N4301 PSYCHOPHARMACOLOGY

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Main Side Effects of Antidepressants. 1. SSRIs 2. NDRI 3. MAOIs 4. Tricyclics

Almost all antidepressants have: GI upset, Headaches, and Drymouth. 1. Activation of behavior (can't sit still), Insomnia, GI upset, Sexual dysfunction, Serotonin Syndrome. NOT compatible with St. Johns Wart 2. Lower seizure threshold, avoid alcohol, activating 3. Insomnia, Orthostatic BP, Hypertensive Crisis, serotonin syndrome, AVOID Tyramine (aged products). 4. Orthostatic BP, Delays cardiac conduction, lethal in overdose, sedation.

Which of the following are common side effects associated with atypical anti-psychotics? select all A. Hypotension B. QT prolongation C. Anticholinergic D. Weight gain E. Sexual side effects F. Agranulocytosis G. Movement disorders

A-F, G-movement disorders are far less common

A client is started on valproic acid (Depakote) for treatment of bipolar disorder. Which of the following laboratory studies should be monitored regularly? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Serum sodium and potassium

A. AST/ALT and LDH Liver function tests should be monitored, because valproic acid is metabolized in the liver, and hepatotoxicity may result. Baseline levels may be drawn for creatinine and BUN (kidney function tests), WBC and granulocyte counts (tests to monitor for infection), or serum sodium and potassium (electrolytes), but regular monitoring of these values is not necessary.

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

A. Aged cheese and sherry Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines. Avoid all matured or aged cheeses, beer, wines, aged meats like salami and pepperoni, pickled herring, Fava beans, avacado, soy sauce, marmite (yeast), sauerkraut are some foods that contain tyramine and will trigger hypertensive crisis in patients taking an MAOI drug.

Older patients are often more susceptible to the anticholinergic side effects of antipsychotic medications? A. True B. False

A. True Anticholinergic crisis can occur-hot as a hare, blind as a bat, mad as a hatter, dry as a bone -or- ABCD'S-Anorexia, Blurry vision, Constipation/Confusion, Dry mouth, Stasis of urine.

_____ has a very fast onset of action and a long half life? A. Valium B. Ativan C. Xanax D. Klonopin

A. Valium

The anti-cholinergics and anti-parkinson's medications used to treat the movement disorders associated with typical antipsychotics include?

ABC'S of anti-cholinergics-Artane, Benadryl, Cogentin, Symmetrel

Which of the following causes orthostatic hypotension? A. TCA's B. MAOI's C. Atypical Antipsychotics D. All of the above

All of the above

A client is prescribed an MAOI. When discussing diet restrictions, which of the following should the nurse instruct the client to avoid? Select all that apply. a) Bananas b) Aged cheese c) Avocados d) Cornflakes e) Oatmeal

a) Bananas, b) Aged cheese c) Avocados Explanation: Aged cheese, bananas and avocados contain significant amounts of tyramine. Elevated levels of tyramine can lead to hypertensive crisis. Oatmeal and cornflakes do not have significant amounts of tyramine.

Which of the following would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? a) Benztropine (Cogentin) b) Risperidone (Risperdal) c) Aripiprazole (Abilify) d) Trihexyphenidyl(Artane)

a) Benztropine (Cogentin) Explanation: A client experiencing a dystonic reaction should receive immediate treatment with benztropine (Cogentin). Risperidone (Risperdal) and aripiprazole (Abilify) are antipsychotics that may cause dystonic reactions. Trihexyphenidyl (Artane) is used to treat Parkinsonism due to antipsychotic drugs.

NCLEX Mnemonic for Neuroleptic Malignant Syndrome (NMS): FEVER

Fever Encephalopathy Vitals unstable Enzymes elevated (CK) Rigidity

What are the side effects of Atypical Antipsychotics?

Hypotension, QT prolongation, anticholinergic, weight gain, sexual side effects.

Mood, sleep, appetite, pain perception. A. 􏰁Dopamine (DA) B. Norepinephrine (NE) C. 􏰁Serotonin (5-HT) D. Gamma amino butyric acid (GABA)

􏰁Serotonin (5-HT) Pain: SSRI used to augment analgesic

A nurse should include which of the following in the teaching of ways to minimize anticholinergic crisis? A. Void just before taking the medication. B. Increase the dietary intake of potassium C. Wear sunglasses when outside D. Change positions slowly E. Chew sugarless gum

A, C, E A-urinary retention C-photophobia E-sugarless gum

Why are anticholinergic drugs prescribed? How do they work?

- Reduce EPSEs - Block ACH (acetylcholine) receptors so muscles relax. Also do this in the brain causing drowsiness, poor memory.

What are the symptoms of serotonin syndrome?

-Agitation -Ataxia -Hyper-reflexia -Fever -Diaphoresis -Diarrhea More Heat (hyperthermia), Beat (tachycardia), Tweak (agitation), Leak (diarrhea/diaphoresis) and twitching of the Feet (hyper-reflexia/ataxia)

What is the therapeutic range of lithium?

0.5-1.5 (Slides) 0.8-1.4 (book)

The therapeutic range for lithium is _____

0.8-1.4

Summarize three points in planning for medication management of older persons using psychotropic medications?

1) Brown bag check up 2) Assess renal function using Cockroft-Gault formula prior to administering renal-clearing drugs 3) Assess individuals (at admission or initial encounter and at discharge) who administer their own medicines with DRUGS tool to identify potential areas of self-administration difficulty 4) The "Beers Criteria" contains lists of medications that pose potential risks outweighing potential benefits for people 65 and older. It emphasizes deprescribing medication with high risk to benefit ratios.

valproate (Depakote) 1. Category. 2. Major Side Effects. 3. Can lead to death?

1. Anti-Seizure/Mood Stabilizer 2. Black Tarry stool, bloating or swelling, blood in urine and stool, change in LOC, slowed HR, fainting mean you need to get to ED! 3. Yes

peroxetine (Paxil) 1. Category. 2. Major Side Effects. 3. Can lead to death?

1. Antidepressant - SSRI 2.Activation of behavior (can't sit still), Insomnia, GI upset, Sexual dysfunction, Serotonin Syndrome. NOT compatible with St. Johns Wart 3. No

Elavil 1. Category. 2. Major Side Effects. 3. Can lead to death?

1. Antidepressant - Tricyclic 2. Orthostatic BP, Delays Cardiac Conduction, Sedation, Anticholinergic toxicity 3. Yes

imipramine (Tofranil) 1. Category. 2. Major Side Effects. 3. Can lead to death?

1. Antidepressant - Tricyclic 2. Orthostatic BP, Delays Cardiac Conduction, Sedation, Anticholinergic toxicity 3. Yes

Wellbutrin 1. Category. 2. Major Side Effects. 3. Can lead to death?

1. Antidepressant - other 2. Appetite, GI upset, headache, Dry mouth, insomnia, sweating, nervousness, Sexual 3. only ingesting large doses (30 g+)

General Symptoms of: 1. Typical Antipsychotics 2. Atypical Antipsychotics

1. Increased EPSEs (TD, Parkinsons' disease symptoms), raise Prolactin levels (male breast enlargement and milk production) 2. Less EPSEs, More "metabolic syndrome" like symptoms, better reduction in negative symptoms of schizophrenia.

The therapeutic lag time for SSRI's is __ to __ weeks?

2-6 weeks

What is a brown bag check up?

A brown-bag check-up is when you gather all of your current medications and over-the-counter products into a "brown-bag" and show them to your doctor or pharmacist so he/she can look for any potential problems.

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

A, B, E SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be tapered slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness it may cause insomnia if taken at bedtime. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what? A. Help control symptoms during the severe manic episode B. Elevate mood during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode

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

Which of the following antidepressants increases the release of serotonin and norepinephrine? A. Mirtazapine (Remeron) B. Venlafaxine (Effexor) C. Trazodone (Desyrel) D. Imipramine (Tofranil)

A. Mirtazapine (Remeron) Mirtazapine increases the release of serotonin and norepinephrine, and thereby increases the amount available in the brain for impulse transmission. Effexor is a serotonin/ norepinephrine reuptake inhibitor. Trazodone is an atypical antidepressant that results in moderate blockade of serotonin. Imipramine is a TCA that blocks the reuptake of norepinephrine and serotonin.

The nurse is caring for a patient receiving fluoxetine (Prozac) for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

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

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

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

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

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

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

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

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

NCLEX Mnemonic for Anti-cholinergic effects: ABCD'S

Anorexia Blurred vision Constipation/Confusion Dry mouth Stasis of urine (Urinary retention)

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

Answers: B (headache can be a sign of hypertensive crisis) E (avocado is a thymine rich food) Why not A-not PRN Why not C-profuse sweating or diaphoresis is a sign of hypertensive crisis, which can occur with MAOI Why not D-ginsing can cause headache and other side effects. MAOI's have many drug interactions. Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis--severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and maniclike reactions have occurred.

Class of drug: valproate (Depakote)?

Anti-seizure mood stabilizer (used for bipolar disorder)

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

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

This class of medications increases activity of GABA, decreases activity of glutamate?

Anticonvulsants/Mood stabilizer

Which categories of medications can cause anticholinergic effects?

Atypical Antipsychotics, TCA's and MAOI's

Class of drug: clozapine (Clozaril)?

Atypical antipsychotic

Class of drug: ziprazadone (Geodon)?

Atypical antipsychotic

Class of drug? risperidone (Risperdal)?

Atypical antipsychotic

Hypotension, QT prolongation, anticholinergic effects, weight gain and sexual side effects are associated with?

Atypical antipsychotics

Which type of antipsychotic medications can cause Metabolic Syndrome symptoms?

Atypicals - Weight gain - Waist size increase - BP, Triglycerides, low HDL, Hyperglycemia.

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

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

A nurse is providing teaching to a client with a new prescription for amitriptyline (Elavil). Which of the following client statements indicates understanding of the teaching? A. "I should stay out of the sun to prevent getting a skin rash." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni anymore." D. "I will finally be able to lose the weight that I have gained over the last year."

B. "I may feel drowsy for a few weeks after starting this medication." This is a TCA. Sedation is a side effect of amitriptyline (Elavil) during the first few weeks of therapy. Usually this is self-limiting. Skin rash is more likely to occur with fluoxetine. Foods such as pepperoni should be avoided if the client is prescribed a monoamine oxidase inhibitor. Weight gain, rather than weight loss is expected with TCAs.

A client who has been on lithium therapy for 6 months has recently developed symptoms of mild arthritis. He tells the nurse that he wants to start taking ibuprofen for his pain. Which of the following is an appropriate response? A. "That is a good choice. Stronger analgesics would not be good for you." B. "Regular aspirin would be a better choice, because ibuprofen can raise your lithium level too high." C. "You will have to stop taking the lithium if you take any pain medication." D. "The ibuprofen will make your lithium level fall too low, and your symptoms may return."

B. "Regular aspirin would be a better choice, because ibuprofen can raise your lithium level too high." Ibuprofen increases renal lithium reabsorption; aspirin does not increase lithium levels. Stronger analgesics are not necessary for mild arthritis. Not all pain medications are contraindicated with concurrent use of lithium. Ibuprofen will not make the lithium level fall too low.

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine (Thorazine)? (Select all that apply.) A. An 85-year-old man with Alzheimer's disease B. A 78-year-old man with intractable hiccups C. A 76-year-old woman with severe dementia D. A 48-year-old woman with schizoaffective disorder E. A 30-year-old man with anxiety and depression

B. A 78-year-old man with intractable hiccups D. A 48-year-old woman with schizoaffective disorder Antipsychotics are NOT used for dementia because of increased mortality. Chlorpromazine is NOT a primary treatment for Alzheimer's disease or depression. The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups.

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

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

A nurse is teaching a client with schizophrenia ways to cope with anticholinergic effects of Fluphenazine (Prolixin). Which of the following strategies should the nurse suggest to the client to minimize anticholinergic effects? A. Avoid foods that can cause diarrhea. B. Chew sugarless gum to moisten the mouth. C. Use cooling measures to decrease fever. D. Take an antacid to relieve nausea.

B. Chew sugarless gum to moisten the mouth. Chewing gum, sucking hard candies, or sipping liquids can help the client cope with dry mouth, which occurs as an anticholinergic effect of some antipsychotic medications. Constipation is an anticholinergic side effect. Fever may indicate neuroleptic malignant syndrome and should be reported to the provider. Nausea is not an anticholinergic effect.

Which of the following medications, if given concurrently with lithium, could produce a toxic effect? A. Insulin B. Prednisone C. Digoxin (Lanoxin) D. Furosemide (Lasix)

Furosemide, a loop diuretic, promotes sodium loss and lithium retention, possibly increasing serum levels. Insulin, prednisone, and digoxin do not interact with lithium

The nurse is preparing to give physostigmine. What best describes the action of this drug? A. It inhibits acetylcholine at all cholinergic synapses. B. It prevents inactivation of acetylcholine. C. It prevents activation of muscarinic receptors. D. It stimulates activation of adrenergic receptors

B. It prevents inactivation of acetylcholine. This treats anti-cholinergic crisis. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions. This drug is used for patients in anticholinergic crisis due to overdose or toxicity of an anticholinergic drug. Patients on first generation antipsychotics experience suppression of DA and an increase in Acetylcholine. This causes the movement disorders. This is treated with an anticholinergic that decreases acetylcholine in the muscles but also the brain, causing confusion. If too much is given they can go into anticholinergic crisis. Prostigmin is given to help with this.

Several hours after administering a typical antipsychotic medication, a nurse should watch for which of the following adverse effects? A. Shuffling gait B. Neck spasms C. Lip smacking D. Continuous pacing

B. Neck spasms This is tricky. ALL are EPSE's but Dystonia is FIRST EPS to show up! Neck spasms are a sign of acute DYSTONIA, a side effect that can occur anywhere between 5 hr to 5 days after administration of a typical antipsychotic medication. Shuffling gait is a sign of parkinsonism, which usually does not occur for at least one month after administration. Continuous pacing is a sign of akathisia and usually develops within 2 months of the initiation of treatment. Lip smacking is a sign of tardive dyskinesia and is an adverse effect that occurs after long-term use of at least a year.

The nurse identifies which most common serious adverse effect of TCA therapy? A. Sedation B. Orthostatic hypotension C. Skin rash D. Sexual dysfunction

B. Orthostatic hypotension Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant (TCA) therapy. Think TCA: Takers Carefully Ascend. This is not the worst side effect just the most common.

A nurse is providing teaching to a client prescribed lithium carbonate for bipolar disorder. For which of the following side effects should the nurse instruct the client to watch and report to the provider? (Select all that apply.) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Weight loss

B. Polyuria D. Muscle weakness Polyuria and muscle weakness are early indications of lithium toxicity. The client is more likely to have diarrhea and weight gain, and a rash is not a sign of lithium toxicity.

The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug? A. Slowly B. Rapidly C. Unpredictably D. Variably

B. Rapidly Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for paroxetine (Paxil). Which is the most likely explanation for these symptoms? A. Depressive psychosis B. Serotonin syndrome C. Escitalopram overdose D. Cholinergic crisis

B. Serotonin syndrome Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever. More heat (hyperthermia/fever), beat (Tachycardia), tweak (hallucinations), leak (diarrhea/diaphoresis) and twitching of the feet (ataxia/hyperreflexia)

A client who has been taking an antipsychotic medication for several years begins to exhibit lip smacking, tongue protrusion, and facial grimaces. Which of the following should the nurse suspect? A. Parkinsonism B. Tardive dyskinesia C. Antiadrenergic effects D. Anticholinergic effects

B. Tardive dyskinesia Tardive dyskinesia includes abnormal movements of the lips, tongue, face, and neck. These symptoms are not characteristic of parkinsonism, antiadrenergic effects, or anticholinergic effects.

The nurse has just administered the first dose of haloperidol (Haldol) to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? A. Dry mouth B. Temperature of 101 °F C. BP of 104/72 mm Hg D. Drowsiness

B. Temperature of 101 °F Sudden high fever is a symptom of neuroleptic malignant syndrome (NMS), a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provide

BOYD Mnemonic for Anticholinergic crisis: "Hot as a hare, blind as a bat, mad as a hatter, dry as a bone"

Hot as a Hare-Fever/Hyperpyrexia, possibly leading to death Blind as a Bat-Photophobia, Blurred vision Mad as a Hatter-Resemebles schizophrenia and can include hallucinations Dry as a Bone-Dry everything

A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body? A. Selectivity and effectiveness B. The ability to cross membranes C. Development of an electric charge D. A transporter protein

B. The ability to cross membranes To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.

Which of the following is an MOAI? A. amitriptyline (Elavil) B. phenelzine (Nardil) C. imipramine (Tofranil)

B. phenelzine (Nardil)

________ used to assess for Potentially Inappropriate Medication Use in Older Adults

Beers Criteria

A patient presents with muscle rigidity and you suspect NMS. You should assess for?

Behavior: often presents as worsening psychosis Vital signs: Fever,Tachycardia, Tachypnea Labs: CK-Creatine Kinase-eleevation means muscle breakdown

NCLEX Mnemonic for SSRI side effects: BAD SSRI

Body weight increase Anxiety Dizziness Serotonin syndrome Stimulated CNS Reproductive/sexual dysfunction Insomnia

Has no action on GABA so no potential for abuse?

BusPar

What teaching points should a nurse include when discussing the anticholinergic effects of antipsychotic medication? Select one or more: a. Maintain usual levels of salt and water intake b. Wear sunglasses outside to prevent photophobia c. Increase intake of dietary fiber and fluids d. Sip fluids throughout the day e. Suck on hard candy

C, D, E C-helps deal with Constipation, D, E-helps with Dry mouth Why not B? wearing sunglasses will not "prevent" photophobia Anticholinergic effects: ABCD'S-Anorexia, Blurry vision, Constipation/Confusion, Dry mouth, Stasis of urine Anticholinergic crisis: Hot as hare, blind as a bat (photophobia), mad as a hatter, dry as bone

All of the following can cause lithium toxicity except? A. Dehydration B. Hyponatremia C. Hypernatremia D. Diuretics E. NSAIDS

C-This would drive lithium down. LOW sodium levels drive lithium up, causing toxicity. The rest cause toxicity requires adequate intake of sodium and water since a balance is required. Low sodium means high lithium and low water (hypertonic fluids) cause kidneys to retain lithium, causing toxicity as well. MOA: competes with Na to enter the cell, decreasing action of DA and NE and increasing action of GABA and 5-HT. Lower dopamine might explain why this helps with mania and psychosis. Increased serotonin and GABA might explain why this helps with depression.

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

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

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

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

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

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

A patient diagnosed with depression is prescribed Elavil. What test should be done before starting this? A. CBC B. EEG C. ECG D. LFT

C. ECG Elavil=TCA (TCA's-Toxic Cardiac Actions=dysrhythmia)

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 motor vehicle crash 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 motor vehicle crash last year and sustained a head injury. The greatest risk to this client is development of seizures. Bupropion can lower the seizure threshold and should be avoided by clients with a history of a head injury. The client's family history of depression, usual activities, and current nutritional status are important but do not need to be reported to the provider immediately.

What are the main side effects of anticholinergic?

Can't poop, pee, spit, or see.

SSRI's exert their effects by acting on ______ on the presynaptic neuron to increase the amount of serotonin in the synapse? A. Ion Channels B. Enzymes C. Carrier Proteins

Carrier Proteins (they inhibit re-uptake of serotonin into the presynaptic membrane thus increasing its concentration in the synapse and action on postsynaptic sites)

The nurse is caring for a patient receiving clozapine (Clozaril). Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL C. Blood glucose level of 60 mg/dL D. Bilirubin level of 2.5 mg/dL E. White blood cell (WBC) count of 2000/mm3

Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

Monitor WBC's with this atypical antipsychotic?

Clozaril

Assess renal function using _______ prior to administering renal-clearing drugs

Cockroft-Gault

NCLEX Mnemonic for lithium toxicity: CAN HAM SUCS

Confusion An increase in thirst and urine Nausea Hand tremor (coarse) Ataxia Muscle twitch Seizures Uncontrolled eye movement Coma Slurred speech

NCLEX Mnemonic for Serotonin Syndrome: HARM

Hyperthermia Autonomic instability Rigidity Myoclonus

The ________ of a drug provides a measure of the expected rate of clearance?

Half-Life (time it takes for plasma concentrations to be reduced by 50%)

SSRI's are used to treat? A. Depression B. Eating disorders C. Anxiety Disorders D. All of the above

Which of the following is associated with TCA's? A. Anticholinergic drugs B. Orthostatic hypotension C. Cardio-toxcity D. All of the above

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

D. "Have you had any changes in your mood or anxiety level?" KEY WORD IS "EARLY" PHASE OF TREATMENT. Elavil is a TCA. The first 3 are anticholinergic symptoms that would be experienced but the last is most important. In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. TCA's are also very toxic and many NCLEX questions emphasize that you should make sure the patient isn't checking med to save them for a suicide attempt. The other questions would be useful in assessing the patient for adverse effects of amitriptyline (Elavil), but assessing suicide risk is the most important intervention. TCA's cause anticholinergic symptoms-think Triggers-Cholinergic-Anti (TCA)

Mnemonic for Serotonin Syndrome: (mine) "More heat, beat, tweak, leak and twitching of the feet"

Heat-hyperthermia/fever Beat-tachycardia Tweak-agitation/hallucinations Leak-diarrhea/diaphoresis Twitching of the feet-ataxia/hyper-reflexia

A nurse assesses a patient receiving haloperidol (Haldol). The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? A. Dystonia B. Tardive dyskinesia C. Parkinsonism D. Akathisia

D. Akathisia Explanation: Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. It is most often treated with propranolol, a beta-blocker. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

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

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

Which of the following medications, if given concurrently with lithium, could produce a toxic effect? A. Insulin B. Prednisone C. Digoxin (Lanoxin) D. Furosemide (Lasix)

D. Furosemide (Lasix) Furosemide, a loop diuretic, promotes sodium loss and lithium retention, possibly increasing serum levels. Insulin, prednisone, and digoxin do not interact with lithium.

The nurse is preparing to administer phenelzine (Nardil) to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more side effects and drug interactions.

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

The nurse is caring for a patient receiving clozapine (Clozaril). Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL B. Blood glucose level of 60 mg/dL C. Bilirubin level of 2.5 mg/dL D. White blood cell (WBC) count of 2000/mm3

D. White blood cell (WBC) count of 2000/mm3 Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

A nurse is caring for a client who has a new prescription for clozapine (Clozaril) Which of the following laboratory values should the nurse plan to monitor weekly during the first few months this client is taking clozapine? A. Serum creatinine B. Serum sodium C. Triglycerides and cholesterol D. White blood cell count

D. White blood cell count

Which of the following does not increase GABA activity by acting on chloride ion channels? A. lorazepam (Ativan) B. alprazolam (Xanax) C. diazepam (Valium) D. buspirone (Buspar)

D. buspirone (Buspar) -not addictive, increases serotonin not GABA

_________ is a rapid decrease in the effectiveness of a drug that can occur in minutes of exposure, while _________ is the gradual decrease in the action of a drug at given dose or concentration in the blood?

Desensitization, Tolerance

Treatment of serotonin syndrome, a life-theratening condition related to SSRI's, involves?

Discontinuation of treatment and symptom management

A ____ -______ interaction can occur if one drug inhibits or alters the enzyme system of another?

Drug-drug

When one therapeutic agent alters either the concentration (pharmacokinetic interactions) or the biological effect of another agent (pharmacodynamic interactions)?

Drug-drug interaction

Which of the following can cause orthostatic hypotension? A. Atypical antipsychotics B. Tricyclic antidepressants C. MAOI's D. A and B E. All of the above

All of the followoing are Atypical (second generation) antipsychotics except? A. clozapine (Clozaril) B. risperidone (Risperdal) C. ziprazadone (Geodon) D. aripiprazole (Abilify) E. haloperidol (Haldol)

E. haloperidol (Haldol)

Which of the following is not an anticholinergic effect? A. Blurred vision B. Photophobia C. Tachycardia D. Mydraisis E. Urinary incontinence F. constipation

E. this is an effect of increased acetylcholine not an anticholinergic effect. Urinary retention/hesitancy is the effect of anticholinergics. Mydriasis is pupil dilation, which results from anticholinergic drugs like atropine. Acetylcholine is part of the rest-and-digest portion of the sympathetic nervous system so it would make sense that it would cause constriction of the pupils. Blocking ACh causing dilation.

The abnormal involuntary movement (AIMS) scale is used to screen for _____ ?

EPS

Which of teh follwoing is not an SSRI? A. Prozac B. Paxil C. Zoloft D. Celexa E. Lexapro F. Effexor

Effexor is an SNRI

The ability of a drug to produce a response?

Efficacy

______ is the ability of a drug to produce a response and ______ refers to the dose of the drug required to produce that response?

Efficacy, Potency

Monamine Oxidase Inhibitor (MAOI) drugs act on ______ to enhance the activity of serotonin, norepinephrine and dopamine? A. Ion Channels B. Enzymes C. Carrier Proteins

Enzymes (MOA is an enzyme that breaks down serotonin, norepinephrine and dopamine) Inhibiting this enzyme increases those neurotransmitters. MOAI's form a strong covalent bond and so their effect are "irreversible".

_________ refers to the removal of drugs from the body wither unchanged or as metabolites?

Excretion

Factors that affect the distribution of a drug? A. size of the organ B. Blood flow to the organ C. Solubility of the drug D. Plasma protein binding E. Anatomic barriers F. All of the above

F. All of the above

In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline (Elavil), but assessing suicide risk is the most important intervention.

During the ______ phase of drug treatment the nurse assesses, observes and monitors the patients response to the medication?

Initiation

Benzodiazapines act on _____ to increase the activity of GABA? A. Ion Channels B. Enzymes C. Carrier Proteins

Ion Channels (chloride)

Steven Johnsons syndrome is associated with this anticonvulsant mood stabilizer?

Lamictal

A patient comes in with ataxia, slurred speech, course tremor, N/V, tinnitus and blurred vision. This is most likely?

Lithium toxicity

Because most psychiatric medications are protein bound and lipid-soluble their excretion occurs through the ______ ?

Liver

A side effect of Depakote is weight gain and patients should be monitored for?

Liver Function Tests (LFT's)

Class of drug: phenelzine (Nardil)?

MAOI

How does MAOI toxicity cause hypertensive crisis?

MAOI causes accumulation of Tyramine, which is a vasocontrictor

Drug-drug interaction with OTC cold medicines? A. SSRI's B. MAOI's C. NDRI's D. TCA's

MAOI's

Teaching for patients taking lithium should include?

Maintaining adequate salt and water intake.

During the ______ phase medications are continued to prevent a relapse?

Maintenance

What causes neuroleptic malignant syndrome? What is done to treat this?

Many neuroleptics (tranquilizers) used to treat schizophrenia block dopamine. Dopamine receptor blockade is believed to cause this and it usually occurs within the first 2 weeks. Assess before implementing. Nursing care involves taking vitals signs and checking CK enzyme levels to see if they are elevated. A cooling blanket and acetaminophen can help with the temperature elevations. This is a MEDICAL EMERGENCY and requires the administration of dopamine agonists, muscle relaxers/benzodiazepines and antipyretics.

What are the signs and symptoms of Serotonin Syndrome?

Mental status changes, agitation, ataxia, hyperreflexia, fever, diaphoresis, diarrhea (drug-drug interactions of SSRIs with triptans, which are used to treat migraines and St. John's Wort). Use the mneumonic: more heat (hypertehermia/fever), beat (tachycardia), tweak (agitation/hallucinations/mental status changes), leak (diarrhea/diaphoresis) and twitching of the feet (hyper-reflexia/ataxia). More heat, beat, tweak, leak and twitching of the feet.

Mnemonics for remembering TCA side effects? (mine)

Mine: TCA=Triggers Cholinergic-Anti (or... Antagonism) TCA=Toxic Cardiac Actions (Dysrhythmias, MI, stroke=toxicity) TCA=Takers Carefully Ascend (Orthostatic Hypotension) NCLEX APP: TCA'S-Thrombocytopenia, Cardiac, Anti-cholinergic Seizure/Suicide risk increased

Contraindicated for patients with seizure disorder? A. SSRI's B. Mood stabilizers C. NDRI's D. TCA's

NDRI's (Wellbutrin) -Lowers the seizure threshold. Avoid in patients with recent head injuries

Atypical antipsychotics are more helpful than typical antipsychotics for some symptoms of schizophrenia. Identify these symptoms. Select one or more: a. Hallucinations b. Delusions c. Memory deficits d. Motivation e. Lack of grooming

Negative symptoms: c. Memory deficits d. Motivation e. Lack of grooming

Class of drug: buspirone (Buspar)?

Non-benzodiazapine anxiolytic

What is an NDRI (Wellbutrin) and side effects

Norepinepherine Dopamine Reuptake Inhibitor - Lowers Seizure threshold - Caution with alcohol - Activating

Sympathetic nervous system (fight or flight); attention, concentration, mood, energy? A. 􏰁Dopamine (DA) B. Norepinephrine (NE) C. 􏰁Serotonin (5-HT) D. Gamma amino butyric acid (GABA)

Norepinephrine (NE)

SNRI's have the same side effects as SSRI's with the exception of high blood pressure. Why does this make sense?

Norepinephrine (NE) is part of the sympathetic nervous system's (fight or flight) response and acts on alpha-adrenergic receptors to increase blood pressure. These drugs increase NE so they would also increase blood pressure.

The most common serious adverse effect of TCA therapy is _________?

Orthostatic Hypotension

What are the effects of TCA's?

Orthostatic hypotension, cadiac toxicity and anticholinergic side effects TCA=TriggersCholinergicAntagonism TCA=ToxicCardiacActions TCA=TakersCarefullyAscend These drugs end in -iL because of their common ILL effects (Elavil, Tofranil, Anafranil) exception is Nardil, which is an MAOI

The action or effects of a drug on living organisms?

Pharmacodynamics

The response of the body to the drug that is affected by receptor binding, postreceptor effects, and chemical interactions.

Pharmacodynamics

Individualizing medications to match a persons CYP450 enzyme profile can be accomplished through ______ ? This will help poor metabolizers who may experience more adverse effects and rapid metabolizers who may not have drugs reach therapeutic levels.

Pharmacogenomics

The process by which a drug is absorbed, distributed, metabolized and eliminated from the body?

Pharmacokinetics (think kinetics=movment through the body)

The time course of absorption, distribution across compartments, metabolism, and excretion of drugs in the body. The metabolism and excretion of many drugs decrease and the physiologic changes of aging require dosage adjustment for some drugs.

Pharmacokinetics:

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

Which of the following is an anticholinergic side effect associated with some antipsychotic medications? a) Increased tearing b) Photophobia c) Salivation d) Diarrhea

Photophobia Explanation: Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications. The other options are actually side effects of Acetylcholine (Ach): the acronym SLUDGE describes the effects of Acetylcholine-Salivation, Lacrimation, Urinary incontinence, Diahrrea, Gastric cramping, Emesis. The acronym ABCD'S describes the effects of Anticholinergics: Anorexia, Blurry vision, Constipation, Dry mouth and Stasis of urine.

All of these drugs have a boxed warning for risk for suicidal behavior?

antidepressants

Polyuria, Muscle weakness Polyuria and muscle weakness are early indications of lithium toxicity. The client is more likely to have diarrhea and weight gain, and a rash is not a sign of lithium toxicity. CAN HAM SUCS A=an increase in thirst and urine M=Muscle weakness/twitch

The dose of a drug required to produce a specific effect?

Potency

Class of drug: bupropion (Wellbutrin)?

SDRI

What are some of the effects of the neurotransmitter Acetylcholine (ACh)?

SLUDGE-Salivation, Lacrimation, Urinary incontinence, Diarrhea, Gastrointestinal cramping, Emesis

Serotonin Syndrome is associated with?

SSRI's

NCLEX mnemonic for acetylcholines effects: SLUDGE

Salivation Lacrimation Urinary incontinence Diarrhea Gastrointestinal cramping Emesis

The less _____ a drug has the more unintended effects it will produce? A. Affinity B. Selectivity C. Intrinsic activity

Selectivity

An antagonist drug has _____ and _____ but not _____?

Selectivity and Affinity but not intrinsic activity

An agonist has ____ , ____ and _____ ?

Selectivity, Affinity and Intrinsic activity

Symptoms of this life-threatening reaction include: mental status changes (hallucinations, agitation, coma) autonomic instability (tachycardia, hyperthermia, changes in blood pressure) neuromuscular changes (hyperreflexia, ataxia) and gastrointestinal changes (nausea, vomiting, diarrhea)?

Serotonin Syndrome

Poses a risk of serotonin syndrome if taken with SSRIs?

St. Johns Wort

During the _____ phase the prescriber usually titrates the dosage to achieve the maximum amount of improvements with minimum side effects?

Stabilization Phase

An antidepressant with a potential for cardio-toxicity? A. SSRI's B. Mood stabilizers C. NDRI's D. TCA's

TCA's (side effects include anticholinergic, sedation, orthostatic hypertension but serious effects to watch for is cardiotoxicity. They do an ECG before they start this)

The Abnormal Involuntary Movement Scale (AIMS) is a standardized tool used to assess for?

Tardive Dyskinesia, also EPS's

A nurse is educating the client on the administration of paroxetine, an SSRI. The nurse teaches the client to avoid which of the following? Select all that apply. a) Grapefruit juice b) Cigarette smoking c) Processed meat d) Alcohol e) Fermented fish

That's correct. a) Grapefruit juice b) Cigarette smoking and d) Alcohol Explanation: Cigarette smoking and alcohol decrease the effects of SSRIs. Clients should avoid grapefruit juice, which has been known to radically alter the plasma concentrations of oral medications, including SSRIs. Clients taking MAOIs should avoid fermented fish and processed meats, which contain tyramine. Elevated levels of tyramine can induce hypertensive crisis.

What is beers criteria for geriatric medication administration?

The "Beers Criteria" contains lists of medications that pose potential risks outweighing potential benefits for people 65 and older. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is a guideline for healthcare professionals to help improve the safety of prescribing medications for older adults. It emphasizes deprescribing medication that is unnecessary health care, which reduces the problems of high risk-benefit ratio, polypharmacy, drug interactions, and adverse drug reactions.

Selectivity

The ability of a drug to be specific for a particular receptor

Identify physiological changes in the older adult with schizophrenia that impact medication planning.

The ability of the liver to metabolize medications may slow by as much as 4 times between the ages of 20 and 70. Renal function also declines with age by 10% per decade. Gastric absorption changes, pH increases (becomes alkaline, which affects absorption) and gastric emptying slows.

Intrinsic activity

The ability to produce a response after it becomes attached to a receptor

What are anticholinergic effects and what medications cause them?

The anticholinergic effects are the ABCD'S-Anorexia, Blurry vision, Constipation/Confusion, Dry mouth, Stasis of urine (hesitancy/retention). Atypical AP's and TCA's have these effects. The medications that treat movement disorders by reducing acetylcholine and can cause anticholinergic crisis if given too much are the ABC'S-Artane, Benadryl, Cogentin, Symmetrel. Anticholinergic crisis also goes by the mnuemonic: hot as a hare, blind as a bat, mad as a hatter, dry as a bone.

Affinity

The degree of attraction or strength of the bond between the drug and its biological target

Pharmacodynamics:

The response of the body to the drug that is affected by receptor binding, postreceptor effects, and chemical interactions. Pharmacodynamic problems occur when two drugs act at the same or interrelated receptor sites, resulting in additive, synergistic, or antagonistic effects. The effects of two or more drugs together can be either additive (combination of drugs "add up" to increase effect), synergistic (one agent magnifies the effect of the other), or antagonistic (one medication inhibits the effect of the other).

Pharmacokinetics:

If a drug has a wide range between the dose at which the drug begins to take effect and the dose at which the drug would be toxic to the body it is considered to have a wide _________ ?

Therapeutic Index

The ratio of the maximum non-toxic dose to the minimum therapeutic dose is called the _______ ?

Therapuetic Index

How do atypical antipsychotics treat positive symptoms of schizophrenia?

They don't block DA everywhere. They block serotonin in some areas, which leads to an increase in DA release in that area. This treats negative symptoms.

What class of medications are imipramine (Tofranil) and amitriptyline (Elavil)?

Tricyclic Antidepressants (TCAs) end in -iL because of so many ill effects. Nardil is exception. Its MAOI.

Class of drug: amitriptyline (Elavil)?

Tricyclic antidepressant (TCA)

Class of drug: imipramine (Tofranil)?

Tricyclic antidepressant (TCA)

MAOI's can cause both orthostatic hypotension and hypertensive crisis? T/F

True

SSRIs have a therapeutic lag time of 2-6 weeks? T/F

True

Most antipsychotic agents increase the risk of mortality in elderly patients with dementia? A. True B. False

True Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality.

Class of drug: haloperidol (Haldol)?

Typical antipsychotic

_______ drugs are contraindicated for older patients with dementia?

Typical antipsychotics

Why do EPSE's happen?

Typical antipsychotics block dopamine all over, resulting in an imbalance in dopamine/acetylcholine. The resulting decrease in dopamine can cause symptoms that resemble parkinsons disease, which is caused by a lack of production of dopamine. The increase of acetylcholine in areas involved in muscle movement also plays a role in some of the EPSE's. This imbalance, which causes dopamine decrease and ACh increase causes the EPSE's.

Patients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in which of the following? a) Tyramine b) Sugar c) Fat d) Sodium

Tyramine has a vasopressor effect that induces hypertension. If the individual ingests food that contains high levels of tyramine while taking MAOIs, severe headaches, palpitations, neck stiffness and soreness, nausea, vomiting, sweating, hypertension, stroke, and (in rare instances) death may result. Patients who are taking MAOIs are placed on a low-tyramine diet. Sodium, fat, and sugar are generally not restricted in patients receiving MAOIs.

Because _____ resembles a psychostimulant structurally it may produce agitation, anxiety, insomnia, and appetite suppression?

Wellbutrin (NDRI) May explain lower incidence of sexual dysfunction

A patient is in the acute phase of mania and is receiving lithium. Which of the following blood levels of lithium is within the therapeutic range for acute mania? a) 0.9 mEq/L b) 1.5 mEq/L c) 0.4 mEq/L d) 0.2 mEq/L

a) 0.9 mEq/L Explanation: During the acute phase of mania, lithium blood levels of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control.

The patient is receiving clozapine (Clozaril). For which life-threatening blood disorder should the nurse be alert when assessing this patient? a) Agranulocytosis b) Diabetes c) Hypotension d) Weight gain

a) Agranulocytosis Explanation: Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a drop in neutrophils in the blood, to develop. Hypotension, weight gain, and diabetes are not blood disorders but are potential side effects of antipsychotics

Which of the following must be present in a client diagnosed with serotonin syndrome? Select all that apply. a) Ataxia b) Hyporeflexia c) Agitation d) Fever e) Constipation f) Diaphoresis

a) Ataxia, c) Agitation, d) Fever, f) Diaphoresis Explanation: The symptoms include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea. More beat, heat, tweak, sweat and poop leak and twitching of the feet. Beat=tachycardia, Heat=hyperthermia, Tweak=hallucinations/agitation, Leak=diarrhea and diaphoresis and twitching of the feet=hyperreflexia/ataxia

Which of the following would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? a) Benztropine (Cogentin) b) Trihexyphenidyl(Artane) c) Aripiprazole (Abilify) d) Risperidone (Risperdal)

In psychiatric-mental health, anticonvulsants are commonly used to treat patients with bipolar disorder and are considered mood stabilizers. Which of the following medications are classified as anticonvulsants? Select all that apply. a) Carbamazepine (Tegretol) b) Lithium c) Lamotrigine (Lamictal) d) Clozapine (Clozaril) e) Valproate (Depakote)

a) Carbamazepine (Tegretol), c) Lamotrigine (Lamictal) e) Valproate (Depakote), Explanation: Valproate (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) are classified as anticonvulsants. Lithium is an antimania medication. Clozapine (Clozaril) is an antipsychotic.

a) Carbamazepine (Tegretol), c) Lamotrigine (Lamictal), d) Valproate (Depakote) Explanation: Valproate (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) are classified as anticonvulsants. Lithium is an antimania medication. Clozapine (Clozaril) is an antipsychotic.

Which of the following could be a potential cause of lithium toxicity? Select all that apply. a) Diarrhea b) Vomiting c) Hypernatremia d) Strenuous exercise e) Hot climate

a) Diarrhea, b) Vomiting, d) Strenuous exercise, e) Hot climate Explanation: Hyponatremia can cause a spike in Lithium. Losing sodium any way will cause this. If body fluid decreases significantly because of a hot climate, strenuous exercise, vomiting, diarrhea, or a drastic reduction in fluid intake, then lithium levels can rise sharply, causing an increase in side effects and a progression to lethal lithium toxicity. The higher the sodium levels, the lower the lithium levels will be. Hypernatremia causes a decrease in lithium levels and hyponatremia can cause lithium toxicity.

After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students identify which of the following as playing a role in the positive symptoms of schizophrenia? a) Dopamine b) Glutamate c) Serotonin d) Gamma-aminobutyric acid (GABA)

a) Dopamine Explanation: Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be related to dopamine hyperactivity. Studies are revealing that schizophrenia does NOT result from the dysregulation of a single neurotransmitter or biogenic amine, such as norepinephrine or serotonin. Hypothesis suggests a role for glutamate and GABA as well. However, dopamine dysfunction is also thought to be involved in psychosis with other disorders. The positive symptoms are caused primarily by dopamine.

Which of the following are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply. a) Dry mouth b) Urinary retention c) Diarrhea d) Constipation e) Runny nose

a) Dry mouth, d) Constipation, b) Urinary retention Explanation: Anticholinergic side effect resulting from blockade of acetylcholine are common side effects associated with antipsychotic drugs. Others include dry mouth, slowed gastric motility, constipation, urinary hesitancy or retention, and nasal congestion. Diarrhea and a runny nose are not anticholinergic side effects.

A client diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? a) Facial flushing b) Incontinence c) Hypothermia d) Bradycardia

a) Facial flushing Explanation: Clinical manifestations of anticholinergic crisis include facial flushing, tachycardia, urinary retention, and hyperthermia (fever).

A client is prescribed phenelzine sulfate, an MAOI-A. The nurse caring for this client is aware that the most serious risk associated with MAOI-As is ______________. a) Hypertensive crisis b) Manic behavior c) Diarrhea d) Vertigo

a) Hypertensive crisis Explanation: The most serious risk for a client taking an MAOI-A is hypertensive crisis. Diarrhea, vertigo, and manic behavior are side effects of MAOIs but are not as dangerous as hypertensive crisis

Which of the following is an examples of a monoamine oxidase inhibitors (MAOIs)? a) Nardil b) Zoloft c) Paxil d) Prozac

a) Nardil Explanation: Examples of MAOIs are phenelzine (Nardil) and isocarboxazid (Marplan). Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are examples of selective serotonin reuptake inhibitors.

The nurse is caring for a client who is taking an SSRI. The combined use of an SSRI with which of the following is a risk factor for serotonin syndrome? Select all that apply. a) TCA b) Diazepam c) Serotonergic agonists d) St. John's wort e) Propranolol

a) TCA, c) Serotonergic agonists and d) St. John's wort, Explanation: Concomitant use of SSRIs with TCAs, serotonergic agonists, or St. wort can lead to serotonin syndrome. Anti-anxiety drugs such as diazepam and propranolol are prescribed if the client experiences serotonin syndrome. Fermeneted fish and soy sauce

A 45-year-old patient who is addicted to alcohol has to drink increasing amounts to experience the same effect of the alcohol. This is an example of which of the following? a) Tolerance b) Efficacy c) Desensitization d) Toxicity

a) Tolerance Explanation: Desensitization is a rapid decrease in drug effects that may develop in a few minutes of exposure to the drug. Efficacy is the ability of a drug to produce a response and is considered when a drug is selected.Tolerance is a gradual decrease in the action of a drug at a given dose or concentration in the blood. In the abuse of substances such as alcohol or cocaine, tolerance is a part of the addiction. Toxicity refers to the point at which concentration of the drug in the bloodstream is high enough to become harmful or poisonous to the body.

A client who is prescribed a trycyclic antidepressant is brought to the emergency department with a suspected overdose. Which of the following would the nurse assess to support this suspicion? Select all that apply. a) Urinary retention b) Pale, moist skin c) Diarrhea d) Headache e) Blurred vision

a) Urinary retention and e) Blurred vision Explanation: In acute overdose of TCA's, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Headache is a side effect of MAOIs. Remember the mnemonic "hot as a hare, blind as a bat, mad as a hatter, dry as a bone" -OR- ABCD'S-Anorexia, Blurred vision, C-constipation/confusion, Dry mouth, Stasis of urine.

In psychiatric-mental health, anticonvulsants are commonly used to treat patients with bipolar disorder and are considered mood stabilizers. Which of the following medications are classified as anticonvulsants? Select all that apply. a) Valproate (Depakote) b) Lamotrigine (Lamictal) c) Clozapine (Clozaril) d) Lithium e) Carbamazepine (Tegretol)

a) Valproate (Depakote), b) Lamotrigine (Lamictal), e) Carbamazepine (Tegretol), Explanation: Valproate (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) are classified as anticonvulsants. Lithium is an antimania medication. Clozapine (Clozaril) is an antipsychotic.

A client has been prescribed clozapine (Clozaril) for treatment of schizophrenia. The patient must be taught to monitor which blood levels WEEKLY while taking this drug? a) WBC b) Platelets c) Hematocrit d) Hemoglobin

a) WBC

Which of the following is considered a first-generation antipsychotic drug used to treat psychosis in the United States? a) fluphenazine (Prolixin) b) clozapine (Clozaril) c) aripiprazole (Abilify) d) olanzapine (Zyprexa)

a) fluphenazine (Prolixin) Explanation: Fluphenazine (Prolixin) is a first-generation antipsychotic medication. Abilify, Clozaril, and Zyprexa are second-generation antipsychotics.

The patient who has just been started on haldol 5 mg bid complains to you that he is having trouble with his neck and jaw twisting to one side, he can't swallow or talk, his eyes are rolling back and back is arching backward. It is most likely that he is having a Select one: a. Dystonic reaction b. Seizure c. Panic attack d. Pseudoparkinsonism

a. Dystonic reaction

A client has been prescribed a tricyclic antidepressant (TCA) for depression. She is also taking an oral anticoagulant for coronary artery disease. Which of the following is a major risk for this client? a) Serotonin syndrome b) Bleeding c) Hypertension d) Manic behavior

b) Bleeding Explanation: The client who is taking an oral anticoagulant and TCA has a major risk of bleeding. Administration of TCAs with clonidine may lead to hypertension. Manic behavior is a side effect of monoamine-oxidase inhibitors, and serotonin syndrome is a fatal condition in which levels of serotonin are too highly increased following the use of SSRIs.

Which of the following are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply. a) Diarrhea b) Dry mouth c) Constipation d) Runny nose e) Urinary retention

b) Dry mouth, c) Constipation, e) Urinary retention Explanation: Anticholinergic side effect resulting from blockade of acetylcholine are common side effects associated with antipsychotic drugs. Others include dry mouth, slowed gastric motility, constipation, urinary hesitancy or retention, and nasal congestion. Diarrhea and a runny nose are not anticholinergic side effects.

A 36-year-old patient has been receiving a selective serotonin reuptake inhibitor for treatment of depression. She is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which of the following symptoms of this syndrome? a) Hypothermia b) Hyperreflexia c) Bradycardia d) Constipation

b) Hyperreflexia Explanation: Symptoms of serotonin syndrome include hyperreflexia, tachycardia, hyperthermia, and diarrhea. Serotonin syndrome can be life threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management. More heat (hyperthermia), beat (tachycardia), leak (diarrhea) and jerking of the feet (hyperreflexia). Think more heat, beat, leak and jerking of the feet.

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which of the following may occur as a result of water intoxication? a) Hypernatremia b) Hyponatremia c) Weight loss d) Oliguria

b) Hyponatremia Explanation: Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium levels rapidly fall below the normal range of 135 to 145 mEq/L, to a level of 120 mEq/L or less. The rapid decrease in sodium produces neurological signs such as muscle twitching and irritability, and the client is at risk for seizures, coma or possible death. Polyuria and increased diurnal weight gain may occur.

A client with schizophrenia is prescribed clozapine (Clozaril). The nurse would monitor the client closely for specific signs of which of the following? a) Nausea b) Infection c) Hypotension d) Weight loss

b) Infection Explanation: Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.

Which of the following are examples of monoamine oxidase inhibitors (MAOIs)? Select all that apply. a) Zoloft b) Marplan c) Paxil d) Nardil e) Prozac

b) Marplan, d) Nardil Explanation: Examples of MAOIs are phenelzine (Nardil) and isocarboxazid (Marplan). Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are examples of selective serotonin reuptake inhibitors.

Both valproate and carbamazepine may be lethal if high doses are ingested. Toxic symptoms appear in one to three hours and include which of the following? a) Tinnitus b) Neuromuscular disturbances c) Bradycardia d) Urinary frequency

b) Neuromuscular disturbances Explanation: Symptoms include neuromuscular disturbances, dizziness, stupor, agitation, disorientation, nystagmus, urinary retention, nausea and vomiting, tachycardia, hypotension or hypertension, cardiovascular shock, coma, and respiratory depression. Tinnitus is not seen in lethal doses of these drugs.

During which phase of drug treatment does the prescriber adjust or titrate the medication dosage to achieve the maximum amount of improvement with a minimum of side effects? a) Maintenance b) Stabilization c) Initiation d) Discontinuation

b) Stabilization Explanation: During stabilization, the prescriber adjusts or titrates the medication dosage to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess for improvements in the target symptoms and for the appearance of side effects. During the maintenance phase, after the individual's target symptoms have improved, medications are usually continued to prevent relapse or return of symptoms. Before the initiation of medications, patients must undergo several assessments, such as psychiatric and physical examinations. During the discontinuation phase, some medications may be stopped, tapered, or kept at the same dosage.

Which of the following is considered a first-generation antipsychotic drug used to treat psychosis in the United States? a) clozapine (Clozaril) b) fluphenazine (Prolixin) c) olanzapine (Zyprexa) d) aripiprazole (Abilify)

b) fluphenazine (Prolixin) Explanation: Fluphenazine (Prolixin) is a first-generation antipsychotic medication. Abilify, Clozaril, and Zyprexa are second-generation antipsychotics.

A paitent on a typical antipsychotic complains of restlessness in his legs and is pacing constantly. He says it is very uncomfortable, he is very upset about it, and that he didn't have this before taking the medication. What condition is this patient most likely experiencing? Select one: a. Acute dystonia b. Akathisia c. Parkinsonism d. Tardive dyskinesia

b. Akathisia

A patient presents with a high fever and the family states it started 2 hours ago suddenly. The patient also has very stiff arms, is confused and lethargic. The patient's blood pressure is unstable. What condition is most likely to be causing this constellation of symptoms? Select one: a. Extrapyramidal symptoms b. Neuroleptic malignant syndrome c. Serotonin Syndrome d. Tardive dyskenesia

b. Neuroleptic malignant syndrome Primary symptom: Muscle rigidity (stiff arms) Check vital signs: elevated temperature (sudden onset of high fever) and tachycardia and tachypnea Check CK: NMS causes muscle breakdown. Check for CK elevation.

The amount of the drug that actually reaches the systemic circulation unchanged

bioavailabality

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate? a) "You should see improvement in about 36 to 48 hours." b) "It will take about 6 to 12 weeks until the drug is effective." c) "Generally, it takes about one to two weeks to be effective in changing symptoms." d) "His symptoms should subside almost immediately."

c) "Generally, it takes about one to two weeks to be effective in changing symptoms." Explanation: Generally, it takes about one to two weeks for antipsychotic drugs to effect a change in symptoms. During the "stabilization period", the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried. lecture: 2-6 week lag time

A patient is in the acute phase of mania and is receiving lithium. Which of the following blood levels of lithium is within the therapeutic range for acute mania? a) 1.5 mEq/L b) 0.2 mEq/L c) 0.9 mEq/L d) 0.4 mEq/L

c) 0.9 mEq/L Explanation: During the acute phase of mania, lithium blood levels of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control. Lecture: 0.5-1.5 mEq/L is range. NCLEX: toxicity is one of the magic 2's-2.0 mEq/L is lithium toxicity. Toxicity is caused by hyponatremia or low body fluids so maintain adequate intake of sodium and water.

The prescription of clozapine (Clozaril) requires weekly blood samples for which of the following timeframes? a) 2 months b) 4 months c) 6 months d) 8 months

c) 6 months Explanation: Although agranulocytosis can occur with any of the antipsychotics, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment and then every 2 weeks after that for as long as the drug is taken

The nurse is caring for a client receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which of the following? a) Hyperactive bowel sounds b) Moist skin c) Blurred vision d) Urinary incontinence

c) Blurred vision Explanation: Anticholinergic effects are prominent with tricyclic antidepressants. These include potentiation of CNS drugs, dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility (constipation), and urinary retention. TCA=TriggersCholinergicAnti. Use one of the mnemonics like: Cant poop, pee, spit or see.

Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter? a) Epinephrine b) Acetylcholine c) Dopamine d) Norepinephrine

c) Dopamine Explanation: Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.

A client diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? a) Incontinence b) Bradycardia c) Facial flushing d) Hypothermia

c) Facial flushing Explanation: Clinical manifestations of anticholinergic crisis include facial flushing, tachycardia, urinary retention, and hyperthermia (fever). Remember the mnemonic "hot as a hare, blind as a bat, mad as a hatter, dry as a bone". Photophobia and blurred vision fall under blind as a bat. Why not A-incontinence is an effect of acetylcholine while urinary retention is an anticholinergic effect.

Which of the following antidepressant medications is classified as a selective serotonin reuptake inhibitor (SSRI)? a) Tranylcypromine (Parnate) b) Phenelzine (Nardil) c) Fluoxetine (Prozac) d) Isocarboxazid (Marplan)

c) Fluoxetine (Prozac) Explanation: The SSRIs include Lexapro, Prozac, Zoloft, Luvox, Paxil, and Celexa. The monoamine oxidase inhibitors include Nardil, Marplan, and Parnate

A 36-year-old patient has been receiving a selective serotonin reuptake inhibitor for treatment of depression. She is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which of the following symptoms of this syndrome? A. Bradycardia B. Hypothermia C. Constipation D. Hyperreflexia

c) Hyperreflexia Explanation: A-tachycardia not bradycardia. B-Hyperthermia not hypothermia. Diarrhea not constipation Symptoms of serotonin syndrome include agitation, hallucinations, hyperreflexia, ataxia, tachycardia, hyperthermia, diaphoresis and diarrhea. Serotonin syndrome can be life threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management.

Which of the following is an anticholinergic side effect associated with some antipsychotic medications? a) Salivation b) Increased tearing c) Diarrhea d) Photophobia

d) Photophobia Explanation: Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications.

Which of the following could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? a) Take medication with food b) Eat a nutritionally balanced diet c) Increase hydration d) Get daily exercise

c) Increase hydration Explanation: Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain seen in clients taking antidepressants.

A client with schizophrenia is prescribed clozapine (Clozaril). The nurse would monitor the client closely for specific signs of which of the following? a) Nausea b) Weight loss c) Infection d) Hypotension

c) Infection Explanation: Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.

Which of the following are examples of monoamine oxidase inhibitors (MAOIs)? Select all that apply. a) Paxil b) Zoloft c) Nardil d) Marplan e) Prozac

c) Nardil, d) Marplan, Explanation: Examples of MAOIs are phenelzine (Nardil) and isocarboxazid (Marplan). Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are examples of selective serotonin reuptake inhibitors.

Which of the following extrapyramidal side effects is noted by the client having bradykinesia and a shuffling gait? a) Akathisia b) Tardive dyskinesia c) Pseudoparkinsonism d) Acute dystonia

c) Pseudoparkinsonism Explanation: Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities.

The client is taking an MAOI for depression. The nurse educates the client to avoid foods containing which of the following while taking this medication? a) Potassium b) Sugar c) Tyramine d) Calcium

c) Tyramine Explanation: If co-administered with food or other substances containing tyramine, MAOIs can trigger a HYPERTENSIVE CRISIS, which may be life threatening. MAOIs given with foods containing calcium, potassium, or sugar do not cause a hypertensive crisis.

An CYP enzyme inducer is a drug that will speed up metabolism, increasing clearance and decreasing the plasma level of the drug. _____ is a potent inducer that decreases the plasma level of the antipsychotic Clozapine?

cigarette smoke. A smoker will clear the drug faster

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate? a) "It will take about 6 to 12 weeks until the drug is effective." b) "His symptoms should subside almost immediately." c) "You should see improvement in about 36 to 48 hours." d) "Generally, it takes about one to two weeks to be effective in changing symptoms."

d) "Generally, it takes about one to two weeks to be effective in changing symptoms." Explanation: Generally, it takes about one to two weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.

The prescription of clozapine (Clozaril) requires weekly blood samples for which of the following timeframes? a) 4 months b) 2 months c) 8 months d) 6 months

d) 6 months Explanation: Although agranulocytosis can occur with any of the antipsychotics, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment and then every 2 weeks after that for as long as the drug is taken.

Which of the following would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? a) Trihexyphenidyl(Artane) b) Aripiprazole (Abilify) c) Risperidone (Risperdal) d) Benztropine (Cogentin)

d) Benztropine (Cogentin) Explanation: A client experiencing a dystonic reaction should receive immediate treatment with benztropine (Cogentin). Risperidone (Risperdal) and aripiprazole (Abilify) are antipsychotics that may cause dystonic reactions. Trihexyphenidyl (Artane) is used to treat another EPSE called Parkinsonism, which is due to antipsychotic drugs. The ABC'S of anticholinergics used to treat EPSE's stands for Artane, Benadryl, Cogentin and Symmetrel (ABCD'S).

d) Dopamine Explanation: Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.

Which of the following extrapyramidal side effects is noted by the client having bradykinesia and a shuffling gait? a) Tardive dyskinesia b) Akathisia c) Acute dystonia d) Pseudoparkinsonism

d) Pseudoparkinsonism Explanation: Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities.

A patient has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which of the following extrapyramidal syndromes (EPS) is the patient displaying? a) Dystonia b) Akathisia c) Neuroleptic malignant syndrome (NMS) d) Pseudoparkinsonism

d) Pseudoparkinsonism Explanation: Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged patients. Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever

A patient is being seen in the mental health clinic. He has been on haloperidol (Haldol) for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. The nurse would document this chronic syndrome as which of the following? a) Dystonia b) Neuroleptic malignant syndrome (NMS) c) Akathisia d) Tardive dyskinesia

d) Tardive dyskinesia Explanation: He has been there for 8 months so this is a late developing (Tardive) EPSE. Tardive dyskinesia involves irregular, repetitive involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. NMS, a serious complication that may result from antipsychotic medications, is characterized by rigidity and high fever. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged patients. Dystonia is impaired muscle tone that generally is the first extrapyramidal symptom to occur, usually within a few days of initiating use of an antipsychotic.

A client has been prescribed clozapine (Clozaril) for treatment of schizophrenia. The patient must be taught to monitor which blood levels weekly while taking this drug? a) Hemoglobin b) Hematocrit c) Platelets d) WBC

d) WBC Explanation: Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins

Which of the following is considered a first-generation antipsychotic drug used to treat psychosis in the United States? a) clozapine (Clozaril) b) olanzapine (Zyprexa) c) aripiprazole (Abilify) d) fluphenazine (Prolixin)

d) fluphenazine (Prolixin) Explanation: Fluphenazine (Prolixin) is a first-generation antipsychotic medication. Abilify, Clozaril, and Zyprexa are second-generation antipsychotics

Anti-cholinergics treat the Extrapyramidal symptoms (EPS) or movement disorders by causing a _______ in Acetylcholine (ACh) in areas involved in motor movement. This also causes a _____ in the brain, leading to confusion and memory problems?

decrease, decrease

Typical (first-generation) antipsychotics cause a Dopamine to _____ in all areas and an Acetylcholine ____ in areas involved in motor movement. This causes the Extrapyramidal symptoms.

decrease, increase

A _____ interaction can develop if one substance inhibits an enzyme system

drug-drug

What classification of medication is haloperidol (Haldol)?

first generation antipsychotic

haloperidol (Haldol) and chlorpromazine (Thorazine) are?

first generation antipsychotics

Bioavaialability of a drug taken orally is reduced by the ______ effect?

first pass

Bioavailability is decreased by the _______ effect

first pass

The process by which oral medications are metabolized within the gastrointestinal tract or liver before reaching the rest of the body, resulting in less of the drug reaching the systemic circulation?

first-pass effect

The _____ of a drug provides a measure of the expected rate of clearance?

half-life

SNRI's cause side effects similar to SSRI's with the addition of?

increased blood pressure (makes sense if you think that norepinephrine is increased and NE acts on alpha-adrenergic receptors=vasocontriction)

What class of medication is Lithium carbonate?

mood stabilizer

_________ is the action or effects of drugs on living organisms?

pharmacodynamics

_________ is the process by which a drug is absorbed, distributed, metabolized and eliminated by the body?

pharmacokinetics

What classification of medication is ziprazadone (Geodon)?

second generation (atypical) antipsychotic

What classification of medication is risperidone (Risperdal)?

second generation antipsychotic

________ occurs when absorption equals excretion so that the therapeutic level of a drug plateaus?

steady state

Which of the following antipsychotics are Typical or First generation? Thorazine (chlorpromazine) Haldol (haloperidol) Rispiradol (resperidone) Zyprexa (olazapine) Geodon (ziprasidone) Prolixin (fluphenazine) Clozaril (clozapine) Seroquel (quetiapine)

the 3 Typical: Thorazine (chlorpromazine) Haldol (haloperidol) Prolixin (fluphenazine)

Q. Precursor to epinephrine and norepinephrine; motor areas of brain; pleasure / reward; attention; concentration; energy; motivation. Psychotic symptoms? A. 􏰁Dopamine (DA) B. Norepinephrine (NE) C. 􏰁Serotonin (5-HT) D. Gamma amino butyric acid (GABA)

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