EXAM 2: Psych Depression

What are some other side effects of MAOIs?

-CNS stimulation -orthostatic hypotension -rash with transdermal patch

When discontinuing effexor, cymbalta, or paxil....what syndrome can occur?

-Discontinuation Syndrome -occurs within first week of stopping med (important to taper dosage)

What are some side effects of SSRIs?

-GI disturbance -Sexual dysfunction -headache -CNS stimulation (insomnia, agitation) -Sedation, lightheadedness -Weight loss/gain -Hyponatremia (need to stay hydrated) -Bruxism -GI bleeding

Which SSRI side effects are start up side effects?

-Headache -CNS stimulation (typical in Prozac)

What are s/s of hypertensive crisis?

-Headache -Increased b/p -Increased heartrate -Palpitations -n/v -Nuchal rigidity -Fever, sweating -photophobia

What are some SSRI drug interactions?

-MAOIs, TCAs, St. John's Wort -Coumadin -TCAs and Lithium can increase levels of SSRIs -Concurrent use of NSAIDs and anticoagulants (can cause GI bleeds)

What are some nursing considerations for people taking TCAs?

-Monitor for cardiac dysrhythmias -Administer at bedtime due to sedation and risk of orthostatic hypotension -Give only 1 week's worth for acutely ill clients -Use caution with driving or operating machinery.

What are some medications that should be avoided when taking MAOIs?

-OTC decongestants and cold remedies -Antidepressants -Mood stabilizers Tegretol and Trileptal -Antihypertensives -Demerol -Vasopressors (caffeine)

What are some common SSRIs?

-Paxil (Paroxetine) -Prozac (Fluoxetine) -Zoloft (sertraline) -Celexa (Citalopram) -Lexapro (Escitalopram)

What are some nursing considerations for people taking MAOIs?

-Provide a list of foods containing tyramine to the reduce the risk of hypertensive crisis -Don't take any prescription or nonprescription medications unless approved by the prescriber

What are some nursing considerations for people taking SSRIs?

-Take meds in a.m. to minimize sleep disturbance -Take meds with food to minimize GI disturbances -Obtain baseline sodium levels for older adults taking diuretics; monitor periodically

What is EMSAM?

-a MAOI transdermal patch -dosage is 6,9,12 mg doses -drug is not doing as well as hoped

What does serotonin syndrome cause?

-altered mental status -autonomic dysfunction -neuromuscular symptoms

What are some side effects of TCAs?

-anticholinergic -orthostatic hypotension -sedation -toxicity -decreased seizure threshold -excessive sweating

Name two characteristics of TCAs

-cheap to buy -if you seen one you have seen them all (does no good to try a different TCA if first one doesn't work)

What are some nursing considerations when a patient is on Effexor (Venlafazine)?

-check BP as this can increase -do NOT abruptly stop this drug...will make you feel like you are dying if you do

What are some nursing considerations for ECT?

-check VS and assess orientation q 15 mins. for 8 hours following ECT -educate patient about adverse reactions (memory loss can happen and is transient and will go away)

What is important to remember with Cymbalta (Duloxetine)?

-do NOT stop abruptly -do not give to some that drinks ever (hard on the liver)

What autonomic dysfunction symptoms can show up with serotonin syndrome?

-fever -shivering -increase BP -pupils dilated -tachycardia, diaphoresis

What is an advantage of taking Wellbutrin?

-good for people with low energy (do NOT give to someone with anxiety as this is a stimulating drug)

What pt hx is important to obtain before prescribing Wellbutrin?

-head injuries and hx of seizures -drug can cause an increase risk of seizures

What are some contraindications for ECT?

-head injury (increased intracranial pressure) -recent MI, -aneuresym -retinal detachment hx

What neuromuscular symptoms can show up with serotonin syndrome?

-hyperreflexia -muscle rigidity -nystagmus -seizures

What is Repetitive transcranial magnetic stimulation?

-massage brain with magnetic impulses -inducing electrical flow indirectly -session are 20-30 min -do every day for 2 weeks

What is a nursing action to help prevent suicide with TCAs?

-only give 1 week of drugs at a time to prevent stockpiling -take blood levels to see if patient is taking drug as directed

What are some common foods that contain tyramine?

-red wine -aged cheese/processed -smoked meats -sauerkraut -soy sauce (msg) -tap beer (bottle beer is ok)

What are nursing interventions for anticholinergic side effects?

-sugarless hard candy -sunglasses -intake water -empty bladder before bedtime

What are side effects of Remeron (Mirtazapine)?

-weight gain (good for tiny older adults) -can increase cholesterol and cause agranulocytosis

A client admitted with MDD has a nursing diagnosis of ineffective sleep pattern related to aches and pains. Which is an appropriate short-term outcome for this client? 1. The client will express feeling rested on awakening. 2. The client will rate pain level at or below a 4/10. 3. The client will sleep 6 to 8 hours at night by day five. 4. The client will maintain a steady sleep pattern while hospitalized.

3. The client will sleep 6 to 8 hours at night by day five.

A client is taking escitalopram (Lexapro) for depression. Which of the following should be reflected in your teaching to the client? A. It increases serotonin levels. B. It decreases norepinephrine levels. C. It increases dopamine levels D. It increases cortisol levels.

A. It increases serotonin levels.

The nurse is preparing a client for electroconvulsive therapy (ECT), which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? Select all that apply. A. Obtain an informed consent. B. Have the client void before the procedure. C. Remove dentures and contact lenses before the procedure. D. Withhold food and fluids for 6 hours before the treatment. E. Administer tap water enemas on the evening before the procedure.

A. Obtain an informed consent. B. Have the client void before the procedure. C. Remove dentures and contact lenses before the procedure. D. Withhold food and fluids for 6 hours before the treatment.

Which statement by a depressed client taking an antidepressant would indicate that further teaching is necessary? A. Once I start taking meds, I should begin to feel better within a day or two. B. My appetite should improve once my depression is resolved. C.My meds work on the synaptic gap in my brain. D. I can expect to be able to sleep through the night once I begin to feel better.

A. Once I start taking meds, I should begin to feel better within a day or two.

A nurse is providing dietary instructions to a client who is taking tranylcypromine sulfate (Parnate). The nurse emphasizes that which needs to be avoided while the client is taking this medication? A.Salami B. Scallops C. Pineapple D. Mashed potatoes

A. Salami Rationale: Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. A tyramine-restricted diet is required during therapy to avoid hypertensive crisis, a life-threatening effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef liver, chicken liver, and dry sausage (salami, pepperoni, and bologna). In addition, figs, bananas, aged cheese, yogurt and sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine, and aged, pickled, fermented, or smoked foods need to be avoided. Many over-the-counter medications also include tyramine and must be avoided as well.

Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? SELECT ALL THAT APPLY A. Urinary hesitancy. B. Constipation. C. Blurred vision. D. Sedation. E. Weight gain.

A. Urinary hesitancy. B. Constipation. C. Blurred vision.

A nurse is teaching a client with a new prescription of Amitriptyline (Elavil) how to minimize anticholinergic side effects. Which of the following should the nurse include in the teaching? SELECT ALL THAT APPLY A. Void just before taking the medication. B. Increase the dietary intake of potassium. C. Wear sunglasses when outside. D. Change positions when getting up slowly. E. Chew sugarless gum. F. Strict oral hygiene.

A. Void just before taking the medication. C. Wear sunglasses when outside. E. Chew sugarless gum. F. Strict oral hygiene.

A client's medication sheet contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, how should the nurse administer the dose? A. On an empty stomach B. At the same time each evening C. Evenly spaced around the clock D. As needed when the client complains of depression

B. At the same time each evening. Rationale: Sertraline (Zoloft) is classified as an antidepressant. Sertraline (Zoloft) generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline (Zoloft) is not prescribed for use as needed.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side/adverse effects of the medication? A. Cardiovascular symptoms B. Gastrointestinal dysfunctions C. Problems with mouth dryness D. Problems with excessive sweating

B. Gastrointestinal dysfunctions Rationale: The most common side/adverse effects related to this medication include central nervous system and gastrointestinal system dysfunction. Fluoxetine (Prozac) affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side/adverse effects associated with this medication.

A monoamine oxidase inhibitor (MAOI) is prescribed for a client. Which sign or symptom is indicative of toxicity? A. Lethargy B. Restlessness C. Lack of energy D. Feelings of fatigue

B. Restlessness Rationale: Acute toxicity of MAOIs is manifested by restlessness, anxiety, and insomnia. Dizziness and hypertension also can occur in acute toxicity. Options 1, 3, and 4 are not signs of toxicity related to MAOIs

A hospitalized client has begun taking bupropion (Wellbutrin) as an antidepressant agent. The nurse understands that which is an adverse effect, indicating that the client is taking an excessive amount of medication? A. Constipation B. Seizure activity C. Increased weight D. Dizziness when getting upright

B. Seizure activity Rationale: Seizure activity can occur in clients taking bupropion (Wellbutrin) dosages greater than 450 mg daily. Weight gain is an occasional side effect, whereas constipation is a common side effect of this medication. This medication does not cause significant orthostatic blood pressure changes.

A group of nursing students are reviewing the different classes of antidepressants. The students demonstrate understanding of the information when they identify sertraline (Zoloft) as exerting its action on which neurotransmitter? A. Dopamine. B. Serotonin. C. GABA D. Norepinephrine

B. Serotonin

Which of the following is a possible indication for ECT? A. Borderline personality disorder. B. Suicidal ideation caused by the recent loss of a significant other. C. Bipolar disorder with mania that has occurred six times in the past year. D. Paranoid schizophrenia and a moderate developmental disability.

C. Bipolar disorder with mania that has occurred six times in the past year.

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? A. Client reports not going to work for this past week. B. Client complains of not being able to "do anything" anymore. C. Client arrives at the clinic neat and appropriate in appearance. D. Client reports sleeping 12 hours per night and 3 to 4 hours during the day.

C. Client arrives at the clinic neat and appropriate in appearance.

A hospitalized client is started on phenelzine (Nardil) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. A. Figs B. Yogurt C. Crackers D. Aged cheese E. Tossed salad F. Oatmeal raisin cookies

C. Crackers E. Tossed salad Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.

A client diagnosed with MDD is being considered for ECT. Which client teaching should the nurse prioritize? A. Empathize with the client about fears regarding ECT. B. Monitor for any cardiac alterations to avoid possible negative outcomes. C. Discuss with the client and family expected short-term memory loss. D. Inform the client that inquiry related to induced seizure commonly occurs.

C. Discuss with the client and family expected short-term memory loss.

A client is taking a monoamine oxidase inhibitor (MAOI). What is the primary reason the nurse needs to assess this client closely? A. Hypotension may indicate toxicity. B. These medications increase the amount of MAO in the liver. C. Headache, hypertension, and nausea and vomiting may indicate toxicity. D. Hypotensive crisis may be precipitated by foods rich in tyramine and tryptophan.

C. Headache, hypertension, and nausea and vomiting may indicate toxicity. Rationale: Headache, hypertension, tachycardia, nausea, and vomiting are precursors to hypertensive crisis brought about by the ingestion of foods rich in tyramine and tryptophan while the client is taking MAOIs. These medications act by decreasing the amount of MAO in the liver, which is necessary for the breakdown and use of tyramine and tryptophan. Hypertensive crisis may lead to circulatory collapse, intracranial hemorrhage, and death.

The health care provider is planning to prescribe a medication for a client with major depression. Which medication should the nurse expect to be prescribed? A. Clozapine (Clozaril) B. Amitriptyline (Elavil) C. Paroxetine hydrochloride (Paxil) D. Tranylcypromine sulfate (Parnate)

C. Paroxetine hydrochloride (Paxil) Rationale: Paroxetine is an antidepressant used in the treatment of major depression. Amitriptyline is a tricyclic antidepressant used to treat various forms of depression. Tranylcypromine is a monoamine oxidase inhibitor used in the symptomatic treatment of severe depression in hospitalized or closely supervised clients, and clozapine is an atypical antipsychotic medication.

A client is being prepared for electroconvulsive therapy (ECT). The nurse's plan of care for the day before ECT includes ensuring that the client follows which guideline? A. Does not smoke at all B. Receives no visitors and participates in limited unit activities C. Reports to the clinic for blood draws and an electrocardiogram (ECG) D. Is placed on nothing by mouth (NPO) status for 16 to 24 hours before the ECT

C. Reports to the clinic for blood draws and an electrocardiogram (ECG)

A client has been prescribed bupropion (Wellbutrin) for depression. Upon reviewing the client's chart, the nurse should report which of the following findings to the client's provider immediately? A. The client has a family history of depression. B. The client swims three times a week for exercise. C. The client had a MVA last year and sustained a head injury. D. The client has been dieting and has lost 10 pounds over the last year.

C. The client had a MVA last year and sustained a head injury.

A client with depression has a prescription for sertraline (Zoloft). The nurse should withhold the medication and question the prescription if which is documented in the client's record? A. History of diabetes mellitus B. History of myocardial infarction C. Use of phenelzine sulfate (Nardil) D. History of irritable bowel syndrome

C. Use of phenelzine sulfate (Nardil) Rationale: Sertraline is a selective serotonin reuptake inhibitor. Fatal reactions may occur if sertraline is administered concurrently with phenelzine, a monoamine oxidase inhibitor (MAOI). MAOIs should be stopped at least 14 days before initiation of sertraline therapy. Likewise, sertraline should be stopped at least 14 days before initiation of MAOI therapy. The other options are incorrect.

Which antidepressant require an EKG before starting and during b/c it can cause QT elongation?

Celexa (citalopram)

What antidepressant drug is also FDA approved for pain?

Cymbalta (Duloxetine) - used to also treat fibromyalgia

Fluoxetine hydrochloride (Prozac) is prescribed for a client. The nurse should teach the client to take the medication by which method? A. Just before bedtime B. With the evening meal C. At noon with an antacid D. In the morning on first arising

D. In the morning on first arising Rationale: Fluoxetine hydrochloride is an antidepressant and is administered in the early morning so that the client will experience an elevated mood during the daytime hours. The other options are incorrect.

What is a MAJOR side effect of MAOIs?

Hypertensive crisis (this can be lethal)

What does Electroconvulsive Treatment (ECT) cause?

Induction of a grand mal seizure *can be alternative for pregnant patient

What class of drugs are Phenelzine (Nardil), Tranylcpromine (Parnate), Isocarboxazid (Marplan)?

MAOIs

Which SSRI is good for someone that is tired all the time?

Prozac (more stimulating than the others)

What class of drug is Elavil (Amitriptyline)?

TCA (tricyclic antidepressant)

What is Tachyphylaxis "Poop-out"?

The return of symptoms of depression after a positive treatment response despite on going treatment or even an increased dose.

Which SSRI has the highest incidence with GI disturbances? How should the patient be educated about this?

Zoloft *intervention (take with food and educate that this side effect will go away after a week or two)

What is the function of SSRIs?

block serotonin uptake (this allows higher levels of serotonin in the brain)

What is ECT thought to cause?

change neurotransmission levels

Why should patients on Trazodone (Desyrel) eat a small snack when taking med?

has a hypnotic effect

What are symptoms of discontinuation syndrome?

myalgias, n/v, dysphoria, crying spells, fatigue, dizziness, irritability, disequilibrium

When should the last dose of Wellbutrin be taken by a patient?

no later than 4pm as it will interfere with sleep

Can SSRIs be lethal?

nope...do not have to worry about overdose - nearly impossible

What does the antidepressant Effexor (Venlafazine) affect?

norepinephrine levels

What are symptoms of Antidepressant Apathy Syndrome?

patient just doesn't feel anything

What side effect of Trazodone (Desyrel) should males be educated on?

priapism (educate males...pt should go to ER if this happens)

What is a major side effect of antidepressants for pregnant females?

pulmonary hypertension *pregnant clients should not be on antidepressants unless absolutely necessary

What can the combination of migraine med and SSRIs cause?

serotonin syndrome

Which SSRI side effect causes a lot of compliance issues?

sexual dysfunction

What is Remeron (Mirtazapine) and Trazodone (Desyrel) mainly used for?

sleep

Why are TCAs lethal?

they are cardiotoxic

What compound found in foods should be avoided if taking MAOIs?

tyramine