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Pharm > Drugs Affecting Mental Health > Flashcards

Drugs Affecting Mental Health Flashcards

1
Q

All drugs manipulating neurotransitters in some way to treat disorder
Chemical messengers of NS
neurotransitters Exert actions through receptors in postsynaptic membrane; goals: increases/decrease neurotransitters in cleft; altering levels neurotransitters lot AE
Interaction of transmitter/receptor results in specific physiologic response
Rapid removal of transmitter needed to maintain precise control of neural transmission - body good at it
All drugs used treat mental disorders - not abruptly d/c - taper off
Receptors named for type of neurotransmitter with which they interact

A

Basic concepts neurophysiology: communication neurotransmitters

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2
Q

Neurotransmitters, neuromodulators, neurotrophic or nerve growth factors

A

Chemical messengers of NS

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3
Q

Enables muscle action, learning and memory

A

Acetylcholine

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4
Q

Influences movement, learning, attention and emotion

A

Dopamine

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5
Q

Affects mood, hunger, sleep, arousal

A

Serotonin

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6
Q

Helps control alertness and arousal

A

Norepinephrine

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7
Q

A major inhibitory NT

A

Gamma- aminobutyric acid (GABA)

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8
Q

Major excitatory NT; involved in memory

A

Glutamate

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9
Q

Pharmacological treatment for mental health and neuro disorders (discussed in this class) modulate neurotransmitters
Result in inhibition or excitation of the CNS
Adverse effects are often primary (related to action of medication; too much medication)
Medications discussed should not be discontinued abruptly if taken scheduled - tapered off - really sick if just d/c med; high risk for seizures if for seizures

A

Mental health and neuro pharmacology

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10
Q

Break cycle anxiety and restore functining
Unpleasant reaction to stimulus
Feelings of:
Treatment goal:
Clinical manifestations (SNS):
Mild anxiety:
Overwhelming or severe:

A

Anxiety

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11
Q

Actual or unknown

A

Unpleasant reaction to stimulus - Anxiety

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12
Q

Tension
Nervousness
Apprehension
Fear

A

Feelings of: - Anxiety

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13
Q

Break feelings
Restore functioning

A

Treatment goal: - Anxiety

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14
Q

Sweating
Tachycardia
Rapid breathing
Elevated BP

A

Clinical manifestations (SNS): - Anxiety

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15
Q

Helpful in certain situations

A

Mild anxiety: - Anxiety

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16
Q

Concerning
Interfere with functioning

A

Overwhelming or severe: - Anxiety

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17
Q

Depress activity of CNS through GABA receptors (inhibitory neurotransmitter) - slow down to decrease anxiety)

A

MoA: - Gen: benzodiazepines

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18
Q

Pregnancy (X - cross barrier)/lactation - AE happen in mom and baby; COPD (get problematic - decrease resp drive CO2 retainers not lot reserve be cautious when admin meds that cause resp depression); older adults

A

Contraindications: - Gen: benzodiazepines

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19
Q

Schedule IV (lower risk for dependence and abuse, careful with admin and doc since is scheduled drug); CNS depressants: alcohol, opioids (higher risk for CNS and resp depression), others

A

Black Box Warning: - Gen: benzodiazepines

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20
Q

CNS depression - slow down activity brain to break manifestations of anxiety - reacts certain way/too much med can have this, major one monitor for; Overdose: respiratory depression, coma - slow down CNS slow down resp sys so imp monitor for this

A

AE: - Gen: benzodiazepines

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21
Q

Caution with IV route: higher risk for AE; Long term use must taper discontinuation (withdrawal syndrome); some addictive properties but lower than seen with opioids

A

Nursing: - Gen: benzodiazepines

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22
Q

anxiety disorders, acute agitation, acute alcohol withdrawal, pre-operative sedation

A

Use: - Benzodiazepines: Prototype: lorazepam (Ativan)

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23
Q

oral or IVP (rate 2 mg/min)

A

Route: - Benzodiazepines: Prototype: lorazepam (Ativan)

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24
Q

drowsiness, dizziness, lethargy, fatigue, hypotension; overdose: respiratory depression (more common when taken with other CNS depressants)

A

AE: - Benzodiazepines: Prototype: lorazepam (Ativan)

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25
Q

Fall risk - anytime CNS depressant high fall risk - drowsy easier and fall easier

A

Nursing: - Benzodiazepines: Prototype: lorazepam (Ativan)

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26
Q

Assessment
Interventions
Evaluation

A

Nursing care plan: benzodiazepines

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27
Q

Focus on neuro and respiratory (major AE) - adequate baseline imp; VS

A

Assessment

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28
Q

Give parenteral only if oral forms are not feasible/available - try oral if can
Taper dose after long term therapy
Fall risk
Teach client: drug name, dose, AE, non-pharm therapy for anxiety, can make them drowsy - avoid operating heavy machinery until know how react to med

A

Interventions

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29
Q

Therapeutic response, AE, teaching, compliance

A

Evaluation

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30
Q

Benzodiazepines would not be beneficial in which situation?
A.A client with extreme fear
B.A client with moderate anxiety
C.A client who is a truck driver
D.A client who is experiencing stress

A

Answer: C
Rationale: Benzodiazepines can cause drowsiness which is problematic for a truck driver. Benzodiazepines are indicated to treat fear, anxiety and stress.

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31
Q

The nurse is caring for a client prescribed lorazepam. When reviewing the client’s medication list, what other medication causes the most concern for the nurse?
A.Oxycodone/Morphine
B.Lisinopril
C.Ondansetron
D.Metoprolol

A

Answer: A
Sedation and resp depression - ondansetron causes sedation; benzo can lower BP - concerning with antihypertensives but more concerned with sedation and resp depression
Rationale: Opioids are the most concerning due to their ability to also cause sedation and respiratory depression. There is a black box warning regarding the drug-drug interaction between benzodiazepines and opioids. Although antihypertensives like lisinopril and metoprolol could increase the risk for hypotension, this is less concerning than respiratory depression. Ondansetron could increase the risk for drowsiness and hypotension, but most patients are taking it on a PRN basis and the risks to the client are lower than that of opioids.

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32
Q

Imbalance of neurotransmitters and drugs trying to restore that
Inhibit effects of monoamine oxidase (monoamine oxidase is an enzyme breaks down neurotransmitters - so not broken down and more available for use)
Block reuptake of neurotransmitters back to neurotransmitter released them; less neurotransmitters available to exert effect on next neurotransmitters in cleft
Regulate receptor sites and/or breakdown - helping increase receptor sites available for neurotransmitters and/or breakdown allowing more regardless type drug give
Goal: More neurotransmitter in synaptic cleft

A

Depression: drug therapy

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33
Q

Indication: depression (Allow 4-6 weeks for therapeutic effect); some off-label uses: fibromyalgia
Black box warning: Increased risk for suicidal ideation when start them (esp. children and young adults)
Contraindications: Pregnancy (X - cross barrier)/lactation - excreted in milk; seizure disorders - increases risk for underlying seizures
Caution: older adult more susceptible to AE - esp anticholinergic
Drug-drug: More than 1 antidepressant increases risk for AE and serotonin syndrome; Serotonergic drugs - increase serotonin levels: fentanyl, St. John’s Wort
Serotonin syndrome: Initiation, increased dose, or overdose on drug; usually self-limiting after discontinuing drug; multiple antidepressants - more on higher risk; first line treatment stop drug and monitor; severe: dialysis

A

Gen: antidepressants

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34
Q

Delirium
Agitation - imp monitor for in combo
Tachycardia/HTN
Sweating - imp monitor for in combo
Clonus (muscle spasms) - imp monitor for in combo
Hyperreflexia - imp monitor for in combo
Tremors - imp monitor for in combo
Shivering

A

Common: - most self-limiting
- Serotonin syndrome CM

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35
Q

Hyperthermia
Seizures
Rhabdomyolysis
Renal failure
Cardiac dysrhythmias

A

Severe: - Serotonin syndrome CM

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36
Q

Tricyclic
MAOI’s
More significant and severe adverse effects
Toxicity lethal
Pregnancy Category D/X

A

First generation - Antidepressant classifications

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37
Q

SSRI
SNRI
More tolerable adverse effects, but still bothersome - same AE but much less severe
Usually first line treatment - sim efficacy but more tolerable because AE not as severe
Pregnancy Category C

A

Second generation - Antidepressant classifications

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38
Q

Orthostatic hypotension first week of therapy
GI effects (n/v/d)
Drowsiness or insomnia
Anticholinergic effects
Weight loss or gain
Sexual dysfunction
Prolonged QTc

A

Antidepressants: gen adverse effects

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39
Q
A
  • Tricyclic Antidepressants (TCA): Prototype: amitriptyline
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40
Q
A
  • Tricyclic Antidepressants (TCA): Prototype: amitriptyline
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41
Q
A
  • Tricyclic Antidepressants (TCA): Prototype: amitriptyline
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42
Q
A
  • Tricyclic Antidepressants (TCA): Prototype: amitriptyline
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43
Q

Reduce reuptake of serotonin and NE into nerves (block cholinergic, histaminergic, adrenergic, dopaminergic receptors) - block lot diff receptor sites resulting in all diff factors

A

MoA: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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44
Q

refractory to other treatment for depression; not used as first line - hinders compliance

A

Use: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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45
Q

CV disease, seizure disorder

A

Caution: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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46
Q

MAOI’s

A

Drug-drug: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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47
Q

sedation, anticholinergic effects, see general; overdose: cardiac arrhythmias and seizure

A

AE: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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48
Q

admin at HS since highly sedating; see general

A

Nursing: - Tricyclic Antidepressants (TCA): Prototype: amitriptyline

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49
Q

Irreversibly inhibits MAO (enzyme breaks down neurotransmitter so no longer there in synaptic cleft) allowing neurotransmitters to accumulate in synaptic cleft (including dopamine) - break down in neurotransmitters and tyramine

A

MoA: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

50
Q

depression refractory to other treatment - not first line; Parkinson’s disease

A

Use: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

51
Q

CV disease

A

Caution: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

52
Q

sympathomimetic, serotonergic drugs; many others; anything raise BP

A

Drug-drug: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

53
Q

Tyramine increases BP and risk for HTN crisis

A

Drug-food: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

54
Q

severe: hypertensive crisis; see general

A

AE: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

55
Q

teach avoid high tyramine-containing foods; wait 2-6 weeks MAOI to SSRI (inc. risk SS); see general

A

Nursing: - Monoamine Oxidase Inhibitors (MAOI): Prototype: Phenelzine

56
Q

Aged cheeses (cheddar, blue, swiss)
Smoked/pickled/cured meats (sausage, pepperoni)
Yeast extracts (Brewer’s yeast)
Red wines

A

High - must avoid - Tyramine-containing foods

57
Q

Avocado
Pasteurized light and pale beer
Distilled spirits (vodka, gin)
Non-aged cheeses
Chocolate and caffeinated beverages
Fruit (bananas, grapes, pineapple)

A

Moderate-Low - can eat low - Tyramine-containing foods

58
Q

Blocks reuptake of serotonin increasing levels in the synaptic cleft

A

MoA: - Selective Serotonin Reuptake Inhibitors (SSRI): Prototype: citalopram (Celexa)

59
Q

First line treatment of depression; OCD, panic attacks, PTSD; off-label: chronic pain, neuropathies

A

Use: - Selective Serotonin Reuptake Inhibitors (SSRI): Prototype: citalopram (Celexa)

60
Q

highly protein bound (warfarin, phenytoin) risk toxicity

A

Drug-drug: - Selective Serotonin Reuptake Inhibitors (SSRI): Prototype: citalopram (Celexa)

61
Q

Less CV, anticholinergic, drowsiness affects than others (1st gen); sexual dysfunction, prolonged QTc

A

AE: - Selective Serotonin Reuptake Inhibitors (SSRI): Prototype: citalopram (Celexa)

62
Q

slowly taper due to withdrawal syndrome; see general

A

Nursing: - Selective Serotonin Reuptake Inhibitors (SSRI): Prototype: citalopram (Celexa)

63
Q

Blocks reuptake of NE and serotonin

A

MoA: - Selective Norepinephrine Reuptake Inhibitor (SNRI): Prototype: duloxetine (Cymbalta)

64
Q

depression, anxiety; off-label: neuropathic pain, fibromyalgia; not as affective as SSRIs - not used as much as those but more than 1st gen since not as many AE

A

Use: - Selective Norepinephrine Reuptake Inhibitor (SNRI): Prototype: duloxetine (Cymbalta)

65
Q

highly protein bound (warfarin, phenytoin) risk toxicity

A

Drug-drug: - Selective Norepinephrine Reuptake Inhibitor (SNRI): Prototype: duloxetine (Cymbalta)

66
Q

GI effects; see general

A

AE: - Selective Norepinephrine Reuptake Inhibitor (SNRI): Prototype: duloxetine (Cymbalta)

67
Q

see general

A

Nursing: - Selective Norepinephrine Reuptake Inhibitor (SNRI): Prototype: duloxetine (Cymbalta)

68
Q

Notice that there is a drug-drug interaction with the SSRIs and SNRIs with highly protein bound drugs like warfarin that may lead to SSRI/SNRI toxicity. Knowing this information, what must also be true regarding SSRIs?

A

ANS: SSRIs/SNRIs are highly protein bound. If a patient is taking 2 drugs that are highly protein bound, both drugs are attempting to bind to proteins but there is limited protein available in the body. In this instance, less drug will bind to protein allowing more drug to remain in the bloodstream for distribution to tissues - increase risk for toxicity
All want bind so less protein to bind to

69
Q

Indication for drug (Depression > suicidal ideation (esp. children and adolescent age) - assess for SI - report to PCP/NP over pat)
Related to AE (CNS, CV, GI, insomnia, sedation)

A

Assessment - Nursing care plan: antidepressants

70
Q

Administer AM or HS (amiltriptolyne) depending on drowsiness or insomnia
Teach:
Report suicidal ideation - help PRN and care appropriately
Drug name, dose, AE and non-pharm therapy for depression
Therapeutic effect in 4-6 weeks

A

Intervention - Nursing care plan: antidepressants

71
Q

Therapeutic response, AE, teaching, compliance
Improving, more + thoughts, engaging in joyful activities

A

Evaluate - Nursing care plan: antidepressants

72
Q

Long term effects not clearly understood
Some studies – efficacy poor, increased risk for suicidal ideation
Assess risk for suicide

A

Children - Drug therapy across the lifespan: antidepressants

73
Q

Caution in pregnancy/lactation
Neurological, cardiac, respiratory effects on fetus/baby

A

Adults - Drug therapy across the lifespan: antidepressants

74
Q

More susceptible to adverse effects
Reduce dose

A

Older Adults - Drug therapy across the lifespan: antidepressants

75
Q

Which nursing intervention would help alleviate potential adverse effects of amitriptyline?
A.Administer on an empty stomach
B.Advise use of St. John’s Wort
C.Limit fluid intake
D.Administer at bedtime

A

Answer: D
Rationale: Amitriptyline is highly sedating so the medication should be given at HS.

76
Q

1.A 68-year-old patient has been taking an SSRI antidepressant for 3 weeks. His wife calls and expresses concern because he has started to give away some of his keepsakes. What is the nurse’s priority action at this time?

A

SI
Meet with pat and if safe to go home
The priority is to watch this patient closely for suicidal ideations, which may increase during the first weeks after antidepressant therapy is started. The nurse should instruct the wife to bring her husband in for a follow-up visit immediately and not to leave him alone.

77
Q

2.A patient has been admitted to the hospital because of a suspected overdose of a TCA. What two problems are the nurse’s priority at this time?

A

Sedation
Safety precautions - why OD
The two priority problems that may occur after an overdose of tricyclic antidepressants are cardiac dysrhythmias and seizures, and both may lead to death. Overdoses of these medications can be lethal, especially if taken with alcohol.

78
Q

Genetic association
Hallucinations
Paranoia
Delusions
Affective problems

A

Schizophrenia - Mental disorders and treatment goals

79
Q

Extremes of depression alternating with hyperactivity/mania

A

Bipolar disorder - Mental disorders and treatment goals

80
Q

Stabilize disorder
Decrease debility
Maintain functionality
Limit adverse effects
Maintain compliance

A

Goals: - Mental disorders and treatment goals

81
Q

Differ in potency, severity of adverse effects, dose, route
Med selection depends on desired potency and tolerance of adverse effects
Varying therapeutic response
Divided into typical and atypical categories
Different mechanism of action
Older adults
Black box warning: not indicated for dementia behaviors (risk CV death)

A

Antipsychotics

82
Q

Dopamine receptor blockers
Due to blocking of dopamine receptor sites: result in
Anticholinergic, antihistamine, alpha-adrenergic blocking effects - block variety receptor sites

A

Typical Antipsychotic: - Antipsychotis: MoA

83
Q

Block both dopamine and serotonin receptors - not block as effectively - not see EPS as well, more metabolic effects
Alleviate some of unpleasant neurological effects and depression associated with typical antipsychotics

A

Atypical Antipsychotic: - Antipsychotis: MoA

84
Q

CNS effects:
Anticholinergic effects
CV effects:
Gynecomastia
Laryngospasm/bronchospasm
Extrapyramidal symptoms - longer use more sig become
Neuroleptic malignant syndrome (Rare)

A

Antipsychotics: gen AE

85
Q

Sedation
Tremor

A

CNS effects:

86
Q

Hypotension (orthostatic)
Arrhythmias (some prolong QTc)
Heart failure (pulmonary edema)

A

CV effects:

87
Q

Acute dyskinesia (tardive dyskinesia)
Dystonia
Pseudo parkinsonism

A

Extrapyramidal symptoms - longer use more sig become

88
Q

Fever
Altered mental status
Muscle rigidity
Autonomic dysfunction

A

Neuroleptic malignant syndrome (Rare)

89
Q

Dystonia: spasms of tongue, neck, back, and legs
Akathisia: continuous restlessness, constant movement –foot tapping
Pseudo parkinsonism: muscle tremors, drooling, shuffling gait - blocking dopamine receptors give appearance have Parkinson’s disease because drug blocking dopamine
Tardive dyskinesia: abnormal muscle movements - lip smacking, tongue darting, chewing movements

A

Neurologic AE - EPS from med; much can be reversed if slow down/stop med

90
Q

CNS depression
Parkinson’s disease - blocking dopamine receptors, exacerbate disease
Cardiac disease/arrhythmias
Bone marrow suppression/immunosuppressed
Dementia
Seizure disorders
Conditions exacerbated by anticholinergic effects (constipation, BPH, etc.)

A

Antipsychotics: contraindications/cautions

91
Q

Any exacerbate AE
Increase risk for sedation:
Increase anticholinergic effects
Increase risk for serotonin syndrome
Increase risk of prolonged QTc:

A

Antipsychotics: drug-drug interactions

92
Q

CNS depressants
Alcohol

A

Increase risk for sedation:

93
Q

Anticholinergics

A

Increase anticholinergic effects

94
Q

SSRI and SNRI

A

Increase risk for serotonin syndrome

95
Q

Antidysrhythmic; any other med prolongs QTc

A

Increase risk of prolonged QTc:

96
Q

The nurse is preparing to administer an antipsychotic to a client. Which additional prescribed medication puts the client at risk for increased sedation?
A.Pseudoephedrine
B.Loperamide
C.Oxycodone
D.Oxybutynin

A

Answer: C
Rationale: Opioids can cause CNS depression and should be used in caution with antipsychotics.
Opioids increase risk for sedation

97
Q

The nurse is preparing to administer an antipsychotic to a client. Which additional prescribed medication puts the client at increased risk of constipation?
A.Lactulose
B.Docusate
C.Oxybutynin
D.Guaifenesin

A

Answer: C
Rationale: Oxybutynin is an anticholinergic medication which increases the risk for constipation. Lactulose and docusate are indicated for the treatment of constipation. Guaifenesin decreases viscosity of respiratory tract secretions and does not cause constipation.

98
Q

Block dopamine receptors, preventing stimulation of post-synaptic neurons; depresses reticular activating system of brain; anticholinergic, antihistaminic, alpha-adrenergic blocking - why variety AE

A

MoA: - Typical Antipsychotics: Prototype: haloperidol (Haldol)

99
Q

Acute psychotic disorders/episodes

A

Use: - Typical Antipsychotics: Prototype: haloperidol (Haldol)

100
Q

PO: 150% of parenteral dose: first pass effect affects bioavailability so need higher dose; IM: inject large muscle; IVP: 5 mg/min, monitor EKG (increased risk arrhythmias); switch to oral ASAP - less dangerous to pat

A

Route: - Typical Antipsychotics: Prototype: haloperidol (Haldol)

101
Q

see general

A

AE: - Typical Antipsychotics: Prototype: haloperidol (Haldol)

102
Q

see general; many other typical antipsychotics used for acute episodes and/or maintenance

A

Nursing: - Typical Antipsychotics: Prototype: haloperidol (Haldol)

103
Q

Block dopamine and serotonin receptors, depresses the reticular activating system of brain; anticholinergic, antihistaminic, alpha-adrenergic blocking

A

MoA: - Atypical Antipsychotics: Prototype: clozapine (Clozaril)

104
Q

Oral only; tablet, oral disintegrating, oral suspension

A

Route: - Atypical Antipsychotics: Prototype: clozapine (Clozaril)

105
Q

increased blood glucose, weight gain, decreased WBC; see general

A

AE: - Atypical Antipsychotics: Prototype: clozapine (Clozaril)

106
Q

periodically monitor blood glucose - induced T2DM because elevated BG; check WBC before starting therapy; see general

A

Nursing: - Atypical Antipsychotics: Prototype: clozapine (Clozaril)

107
Q

Head to toe (many AE to monitor): CNS, listen to heart, BP,; Vital signs
Labs as appropriate - BG, WBC - not often monitor

A

Assessment - Nursing care plan for antipsychotics

108
Q

Taper with long term use
Manage AE of medications - need maintain compliance as best can: manage anticholinergic effects: laxatives, water always available, EPS: not lot can do: higher fall risk
High fall risk
Teach

A

Interventions - Nursing care plan for antipsychotics

109
Q

Abrupt withdrawal: gastritis, nausea, vomiting, dizziness, arrhythmias, insomnia

A

Taper with long term use

110
Q

Drug name, dose, AE and how to manage
Do not abruptly discontinue medication once feel better; diff with AE find ways to manage AE nonpharm

A

Teach

111
Q

Therapeutic response, AE, teaching, compliance

A

Evaluate: - Nursing care plan for antipsychotics

112
Q

Alters Na2+ transport in nerve and muscle cells; inhibits release of NE and dopamine from neurons; vary effective
Is a salt: Follows same distribution pattern in body as water; excreted in kidneys, 80% reabsorbed of drug in renal tubule of kidneys
Narrow therapeutic window/index: Therapeutic level: 0.6-1.2 mEq/L - blood levels monitored constantly - more effort on part of pat
Issues when up to 1.5
Life-threatening toxicity > 2.5 mEq/L - narrow window of safety

A

MoA: - Bipolar Disorder Agents: Prototype: Lithium

113
Q

renal disease, cardiac disease, sodium depletion/altered sodium levels - alters where drug goes and how reabsorped - needs be consistently rehydrated because effects how moved throughout body, pregnancy (X)/lactation

A

Contraindications/cautions: - Bipolar Disorder Agents: Prototype: Lithium

114
Q

diuretics (excess fluid - hyponatremia, dehydration); haloperidol (encephalopathic syndrome and could have irreversible brain damage)

A

Drug-drug: - Prototype: lithium

115
Q

Related to serum levels of the medication - therapeutic level not lot AE, issue when levels rise; higher get more severe AE; teach to monitor for GI effects and increase urination if having lot of that

A

AE: - Prototype: lithium

116
Q

GI effects (n/v/d) - early indication of increasing blood levels (1.5)
CNS: lethargy, slurred speech, weakness, tremor, ataxia, clonic movements, hyperreflexia, seizures
Renal: mild: polyuria; toxicity: Nephrogenic (originating from kidneys) diabetes insipidus - DI: large amounts urine output, toxic: large volumes output - monitor for CNS and how severe DI is
Cardiac: life-threatening arrhythmias

A

AE: Related to serum levels of the medication - therapeutic level not lot AE, issue when levels rise; higher get more severe AE; teach to monitor for GI effects and increase urination if having lot of that

117
Q

Neurologic status: LOC, gait, reflexes, tremors
Monitor s/s toxicity - GI effects/renal first; see where at with bipolar: well controlled/not
Serum lithium levels 2x’s/week initially and once levels stable and adequately treating levels, then every 2 months - quite a bit and struggle for those with issues with compliance
Skin turgor daily
Weigh daily
Look for Edema - dehydration/disorder with water balance because effects med
Kidney function - as declines excretion drug declines so at risk for toxicity

A

Assessment - Nursing care plan: lithium

118
Q

Maintain consistent hydration and sodium intake!
Fall risk if CNS effects associated with elevated lithium occur
Teach

A

Interventions - Nursing care plan: lithium

119
Q

Follows same distribution pattern in body as water; excreted in kidneys, 80% reabsorbed - not want alter Na and water intake and at risk for dehydration - higher risk for toxicity
Sodium depletion or dehydration = more reabsorption lithium = toxicity

A

Maintain consistent hydration and sodium intake!

120
Q

Drug name, dose, AE (minor vs. severe toxicity-ER), blood monitoring
Therapeutic effects 1-3 weeks to become therapeutic
Not to operate heavy machinery until levels are stable - not too sedated or CNS effects and stable before that
Contraception as appropriate - Pregnancy category X
Lot urine output/dysrhythmia - toxicity - ER

A

Teach

Pharm (30 decks)

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