Pharm - Chapter 16 - Psychotherapeutic Drugs

Which condition would the nurse suspect that a patient on lithium has been diagnosed with? 1 Bipolar disorder 2 Absence seizures 3 Paranoid schizophrenia 4 Obsessive-compulsive disorder

1 Bipolar disorder Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorder. Therapeutic effects of the mood stabilizer lithium are decreased mania and stabilization of the patient's mood. Lithium is not used to treat absence seizures, paranoid schizophrenia, or obsessive-compulsive disorder.

Which anxiolytic drug promotes agonistic activity at both the serotonin and dopamine receptors? 1 Buspirone 2 Alprazolam 3 Lorazepam 4 Amitriptyline

1 Buspirone Buspirone is an anxiolytic drug, which has agonist activity at both the serotonin and dopamine receptors to exert its antianxiety effect. Alprazolam is a benzodiazepine that is commonly used as an anxiolytic. The drug elicits its effects by increasing the activity of gamma-aminobutyric acid (GABA) receptors that block nerve transmission in the central nervous system. Lorazepam is an intermediate-acting benzodiazepine that increases the activity of the GABA receptors. Amitriptyline is the most commonly used tricyclic antidepressant.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? 1 Increasing the placebo effect 2 Increasing alertness levels in the brain 3 Blocking the reuptake of neurotransmitters at nerve endings 4 Decreasing levels of epinephrine and serotonin at nerve endings

3 Blocking the reuptake of neurotransmitters at nerve endings SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin. These do not increase the placebo effect or increase alertness levels in the brain.

Which class of medication found in the patient's prescription is responsible for constipation and urinary retention in a patient that takes nortriptyline for depression? 1 Diuretics 2 Anxiolytics 3 Anticholinergics 4 Antihypertensives

3 Anticholinergics Nortriptyline is a tricyclic antidepressant. These medications interact with anticholinergics and potentiate the effects by blocking the cholinergic receptors. This can, in turn, lead to constipation and urinary retention. Diuretics cause increased urinary outflow; they do not lead to constipation or urinary retention. Anxiolytics may cause increased sedation and hypnosis in the patient. Antihypertensive drugs may cause hypotension in the patient. Therefore diuretics, anxiolytics, and antihypertensive medications will not cause constipation and urinary retention.

Which class of drugs is administered to treat on-off phenomenon in a patient with Parkinson's disease? 1 Anticholinergic drugs 2 Dopamine modulators 3 Catechol ortho-methyltransferase 4 Indirect-acting dopamine receptor agonists

3 Catechol ortho-methyltransferase Catechol ortho-methyltransferase drugs are useful for treating the on-off phenomenon in Parkinson's disease, which is caused by fluctuations in dopamine concentrations. These drugs inhibit the enzyme catalyzing the breakdown of catecholamines, thereby maintaining uniform concentrations of dopamine. Anticholinergic drugs enhance the dopaminergic effects of the central nervous system, thus reducing the symptoms of Parkinson's disease. They do not affect dopamine concentrations. Dopamine modulators are useful in case of depleted dopamine concentrations. Indirect-acting dopamine receptor agonists bind to the dopaminergic receptors, irrespective of the concentrations of dopamine.

Which food would the nurse instruct a patient to eliminate from the diet when taking carbamazepine? 1 Aged cheeses 2 Milk products 3 Grapefruit juice 4 Carbonated beverages

3 Grapefruit juice Grapefruit and its juice should be avoided in patients taking carbamazepine because it can lead to drug toxicity. Aged cheeses are avoided in patients taking monoamine oxidase inhibitors (MAOIs). Milk products and carbonated beverages should be eliminated in patients taking valproic acid.

Which assessment is appropriate for a patient who has recently been diagnosed with Parkinson's disease and was prescribed tolcapone? 1 Blood pressure 2 Mood 3 Liver function 4 Blood urea nitrogen and creatinine

3 Liver function Tolcapone is a catechol ortho-methyltransferase inhibitor prescribed for the treatment of Parkinson's disease. It should be used with caution in patients with liver failure because it impairs hepatic functioning and worsens the symptoms. In these patients, drug doses should be adjusted and liver function should be monitored. Tolcapone is not associated with changes in blood pressure, bruising, mood fluctuations, or kidney failure, so the nurse would not need to monitor for these conditions in this patient. It is prescribed only in cases in which the patient does not respond to other therapy due to its potential toxicity.

Which type of medication is indicated to help the patient manage withdrawal symptoms while detoxifying from alcohol abuse? 1 Phenothiazine 2 Dibenzazepine 3 Benzisoxazole 4 Benzodiazepine

4 Benzodiazepine A benzodiazepine is indicated in the management of the clinical manifestations of alcohol withdrawal because of their wide range of therapeutic effects. Dibenzazepines, benzisoxazoles, and phenothiazines are antipsychotic agents and are not indicated for alcohol withdrawal.

What does the nurse infer from a patient with increased blood glucose levels, increased blood pressure (BP), and abnormal cholesterol levels? 1 The patient has mania. 2 The patient has dystonia. 3 The patient has dyskinesia. 4 The patient has metabolic syndrome.

4 The patient has metabolic syndrome. Increased blood glucose level, increased BP, and abnormal cholesterol levels are the symptoms of metabolic syndrome. Thus the nurse concludes that the patient has metabolic syndrome. Mania, dystonia, and dyskinesia are not characterized by increased blood pressure and abnormal cholesterol levels. Mania is a condition that involves an expansive emotional state, including extreme excitement, elation, hyperactivity, agitation, and anorexia. Dystonia refers to the condition of abnormal muscle contraction that produces repetitive involuntary twisting movements and abnormal posturing of the neck, face, trunk, and extremities. Dyskinesia refers to the condition of abnormal and distressing involuntary movement.

The nurse is administering intravenous phenytoin. When will the nurse expect the drug to take affect? 1 Immediately 2 Within 5 minutes 3 Within 15 minutes 4 Within 1 to 2 hours

4 Within 1 to 2 hours When phenytoin is given intravenously, the nurse would expect onset of the drug to occur within 1 to 2 hours.

Which adverse effects does the nurse monitor for in a patient that has been prescribed alprazolam to treat panic disorder? Select all that apply. 1 Ataxia 2 Dizziness 3 Confusion 4 Visual changes 5 Paradoxical anxiety

1 Ataxia 2 Dizziness 3 Confusion 4 Visual changes Ataxia, dizziness, confusion, and visual changes are adverse effects of alprazolam caused by the drug's mechanism of action. Paradoxical anxiety is an adverse effect of buspirone, not alprazolam.

Which outcome in a patient started on carbidopa-levodopa indicates a therapeutic effect of the medication? 1 Decreased tremors 2 Increased urination 3 Increased appetite 4 Decrease in "dry mouth"

1 Decreased tremors Carbidopa-levodopa is an antiparkinson drug that should decrease symptoms such as tremors. Increased urination and appetite and a decrease in dry mouth are not therapeutic effects of this medication therapy.

Which are common symptoms of serotonin syndrome? Select all that apply. 1 Delirium 2 Myoclonus 3 Drowsiness 4 Coarse tremors 5 Suicidal thoughts

1 Delirium 2 Myoclonus 4 Coarse tremors Serotonin syndrome is a condition that occurs because of an adverse effect of any drug or because a combination of drugs have serotoninergic activity. The symptoms of serotonin syndrome include delirium, myoclonus (muscle spasms), coarse tremors, agitation, sweating, and tachycardia. Drowsiness is an abnormal feeling that occurs as a side effect of sedatives, hypnotics, and mood stabilizers, but is not a symptom of serotonin syndrome. Suicidal thoughts are observed in patients who have severe depression.

Which activity would the patient be cautioned to avoid while taking a monoamine oxidase (MAO) inhibitor? 1 Eating aged cheese 2 Sunbathing at the pool 3 Participating in a bowling league 4 Smoking a low-nicotine cigarette

1 Eating aged cheese Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors. The patient does not need to avoid sunbathing and bowling while taking an MAO inhibitor.

Which patient is a poor candidate for therapy with diazepam to treat generalized anxiety disorder? 1 One with a history of alcoholism 2 One with type 2 diabetes mellitus 3 One who had convulsions as a child 4 One who has had a myocardial infarction

1 One with a history of alcoholism A patient with a history of alcoholism is a poor candidate for therapy with diazepam because of the potential for substance abuse and the adverse effects of therapy. The patient has an addictive personality, meaning that the patient has resorted to habitual use of a substance to manage anxiety; as a means of preventing additional substance abuse, benzodiazepines should be withheld from this patient. Moreover, benzodiazepines can cause respiratory depression. If the patient takes a benzodiazepine with alcohol, the combination could result in respiratory failure. Diazepam may be indicated for a patient with a history of convulsions because diazepam has antiseizure properties. The use of diazepam by a patient who has had a myocardial infarction or who has diabetes is also potentially suitable.

Which is another approved and indicated use for bupropion, a second-generation antidepressant? 1 Smoking cessation 2 Orthostatic hypotension 3 Nocturnal enuresis in children 4 Anorexia in patients undergoing chemotherapy

1 Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients quit smoking.

Which phenomena does the nurse recognize as positive symptoms of schizophrenia? Select all that apply. 1 Catatonia 2 Delusions 3 Hallucinations 4 Poverty of speech 5 Social withdrawal 6 Conceptual disorganization

2 Delusions 3 Hallucinations 6 Conceptual disorganization Positive symptoms of schizophrenia include psychotic behaviors such as hallucinations. They also include conceptual disorganization such as chaotic thinking and poor insight. Negative symptoms include catatonia characterized by social withdrawal, apathy, blunted affect, poverty of speech, and catatonia.

Which are the current indications for tricyclic antidepressants (TCAs)? Select all that apply. 1 Seizures 2 Insomnia 3 Depression 4 Childhood enuresis 5 Neuropathic pain syndrome

2 Insomnia 4 Childhood enuresis 5 Neuropathic pain syndrome Drugs for affective disorders (TCAs) are the original first-generation antidepressants; however, insomnia and neuropathic pain syndrome are the current indications for TCAs. Imipramine is a TCA used as an adjunct in the treatment of childhood enuresis. A history of seizures or a current seizure episode contraindicates the use of TCAs because of a risk of death. TCAs are primary antidepressants but are currently replaced with a newer class of drugs.

Which adverse effects result from antipsychotic drugs' action on alpha-adrenergic receptors? Select all that apply. 1 Weight gain 2 Lightheadedness 3 Reflex tachycardia 4 Tardive dyskinesia 5 Postural hypotension

2 Lightheadedness 3 Reflex tachycardia 5 Postural hypotension Antipsychotics are a group of drugs used to treat serious mental illnesses. They act on the various receptors in the central nervous system to produce a therapeutic effect. Adverse effects of antipsychotics occur as a result of a blockage of certain receptors or because of abnormal activity. The action of antipsychotics on alpha-adrenergic receptors results in lightheadedness, reflex tachycardia, and postural hypotension. Weight gain is an adverse effect of antipsychotic drugs due to the involvement of histamine receptors. Tardive dyskinesia is an abnormal and uncontrollable movement that occurs because of the involvement of dopamine receptors.

Which instruction does a nurse provide to a patient who is taking a selective serotonin reuptake inhibitor (SSRI)? 1 "Change positions frequently." 2 "Avoid foods or beverages rich in tyramine." 3 "Avoid hot baths, saunas, and hot climates." 4 "Increase the intake of dietary fiber supplements."

4 "Increase the intake of dietary fiber supplements." Fiber supplements are appropriate for a patient who is taking an SSRI and should be taken at least 2 hours before or after the administration of an SSRI to avoid interference with drug absorption. Frequent changes of position are recommended for patients who are taking tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs) to prevent hypotension. The nurse advises patients who are taking MAOIs to avoid foods or beverages rich in tyramine to prevent cheese effect. Hot baths, saunas, and hot climates should be avoided by patients taking antipsychotics to prevent the risk of a further drop in blood pressure.

Which information would the nurse include in patient education to promote adherence to a therapeutic regimen of fluoxetine to treat anxiety for a patient that has been taking the medication for 2 weeks? 1 This medication usually requires titration. 2 The adverse effects can be managed well. 3 Relaxation exercises can offer some relief. 4 A therapeutic effect can be expected in another 2 to 4 weeks.

4 A therapeutic effect can be expected in another 2 to 4 weeks. The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

Which theory states that depression and mania are caused by alterations in the concentration of dopamine and norepinephrine and serotonin and histamine in the brain? 1 Dopamine hypothesis 2 Permissive hypothesis 3 Dysregulation hypothesis 4 Biogenic amine hypothesis

4 Biogenic amine hypothesis Biogenic amine hypothesis states that depression and mania are caused by alterations in the concentrations of dopamine and norepinephrine and serotonin and histamine in the brain. Dopamine hypothesis states that psychotic disorders are developed because of dopamine dysregulation in certain parts of the brain. Permissive hypothesis states that reduced concentration of serotonin is the predisposing factor in patients who have affective disorders. According to dysregulation hypothesis theory, depression and other affective disorders are not simply caused by decreased or increased catecholamine activity but are also caused by failure of the regulation of these systems.

Which drug would the nurse expect to administer to a patient as the first line of treatment for generalized tonic-clonic seizures? 1 Pregabalin 2 Topiramate 3 Valproic acid 4 Carbamazepine

4 Carbamazepine Carbamazepine is usually the first-line treatment for generalized tonic-clonic and partial seizures. Pregabalin and topiramate are used as adjunct therapy for partial seizures. Valproic acid is used mainly for absence, myoclonic, and tonic-clonic seizures.

Which mood-stabilizing drugs are used to treat bipolar disorder? Select all that apply. 1 Bupropion 2 Imipramine 3 Isocarboxazid 4 Oxcarbazepine 5 Lithium carbonate

4 Oxcarbazepine 5 Lithium carbonate Mood stabilizers are drugs that are used to treat the cycles of mania, hypomania, and depression by regulating the metabolism of catecholamines. Examples of mood stabilizers include oxcarbazepine and lithium carbonate. Imipramine is a tricyclic antidepressant, not a mood stabilizer. It is a second-line therapeutic drug for bipolar disorders. Bupropion is a drug that is categorized under a miscellaneous group and is used for the treatment of depression. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of depression.

Which mechanism of action explains why levodopa is the mainstay of treatment for patients with Parkinson's disease? 1 Enhances dopamine release 2 Promotes dopamine synthesis 3 Impairs dopamine breakdown 4 Provides a dopamine precursor

4 Provides a dopamine precursor Levodopa is a biologic precursor of dopamine that must be combined with carbidopa so that the brain can use it to synthesize dopamine; it is the only agent that acts in this manner. Other dopaminergic agents increase the brain's dopamine by stimulating its release, directly and indirectly, stimulating its synthesis, and inhibiting enzymes that degrade it.

Which atypical antipsychotic medication would the nurse anticipate a health care provider prescribing for treatment of refractory schizophrenia? 1 Trazodone 2 Phenelzine 3 Amoxapine 4 Risperidone

4 Risperidone Risperidone is effective for refractory schizophrenia, including negative symptoms. Trazodone, phenelzine, and amoxapine are antidepressants.

Which medication increases the rate of urinary elimination of tricyclic antidepressants (TCAs) in the event of an overdose? 1 Diazepam 2 Antidysrhythmic 3 Activated charcoal 4 Sodium bicarbonate

4 Sodium bicarbonate Sodium bicarbonate alkalizes the urine and enhances the elimination of medication; therefore it is used to speed up the elimination of high doses of TCAs. Diazepam is used to reduce central nervous system damage associated with high doses of TCAs. Antidysrhythmics are drugs used to treat cardiovascular events that occur as a result of an overdose of TCAs. The administration of activated charcoal reduces the absorption of TCAs.