ATI mental health meds

Question 1

Mood stablizer used for Bipolar mania & depression. Narrow therapeutic range

Answer 1

Lithium carbonate

Question 2

lithium common adverse effects

Answer 2

diarrhea, N/V, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy

Question 3

Lithium toxicity symptoms:

Answer 3

mental confusion, sedation, coarse tremors, extreme polyuria (dilute urine), jerking movements, blurred vision, tinnitus, coma, convulsions

Question 4

lithium therapeutic range and level for toxicity:

Answer 4

therapeutic = 0.6-1.2
toxic = >1.5

Question 5

lithium complications and nursing action:

Answer 5

-Gi distress (administer meds with -meals)
-fine hand tremors (an increase means toxicity)
-polyuria, thirst (maintain good fluid intake)
- weight gain (exercise regimen)
- renal toxicity (assess baseline kidney labs)
- hypothyroidism (monitor for cold, dry skin, decreased HR, weight gain)
-hypotension/electrolyte imbalance (maintain adequate fluid and sodium intake)

Question 6

do not administer these meds with Lithium:

Answer 6

diuretics, NSAIDS, anticholinergics

Question 7

class of antidepressant that inhibits reuptake of serotonin. used for depression, anxiety, OCD and eating disorders

Answer 7

SSRI

Question 8

common SSRI meds:

Answer 8

sertaline (Zoloft)
citalopram (Celexa)
escitalopram (lexapro)
paroxetine (Paxil)
fluoxetine (Prozac)

Question 9

commons SSRI side effects

Answer 9

sexual dysfuntion, weight gain, insomnia, GI distress

Question 10

serotonin syndrome symtoms:

Answer 10

agitation, mental changes, delirium, hallucinations, seizures, tachycardia, labile BP, diaphoresis, fever, hyperreflexia, difficulty walking, N/V, coma leading to apnea

Question 11

SSRI nursing considerations:

Answer 11

-up to 4 weeks for therapeutic effect
-take med in morning (sleep disturbances)
-do not use with MAOIs, TCAs, or St. John’s wort (serotonin syndrome)
-increased risk for suicide! watch for increased energy
- TAPER! (withdrawal syndrome)
-NO paroxetine if PREGNANT
-risk for bleeding if taken with NSAIDs an d anticoagulants

Question 12

class of antidepressant that inhibits reuptake of serotonin AND norepinephrine. for major depression, panic disorders, generalized anxiety

Answer 12

SNRIs

Question 13

common side effects SNRI’s

Answer 13

nausea, insomnia, weight gain, diaphoresis, sexual dysfunction

Question 14

nursing considerations for SNRI’s

Answer 14

• all SNRI’s are teratogenic
  -up to 4 weeks for therapeutic effect
• do not take with MAOIs or St. John’s Wort
  -no duloxetine for liver disease or alcoholics
  -TAPER!
  -CNS depression with alcohol, opiods, antihistamines, sedatives
  -do not take NSAIDS or anticoagulants – monitor for bleeding

Question 15

common tricyclic antidipressants:

Answer 15

ammitripyline

Question 16

education for amitriptyline

Answer 16

• therapeutic effects can take several weeks
  -orthostatic hypotension (change positions slowly)
  -anticholinergic effects - chew gum, increase fluid intake, high fiber diet

Question 17

class of antidepressant that blocks monoamine oxidase. used for depression

Answer 17

MAOi

Question 18

MAOI client education

Answer 18

-risk of hypertension crisis! avoid foods with tyramine (ripe avocado, figs, fermented/smoked meats, liver, dried/cured fish, most cheese, beer and wine, protein supplements)
- avoid all OTC meds without talking to provider first – do not take with decongestants (pseudoephedrine)
-discontinue for 2 WEEKS prior to starting other antidepressants

Question 19

symptoms of hypertensive crisis from MAOIs:

Answer 19

headache, stiff neck, N/V, fever, dilated pupils

Question 20

common MAOIs:

Answer 20

phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)

Question 21

common Tricyclic antidepressants

Answer 21

amitriptyline, amoxapine, clomipramine, protriptyline, nortriptyline

Question 22

class of anxiety medication used for short term treatment. increases GABA. used for generalized anxiety, alcohol withdrawal, insomnia, seizure disorders, amnesia prior to surgery

Answer 22

benzodiazepines

Question 23

common benzodiazepines:

Answer 23

alprazolam (xanax)
diazepam (valium)
lorazepam (ativan)
chlordiazepoxide
clorazepate
oxazepam
clonazepam (klonopin)

Question 24

benzodiazepam complications/contraindications/precautions

Answer 24

-CNS depression! it is a sedative!! (avoid alcohol, avoid hazardous activities, long half-life) FLUMAZENIL is antidote
-withdrawal effects (TAPER! after regular use)
- risk for dependence/substance abuse
-risk for falls
- teratogenic

Question 25

antidote to benzodiazepines

Answer 25

flumazenil

Question 26

atypical anti-anxiety medication that is a non-sedative and good for long term use

Answer 26

Buspirone

Question 27

mood-stablilizing anti-epileptic meds that treat bipolar disorders: (3)

Answer 27

carbamazepine
Valproate
Lamotrigine

Question 28

carbamazepine complications and teaching

Answer 28

-CNS effects (nystagmus, double vision, vertigo, staggering gait, headache)
-blood dyscrasias (leukopenia, thrombocytopenia, anemia). – MONITOR FOR INFECTION! and bruising/bleeding!
-skin disorders – dermatitis and steven johnson syndorme (wear sunscreen)
-hypo-osmolarity (risk for fluid overload! monitor sodium, edema, hypertension, i&Os)
-do not use when pregnant
-use alternative form of birth control
- no grapefruit juice (inhibits metabolism of drug)

Question 29

lamotrigine complications and teaching

Answer 29

-SKIN RASH! (steven johnson syndrome)
-blurred vision, dizziness, N/V
-use alternate form of birth control

Question 30

Valproate complications/ teaching

Answer 30

-LIVER toxic! monitor liver function (AST, ALT, LDH)
-pancreatitis
-thrombocytopenia (low platelets, watch for bruising)
- do not take if pregnant
- gi effects (nausea, vomiting, indigestion)

Question 31

first generation anti-psychotics that treat schizophrenia, manic phase of bipolar, acute/chronic psychotic disorders

Answer 31

haloperidol (haldol)
fluphenazine
loxapine
thiothixene
perphenazine

Question 32

complications of first-generation anti-psychotics

Answer 32

-agranulocytosis (watch for infection!)
- anticholinergic (maintain fluid intake, gum, sunglasses for photophobia, high fiber diet)
-EPS effects (acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia)
-neuroleptic Malignant syndrome (NMS)
-orthostatic hypotension
-sedation
-seizures
-dysrhythmias
-sexual dysfunction
-photosensitivity
-liver impairment

Question 33

extrapyramidal symptoms:

Answer 33

-acute distonia
-pseudoparkinsonism
-akathisia
-tardive dyskinesia

Question 34

what is acute dystonia

Answer 34

severe spasm of the tongue, neck, face, back

Question 35

what is acute pseudoparkinsonism

Answer 35

bradykinesia, rigidity, shuffling gait, drooling, tremors, mask-like face

Question 36

what is akathisia

Answer 36

inability to sit/stand still, pacing, agitation

Question 37

what is tardive dyskinesia?

Answer 37

LATE EPS - involuntary movement of tongue and face, arm, legs, and trunk. lip smacking

Question 38

neuromalignant syndrome (NMS)

Answer 38

adverse effect of first generation anti-psychotics.
medical emergency!

sudden, HIGH fever
blood pressure fluctuations
diaphoresis
tachycardia
muscle rigidity
decreased LOC
coma

Question 39

nursing actions for NMS

Answer 39

stop medication
monitor vitals
cooling blanket
antipyretic
administer muscle relaxant and antiarrhythmia

Question 40

atypical antipsychotics that treat positive and negative symptoms of schizophrenia

Answer 40

risperidone
asenapine
clozapine
iloperidone
lurasidone
olanzapine
paliperidone
quetiapine
ziprasidone
aripiprazole

Question 41

second generation psychotics complications:

Answer 41

-agranulocytosis (watch for infection!)
-metabolic syndrome (new onset of diabetes and loss of glucose control)
- orthostatic hypotension
-anticholinergic effects
- mild EPS (tremors)
- elevated prolactin levels
- sexual dysfunction
-agitation, dizziness, sedation, sleep disruption

Question 42

a medication that counteracts these extrapyramidal symptoms

Answer 42

Benztropine

Question 43

patient teaching for disulfiram for management of alcohol dependence

Answer 43

read all labels! do not consume anything with alcohol, even trace amounts

Question 44

medication for a client who has moderate to severe Alzheimer’s disease. an NMDA receptor agonist, is shown to slow the progression of manifestations and to improve cognitive function.

Answer 44

Memantine

Question 45

med used to prolong the client’s ability to function in the early stages of the alzheimer’s. administer this medication at bedtime to reduce the risk for injury due to bradycardia and syncope.

Answer 45

donepezil