Antipsychotics

Question 1

First generation antipsychotics / conventional

What antipsychotics for schizophrenia block receptors for dopamine in the CNS but cause serious movement disordeers known as extrapyramidal symptoms (EPS)?

a. Haloperidol & Chlorpromazine
b. Clozapine & Lithium
c. Divalproex & Zolbidem
d. Secobarbital & Ramelteon

Answer 1

a. Haloperidol & Chlorpromazine

Question 2

second generation antipsychotics / conventional

What antipsychotics for schizophrenia block receptors for serotonin in the CNS and because they are second generation have fewer extrapyramidal symptoms (EPS), but have increased metabolic effects?

a. Haloperidol
b. Clozapine
c. Divalproex
d. Secobarbital

*effects: weight gain, dyslipidemia CV events

Answer 2

b. clozapine

Question 3

What is the key drug for schizophrenia that has a high potency and suppresses psychosis by blocking D2 receptor?

a. Haloperidol
b. Clozapine
c. Divalproex
d. Secobarbital

Answer 3

a. Haloperidol

Question 4

Extrapyramidal symptoms are more severe when a patient is taking chlorpromazine rather than Haloperidol. True or false?

• Acute dystonia
• Parkinsonism
• Akathisia
• Tardive Dyskinesia

Answer 4

False

Extrapyramidal symptoms are more severe when a patient is taking Haloperidol rather than chlorpromazine because haloperidol is a first generation antipsychotic that has a stronger blockade for dopamine in the CNS where these symptoms manifest.

Question 5

Which of the following is not an early onset symptom that responds to pharmacological intervention when a patient is taking haloperidol?

a. Acute dystonia
b. Parkinsonism
c. Akathisia
d. Tardive Dyskinesia

Answer 5

d. Tardive Dyskinesia

Tardve Dyskinesia is a late onset symptom that does not respond to pharmacological intervention, therefore once schizophrenia progresses past the early onset symptoms of (acute dystonia, parkinsonism, akathisia) it can no longer be treated.

Question 6

Extrapyramidal early onset symptoms

Acute dystonia is the contraction of involuntary muscle and will appear when after taking the first dose of Haloperidol?

a. 3 weeks
b. 6 months
c. the first 15 minutes
d. first few hours to days

Answer 6

d. first few hours to days

• after the first dose the nurse must differentiate acute dystonia from their psychosis because of the positive and negative effects of schizophrenia where they may be flinching or reacting to things they see and the nurse doesnt (psychosis) or if they are experiencing (acute dystonia) and having spasms of their tongue, face, neck, and/or back.

Question 7

Intense effects from haloperidol require rapid intervention with what anticholinergic?

Answer 7

Benztropine

IV or IM short -term for a few months

Question 8

Extrapyramidal early onset symptoms

Parkinsonism is the development of symptoms seen in parkinson’s but due to the effect of haloperidol tx and will appear when after taking the first dose of Haloperidol?

a. 3 weeks
b. multiple days
c. the first 15 minutes
d. first 5 hours

Answer 8

b. multiple days

needs to switch to 2nd generation chlorpromazine

Question 9

Extrapyramidal early onset symptoms

Akathisia is the feeling of inner restlessness and the inability to stay still. Often people feel like they need to crawl out of their own skin. What anticholinergics will help a patient with these affects?

Answer 9

- benztropine
- benzodiazepines
- beta blockers

the three bees

the nurse must also differentiate the akathisia from psychosis that will occur days to months after treatment.

Question 10

Extrapyramidal LATE onset symptoms

Tardive Dyskinesia is the development of facial ticks due to the effect of haloperidol tx and will appear when after taking the first dose of Haloperidol?

a. 3 weeks
b. months to years
c. the first 15 minutes
d. first 5 hours

lip-smacking, tongue thrusting and rapid blinking

Answer 10

b. months to years

Question 11

Tardive Dyskinesia is irreversible and there is no reliable tx. True or false?

Answer 11

True.

Question 12

The nurse knows that a patient taking a high potency drug like haloperidol needs to report what syndrome immediately?

a. fragie x syndrome
b. turner syndrome
c. klinefelter syndrome
d. neuroleptic malignant syndrome (NMS)

Answer 12

d. neuroleptic malignant syndrome (NMS)

DEADLY

rare, but potentially deadly without treatment – report immediately, stop medication immediately

death from RF, Cardio collapse, dyrhysthmias if medication cannot be flushed out of the system

Question 13

If a patient is experiencing “lead pipe” rigidity from NMS the nurse should tx the patient with what?

and autonomic instability

Answer 13

dantrolene

to relax the muscles

Question 14

If a patient is experiencing a sudden high fever from NMS the nurse should tx the patient with what?

Answer 14

cooling blankets, acetaminophen

Question 15

If a patient is experiencing a sweating/diaphorisis from NMS the nurse should tx the patient with what?

Answer 15

fluids

for hydration

Question 16

A first generation antipsychotic drug with low potency used to suppress acute psychotic episodes by blocking D2 receptor and reduce relapse.

also used for emesis, intractable hiccups, and severe behavioral problems in children

Answer 16

chlorpromazine

Question 17

The use of chlorpromazine also blocks acetylcholine, histamine, and norepinephrine actions. true or false?

Answer 17

true

thu can cause seizures and sexual dysfunction

**Anticholinergic **effects – educate patients on minimizing discomfort

Orthostatic hypotension (sympatholytic effects) – in the hospital setting monitor blood pressure before and after dosing

**Sedation **– advise patients to take at bedtime

Question 18

A schizophrenic patient notifies the nurse that they are prone to having seizures. The nurse will question what rx?

a. Haloperidol
b. Chlorpromazine
c. Clozapine
d. Lithium
e. Ivalproex

Answer 18

b. Chlorpromazine

chlorpromazine can lower the threshhold of the patients seizure activity.

Question 19

Which of the following is not a second generation antipsychotic that suppresses psychosis by blocking serotonin (5-HT) receptors?

a. clozapine
b. risperidone
c. labetalol
d. ziprasidone

Answer 19

c. labetalol

Question 20

which of the following has a high risk for agranulocytosis where the nurse must monitor their WBC and ANC to observe early signs of infection?

a. Clozapine
b. Risperidone
c. Ziprasidone

ANC = absolute neutrophil count

Answer 20

a. Clozapine

the nurse must also be aware of orthostatic hypotention when a pt is taking Clozapine, Risperidone, and Ziprasidone.

Question 21

A nurse understands that the main difference between first generation antipsychotics and second generation antipsychotics is the adverse effects they propose.

First generation antipsychotics have EPS while second generation antipsychotics have metabolic effects. What three metabolic effects does the nurse know may occur?

a. weight gain
b. hypothyroidism
c. diabetes
d. dyslipidemia

Answer 21

a. weight gain
c. diabetes
d. dyslipidemia

• Weight gain – baseline and monitoring every 3 months
• Diabetes – baseline fasting glucose and monitoring 12 weeks later, then annually
• Dyslipidemia – baseline fasting lipid levels and monitoring 12 weeks later, then every 5 years

Question 22

Patients taking ziprasidone may have dysrhythmias and experience prolonged QT interval. True or false?

Answer 22

True.

Question 23

NI of Antipsychotic Drugs

Answer 23

• Adherence is critical and sometimes requires monitoring
• Avoid alcohol or other CNS-depressants outside of the hospital setting (opioids, antihistamines, barbiturates, benzodiazepines)
• NOT safe in dementia
• Monitor QT
  Avoid other QT Prolonging Agents (haloperidol, dysrhythmic drugs, tricyclic antidepressants, macrolide antibiotics)
• Monitor potassium and magnesium

Question 24

what is the drug of choice for BPD that a pt can take during a acute manic episode to reduce mania without sedation and can be taken long-term for prophylaxis?

a. Lithium
b. Divalproex
c. Carbamazepine
d. Fluoxetine

works slowly - 5 days to 2 weeks

Answer 24

a. LITHIUM

Question 25

The nurse knows that a pt experiencing most adverse affects of lithium may subside, but a patient may still experience which of the following? a. fine hand tremors b. polyuria c. renal toxicity d. hepatotoxicity

Answer 25

a. fine hand tremors b. polyuria c. renal toxicity

Question 26

Because the nurse knows that lithium has a narrow therapeutic window she will need to monitor what lab value? a. Plasma b. RBC c. WBC d. H & H

Answer 26

a. Plasma ## Footnote - Measured 12 hours after the evening dose - Every 2-3 days, then every 3-6 months

Question 27

**lithium toxicity**

Answer 27

A good plasma level **LESS THAN 1.5** | GREATER THAN 1.5 = HOLD LITHIUM ## Footnote the risk of a high lithium level is increased in patients with **poor kidney function, hyponatremia and dehydration**.

Question 28

lithium adverse effects

Answer 28

L - levels I - increased urination T - thirsty tremors H - air thinning Hypothyroidism I - interactions U - upset stomach M - muscle weakness S - skin affects

Question 29

What are two antiseizure medications used during **acute manic episodes and LONG-TERM for prophylaxis**? They work faster and safer but not as well as lithium. a. Divalproex & Carbamazepine b. Fluoxetine & Venlafaxine c. Imipramine & Phenelzine d. Bupropion & sleep

Answer 29

a. Divalproex & Carbamazepine

Question 30

What medication must the nurse monitor for **thrombocytopenia** and **liver failure** because the patient **must be taken off** this medication if experiencing these symptoms. a. Divalproex b. Fluoxetine c. Imipramine d. Carbamazepine

Answer 30

a. Divalproex

Question 31

What medication must the nurse monitor for **thrombocytopenia** and **liver failure** because the patient **must be taken off** this medication if experiencing these symptoms. a. Divalproex b. Fluoxetine c. Imipramine d. Carbamazepine

Answer 31

a. Divalproex

Question 32

What medication must the nurse monitor for **leukopenia** and **effectiveness of oral birth control**. a. Divalproex b. Fluoxetine c. Imipramine d. Carbamazepine

Answer 32

d. Carbamazepine

Question 33

A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia? a. Loxapine b. Clozapine c. Thiothixene d. Haloperidol

Answer 33

b. Clozapine ## Footnote Second-generation antipsychotics such as clozapine carry a higher risk of serious metabolic effects (eg, diabetes and dyslipidemia) than first-generation antipsychotics (eg, loxapine, thiothixene, and haloperidol). Among the second-generation antipsychotics, the risk of metabolic effects is greatest with clozapine and olanzapine. Clozapine should be used with caution in patients with diabetes.

Question 34

The nurse prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what? a. The range of motion of the upper and lower extremities b. The orthostatic blood pressure measurements c. The abdomen for distention and bowel sounds d. The tympanic membrane with an otoscope

Answer 34

b. The orthostatic blood pressure measurements ## Footnote Antipsychotic drugs promote orthostatic hypotension. The blood pressure and pulses should be checked before dosing and 1 hour afterward. Measurements should be taken while the patient is lying down and again after the patient has been sitting or standing for 1 to 2 minutes. Hypotension is more likely with low-potency first-generation antipsychotics than with high-potency first-generation antipsychotics. Tolerance to hypotension develops after 2 to 3 months.

Question 35

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching? a. “I can take the medication with milk or a snack.” b. “I will call my doctor if I feel hyperactive.” c. “I should drink at least 8 to 10 glasses of water every day.” d. “I will reduce my salt intake while taking this medication.”

Answer 35

d. “I will reduce my salt intake while taking this medication.” ## Footnote Lithium may be taken with milk or food to decrease gastric upset. Feelings of mania should be reported promptly; patients may need a mood stabilizer in addition to lithium. Patients who are taking lithium often experience polyuria and should drink 8 to 10 glasses of water each day. Lithium will accumulate if sodium is restricted in the diet.

Question 36

The nurse prepares to administer lithium to a patient. Which laboratory result should first be assessed? a. Urinary creatinine clearance b. Serum troponin I and T levels c. Fasting blood glucose level d. Serum lipid profile

Answer 36

d. Serum lipid profile ## Footnote Renal function (eg, serum creatinine level, creatinine clearance, urinalysis) should be evaluated before the administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include a complete blood count with differential, serum electrolyte levels, renal function, and thyroid function.

Question 37

Considerations for All Antidepressants

Answer 37

- **symptoms resolve slowly** - Failure when taken 1 month without success - Taper on and taper off – **do not stop abruptly** - Antidepressants have nearly **equal efficacy** - **All may increase suicidal tendencies** (BBW), particularly early on

Question 38

Depression is the second most common psychiatric disorder. True or false.

Answer 38

True. | axiety is #1 ## Footnote 60% of people dont seek help

Question 39

# Selective serotonin reuptake inhibitors (SSRIs) This drug **increases serotonin** only and produces **CNS excitation** and is useful in pts experiencing fatigue. a. Divalproex b. Carbamazepine c. Fluoxetine d. Venlafaxine

Answer 39

c. Fluoxetine

Question 40

# Selective serotonin reuptake inhibitors (SSRIs) This drug **increases serotonin and norepinephrine** and produces **CNS excitation** and is useful in pts experiencing fatigue. a. Menlafaxine b. Imipramine c. Fluoxetine d. Venlafaxine

Answer 40

d. Venlafaxine | So does **IMIPRAMINE**!!! (tricyclic antidepressant) ## Footnote **Duloxetine** is given off label for CHRONIC PAIN

Question 41

Fluoxetine (SSRI), Venlafaxine (SNRI) like mostly all other antidepressants can cause **sexual dysfunction** and weight gain. True or false.

Answer 41

True. ## Footnote take drug holidays by skipping days to take a break

Question 42

Because Fluoxetine (SSRI), Venlafaxine (SNRI) produce CNS exitation, what are some s/s a pt may experience?

Answer 42

**insomnia, agitation, nervousness**

Question 43

A nurse notices a patient experiencing altered *mental staus, autonomic symptoms, and neuromuscular excitation* . She knows the pt is taking antidepressant and St. johns Wort can assume the patient is experiencing what syndrome and has to take what steps to help the patient? ## Footnote **SSRI/SNRI combined with MAOI or St. Johns wort**

Answer 43

**Serotonin syndrome** and **withhold the drug**

Question 44

Because pts sometimes have trouble with **adherence** to medications the nurse knows that **withdrawl syndrome** is not a risk in patients taking antidepressants. True or false.

Answer 44

False. ## Footnote Because pts sometimes have trouble with adherence to medications the nurse knows that **withdrawl syndrome is a risk in patients taking antidepressants**.

Question 45

A patient who is **pregnant** should know that an adverse effect of what two drugs is **persistent pulmonary hypertension** that poses a risk for cognitive delay or death in the neonate? a. Fluoxetine & Venlafaxine b. Imipramine & Phenelzine c. Bupropion & Lorazepam d. Zolbidem & Secobarbital

Answer 45

a. Fluoxetine & Venlafaxine

Question 46

Older patients, those with history of GI ulcers or bleeding, and those on antiplatelets/anticoagulants should be aware that what two medications pose a risk for **GI Bleeding**? a. Fluoxetine & Venlafaxine b. Imipramine & Phenelzine c. Bupropion & Lorazepam d. Zolbidem & Secobarbital

Answer 46

a. Fluoxetine & Venlafaxine

Question 47

**citalopram greater than 40mg/day**

Answer 47

can cause dysrhythmias

Question 48

Since **Imipramide** secondarily blocks cholinergic and histamine receptors the nurse the knows the patient may experience **orthostatic hypotension**, **anticholinergic effects,** **sedation** and **cardiac toxicity**. True or false.

Answer 48

True. ## Footnote **Orthostatic Hypotension** NI: - slow position changes, monitor BP & HR **Anticholinergic Effects** NI: - Blurred vision – cautious with dangerous activity - Urinary Retention – Increase fluid intake - Dry Mouth – Sugar free candy - Constipation – increased fiber **Sedation** (antihistamine) NI: - avoid hazardous activities, take at night **Cardiac toxicity** NI: - baseline ECG

Question 49

# Monoamine oxidase inhibitors (MAOIs) This drug **increases serotonin, norepinephrine and dopamine** and by preventing their breakdown through MOA. a. Phenelzine b. Imipramine c. Fluoxetine d. Venlafaxine

Answer 49

a. Phenelzine ## Footnote AE: CNS stimulation and orthostatic hypotension

Question 50

A pt taking **Phenelzine** needs to avoid **tyramine rich foods and all other drugs** to avoid a **hypertensive crisis**, which of the following foods does the patient need to avoid? a. overripe vegetables and fruits b. potatoes c. rice d. fermented, smoked, or aged meats or fish e. cheese f. alcohol

Answer 50

a. overripe vegetables and fruits d. fermented, smoked, or aged meats or fish e. cheese f. alcohol ## Footnote Avoid fermented, pasteurized, aged foods bc they are thyramine rich and cause Severe headache, Tachycardia, Hypertension, N/V, Confusion, Sweating Profusely.

Question 51

Bupropion can cause weight gain, sexual dysfunction because they decrease norepinephrine and dopamine. True or false?

Answer 51

**False** ## Footnote Bupropion **DOES NOT** cause *weight gain or sexual dysfunction* and **INCREASES** *norepinephrine* and *dopamine*. PT NEED TO BE ON LESS THAN 450MG/DAY TO AVOID **SEIZURES**

Question 52

# Nonconventional Agents Esketamine

Answer 52

Nasal spray form of ketamine

Question 53

# Nonconventional Agents Psilocybin

Answer 53

Magic Mushrooms

Question 54

A patient with depression has been prescribed fluoxetine. Which statement made by the patient indicates an understanding of the medication teaching? a. “Disorientation and hallucinations are common.” b. “The drug may enhance my interest in sex.” c. “It may take 3 to 4 weeks before my mood is elevated.” d. “I can stop this medication when I feel less depressed.”

Answer 54

c. “It may take 3 to 4 weeks before my mood is elevated.” ## Footnote The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (eg, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (eg, dizziness, headache, nausea, tremor, anxiety, and dysphoria).

Question 55

A patient is prescribed isocarboxazid for the treatment of depression. Which foods should the patient be taught to avoid? a. Broccoli, shrimp, and yogurt b. Tomatoes, chicken, and milk c. Bananas, smoked fish, and cheese d. Apples, steak, and cottage cheese

Answer 55

c. Bananas, smoked fish, and cheese ## Footnote Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

Question 56

A patient is prescribed doxepin for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid? a. Glucosamine sulfate b. Omeprazole c. Fish oil (omega-3 fatty acids) d. Diphenhydramine

Answer 56

d. Diphenhydramine ## Footnote Drugs that are capable of blocking muscarinic receptors will enhance the anticholinergic effects of doxepin and other tricyclic antidepressants. The nurse should warn patients against the concurrent use of other anticholinergic drugs such as scopolamine, antihistamines, and phenothiazines. Diphenhydramine is an antihistamine.

Question 57

The nurse teaches a patient about bupropion. Which statement by the patient should the nurse question? a. “I can take the drug with food to reduce nausea.” b. “This drug will increase my interest in sex.” c. “I may experience decreased appetite and weight loss.” d. “I had a serious head injury 3 years ago.”

Answer 57

d. “I had a serious head injury 3 years ago.” ## Footnote Bupropion is generally well tolerated, but it can cause seizures. Therefore, bupropion should be avoided in patients with prior head trauma, because their risk for seizures is increased. Bupropion does not cause weight gain or sexual dysfunction, and it appears to increase sexual desire and pleasure. Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset.

Question 58

*Lorazepam* **enhances GABA activity** that helps to inhibit nerve impulses, but adversely can cause **CNS, IV respiratory, cardiac, and blood pressure depression**. True or false?

Answer 58

True. ## Footnote a pt should be **tapered off** this drug - **IV **can be** fatal**

Question 59

What is the antidote for (Lorazepam) a type of **Benzodiazepines**?

Answer 59

**Flumazenil**

Question 60

**Zolpidem** is used for insomnia to help people fall asleep, but adversely cause **sleep-related complex behaviors**. True or false.

Answer 60

True.

Question 61

# Barbiturates This drug is used for seizures and anesthesia by **increasing GABA effects** by binding and holding the channel open, but are very dangerous because they have no ceiling. a. Lorazepam b. Zolbidem c. Secobarbital d. Ramelteon

Answer 61

c. secobarbital | *ital*

Question 62

Ra**melteon**

Answer 62

- Hypnotic used for insomnia to help falling asleep Mechanism of Action: **Melatonin** receptor agonist

Question 63

Blocks orexin to promote falling & staying asleep a. Zolbidem b. Secobarbital c. Ramelteon d. Suvorexant ## Footnote orexin = tells the body to wake up, promotes the state of wakefulness

Answer 63

d. Suvorexant

Question 64

Types of Anxiety Disorders

Answer 64

- **Generalized anxiety disorder**: uncontrollable worrying (>6 months) - **Panic disorder**: panic attacks - **Obsessive-compulsive disorder**: obsessions/compulsions consuming >1 hour per day - **Social anxiety disorder** (social phobia): irrational fear of situations that might bring scrutiny, embarrassment, or humiliation - **Post-traumatic stress disorder**: anxiety surrounding a traumatic event

Question 65

The nurse instructs a young adult patient about triazolam for the short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of the instructions? a. “The medication will not affect my breathing.” b. “I can safely drink wine while taking this drug.” c. “My chance of addiction to this drug is high.” d. “This drug is safe to use if I am pregnant.”

Answer 65

a. “The medication will not affect my breathing.” ## Footnote The use of oral benzodiazepines does not cause respiratory depression unless they are used with opioids, barbiturates, or alcohol. Patients who are taking benzodiazepines should be warned to abstain from alcohol. The chance of addiction to triazolam is low. Triazolam should not be taken during pregnancy.

Question 66

A patient is brought to the emergency department for the treatment of an overdose of alprazolam. Which medication should the nurse prepare to administer to this patient? a. Protamine sulfate b. Acetylcysteine c. Naloxone d. Flumazenil

Answer 66

d. Flumazenil ## Footnote Flumazenil, which is a benzodiazepine receptor antagonist, can be used to treat benzodiazepine overdose. Protamine sulfate is the antidote for heparin overdose, acetylcysteine is the antidote for acetaminophen overdose, and naloxone is the antidote for opioid overdose.

Question 67

A patient is prescribed venlafaxine and requests information about the medication. Which response by the nurse is most appropriate? a. “You will need to talk with the doctor about that.” b. “I will get you a pamphlet so that you can read about the drug.” c. “Call your pharmacist, because he or she will know the most about this drug.” d. “Venlafaxine is used to treat anxiety and depression.”

Answer 67

d. “Venlafaxine is used to treat anxiety and depression.” ## Footnote Venlafaxine [Effexor XR] is used to treat anxiety and depression.

Question 68

The nurse provides teaching for a patient with obsessive-compulsive disorder who has been prescribed Sertraline. Which statement by the patient indicates that more teaching is necessary? a. “I may develop headaches and trouble sleeping.” b. “I will feel better in 3 weeks.” c. “I need to take this medication for at least a year.” d. “I should watch my diet so that I don’t gain weight.”

Answer 68

b. “I will feel better in 3 weeks.” ## Footnote Beneficial effects of sertraline develop slowly over several months to become maximal. Common side effects include nausea, headache, insomnia, and sexual dysfunction. Weight gain can also occur. Treatment lasts for at least a year, and a trial discontinuation is conducted.

Question 69

The nurse is caring for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety? a. Fluvoxamine b. Paroxetine c. Sertraline d. Clonazepam

Answer 69

D. Clonazepam ## Footnote Benzodiazepines (such as clonazepam and alprazolam) provide immediate relief of anxiety and can be used as needed for intense anxiety. Selective serotonin reuptake inhibitors (SSRIs) are first-line drugs for most patients with social anxiety disorder, and they are especially well suited for patients who fear multiple situations and are obliged to face those situations on a regular basis. Currently, only three SSRIs (fluvoxamine, paroxetine, and sertraline) are approved for social anxiety disorder. Initial effects take about 4 weeks to develop; optimal effects are seen in 8 to 12 weeks.

Question 70

# Nonbenzodiazepine-Nonbarbiturate **Burspirone**

Answer 70

**NON sedating**