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35 Cards in this Set

  • Front
  • Back
___________ is a major depressive episode occurring after the birth of a child.
Postpartum Depression
________ is associated with impaired ability to function in usual activities and relationships.
Major depression
_______________ is characterized by episodes of major depression plus mania and occurs equally in men and women.
Bipolar disorder Type I
___________ is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.
Bipolar disorder Type II
The average depressive episode lasts about ____ months.
5
Considered to be third line medications in treatment of depression because of high incidence of food and drug interactions that can potentially lead to hypertensive crisis.
MAOI's aka Mono-amine inhibitors
Second line of medications in the treatment of depression producing a high incidence of adverse effects
TCA's Tricyclic antidepressants
Similar to SSRI's in terms of therapeutic effects but produce more anticholinergic CNS sedation and cardiac conduction abnormalities.
SNRI's serotonin norepinephrine reuptake inhibitors
Must be taken for 2 to 4 weeks before depressive symptoms improve.
Antidepressants
Considered to be first line medications in the treatment of depression because they have a more favorable side effect profile.
SSRI's Select serotonin reuptake inhibitors
Discuss the methods used to prevent antidepressants toxicity and the interventions used to treat toxicity.
Toxicity is most likely to occur in depressed clients who intentionally ingest large amounts of drug in suicide attempts and in young children who accidentally gain access to medication containers. Measures to prevent acute poisoning from drug overdose include dispensing only a few days supply to clients with suicidal tendencies and storing the drug in places that are inaccessible to young children. General measures to treat acute poising include early detection of signs and symptoms stopping the drug and instituting treatment if indicated.
For clients with certain concurrent medical conditions antidepressants may have adverse effects. Discuss disease specific adverse reactions related to antidepressants.
For clients with certain concurrent medical conditions antidepressants may have adverse effects. For clients with cardiovascular disorders most antidepressants can cause hypotension, but the SSRI's, bupropion, and venlafaxine are rarely associated with cardiac dysrhythmias. Duloxetine venlafxine and MAOI's can increase blood pressure. For clients with seizure disorder bupropion, clomipramine and duloxetine should be avoided. SSRI's, MAOI's and desipramine are less likely to cause seizures. For clients with diabetes mellitus,SSRI's may have a hypoglycemic effect. Duloxetine may slightly increase fasting glucose levels and bupropion and venlafaxine have little effect on blood sugar levels. Duloxetine can cause mydriasis increasing intraocular pressure in patients with narrow angle glaucoma.
Why is lithium considered the drug of choice for bipolar disorder?
Lithium is the drug of choice for clients with bipolar disorder. When used therapeutically, lithium is effective in controlling mania in 65% to 80% of clients. When used prophylactically the drug decreases the frequency and intensity of manic cycles.
Dosages of antidepressant drugs should be individualized according to clinical response. Discuss the method of dosage adjustment used with SSRIs and venlafaxine.
With SSRIs and venlafaxine therapy is begun with once daily oral administration of the manufacturers recommended dosage. Dosage may be increased after 3 to 4 weeks if depression is not relieved. As with most other smaller doses may be indicated in older adults and in clients taking smaller doses may be indicated in older adults and in clients taking multiple medications. Duloxetine is initiated with twice a day oral administration without regard to food.
Discuss both the cases and the signs and symptoms of serotonin syndrome.
Serotonin syndrome a serious and sometimes fatal reaction characterized by hypertensive crisis hyperpyrexia extreme agitation progressing to delirium and coma, muscle rigidity, agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an SSRI and an MAOI or other drugs that protentiate serotonin neurotrasmission. An SSRI or SNRI and an MAOI should not be given concurrently or within 2weeks of each other. In most cases if a client taking an SSRI is to be transferred to an MAOI the SSRI should be discontinued at least 14 days before starting the MAOI. However, because of its prolonged half life fluoxetine should be discontinued at least 5weeks before starting an MAOI.
True or false?

When antidepressant medication is stared it takes 2 to 4 weeks to take effect. The nurse should encourage the client to continue taking the medication.
True
Mrs. Nate is prescribed fluoxetine during the third trimester of her pregnancy for depression. After birth her child exhibits symptoms of neonatal withdrawal syndrome. When would your expect the symptoms to abate?

a. In a few days

b. After 6weeks

c. In a few hours

d. With administration of fluoxetine.
a.
Rationale: Third trimester intrauterine exposure to fluoxetine or other SSRIs may result in a neonatal withdrawal syndrome which shares some similarity to a mild serotonin syndrome. Common symptoms include irritability prolonged crying respiratory distress, rigidity, and possible seizures. Care for an infant with neonatal withdrawal syndrome is supportive; symptoms usually abate within a few days.
Mr. Finch takes an SSRI for his depression. He discontinues the SSRI and asks why he cannot begin his prescription for an MAOI immediately. You respond that combination therapy may cause ________.
Serotonin syndrome.

Rationale: Serotonin syndrome a serious and sometimes fatal reaching characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures may occur due to combined therapy with an SSRI or SNRI and an MAOI or other drug that protentiates serotonin neurotransmission.
Children, adolescents, and young adults ages 18 to 24 may have an increased risk of which of the following effects when taking antidepressants medications?

a. Manic episodes

b. suicidal episodes

c. Somnolence

d. Postural hypotension
b.

Rationale: A black box warning alerts health care providers to the increased risk of suicidal ideation in children adolescents and young adults 18 to 24yrs of age when taking antidepressants medications.
Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in which of the following categories of patients?

a. Men

b. Children

c. Women

d. The elderly
c.

Rationale: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.
Mr. Gatz age 35 is slowly recovering from an abdominal aortic aneurysm repair and cerebral vascular accident 6 weeks ago. His physician prescribes a low dose antidepressant from him based on a diagnosis of situational depression. Mr. Gatz's wife asks if a higher dose might be more beneficial. Which of the following would you teach the family regarding this patients dosage?

a. Dosage is based on the clients diagnosis.

b. Dosage must be titrated based on the clients weight.

c. A higher dose may cause postural hypertension.

d. Dosage must be cautious and slow and the clients responses carefully monitored.
d.

Rationale: Critically Ill clients may be receiving an antidepressant when the critical illness develops or the may need a drug to combat the depression that often develops with major illness. The decision to continue or start an antidepressant should be based on a thorough assessment of the clients condition other drugs being given potential adverse drug effects and other factors. If an antidepressant is given its use must be cautious and slow and the clients responses must be carefully monitored because critically ill clients are often frail and unstable with multiple organ dysfunctions.
Mr. Alexander has a history of hepatic dysfunction secondary to alcoholism. Based on Mr. Alexanders diagnostic history which of the folowing would your expect his physician to order?

a. A higher dose of the antidepressant

b. A lower dose of the antidepressant

c. More frequent doses of the antidepressant

d. No antidepressants because they would be contraindicated for this client.
b.

Rationale: Hepatic impairment leads to reduced first pass metabolism of most antidepressant drugs resulting in higher plasma levels. The drugs should be used cautiously in clients with severe liver impairment. Cautious use means lower doses longer intervals between doses, and slower dose increases than usual.
Which of the following antidepressant medications would not be a drug of choice for an adolescent?

a. SSRI's

b. TCAs

c. MAOIs

d. ACE inhibitors
b.

Rationale: A TCA probably is not the drug of first choice for adolescents because TCAs are more toxic in overdose than other antidepressants and suicide is a leading cause of death in adolescents.
If a TCA is prescribed for a child older than 12yr of age which of the following tests would routinely be ordered by the physician?

a. CBC and chemistry panel and plasma drug levels

b. Hemoglobin and hematocrit and plasma drug levels

c. Chest x ray and plasma drug levels.

d. Blood pressure, ECG, and plasma drug levels
d.

Rationale: Amitriptyline, desipramine, imipramine, and nortriptyline are the TCAs most commonly prescribed to treat depression in children older then 12yrs of age. Because of potentially serious adverse effects blood pressure, ECG, and plasma drug levels should be monitored.
Mr. Haven asks the physician for antidepressant therapy for his son Jame age 14. They physician order s psychiatric consultation before prescribing medication, for which of the following reasons?

a. Its unsafe to administer antidepressants to an adolescent without a psychiatric consultation.

b. It is probably best to reserve drug therapy for those who do not respond to non pharmacologic treatments such as cognitive behavioral therapy.

c. A definitive diagnosis has not been established.

d. Adolescents require higher doses of anti depressants than adults do.
b.

Rationale: For most children and adolescents it is probably best to reserve drug therapy for those who do not respond to pharmacological treatments such as cognitive behavioral therapy.
Mr. Murphy and African American is prescribed a TCA for his depression. He asks you why the dose he receives is lower than that of his calcasian friend. Which of the following responses is correct?

a. African Americans tend to metabolize TCAs more slowly than Calcasians do.

b. African Americans tend to metabolize TCAs more quickly then Caucasians do.

c. African Americans experience side effects with higher doses.

d. African American experience suicide ideation with higher doses.
a.

Rationale: African Americans tend to have higher plasma drug levels for a given dose, respond more rapidly, experience a higher incidence of adverse effecs and metabolize TCA more slowly then whites. To decrease adverse effects initial dose may need to be lower than those given to whites, and later doses should be titrated according to clinical response and serum drug levels.
Mrs. Balls bipolar disorder symptoms have been successfully managed or many years. She is scheduled for a CABG and is instructed to stop her lithium 1 to 2 days before surgery and resume when full oral intake of food and fluids is allowed. She asks why she must stop the medication? Which of the following explanations would you give?

a. You will not have bipolar symptoms during surgery or immediately afterwords because of the anesthetics.

b. Lithium will cause hypertension during surgery.

c. Lithium may prolong the effects of anesthetics and neuromuscular blocking drugs

d. Lithium may cause cardiac complications during surgery.
c.

Rationale: Lithium should be stopped 1 to 2 days before surgery and resumed when full oral intake of food and fluids is allowed. Lithium may prolong the effects of anesthetics and neuromuscular blocking drugs.
Mrs. Meese discontinues her SSRI abruptly. Which of the following signs and symptoms of withdrawal would you expect to see when she arrives at the physicians office 1 week later?
(select all that apply)

a. Dizziness

b. Lethargy or anxiety hyperarousal

c. Chest pain

d. Headache

e. Gastrointestinal upset
a, b, d, e

Rationale: The most clearly defined withdrawal syndromes are associated with SSRIs and TCAs. With SSRIs withdrawal symptoms include dizziness, gastrointestinal upset, lethargy or anxiety hyperarousal, dysphoria, sleep problems, and headache. Symptoms can last for several days to several weeks.
Mr. Janis presents to your ER department with tactile hallucinations choreiform movements and convulsions. His wife states that he may have overdosed on lithium. Treatment may include which of the following? (select all that apply)

a. Correction of fluid and electrolyte imbalances.

b. Hemodialysis

c. Administration of Narcan

d. Medication induced coma
a,b

Rationale: Toxic manifestations of lithium over-dosage occur at serum lithium levels greater than 2.5 mEq/L. Treatment involves supportive care to maintain vital function including correction of fluid and electrolyte imbalances. With severe overdoses hemodialysis is preferred because it removes lithium from the body.
How frequently should the serum concentration of lithium be monitored when therapy is initiated?

a. Monthly in the morning, 12hrs after the last dose of lithium.

b. Four times weekly in the morning 12hr after the last dose of lithium.

c. Weekly in the morning after the last dose of lithium

d. Two or three times weekly in the morning 12hrs after the last dose of lithium.
d.

Rationale: When lithium therapy is being initiated the serum drug concentration should be measured two or three times weekly in the morning 12hr after the last dose of lithium.
Dosages of antidepressant drugs should be individualized according to _____________.
clinical response.
Mr. Smith wishes to discontinue his antidepressant secondary to sexual dysfunction. Which of the following antidepressant medications may be ordered by his physician because it does not interfere with sexual function?

a. Mirazapine

b. Bupropion

c. Duloxetin

d. Venlafaxine
b.

Rationale: Bupropion does not cause orthostatic hyoptension or sexual dysfunction.
Because the available drugs have similar efficacy in treating depression the choice of an antidepressant depends on which of the following factors? (select all that apply)

a. Cost

b. Age

c. Gender

d. Medical conditions

e. The specific drugs adverse effects.
a, b, d, e

Rationale: Because the available drugs have similar efficiency in treating depression the choice of an antidepressant depends on the clients age medical conditions previous history of drug response if any and the specific drugs adverse effects. Cost also needs to be considered.
Mr. Jones is taking warfarin and presents to the physicians office wiht calf pain and a positiave holmans sign. He tells the physician that he has been depressed lately and is taking an herbal remedy. Which of the following antidepressants may reduce the effectiveness of his warfarin?

a. St John's Wort

b. Feverfew

c. Watercress

d. Wallwort
a.

Rationale: St Johns wort may reduce the effectiveness of cyclosporine, HIV protease inhibitors, oral contraceptives, digoxin, warfarin, and theophylline through interactions medicated by CYP3A4, CYP1A2, CYP2C19 enzymes systems as well as other mechanisms.
_____________ is a naturally occurring metallic salt that is used in clients with bipolar disorder, mainly to treat and prevent manic episodes.
Lithium carbonate (Eskalith)