midterm

Carbamazepine (Tegretol) Use

Acute mania

2 most serious SE of clozaril

Agranulocytosis convulsions

The patient presents with subjective feelings of anxiety and restlessness and objective signs of pacing, rocking, and an inability to sit or stand in one place for extended periods of time. Which one of the following diagnoses do these symptoms suggest?

Akathisia

EPS symptoms

Akathisia Acute dystonia Pseudoparkinsonism Tardive dyskinesia

Which of the following groups of side effects are associated with meds used to treat EPS (extrapyramidal symptoms)?

Blurred vision, dry mouth, constipation, and urinary retention

A nurse can anticipate anticholinergic side effects are likely when a patient takes a. lithium. b. buspirone. c. imipramine. d. risperidone.

C Imipramine (Tofranil) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.

A patient is hospitalized for severe major depressive disorder. Of the medications listed below, the nurse can expect to provide the patient with teaching about a. chlordiazepoxide .b. clozapine. c. sertraline. d. tacrine.

C Sertraline (Zoloft) is an selective serotonin reuptake inhibitor (SSRI). This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimer's disease.

Lithium use?

Mood stabilizer in bipolar disorder can be antimanic

Which one of the following is considered a life threatening side effect of psychopharmacological medication?

NMS

2 serious and potentially irreversible Side effects of antipsychotics

NMS Tardive dyskinesia

The psych tech student is teaching about the symptoms of moderate Lithium toxicity. Which would be incorrect to include in their presentation?

Seizures

2 symptoms that necessitate discontinuing a client on MAOI

Seizures Servere cns depression

Toxic side effect of lithium

Seizures oliguria coma

Medication to be used in place of lithium to treat mania?

Valporic acid and carbazapene

A client taking lithium develops coarsening of tremors, vomiting, drowsiness, dysarthria, and diarrhea. Which one of the following best describes these symptoms?

Prodromal symptoms of toxicity or moderate side effects of lithium

serotonin syndrome cognitive effects

confusion, hypomania, hallucinations, agitation, coma

Dietary restriction of maoi

cured meat cured cheese fish sauce soy sauce etc...

buspar use

anti anxiety without strong sedative hypnotic affect (NOT A CNA DEPPRESSANT)

2 reason not to give ssri

anticholinergic effects maoi contradiction

4 se of tar dive dyskinesia

lip smacking teeth grinding tongue protusion sucking movement

annoying but not lifethrrating se of clozaril

drooling night urination

Benzodiazepines

drugs that lower anxiety and reduce stress do not take with alcohol good for alcohol withdrawal

acetylcholine function

enables muscle action, learning, and memory and mood

FRONTOL LOBE

entire thought process

3 SE of NMS

fever rigidity hyperreflexia

The symptoms associated with Neuroleptic Malignant Syndrome include which one of the following?

fever, muscle rigidity, altered level of consciousness, tachycardia, and labile hypertension

Memory loss in Alzheimer's is attributed to?

insufficient acetylcholine

what is clozaril used for

refractory schizophrenia

cerebellum

regulates voluntary movements, skeletal movement and equilibrium

Morphine sulphate you must monitor

respirations

4 categories of antidepressent

ssri snri maoi Tricyclic

Atomoxetine is a non-stimulant medication used in the treatment of some conditions associated with IDD clients. Which of the following side effects of this medication are important to be aware of?

suicidal ideation

nonselective inhibition of ne and serotonin

tca

First line antidepressants

SSRIs, SNRIs, NassA

schizophrenia is associated with excess transmission of ...?

dopamine

cautioned when taking ssri can cause

insomnia anxiety nervousness

A student is preparing to do patient teaching about Dextroamphetamine. Which of the following should the student include as a rationale for using this medication?

"It is similar to Ritalin; however, its action lasts twice as long"

Normal lithium levels

0.6-1.2

2 dietary restriction for lithium

2.5-3 liters of water sodium intake a(constant)

Atamoxetine us used to patients...(Age)

6 and up

Guanfacine/ Clonidine is used in patents ....(Age)

6-17

The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the A: parasympathetic nervous system. B: sympathetic nervous system. C: reticular activating system. D: medulla oblongata.

A Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.

The nurse administers a medication that potentiates the action of ã-aminobutyric acid (GABA). Which effect would be expected? A: Reduced anxiety B: Improved memory C: More organized thinking D: Fewer sensory perceptual alterations

A Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations. See relationship to audience response question.

A drug causes muscarinic receptor blockade. The nurse will assess the patient for A:dry mouth. b. gynecomastia. c. pseudoparkinsonism. d. orthostatic hypotension.

A Muscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with á1 antagonism.

An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain? A: H1. B: 5 HT2 c: Acetylcholine d: GABA

A H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patient's weight.

A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. With which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance? The patient receiving a. lithium. b. clozapine. c. fluoxetine. d. venlafaxine. .

A Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety.

The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm cubed . Select the nurse's best action. A: Report the results to the health care provider immediately. B: Administer the next dose as prescribed. C: Give aspirin and force fluids. D: Repeat the laboratory test.

A These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. (Note: This question requires students to apply previous learning regarding normal and abnormal values of white blood cell counts.)

What is lithium used for?

A mood stabilizer in patients with bipolar disorder.

Mertazepine (Remron) Use?

Antianxiety and antidepressant affects with minimum sexual dysfunction and improved sleep

Mostly minor side effects, i.e. drowsiness, weakness, G.I distress, skin rash, and slurred speech are attributed to which one of the following categories of meds?

Antidepressants medications

what group of people taking carbfazipine have a higher risk of SJS and require genetic testing for HLA-B Allele?

Asian decent

A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer's disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first? A:Skull x-rays B:CT scan C:PET D: Single photon emission computed tomography (SPECT)

B CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider. PET and SPECT show brain activity rather than structure and may occur later. See relationship to audience response question.

Which instruction has priority when teaching a patient about clozapine? A: "Avoid unprotected sex." B: "Report sore throat and fever immediately." C: "Reduce foods high in polyunsaturated fats." D: . "Use over-the-counter preparations for rashes."

B Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. The other options are not relevant to clozapine.

The therapeutic action of neurotransmitter inhibitors that block reuptake cause? A: decreased concentration of the blocked neurotransmitter in the central nervous system. B: increased concentration of the blocked neurotransmitter in the synaptic gap. C:destruction of receptor sites specific to the blocked neurotransmitter. D: limbic system stimulation.

B If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.

A nurse would anticipate that treatment for a patient with memory difficulties might include medications designed to A: inhibit GABA. B: prevent destruction of acetylcholine. C: reduce serotonin metabolism. D: increase dopamine activity.

B Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinson'sdisease rather than improving memory.

A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop? A: Anticholinergic effects B: Dopamine-blocking effects C: Endocrine-stimulating effects D: Ability to stimulate spinal nerves

B Medication that blocks dopamine often produces disturbances of movement, such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.

The nurse prepares to assess a patient diagnosed with major depressive disorder for disturbances in circadian rhythms. Which question should the nurse ask this patient? A: "Have you ever seen or heard things that others do not?" B: "What are your worst and best times of the day?" C: "How would you describe your thinking?" D: "Do you think your memory is failing?"

B Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.

A drug blocks the attachment of norepinephrine to 1 receptors. The patient may experience a. hypertensive crisis. b. orthostatic hypotension. c. severe appetite disturbance. d. an increase in psychotic symptoms.

B Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of 1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach patients ways of minimizing this phenomenon.

A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain? A: Hippocampus B: Frontal lobe C: Cerebellum D: Brainstem

B The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.

The parent of an adolescent diagnosed with schizophrenia asks the nurse, "My child's doctor ordered a PET. What kind of test is that?" Select the nurse's best reply. A: "This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?" B: "PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain." C: "A PET scan passes an electrical current through the brain and shows brain-waveactivity. It can help diagnose seizures." D: "It's a special x-ray that shows structures of the brain and whether there has ever been a brain injury."

B The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean. The correct response is the only option that provides information relevant to PET scans. The distracters describe magnetic resonance image (MRI), computed tomography (CT) scans, and EEG. See relationship to audience response question.

A patient diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? A:Psychostimulants B:Mood stabilizers C:Anticholinergics D:Antidepressants

B The symptoms describe mania, which is effectively treated by mood stabilizers, such as lithium, and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania.

By which mechanism do SSRI medications improve depression? A:Destroying increased amounts of serotonin B: Making more serotonin available at the synaptic gap C:Increasing production of acetylcholine and dopamine D: Blocking muscarinic and á1 norepinephrine receptors

B Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or á1 norepinephrine blockade.

A fearful patient has an increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter? A: GABA B: Norepinephrine C: Acetylcholine D: Histamine

B Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for "fight or flight." GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.

onsider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group? A:Galantamine b. Valproate c. Buspirone d. Tacrine

B The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimer's disease and anxiety.

A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment? A: Write the appointment day, time, and location on a piece of paper and give it to the player. B: Log the appointment day, time, and location into the player's cell phone calendar feature. C: Ask the health care provider to admit the patient to the hospital overnight. D: Verbally inform the patient of the appointment day, time, and location.

B This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has significant role in maintaining memory. Logging the appointment into the player's cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology.

A nurse caring for a patient taking a SSRI will develop outcome criteria related to A:coherent thought processes. b. improvement in depression. c. reduced levels of motor activity. d. decreased extrapyramidal symptoms.

B SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.

Hypothalamus

BASIC drives hunger thirst and sex with higher brain activities, processing sensory Information and regulate sleep cycle

2 meds that treat eps

Benadryl and benztpropine

A nurse instructs a patient taking a drug that inhibits MAO to avoid certain foods and drugs because of the risk of A: cardiac dysrhythmia. B: hypotensive shock. C: hypertensive crisis. D: hypoglycemia.

C Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.

A nurse cares for a group of patients receiving various medications, including haloperidol, carbamazepine, trazodone, and phenalgine. The nurse will order a special diet for the patient who takes a. carbamazepine. b. haloperidol. c. phenelzine. d. trazodone.

C Patients taking phenelzine, an MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis. There are no specific dietary precautions associated with the distracters.

Test used for clozaril

CBC

Two blood test that should be performed when client is taking depakote?

CBC LFT

Moderate side effect of lithium

Coarsening of tremor vomiting poor coordination

A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group? A: Tricyclic antidepressants B: Antipsychotic drugs C: Mood stabilizers D: Benzodiazepines

D Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Mood stabilizers are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.

A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drug's strong dopaminergic effect? A:Chew sugarless gum. B:Increase dietary fiber. C:Arise slowly from bed. D:Report changes in muscle movement.

D Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonism medication can increase the patient's comfort and prevent dystonic reactions. The distracters are related to anticholinergic effects.

A patient's history shows drinking 4 to 6 L of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient? A: Amygdala B: Parietal lobe C: Hippocampus D: Hypothalamus

D The hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vital role in such basic drives as hunger, thirst, and sex. See relationship to audience response question.

An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individual's vital signs is most likely? A: Pulse rate changes from 90 to 72. B: Respiratory rate changes from 22 to 18. C: Complaints of intestinal cramping begin. D: Blood pressure changes from 114/62 to 136/78.

D This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.

A patient tells the nurse, "My doctor prescribed paroxetine for my depression. I assume I'll have side effects like I had when I was taking imipramine." The nurse's reply should be based on the knowledge that paroxetine is a(n) A: selective norepinephrine reuptake inhibitor. B: tricyclic antidepressant. C: monoamine oxidase (MAO) inhibitor. D: SSRI.

D Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension.

A patient asks, "What are neurotransmitters? My doctor said mine are imbalanced." Select the nurse's best response. A:"How do you feel about having imbalanced neurotransmitters?" B:"Neurotransmitters protect us from harmful effects of free radicals." C:"Neurotransmitters are substances we consume that influence memory and mood." D:"Neurotransmitters are natural chemicals that pass messages between brain cells."

D The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patient's question or provide untrue, misleading information.

Transient Side effects of lithium

Dry Mouth polyuria polydipsia fine tremor

In the course of treatment with a psychotropic medication, Sam experiences akathisia, dystonia, and tremors. Which one of the following terms describes these symptoms?

Extrapyramidal symptoms

2 advantages of clozaril

Fewer SE Less EPS

tardive dyskinesia

Grimacing Tongue movements Lip smacking Lip puckering Pursing of the lips Excessive eye blinking Brought on by antipsychotics

brainstem function

Heart rate breathing digestion sleep

Increased glutamate in the hippocampus can lead to ?

Hippocampus atrophy leading to memory impairment

MAOI LT?

Hypertensive crisis seen by... increased bp fever stiffness decreased LOC

SSRI SE?

Inhibit orgasms reflex, apathy, low libido, nausea, vomiting

3 SE of MAOI

Insomnia nausea agitation

3v long acting injectables

Invega sustena haldol deconoate fluphenazine decanoate

Clozaril pros and cons

Less motor SE and less EPS can cause Agranulocytosis and convulsions

Third line of antidepressants

MAOI's (monoamine oxzidase inhibitors)

Trazadone use

MDD in adults and insomnia * can cause priapism ( painfully erection > 4 hours)

2 ADHD drugs used for their paradoxical affects

Methylphenidate (Ritalin) Dextroamphetamine (Adderall)

Valporate use and SE? Lt?

Mixed episodes and rapid cycling tremor weight gain sedation Lt: thrombocytopenia and hepatic failure

A client, John, who is receiving a psychotropic drug experiences tremors, muscular rigidity, mask-like face, shuffling gait, and loss or weakness of motor function (akinesia). The term describing this experience is which one of the following?

Pseudoparkinsonian symptoms

Ziprasidone (Geodon) contraindications

QT interval prolongation recent MI HF

Serotonin syndrome is a form of toxicity that is best characterized by which of the following cluster of symptoms?

Restlessness, confusion, and diaphoresis

NMS signs and symptoms

Rigidity, fever, hyperthermia, loss of consciousness

Drugs to avoid while on MAOI

SSRI TCA

second line antidepressant

TCA

Stereotyped involuntary choreiform movements of the tongue, facial, and neck muscles including sucking, chewing, licking, pursing movements of the tongue and mouth-affect posture and breathing muscles, are symptoms of which one of the following?

Tardive dyskinesia

Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. (Drug movement)

Pharmacodynamics

The study of what the drug does to the body

Which one of the following statements about Prolixin Decanoate and Haldol is true?

They are prepared in a sesame oil base

serotonin syndrome somatic effects

ataxia twitching hyperreflexia rigidity tremor

temporal lobe

auditory and language

antidepressants may be used to stabilize ...

bipolar disorder

how antipsychotic medications work

block dopamine receptors

antidepressant apathy Syndrome

blunting affects loss of motivation loss of intellectual curiosity

Anticholinergic side effects

blurred vision dry mouth constipation urinary retention

Anticholinergics se

blurred vision dry mouth constipation urinary retention

4 signs of eps

bradykinesia, Tardive Dyskinesia, Dystonia, Akathisia

Serotonin syndrome symptoms

diaphoresis confusion muscle jerks

How SSRIs work

increase brain serotonin levels

doxepin use

low dose tricyclic antidepressant used to treat insomnia mainly geriatric pt

Akathisia

motor restlessness

Give one example of non-psychotropic medication used for impulse control?

propranolol

3 se of serotonin syndrome

seizures sweating elevated bp

parietal lobe

sensory information abstract thinking proprioception

serotonin syndrome autonomic effects

shivering, sweating, hyperthermia, hypertension, tachycardia,

why are ssri given in morning

to prevent insomnia

Pseudoparkinsonism

tremor, shuffling gait, drooling, rigidity

Artane use

used in movement disorders

OCCIPITAL LOBE

vision and language formation

first generation antipsychotics

work by blocking dopamine receptors and most effective in positive symptoms of schizophrenia EPS is common Can lead to increased prolactin secretion leading to ... women: amennorea and galacteria men: gynecomasteria and galacteria