Pharmacology - Prep U - Chapter 21

A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapuetic effect of the treatment in the care of this client?

Assessment of the client's behaviors and thought processes The nurse's priority should be to assess the signs and symptoms of the client's underlying health problem in order to identify therapeutic effects. The client's vital signs are not likely to be volatile, and hepatic and renal status are not commonly affected by Risperdone. Bone marrow suppression is not an expected adverse effect.

A client is receiving a selective serotonin reuptake inhibitor (SSRI) and is being switched to a monoamine oxidase inhibitor (MAOI) due to lack of response. When would the nurse teach the client to begin the MAOI?

The MAOI would be started 2 to 4 weeks after stopping the SSRI. At least 2 to 4 weeks should be allowed to pass between stopping a SSRI and starting a MAOI to reduce the risk of serotonin syndrome.

What statement should the nurse rely upon to describe to a client the general characteristic associated with antidepressant therapy? Select all that apply.

While all of these drugs are effective in relieving depression, the drugs differ in adverse effects. These drugs are metabolized by the body's cytochrome P450 enzymes. Antidepressants are commonly administrated by the oral route. Antidepressants are metabolized by the cytochrome P450 enzymes in the liver. They are administered orally and have differing adverse effects. Two to four weeks are usually necessary for the relief of symptoms.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?

14 days Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks It may take up to 4 weeks before the full effect of an SSRI is noted.

A nurse is reviewing the indications for the use of fluoxetine. For what client would this drug be appropriate?

A young adult client with bulimia Fluoxetine is indicated for the treatment of bulimia. Escitalopram is indicated for the treatment of generalized anxiety disorder. Duloxetine is indicated for the treatment of diabetic neuropathic pain. Citalopram is indicated for the treatment of trichotillomania.

A nurse is preparing to administer selective serotonin reuptake inhibitors (SSRIs) to a group of clients. The nurse would administer the drug cautiously to which clients?

Clients with diabetes mellitus The nurse should administer SSRIs cautiously to clients with diabetes mellitus. Sinequan (doxepin) is contraindicated in clients with a tendency for urinary retention. The nurse should use caution with clients with increased intraocular pressure and narrow-angle glaucoma when administering tricyclic antidepressants.

Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children?

Enuresis Besides being prescribed as an antidepressant, imipramine is used to treat enuresis in children older than age 6.

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness The nurse should monitor the patient for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are the symptoms of hypertensive crisis.

Which agent would a nurse identify as a selective serotonin reuptake inhibitor?

Fluvoxamine Fluvoxamine is classified as a selective serotonin reuptake inhibitor. Selegiline is not classified as a selective serotonin reuptake inhibitor; it is a MAO-type B inhibitor. Nefazadone is not classified as a selective serotonin reuptake inhibitor. Mirtazapine is not classified as a selective serotonin reuptake inhibitor.

A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions?

Monitor the client closely for bleeding and review coagulation indices when available. Combining TCAs with warfarin creates a risk for bleeding, which should be addressed in the nursing care plan. There is no known interaction between TCAs and calcium supplements or bisphosphonates that would create a risk for hypocalcemia. TCAs do not heighten the risk of gastroesophageal reflux. TCAs can affect blood pressure, but this is unrelated to any known drug-drug interactions.

Which side effect of fluoxetine is most commonly the cause for poor client adherence?

sexual dysfunction Fluoxetine produces adverse effects, such as sexual dysfunction. It is imperative that the nurse assess for sexual dysfunction, which is a major reason for noncompliance in men. The assessment of hypotension is not accurate without symptoms of hypotension. The assessment of pain or discomfort is not accurate in this client. The assessment of cardiac dysrhythmia is not accurate in this client.

A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status?

"Have you felt hopeless anytime lately?" A quick depression assessment involves asking the client if he/she has felt helpless or hopeless over the last two weeks. The other questions will not be helpful in assessing the client's current mental status.

After teaching a client who is prescribed isocarboxazid, the nurse determines that additional teaching is needed when the client states a need to avoid what food?

whole milk. Whole milk is not high in tyramine and thus does not need to be avoided during treatment with an MAOI. Red wine, sausage, and aged cheeses are high in tyramine and should be avoided.

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet. The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth." Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function.

The psychiatric-mental health nurse is providing care for several clients. Which client should the nurse monitor most closely for adverse medication effects?

A client with depression who is prescribed paroxetine 15 mg PO daily The potential adverse effects of monoamine oxidase inhibitors far exceed those of SSRIs or tricyclic antidepressants, even when the latter are combined with ECT. For this reason, a client taking phenelzine requires exceptionally close monitoring.

A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize?

Blood pressure monitoring The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.

A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid which foods? (Select all that apply.)

Blue cheese Pepperoni Chocolate A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) as the combination can result in a life-threatening hypertensive crisis.

A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?

Clomipramine Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.

The nurse is providing care for a client who has been prescribed trazodone for the treatment of depression. What assessment should the nurse prioritize?

Cognition and level of consciousness Trazodone (Desyrel) is effective in some forms of depression but has many CNS effects associated with its use. For this reason, the nurse should prioritize the assessment of neurologic status over respiratory, renal or integumentary status.

The nurse in a long-term care facility is providing care for an 83-year-old client who has depression and who has been prescribed clomipramine. The client has twice reported urinary hesitation since starting this treatment and required intermittent urinary catheterization overnight to relieve bladder distention. What is the nurse's best action?

Contact the care provider promptly to advocate for a change in the medication regimen. Urinary hesitancy that requires catheterization suggests that the client cannot likely tolerate the anticholinergic effects of this medication. A dose reduction or a change to a different class of antidepressants may be necessary. Increasing fluid intake may exacerbate, rather than relieve, the problem. Indwelling catheters create high risks for infection and loss of function; a change in medication would be a preferred approach. The nurse should monitor the client closely, but interventions are needed in addition to this assessment.

A nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body?

Decreased reuptake of norepinephrine The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the patient's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.

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

SSRIs usually produce fewer and milder adverse effects than other antidepressants. SSRIs are the antidepressants of first choice, because they are effective and usually produce fewer and milder adverse effects than other drugs.

The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.

A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?

onset of suicidal ideation. The nurse should closely assess the client for evidence of worsening depression or onset of suicidal ideation. The most critical time to monitor for behavioral changes is during the first few weeks of drug therapy. Although sertraline is not approved by the FDA for treating depression in children at this time, the SSRI is widely used on an unlabeled basis to treat pediatric depression. While it is important to monitor for weight loss, it is not critical. Feelings of grandiosity and decreased sleep are symptoms of mania and are not adverse effects related to this drug.

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?

orthostatic hypotension Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline. Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.

A client, prescribed fluoxetine 1 week ago, presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?

presence of suicidal ideation It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.

The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize?

"How would you describe your mood and energy level today?" Mirtazapine is an antidepressant and it is prudent for the nurse to assess the client's mood and level of energy. Anxiety is not synonymous with depression and is not treated with this medication. Asking a client how the client feels is often too vague and open-ended to obtain meaningful data. Asking a client if she or she feels "happier" is a closed-ended (yes/no) question and could easily be interpreted by the client as downplaying the severity of depression.

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective." Fluoxetine may take up to four weeks to be completely effective. It would not be appropriate for the nurse to ask the healthcare provider to change the medication, and the client has not given any indication of suicidal ideation.

A 33-year-old woman has been diagnosed with major depression and has recently begun treatment with citalopram. What teaching point should the nurse emphasize when providing health education for this patient?

"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning." SSRIs such as citalopram tend to have fewer adverse effects than many other medications for mood disorders. However, sexual functioning is often affected. OTC medications should be taken with caution but not all of these must necessarily be avoided. Symptom relief takes longer than 2 to 3 days, and significant dietary changes are not normally required with SSRIs.

A client is prescribed transdermal selegiline. What health education should the nurse provide?

"Place the patch on dry skin on your torso that has no cuts or openings." Transdermal selegiline should be applied to dry intact skin on the upper torso, upper thigh, or upper arm. The old patch should be removed before placing the new one and there is no need to massage the area.

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

"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective." Achieving antidepressant effects from sertraline, as with other antidepressants, can take anywhere from 10 days to 4 weeks. Some symptoms of depression, such as loss of energy, may be corrected before the mood is fully elevated.

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." Most experts agree that there is insufficient evidence to establish that St. John's wort is effective in treating depression. The herb has some side effects (such as photosensitivity, dizziness, and nausea), though they are usually infrequent and mild. Drug interactions, however, may be extensive. St. John's wort may decrease the effectiveness of some drugs, and combining it with others, such as cold and flu medications, may result in severe hypertension.

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?

A 45-year-old man with angina pectoris Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in clients with obesity or diabetes.

A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?

A client has dysphagia Antidepressants are almost exclusively administered in oral form not IV or IM. For clients with dysphagia, they have the potential for aspiration.

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug Worsening mood that accompanies the use of an SSRI could constitute an increased risk for suicidality. The nurse should communicate this to the provider promptly so the client can be reassessed. The client taking amitriptyline is experiencing anticholinergic effects which the nurse can likely manage. A client's sexual dysfunction should be addressed but this is not a safety risk. The fact that the nurse needed to review a client's dietary restrictions is not necessarily problematic and could indicate the client's firm commitment to adhering to the restrictions.

The nurse is providing care on an inpatient psychiatric unit. Which adult client should the nurse monitor most closely for signs of adverse drug effects?

A client who is taking phenelzine MAOIs such as phenelzine carry risks of serious adverse effects; clients taking MAOIS must be closely monitored, likely to a greater degree than clients taking SSRIs or buproprion.

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?

A lower dose of the antidepressant Hepatic impairment leads to reduced first-pass metabolism of most antidepressant drugs, resulting in higher plasma levels. The drugs should be used cautiously in clients with severe liver impairment. Cautious use means lower doses, longer intervals between doses, and slower dose increases than usual.

The client has been perscribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension MAO inhibitors may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Clients who take MAO inhibitors should avoid foods that contain tyramine, such as aged cheeses and fava beans.

A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe?

Hypertensive crisis Hypertensive crisis is an adverse reaction of MAOIs. Photosensitivity is an adverse reaction of tricyclic antidepressants. Change in libido and skin rash are adverse reactions of desvenlafaxine and bupropion.

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

In 4 to 6 weeks after stopping the paroxetine Paroxetine, a SSRI, and phenelzine, an MAOI, should not be given together because of the risk for serotonin syndrome. At least 4 to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?

It may take up to two more weeks before the client feels better It may take up to 4 weeks before the full effect of a SSRI such as escitalopram is noted. This phenomenon is the most likely cause of the client's appraisal, not a lack of perspective or worsening symptoms.

Which medications should not be administered to clients receiving monoamine oxidase inhibitors (MAOIs) because of the increased risk of hypertensive episodes? (Select all that apply.)

Meperidine (Demerol) Sertraline (Zoloft) Amitriptyline (Elavil) Clients receiving MAOIs should not be given meperidine, SSRIs (sertraline), or TCAs (amitriptyline) because of the increased risk of hypertensive episodes.

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?

Phenelzine MAOIs are drugs used in the treatment of mood disorders. They require that the client follow a strict diet that restricts tyramine to prevent a hypertensive crisis. Nardil is an MAOI. Diazepam and triazolam are benzodiazepines and paroxetine is an SSRI.

A group of students are reviewing information about antidepressants that inhibit the activity of monoamine oxidase, leading to increase in epinephrine, norepinephrine, dopamine, and serotonin. The students demonstrate understanding when they identify which drug as acting in this manner?

Phenelzine Monoamine oxidase inhibitors such as phenelzine exert their effects by inhibiting the activity of monoamine oxidase. Selective serotonin reuptake inhibitors such as sertraline exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants such as amitriptyline exert their effects by inhibiting reuptake of norepinephrine and serotonin. Serotonin/norepinephrine or dopamine/norepinephrine reuptake inhibitors such as bupropion affect the neurotransmission of norepinephrine, serotonin, and dopamine.

A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?

Question the prescriber about the dose Fluoxetine is usually prescribed at 20 mg/day in the morning, with a ceiling of 60 mg per day. Consequently, the nurse should clarify the dose with the prescriber. Anticholinergic effects are not expected with SSRIs such as fluoxetine.

A client with major depression has not experienced an improvement after treatment with SSRIs and electroconvulsive therapy. Consequently, the provider has prescribed isocarboxazid. When planning this client's care, what nursing diagnosis should the nurse prioritize?

Risk for injury related to adverse drug effects MAOIs such as isocarboxazid have a very high risk for injury because of the serious and diverse adverse effects. MAOIs do not typically cause anticholinergic effects. Insomnia is a possibility but less of a safety risk than many other adverse effects. Dietary modifications are necessary but these do not normally threaten the client's nutritional status because prohibited foods are not the staples of most individuals' diets.

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

SSRIs prevent serotonin from being reabsorbed. Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA.

Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?

Selective serotonin reuptake inhibitor SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.

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

Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.

Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

St. John's wort Clients should be assessed for use of the herbal preparation containing St. John's wort because of the potential for adverse reactions when taken with antidepressants. Ginseng is believed to be helpful with memory loss. Feverfew is known to have properties to aid in the relief of migraine headaches. Eucalyptus has many benefits, from aiding in cough relief, stuffy noses but the concomitant use of eucalyptus with sedative and hypnotic drugs, not antidepressants, has been reported to cause increased sedation.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation.

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. Sertraline should be administered with caution in clients with compromised liver function. Adjustments such as a lower dosage or less-frequent dosing schedule may be made for these clients.

A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?

Venlafaxine Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, as treatment for social anxiety disorder, and to help decrease addictive behaviors. Buproprion is an antidepressant that is also used for smoking cessation in lower dosages. Mirtazapine is used to treat depression. Selegiline is used to treat depression.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives. Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm). SSRIs do not necessarily eliminate the risk of suicide.

Anticholinergic effects such as dry mouth, sedation, and urinary retention are common adverse events occurring with the use of which classes of antidepressants?

Tricyclic antidepressants Anticholinergic side effects commonly occur with the use of the tricyclic class of antidepressants. Common adverse effects for selective serotonin reuptake inhibitors are somnolence, dizziness, headache, insomnia, tremor, and weakness. Monoamine oxidase inhibitors' most common side effects include orthostatic hypotension, dizziness, vertigo, headache, and blurred vision. Adverse effects of lithium include tremors, nausea, vomiting, thirst, and polyuria. Toxic reactions may occur when serum lithium levels are greater than 1.5 mEq/L.

Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin?

Tricyclic antidepressants Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a mood disorder characterized by severe swings from extreme hyperactivity to depression).

The nurse is caring for a group of clients in a long-term care facility. The nurse is aware that SSRIs are associated with what side effect that is especially undesirable in older adults?

Weight loss Weight loss is a common side effect of SSRIs and is particularly undesirable in older adults.

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

Yogurt The nurse should ask the patient to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when undergoing treatment with MAOIs.

A client prescribed a selective serotonin reuptake inhibitor (SSRI) has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

dangerous drug interactions Combining St. John's wort with antidepressants can cause serious drug-to-drug interactions. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

dizziness. The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

What medication is effective in treating enuresis in children older than 6 years of age?

imipramine Imipramine is approved for treating childhood enuresis in children older than 6 years. Amitriptyline is a tricyclic antidepressant but is not used for childhood enuresis. Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is used for depression. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is used for depression.

Which laboratory value would prevent a client from being prescribed duloxetine?

increased alanine aminotransferase level (ALT) Duloxetine is highly protein bound, extensively metabolized by CYP2D6 and CYP1A2 enzymes in the liver, and excreted by the kidneys. It is not recommended for use in clients with severe renal or any degree of liver impairment indicated by an increased ALT result. Low hemoglobin, elevated potassium, and increased ESR do not necessarily preclude the use of duloxetine.

The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means?

increasing levels of both serotonin and norepinephrine Venlafaxine increases the levels of serotonin and norepinephrine in the brain by preventing the reuptake of these neurotransmitters known to play an important part in mood. It does not directly affect endorphins or acetylcholine. The drug weakly inhibits dopamine reuptake.

The normal function of which neurotransmitter is most likely impaired when a client expresses feelings of gloom and the inability to perform activities of daily living?

serotonin Serotonin helps regulate several behaviors that are disturbed in depression. Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.