NU141- Chapter 21 Antidepressant Agents

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

A client with depression began taking fluoxetine 10 days ago. The nurse should monitor the client for what adverse effect?

Urinary incontinence

What should the nurse's pre-administration assessment for a client receiving an antidepressant include? (Select all that apply.)

Vital signs assessment Presence of suicidal ideation Complete medical history Weight Mental status assessment

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

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

Depression is a common affective disorder that strikes many people. In assessing a client who might be suffering from depression, the nurse would expect to find which conditions? a. Lack of energy b. Hyperactivity c. Sleep disturbances d. Libido problems e. Confusion f. Decreased reflexes

a. Lack of energy c. Sleep disturbances d. Libido problems

A client reports that he thinks he is taking an antidepressant, but he is not sure. In reviewing his medication history, which drugs would be considered antidepressants? a. Tetracyclic drugs b. Cholinergics c. SSRIs d. MAOIs e. Angiotensin II receptor blockers f. Benzodiazepine

a. Tetracyclic drugs c. SSRIs d. MAOIs

Depression

affective disorder in which a person experiences sadness that is much more severe and longer lasting than is warranted by the event that seems to have precipitated it, with a more intense mood; the condition may not even be traceable to a specific event or stressor

Which food should the client avoid eating when prescribed phenelzine sulfate?

aged Swiss cheese and bratwurst

Tyramine

an amine found in food that causes vasoconstriction and raises blood pressure; ingesting foods high in tyramine while taking an MAOI poses the risk of a severe hypertensive crisis

A client recently started on fluoxetine for the treatment of depression asks the nurse ask if there are any side effects to be aware of. The nurse should inform the client to be alert for what adverse effect? Select all that apply.

anxiety insomnia nervousness

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.

You might question an order for a MAOI as a first step in the treatment of depression remembering that these drugs are reserved for use in cases in which there has been no response to other agents because MAOIs a. can cause hair loss. b. are associated with potentially serious drug-food interactions. c. are mostly recommended for use in surgical patients. d. are more expensive than other agents.

b. are associated with potentially serious drug-food interactions

A client with a history of coronary artery disease has been diagnosed with depression and has been prescribed escitalopram 10 mg PO daily. The client's current drug regimen includes clopidogrel. The nurse recognizes that this combination creates a need to monitor the client closely for signs of:

bleeding.

Depression is an affective disorder that is a. always precipitated by a specific event. b. most common in patients with head injuries. c. characterized by overwhelming sadness, despair, and hopelessness. d. very evident and easy to diagnose in the clinical setting.

c. characterized by overwhelming sadness, despair, and hopelessness

The biogenic amine theory of depression states that depression is a result of a. an unpleasant childhood. b. gamma-aminobutyric acid (GABA) inhibition. c. deficiency of NE, dopamine, or 5HT in key areas of the brain. d. blockages within the limbic system, which controls emotions and affect.

c. deficiency of NE, dopamine ,or 5HT in key areas of the brain

When teaching a patient receiving TCAs, it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of a. increased libido and increased appetite. b. polyuria and polydipsia. c. urinary retention, arrhythmias, and constipation. d. hearing changes, cataracts, and nightmares.

c. urinary retention, arrhythmias, and constipation

Your patient is being treated for depression and is started on a regimen of fluoxetine (Prozac). She calls you 10 days after the drug therapy has started to report that nothing has changed and she wants to try a different drug. You should a. tell her to try sertraline (Zoloft) because some patients respond to one SSRI and not another. b. ask her to try a few days without the drug to see whether there is any difference. c. add an MAOI to her drug regimen to get an increased antidepressant effect. d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect.

d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect

Venlafaxine (Effexor) is an antidepressant that might be very effective for use in patients who a. are being treated effectively with a SSRI. b. can tolerate multiple side effects. c. are reliable at taking multiple daily dosings. d. have not responded to other antidepressants and would benefit from once-a-day dosing.

d. have not responded to other antidepressant and would benefit from once-a-day dosing

Adverse effects may limit the usefulness of TCAs with some patients. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include a. always administering the drug when the patient has an empty stomach. b. reminding the patient not to void before taking the drug. c. increasing the dose to override the adverse effects. d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects.

d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects

Which of the following medications is NOT indicated for obsessive-compulsive disorder, depression, and panic disorder? a. citalopram (Celexa) b. paroxetine (Paxil) c. fluvoxamine (Luvox) d. vortioxetine (Brintellix)

d. vortioxetine (Brintellix)

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

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.

Tricyclic antidepressants (TCAs)

drug that blocks the reuptake of norepinephrine and serotonin; relieves depression and has anticholinergic and sedative effects

Serotonin norepinephrine inhibitor (SNRI)

drug that increases both serotonin and norepinephrine concentrations in synaptic cleft; relieves depression with varying serotonergic or noradrenergic activity

Monoamine oxidase inhibitor (MAOI)

drug that prevents the enzyme monoamine oxidase from breaking down norepinephrine (NE), serotonin (5HT), and dopamine (DA), leading to increased neurotransmitter levels in the synaptic cleft; relieves depression and also causes sympathomimetic effects

Selective serotonin reuptake inhibitor (SSRI)

drug that specifically blocks the reuptake of serotonin and increases its concentration in the synaptic cleft; relieves depression and is not associated with anticholinergic or sympathomimetic adverse effects

A client being treated for schizophrenia with a traditional antipsychotic medication is taking an herbal preparation for arthritis. The client buys the herbal remedy at the local retail store. Which herbal medication should the nurse caution the client about taking for arthritic pain?

evening primrose

Affect

feeling that a person experiences when he or she responds emotionally to the environment

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

imipramine

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

increased alanine aminotransferase level (ALT)

Biogenic amine

one of the neurotransmitters norepinephrine, serotonin, or dopamine; it is thought that a deficiency of these substances in key areas of the brain results in depression

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.

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

orthostatic hypotension

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

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

A black box warning alerts health care providers to risks in young adults 18 to 24 years of age when taking antidepressant medications. Which symptoms of concern should be included?

statements or resignation and futility and a desire to die

The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply.

temperature blood pressure level of consciousness

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

When a client is started on an antidepressant, it is important for the nurse to explain to the client that it may take time to see a change in mood. How long can it take for the client to see the beneficial effects of an antidepressant?

4 weeks

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

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

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

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

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

A client tells the nurse that the client recently started on SSRIs for the treatment of depression. The client asks if there are any side effects to the SSRIs. The nurse should inform the client to watch for the following adverse effects:

A high incidence of nausea, diarrhea, and weight loss, as well as anxiety, nervousness, and insomnia.

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

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."

After teaching a client who is to receive transdermal selegiline, which client statement would indicate to the nurse that the client has understood the instructions?

"I can apply a new patch to my upper arm, thigh, or torso."

An adult client, diagnosed with depression several weeks ago, has begun taking citalopram 10 days ago. The client has told the nurse of the intent to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the client's statement?

"I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."

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."

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."

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."

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."

c A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?

"There may be an increased risk of suicide while taking this drug."

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."

A client is at the clinic for a follow-up appointment related to treatment for depression. The client had began taking fluoxetine 2 weeks ago. The client states, "This medication must not be working, because I don't feel better at all." What would be the nurse's best response?

"You may have to take this drug for a few more days before you feel its effects."

A 12 year-old client with depression has been prescribed trazodone 1.5 mg/kg/day in three divided doses. The client weighs 110 lbs. How many 50-mg tablets should the nurse administer for each dose?

0.5

The psychiatric-mental health nurse is overseeing care of several clients who are being treated with selective serotonin reuptake inhibitors. Which client should the nurse monitor most closely for adverse effects?

A severely depressed 14-year-old client who is receiving inpatient care

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

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

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?

Asking the client to sit on the side of the bed for 1 minute before getting up

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

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

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 client has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which food should the client be instructed to avoid eating?

Cheddar cheese and bratwurst

A client taking phenelzine (Nardil) is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department. This client might be experiencing a hypertensive crisis. As the nurse in the ED, what other symptoms might the client experience if they are having a hypertensive crisis? (Select all that apply.)

Chest pain Tachycardia Stiff neck

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

Clomipramine

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

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.

A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?

Dry mouth

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

Extreme sadness

A client is admitted to the nursing unit with OCD. What drug has been found to be effective for treating OCD?

Fluvoxamine

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

Fluvoxamine

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

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

The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI?

Hypoglycemia

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

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

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.

The emergence of psychotropic medications has given us the ability to target specific actions in the brain as treatment for mental illness. What psychotropic medication is an MAO inhibitor?

Nardil

A client is prescribed a tricyclic antidepressant. The nurse would anticipate administering this drug by which route?

Oral

An elderly patient is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

Which adverse effects would the nurse instruct a client to report to the health care provider immediately when taking trazodone?

Painful continued erection

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

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

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

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.

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.

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

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

When assessing a client's medication history, the use of which herb would alert the nurse to the potential for adverse reactions when taken with antidepressants?

St. John's wort

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.

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.

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.

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.

The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?

1.8 mEq/L

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

14 days

A nurse is preparing a presentation about the use of antidepressants in children and adolescents. What would the nurse need to keep in mind?

The smallest amount of drug that is feasible should be dispensed.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs.