Last Pharmacology
What is the therapeutic range for lithium
0.5 - 1.5
How long for serotonin syndrome to appear
2-72 hours after initiation
What would be considered the toxic level of lithium
> 1.5- 2
A nurse should use caution when administering amitriptyline to which clients A clients with cardiac disease B clients with hypothyroidism C clients with diabetes D elderly clients E adolescent clients
A D
The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg po daily what assessment question should the nurse prioritize A how would you describe your mood and energy level today B on a scale from zero to ten, how would you rate your anxiety level C how are you feeling today D are you feeling happier today than in the past
A ( mirtazapine is an antidepressant and it is prudent for the nurse to assess the clients mood and level of energy.)
A client with bipolar disorder having experienced a depressive episode, its prescribed lamotrigine. After educating he client on this medication. The nurse determines that the education was successful when the client states what A i need to notify my physician if I develop a skin rash B i need to have my blood tested about once a month C i have to watch how much salt I use every day D This drug can affect my liver function
A (Stevens Johnson syndrome)
A client has been taking fluoxetine (Prozac) for the last 10 days. Today the client in the clinic reported not feeling any better. What is the nurses best response to this client A it may take another two to three weeks before the medication is completely effective B i realize this is frustrating but most medications for mood disorders aren't fully effective for 2 to 3 months C i will tell the healthcare provider ad see if there is another medication that would be better D please come tot he clinic immediately so you can be reassessed for suicidal thoughts
A (fluoxetine may take up to 4 weeks to be completely effective
What type of medication is lithium (lithobid) and lamotrigine (lamictal)
A mood stabilizer (antimanic)
A nurse education a client starting phenelzine (Nardil) should educate the client to avoid which foods A blue cheese B pepperoni C apples D chocolate E Celery
A, B, D
What is the antidote for tylenol
Acetylcysteine (mucomyst)
What are some types of tyramine foods
Ages cheeses Coffee Chocolate Raisins Pickled foods Sausage Beer, wine, yeast
What are symptoms of serotonin syndrome
Agitation, confusion Diaphoresis, fever Tachycardia Hypotension Muscle rigidity Sluggish pupils Tremors Hyper salivation Coma, death
What is the action of lithium (lithobid)
Alters Na+ ion transport in muscle and nerve cells Increased receptor sensitivity to serotonin Depletes sodium
What is a tricyclics antidepressants (TCA)
Amitriptyline (Elavil)
What is the drug of choice for adolescence
Amitriptyline (Elavil)
What is the indication of use for acetaminophen (Tylenol)
Analgesia Antipyretic
What are the indications of use for moderate to strong opioids
Analgesia Cough suppression
What are the indications for strong opioid use
Analgesia Sedation Cough suppression Suppression of bowel motility
What is the indication of use for ibuprofen ( Advil, Motrin)
Analgesic Anti inflammatory Antipyretic
What are the ADR of strong opioids
Apnea Respiratory depression Thrombocytopenia Bradycardia
What does capsicum/cayenne pepper do for the body
Arthritis Nerve pain Circulatory stimutlation
What are nursing considerations for ibuprofen
Assess renal function Take with food Hydrate
Which interventions should the nurse perform regarding the diet of a patient who is being administered lithium A take the drug on an empty stomach B ensure that extra salt is added to foods C drink at least five large glasses of fluid each day D increase food intake during drug regimen
B The nurse should ensure that food for the pt contains extra salt
A nurse is giving venlafaxine capsules to a client diagnosed with depression. What education will the nurse provide to the client about venlafaxine A if you have trouble swallowing the capsule, it can be opened and put in food B it's best to take the medication with food at the same time each day C you should notice an improved mood after taking he medication for two weeks D if you experience side effects, stop taking the medication immediately
B venlafaxine is prescribed to treat depressive disorders and should be taken with food at the same time each day.
What is the action of amitriptyline (Elavil)
Blocks reuptake of norepinephrine and serotonin in brain Blocks histamine receptors Elevate mood, increase interest in ADL Decreases insomnia Takes 2-4 weeks
What does Narcan do
Blocks the effects of opioid agonists
What are the ADR's of moderate to strong opiods
Bradycardia Respiratory depression
What are 3 known reasons for depression deficiencies
Broken down by MAO Rapid fire of neurons Number of postsynaptic receptors
What is the SE of capsicum/cayenne pepper
Burning sensation
What are the contraindications of remeron
CV Hepatic or Renal disease
What are some intervention to help avoid migraines
Caffeine Low stimulus environment Rescue noise and dim lights Cool cloth over eyes
What is common side effect of melatonin
Can potentiate CNS depressants
When assessing a patient on phenelzine (Nardil) what do you need to look for
Cardia dysfunction Impaired liver/kidney function Tyramine foods Suicidal ideation Vital signs
What is the contraindication and cautions of Lamictal
Caution with suicidal ideation Pregnancy category C Infant risk due to breast feeding
What are some common side effects of strong opioids
Chang in LOC Euphoria Pupil changes Decreased GI motility Urinary retention Hypotension Emesis
What are some prototypes of moderate to strong opioids
Codeine Oxycodone
When assessing a pt on Prozac what do you look for
Complete history review for depression/suicidal/mania Diabetes Glaucoma Pregnancy Lactation
What is affective disorder
Depressed mood, despair, insomnia Loss of interest in normal activities Fatigue, decreased ability to think Suicidal thoughts
What is the indication for use of Prozac
Depression
What is the indication of use for phenelzine (Nardil)
Depression not controlled by other antidepressents
Morphine is
Derived from opium or from the poppy seed
What are some common side effects fo lithium
Dry mouth Thirst Polyuria Weight gain Metallic taste Tremors Neuroleptic malignant syndrome
What are common side effects fo lamictal
Dysmenorrhea Rhinitis Liver failure-toxic Blurred vision
What is a selective serotonin reputable inhibitors (SSRI)
Fluoxetine (Prozac)
What are the contraindications and cautions of Nardil
HTN CAD Angina CHF Hyperthyroidism Seizure disorders
What are some nursing considerations to teach client about depression medications
Has delayed effect 3-4 weeks Shifts depression to hypo/mania in bipolar Serotonin syndrome
What are some common side effects of prozac
Headache Insomnia Anxiety Dry mouth Anorexia Change in taste Mensturation Impotence
What are common side effects fo SNRI's (Effexor)
Hypertension Insomnia Euphoria Amnesia Photo sensitivity Ejaculation dysfunction
What is the interaction of Nardil with TCA
Hypertensive crisis Coma Severe convulsions
When giving Prozac what are some contraindictions
Impaired renal or hepatic functions Diabetes Severely depressed or suicidal Pregnancy Lactation
What does MAO do
Inactivated norepinephrine and dopamine in the brain
What type of action does venlafaxine take
Increase availability of serotonin and NE, dopamine in synapse
What does Gingko Biloba do
Increase energy levels, fatigue and lethargy May improve sleep patterns, poor concentration and mood disturbances
Teaching a client on lithium about :
Increase fluids Avoid caffeine Therapeutic blood draws
When giving SSRI's to adolescents/young adults with severe depression can to what
Increase suicidal thoughts
What is the indication of use for Melatonin
Insomnia Jet lag
What is the action of phenelzine (Nardil)
Irreversibly inhibits MAO Enzyme found in nerves and other tissues
What does St John's Wort do
It can decrease reputable of the neurotransmitters serotonin, norepinephrine, and dopamine
What are ADR os lithium
Lithium toxicity Brady cardia
What is the ADR of acetaminophen
Liver failure in OD Hypoglycemia Hypokalemia Hypomagnesemia Pulmonary edema Stridor
What is the contraindictions and cautions of lithium
Liver/renal disease Hyponatremia Pregnancy
What is the indication of use for lamotrigine (Lamicatal)
Long term maintenance of bipolar disease
What is a general anesthetic
Loss of consciousness
What is a local anesthetic
Loss of sensation
When using Prozac you need to watch out for these medication interatctions
MAOI TCA St John's wort Evening primrose Ginkgo biloba Ginseng Valerian
What are some contraindications and cautions of amitriptyline (Elavil)
MI CV disease Angle closure glaucoma Urinary retention BPH Psychiatric pt's
What are some ADR to Elavil
MI Stroke Thrombocytopenia Hypoglycemia
What is the food interaction with Nardil
Mainly tyramine and other pressor amines resulting in high bP
What is the indication for sue of mirtazapine (Remeron)
Major depression
What are the indications for use of venlafaxine (Effexor)
Major depression Generalized anxiety disorder Social anxiety disorder
What is the indication of use for amitriptyline (Elavil)
Major depression and agitated depression
What is the nursing consideration when using Triptans
Mild GI effects
What is an Atypical antidepressant
Mirtazapine (Remeron)
The action of this medication is unknown
Mirtazapine (remeron)
What is the most important assessment for lithium
Monitor sodium intake and fluid intake
What are some strong Opiods
Morphine sulfate Fentanyl
What is the action of antidepressants
Most antidepressant work by effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression
What is an opioids
Natural or synthetic drugs that have actions similar to morphine
What are the key biogenic amines in key areas of the brain
Norepinephrine Serotonin Dopamine
When assessing a pt on Effexor look for this
Nsaids Antiplatelet agents MAOI Tca's
When would a general anesthetic be used
Operative procedures Diagnostic exams Injury to Respiratory control
What is the most effective pain relievers available
Opiods
What is serotonin syndrome
Over activation of serotonin receptors Rare and life threatening event
What is monoamine oxidase inhibitors (MAOI)
Phenelzine (Nardil)
What is the ADR fo lamotrigine (lamicatal)
Rash Stevens Johnson syndrome
When using Ergot what is a nursing consideration
Severe GI effects such as N/V, diarrhea
What are some client teachings when using Mirtazapine (Remeron)
Similar common SE to other antidepressants MORE sedative effects than other antidepressants
What are some physical manifestations of depression
Sleep disturbances Anorexia Alcoholism
Effexor (venlafaxine) has drug to drug interaction with
St. John's wort Amoxicillin Tramadol NSAIDs Antiplatelet agents Haloperidol
What is an adverse reaction to effexor
Suicidal ideation
What is the name of medication that treats migraines
Sumatriptan (imitrex) Ergotamine with caffeine (Cafergot)
What is the interaction of Nardil and sympathomimetics
Sympathomimetics effects mimic effects of the sympathetic nervous system
What are some nursing considerations for Tylenol use
Take on empty stomach or with food Not good for arthritic pain Can be alternated with NSaids
There can be an unsafe reaction between your antidepressant and St Johns wort, which is why taking them both is discouraged. What is the thinking behind this
The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rational. It is true that many herbal remedies contain inconsistent doses but this is not the primary risk of combining SSRI's with St Johns wort
What action does Prozac take
Thought to be linked to drugs inhibition of CNS neuronal uptake of serotonin
What are ADR of ibuprofen
Thrombocytopenia Hypokalemia Hypoglycemia Renal failure
What causes serotonin syndrome
Too high med interaction Medication combination of SSRI WITH MAOI
What is the indication of mood stabilizer use
Treatment of bipolar affective disorder
What is serotonin norepinephrine reputable inhibitors (SNRI)
Verlafaxine (effexor)
What is the common side effects for Elavil
Weight gain
