ALL OF PSYCHOPHARM
symptoms of serotonin syndrome HARMFUL
(H)yperthermia-high body temp (A)nticognitive-delirium,confusion, agitation (R)eflexes-hyperreflexia (M)yoclonus-jerking, twitching (F)ast HR- tachycardia (U)nconsciousness-coma,etc (L)oss of GI control-N/D
Decrease in acetylcholine can cause?
- Alzheimer's disease - Huntington's disease - Parkinson's disease
decrease in GABA can cause?
- Anxiety disorders - Schizophrenia - Mania - Huntington's disease
Where is Tyramine located?
- CNS - Kidney
Where is Glutamate located?
- CNS - PNS
increase in dopamine can cause?
- schizophrenia - Mania
how can sodium affect lithium levels
-HIGH Na intake leads to LOWER levels of lithium and less therapeutic effects -LOW Na intake leads to higher lithium levels, which could lead to toxicity
Depakote (divalproex sodium)
-Important to monitor liver function and platelet count periodically. -Common side effects: tremors, GI upset, weight gain, and rarely alopecia
whats the difference between positive and negative symptoms of schizophrenia
-Positive symptoms has the presence of something that should NOT be present -Negative symptoms has the absence of something that SHOULD be present
lithium
-approved for acute mania & maintenance treatment -onset of action is 10-21 days -great risk for toxicity
Since the onset of lithium is 10-21 days it is supplemented in the early phases of treatment with______
-atypical antipsychotics -anticonvulsants -antianxiety medications
severe lithium toxicity signs
-convulsions -oliguria (producing none or smalls amounts of urine) -death
first generation antipsychotics
-dopamine antagonists in both motor and limbic areas -blockage of D2 receptors in motor areas causes EPS
second generation antipsychotics
-first line treatment -antagonize D2 receptors & bind to serotonin receptors
what are some positive symptoms of schizophrenia
-hallucinations -delusions -disorganized speech -bizarre behavior
what will you see with someone who is in a depressed state
-hopelessness -decreased interest in pleasure -decreased appetite -decreased libido -thoughts of suicide
Tegretol contraindications
-hx of bone marrow suppression -hypersensitivity to TCAs -impaired hepatic, liver, renal functions
interventions at therapeutic level of lithium
-keep doses LOW -kidney function & thyroid function should be assessed at treatment initiation and annually
what should you tell your pt that is taking Naltrexone for alcohol withdrawal
-nausea usually goes away after first month, comes in oral or long acting (once a month) injectable form, may cause headache, sedation
lithium expected side effects at the therapeutic level
-polyuria -fine hand tremor -mild thirst -mild nausea -general discomfort -weight gain
lithium is contraindicated in
-pregnancy or breastfeeding -people with thyroid or kidney issues
tardive dyskinesia (EPS)
-protrusion and rolling of the tongue -lip sucking and smacking -chewing motion -facial dyskinesia -involuntary body movements
neuroleptic malignant syndrome
-reduced conxciousness/responsiveness -generalized muscle rigidity -autonomic dysfunction -EMERGENCY
Tegretol (Carbamazepine) action
-reduces post-tetanic potentiation at the synapse, preventing repetitive discharge
before beginning treatment for lithium you MUST assess
-renal & thyroid function -perform EKG -assess women to see if they are pregnant or breastfeeding
there is a strong correlation between genetics and bipolar disorder
-risk is greatest when disorder is present in 1st degree family members(mom,dad,sibling) -risk to relatives of individuals with bipolar disorder is greater than those w/out
patient teaching for lithium
-take with meals to avoid stomach irritation -if discontinued the dosage will be tapered gradually to minimize the risk of relapse -NOT addictive -IMPORTANT to monitor lithium levels -maintain a consistent fluid intake -sodium intake can affect lithium levels -stop taking lithium if you experience excessive diarrhea, vomiting, sweating (can lead to dehydration and increase blood lithium to toxic levels) -talk to provider about having thyroid, parathyroid, renal functions checked periodically
A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, I took a few extra tablets earlier today and now I feel bad. Which assessments are most critical? Select all that apply.
-vital signs -presence of abdominal pain and diarrhea -hyperactivity or feelings of restlessness
Alcohol delirium can occur
2-3 days after stopping alcohol
2. A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions
2. A. Genitourinary soreness indicates a somatic reaction. B. Difficulties with low self-esteem are an indication of a sustained and maladaptive emotional response beyond the initial reaction. C. Sleep disturbances indicates a somatic reaction. D. CORRECT: Emotional outbursts indicate an expressed initial reaction of rape-trauma syndrome. E. CORRECT: Difficulty making decisions indicates a controlled initial reaction of rape-trauma syndrome.
Advanced lithium toxicity level
2.0-2.5
advanced signs of lithium toxicty
2.0-2.5 -ataxia -giddiness -serious EKG changes -blurred vision -clonic movements -seizures -hypotension -coma -stupor -death -large output of dilute urine
3. A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of teaching? A. "I will administer prophylactic treatment for sexually transmitted infections, like chlamydia." B. "I am not required to obtain informed consent before the sexual assault nurse examiner collects forensic evidence." C."I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D."I should use narrative documentation when documenting subjective data."
3. A. CORRECT: The nurse should administer prophylactic treatment for infections such as chlamydia according to the Centers for Disease Control and Prevention. B. The nurse must obtain informed consent to collect data that can be used as legal evidence. C. Manifestations of rape-trauma syndrome are similar to posttraumatic stress disorder. D. The nurse should document subjective data, using the client's verbatim statements.
therapeutic responses for atomoxetine may take
4-6 weeks
full effects for TCAs take
4-8 weeks but starts to work in 10-14 day
risperidone & aripiprazole are used for ASD in treating children
5 & 6 years of age and older
12- The charge nurse is planning a staff education session to discuss medications used during the care of a client experiencing alcohol withdrawal which medications should the nurse include in the discussion A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. acamprosate
A, B Used during withdrawal to decrease anxiety
11- I nurse is teaching a school-age child and his parents about a new prescription for Lisdexamfetamine, which of the following should the nurse include in teaching (select all that apply) A. And I am verse affect of this medication is CNS stimulation B. Administer the medication before bedtime C. Monitor blood pressure while taking this med D. Therapeutic effects of this med will take 1-3 weeks to fully develop E. This medication raises the levels of dopamine in the brain
A, C, E
16- A nurse is providing instructions to a client has been experiencing insomnia and has a new prescription for to Maza Pam the nurse should inform the client that which of the following manifestations are adverse affects (select all apply ) A. Incoordination B. Hypertension C. Pruritis D. Sleep driving E. Amnesia
A, D, E
35- nurse is assessing a client who has salicylism which of the following findings should the nurse expect (select all apply ) A. Dizziness B. diarrhea C. jaundice D. Tinnitus E. headache
A, D, E
8- A nurse is caring for a client who has depression and the new prescription for venaflaxine, for which of the following adverse effects to the nurse monitor this client (select all that apply) A. Cough B dizziness C. Decreased libido D alopecia E hypotension
A,B,C
7- A nurse is teaching a client who obsessive compulsive disorder and has a new prescription for paroxetine which of the following instructions should the nurse include? A. It can take several weeks before you feel like the medication is helping B. Take the medication just before bedtime to promote sleep C. you should take the medication when needed for obsessive urges D. Monitor for weight gain while taking this medication
A- paroxetine can take 1-4 weeks before the client reaches full therapeutic benefit
7- A nurse is caring for a client who takes peroxidation to treat post dramatic stress disorder he reports that he grinds his teeth during the night the nurse should identify which of the following interventions to manage bruxism (select all that apply) A. Concurrent administration of buspirone B. administration of a different SSRI C. use of a mouth guard D. changing to a different class of anti-depressant medication E. increasing the dose of paroxetine
A-C-D (low dose of buspirone manage the adverse effects, mouth guard decrease risk of oral damage, changing to different class that does not have same adverse effects)
35- A nurse is admitting a toddler to the hospital after and acetaminophen overdose which of the following medications should the nurse anticipate administering to this client A. Acetylcysteine B. Pegfilgrastim C. Misoprostol D. Naltrexone
A.
38- A nurse is caring for a client who receives a local anesthetic of light Okane during the repair of the skin laceration which of the following adverse reactions should the nurse monitor for the client A. Seizures B. TachyCardia C. hypertension D. fever
A.
8- A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for post dramatic stress disorder which of the following statements should the nurse include in the teaching A. You may have a decrease desire for intimacy while taking this medication B. you should take this medication at bedtime to help promote sleep C. you have fewer urinary adverse effects if you urinate just before taking this medication D. you will need to wear sunglasses when out doors due to the light sensitivity cause by this method
A. Decreased libido is a potential adverse effect of fluoxetine and other SSRIs
37- I nurse is planning care for a client has brain cancer and is experiencing headaches which of the following adjuvant medications are indicated for this client A. Dexamethasone B. Methylphenidate C. Hydroxyzine D. Amitriptyline
A. Dexamethasone decreases inflammation and swelling
L-DOPA (notes)
Able to cross the blood brain barrier making it an excellent pharmaceutical for treatment of Parkinsons or depression.
Good for ongoing restless and anxiety when they quit drinking alcohol
Acamprosate
Where is norepinephrine found?
Adrenal medulla
What are the receptors for norepinephrine?
Andrenergic
SNRI used for ADHD
Atomoxetine (strattera)
38- A nurse is providing teaching to a client who is experiencing migraine headaches which of the following instructions to the nurse provide (select all apply ) A. Take ergotamine as a prophylaxis to prevent a migraine headache B. identify and avoid trigger factors C. lie down in a dark quiet room at the onset of a migraine D. avoid foods that contain tyramine E. avoid exercise that canincrease heart rate
B, C, D
9- A nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine which of the following instructions to the nurse include in the teaching A. This medication can safely be taking during pregnancy B. Eliminate grapefruit juice from your diet C. You will need to have a complete blood count and carbamazepine levels drawn periodically D. Notify your provider if you develop a rash E. Avoid driving for the first few days after starting this medication
B,C,D,E
9- A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder the nurse should recognize which of the following findings as a possible indication of toxicity to this medication A. Severe hypertension B. course trimmers C. constipation D. muscle spasms
B. Course trimmers are an indication of toxicity
16- nurse is teaching a client who has a new prescription for remelton. The nurse should instruct the client to avoid which of the following foods while taking this medication A. Baked potato B. Fried chicken C. Whole grain bread D. Citrus fruits
B. Fried foods prolong the absorption of the medication
10- I nurse is providing teaching for mail 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 med D. This medication is likely to increase your libido
B. Gynecomastia breast enlargement and galactorrhea
10- A nurse is assessing a mail 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 are an indication of acute dystonia which is a crisis situation requiring rapid treatment
37- A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer which of the following precautions should the nurse take when administering pamidronate A. Inspect the skin for redness and irritation when changing the intradermal patch B. assess the IV site for thrombophlebitis frequently during administration C. instruct the client to sit upright or stand for 30 minutes following oral administration D. watch for manifestations of anaphylaxis for 20 minutes after IMadministration
B. Pamodronate is irritating to veins
Halcion
Benzodiazepine used for DFA
prosom
Benzodiazepine used for DFA, DMS
Restoril
Benzodiazepine used for DMS
Dalamane
Benzodiazepine used for DMS, DFA
Doral
Benzodiazepine used for DMS, DFA
A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group?
Benzodiazepines
Propranolol
Beta Blockers •hyperarousal and panic
selective Serotonin-Reuptake Inhibitors (SSRIs)
Blocks the synaptic reuptake of serotonin
What is the primary function for Tyramine?
Blood Pressure Regulation
Given in weekly forms; helps reduce or quit the use of heroin or other opiates
Buprenorphine
This drug is used only after abstaining from opioids for 12 to 24 and in the EARLY stages of opioid withdrawal
Buprenorphine
norepinephrine dopamine reuptake inhibitor
Bupropion (Wellbutrin)
norepinephrine dopamine reuptake inhibitor (NDRI)
Bupropion (Wellbutrin)
15- The nurse is caring for a client who has a prescription for bethanechol to treat urinary retention the nurse should recognize that which of the following findings is a manifestation of musfanatic stimulation A. Dry mouth B. Hypertension C. Excessive perspiration D. Fecal impaction
C
36- A nurse is planning to administer morphine IV to a client who is postoperative which actions should the nurse take A. Monitor for seizures and confusion with repeated doses B. protect the client skin from the severe diarrhea that occurs with morphine C. withhold this medication is respiratory rate is less than 12 per minute D. give morphine intermittent via IV bolus over 30 seconds or less
C
38- A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine for which of the following adverse effects should the nurse instruct the client to stop taking the medication and notify the provider (select all apply ) A. Nausea B. visual disturbances C. positive home pregnancy test D. numbness in tingling in fingers E. muscle pain
C, D, E Numbness in tingling and explain muscle pain can be findings of ergotamine overdose and it is a pregnancy risk category X medication
8- A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression which of the following should the nurse include in the teaching (select all that apply) A. Expect therapeutic effects in 24 to 48 hours B. discontinue the medication after a week of improved mood C. change position slowly to minimize dizziness D decrease dietary fiber intake to control diarrhea E. chew sugarless gum to prevent drama now
C, E Changing positions slowly helps prevent orthostatic hypotension and chewing sugarless gum can minimize dry mouth both are adverse effects of amitriptyline
7- A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A- i should take the medication on an empty stomach B- i will follow a low-sodium diet while taking this med C- i need to discontinue this med slowly? D- i should not crush this med before swallowing
C- when discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome
35- I nurses taking history for a client who reports that he is taking aspirin about four times daily for a sprained wrist which of the following prescribe medications taken for the client is contra indicated with aspirin A. Digoxin B. metformim C. warfarin D. nitroglycerin
C. Warfarin and other anticoagulants or increased by aspirin
Clonidine
Centrally Acting Alpha 2 Agonists •Addresses hyperarousal and intrusive symptoms
Prazosin (minipress)
Centrally Acting Alpha Blockers •nightmares and sleep disturbances, flashblacks
increases availability of acetylcholine
Cholinesterase inhibitors
Beneficially it is always good for anxiety; the feeling of always having to be alert (with PTSD)
Clonidine
35- nurses in an emergency department performing admission assessment for a client who has severe aspirin toxicity which of the following findings should she expect A. Body temperature 35°C 95 Fahrenheit B. lung crackles C. cool dry skin D. respiratory depression
D
36- nurse is preparing to administer Butorfanol to a client who has a history of substance use disorder the nurse should I didn't file which of the following information is true regarding Butorphanol A. It has a greater risk for abuse than morphine B. It causes a higher incidence of respiratory depression than morphine C. It cannot be reversed with an opiate antagonist D. It can cause abstinence syndrome in opiod dependent clients
D
7- A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which info should the nurse include? A- take this med on an empty stomach B- expect optimal therapeutic effects within 24hr C- take this med when needed for anxiety D- this med has a low risk for dependency
D- buspirone has a low risk for physical/psychological dependence/tolerance
12- I nurse in an acute mental health facility is caring for a client who is experiencing with drawl from opioid use and has a new prescription for clonidine which of the following actions should the nurse identify as a priority A. Administer the chlonidine on the prescribed schedule B. Provide ice chips at the clients bedside C. Educate the client on the effects of clonidine D. Obtain baseline vital signs
D.
37- I nurses in ministering amitriptyline to a client who is experiencing cancer pain for which of the following adverse effects of the nurse monitor A. Decreased appetite B. explosive diarrhea C. decreased pulse rate D. Orthostatic hypotension
D.
10- 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 and after each dose D. You should have your white blood cell count monitored every week
D. Due to the risk for fatal agranulocytosis
38- A nurse is reviewing the health history of a client who has migraine headache and is to begin prophylaxis therapy with Propanolol which of the following findings is a clot history should the nurse report to the provider A. The client had a prior myocardial infarction B. the client takes warfarin for arterial fibrillation C. the client takes an SSRI for depression D. an ECG indicates a 1st° heart block
D. Propanolol is contra indicated with heart blocks
What are the receptors for Dopamine
D1 , D2, D3, D4, D5
cariprazine (Vraylar)
D3 partial agonist improves cognitive symptoms
When a person going through stimulant withdrawal, you should assess for
Depression and Suicide
Propranolol & Atenolol with alcohol withdrawal
Depression of autonomic response/decrease in craving Decrease BP & HR
SNRIs
Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine (Effexor) Levomilnacipran (fetzima)
used as aversion therapy with alcohol withdrawal
Disulfiram (Antabuse)
when treating tics with FGAs you want to watch for
EPS tardive dyskinesia anticholinergic effects
What are the receptors for GABA?
GABAA GABAB
s/e of Atomoxetine (strattera)
GI disturbance reduced appetite wt loss urinary retention dizziness fatigue insomnia
Where is serotonin found?
Gut CNS
haldol and prolixin has __ potency
HIGH potency -more likely to have EPS
the lower the schedule number the ___ potential for addiction/abuse
HIGHER
Used to decrease the painful symptoms of opiate withdrawal
Methadone
SARIs
Nefazodone (Serzone) Trazodone (Desyrel) brexpiprazole (rexulti)
Acetylcholine (notes)
One of the most common, very well studied. A major player in memory. Imbalances cause twitching or paralysis
MAOIs useful for PTSD
Phenelzine (Nardil) great for symptoms relief, popular with PTSD treatment
What are the primary functions for Dopamine
Reward pathways Cognition Voluntary motion Involved in fine muscle movement Involved in integration of emotions and thoughts Stimulates the hypothalamus to release hormones
SGAs used for ASD
Risperidone (Risperdal) and Aripiprazole (Abilify)
Only 2 FDA approval antidepressant drugs (SSRIs) used for PTSD
Sertraline (Zoloft) Paroxetine (Paxil)
Where is Glycine located?
Spinal cord and Brainstem
What is the receptor for Tyramine?
TA1
A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse will advise the patient to:
Take a dose of your antidepressant now and come to the clinic to see the health care provider.
Tricycyclic (TCA) notes
Therapeutic effects similar to SSRIs but SE are more prominent May work better in melancholic depression and in people with comorbid medical conditions Some therapeutic serums levels may be monitored
Chance of suicide; wouldn't give to someone with a history of suicide
Varenicline (chantix)
serotinin syndrome
a condition that occurs when there's too much of the neurotransmitter serotonin in the body
-___ is a mood stabilizer and helps prevent relapse. it is important to continue taking the drug even after the current episode subsides. -___ is not addictive - it is important to monitor ___ blood levels closely until a therapeutic level is reached. - you should stop taking __ if you have excessive diarrhea, vomiting, or sweating. all these symptoms can lead to dehydration and increase blood levels of __ to toxic levels. - take __ with meals to avoid stomach irritation
lithium
mood stabilizer
lithium
which drug MUST reach therapeutic levels to be effective
lithium
which drug has a low therapeutic index
lithium
hyponatremia can increase the risk of
lithium toxicity because increased renal reabsorption of Na leads to increased reabsorption of lithium as well
A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?
mashed potatoes, ground beef patty, corn, green beans, apple pie
alprazolam
may be used short term to treat panic disorder and agoraphobia
notes with Vortioxetine (Trintellix)
may improve memory and cognition
warnings with Levomilnacipran (Fetzima)
may increase the effects of anticoagulants
warnings with Duloxetine (Cymbalta)
may reduce pain associated with depression and is approved for fibromyalgia and pain of diabetic peripheral neuropathy
progestin derivatives
medroxyprogesterone acetate (progesterone analog) & cyproterone acetate (testosterone inhibitor)
Decrease libido and aim to reduce sexually impulsive/deviant behavior
medroxyprogesterone acetate (progesterone analog) and Cyproterone acetate (testosterone inhibitor).
Ramelteon (Rozerem)
melatonin receptor agonist used for DFA
Prozac is very helpful for _____ experiencing anger with PTSD and general aggression
men
all second generation antipsychotics carry a risk of______
metabolic syndrome
a chosen medication for opioid abstinence & synthetic narcotic opioid
methadone substitution
medications to support withdrawal/abstinence from opioids
methadone substitution clonidine naltrexone (vivitrol) buprenorphine
noradrenergic and specific serotonergic antidepressant (NaSSA)
mirtazapine (remeron)
Venlafaxine (effxor)
mixed anxiety/depression, anxiety, nerve pain
lithium is a what
mood stabilizer
SE of Duloxetine (Cymbalta)
nausea, dry mouth, insomnia, somnolence, constipation, reduced appetite, fatigue, sweating, blurred vision
stimulant drugs are
often drmatic quickly increase attention & task-directed behavior while reducing impulsivity, restlessness, and distractibility
when is opioid withdrawal most intense
on 2nd and 3rd day of withdrawal
Suvorexant (Belsomra)
orexin receptor antagonist used for DFA, DMS
beta blocker used for hyperarousal and panic
propranolol (Inderal)
varenicline (chantix)
provides some nicotine effects to ease withdrawal symptoms and blocks the effects of nicotine from cigarettes if smoking is resumed
Acamprosate
relapse prevention with alcohol withdrawal •Decreases unpleasant affects of abstinence
A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about:
reporting increased suicidal thoughts
Nefazodone (Serzone)
risk for liver failure; avoid individual with pre-existing liver disease
trazodone
risk for priapism
SE of nefazodone
sedation, hepatotoxicity, dizziness, hypotension, parasthesias
nefazodone
selective blockage of serotonin-2 receptors and a1-adrenergic receptors
A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about:
sertraline (Zoloft).
black box warning for flibanserin
hypotension and syncope
long term use of lithium can cause
hypothyroidism
serotonin antagonists and reuptake inhibitors (SARIs)
nefazodone trazodone&trazodone ER (oleprtro)
when should blood levels be drawn when checking lithium
-morning -10-12 hours after the last dose taken
adverse effects of lithium
-nervous and muscular: tremor, ataxia, confusion, convulsions -digestive: nausea, vomiting, diarrhea -cardiac: arrhythmias -fluid & electro: polyuria, polydipsia, edema -endocrine: goiter & hypothyroidism
Pseudoparkinsonism (EPS)
-shuffling gait -rigidity -posture stooped -tremors at rest -pill rolling motion in figures
treatment for neuroleptic malignant syndrome
-stop medication -fluid resuscitation -antipyretic -monitor for rhabdomyolysis
lamictal
-tolerated well -DO NOT skip dosage -notify provider about any new skin rashes -Do not change soaps/detergents; utilize new skin products when starting. -provide patient teaching about stevens johnson syndrome
metabolic syndrome includes
-weight gain (mainly in the abdominal area) -dyslipidemia -increased blood glucose -insulin resistance ***SIGNIFICANT CONCERN*** and increases the risk of diabetes, certain cancers, HTN, cardiova disease
must have five or more to be dx with major depressive disorder within a 2-wk period
-weight loss & appetite changes -sleep disturbances -fatigue -worthlessness or guilt -loss of ability to concentrate -recurrent thoughts of death
signs of liver impairment
-yellowish skin & eyes -abdominal pain -ascites -vomiting -swelling in lower extremities -dark urine, pale or tar-colored stool -easily bruising -patient may complain of itchy skin, chronic fatigue, nausea, loss of appetite
blood serum levels for lithium therapeutic dosing
0.6-1.2
warnings with desvenalafaxine (pristiq)
neonates with in utero exposure have required respiratory support and tube feeding
Where is acetylcholine found?
neuromuscular junction CNS
What are the receptors for acetylcholine
nicotinic and muscarinic
Which neurotransmitters are most responsible for wakefulness? Select all that apply.
norepinephrine acetylcholine dopamine
Abstinence Syndrome
occurs when clients abruptly withdraw from a substance, they are physically dependent on.
Naloxone (narcan)
opioid antagonist (IM, IV, IN, SQ) increased respirations, dilated pupils happen quickly short duration of action, may require repeated doses
buprenorphine
opioid partial agonist reduce or quit -produces a euphoria or respiratory depression but in a weaker form -used only after abstaining from opioids for 12 to 24 hours and in early stages of opioid withdrawal
lacrimation, rhinorrhea, dilated pupils, muscle aches are signs and symptoms associated with
opioid withdrawal
A drug blocks the attachment of norepinephrine to a1 receptors. The patient may experience:
orthostatic hypotension.
what patients are lithium contraindicated in
patients with -cardiovas disease -brain damage -renal & thyroid disease -myasthenia gravis -pregnant or breastfeeding women -children younger than 12
major depressive disorder
persistent for minimum of 2 wks to 6 months chronic:lasting more than 2 yrs recurrent episodes are common symptoms cause distress or impaired function
A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes:
phenelzine.
Bensodiazepines
potentiate GABA and fortify membrane
an alpha-receptor antagonist used for nightmares , sleep disturbances, and flashbacks
prazosin (minipress)
this medication is used for treatment of nightmares and flashbacks associated with PTSD
prazosin (minipress)
naltrexone (vivitrol)
prevention of relapse opioid antagonist -if a person relapses and uses the misused drug, naltrexone blocks the euphoric and sedative effects
interventions that can be done with advanced lithium toxicity
•Hospitalization, Stop drug and hasten excretion, whole bowel irrigation
schedule 5 drugs
•Lomotil, Lyrica, robitussin AC
Risperidone (Risperdal)
•Low potential for agranulocytosis or convulsions •Highest risk of EPS among second generation •Risperdal Consta (INJ) Every 2 weeks: increased compliance
schedule 2 drugs
•Methadone, Ritalin, demerol
stimulant drugs for ADD/ADHD
•Methylphenidate (Ritalin) •Mixed amphetamine salts (Adderall)
NSSA used for PTSD
•Mirtazapine (Remeron) helpful for sleep disturbance and breaking looping thought patterns
patient teaching for tegretol
•Monitor therapeutic levels •Assess for early signs toxicity (fever, sore throat, mouth ulcerations, easy bruising bleeding, joint pain) •Blood tests frequent during first 3 months and after that at monthly intervals •Do not abruptly stop med •Administer with meals to avoid GI upset •Report visual abnormalities •Avoid tasks that require mental alertness until known response of drug •Avoid alcohol
Post Traumatic Stress Disorder
•Persistent re-experience of a highly traumatic event that involves actual or threatened death or serious injury to self or others.
Agranulocytosis
•Signs of infection •Fever/chills/sore throat/ •Increased susceptibility to infection
Stimulant Medications are used with ASD to
•Target hyperactivity, impulsivity, and inattention
schedule 3 drugs
•Testosterone, suboxone, tylenol with codeine
Librium
•Tremors/mild to moderate agitation
Venlafaxine (Effexor)
•Utilized off-label; targets anxiety and depressive symptoms
Anticonvulsants mood stablizers
•Valproate (Depakote) •Carbamazepine (Tegretol) •Lamotrigine (Lamictal)
schedule 4 drugs
•Xanax, Ativan, darvocet, gabapentin
Withdrawal
•physiological symptoms when an individual stops using the substance.
Side effects of Clozaril
•sedation, hypotension, tachycardia, and severe drooling.
medications for ASD are utilized to target
•specific symptoms and improve relatedness, decrease anxiety, compulsive behaviors, and agitation.
What are the primary functions for serotonin
Intestinal movement control Mood regulation Appetite Sleep Muscle control - plays a role in sexual aggression and behavior
Thorazine has ___ potency
LOW potency -more likely to have ACH effects
HIGH Na intake leads to
LOWER levels of lithium and less therapeutic effects
Norepinephrine (notes)
produced from Dopamine in the adrenal glands (on kidneys)
increase in Glutamate (NMDA) can cause?
prolonged increased state can be neurotoxic Neurodegeneration in Alzheimer's
for treatment of OD with opioid
promote breathing, aspirate secretions, maintain airway
long acting versions of stimulants allow
for a morning administration with sustained release of the medication over the course of the day and with a decreased incidence of insomnia
decrease in Glutamate can cause?
psychosis
SGAs ____,_____&____ can prolong the QT interval
quetiapine (Seroquel), risperidone (Risperdal), & ziprasione (Geodon)
bupropion (zyban)
reduces cravings for nicotine
sex offenders may be placed on medication to reduce ____
testosterone
what does having a low therapeutic index mean
that the blood level of a drug that can cause death is not far above the blood level required for drug effectiveness
Valproate (Depakote, Depakene) serious side effects
thrombocytopenia, pancreatitis, hepatic failure, birth defects
what happens if Naloxone is given with a high dose
too high of a dose will initiate withdrawal symptoms
nursing assessment of alcohol dependent client 6 to 8 hrs after the last drink would most likely reveal
tremors
Side effects of depakote
tremors, GI upset, weight gain, and rarely alopecia
Doxepin (Silenor)
tricyclic antidepressant used for DMS
MAOIs shouldn't be taking with anything containing
tyramine can result in high BP, hypertensive crisis, and can lead to CVA
Levomilnacipran (Fetzima)
unlike other SNRIs, inhibits reuptake of norepinephrine more than serotonin
A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
urinary retention
sonata
used for DFA
zolpridem
used for DFA
ambien CR
used for DFA, DMS
lunesta
used for DFA, DMS
ambien
used for DMS
intermezzo
used for DMS (sublingual taken in the middle of the night when there are at least 4 hours of sleep left)
Serotonin partial agonist and reuptake inhibitor
vilazodone (viibryd)
Serotonin Modulator and Stimulator
vortioxetine (trintellix)
SE with mirtazapine (remeron)
weight gain/appetite stimulation, sedation, dizziness, headache, sexual dysfunction is rare
when depression is happening during stimulant withdrawal what medication can be prescribed
wellbrutrin
when does stimulant use withdrawal start
withdrawal symptoms begin within a few hours to several days after stopping the stimulant
Naltrexone with alcohol withdrawal
withdrawal, relapse prevention, decreases pleasurable feelings and cravings
withdrawal from alcohol begins
within 4-12 hours of last intake of alcohol
is alcohol delirium a medical emergency
yes
A patient says, I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep. Which medication would the nurse expect a health care provider to prescribe for this patient?
zolpidem (Ambien)
what would you tell a pt that is taking Acamprosate(campral) for alcohol withdrawal
-begin taking on 5th day of abstinence from alcohol -tablets taken 3 times a day -S/E are GI upset, diarrhea, appetite loss, dizziness, anxiety, difficulty sleeping -contraindicated in pt with renal impairment
What are the negative symptoms of schizophrenia
-blunted affect -poverty of thought -loss of motivation -inability to experience pleasure or joy -lack of goal directed behavior
antipsychotic medications
-can take 2 to 6 weeks to achieve desired effect -discontinuation syndrome -RARE lethality in OD
before administering lithium what should you do
-complete a baseline assessment of renal function and thyroid status -perform electrocardiogram as needed
Clozaril
• Effects positive & negative symptoms •1st atypical antipsychotic •Low EPS & ACH •Slow dosage increases •Monitor WBCs •Weekly blood levels •Incidence of seizures •Monitor smoking habits of patients
hypertensive crisis
• Severe headache • Stiff, sore neck • Flushing; cold, clammy skin • Tachycardia • Severe nosebleeds, dilated pupils • Chest pain, stroke, coma, death • Nausea and vomiting
TCAs used for PTSD
•Amitriptyline (Elavil) •Imipramine (Tofranil)
Tolerance
•An individual no longer responds to the drug as they did in the beginning; require more and more of the drug.
Carbamazepine
•Decrease in seizures
lithium is especially useful for
-elation -strong protective agent for suicidal ideation and hx of suicide attempts -flight ideas -anxiety -self-injury -irritability
SSRIs notes
-first line of TX for major depression -Some activate, some sedate, depends on the PT symptoms -risk of lethal OD minimized with SSRIs
what will you see in someone who is in a manic state
-loud rapid speech -punning -rhyming -hyperactive -elevated -irritable -easily distracted
first generation antipsychotics side effects
-anticholinergic side effects -EPS (acute dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia) -sedation -orthostatic hypotension -lowered seizure threshold -photosensitivity -visual changes/cataracts -increased release of prolactin -weight gain -sexual dysfunction
for carbamazepine (tegretol)
-baseline liver function test, CBC, electrocardiogram, and electrolyte levels should be obtained
What are the primary functions of Glutamate
- Long term potentiation - Memory
increase in norepinephrine can cause?
- Mania - Anxiety states - Schizophrenia
GABA (notes)
- Mediates muscle tone - Receptors susceptible to alcohol which creates CNS depression
decrease in Dopamine can cause?
- Parkinsons - Depression
Tyramine (notes)
- amino acid - minor neurotransmitter that is largely not understood
increase in GABA can cause?
- reduction of anxiety
blood levels for lithium should be measured
-5 days after beginning treatment and after any dosage change until therapeutic levels reached -checked monthly until 6 mo to 1 year of stable dosing, then every 3 mo
which medications are used to treat anticholinergics side effects
-Benztropine (Cogentin) -Trlexyphenldyl (Artane) -Diphenhydramlne (benadryl)
Tegretol adverse effects
-CARDIO: CHF, arrythmias -CNS: abrupt withdrawal-seizures (status epilepticus) -Hematological: blood dyscrasias Hepatic:abnormal liver function tests, jaundice, hepatitis
Tegretol side effects
-GIVE with meals to REDUCE GI upset -Frequent SE: drowsy, dizzy, N/V -Infrequent SE: Lethargy, visual abnormalities, dry mouth, headache, urinary frequency, rash
Clonidine for alcohol withdrawal
•Depression of autonomic response give every 4 to 6 hrs as PRN S/E- dizziness, hypotension, fatigue, headache
9- A nurse is reviewing laboratory findings and notes that the clients plasma lithium level is 2.1 MEQL which of the following is an appropriate action by the nurse A. Perform immediate gastric lavage B. prepare the client for hemodialysis C. administer an additional oral dose of lithium D request a stat repeat of the laboratory test
A. Gastric lavage is appropriate for severe toxicity this action will lower the clients lithium level
what are the Cholinesterase inhibitors
•Donepezil •Rivastigmine •Galantamine
1. A nurse is discussing silent rape reaction with a newly licensed nurse. The nurse should identify which of the following characteristics as expected for this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault
1. A. CORRECT: Sudden onset of phobic reactions is a characteristic of a silent rape reaction. B. Development of substance use disorder is a characteristic of a compound rape reaction. C. CORRECT: Increased anxiety during interview is a characteristic of a silent rape reaction. D. Reactivation of a prior physical disorder is a characteristic of a compound rape reaction. E. CORRECT: No verbalization of the sexual assault is a characteristic of a silent rape reaction.
what are the levels of lithium during early toxicity
1.5-2.0
8- A nurse is caring for a client who has a new prescription for phenalzine for the treatment of depression. which of the following indicates that the client has developed an adverse effect of this medication A. Orthostatic hypotension B. hearing loss C. gastrointestinal bleeding D. weight loss
A. Orthostatic hypotension is an adverse of affects of MAOIs including phenelzine
11- I nurse is teaching the parents of the school-age child about trans dermal methylphenidate which of the following instructions should the nurse include A. Apply one patch twice a day B. Leave the patch on for 9 hours C. Apply the patch to the child's wrist D. Used open tray within six months
B
12- I nurse is providing teaching to a client who has a new prescription for clonidine to assist with maintenance of abstinence from opioids the nurse should instruct the client to monitor for which of the following adverse effects A. Diarrhea B. Dry mouth C. Insomnia D. Hypertension
B
36- I nurse is reviewing the medication administration record for a client who is receiving trans dermal Fentonaylfor severe pain which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl A. Ampicillin B. diazepam C. Furosemide D. prednisone
B
4. A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following responses should the nurse make? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C."You believe this wouldn't have happened if you hadn't been out alone?" D."Why do feel that you should not have been alone on the street at night?"
4. A. This response offers the nurse's opinion, which is a nontherapeutic communication technique. B. This responses indicates disapproval, which is a nontherapeutic communication technique. C. CORRECT: This response uses the therapeutic communication technique of restating, which promotes reflection and verbalization of feelings. D. This responses asks a "why" question, which is a nontherapeutic communication technique.
how long can alcohol withdrawal last
5-7 days
What are the receptors for serotonin?
5-HT
5. A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? A. "Rape is a crime of passion." B. "Acquaintance rape often involves alcohol." C."Young adults are the typical victims of sexual assault." D."The majority of rapists are unknown to the victims."
5. A. Rape is a crime of violence, aggression, anger, and power. B. CORRECT: Alcohol and other substances are often associated with date or acquaintance rape. C. Individuals of all ages are affected by sexual assault and can be male or female. D. The majority of perpetrators are known to the vulnerable persons.
opiod withdrawal begins
6 to 8 hours after last dose
lithium therapeutic levels is
<1.5
severe lithium toxicity
>2.5
36- nurse is preparing to administer an opioid agonist to a client who has acute pain which of the following complications should the nurse monitor A. Urinary retention B. Tachy apnea C. hypertension D. irritating cough
A
38- The nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy which of the following actions should the nurse include in the plan care A. Keep the client NPO until pharyngeal response returns B. monitor the insertion site for hematoma C. palpate the bladder to detect urinary retention D. maintain the client on bed rest for 12 hours following the procedure
A
37- I nurse is caring for a client who has cancer and is taking morphine and Carbamazepine for pain which of the following affects the nurse monitor when given these medications together (select all apply ) A. Need for reduced dosage of the opioid B. reduced adverse affects of the opioid C. increased analgesic effects D. enhanced CNS stimulation E. increased opioid tolerance
A, B, C
15- A nurse in the post anesthesia care unit is caring for a client who is experiencing malignant hyperthermia which of the following actions should the nurse take (select all apply) A. Place a cooling blanket on the client B. administer oxygen at 100% C administer iced 0.9% sodium chloride D administer potassium chloride IV E monitor core body temperature
A, B, C, E
10- I nurse is preparing to perform a follow-up assessment on a client who takes for chlorpromazine for the treatment of schizophrenia . The nurse should expect to find the greatest improvement in which of the following manifestations ( select all apply ) A. Disorganize speech B. Bizarre behavior C. Impaired social interactions D. Hallucinations E. Decreased motivation
A, B, D
9- I nurse is caring for a client who has a new prescription for that Protec acid the nurse should instruct the client that while taking this medication he will need to have which of the following lab test completed periodically (select all apply) A. Thrombocytes count B. hematocrit C. amylase D liver function test E. potassium
A,C,D Valproic acid can result in thrombocytopenia, pancreatitis and hepatotoxicity
16- A nurse is providing instructions to a female client who has a new prescription for zolpidem, what instructions should the nurse include A. Notify the provider if you plan to become pregnant B. Take the medication one hour before you plan to go to sleep C. Allow at least six hours for sleep when taking zolpidem D. To increase the effectiveness of zolpidem take it with a bedtime snack
A.
35- I nurse is teaching a client about a new prescription for celecoxib which of the following information should she include in the teaching A. Increases the risk for a myocardial in farction B. Decreases the risk of stroke C. Inhibits COX-1 D. Increases platelet aggregation
A.
7- A nurse is assessing a client 4 hrs after receiving an initial dose of fluoxetine the nurse is concerned that the client is developing serotonin syndrome A. Alteration in health (diagnosis) B. identify six expected findings C. risk factors
A. Serotonin syndrome is a potentially lethal complication that usually begins 2 to 72 hours after initiation of treatment with an SS our eyes syndrome resolves with the medication is discontinued B. Agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, incoordination, hyperreflexia, trimmers, fever, diaphoresis C. Onset of treatment with an SSRI within the last 2 to 72 hours , concurrent use of an SSRI with an MAOI and concurrent use of an SSRI with a TCA
12- I nurse is teaching a female client who has tobacco use disorder about nicotine replacement therapy which indicates the client understands the teaching A. I should avoid eating right before I chew a piece of nicotine gum B. I will need to stop using the nicotine gum after one year C. I know the nicotine gum is safe alternative to smoking if I become pregnant D. iMessage to the nicotine gum quickly for about 15 minutes
A. The client should avoid eating or drinking anything 15 minutes prior to and during chewing the gum
11- A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD which of the following instructions should the nurse include to minimize an adverse effect to this medication A. Wear sunglasses went outdoors B. Check your temperature daily C. Take this medication in the morning D. Add extra calories to your diet
A. Wearing sunglasses will decrease the photophobia
SSRIs used for PTSD
•Fluoxetine (Prozac) •Sertraline (Zoloft): FDA approval •Paroxetine (Paxil): FDA approval •Citalopram (Celexa) •Escitalopram (Lexapro) •Fluvoxamine (Luvox)
Glycine (notes)
Amino acid
Tricycyclic (TCA)
Amitriptyline(elavil) Impipramine (tofranil) Nortriptyline (Aventyl, Pamelor)
15- A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms which of the following statements by the client indicates they understand (select all apply) A. I will stop taking this medication right away if I develop dizziness B. I know the doctor will gradually increase my dose of this medication for a while C. I should increase fiber to prevent constipation from this medication D. I won't be able to drink alcohol while I'm taking this medication E. I should take this medication on an empty stomach each morning
B, C, D
37- A nurse is planning care for a client who has cancer and is taking a glucocorticoid as a adjuvant medication for pain control which of the following interventions the nurse include in the plan of care (select all apply) A. Monitor for urinary retention B. monitor serum glucose C. monitor serum potassium level D. monitor for gastric bleeding E. monitor for respiratory depression
B, C, D Glucocorticoids raise good ghost level cause hypokalemia and put a client at risk for peptic ulcer
7- A nurse working in an emergency dept. Is caring for a client who has benzodiazepine toxicity due to an overdose. Which actions is the nurses priority? A- administer flumazenil B- identify the clients level of orientation C- infuse iv fluids D- prepare the client for gastric lavage
B- the first action the nurse should take when using the nursing process is to assess the client. Identifying the clients level of orientation is the priority action
8- A nurse is caring for a client who is been taking sertraline for the past two days which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome A. Bruising B. Fever C. Abdominal pain D. Rash
B. Fever is a manifestation of serotonin syndrome which can result from taking an SSRI such as sertraline
10- A nurse is teaching a client who has schizophrenia strategies to cope with anti-cholinergic effects of Fluphenazine which of the following should the nurse suggest to the client to minimize anti-cholereginic effects A. Take the medication in the morning to prevent insomnia B. Chew sugarless gum to moisten the mouth C. Used cooling measures to decrease fever D. Take an antacid to relieve nausea
B. Helps with dry mouth
11- A nurse is teaching the parents of a child who has a new prescription for desipramine the nurse should instruct the parents that which of the following adverse affects is the priority to report to the provider A. Constipation B. Suicidal thoughts C. Photophobia D. Dry mouth
B. The greatest risk is injury from a suicide attempt
11- A nurse is caring for a school-age child who has a new prescription for Atomoxetine the nurse should monitor the client for which of the following adverse affects of this medication A. Kidney toxicity B. Liver damage C. Seizure activity D. Adrenal insufficiency
B. The nurse should monitor for manifestation such as jaundice upper of Domino tenderness darkening of the urine and elevated liver enzyme's
36- I nurse is caring for a client who has and stage cancer and is receiving morphine the clients daughter asks why the provider prescribed myethylnaltrexone which of the following responses to the nurse make A. The medication will increase your mothers respirations B. Medication will prevent dependent on the morphine C. The medication to relieve your mothers constipation D. Medication works with the morphine to increased pain relief
C
15- A nurse in the operating room is caring for a client who received a dose of Succinylcholine during operation the client suddenly develop his rigidity and his body temperature begins to rise the nurse should anticipate a prescription for which of the following meds A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium
C. Dantrolene ask on skeletal muscles to reduce metabolic activity and treat malignant hypa thermia
12- A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol which of the following should be included in the teaching A. Increases the risk for seizure activity B. Provides a form of aversion therapy C. Decreases cravings D. Results in mild hypertension
C. Propranolol is used during withdrawal to decrease cravings
nicotine replacement therapies
gum lozenges nasal sprays patches inhaler
FGAs used for tic disorder
haloperidol (haldol) pimozide (orap)
Decrease in risk of seizures, substitution therapy for alcohol
Diazepam (valium)
MDMA/Ecstasy
•Given in 3 doses, patients reported 56% decrease in symptom severity •Results lasted for more than a year after treatment Reduces painful memories and aids in stopping concurrent substance abuse
schedule 1 drugs
•Heroin; LSD; ecstasy
Olanzapine (Zyprexa)
•High risk of metabolic syndrome
A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to:
improvement in depression.
increase in Glutamate (AMPA) can cause?
improvement of cognitive performance in behavioral tasks
Important to monitor liver function and platelet count
Depakote/valproate
decrease in norepinephrine can cause?
Depression
SE of desvenalafaxine (pristiq)
nausea, headache, dizziness, insomnia, diarrhea, dry mouth, sweating, constipation
15- A nurse is reviewing the healthcare record of a client reports urinary incontinence and asks about a prescription for oxybutynin the nurse should recognize that Oxybutynin is contra indicated in the presence of A. Bursitis B. Sinusitis C. depression D. glaucoma
D. It can increase intraoccular pressure
16- A nurse is caring for a client who is admitted to undergo a surgical procedure which of the following pre-existing conditions can be a contraindication for the use of ketamine as an intravenous anesthetic A. Peptic ulcer disease B. Breast cancer C. Diabetes mellitus D. Schizophrenia
D. Ketamine can produce hallucinations making schizophrenia even worse
9- A nurse is caring for a client who has a new prescription for lithium carbonate when teaching the client about ways to prevent lithium Toxicity the nurse should advise the client to do which of the following A. Avoid the use of acetaminophen for headaches B. restricted intakes of foods rich in sodium C. decreased fluid intake to less than 1500 ML daily D. limit aerobic activity in hot weather
D. The client should avoid activities that can cause sodium and water depletion which could increase the risk for toxicity
SE of Levomilnacipran (Fetzima)
nausea, orthastatic hypotension, constipation, sweating increased HR, palpitations, difficulty urinating, decreased appetite, sexual dysfunction
Brexpiprazole (rexulti)
FDA for the tx of depression that accompanies schizophrenia -akathisia and weight gain
What are the primary functions for Norepinephrine?
Fight or flight response (Increased heart rate, increased glucose in blood stream, increased oxygen to brain and muscles) - level in brain effects mood - attention and arousal
Quetiapine (Seroquel, Seroquel XR)
High sedation, weight gain
interventions for severe toxicity
Hospitalization, Stop drug and hasten excretion, whole bowel irrigation, hemodialysis
Where is Dopamine found?
Hypothalamus
Dopamine (notes)
Imbalances of this drug cause Parkinson's, cocaine and opiates have a significant effect on its release
these drugs are used to
Improve irritability expressed by severe temper tantrums, aggression and self-injurious behavior
Where is GABA located?
In the Brain
Where is Tryptophan located?
In the blood
What are the primary functions of GABA?
Inhibits CNS - reduces aggression, excitation, and anxiety - may play a role in pain perception - has anticonvulsant and muscle relaxing properties
What is the primary function for Glycine?
Inhibits signals
Where is L-DOPA located?
Inside the Hypothalamus
Patient teaching about important side effect of Stevens Johnson Syndrome (rare potentially fatal skin rash)
Lamictal
Strong protective agent for suicidal ideation and Hx of suicide attempts
Lithium
used for treatment of PTSD to reduced painful memories
MDMA
Reduces painful memories and aids in stopping concurrent substance abuse.
MDMA/Ecstasy
Disulfiram (Antabuse)
Maintains abstinence from alcohol physical effects when alcohol is used: intense N/V, headache, sweating, flushed skin, respiratory difficulties, confusion
By which mechanism do selective serotonin reuptake inhibitors (SSRI) improve depression?
Making more serotonin available at the synaptic gap
Norepinephrine and serotonin specific antidepressant
Mirtazapine (remeron)
Serotonin (notes)
Most antidepressants mimic the effect of this. Most narcotics affects its release or reuptake
What are the primary functions for Acetylcholine
Muscle control Memory formation Sensory response Excitatory - regulates mood: mania, sexual aggession - stimulates parasympathetic nervous system
S/E of buprenorphine
N/V constipation muscle aches cramp insomina irritability fever
alcohol withdrawal symptoms
N/V; tremors, irritability, increased heart rate, BP, increased RR, increased temperature, sweating, tonic-clonic seizures, illusions
What are the receptors for Glycine?
NMDA
memantine is a
NMDA receptor antagonist
regulates glutamate
NMDA receptor antagonists
What are the receptors for Glutamate?
NMDA, others
Increased RR,Dilated pupils happen quickly, Short duration
Naloxone (Narcan)
Treats OD of opioids
Naloxone (narcan)
Used for prevention of relapse to opioid dependence
Naltrexone(vivitrol)
second generation antipsychotics medications
Olanzapine (Zyprexa) Risperidone (Risperdal) Asenaprine (Saphris) Lurasidone (Latuda) Quetiapine (Seroquel, Seroquel XR) Ziprasidone (Geodon)
Dilated pupils
Opioid withdrawal
Known as minipress and good for flashbacks
Prasozin
What are the primary functions of Tryptophan?
Precursor of Serotonin
What is the primary function for L-DOPA?
Precursor to dopamine
Good for heart racing and sweating
Propranolol
A nurse in the emergency department is caring for a client who is a survivor of date rape after being given a substance. Use the ATI Active Learning Template: Basic Concept to complete this item. RELATED CONTENT: Identify at least two substances, other than alcohol, commonly associated with date rape. Include the street names for these substances. UNDERLYING PRINCIPLES: Compare and contrast rape and date rape. NURSING INTERVENTIONS: Identify at least four interventions that are appropriate during the physical examination.
RELATED CONTENT ● Gamma-hydroxybutyrate: Street names "G," "liquid ecstasy" ● Flunitrazepam: Street names "roofies," "club drug," "roachies" ● Ketamine: Street names "black hole," "kit kat," "special K" UNDERLYING PRINCIPLES: Both rape and date rape are forced sexual penetration and a form of sexual assault. However, date rape specifically refers to rape by a known acquaintance during a mutually agreed upon social engagement. NURSING INTERVENTIONS ● Provide a private, secure environment. ● Provide nonjudgmental and empathetic care. ● Assist the sexual assault nurse examiner with obtaining, documenting, and preserving legal evidence. ● Treat any injuries, and document care given. ● Administer prophylactic treatment for the prevention of STIs. ● Evaluate the client for pregnancy risk and provide prevention if indicated. ● Call the client's available personal support system, if the client gives permission. ● Encourage the client to verbalize her story and emotions. ● Use therapeutic communication techniques.
Duloxetine (Cymbalta)
SNRI benefits in chronic pain
Levomilnacipran (Fetzima)
SNRI can cause increase in HR and BP
Venlafaxine(Effexor)
SNRI risk for HTN
Fluvoxamine (Luvox)
SSRI anxiety reducing
sertraline (zoloft)
SSRI anxiety reducing may have some antipsychotic effect
Fluoxetine (prozac)
SSRI appetite suppression at higher doses
paroxetine (paxil)
SSRI most anticholinergic avoid in patients with contraindications to anticholinergic agents significant weight gain possible
A patient tells the nurse, My doctor prescribed Paxil (paroxetine) for my depression. I assume Ill have side effects like I had when I was taking Tofranil (imipramine). The nurses reply should be based on the knowledge that paroxetine is a(n):
SSRI.
This class of drugs improve mood and reduce anxiety, which provides the pt with a higher degree of tolerance for new situations
SSRIs
which class of medications are used for premature ejaculation disorder
SSRIs
warnings with Bupropion (Wellbutrin)
high doses increase seizure risk, especially in people who are predisposed to them
Ziprasidone (Geodon)
Take with food Avoid in cardiac patients/hx of QT prolongation
Which anticonvulsant mood stabilizer works well especially in rapid-cycling pts, severely paranoid angry pts, and dysphoric patients?
Tegretol
Contraindicated hx of bone marrow suppression, and hypersensitivity to TCAs, caution using with pts. Impaired hepatic, liver, and renal function
Tegretol (Carbamazepine)
LOW Na intake leads to
higher lithium levels, which could lead to toxicity
what are some interventions that should happen during early toxicity
hold dose, close evaluation, blood draw
SE of Venalfaxine (Effexor)
hypertension, nausea, insomnia, dry mouth, sedation, sweating, agitation, headache, sexual dysfunction
SNRI used for PTSD
Venlafaxine (Effexor) Levomilnacipran (Fetzima)
should benzo be tapered off slowly during the course of treatment
YES
desvenalafaxine (pristiq)
a metabolite of venalafaxine
A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:
hypertensive crisis
SE of Bupropion (Wellbutrin)
agitation, insomnia, headache, N/V, seizures (0.4%)
Side effects of SSRIs
agitation, insomnia, headache, N/V, sexual dysfunction, hyponatremia
Vortioxetine (Trintellix)
agonist of serotonin receptors
what should patients avoid when taking flibanserin
alcohol
Paroxetine (paxil)
also helpful with GAD
A patient says to the nurse, My life doesnt have any happiness in it anymore. I once enjoyed holidays, but now theyre just another day. The nurse documents this report as an example of:
anhedonia
Mirtazapine (Remeron)
antianxiety/antidepressant effects minimal sexual dysfunction improved sleep SE: sedation, increased appetite, weight gain
TCAs
anticholinergic adverse reactions
SE of TCAs
anticholingerics: dry mouth, blurred vision, constipation, urinary retention, tachycardia, possible confusion
-superior for continuously cycling patients -more effective when there is no family hx of bipolar -effective at diminishing impulsive and aggressive behavior -helpful in cases of alcohol and benzo withdrawal -beneficial in controlling mania (within 2 weeks) & depression (3 weeks or longer)
anticonvulsant drugs
notes with mirtazapine (remeron)
antidepressants effects equal SSRIs and may occur faster
_______ can be used for agitation & paranoia with stimulant use withdrawal
antipsychotics
clonidine
anxiety disorders, panic attacks
SGAs used for tx of tics
aripiprazole (abilify)\risperidone (risperdal)
what is the black box warning for Atomoxetine (strattera)
associated with an increased suicidal ideation
untreated depression leads to the
atrophy of neurons in the pre-frontal cortex, an area associated with planning, reasoning and decision-making and socially appropriate manner
When alprazolam (Xanax) is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to:
avoid alcoholic beverages.
vortioxetine (trintellix)
beneficial for elderly with depression as may improve cognitive impairment SE:hyponatremia
Slow taper of ______ medication to prevent life threatening complications such as seizures; may note autonomic hyperactivity, tremor, insomnia, psychomotor agitation, anxiety.
benzo
indicated for use in anxiety disorders, sedation, seizures, muscle relaxant, substance abuse withdrawal, depression
benzodiazepines
what is the black box warning for second generation antipsychotics
black box warning for INCREASED death when utilized in elderly patients with dementia
second generation antipsychotics side effects
black box warning for INCREASED death when utilized in elderly patients with dementia -sedation -sexual dysfunction -seizures -decreased risk of EPS and TD -metabolic syndrome -increased risk of suicidality in younger patients -anticholinergic toxicity -neuroleptic malignant syndrome -prolongation of QT interval
loxapine (adasuve) inhaled
black box warning for bronchospasm
Muscarinic receptor
blockade includes atropine-like side effects, such as dry mouth, blurred vision, and constipation
Vilazodone (Viibryd)
blocks reuptake of serotonin and serotonergic receptor partial agonist activity
Bupropion (Wellbutrin)
blocks the synaptic reuptake of norepinephrine and dopamine
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
blocks the synaptic reuptake of serotonin and norepinephrine
SE of SSRIs
body weight increase anxiety, aggression dizziness sedation stimulated CNS reproductive/sexual dysfunction insomnia
it can bring on acute withdrawal for patients not in the early stages of withdrawal and have other opioids in their bloodstream
buprenorphine
16- I nurse is caring for a client who is receiving moderate sedation with diazepam IV the client is oversedated which of the following medications should the nurse anticipate administering to this client A. Ketamine B. Naltrexone C. Flumazenil D. Fluvoxamine
c.
liver impairment may occur with taking ____ & usually occurs in the first weeks of therapy
first generation antipsychotics
Vilazodone (Viibryd)
can cause insomnia, take with food
Elavil & Tofranil
can help with pain, sensational feeling associated with PTSD
Buspirone (BuSpar)
can treat the worry associated with GAD rather than the muscle tension
akathisia (EPS)
can't sit still -restless -paces -difficulty standing still -feet constantly in motion
-work better in patients with rapid cycling and in severely paranoid angry patients with mania -more effective in dysphoric patients experiencing manias -liver enzymes should be monitored at least weekly for the first 8wks of treatment b/c the drug can increase levels of liver enzymes that can speed its own metabolism -known to cause leukopenia & aplastic anemia
carbamazepine (tegretol)
first generation antipsychotics meds
chlorpromazine (thorazine) loxapine (adasuve) inhaled haldol (haloperidol)
SSRIs
citalopram(celexa) escitalopram(lexapro) fluoxetine(prozac, prozac weekly) paroxetine(paxil, paxil CCR, pexeva) sertraline(zoloft)
these medications are used in the treatment of sexual obsessions, addictions, paraphilic disorders
clomipramine (Anafranil) and Fluvoxamine (Luvox)
which benzo is used to treat tics
clonazapam (klonopin)
watch for HYPOtension with which 3 medications
clonidine propranolol prazosin
decreases sympathetic activity and reduces withdrawal symptoms of nicotine
clonidine (catapres)
this medication is used for hyperarousal and intrusive symptoms associated with PTSD
clonidine (catapres)
used for hyperarousal and intrusive symptoms centrally acting alpha-2 recepor
clonidine (catapres)
alpha 2 adrenergic agonist used for tic
clonidine hydrochloride (catapres)
Agranulocytosis is most associated with
clozaril
Atomoxetine (strattera) is also useful for
comorbid anxiety substance use disorders tics
A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient:
confers with a pharmacist when selecting over-the-counter medications.
SE of Vortioxetine (Trintellix)
constipation, N/V hypnotremia, rare induction of manic states, serotonin syndrome
warnings with MAOIs
contraindicated in people taking SSRIs, used cautiously in people taking TCAs; tyramine rich food could bring about hypertensive crisis
Duloxetine (Cymbalta)
cymbalta may be more effective than SSRIs in the TX of major depression
SSRIs
first line therapy for usage of antidepressants
this drug is a serotonin agonist & antagonist used for female sexual interest/arousal disorder
flibanserin (addyi)
St. John's Wort
flower processed into tea or tablets thought to increase serotonin, norepinephrine and dopamine in the brain useful in mild to moderate depression
improve mood, reduce impulsivity, decrease sexual obsessions, cause sexual dysfunction
fluoxetine (prozac)
this med is used to treat exhibitionism, voyeurism, pedophilia
fluoxetine (prozac)
plus at least one symptom either has to be
depressed mood or loss of interest or pleasure (anhedonia)
Increase in Acetylcholine can cause?
depression
decrease in Serotonin can cause?
depression
symptoms for stimulant withdrawal
depression hypersomnia or insomnia fatigue anxiety irritability poor concentration psychomotor retardation or agitation increased appetite paranoia drug craving vivid nightmares
what can occur during stimulant withdrawal
depression and suicidal thoughts
SE of Vilazodone (Viibryd)
diarrhea, N/V, dry mouth, dizziness, insomnia palpitations, ventricular premature beats, serotonin syndrome
may utilize _____ for hyperactivity & agitation
diazepam (valium)
SSRIs warnings
discontinuation syndrome- dizziness, insomnia, nervousness, irritability, nausea and agitation- may occur with abrupt withdrawal (depending on half-life), taper slowly
S/E of Benzodiazepines
disinhibition, respiratory distress, mild cognitive impairment, anterograde amnesia, withdrawal
SGAs antipsychotics are predominantly
dopamine and serotonin antagonists (blockers) -the blockade at the mesolimbic dopamine pathway decreases psychosis
extended release formulations of these medications have improved
dosing and scheduling
warnings with mirtazapine (remeron)
drug-induced somnolence exaggerated by alcohol, benzodiazepines, and other CNS depressants
A drug causes muscarinic receptor blockade. The nurse will assess the patient for:
dry mouth
clonidine s/e
dry mouth somnolence fatigue insomnia nightmares irritability constipation respiratory symptoms ear pain
SE of Tricycyclic (TCA)
dry mouth, constipation, urinary retention, blurred vision, hypotension, cardiac toxicity, sedation
Venalfaxine (Effexor)
effexor is a popular next step strategy, after trying SSRIs
(MAOIs) notes
efficacy similar to other antidepressants but strict dietary (tyramine) restrictions and potential drug interactions make this drug class less desirable
mirtazapine (remeron)
enhances the release of norepinephrine and serotonin by blocking a1-adrenergic receptors that normally inhibit norepinephrine and serotonin
Tryptophan (notes)
essential amino acid
benzo are useful for treating alcohol withdrawal because they are associated with which action
exerting a calming effect
. A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, This medicine isnt working. The nurses best intervention would be to:
explain the time lag before antidepressants relieve symptoms
FGAs are strong antagonists (blocking the action) of D2 receptors for dopamine....the blockade of dopamine transmission can lead to
increased pituitary secretion in prolactin -in women this can result in amenorrhea (absence of menses) or galactorrhea (excessive or inappropriate breast milk production) - in men it can lead to gynecomastia (development of male mammary glands) and galactorrhea
may be at increased risk to develop agranulocytosis and should have a baseline ANC before starting
individuals of african descent, middle eastern descent
Monoamine Oxidase Inhibitors (MAOIs)
inhibit monoamine oxidase, the enzyme that terminates the actions of neurotransmitters such as dopamine, norepinephrine, and serotonin
tricyclic antidepressants (TCAs)
inhibits the reuptake of norepinephrine and serotonin at the presynaptic neurons in the CNS
Tricycyclic (TCA) action
inhibits the synaptic reuptake of serotonin and norepinephrine. antagonizes adrenergic, histaminergic, muscarinic, and dopainergic receptors
s/e of stimulants
insomnia appetite suppression headache abdominal pain lethargy
SE of MAOIs
insomnia, nausea, agitation, and confusion hypertensive crisis
-can cause a life threatening rash instruct patient to seek immediate medical attention if rash appears
lamotrigine (lamictal)
warnings with Tricycyclic (TCA)
lethal in OD, use cautiously in older adults with cardiac disorders, elevated intraocular pressure, hyperthryoidism, seizure disorders and liver or kidney dysfunction
Early signs of lithium toxicity
levels 1.5-2.0 -GI upset -course hand tremor -confusion -hyperirritability of muscles (muscle spasm) -EKG changes -sedation -incoordination
Lithium levels should NOT exceed
levels of 1.5
warnings with nefazodone
life threatening liver failure is possible but rare; priapism of penis and clitoris is a rare but serious SE
Eszopiclone (Lunesta)
longest half life, sleep duration of 7-8 hours
A patient experiences a sudden episode of severe anxiety. Of these medications in the patients medical record, which is most appropriate to give as a prn anxiolytic?
lorazepam (Ativan)
Benzodiazepines for alcohol withdrawal
lorazepam (ativan) Diazepam (valium)
nefazodone notes
lower risk of long term weight gain than SSRIs or TCAs lower risk of sexual side effects than SSRIs
often gives people a bitter taste when waking up
lunesta
Anticonvulsants is beneficial in controlling
mania within 2 weeks and depression within 3 weeks
trazodone & trazodone ER (oleptro)
moderate blockade of 5-HT (serotonin) synaptic uptake
warnings with Venalfaxine (Effexor)
monitor BP especially with higher doses and with HX of hypertension discontinuation syndrome
Anticonvulsants
more effective with no family history of bipolar, effective in impulsive and aggressive behavior, helpful in alcohol and benzo withdrawal
what is a patient teaching about disulfiram (antabuse)
most over the counter cough medicines aren't safe to use
has a short duration and may require repeated doses
naloxone (narcan)
increased respirations, dilated pupils happen quickly
naloxone (narcan)
main medication giving for opioid OD
naloxone (narcan)
helps prevent relapse of opioids by reducing drug craving
naltrexone
if a person relapses and uses the misused drug, _____ blocks the euphoric and sedative effects
naltrexone
alcohol delirium can have
severe auditory and visual hallucinations, severe hypertension, cardiac dysrhythmias
signs of hypertensive crisis
severe headache stiff, sore neck flushing; cold, clammy skin tachycardia severe nosebleeds, dilated pupils chest pain, stroke, coma , death N/V
SE with trazodone & trazodone ER (oleptro)
severe sedation, hypotension, nausea priapism has been reported
Propranolol
short term relief of social anxiety and performance anxiety
chlorpromazine (thorazine)
significant reduction in agitation positive sx of scizophrenia route: po, IM, rectal side effects: orthostatic hypotension, photosensitivity, lowers seizure threshold
notes with trazodone & trazodone ER (oleptro)
significant sedative effect helps with antidepressant induced insomnia
guanfacine s/e
somnolence lethargy fatigue insomnia nausea dizziness HYPOtension abdominal pain
for older adults taking lithium you want to
start low and go slow
notes with Bupropion (Wellbutrin)
stimulant action may reduce appetite may increase sexual desire used as aid to quit smoking
Atomoxetine (strattera) is preferable for individuals whose anxiety is increased with
stimulants
when treating tic disorders you want to avoid which medications and why
stimulants they can increase severity of tics
cocaine exerts which of the following effects
stimulation and euphoria
moderate to high dose of stimulants
suppress aggression
Methadone substitution
synthetic narcotic opioid blocks euphoric effect of opioids chosen treatment in pregnancy
S/E of opioid withdrawal
tachycardia HTN hyperthermia insomnia Mydriasis(enlarged pupils), hyperreflexia diaphoresis piloerection (gooseflesh), increased RR lacrimation, yawning, rhinorrhea (runny nose) muscle spasms abdominal cramps, N/V, diarrhea bone & muscle pain anxiety
notes with Vilazodone (Viibryd)
take with food to reduce GI disturbances
haldol (haloperidol)
targets positive symptoms low anticholinergic effects HIGH EPS low sedative properties route: po, IM, decanoate (haldol D)
A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse will:
teach the patient strategies to manage postural hypotension