The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated? "I can take the drug with food to reduce nausea." "This drug will increase my interest in sex." "I may experience decreased appetite and weight loss." "I had a serious head injury 3 years ago."

The nurse prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what?

The orthostatic blood pressure measurements

The nurse is caring for a patient with migraine headaches. Which assessment best indicates that sumatriptan [Imitrex] is exerting the desired therapeutic effect?

The patient reports the termination of the migraine headache after the drug is administered

Therapeutic Uses and Adverse Effects of MAOIs.

Therapeutic uses Depression Other uses Bulimia nervosa Agoraphobia Attention-deficit/hyperactivity disorder Obsessive-compulsive disorder Panic attacks Adverse effects CNS stimulation Orthostatic hypotension Hypertensive crisis from dietary tyramine

A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms?

There is an imbalance between dopamine and acetylcholine.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? a. To increase the amount of acetylcholine at the presynaptic neurons b. To reduce the amount of dopamine available in the substantia nigra c. To balance cholinergic and dopaminergic activity in the brain d. To block dopamine receptors in presynaptic and postsynaptic neurons

To balance cholinergic and dopaminergic activity in the brain. Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? To reduce the risk of suicide with overdose To avoid weight gain and other gastrointestinal (GI) effects To help prevent sexual dysfunction To prevent the risk of serotonin syndrome

To reduce the risk of suicide with overdose The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

Is there tolerance or physical dependence with barbituates?

Tolerance Develops to many—but not all—of the CNS effects Very little tolerance develops to respiratory depression Physical dependence

Toxicity of Treatment in Tricyclics

Treatment Gastric lavage Ingestion of activated charcoal Intravenous sodium bicarbonate to treat cardiac dysrhythmias caused by cardiotoxicity

Hypertensive crisis/dietary tyramine Tx

Treatment: Intravenous vasodilator Sodium nitroprusside (a nitric oxide donor) Phentolamine (an alpha-adrenergic antagonist) Labetalol (an alpha-adrenergic and beta-adrenergic antagonist)

The nurse instructs a young adult patient about triazolam (Halcion) for short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of instructions?

Use of oral benzodiazepines does not cause respiratory depression unless used with opioids, barbiturates, or alcohol. Patients taking benzodiazepines should be warned to abstain from alcohol. Chance of addiction to triazolam is low. Triazolam should not be taken during pregnancy.

Important side effects of SGA(3)

Weight gain, diabetes, dyslipidemia

A child takes Adderall XR (amphetamine/dextroamphetamine mixture) for ADHD. The nurse should assess the child for which adverse effects?

Weight loss, restlessness, and chest pain

Additional Adverse effects of SSRIs

Withdrawal syndrome Neonatal effects when used during pregnancy Teratogenesis Extrapyramidal side effects Bruxism Bleeding disorders Sexual dysfunction Weight gain

A client with depression was prescribed fluoxetine. After two days, the client arrives at the hospital and reports restlessness, confusion, and poor concentration. Upon assessment, the nurse finds an elevated body temperature. Which intervention by the healthcare provider would be beneficial to the client? Withdrawing the drug Administering isocarboxazid Reducing the dose of the drug Informing the client that these are expected side effects

Withdrawing the drug

9. A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?

Zaleplon [Sonata] explanation: Zaleplon [Sonata] works well for people who have trouble falling asleep and, because of its short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning. Zolpidem [Ambien] has a longer duration and is a good choice for patients who have difficulty maintaining sleep. Flurazepam has a long duration of action. Trazodone causes daytime grogginess.

Which agent is most likely to be prescribed today for short-term management of insomnia?

Zolpidem [Ambien] Correct

Which agent is most likely to be prescribed today for short-term management of insomnia? Secobarbital [Seconal Sodium] Meprobamate [Miltown] Zolpidem [Ambien] Flumazenil [Romazicon]

Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.

Benzo-like drugs

Zolpidem- only recommended for 7-10 days if they need it -may cause dizziness

A 64-year-old-client has been prescribed lorazepam because of increasing periods of anxiety. The nurse should be careful to assess for which?

a history of current or past alcohol use.

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

a. About 80% of women experience depressive symptoms after giving birth. b. Thyroid insufficiency as contributing factor in postpartum depression. e. Sertraline drug of choice for treating postpartum depression in breast-feeding mothers. The drug of choice for postpartum depression is an SSRI, such as sertraline [Zoloft], because these drugs are effective, well tolerated, and present little risk of toxicity if taken in overdose. If a woman has responded to another antidepressant in the past, that drug should be used first. The risk of relapse is high, as is the risk of postpartum depression with subsequent pregnancies. The statements in options C and D are false.

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) a. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." b. "You may have some mild sedation. Do not drive until you know how this drug will affect you." c. "This drug may cause easy bruising. If you notice this, call the clinic immediately." d. "It is very important to have good oral hygiene and to visit your dentist regularly." e. "You may continue to have wine with your evening meals, but only in moderation."

a. call the clinic if increased anxiety or agitation." b. mild sedation. Do not drive d. good oral hygiene and visit dentist Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

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

a. may cause some sexual side effects. b. Dp not withdraw it abruptly e. worsening mood, agitation, or increased anxiety Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

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

alcohol - bulimia - schizophrenia - glucocorticoid Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).

med associated with Reye's Syndrome

aspirin

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?

avoid driving until he is aware of the adverse effects.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) a. The patient complains of excessive facial hair growth. b. The patient is walking with a staggering gait. c. The patient's gums are swollen, tender, and bleed easily. d. The patient complains of double vision. e. The nurse observes rapid back-and-forth movement of the patient's eyes.

b. The patient is walking with a staggering gait. d. The patient complains of double vision. e. rapid back-and-forth movement of eyes. Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

Pt. is presvribed isocarboxazid(marplan) for treatment of depression. Which foods should pt. be taught to avoid? a. broccoli, shrimp, yogurt b. tomatoes, chicken, milk c. bananas, smoked fish, cheese d. apples, steak, cottage cheese

bananas,smoked fish,cheese

first line management therapy for asthma

beclomethasone (qvar)

First line drugs for panic disorder

benzodiazepines

Drug therapy for generalized anxiety disorder

benzodiazepines and buspirone (BuSpar)

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?

bowel patterns.

the nurse is caring for a patient with social anxiety disorder. The pt is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety? a. fluvoxamine (luvox) b. paroxetine (paxil) c. sertraline (zoloft) d. clonazepam (klonopin)

clonazepam (klonopin)

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine.

Adverse effects of buspirone (BuSpar)

dizziness, nausea, headache, nervousness, sedation, lightheadedness, and excitement

A nurse administrating an opioid medication should assess for what related side effect?

drowsiness

Which adverse effect should the nurse assess for when administering cyclobenzaprine?

drowsiness

Common side effects of anticholinergics include:

dry mouth, urinary retention, constipation, and increased pulse rate.

Other drugs used for generalized anxiety disorder

duloxetine (Cymbalta), paroxetine (Paxil), and escitalopram (Lexapro)

busiprone (BuSpar) drug and food interactions

erythromycin and ketoconazole; also grapefruit juice

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for:

falls

An older adult client is diagnosed with generalized anxiety disorder. The use of benzodiazepines in this client population creates a specific need for which intervention?

falls risk assessment

Social anxiety disorder (social phobia)

fear of interacting with others or being in social situations that might lead to a negative evaluation

strongest oipoid

fentanyl

mineralcorticoid

fludrocortisone

antidote for benzo OD

flumazenil

a pt is brought to the emergencry department for the treatment of an overdose of alpraxolam (xanax) which medication should the nurse prepare to administer to this patient? a. protamine sulfate b. acetylcysteine (acetadote) c. naloxone (narcan) d. flumazenil (romazicon)

flumazenil (romazicon)

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question? a. levothyroxine (synthroid) b. sulindac (clinoril) c. furosemid (lasix) d. propranolol (inderal)

furosemid (lasix)

Barbituates

has 3 classes: -Ultrashort-acting (thiopental) -Short- to intermediate-acting (secobarbital) -Long-acting (phenobarbital)

Other common reactions of venlafaxine (Effexor XR)

headache, anorexia, nervousness, sweating, daytime somnolence, insomnia, and hypertension

an anticholinergic drug used to treat bronchoconstriction

ipratropium

Antipsychotic drugs are contraindicated in clients with:

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.

Benzodiazepine prototype

lorazepam (ativan)

8. A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?

maintaining adequate O2 to the brain explanation: Because time has elapsed, enough medication is present in the system to warrant treatment for systemic effects. A central nervous system stimulant is contraindicated, and intravenous fluids do not address the overdose. Although activated charcoal may assist in absorption of medication in the gut, flumazenil will be effective only for the benzodiazepines. Naloxone, a narcotic antagonist, is not effective for barbiturates and benzodiazepines.

Treatment for sexual dysfunction when taking SSRI

medication holiday switch class ex: Buspirone

drug class for lithium

mood stabilizer

buspirone (Buspar) tolerance, dependence, and abuse

no withdrawal symptoms have been observed,

busiprone (BuSpar)

not a CNS depressant, no abuse potential, doesn't intensify CNS depressant effects

The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?

paradoxical excitement, which is the opposite reaction than what was expected

what is the long acting barbituate

phenobarbital

Pt. dxnsed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the pt for which s/s? a. insomnia, increased appetite, abdominal distention b. dry cough, hyperactive reflexes, hypertension c. polydipsia, slurred speech, fine hand tremors d. constipation, asterixis, generalized edema

polydipsia, slurred speech, fine hand tremors

A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:

potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression. explanation: Benzodiazepines potentiate the actions of GABA, and because the amount of GABA in the CNS is finite, these drugs' depressive effect on the CNS is limited. Benzodiazepines depress the CNS but not to the extent that barbiturates do. Benzodiazepines are weak respiratory depressants at therapeutic doses and moderate respiratory depressants at toxic doses. Barbiturates mimic GABA; therefore, because they produce CNS depression, this effect is limited only by the amount of barbiturate administered.

Characteristics of panic disorder

pounding pulse, chest pain or discomfort, feeling of choking, nausea or abdominal discomfort, fear of dying, flushes or chills, and fear of losing self control

beta blocker used for hyperthyroidism

propanolol

A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the family be taught to make while caring for this client at home?

respiratory depression

7. A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following?

respiratory support

what is the short to immediate acting barbituate

secobarbital

The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug?

sedation explanation: The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).

what are the stages of sleep

stage 1 and II= light sleep stage III and IV= deep sleep

The nurse should prioritize which assessment when caring for a teenager who has recently been prescribed a selective serotonin reuptake inhibitor (SSRI)?

suicidal ideation

Nondrug treatment approaches for generalized anxiety disorder

supportive therapy, cognitive behavioral therapy, biofeedback, and relaxation training

A client is prescribed phenytoin and reports gastrointestinal (GI) upset. The nurse should tell the client to:

take the medication with meals.

While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:

tardive dyskinesia.

the nurse teaches a pt about eszopiclone (lunesta) which statement by pt indicates that the teaching has been effective? a. i should take the drug 1 hour before bedtime b. the drug may leave a bitter taste in my mouth c. i may experience amnesia with prolonged use d. my body may build up a tolerance to this drug

the drug may leave a bitter taste in my mouth

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:

the patient has a cross-dependence to the benzodiazepine. explanation: Benzodiazepines are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzodiazepine to suppress withdrawal symptoms. Alcohol and benzodiazepines can potentiate one another. The benzodiazepine does not potentiate withdrawal symptoms. Benzodiazepines relieve muscle spasms, but this is not why they are given for alcohol withdrawal.

Dantrolene bromocriptine

treatment for neuroleptic malignant syndrome

how do you reverse acute toxicity from benzodiazepines

treatment with flumazenil ** - is a receptor antagonist - reverses sedative effects but will not reverse respiratory depression

Anxiety

uncomfortable state with psychologic and physical components

An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which?

use another form of birth control, such as condoms.

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids?

withdrawal symptoms

A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia?

•Answer: B •Rationale: Second-generation antipsychotics such as clozapine carry a higher risk of serious metabolic effects (eg, diabetes and dyslipidemia) than first-generation antipsychotics (eg, loxapine, thiothixene, and haloperidol). Among the second-generation antipsychotics, the risk of metabolic effects is greatest with clozapine and olanzapine. Clozapine should be used with caution in patients with diabetes.

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question?

•Answer: C •Rationale: Diuretics (such as furosemide) promote sodium loss. If the sodium level is low, the renal excretion of lithium is reduced; lithium levels are thus increased, which may result in toxicity. Nonsteroidal anti-inflammatory drugs can increase lithium levels by suppressing prostaglandin synthesis in the kidney and increasing renal reabsorption of lithium. Nonsteroidal anti-inflammatory drugs known to increase lithium levels include ibuprofen, naproxen, piroxicam, indomethacin, and celecoxib. However, sulindac does not increase lithium levels. Anticholinergics can cause urinary hesitancy; lithium-induced polyuria may result in considerable discomfort. Patients should avoid drugs with prominent anticholinergic actions (eg, antihistamines, phenothiazine antipsychotics, tricyclic antidepressants). Levothyroxine is safe to administer with lithium, and lithium may cause hypothyroidism. Propranolol should be administered with caution, because lithium toxicity can cause hypotension, and propranolol may also cause hypotension.

A patient is prescribed isocarboxazid [Marplan] for the treatment of depression. Which foods should the patient be taught to avoid?

•Answer: C •Rationale: Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms?

•Answer: C •Rationale: Signs and symptoms of lithium toxicity include polydipsia, slurred speech, and fine hand tremors. They also include nausea, vomiting, persistent gastrointestinal upset, diarrhea, clonic movements, hyperirritability of muscles, muscle weakness, and hypotension.

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid?

•Answer: D •Rationale: Drugs that are capable of blocking muscarinic receptors will enhance the anticholinergic effects of doxepin and other tricyclic antidepressants. The nurse should warn patients against the concurrent use of other anticholinergic drugs such as scopolamine, antihistamines, and phenothiazines. Diphenhydramine is an antihistamine.

Neuroleptic malignant syndrome

•Rare but serious reaction •Risk of death without treatment •"Lead pipe" rigidity, sudden high fever, sweating, autonomic instability, dysrhythmias, fluctuations in blood pressure, altered level of consciousness, and seizures or coma may develop •Death can result from respiratory failure, cardiovascular collapse, dysrhythmias, and other causes

A client is receiving carbamazepine for the treatment of a manic episode of bipolar disorder. What does the nurse include when planning client teaching about this medication? "You have to eat a low-sodium diet every day." "You'll have to take a diuretic with this medication." "You'll have to take this medication for the rest of your life." "You may want to suck on sugar-free hard candy when you get a dry mouth." "We'll need to test your blood often during the first few weeks of therapy."

"You may want to suck on sugar-free hard candy when you get a dry mouth." "We'll need to test your blood often during the first few weeks of therapy."

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid?

Diphenhydramine [Benadryl]

Why should healthcare team carefully consider the necessity of administering antpsychotics (FGA-SGA's) to older patients with dementia?

They cause greater mortality (earlier death) in older populations

The nurse is caring for a patient who is starting clozapine (Clozaril). Which nursing intervention is a priority for this patient? A. Assess baseline white blood cell count and absolute neutrophil count. B. Evaluate suicidal tendencies. C. Take a baseline EEG. D. Evaluate creatinine clearance.

A. Assess baseline white blood cell count and absolute neutrophil count. Patients taking clozapine (Clozaril) must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia

A. Auditory hallucunations C. Delusions of grandeur D. Severe agitation Positive symptoms of schizophrenia, such as auditory hallucinations, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as delusions of grandeur, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as severe agitation, are effectively treated with first-generation antipsychotics.

A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse shoudl 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

A. Disorganized speech B. Bizarre behavior D. Hallucinations A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.

The patient has been ordered a medication regimen that includes loxitane (Loxapine). During instructional sessions regarding the medication, the nurse should emphasize which information? (Select all that apply.) A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. D. Nausea reduction will occur.

A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. Loxitane (Loxapine) is known to cause sedation, hypotension, and extrapyramidal symptoms. Nausea may result as a side effect of loxitane.

Which statement is true concerning the use of antipsychotic medications during pregnancy? A.Their use should be monitored closely by the mother's healthcare provider. B. Such medication poses severe risks when used during pregnancy. C. Medications in this class do not cross the placental barrier. D. There is no record of side effects in newborns exposed to such medications.

A. Their use should be monitored closely by the mother's healthcare provider. While antipsychotics do pose some risks to the pregnant woman, these risks are not generally considered severe; nonetheless, their use should be carefully monitored by the woman's healthcare provider. These drugs do pass the placental barrier and can cause EPSEs in some newborns but the risks of such exposure is small and levels are carefully monitored when a pregnant woman is prescribed this classification of medications in order to minimize the risk

A therapeutic benefit of fluphenazine decanoate (Prolixin Decanoate) is that the individual: A. does not have to remember to take medication daily. B. will not experience extrapyramidal side effects (EPSEs). C. may have daily doses titrated up or down. D. will experience a reduction in both negative and positive symptoms.

A. does not have to remember to take medication daily. This medication is not given daily but rather by injection every 2 to 3 weeks and does not require titration. Fluphenazine, a traditional first-generation antipsychotic drug, targets only positive symptoms of schizophrenia.

Upon assessment, the primary healthcare provider finds that the client is experiencing weight gain as well as elevated lipid and blood glucose levels. Which drugs in the client's prescription list are most likely to cause these metabolic side effects? Clozapine Asenapine Quetiapine Olanzapine Ziprasidone

Clozapine Olanzapine

A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia?

Clozapine [Clozaril]

Difference between acute dystonic reaction and Neuroleptic malignant syndrome

Acute dystonic has eyes rolling back and is around eyes and neck Neuroleptic malignant syndrome ("lead pipe" rigidity whole body) high fever sweating, muscle aches

Which EPS is the most life threatening?

Acute dystonic reaction because of laryngospasm

All other effects of FGA and SGA (7)

Neuroleptic malignant syndrome (sweating, rigidity, sudden high fever, muscle pain and breakdown)(KIDNEY FAILURE) Anticholinergic effects (dry mouth constipation, blurry vision, urinary retention) Orthostatic hypertension (alpha 1 blockaid) Sedation Gyno sexual dysfunction Rashes

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."

B. "Notify the provider if you develop breast enlargement." Gynecomasia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider is theses manifestations occur.

The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless," as he paces the floor. What is the nurse's primary intervention? A. Stop the medication immediately and notify the health care provider. B. Administer the prescribed benzodiazepine. C. Administer benztropine (Cogentin) as ordered. D. Stay with the patient and offer reassurance.

B. Administer the prescribed benzodiazepine. Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? A. Wearing sunglasses when outdoors B. Changing from a sitting to standing position slowly C. Being frequently monitored for suicidal ideations D. Avoiding foods with high fat content

B. Changing from a sitting to standing position slowly Hypotension is the major antiadrenergic effect of antipsychotic drugs. Hypotension occurs most often in older adults and when the individual stands or changes positions suddenly (orthostatic hypotension); thus, precautions against falls must be instituted. Frequent monitoring for suicidal ideation is appropriate for antidepressant medications. While wearing sunglasses and avoiding high-fat foods are appropriate health habits, they are not associated directly with antipsychotic medication therapy.

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 insomnia. B. Chew sugarless gum to moisten the mouth. C. Use cooling measure to decrease fever. D. Take an antacid to relieve nausea.

B. Chew sugarless gum to moisten the mouth. Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect of fluphenazine.

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing

B. Drooling C. Involuntary arm movements E. Continual pacing Drooling is an indication of pseudoparkinsonism, which is an EPS. Incoluntary arm movements are an indication of tardive dyskinesia, which is an EPS. Continual pacing is an indication of akathesia, which is an EPS.

The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? A. Lorazepam (Ativan) B. Flumazenil (Romazicon) C. Oxazepam (Serax) D. Buspirone HCl (BuSpar)

B. Flumazenil (Romazicon) Of the medications listed, flumazenil (Romazicon) is the only one that would be effective as a benzodiazepine antagonist.

The nurse will hold the next dose of antipsychotic medication for which patients? (Select all that apply.) A. The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips C. The patient who has pill-rolling motions of the hand D. The patient who has a sudden high fever

B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips D. The patient who has a sudden high fever The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

A patient is prescribed Phenelzine for the treatment of depression. Which foods should the patient be taught to avoid?

Bananas, smoked fish, and cheese

A client has recently started taking a new neuroleptic drug, and the nurse notes extrapyramidal effects. Which drug does the nurse anticipate will be prescribed to limit these side effects? Zolpidem Hydroxyzine Dantrolene Benztropine mesylate

Benztropine mesylate

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "Iwill be able to stop taking this meciation as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while I am taking this medication." D. "This medication is highly addictive and must be withdrawal slowly.

C. "I will be careful not to gain too much weight while I am taking this medication." Antipsychotic medications, such as iloperidone, have a high risk for significant weight gain.

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine

C. Aripiprazole D. Clozapine E. Asenapine Aripiprazole is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Clozapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Asenapine is available in a sublingual tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection.

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? A. Limit protein intake. B. Increase fluid intake by 200 ml daily. C. Prepare to cope with a craving for carbohydrates. D. Increase calories to manage an expected weight loss.

C. Prepare to cope with a craving for carbohydrates. Carbohydrate craving is a common feature of this type of medication therapy. Weight gain can be significant, particularly for patients taking the newer agents. There is no need to limit protein or to increase fluid intake above normal consumption.

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticiptae a prescription of which of the following? A. Chlorpromazine B. Thiothixene C. Risperdone D. Haloperidol

C. Risperdone Second-generation antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect.

The multidisciplinary team discusses the patient's negative symptoms of schizophrenia. The nurse expects which medication to be ordered? A. Prolixin (fluphenazine) B. Haldol (haloperidol) C. Seroquel (quetiapine) D. Thorazine (chlorpromazine)

C. Seroquel (quetiapine) Quetiapine, an atypical second-generation antipsychotic drug, targets both the positive and negative symptoms of schizophrenia. Fluphenazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Haloperidol predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Chlorpromazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication.

Which drug is contraindicated in clients with blood dyscrasias? Duloxetine Bupropion Mirtazapine Chlorpromazine

Chlorpromazine

What are the two FGA's

Chlropromazine HCL (thorazine) Haloperidol (Haldor)

Which clients with schizophrenia should not be prescribed chlorpromazine? Clients with glaucoma Clients with dynamic ileus Clients with Parkinson disease Clients with severe hypertension Clients with prostatic hypertrophy

Clients with Parkinson disease Clients with severe hypertension

A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The primary healthcare provider prescribes the anticholinergic medication benztropine, 2 mg daily. What will the nurse assess the client for daily when administering these medications together? Constipation Hypertension Increased salivation Excessive perspiration

Constipation

Before administering ramelteon [Rozerem] to a patient on the medical unit, which action by the nurse is best?

Consult the prescriber if the patient has chronic hepatitis

A preceptor is working with a new RN. The preceptor will note understanding of Clozaril (clozapine) by the new RN when he or she says: A. "I need to carefully assess each patient for EPSEs, since it is a major risk factor with clozapine." B. "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." C. "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." D. "The patient's WBC and ANC meet the criteria to start clozapine."

D. "The patient's WBC and ANC meet the criteria to start clozapine." The new RN demonstrates knowledge of clozapine with establishing a baseline for the white blood cell count (WBC)/absolute neutrophil count ANC with the potential risk of agranulocytosis in mind. EPSE liability is lower with clozapine rather than higher. Clozapine is not the first-line treatment for schizophrenia because of the expense and dedication necessary to monitor bone marrow health and WBC. Abnormal motor movements are not expected following a first dose of clozapine.

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."

D. "You should have your white blood cell count monitored every week." Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is recommended while taking clozapine.

There is an anticholinergic effect on the peripheral nervous system resulting from the effects of some antipsychotic medication. Tachycardia, constipation, and urinary hesitation are the result of this effect on which cranial nerve (CN)? A. CN III B. CN VII C. CN IX D. CN X

D. CN X The anticholinergic effects on CN X, the vagus nerve, would include tachycardia, constipation, and urinary hesitation. Anticholinergic effects on CN IX, the glossopharyngeal nerve, include dry mouth and dry nasal passages, while effects on CN VII, the facial nerve, result in dry mouth, decreased tearing, and dry nasal passages. An anticholinergic effect on CN III, the oculomotor nerve, would bring about dilated pupils, impaired accommodation, and blurred vision.

What aspect of traditional antipsychotic medication therapy is most responsible for a patient's medication nonadherence and resulting rehospitalization? A. The cost of the medication B. The need for frequent blood tests C. The biases against such medications D. The occurrence of EPSEs.

D. The occurrence of EPSEs. EPSEs → nonadherence → relapse → rehospitalization. It has been estimated that most patients who receive antipsychotic medications have EPSEs and, in turn, EPSEs account for many readmissions. High-potency traditional antipsychotics are most likely and atypical antipsychotics are least likely to cause EPSEs. While the cost of medication, the need for monitoring, and biases against medication can all be factors, the greatest impact on nonadherence is the development of EPSEs.

Prior to administering Clozaril (clozapine) and at regular intervals during treatment, the nurse will evaluate the patient's: A. electroencephalogram (EEG). B. electrocardiogram (ECG). C. lipids. D. complete blood count (CBC).

D. complete blood count (CBC). Related to the risk for agranulocytosis from bone marrow suppression, monitoring of the WBC count by the prescriber, nurse, and/or pharmacist is required. This medication does not require monitoring of EEG, ECG, or serum lipids.

Big distinction between FGA and SGA

FGA higher risk of EPS SGA higher risk of metabolic effects (diabetes, dyslipidemia(LDL goes up, HDL goes down) /weight gain)

Which drug is a high-potency medication used to treat schizophrenia? Loxapine Thioridazine Fluphenazine Perphenazine

Fluphenazine

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question?

Furosemide [Lasix]

The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated?

I had a serious head injury 3 years ago

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client? Constricted pupils Intractable diarrhea Increased heart rate Decreased respirations

Increased heart rate

The physician prescribes propranolol [Inderal] for a patient with migraine headaches. It is most important for the nurse to do what?

Instruct the patient that the medication will prevent migraines

A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching?

It may take 3 to 4 weeks before my mood is elevated

The nurse cares for a client with schizophrenia and who is receiving ziprasidone. Which conditions in the client may indicate discontinuation of the drug? Leukopenia Tachycardia Hypokalemia Hypermagnesemia Prolonged QT interval

Leukopenia Hypokalemia Prolonged QT interval

Best dosing for Antipsychotics?

Lower dose (so not to have all these side effects)

A client is started on chlorpromazine. To prevent life-threatening complications from the administration of this medication to an anxious, restless client, it is important that the nurse take which action? Provide adequate restraint. Monitor the client's vital signs. Protect against exposure to direct sunlight. Watch the client for extrapyramidal side effects.

Monitor the client's vital signs.

A client begins fighting and biting other clients. The primary healthcare provider prescribes a stat injection of haloperidol. How will the nurse implement this prescription? Quickly, with an attitude of concern Before the client realizes what is happening After the client agrees to receive the injection Quietly, without any explanation of the reason for it

Quickly, with an attitude of concern

A child with ADHD has been prescribed Daytrana (a transdermal methylphenidate patch). When teaching the child's caregiver how to administer the medication, which instruction should the nurse include in the teaching?

Remove the patch within 9 hours of application

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. The nurse is confident that the medication information discussed has been understood when the client takes which action? Removes the pepperoni from a pizza Asks for an extra bottle of flavored water to drink with dinner Requests a prescription for oral birth control before being discharged States that chewable antacids may be taken to relieve heartburn

Requests a prescription for oral birth control before being discharged

Antipsychotic drugs can cause extrapyramidal side effects. Which responses does the nurse document as indicating pseudoparkinsonism? Rigidity Tremors Mydriasis Photophobia Bradykinesia

Rigidity Tremors Bradykinesia

The mother of a client reports, "My son is afraid of every small thing and has a fear of dying." Upon assessment, the nurse finds palpitations, racing heartbeat, and sweating. Which first-line medications would be beneficial for the client? Sertraline Fluoxetine Phenelzine Alprazolam Imipramine

Sertraline Fluoxetine

A patient with schizophrenia is prescribed chlorpromazine oral concentrate. Which instruction should the nurse include in the teaching plan?

Sexual arousal may be enhanced with this medication

A nurse instructs a parent about the administration schedule forAdderall XR (amphetamine/dextroamphetamine mixture) to treat the child's ADHD. The nurse determines that teaching is successful if the parent makes which statement?

The drug should be given in the morning, before school

What instructions should the nurse provide to a client who has expressed dissatisfaction with lorazepam therapy and wants to safely discontinue the drug?

The drug should be tapered gradually to prevent severe symptoms of withdrawal.

The nurse instructs a young adult patient about triazolam [Halcion] for the short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of the instructions?

The medication will not affect my breathing

A client is to take an antipsychotic drug twice a day. Two-thirds of the daily dose is given in the evening and one-third in the morning. What will the nurse tell the client is the rationale for this schedule? To facilitate dreaming To maintain the daily sleep rhythm To reduce sedation during the daytime To decrease assaultiveness in the evening

To reduce sedation during the daytime

The nurse prepares to administer lithium to a patient. Which laboratory result should first be assessed?

Urinary creatinine clearance

A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way? a. Blocking actions of dopamine b. Blocking actions of epinephrine c. Promoting prostaglandin synthesis d. Enhancing the action of gamma-aminobutyric acid

a. Blocking actions of dopamine

A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? (Select all that apply.) a. Gastric lavage b. Adequate hydration c. Maintaining an airway d. Fluphenazine (Prolixin) e. Risperidone (Risperdal) f. Activated charcoal administration

a. Gastric lavage b. Adequate hydration c. Maintaining an airway f. Activated charcoal administration

An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply.) a. clozapine (Clozaril) b. fluphenazine (Prolixin) c. haloperidol (Haldol) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

a. clozapine (Clozaril) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Pseudoparkinsonism

b. Acute dystonia

An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication? a. quetiapine (Seroquel) b. aripiprazole (Abilify) c. benztropine (Cogentin) d. chlorpromazine (Thorazine)

c. benztropine (Cogentin)