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
what are examples of second generation antidepressants ?
- Wellbutrin
- Effexor
What are side effects of Second generation antidepressants ?
- Constipation
- Diarrhea
- Dizziness
- Headache
- Insomnia
- Nausea
- Sexual dysfunction
- Somnolence
What type of Bipolar Disorder medication is rarely used now ?
MAOI’s
What are examples of MAOI’s ?
- Marplan (isocarboxazid)
- Nardil (phenelzineu)
- Parnate (tranylcypromine)
With what Biopolar Disorder drug, should you avoid foods high in tyramine ?
MAOI’s
What are examples of foods high in tyramine ?
- Aged cheeses
- fermented foods
- chocolate
- liver
- bean pods
- yeast
- sausage
- bologna
- beer
- certain wines
What are side effects of MAOI’s ?
- insomnia
- nausea
- agitation and confusion
- hypertensive crisis
MAOI’s are at high risk for what ?
drug interactions
Taking MAOI’s and foods high in tyramine, can cause what ?
- Severe hypertensive crisis that can lead to death
What kind of drug is Lithium ?
Mood stabilizer
What are examples of Lithium names ?
- Eskalith
- Lithobid
- Lithotabs
What assessments/labs should you check prior to starting Lithium ?
Thyroid, cardiac, and renal function
What are side effects of Lithium ?
- Tremors
- Lethargy
- Polyuria
- Thirst
- Weight gain
- Fatigue
True or False: Lithium levels must be monitored when taking Lithium drugs ?
True
With which Bipolar Disorder drug must the pt. drink sufficient water ?
Lithium
A pt. taking lithium should notify the physician if the client has persistent what ?
Vomiting and diarrhea
True or False: Lithium has many contraindications ?
True
True or False: Lithium can lead to toxicity ?
True
What are s/s of Lithium toxicity ?
- vomiting
- diarrhea
- lethargy
- muscle twitching
- ataxia
- slurred speech
- coma
- seizure
- cardiac arrest
MAOI’s are contraindicated in patients taking what classification of Bipolar Disorder drugs ?
SSRI”s
MAOI’s need to be used cautiously in pt’s taking what Bipolar Disorder drugs ?
Tricyclic Antidepressants
Second generation antipsychotics (atypical) contain what type of properties ?
Mood stabilizing properties
What are side effects of Second Generation antipsychotics (atypical) ?
- Sedation during the early phase of treatment
- Serious SE’s stem from a tendency toward weight gain (insulin resistance, DM, dyslipidemea, cardiovascular impairment)
Serious side effects from Second generation antipsychotics (atypical) , stem from what ?
A tendency toward weight gain…
- insulin resistance
- DM
- Dyslipidemia
- cardiovascular impairment
What are Names of Anticonvulsants ?
- Valporate
- Carbamazepine
- Lamotrigine
What are side effects of Anticonvulsants ?
- Liver damage
- N/V
- Double vision
- Loss of coordination
- Drowsiness
- Headache
True or False: with anticonvulsants you should monitor for toxicity ?
True
With Anticonvulsants, what should you assess/monitor for ?
SI thoughts/behaviors
What teaching should be provided in regards to Anticonvulsants ?
- Take as directed
- Be safe if drowsiness occur
- Avoid alcohol or other CNS depressants
- Carry ID card
What drug classification is not usually given alone, since manic episodes may then appear ?
Antidepressants
What are Names of Antidepressants ?
- SSRI’s
- SNRI’s
- TCA’s
- Atypical antidepressants
- MAOI’s
- Newer medications
What are side effects of Antidepressants ?
- Nausea
- Increased appetite & weight gain
- Fatigue
- drowsiness
- Insomnia
- Dry mouth
- Constipation
- Dizziness
- Agitation, restlessness, anxiety
- Sexual side effects
- Heart related side effects
- Genetic variations
What should you monitor for in patients taking Antidepressants ?
- Monitor mental status and affect & SI thoughts/behaviors
True or False: you should monitor for toxicity in pt’s taking Antidepressants ?
True
What teaching should be given to pt’s taking Antidepressants ?
- Avoid alcohol or other CNS depressants
- Be safe if causes drowsiness
- Alert physician if dry mouth, urinary retention, or constipation occurs
- Educate on orthostatic hypotension
- Monitor/maintain oral hygiene
- Emphasize need for psychotherapy in addition
