MH Exam 2 Drugs
A narcotic analgesic with the only purpose of treating opiate dependence. It is used in the same manner as methadone
Levomethadyl (Orlaam)
The parent of a young adult client diagnosed with schizophrenia is asking questions about his son's antipsychotic medication, ziprasidone. Which statement by the parent reflects a need for further teaching? "If he experiences restlessness or muscle stiffness, he should tell his health care provider." "I should give him benztropine to help prevent constipation from the ziprasidone." "If he becomes dizzy, I'll make sure he doesn't drive." "The ziprasidone should help him be more motivated and less withdrawn."
"I should give him benztropine to help prevent constipation from the ziprasidone." Constipation caused by medication is best managed by diet, fluids, and exercise. Benztropine can increase constipation. However, it may be prescribed for restlessness and stiffness. Restlessness and stiffness should be reported to the health care provider (HCP). Drowsiness and dizziness are adverse effects of ziprasidone. Clients should not drive if they are experiencing dizziness. Ziprasidone does help improve the negative symptoms of schizophrenia such as avolition.
How many weeks before MOAIs reach therapeutic level? Because of this lag period, how much time is recommended between the times the MAOI is d/ced and another class of antidepressant is started
2 to 4 weeks to reach therapeutic level Adequate washout period of 5 to 6 weeks recommended
The nurse is planning the care of a client with schizophrenia. The nurse understands that the client will need the most extensive laboratory monitoring regiment if which medication is prescribed? clozapine haloperidol olanzapine risperidone
Clozapine Because clozapine carries the serious risk of neutropenia and agranulocytosis, all clients in the United States and Canada must be enrolled in a risk management system and have frequent blood work. Haloperidol, olanzapine, and risperidone do not carry the same risk of life threatening blood disorder and do not require enrollment in a risk management system.
Pemoline
Cylert Stimulant used to treat ADHD *can cause liver damage, so it is the last stimulant to be prescribed.*
Divalproex
Depakote Anticonvulsants Used as Mood Stabilizers
Dextroamphetamine
Dexedrine Stimulant used to treat ADHD
Which drug to use for substance abuse tx? Maintains abstinence from alcohol
Disulfiram (Antabuse)
A client experiencing a schizophrenic episode is hospitalized. The client is attempting to hit and bite the staff. When the nurse phones the primary care provider for orders to help calm the client, the nurse anticipates what medication is likely to be ordered? chlorpromazine haloperidol lithium carbonate amitriptyline hydrochloride
Haloperidol Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar disorder, and amitriptyline is used for depression.
Most serious side effect of an MAOI?
Hypertensive crisis: a life-threatening condition that can result when a client taking MAOIs ingests tyramine-containing foods and fluids or other medications
What are the 3 MAOIs?
Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate)
Which drug to use for substance abuse tx? Alcohol withdrawal.
Lorazepam (Ativan) or Chlordiazepoxide (Librium)
A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. What complication of antipsychotic therapy does the nurse suspect? agranulocytosis extrapyramidal effects anticholinergic effects neuroleptic malignant syndrome
NMS Neuroleptic malignant syndrome is a rare but potentially fatal effect of antipsychotic medication. This condition generally begins with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism. Anticholinergic effects include blurred vision, drowsiness, and dry mouth.
Desipramine
Norpramin Tricyclic Antidepressant
Galantamine
Reminyl, Razadyne, Nivalin Treatment of dementia: cholinesterase inhibitors/ temporarily slow the progress of dementia
A nurse is teaching a client about the prescribed drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs? The client displays akathisia while sitting. The client is experiencing less psychosis and a decrease in extrapyramidal symptoms. The client does not report nausea and vomiting. The client expresses a decrease in anxiety.
The client is experiencing less psychosis and a decrease in extrapyramidal symptoms. Benztropine is an anticholinergic medication administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting. If the client displays akathisia or meaningless movements, this is not a therapeutic effect of the medication.
Sertraline
Zoloft SSRI
Olanzapine
Zyprexa Atypical (2nd generation) Antipsychotic
Duloxetine What does it block?
Cymbalta SNRI Selectively blocks both serotonin and norepinephrine.
Escitalopram
Lexapro SSRI
The (2) most common medications effective in decreasing hyperactivity and impulsiveness and improving attention
Methylphenidate (Ritalin) Amphetamine compound (Adderall)
Gabapentin
Neurontin Anticonvulsants Used as Mood Stabilizers
Nortriptyline
Pamelor Tricyclic Antidepressant
Desvenlafaxine
Pristiq SNRI Atypical Antidepressant
Fluphenanzine
Proloxin Typical (1st generation) Antipsychotic
Carbamazepine
Tegretol Anticonvulsants Used as Mood Stabilizers
Oxcarbazepine
Trileptal Anticonvulsants Used as Mood Stabilizers
MAOI drug interactions
•Amphetamines •Ephedrine •Fenfluramine •Isoproterenol •Meperidine •Phenylephrine •Phenylpropanolamine •Pseudoephedrine •SSRI antidepressants •Tricyclic antidepressants •Tyramine
A client is receiving paroxetine 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets his stomach. What instruction should the nurse give to the client? "Take the medication an hour before breakfast." "Take the medication with some food." "Take the medication at bedtime." "Take the medication with 4 oz (120 mL) of orange juice."
"Take the medication with some food." Nausea and gastrointestinal upset is a common, but usually temporary, side effect of paroxetine. Therefore, the nurse would instruct the client to take the medication with food to minimize nausea and stomach upset. Other more common side effects are dry mouth, constipation, headache, dizziness, sweating, loss of appetite, ejaculatory problems in men, and decreased orgasms in women. Taking the medication an hour before breakfast would most likely lead to further gastrointestinal upset. Taking the medication at bedtime is not recommended because paroxetine can cause nervousness and interfere with sleep. Because orange juice is acidic, taking the medication with it, especially on an empty stomach, may lead to nausea or increase the client's gastrointestinal upset.
When does akathisia usually develop?
Akathisia usually develops when the antipsychotic is started or when the dose is increased. Clients are typically uncomfortable with these sensations and may stop taking the antipsychotic medication to avoid these side effects.
Type of antidepressants used when the client has an inadequate response to or side effects from SSRIs
Atypical Antidepressant
An alpha-2-adrenergic agonist used to treat hypertension. It is given to clients with opiate dependence to suppress some effects of withdrawal or abstinence. It is most effective against nausea, vomiting, and diarrhea, but produces modest relief from muscle aches, anxiety, and restlessness
Clonidine (Catapres)
Perphenazine
Etrafon Typical (1st generation) Antipsychotic
Rivastigmine
Exelon Treatment of dementia: cholinesterase inhibitors/ temporarily slow the progress of dementia
A potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client takes 1 daily dose of this, which meets the physical need for opiates but does not produce cravings for more.
Methadone (Dolophine)
Antidepressant class that may be superior to typical medications for treatment of typical and treatment-resistant depression, but have several potentially fatal side effects and interactions with numerous other drugs
Monoamine Oxidase Inhibitors (MAOI)
Memantine
Namenda Treatment of dementia: cholinesterase inhibitors/ temporarily slow the progress of dementia
A 5-HT3 antagonist that blocks the vagal stimulation effects of serotonin in the small intestine, is used as an antiemetic. It has been used in young males at high risk for alcohol dependence or with early-onset alcohol dependence.
Ondansetron (Zofran)
Amitriptyline; Prednisone; Buspirone; Gabapentin A young adult client diagnosed with bipolar disorder has been managing the disorder effectively with medication and treatment for several years. The client suddenly becomes manic. The nurse reviews the client's medication record. Which new medication may have contributed to the development of his manic state? amitriptyline prednisone buspirone gabapentin
Prednisone The use of prednisone or other steroids can initiate a manic state in a bipolar client even if he is well controlled on medication. The other medications would decrease the client's depression, mood swings, and anxiety, making him calmer rather than more agitated.
What can several anticonvulsant medications also treat?
Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.
What should you do if you miss a dose of antipsychotic?
Take it if the dose is only 3 to 4 hours late. If the missed dose is more than 4 hours late or the next dose is due, omit the forgotten dose.
A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: tension and irritability. slow pulse. hypotension. constipation.
Tension and irritability Amphetamines are a nervous system stimulant that are subject to abuse because of their ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Diarrhea, not constipation, is a common adverse effect.
Vortioxetine
Trintellix SSRI
A client begins clozapine therapy after several other antipsychotic agents fail to relieve psychotic symptoms. The nurse instructs the client to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? hepatitis infection granulocytopenia systemic dermatitis
granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions to clozapine thera
A client is taking lithium carbonate. The client asks for explanations of why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. Which statement, if made by the client, indicates to the nurse that the teaching about lithium toxicity has been effective? "There may be too much medication in my bloodstream." "This blood test tells the doctor if the medication is effective." "I should get my blood checked if I don't feel well." "Blood tests will prevent common side effects of taking the medication."
"There may be too much medication in my bloodstream." Lithium has a very narrow range between the therapeutic range and the toxic level. Toxicity describes the systemic effects of the medication when there is an excess of medication in the bloodstream. The level at which the medication is most effective (therapeutic level) is the desired state of having the correct amount of medication in the bloodstream. Having a lithium level drawn will not prevent common side effects. The client should still get blood level drawn even if they feel well and are not having side effects. A therapeutic level is more likely to have positive effects on bipolar disorder. The level is individualized for each client, and effectiveness should be determined by penetrance of symptoms
Clozapine has the potentially fatal side effect of _____________________(failure of the bone marrow to produce adequate white blood cells). This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately but can occur as long as 18 to 24 weeks after the initiation of therapy.
Agranulocytosis
Which tricyclic may cause extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome. It can create tolerance in 1 to 3 months. It increases appetite and causes weight gain and cravings for sweets.
Amoxapine (Asendin)
Donepezil
Aricept Treatment of dementia: cholinesterase inhibitors/ temporarily slow the progress of dementia
Amoxapine
Asendin Tricyclic Antidepressant
The only nonstimulant drug specifically developed and tested by the U.S. Food and Drug Administration for the treatment of ADHD? Which drug class is it in?
Atomoxetine (Strattera) SNRI antidepressant
The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which symptom would be most responsive to these types of drugs? apathy delusions social withdrawal attention impairment
Delusions Positive symptoms such as delusions, hallucinations, thought disorder, and disorganized speech respond to traditional antipsychotic drugs. The other options belong in a category of negative symptoms, including affective flattening, restricted thought and speech, apathy, anhedonia, asociality, and attention impairment. Negative symptoms are more responsive to the new atypical antipsychotics, such as clozapine, risperidone, and olanzapine.
Venlafaxine What does it block?
Effexor SNRI Atypical Antidepressant Blocks the reuptake of serotonin, norepinephrine, and dopamine (weakly)
Amitriptyline
Elavil Tricyclic Antidepressant
A client who reports consuming 1 qt (1 L) of vodka daily is admitted for alcohol detoxification. The nurse anticipates the need to teach the client about which medication? clozapine thiothixene lorazepam lithium carbonate
Lorazepam The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Benzodiazepines are cross-dependent with alcohol and possess antianxiety and anticonvulsant properties. Both heightened anxiety and seizures are associated with alcohol withdrawal. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs are not used to manage alcohol withdrawal syndrome.
An opioid receptor antagonist often used to treat overdose. It blocks the effects of any opioids that might be ingested, thereby negating the effects of using more opioids. It has also been found to reduce the cravings for alcohol in abstinent clients.
Naltrexone (ReVia, Trexan)
A nurse is caring for a client who recently starting taking haloperidol. Which client assessment would be a priority for nurse follow up? Elevated liver function tests Neck stiffness with head tilt Frequent day naps Dry mouth with nausea
Neck stiffness with head tilt An antipsychotic agent like haloperidol can cause acute dystonic reactions such as muscle spasms in the neck, face, tongue, back, and legs, as well as torticollis. Torticollis is neck stiffness that causes the head to tilt to one side with the chin pointing in the opposite direction. This adverse reaction requires prompt follow up by the nurse as early detection of dystonic reactions can minimize complications. Elevated liver function tests, dry mouth, and nausea are common adverse reactions that require follow up; however, they are not priority. Although haloperidol is one of the least sedating antipsychotics, drowsiness and dizziness are common side effects and usually subside after a few weeks.
Paroxetine
Paxil SSRI
Has been specifically FDA approved to treat delusions and hallucinations that some experience with Parkinson disease
Pimavanserin (Nuplazid)
After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective if the client does not develop which complication? psychosis seizures hypotension hypothermia
Seizures Generalized seizures may occur on the 2nd or 3rd day of withdrawal from barbiturates. Without treatment, the seizures may be fatal. Psychosis is a possibility but is not fatal and will not be prevented by the pentobarbital sodium regimen. Orthostatic hypotension is possible but is unlikely to be fatal; it is also not treatable by the pentobarbital sodium regimen. Hyperthermia, rather than hypothermia, occurs during withdrawal.
An anticonvulsant used for simple absence and mixed seizures, migraine prophylaxis, and mania. The mechanism of action is unclear. Therapeutic levels are monitored periodically to remain at 50 to 125 µg/mL, as are baseline and ongoing liver function tests, including serum ammonia levels and platelet and bleeding times.
Valproic acid (Depakote), also known as divalproex sodium or sodium valproate
Bupropion What does it block? What else is its marketed use for?
Wellbutrin Atypical Antidepressant Modestly inhibits the reuptake of norepinephrine, weakly inhibits the reuptake of dopamine, and has no effects on serotonin. Marketed as Zyban for smoking cessation.
The nurse should suspect that the client taking disulfiram has ingested alcohol when the client exhibits which symptom? sore throat and muscle aches nausea and flushing of the face and neck fever and muscle soreness bradycardia and vertigo
nausea and flushing of the face and neck The client who drinks alcohol while taking disulfiram experiences sweating, flushing of the neck and face, tachycardia, hypotension, a throbbing headache, nausea and vomiting, palpitations, dyspnea, tremor, and weakness.
A client has a history of schizophrenia. Because of a history of noncompliance with antipsychotic therapy, the client will receive fluphenazine decanoate injections every 4 weeks. Before discharge, what should the nurse include in the teaching plan? asking the physician for droperidol to control any extrapyramidal symptoms that occur sitting up for a few minutes before standing to minimize orthostatic hypotension notifying the physician if the client's thoughts do not normalize within 1 week expecting transient symptoms of tardive dyskinesia to occur
sitting up for a few minutes before standing to minimize orthostatic hypotension The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may not become evident for several weeks. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately.
A client admitted for alcohol detoxification is taking disulfiram. The nurse should instruct the client to avoid ingestion of which foods and/or liquids? Select all that apply. aged cheese beer communal wine at church chocolates cough syrup
beer communal wine at church cough syrup The client who is taking disulfiram is advised to avoid all forms of alcohol including beer, communal wine at church, and cough syrup; these can trigger a serious physical reaction. Aged cheeses and chocolate are to be avoided by the client taking monoamine oxidase inhibitors.
Which statement by a client taking trazodone as prescribed by the health care provider indicates to the nurse that further teaching about the medication is needed? "I'll continue to take my medication after a light snack." "Taking trazodone at night will help me to sleep." "My depression will be gone in about 5 to 7 days." "I won't drink alcohol while taking trazodone."
"My depression will be gone in about 5 to 7 days." Symptom relief can occur during the first week of therapy, with optimal effects possible within 2 weeks. For some clients, 2 to 4 weeks is needed for optimal effects. The client's statement that the depression will be gone in 5 to 7 days indicates to the nurse that clarification and further teaching is needed. Trazodone should be taken after a meal or light snack to enhance its absorption. Trazodone can cause drowsiness, and therefore the major portion of the drug should be taken at bedtime. The depressant effects of central nervous system depressants and alcohol may be potentiated by this drug.
A client was admitted to the behavioral health unit with a diagnosis of severe depression. The client was started on bupropion. Forty-eight hours after initiating the drug therapy, the client has recovered from depression, is laughing, singing, and dancing in the hallway and in the sitting room. How should the nurse interpret this behavior? The medication is therapeutic. The client is acting this way so that they can be discharged. The client is most likely bipolar rather than depressed, and the healthcare provider should be notified of the behavior. These are unusual side effects of the medication.
The client is most likely bipolar rather than depressed, and the healthcare provider should be notified of the behavior. This behavior is often seen in clients who are bipolar when placed on an antidepressant. A mood stabilizer, such as lithium or lamotrigine, is needed to balance emotional states. The medication has affected the depression, but the client is bipolar and needs a mood stabilizer instead. These side effects occur in a person who is bipolar rather than someone suffering from depression.
A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug? Disulfiram decreases the need for alcohol. Disulfiram acts to deter alcohol consumption. Disulfiram improves the alcoholic's ability to drink limited amounts of alcohol. Disulfiram creates a nerve block so that the effects of alcohol are not felt.
Disulfiram acts to deter alcohol consumption. Disulfiram helps curb the impulsiveness of the problem drinker because disulfiram blocks the breakdown of alcohol in the blood, which produces marked discomfort, such as throbbing headache, flushing, and nausea and vomiting. Disulfiram does not decrease cravings for alcohol. No substance can improve the alcoholic's ability to drink moderately. Disulfiram does not block the effects of alcohol, unlike naloxone, which blocks the effects of opioids and can be helpful in the treatment of opioid addicts.
The health care provider is preparing a plan of care for a client with borderline personality disorder. Which medication would the nurse anticipate for this client? Monoamine oxidase inhibitors (MAOIs) work best because the effects are felt very quickly. Selective serotonin reuptake inhibitors (SSRIs), along with an atypical antipsychotic, are used to treat mood instability and impulsivity. Antipsychotics, along with an antidepressant, will treat illusions, ideas of reference, paranoid thinking, anxiety, and hostility in clients. Anxiolytics will reduce the anxiety and cognitive distortions that frequently occur in these clients.
Selective serotonin reuptake inhibitors (SSRIs), along with an atypical antipsychotic, are used to treat mood instability and impulsivity. Selective serotonin reuptake inhibitors and atypical antipsychotics are used to treat dysphoria, mood instability, and impulsivity in clients with borderline personality disorder. This is the best choice of medications for a client with borderline personality disorder. Monoamine oxidase inhibitors have food restrictions, and clients with borderline personality disorder would not comply with such restrictions. Antipsychotics are prescribed for psychotic behaviors such as illusions, ideas of reference, and paranoid thinking. Anxiolytics may be prescribed for clients with borderline personality disorder, but these medications are limited to addressing anxiety. Clients with borderline personality disorder experience symptoms other than anxiety
The nurse is reviewing laboratory values of a client receiving clozapine. Which laboratory value should the nurse report to the healthcare provider (HCP)? WBC of 3,500/µL (3.5 X 109/L) hemoglobin of 8.2 g/dL (82 g/L) sodium level of 136 mEq/L (136 mmol/L) hyaline casts in the urinalysis
WBC of 3,500/µL (3.5 X 109/L) A low WBC may indicate the development of agranulocytosis, a serious life threatening side-effect of clozapine, and should be reported immediately. While a hemoglobin of 8.2 mg/dL (8.2 g/L) is low, it is not life threatening. The sodium level of 136 mEq/L (136 mmol/L) is normal. Hyaline cast are usually caused by dehydration and indicate the need for more fluids.
Client/family education for antipsychotics
•Drink sugar-free fluids and eat sugar-free hard candy to ease the anticholinergic effects of dry mouth. •Avoid high calorie beverages/candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. •Constipation can be prevented or relieved by increasing intake of water and bulk-forming foods in the diet and by exercising. •Stool softeners are permissible, but laxatives should be avoided. •Use sunscreen to prevent burning. Avoid long periods of time in the sun, and wear protective clothing. •Rising slowly from a lying or sitting position prevents falls from orthostatic hypotension or dizziness due to a drop in blood pressure. •Avoid driving a car or performing other potentially dangerous activities until your response time and reflexes seem normal.
Clozapine
Clozaril Atypical (2nd generation) Antipsychotic
The nurse is caring for a client taking risperidone 2 mg daily. It is most important for the nurse to follow up on which client statement? "I take my medication every morning before breakfast." "I'm constantly sick and feel like I always have a fever." "I've been exercising regularly and lost 5 pounds." "Sometimes I get dizzy if I stand up quickly."
"I'm constantly sick and feel like I always have a fever." A major adverse reaction of risperidone is agranulocytosis. Therefore, it is a priority for the nurse to follow up if the client reports constantly being sick. Risperidone can be given without regard to meals; taking it at the same time every day is encouraged. Clients are encouraged to exercise regularly; the nurse should monitor the client taking risperidone for weight gain. Orthostatic hypotension is a common side effect of risperidone, and the nurse should follow up; however, the priority concern is agranulocytosis. Additionally, the client indicates experiencing dizziness "sometimes" but the feeling sick "constantly."
Clozapine therapy has been initiated for a client with schizophrenia who has been unresponsive to other antipsychotics. The client states, "Why do I have to have a blood test every week?" Which response by the nurse would be most appropriate? "Weekly blood tests are necessary to determine safe dosage and to monitor the effect of the medication on the blood." "Weekly blood tests are done so that you can receive another week's supply of the medication." "Your health care provider (HCP) will want to know how well you're progressing with the medication therapy." "Everyone taking clozapine has to go through the same procedure because it's required by the drug company."
"Weekly blood tests are necessary to determine safe dosage and to monitor the effect of the medication on the blood." The client needs specific information about the effects of the drug, specifically that the drug can cause agranulocytosis. The statement about weekly blood tests to determine safe dosage and monitoring for effects on the blood gives the client specific information to ensure follow-up with the required protocol for clozapine therapy. Lack of accurate knowledge can lead to noncompliance with necessary follow-up procedures and noncompliance with medication. The supply of medication is not dependent on blood testing. Telling the client that the health care provider (HCP) wants to know the progress does not provide specific information for this client. The blood tests are not required by the drug company.
The nurse is about to administer lithium carbonate to a client with bipolar disorder in a mania state. What is the nurse's action after assessing the client's lithium level to be 1.0 mEq/L (mmol/L)? Notify the healthcare provider. Hold the lithium carbonate. Administer the lithium carbonate. Repeat the lithium level.
Administer the lithium carbonate. To treat acute mania, the client's serum lithium level should be between 0.6 and 1.2 mEq/L (mmol/L). The serum lithium level shouldn't exceed 2 mEq/L (mmol/L). The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy. The nurse must also keep in mind that even a normal lithium level can become toxic. Notifying the healthcare provider of the normal level with a client in mania is not appropriate. There are no signs and symptoms of toxicity, so the medication should not be held. There is no reason to repeat the level.
A client whose symptoms of schizophrenia are under control with olanzapine, and who is functioning at home and in part-time employment, reports being very concerned about gaining 20 lb (9.1-kg) since starting the medication 6 months ago. What should the nurse do? Suggest that the client talk to the health care provider about changing to another antipsychotic. Advise the client to decrease the dosage by one-half. Tell the client not to worry, because the weight gain will stop. Discuss nutrition, daily diet, and exercise with the client.
Discuss nutrition, daily diet, and exercise with the client. The nurse should discuss nutrition, daily diet, and exercise with the client concerned about weight gain while taking olanzapine. Weight gain is common with this drug therapy. The client would benefit from nutrition and exercise teaching, and the nurse should provide the client with an initial course of action. Suggesting that the client talk with the health care provider about changing to another antipsychotic may not be in the client's best interest. Olanzapine is keeping the symptoms of illness under control, and the client is able to function at home and on the job. Advising the client to cut the dose in half may lead to decompensation and is outside the nurse's scope of practice. Telling the client not to worry because the weight gain will stop minimizes the client's concern. Also, additional weight gain is possible
A nurse is caring for a client admitted with arching of the back, extension and rotation of the neck, and slow involuntary contractions of the arms and neck. After review of the client's medication list, the nurse would be correct in associating these symptoms with which medication? benztropine pantoprazole propranolol haloperidol
Haloperidol (Haldol) Slow, involuntary contractions of the arms and neck, arching of the back, and extension and rotation of the neck are signs of dystonia. Dystonia is a common adverse effect of antipsychotic medications such as haloperidol. Benztropine is an antiparkinsonian drug, pantoprazole is an antiulcer medication, and propranolol is an antihypertensive.
After 10 days of lithium therapy, the client's lithium level is 1.0. How does the nurse interpret this value? a laboratory error an anticipated therapeutic blood level of the drug an atypical client response to the drug a toxic level
an anticipated therapeutic blood level of the drug The therapeutic blood level range for lithium is between 0.6 and 1.2 for adults. A level of 1.0 can be anticipated after 10 days of treatment. Lithium toxicity occurs at levels above 1.5.While laboratory error can occur, that possibility would be more plausible if the level were extremely high or low.An atypical response would be manifested as an unusual physical or psychological response, not through blood levels.
A client with schizophrenia who receives fluphenazine develops pseudoparkinsonism and akinesia. What drug should the nurse administer as ordered to minimize this client's extrapyramidal symptoms? benztropine dantrolene clonazepam diazepam
benztropine Benztropine is an anticholinergic administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine, is administered to reduce anxiety
A client on a psychiatric care unit has muscle spasms in the neck and stiffness in other muscles, and the eyes are rolling upward. The client had two PRN doses of haloperidol in the last 6 hours. Of the drugs that have been prescribed for the client as needed (see chart), which drug should the nurse administer? lorazepam amantadine diphenhydramine benztropine
benztropine Dystonic adverse effects of haloperidol, especially oculogyric crises, are painful and frightening. IM benztropine is the fastest and most effective drug for managing dystonia. Lorazepam is an antianxiety medication and is not effective for treatment of dystonia. Although amantadine and diphenhydramine can be used for extrapyramidal symptoms, oral medications do not work as quickly, and amantadine may worsen psychotic symptom
A physician orders naltrexone for a client participating in an outpatient drug and alcohol rehabilitation program. Which action reflects the nurse's knowledge about this medication and the client's informed consent? writing down medication information for the client telling this client about the problems other clients have had with the drug talking about how this drug prevents aggressive behavior discussing the health risks related to this medication
discussing the health risks related to this medication A nurse is mindful of the principal of informed consent when she discusses medication-related health risks with a client. The client has the right to adequate information about the drug as it relates to the treatment of their condition. Giving written information about medication to a client is an appropriate intervention; however, this action does not indicate whether the client has given informed consent. Although informed consent in treatment includes discussing a medication's advantages and disadvantages, it is not ethical for the nurse to discuss problems other clients experienced when using the drug. Naltrexone does not prevent aggressive behavior.
When caring for a client receiving haloperidol, the nurse should assess for which problem? orthostasis extrapyramidal symptoms hypersalivation oversedation
extrapyramidal symptoms Haloperidol, a traditional antipsychotic drug, is associated with a high rate of extrapyramidal adverse effects.At therapeutic dosages, haloperidol is associated with a low incidence of sedation and orthostasis.Hypersalivation is an adverse effect of clozapine.
When collaborating with the health care provider (HCP) to develop a the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments? antianxiety medications, such as buspirone, and home schooling antidepressant medications, such as imipramine, and family therapy anticonvulsant medications, such as carbamazepine, and monthly blood levels psychostimulant medications, such as methylphenidate, and behavior modification
psychostimulant medications, such as methylphenidate, and behavior modification ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline, along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are indicated for major depressive disorders and must be used with extreme caution in children because they carry the risk of suicidal thinking. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.
Which SSRI produces a slightly higher rate of mild agitation and weight loss but less somnolence. It has a half-life of more than 7 days, which differs from the 25-hour half-life of other SSRIs.
Fluoxetine (Prozac)
What have been most effective in treating akathisia?
Propanolol (Inderal) *Benzos have provided some success
Fluoxetine
Prozac SSRI
Risperidone
Risperdal Atypical (2nd generation) Antipsychotic
The most frequently prescribed category of antidepressants
SSRI
Best antidepressant class to prescribe to elderly? Why?
SSRIs. Their action is specific to serotonin reuptake inhibition; these drugs produce few sedating, anticholinergic, and cardiovascular side effects, which make them safer for use in older adults.
Which drug prevents or treats Wernicke-Korsakoff syndrome in alcoholism
Thiamine (Vit B12)
Chlorpromazine
Thorazine Typical (1st generation) Antipsychotic
Imipramine
Tofranil Tricyclic Antidepressant
Topiramte
Topamax Anticonvulsants Used as Mood Stabilizers
After a period of unsuccessful treatment with amitriptyline, a woman diagnosed with depression is switched to tranylcypromine. Which statement by the client indicates the client understands the side effects of tranylcypromine? "I need to increase my intake of sodium." "I must refrain from strenuous exercise." "I must refrain from eating aged cheese or yeast products." "I should decrease my intake of foods containing sugar."
"I must refrain from eating aged cheese or yeast products." Cheese and yeast products contain tyramine, which the client should avoid to prevent a negative interaction with tranylcypromine, a monoamine oxidase (MAO) inhibitor. Sodium will not interact with tranylcypromine, and neither exercise nor sugar needs to be limited.
This may be prescribed for clients recovering from alcohol abuse or dependence to help reduce cravings for alcohol and decrease the physical and emotional discomfort that occurs especially in the first few months of recovery. These include sweating, anxiety, and sleep disturbances. Who cannot take this drug?
Acamprosate (Campral) Individuals with renal impairment cannot take this drug
A combination drug used for opiate maintenance and to decrease opiate cravings.
Buprenorphine/Naloxone (Suboxone)
Anticonvulsant mood stabilizer used for grand mal and temporal lobe epilepsy as well as for trigeminal neuralgia, and was the first anticonvulsant found to have mood-stabilizing properties The threat of agranulocytosis was of great concern. Clients taking this need to have drug serum levels checked regularly to monitor for toxicity and to determine whether the drug has reached therapeutic levels, which are generally 4 to 12 µg/mL
Carbamazepine (Tegretol)
Citalopram
Celexa SSRI
How often must labs be done for a client taking Clozapine?
Clients taking this antipsychotic must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter. Clozapine is dispensed every 7 or 14 days only, and evidence of a white blood cell count above 3,500 cells/mm3 is required before a refill is furnished.
This atypical antipsychotic drug, has not been found to cause tardive dyskinesia, so it is often recommended for clients who have experienced this side effect while taking conventional antipsychotic drugs.
Clozapine (Clozaril)
If a client taking disulfiram drinks alcohol, what are some of the severe adverse reaction that can occur?
Flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result *They need to avoid ANYTHING that contains alcohol, (mouthwashes, perfumes, aftershave, vinegar, vanilla, cough syrup, mouthwash , etc..)
Ziprasidone
Geodon Atypical (2nd generation) Antipsychotic
Haloperidol
Haldol Typical (1st generation) Antipsychotic
Lamotrigine
Lamictcal Anticonvulsants Used as Mood Stabilizers
Which drug class is often used in conjunction with mood stabilizers or antidepressants to treat bipolar disorder. They prevent a "switch to mania" when persons are treated for a depressed episode and manage psychotic symptoms that are associated with mania in some people
Second-generation antipsychotic medications Ziprasidone (Geodon), lurasidone (Latuda), and quetiapine (Seroquel) are most effective.
Quetiapine
Seroquel Atypical (2nd generation) Antipsychotic
Occurs when there is an inadequate washout period between taking MAOIs and SSRIs or when MAOIs are combined with meperidine
Serotonin Syndrome
Doxepin
Sinequan Tricyclic Antidepressant
Who are tricyclic antidepressants contraindicated in?
Tricyclic antidepressants are contraindicated in severe impairment of liver function and in myocardial infarction (acute recovery phase). They cannot be given concurrently with MAOIs Because of their anticholinergic side effects, tricyclic antidepressants must be used cautiously in clients who have glaucoma, benign prostatic hypertrophy, urinary retention or obstruction, diabetes mellitus, hyperthyroidism, cardiovascular disease, renal impairment, or respiratory disorders
Which drug class relieves symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variations (cranky in the morning and better in the evening). Other indications include panic disorder, obsessive-compulsive disorder, and eating disorders.
Tricyclics
A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible symptoms cause? drinking alcohol with the clonazepam developing tolerance to the clonazepam stopping the clonazepam suddenly increasing the clonazepam dose independently
stopping the clonazepam suddenly The nurse should first confirm that the client has stopped taking the clonazepam because the client is reporting symptoms of benzodiazepine withdrawal from stopping the clonazepam abruptly. The client would report symptoms of being sedated if the client took alcohol with the clonazepam. Tolerance symptoms would be increased anxiety, not these physical symptoms. The client symptoms are consistent with clonazepam withdrawal, not excess; thus, asking about increased use is not relevant.
