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74 Cards in this Set
- Front
- Back
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What are the s/e of SSRI's
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Anticholinergic effects
Nausea HA Weight gain Sexual dysfunction insomnia |
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What do SSRI's do
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Slow the re-uptake of serotonin
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According to Pernick, what is the conern when taking a CL off SSRI
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You have to ween them off gradually or there is a risk of seizure
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Two major s/e with SSRI's
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Serotonin Syndrome
Cytochrome P450 inhibition |
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What are the s/s of serotonin syndrome?
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Confusion/disorientation
mania restlessness/agitation |
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What is the effect of cytochrome P450 inhibitation?
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Inhibits this enzyme in the liver needed to metabolize other drugs
- You can get too much 5HT - Or other drugs become too toxic |
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What do you give for Serotonin Syndrome?
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Serotonin antagonist
- Clonazepam (for myoclonus) - Lorozepam/Ativan (for restless/agitation) |
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Fluoxetine (Prozac)
Type of med Dose |
SSRI
20-80 PO |
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Setraline (Zoloft)
Type of med Dose |
SSRI
25-200 PO |
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Paroxetine (Paxil)
Type of med Dose |
SSRI
20-50 PO |
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What do TCA's do
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Inhibit reuptake of NE & 5HT
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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 |
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Pernick:
What is concern with TCA's |
You're giving CLs the implements to kill themselves
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Amitriptyline (Elavil) Pernick mentioned this one
Type of med Dose |
TCA
50-300 |
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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 |
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Norpramin (Desipramine) Pernick
Type of med Dose |
TCA
50-300 PO or Liquid oral |
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Imipramine (Tofranil) Pernick
Type of med Dose |
TCA
50-300 PO |
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In CL taking TCA, what is required for kids & people over 40?
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ECG's
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Which clients should be assessed carefully before giving TCA's?
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Clients with cardiac conduction problems
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Pernick: What is the big s/e with TCAs?
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Dry mouth
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What do MAOI's do?
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make more NE available by preventing NE breakdown
Remember that NE stimulates symp or "fight" or "flight" response |
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What is the effect of having more NE available (which occurs with MAOI's)?
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Stimulates the brain, but also other parts of the sympathetic NS (fight/flight)
- Incr. HR, B/P - Orthostatic Hypotension - Wt gain/ decr sexual functioning |
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What are s/e of MAOI's
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Anticholinergic
Hypertensive crisis Weight gain Sexual dysfunction Drowsiness/insomnia |
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Which class of drugs is associated with hypertensive crisis?
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MAOI's
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Phenelzine (Nardil)
Type of drug Dose |
MAOI
45-90 PO |
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Tranylcypromine
(Parnate) Type of drug Dose |
MAOI
20-60 PO |
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Isocarboxazid
(Marplan) Type of drug Dose |
MAOI
20-60 |
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S/S of MAOI toxicity
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Restlessness
Anxiety Insomnia Dizziness Hypotension can also occur |
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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 |
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What is the treatment for a hypertensive crisis?
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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) |
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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 |
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Which drug class requires the CL to avoid tyramine?
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MAOI's
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What are some foods, ETOH, meds, that contain tyramine?
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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) |
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Yeast extracts, miso, ginsing, soy sauce & saurkraut should be avoided by CL's taking what group of drugs?
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MAOI's
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What are the "novel" meds mentioned by Pernick?
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Bupropion (Wellbutrin)
Venlafaxine (Effexor) Book also mentions Nefazodone (Serzone) |
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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!!! |
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Venlafaxine (Effexor)
Type of drug Dose Mentioned by Pernick |
Per Pernick...novel
Serotonin & NE Reuptake inhibitor 25-375 PO & XT |
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Book mentions...
Nefazodon (Serzone Trazodone Types of med Dose for Serzone) |
Serotonin Antagonist & RI
200-600 PO |
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Lithium Carbonate
Type of drug Dose |
Mood stabilizer
Therapeutic dose .4-1.3 Toxic above 1.5 |
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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 |
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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 |
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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
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Before starting CL on lithium, what tests should be done?
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Complete physical
Kidney function Thyroid function |
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How often should blood serum levels be checked for clients on lithium?
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q3months (1st 6 months)
- q6months (reassess renal, serum, TSH) - q12month (reassess thyroid & ECG) |
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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) |
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Anticonvulsant mood stabilizers...
HGow are they thought to act? |
enhance inhibitory neurotransmitter GABA so they inhibit kindling effect of bipolar
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Carbamazepine (Tegretol)
Type of med Dose |
200-1600 PO-chewable
Mood stabilizer - anticonvulsive |
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Carbamazepine (tegretol)
Type of med S/E? |
Anti-convulsive
Drowsiness, dizziness, nausea/vomiting Also sore throat d/t blood dyscrasia |
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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 |
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Valproate (Depakote)
Type of med Dose |
Anticonvulsive
750 + mg |
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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 |
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Valproate (Depakote)
Because of rare but serious s/e, what tests should be done? |
Pancreatitis/severe hepatic dysfunction
Do renal, liver, & blood panels |
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Gabapentin (Neurotin) Pernick
Type of drug Dose |
Anti-convulsive (one of the newer ones)
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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) |
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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!!!! |
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Lithium
Effect on Cl if CL is taking NSAID therapy? |
Could lead to increase in serium lithium to toxic levels!!
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Which neurotransmitters are thought to be involved in:
Depression? Bipolar? |
Depression: low NE & low 5HT
Bipolar: High NE & low 5HT |
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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 |
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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!) |
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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
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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?
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Assess client's level of self esteem
NOT institute suicide precautions |
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What are s/s of mild lithium toxicity?
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Diarrhea
muscle weakness polydipsia |
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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?
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Give it
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Wellbutrin is classified as:
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Nonserotonergic antidepressant
NOT SSRI |
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Cl's wife comes home early from business meeting & finds husband unconscious w/ empty bottle of pills. Which fact in scenario is most important?
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That client planned his attempt for a time when he thought no one would rescue him.
NOT that client is unconscious |
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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
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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.
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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
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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
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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
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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
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Pre-procedure nursing actions for ECT:
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Obtain consent
get baseline v/s Have client void remove hair pins/contacts/dentures Give Atropine or Robinul |
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During ECT, what are nursing actions?
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Monitor b/p and give 100% oxygen
Use airway or bite block Maybe give anesthetic & succinylocholine Seizure will last 30 to 60 seconds |
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After ECT, what are nursing actions?
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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% |
