ATI CH 11 Mental Health

Question 0

Name some CNS stimulant drugs.

Answer 0

methylphenidate.       ( Ritalin,Methylin)
Dexmethylphenidate (Focalin)
Dextroamphetamine (Dexedrine) 
Amphetamine mixture ( adderall)
Lisdexamfetamine

Question 1

What are medications for children and adolescents with mental health issues?

Answer 1

Tricyclic antidepressants
Nonbarbiturate anxiolytics
CNS stimulants
Norepinephrine selective reuptake inhibitors

Question 2

For CNS stimulants such as methylphenidate, dexmethylphenidate, dextroamphetamine, amphetamine mixtures and Lisdexamfetamine, what is the expected pharmacological action?

Answer 2

These meds raise the levels of norepinephrine, serotonin, and dopamine into the CNS.

The therapeutic uses of these meds are ADHD, conduct disorder

Question 3

What are adverse effects of CNS stimulants?

Answer 3

CNS stimulation( insomnia, restlessness)
Wt. loss
Cardiovascular effects ( HTN, angina, dysrhythmias) may increase the risk of sudden death in clients who have heart abnormalities.
Development of psychotic manifestations such as hallucinations, paranoia.
Withdrawal reaction
Hypersensitivity skin reaction to transdermal methylphenidate ( rash, hives)

Question 4

CNS stimulant drugs are contraindicated in clients who…..

Answer 4

Who have a history of substance use disorder, cardiovascular disorders, severe anxiety and psychosis.

Question 5

What are medication food interactions of CNS stimulant drugs?

Answer 5

Concurrent use w/ MAOI’s may cause hypertensive crisis
Concurrent use of caffeine may increase CNS stimulants
Methylphenidate inhibits metabolism of phenytoin, warfarin, and Phenobarbitol, leading to increased serum levels.
OTC cold and decongestant meds with sympathomimetic action can increase CNS stimulants.

Question 6

What should a nurse educate a client to do with sustained release tablets?

Answer 6

Advise clients to swallow the tablets WHOLE and to not chew or crush the tablets.

Question 7

What should the nurse educate a client to do with a transdermal medication( Daytrana)?

Answer 7

Advise the client to place the patch on one hip daily in the morning and leave in place no longer than 9 hr.
Alternate hips daily.

Question 8

What should nurses educate parents about regarding ADHD?

Answer 8

Instruct parents that ADHD is not cured by medication.
Management with an overall treatment plan that includes family therapy and cognitive therapy will improve outcomes.
Advise parents that these meds have a high potential for development of a substance use disorder, especially in adolescents.

Question 9

What is the prototype drug of norepinephrine selective reuptake inhibitors?

Answer 9

atomoxetine (Straterra)

Pharmacological action: block reuptake of norepinephrine at synapses in the CNS. atomoxetine in NOT a stimulant medication.

Therapeutic uses: ADHD

Atomoxetine is usually tolerated well with minimal adverse effects.

Question 10

What are adverse effects of atomoxetine?

Answer 10

Appetite suppression, wt. loss, growth supression
GI effects (nausea and vomiting)
Suicidal ideation ( in children and adolescents)
Hepatoxicity

Question 11

What are contraindications & precautions regarding atomoxetine?

Answer 11

Use cautiously in clients who have cardiovascular disorders.

Question 12

What are medication food interactions of atomoxetine?

Answer 12

Concurrent use of MAOI’s may cause hypertensive crisis.
paroxetine (Paxil), fluoxetine (Prozac), or quinidine fluconazole ( Quinidine dura tabs) inhibit hepatic metabolizing enzymes, thereby increasing levels of atomoxetine.

Question 13

How should a nurse administer the doses of atomoxetine?

Answer 13

Administer the medications in a daily dose in the morning, or in 2 divided doses, morning and afternoon with or without food.
Instruct clients that therapeutic effects may take 1-3 weeks to fully develop

Question 14

What is the prototype drug of Tricyclic antidepressant?

Answer 14

desipramine (Norpramine)

Other medications:
imipramine ( Tofranil)
clomipramine ( Anafranil)

Question 15

What are expected pharmacological actions of TCA’s?

Answer 15

These medications block reuptake of the monoamine neurotransmitters norepinephrine, and serotonin in the synaptic space, thereby intensifying the effects these neurotransmissions produce.

Question 16

What are the therapeutic uses for TCA’s in children?

Answer 16

Depression
Autism spectrum disorder
ADHD
Panic, school phobia, separation anxiety disorder
OCD

Question 17

What are complications/ adverse effects of TCA’s?

Answer 17

Orthostatic hypotension
Anticholinergic effects
Weight gain
Sedation 
Toxicity resulting in cholinergic blockade and cardiac toxicity AEB dysrhythmias, mental confusion, and agitation, followed by seizures and coma.
Decreased seizure threshold 
Excessive sweating ( diaphoresis)

Question 18

What are the symptoms of anticholinergic effects and how can a pt. Treat the symptoms.?

Answer 18

Dry mouth..can b relieved by chewing sugarless gum
Blurred vision…can b relieved by avoiding hazardous activities
Photophobia…can b relieved by wearing sunglasses outdoors.
Urinary hesitancy/ retention…can b relieved by void just before taking meds and drinking more fluids.
Constipation can be relieved by eating foods high in fibers
Tachycardia….participate in regular exercise

Question 19

What are contraindications and precautions to consider while taking TCA’s?

Answer 19

Use cautiously in clients who have seizure disorders, diabetes, liver and respiratory disorders, and hyperthyroidism.

Question 20

What are medication/ food interactions of TCA’s?

Answer 20

Concurrent use of monoamine oxidase inhibitors causes hypertension
Antihistamines and other cholinergic agents have additive anticholinergic effects.
TCA’s block uptake of epinephrine and norepinephrine ( direct acting sympathomimetics)in the synaptic space, leading to decreased intensity to their effects.
TCA’s inhibit uptake of ephedrine and amphetamine ( indirect acting sympathomimetics) and reduce their ability to get to the site of action in the nerve terminal, leading to decreased responses to these medications.
Alcohols, benzodiazepines, opioids and antihistamines cause additive CNS depression when used concurrently.

Question 21

What is the prototype drug of alpha2-adrenergic agonists?

Answer 21

guanfacine ( Imtuniv)

Other medications: clonidine ( Kapvay)

**Used for ADHD

Question 22

What is the expected pharmacological action of alpha 2 adrenergic agonists?

Answer 22

The action of alpha2 adrenergic agonists is not completely understood however they are known to activate presynaptic alpha2 adrenergic receptors within the brain.

Used for ADHD

Question 23

What are adverse effects of alpha2 adrenergic agonists?

Answer 23

CNS effects( sedation, drowsiness, fatigue)
Cardiovascular effects ( hypotension, bradycardia) 
Weight gain

Question 24

What are contraindications and precautions of alpha2 adrenergic agonists?

Answer 24

Extended release clonidine is contraindicated for children less than 6yrs old.
Use cautiously in clients who have cardiac disease.

Question 25

What are medication / food interactions of alpha2 adrenergic agonists?

Answer 25

CNS depressants, including alcohol, can increase CNS effects
Antihypertensives can worsen hypotension
Foods with high fat content will increase guanfacine absorption.

Question 26

What is the prototype drug of atypical antidepressants?

Answer 26

risperidone (Risperidone)

Other medications:
olanzapine (Zyprexa)

Question 27

What is the expected pharmacological action of atypical antidepressants?

Answer 27

These antipsychotic agents work mainly by blocking serotonin and to a lesser degree, dopamine receptors for norepinephrine, histamine and acetylcholine.

Question 28

What are the therapeutic uses of atypical antipsychotic drugs?

Answer 28

Autism spectrum disorder
Conduct disorder
PTSD
Relief of psychotic manifestations

Question 29

What are complication/adverse effects of atypical antipsychotics?

Answer 29

New onset of diabetes or loss of glucose control in pt.who have diabetes
Wt. gain
Hypercholesterolemia w/ increased risk for HTN and other cardiovascular diseases.
Orthostatic hypotension
Anticholinergic effects
Agitation, dizziness, sedation, and sleep disruption
May cause mild extrapyramidal adverse effects such as tremor.

Question 30

For a pt. With an adverse effect of hypercholesterolemia with increase risk of hypertension and other cardiovascular diseases what should a nurse do?

Answer 30

Monitor cholesterol, triglycerides and blood glucose if wt gain is more than 14 kg ( 30lb)

Question 31

What are contraindications and precautions to consider when a client is taking atypical antipsychotics?

Answer 31

Use cautiously in clients who have cardiovascular disease, seizures or diabetes mellitus. Obtain baseline fasting glucose for clients who have diabetes mellitus and monitor carefully.

Question 32

What are medication/ food interactions for atypical antipsychotics?

Answer 32

Alcohol, opioids, and antihistamines cause additive CNS depressant effects.
By activating dopamine receptors, levodopa counteracts effects of antipsychotic agents
TCA’s amiodarone ( Cordarone) and clarithromycin ( Biaxin) prolong QT intervals and thus increases the risk of cardiac dysrhythmias.
Barbituates and phenytoin ( Dilantin) promote hepatic drug metabolizing enzymes, thereby decreasing drug levels of quetiapine.
Medications that inhibit CYP3A4, such as fluconazole (Diflucan) inhibit hepatic drug metabolizing enzymes

Question 33

What is a nursing administration to consider when a giving atypical antipsychotics?

Answer 33

Administer by ORAL or IM route.

risperidone is avail in an oral solution and quick dissolving tablets for ease of administration.

Olanzapine is avail in an orally disintegrating tab for ease of administration.

Question 34

A nurse is teaching the parents of a child who has a new prescription for desipramine ( Norpramin) about possible adverse effects. The nurse should instruct the parents that what adverse effect is the highest priority to report to the provider?

Answer 34

Confusion is an indication of toxicity which is greatest risk to the client.

Question 35

A nurse is teaching an adolescent client who has a new prescription for clomipramine (Anafranil) for OCD. what should the nurse teach the client in order to minimize an adverse effect of his medication?

Answer 35

Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use.

Question 36

A nurse is caring for a school age child who recently began a prescription for atomoxetine (Straterra). What possible complication should the nurse monitor with the child?

Answer 36

Liver damage is a potential complication of atomoxetine. The nurse should monitor for manifestations such as jaundice, upper abdominal tenderness, darkening of urine, and elevated liver enzymes.

Question 37

A nurse is caring for a school age child,who,has a new prescription for methylphenidate ( Concerta) to treat ADHD. What should the nurse teach the client and family about this medication?

Answer 37

Take this med orally once daily in the morning.

Question 38

A nurse is teaching a school age child and his parents about a new prescription for Lisdexamfetamine dimesylate ( Vyvanse). What is appropriate for the nurse to include in the teaching?

Answer 38

An adverse effect of this med is CNS stimulation…such as insomnia and restlessness

Monitor BP while taking this med….due to the cardiovascular effects of VyVanse.

This med raised the level of dopamine into the brain… This med works by raising the levels of norepinephrine, serotonin and dopamine into the CNS.