Exam #1 Flashcards
A client with bipolar disorder I is experiencing a depressive episode. What would the nurse expect to be prescribe?
Lamotrigine
A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?
Orthostatic hypotension and urinary retention
Which medication classification has most commonly been used to treat social phobia?
SSRIs
prazosin in PTSD
Used to treat nightmares in PTSD
A client with posttraumatic stress disorder (PTSD) tells the nurse that he often feels like he has left his body and is looking at things from a distance. The nurse interprets this as what?
Dissociation
derealization
sensing that things are not real
expansive mood
lack of restraint in expressing feelings, overvalued self importance, constant enthusiasm for interactions
cyclothymic disorder
periods of hypomanic episodes and depressive episodes that do not meet the full criteria for a major depressive episode
rapid cycling
four or more mood episodes that meet criteria for manic, mixed, hypomanic, or depressive episodes during the previous 12 months
mean age of onset of bipolar disorder
21-30 years
relationship of lithium with salt levels
higher sodium levels = lower lithium levels
symptoms of lithium toxicity
arrythmas, blackouts, tremors, seizures, metallic taste, diarrhea, twitching, slurred speech, tinnitus
divalproex sodium (Depakote)
anticonvulsant used as a mood stabilizer in bipolar patients
liver function tests and CBC with platelets should be obtained before starting therapy
drug levels tested weekly until pt is stable, then tested every 6 months
Carbamazepine
anticonvulsant
levels measured monthly until the patient is on a stable dosage
SJS possibility
Lamotrigine
mood stabilizer; requires dose titration
particularly effective for rapid cycling and depressed phase of BPD
Risk of SJS rash— report any rash with Lamotrigine
GAD comorbities
3/4 of GAD pts have another psych diagnosis
buspirone
anxiolytic
inhibits spontaneous firing of serotonergic neurons in the dorsal raphe
must be taken for 3-4 weeks before effects are felt
antidepressants approved for anxiety treatment
venlafaxine (SNRI), paroxetine (SSRI), imipramine (TCA)
treatment of choice for phobias
exposure therapy
Average age of onset of OCG
19 (may occur in 20s and 30s)
pharmacologic interventions for OCD
SSRIs, TCAs (clomipramine)
sertraline, fluvoxamine, paroxetine, fluoxetine
response prevention
patient with OCD put in situations that induce anxiety but asked to refrain from performing rituals
thought stopping
patient taught to interrupt obsessional thoughts
cognitive restructuring in OCD
therapy helps patient understand that feared event is unlikely to happen if rituals arne’t performed.
TCA level monitoring
TCAs have levels that should be monitored
Levels taken 12 hours after last dose
MAOI side effects
headache, drowsiness, dry mouth and throat, constipation, blurred vision, orthostatic hypotension
clomipramine
TCA
TCA overdose symptoms
Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention.
Central nervous system suppression (ranging from drowsiness to coma) or an agitated delirium may occur.
serotonin syndrome symptoms
mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.
