Chapter 21: Antidepressant Agents
A client has been diagnosed with depression following several months of worsening mood and affect. The client's provider has prescribed fluoxetine 20 mg PO daily. What education should the nurse provide to the client?
"For most people, the side effects of this drug aren't particularly serious or common."
The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize?
"How would you describe your mood and energy level today?"
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 has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse?
"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective."
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."
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."
An adult client has been diagnosed and the client's psychiatrist has prescribed amitriptyline 100 mg PO daily. What education should the nurse provide about this drug regimen?
-"Many people find this drug makes them drowsy, so it's best to take it at bedtime." -"If you find that you have a dry mouth, try sucking on lozenges or hard candies." -"It's possible that you might have a bit of difficulty starting your urine stream." -"Let your psychiatrist know promptly if you have any changes in your vision."
When educating a client prescribed monoamine oxidase (MAO) inhibitor therapy, the nurse should encourage avoidance of what food?
-aged cheeses -chocolate -bananas -coffee
A nurse is caring for a client with depression. The client has been prescribed a tricyclic antidepressant. The nurse obtains the medical history of the client, which states that the client has also been receiving a monoamine oxidase inhibitor (MAOI) for 2 weeks. Which should the nurse identify as the possible effects of interaction between a tricyclic antidepressant and an MAOI?
-increased risk for hypertensive episodes -increased risk for severe convulsions -increased risk for hyperpyretic episodes
The nurse interviews the family of a client hospitalized with severe depression and suicidal ideations. What assessment data is important in planning this family's plan of care?
-recent suicide attempts -GI obstruction -affect
How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?
14 days
The nurse at an outpatient mental health unit is reviewing the black box warning that applies to clients who are taking antidepressants. To which of the nurse's clients would the black box warning apply?
14 year-old client who has been diagnosed with major depression
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?
4 to 6 weeks after stopping the paroxetine
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
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
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?
45-year-old man with liver impairment
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?
MAOI would be started 2 to 4 weeks after stopping the SSRI
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 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 as the SSRI is being tapered.
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.
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.
The client has been prescribed 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 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
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 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?
client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug
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
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 interaction
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
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?
dosage of the medication will be gradually reduced over a period of 6 to 8 weeks
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
Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?
extended release form is available
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 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 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?
lower dose of antidepressants
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
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
Which adverse effects would the nurse instruct a client to report to the health care provider immediately when taking trazodone?
painful continued erection
A group of students are reviewing information about antidepressants that inhibit the activity of monoamine oxidase, leading to increase in epinephrine, norepinephrine, dopamine, and serotonin. The students demonstrate understanding when they identify which drug as acting in this manner?
phenelzine
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, 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
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 (SSRI)
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
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
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
