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74 Cards in this Set

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What are the s/e of SSRI's
Anticholinergic effects
Nausea
HA
Weight gain
Sexual dysfunction
insomnia
What do SSRI's do
Slow the re-uptake of serotonin
According to Pernick, what is the conern when taking a CL off SSRI
You have to ween them off gradually or there is a risk of seizure
Two major s/e with SSRI's
Serotonin Syndrome

Cytochrome P450 inhibition
What are the s/s of serotonin syndrome?
Confusion/disorientation
mania
restlessness/agitation
What is the effect of cytochrome P450 inhibitation?
Inhibits this enzyme in the liver needed to metabolize other drugs
- You can get too much 5HT
- Or other drugs become too toxic
What do you give for Serotonin Syndrome?
Serotonin antagonist
- Clonazepam (for myoclonus)
- Lorozepam/Ativan (for restless/agitation)
Fluoxetine (Prozac)
Type of med
Dose
SSRI

20-80 PO
Setraline (Zoloft)
Type of med
Dose
SSRI
25-200 PO
Paroxetine (Paxil)
Type of med
Dose
SSRI
20-50 PO
What do TCA's do
Inhibit reuptake of NE & 5HT
TCA's
- Compared to MAOIs
- S/E
Less CV s/e than MAOI's

Dry mouth
Blurred vision
ortho hypotenion
Seizure activity
Heart palpitations
increased heart rate
Weight gain
Pernick:
What is concern with TCA's
You're giving CLs the implements to kill themselves
Amitriptyline (Elavil) Pernick mentioned this one
Type of med
Dose
TCA
50-300
Amitriptyline (Elavil) Pernick mentioned this one

What is most important nursing intervention for CL taking this drug?
Assess for ortho hypotension

Anticholinergic effects are transient & disappear over time. MOre common is ortho hypo because can frighten CL and creates fall risk
Norpramin (Desipramine) Pernick
Type of med
Dose
TCA
50-300 PO or Liquid oral
Imipramine (Tofranil) Pernick
Type of med
Dose
TCA
50-300 PO
In CL taking TCA, what is required for kids & people over 40?
ECG's
Which clients should be assessed carefully before giving TCA's?
Clients with cardiac conduction problems
Pernick: What is the big s/e with TCAs?
Dry mouth
What do MAOI's do?
make more NE available by preventing NE breakdown
Remember that NE stimulates symp or "fight" or "flight" response
What is the effect of having more NE available (which occurs with MAOI's)?
Stimulates the brain, but also other parts of the sympathetic NS (fight/flight)
- Incr. HR, B/P
- Orthostatic Hypotension
- Wt gain/ decr sexual functioning
What are s/e of MAOI's
Anticholinergic
Hypertensive crisis
Weight gain
Sexual dysfunction
Drowsiness/insomnia
Which class of drugs is associated with hypertensive crisis?
MAOI's
Phenelzine (Nardil)
Type of drug
Dose
MAOI
45-90 PO
Tranylcypromine
(Parnate)
Type of drug
Dose
MAOI
20-60 PO
Isocarboxazid
(Marplan)
Type of drug
Dose
MAOI
20-60
S/S of MAOI toxicity
Restlessness
Anxiety
Insomnia
Dizziness
Hypotension can also occur
Most dangerous side effect of MAOI's?
Symptoms
Hypertensive crisis
- Sudden increase in b/p
- Explosive occipital headache
- Head/face flushed & feel full
- Palpitations & chest pain
- Sweating/N&V/dilated pupils
What is the treatment for a hypertensive crisis?
Don't lie down (will incr cranial b/p)
Give IM chlorpromizine (thorazine) to block NE: 100 mg
or
Give IV phentolamine (Regitine) slow dose of 5 mg (binds with NE)
After taking an antidepression drug, CL has a sudden increase in b/p, explosive headache, palpitations, and claims face is flushed & feels hot. Also n/v; What do you suspect?
What do you do?
Hypertensive crisis d/t MAOI

Give chlorpromizine (thorazine) IM 100 mg to block NE
OR IV phentolamine (regitine) slow 5 mg to bind with NE
Which drug class requires the CL to avoid tyramine?
MAOI's
What are some foods, ETOH, meds, that contain tyramine?
Food (aged & pickled; banana peels, tofu, broad bean pods)
ETOH: (beer, wine, & etoh-free beer)
Med: any anti-depress; decongestant, allergy meds, narcotics (esp demerol) and stimulants)
Yeast extracts, miso, ginsing, soy sauce & saurkraut should be avoided by CL's taking what group of drugs?
MAOI's
What are the "novel" meds mentioned by Pernick?
Bupropion (Wellbutrin)
Venlafaxine (Effexor)

Book also mentions Nefazodone (Serzone)
Bupropion/Wellbutrin
Type of drug
Dose
Mentioned by Pernick
Novel per Pernick
NE & Dopamine Reuptake Blocker
150-450 PO or SR
There is a ceiling dose d/t dose-related seizures!!!
Venlafaxine (Effexor)
Type of drug
Dose
Mentioned by Pernick
Per Pernick...novel
Serotonin & NE Reuptake inhibitor
25-375 PO & XT
Book mentions...
Nefazodon (Serzone
Trazodone
Types of med
Dose for Serzone)
Serotonin Antagonist & RI
200-600 PO
Lithium Carbonate
Type of drug
Dose
Mood stabilizer
Therapeutic dose .4-1.3
Toxic above 1.5
Lithium
What is usual start dose & duration till steady state achieved?
600-2400 mg/day PO/SR/L

Usually 300 mg TID for 7 days
Lithium
Usual adult dose
What lab test should be done & when
300 mg TID (600-2400 mg/day)

Draw blood in the a.m. 12 hours after last dose
Lithium
Client teaching should include which?
- Check with doctor before taking OTCs
- No soy sauce, tofu or aged products
- Take as prescribed because addictive
- Check blood serum levels q2weeks
Check with doctor before taking OTS
Before starting CL on lithium, what tests should be done?
Complete physical
Kidney function
Thyroid function
How often should blood serum levels be checked for clients on lithium?
q3months (1st 6 months)
- q6months (reassess renal, serum, TSH)
- q12month (reassess thyroid & ECG)
Lithium
S/E
weight gain (60%)
ECG changes
Hand tremor, fatigue, HE, lethargy
hypothroid
GI irritation (give w/ milk or food)
Polyuria/polydypsia (watch for DM)
Anticonvulsant mood stabilizers...
HGow are they thought to act?
enhance inhibitory neurotransmitter GABA so they inhibit kindling effect of bipolar
Carbamazepine (Tegretol)
Type of med
Dose
200-1600 PO-chewable

Mood stabilizer - anticonvulsive
Carbamazepine (tegretol)
Type of med
S/E?
Anti-convulsive

Drowsiness, dizziness, nausea/vomiting

Also sore throat d/t blood dyscrasia
What is are rare but serious s/e of carbamazepine (tegretol)?

What tests should be done?
Agranulocytosis
(Do blood, platelet, renal & hepatic)

Can also induce cytochrome P450

Is also lethal in overdose
Valproate (Depakote)
Type of med
Dose
Anticonvulsive
750 + mg
Valproate (Depakote)

S/E (general)
What is rare but serious s/e of this med?
Gi disturbances
Neuro SX (hand tremor, sedation, ataxia)
Increased appetite & weight gain
Thrombocytopenia (may need to decr dose)
RARE: Pancreatitis/severe hepatic dysFX
Valproate (Depakote)

Because of rare but serious s/e, what tests should be done?
Pancreatitis/severe hepatic dysfunction

Do renal, liver, & blood panels
Gabapentin (Neurotin) Pernick
Type of drug
Dose
Anti-convulsive (one of the newer ones)
What exactly is lithium?
How does this drive particular lab workups?
It's a naturally occurring salt
Do renal (because excreted in kidneys)
Do thyroid (inhibits steps in thyroid hormone synthesis)
Lithium
What can affect and increase lithium levels in clients (what nurse should watch for)
Decreased sodium/water intake
Diuretic therapy
Decreased renal function
Sweating/fever
Diarrhea/N&V/ dehydration, F&E loss
NSAID therapy!!!!
Lithium

Effect on Cl if CL is taking NSAID therapy?
Could lead to increase in serium lithium to toxic levels!!
Which neurotransmitters are thought to be involved in:
Depression?
Bipolar?
Depression: low NE & low 5HT
Bipolar: High NE & low 5HT
Which model of depression addresses issues of negative ideations about world, self, & future?
- Cognitive
- Psychoanalytic
- Learned helplessness
Cognitive

Psychoanalytic says depression is internalized anger;
Learned helplessness links loss of control with helplessness
Cl is creating chaos on ward with dominating & manipulative behavior.
- Provide Cl with alternate behaviors
- Tell Cl behavior is unacceptable
- Establish specific limits on behavior
Provide Cl with alternates (helps CL develop self control)
NOT tell behavior is unacceptable because you want to increase selfcontrol
NOT establish limits because you have to work with the entire treatment team!)
In planning activities for depressed CL during initial stage of TX:
- Prepare schedule of daily activities
- Wait for Cl to indicate willingness to participate
Prepare schedule of daily activities to follow each day
CK wgi was psychotically depressed begins to take responsibility for self & expresses interest in getting ready for discharge. Treatment has been for last 2 weeks. What should nurse do?
Assess client's level of self esteem

NOT institute suicide precautions
What are s/s of mild lithium toxicity?
Diarrhea
muscle weakness
polydipsia
Client on 300 mg lithiumpid pO. Lab test shows serum level 1.5 mEq/L. Client has no complaints & exhibits no side effects. What is appropriate nursing action regarding next scheduled dose?
Give it
Wellbutrin is classified as:
Nonserotonergic antidepressant
NOT SSRI
Cl's wife comes home early from business meeting & finds husband unconscious w/ empty bottle of pills. Which fact in scenario is most important?
That client planned his attempt for a time when he thought no one would rescue him.

NOT that client is unconscious
A potential victim of suicide is most likely to commit suicide at what time?
- When depression symptoms decrease
- Just before discharge
When depression symptoms decrease
Wife of cheating husband says "I can't blame him; I'm a terrible wife". Nurse:
- "obviously you're not feeling well. Let's talk about it"
- "Tell me what makes you feel so terrible?"
Obviously you're not feeling well. Let's talk about it.
After regaining consciousness, an ECT CL seems to go to sleep. YOu should:
- Let the CL sleep
- Try to take the client
Let the Cl sleep
Cl with major dperession & psychotic features. SX appeared after mom died. His response can be viewed as:
- reaction to what he perceives as severe blow to security
- Result of maturational crisis
Reaction to what he perceives as severe blow to security
Cl having ECT asks what to expect:
- You will be given something to help you relax and will not feel the shock
- It's relatively safe & your depression will decrease over time
You wil be given something to help you relax and will not feel the shock
Depressed 28 woman is slow dressing & getting ready for breakfast. You should
- Assist in dressing/preparing
- Permit as much time as Cl wishes
Assist in dressing/preparing
Pre-procedure nursing actions for ECT:
Obtain consent
get baseline v/s
Have client void
remove hair pins/contacts/dentures
Give Atropine or Robinul
During ECT, what are nursing actions?
Monitor b/p and give 100% oxygen
Use airway or bite block
Maybe give anesthetic & succinylocholine
Seizure will last 30 to 60 seconds
After ECT, what are nursing actions?
Frequent, simple orientation upon waking
Assess gag reflex before food/fluid/med
Talk and take v/s
May have memory deficit (short term)
Only to room is v/s stable & O2 >90%