NSG 211 Ch. 21 (AntiDepressants) - (test 1)

orthostatic hypotension

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? urinary frequency orthostatic hypotension visual disturbances urinary retention

-"Use sugarless hard candies and gum to deal with dry mouth." **amitriptyline is a TCA **Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function. (pharm - p. 356)

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." -"Take the drug daily in the morning for maximum benefit." -"Limit your fluid intake so you don't have to urinate during the night." -"Be sure to eat a low fiber diet to prevent diarrhea."

They may cause dangerous interactions with some foods and drugs.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today? 1. They may cause dangerous interactions with some foods and drugs. 2. They can cause gastrointestinal (GI) bleeding and esophageal varices. 3. They are under a scheduled drug classification. 4. They are ineffective in treating depression or anxiety disorders.

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? 3 days 2 months 4 weeks 6 months

-The medications have fewer anticholinergic effects than alternatives. (pharm p. 363)

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? -The medications eliminate the risk of suicide during treatment. -The onset of action is sooner than with other medications. -The medications have fewer anticholinergic effects than alternatives. -The medications have no sexual side effects.

-Lithium can reach toxic levels in serum very fast -lithium excreted by kidneys -Thiazide diuretics increase sodium loss which increases retention of lithium, thus increasing risk of toxicity!

Why is it contraindicated for a patient to take Lithium AND a thiazide diuretic?

false!! *patch should be applied to dry, intact skin on the upper torso, upper thigh, or upper arm **pt teaching: make sure they know to take OFF old patch before applying new one!

transdermal selegiline is now available to treat major depressive disorder. T/F: The patient's skin needs to be a little damp when they apply the patch.

-statements or resignation and futility and a desire to die

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? -alternating periods of hypomania and depression -reports of headaches, sleepiness, and apathy -paranoia, rapid speech, and difficulty with concentration -statements or resignation and futility and a desire to die

3. "Have you felt hopeless anytime lately?"

A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status? 1. "What have you eaten in the last two days?" 2. "Why are you feeling sad?" 3. "Have you felt hopeless anytime lately?" 4. "Can you name six things you would like to change in your life?"

Salami **aged cheeses, aged or fermented meats/fish/poultry, Brewer's yeast, red wines, smoked or pickled meats/fish/poultry, soy sauce = ALL have HIGH levels of tyramine and should be avoided by pts taking MAOIs **phenelzine is MAOI

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating? -Ice cream -Apples -Leafy greens -Salami

-It may take up to two more weeks before the client feels better **citalopram = SSRI

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? Improvements are likely evident to others even if not to the client -It may take up to two more weeks before the client feels better -The drug requires six to eight weeks before it reaches peak levels -The client's pessimism is likely a symptom of the underlying depression

"It may take another two to three weeks before the medication is completely effective."

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client? -"I will tell the healthcare provider and see if there is another medication that would be better." -"I realize this is frustrating but most medications for mood disorders aren't fully effective for two to three months." -"Please come to the clinic immediately so you can be reassessed for suicidal thoughts." -"It may take another two to three weeks before the medication is completely effective."

-"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." **citalopram = celexa (SSRI) **Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.

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." -"You'll likely be feeling significantly better by the weekend, but remember to avoid drinking alcohol at the wedding." -"This is very good timing for you, but remember that you might have some side effects, especially for the first couple of weeks." -"Antidepressants help relieve the lack of energy and concentration during depression but your mood might not be affected."

Oral

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

"Place the patch on dry skin on your torso that has no cuts or openings."

A client is prescribed transdermal selegiline. What health education should the nurse provide? -"Leave the old patch in place for no more than one hour after placing a new one." -"Place the patch on dry skin on your torso that has no cuts or openings." -"Gently massage the area after you put a new patch on your skin." -"Put the patch on the back of your hand where you'll be reminded of it."

4 wk+

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? 1 week 2 weeks 4 weeks 3 weeks

Dangerous drug interactions **increased risk of serotonin syndrome

A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction? -Hemostatic instability -Dangerous drug interactions -Development of blood dyscrasias -Worsened symptoms of depression

presence of suicidal ideation

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 -indications of a type IV hypersensitivity reaction -cardiac rate and rhythm -improvement in the ability to concentrate

Serotonin

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired? Acetylcholine Serotonin Insulin Epinephrine

1-manic behavior 2-mood swings **Subtherapeutic levels of lithium may result in worsening symptoms of bipolar disorder. Primarily, this involves mood swings and mania. Tremors and weakness are adverse effects of lithium therapy. Cognitive changes and suicidal ideation would not be expected

A client who has been prescribed long-term lithium therapy reports taking the medication only erratically since starting a new job. What assessments should the nurse prioritize? Select all that apply. 1. manic behavior 2. mood swings 3. suicidal ideation 4. fine tremors 5. memory lapses

1. "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

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? 1. "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." 2. "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." 3. "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." 4. "It's very important that you comply with your prescribed treatment."

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug **Worsening mood that accompanies the use of an SSRI could constitute an increased risk for suicidality. The nurse should communicate this to the provider promptly so the client can be reassessed. The client taking amitriptyline is experiencing anticholinergic effects which the nurse can likely manage. A client's sexual dysfunction should be addressed but this is not a safety risk. The fact that the nurse needed to review a client's dietary restrictions is not necessarily problematic and could indicate the client's firm commitment to adhering to the restrictions. (pharm - p 356)

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 takes sertraline 24 mg PO daily says he has noticed some sexual dysfunction since starting the drug -A client taking isocarboxazid with whom the nurse needed to review dietary restrictions -A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug -A client who takes amitriptyline reports a dry mouth and occasional urinary hesitation

-The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. **Sertraline should be administered with caution in clients with compromised liver function. Adjustments such as a lower dosage or less-frequent dosing schedule may be made for these clients. (pharm 362)

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? -She should have an ultrasound of the liver to check for disease. -The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. -The client should have monthly evaluation of liver function to monitor the disease progression. -The client should not take any medications because of her liver dysfunction.

-The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

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 client should have monthly evaluation of liver function to monitor the disease progression. -The client should not take any medications because of her liver dysfunction. -The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. -She should have an ultrasound of the liver to check for disease.

Clomipramine (pharm p. 357)

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 -Amoxapine -Maprotiline -Desipramine

-A lower dose of the antidepressant

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? -No antidepressants, because they would be contraindicated for this client. -A lower dose of the antidepressant -More frequent doses of the antidepressant -A higher dose of the antidepressant

Hypertension **MAO inhibitors may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Clients who take MAO inhibitors should avoid foods that contain tyramine, such as aged cheeses and fava beans (pharm p. 359)

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? -Decreased urinary output -Hypertension -Respiratory congestion -Anemia

Yogurt (fermented meats, fish, cheeses and dairy products all high tyramine, which pts on MAOIs should avoid) Chart on p. 362 (pharm)

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 Milk Butter Rice

Extreme sadness

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? Drowsiness Extreme sadness Severe headache Dilated pupils

A client has dysphagia **Antidepressants are almost exclusively administered in oral form not IV or IM. For clients with dysphagia, they have the potential for aspiration (Pharm Page 356)

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 actively resists IM injections A client has dysphagia A client has a history of pulling out her IV cannula A client has an intense fear of injections

avoid use of soy sauce in the diet

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? -discuss the cultural significance of taking an MAOI. -avoid use of soy sauce in the diet. -avoid taking the drug on an empty stomach. -adhere to combination drug therapy.

3. Monitor the client closely for bleeding and review coagulation indices when available. **combination of TCAs and oral anticoagulants leads to higher serum levels of the anticoagulants and increased risk of bleeding. Blood tests should be done frequently, and appropriate dose adjustments in the oral anticoagulant should be made (pharm, p 359)

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? 1. Ask the client at each meal about any episodes of gastresophageal reflux. 2. Assess the client's blood pressure every six hours for the first week of therapy. 3. Monitor the client closely for bleeding and review coagulation indices when available. 4. Monitor the client for tetany and review serum calcium levels when available.

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

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 should leave the previous patch on for an hour after applying a new one." "My skin needs to be a little damp when I apply the patch." "I probably won't feel drowsy, dizzy, or nauseous from this drug." "I can apply a new patch to my upper arm, thigh, or torso."

-Selective serotonin reuptake inhibitors

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 -Atypical antidepressants -Monoamine oxidase inhibitors -Tricyclic antidepressants

The need to use barrier contraceptives **Because of the potential for congenital anomalies, a female client of childbearing age should be encouraged to use contraceptives. SSRIs are not associated with hepatotoxicity even though they are metabolized in the liver. Blood levels do not need to be quantified and dosage changes are made on the basis of the client's response. High-tyramine foods are contraindicated with MAOIs, not SSRIs (Pharm, p. 366)

At the insistence of her roommate, a college student has presented to the campus medical clinic and reports a history of anhedonia, insomnia, anorexia and fatigue. The client is diagnosed with depression and the nurse is providing health education about the client's prescribed SSRI. What teaching should the nurse prioritize? -The importance of follow-up blood work -The signs and symptoms of hepatotoxicity -The need to use barrier contraceptives -The need to avoid high-tyramine foods

Selective serotonin reuptake inhibitor

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? Tricyclic Selective serotonin reuptake inhibitor Benzodiazepine Monoamine oxidase inhibitor

The need to avoid high-tyramine foods **Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body, and it's found in certain foods. Medications called monoamine oxidase inhibitors (MAOIs) block monoamine oxidase, which is an enzyme that breaks down excess tyramine in the body.

Pt was newly diagnosed w/ depression and prescribed and MAOI. Which of the following teaching points should the nurse prioritize? -The importance of follow-up blood work -The signs and symptoms of hepatotoxicity -The need to use barrier contraceptives -The need to avoid high-tyramine foods

A 45-year-old man with liver impairment **Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in clients with obesity or diabetes. (Pharm 363)

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse? A 32-year-old man who is obese A 38-year-old woman who has diabetes An 11-year-old child with no other illnesses A 45-year-old man with liver impairment

FALSE Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm).

T/F: Currently, MAOIs are considered the FIRST line of defense for treating depression.

FALSE: SSRIs do not necessarily eliminate the risk of suicide. **They can increase the risk of suicidal thoughts for youth and young adults

T/F: SSRIs eliminate the risk of suicide for patients with suicidal ideation.

TRUE (risk of suicidal thoughts increasing when taking antidepressants is highest in children, teens, and young adults)

T/F: The FDA has issued a black box warning alerting health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications.

TRUE **psychotherapeutic agents drugs = used to treat psychoses, perceptual and behavioral disorders

T/F: psychotherapeutic agents are targeted at thought processes rather than affective states

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? Paroxetine Diazepam Phenelzine Triazolam

temp, BP, and LOC **Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an drugs that potentiate serotonin neurotransmission. While worthy of assessment, neither cardiac nor respiratory functions are usually affected (Pharm 363)

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 -cardiac function -respiratory function -level of consciousness -blood pressure

2

The nurse is caring for a teenage client who has recently been prescribed a selective serotonin reuptake inhibitor. What assessment should the nurse prioritize? 1. Hypomanic state 2. Suicidal ideation 3. Venous thromboembolism (VTE) 4. Cardiac rate and rhythm

-"Measure and record your blood pressure daily."

The nurse is caring for an older adult client who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the client monitor for adverse effects? -"Measure and record your blood pressure daily." -"Adverse effects will subside as you adjust to the medication." -"If mild chest pain occurs, an over-the-counter pain reliever will help." -"Nasal congestion suggests that the drug might not be effective."

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

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 60-year-old female client who is also taking hormone replacement therapy -A 79-year-old client who has a comorbidity of early stage dementia -A client whose treatment regimen also includes electroconvulsive therapy (ECT)

A. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued? A. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. B. Electroconvulsive therapy (ECT) will be prescribed 2 to 3 weeks before stopping the fluoxetine. C. It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed. D. A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks.