Exam 2 - Bipolar Disorder Flashcards
What interventions can be utilized for a pt. experiencing a severe manic episode ?
- provide physical care
- frequent small feedings ; finger food
- Protect from impulsive activity
- reduce external stimuli
- communicate calmly
- avoid competitive activities
What are signs and symptoms of Mania ?
- Abnormally upbeat, jumpy, or wired
- Increased activity, energy or agitation
- Euphoria (exaggerated sense of well-being and self-confidence)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Distractability
- Poor decision making
What are signs and symptoms of Depression ?
- Depressed mood (such as feeling sad, empty, hopeless or tearful)
- Marked loss of interest or feeling. (no pleasure in all or almost all activities)
- Unintentional weight changes or changes in appetite
- Either insomnia or sleeping too much
- Fatigue or loss of energy
- Feelings of worthlessness or excessive inappropriate guilt
- Decreased ability to think or concentrate or indecisiveness
- Thinking about, planning, or attempting suicide
What are some Antidepressant medications ?
- Tricyclic antidepressants
- SSRI’s
- SNRI’s
- Second generation antidepressants
- Lithium
- MAOI’s (rarely used now)
- Second generation antipsychotics (atypical)
- Anticonvulsants
- Antidepressants
What are 2 names of Tricyclic antidepressants ?
- Amitriptyline
- Nortriptyline
Tricyclic antidepressants have what type of effect(s) ?
Anticholinergic effects
True or False: Tricyclic antidepressants have the potential for fatal overdose ?
True
Tricyclic antidepressants, should be used carefully in which type of patients ?
Older adults
What are the most common side effects of Tricyclic antidepressants ?
- Drowsiness (sedation)
- Blurred vision
- Constipation
- Dry mouth
- Orthostatic hypotension
- Urine retention
- Cardiac toxicity
What assessments should be done for patients on Tricyclic antidepressants ?
- May need to monitor serum drug levels to determine therapeutic dosing
- Monitor for more increased seizures in pt’s who experience seizures
- Black Box Warning: increased SI thoughts/behaviors, especially in first few weeks or with dose change
What is the Black Box Warning for Tricyclic antidepressants ?
Increased SI thoughts/behaviors, especially in first few weeks or with dosage change
What teaching should be given for pt’s taking Tricyclic antidepressants, SSRI’s, SNRI’s ?
- Medication adherence
- Do not stop taking abruptly
- Consider potential harm during pregnancy
- Do not use St. Johns wart
Why shouldn’t St. Johns wart be taken with Tricyclic antidepressants ?
Can enhance the effects of the medication (cause an overall excessive increase in serotonin or dopamine?)
what are examples of Selective Serotonin Reuptake Inhibitors (SSRI’s) ?
- Prozac
- Zoloft
- Paxil
- Celexa
SSRI’s have _____ adverse effects ?
Few
True or False: SSRI’s are safe for the elderly ?
True
What is the most commonly used Antidepressant ?
SSRI’s
With SSRI’s the risk of lethal dose is what ?
Minimized
What are side effects of SSRI’s ?
- Agitation
- Insomnia
- Headache
- N/V
- Sexual dysfunction
- Hyponatremia
What should you assess for in patients taking SSRI’s ?
- Monitor for more frequent seizures in patients who experience seizures
- Black Box Warning: increased SI thoughts/behaviors, especially in first few weeks or with dose change
Cymbalta is considered what type of Antidepressant ?
Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s)
What are the most common side effects of SNRI’s ?
- Nausea
- Dry mouth
- Dizziness
- Headache
- Excessive sweating
What are signs and symptoms of Serotonin Syndrome ?
- Anxiety
- Agitation
- High fever
- Sweating
- Confusion
- Tremors
- Restlesness
- Lack of coordination
- Major changes in BP and rapid HR
What assessments should you monitor for in pt’s taking SNRI’s ?
- Serotonin syndrome
- Black Box Warning: increased SI thoughts/behaviors, especially in first few weeks or with dosage change
