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J2 - Mental Health > Exam 2 - Bipolar Disorder > Flashcards

Exam 2 - Bipolar Disorder Flashcards

1
Q

What interventions can be utilized for a pt. experiencing a severe manic episode ?

A
  • provide physical care
  • frequent small feedings ; finger food
  • Protect from impulsive activity
  • reduce external stimuli
  • communicate calmly
  • avoid competitive activities
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2
Q

What are signs and symptoms of Mania ?

A
  • 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
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3
Q

What are signs and symptoms of Depression ?

A
  • 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
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4
Q

What are some Antidepressant medications ?

A
  • Tricyclic antidepressants
  • SSRI’s
  • SNRI’s
  • Second generation antidepressants
  • Lithium
  • MAOI’s (rarely used now)
  • Second generation antipsychotics (atypical)
  • Anticonvulsants
  • Antidepressants
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5
Q

What are 2 names of Tricyclic antidepressants ?

A
  • Amitriptyline

- Nortriptyline

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6
Q

Tricyclic antidepressants have what type of effect(s) ?

A

Anticholinergic effects

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7
Q

True or False: Tricyclic antidepressants have the potential for fatal overdose ?

A

True

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8
Q

Tricyclic antidepressants, should be used carefully in which type of patients ?

A

Older adults

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9
Q

What are the most common side effects of Tricyclic antidepressants ?

A
  • Drowsiness (sedation)
  • Blurred vision
  • Constipation
  • Dry mouth
  • Orthostatic hypotension
  • Urine retention
  • Cardiac toxicity
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10
Q

What assessments should be done for patients on Tricyclic antidepressants ?

A
  • 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
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11
Q

What is the Black Box Warning for Tricyclic antidepressants ?

A

Increased SI thoughts/behaviors, especially in first few weeks or with dosage change

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12
Q

What teaching should be given for pt’s taking Tricyclic antidepressants, SSRI’s, SNRI’s ?

A
  • Medication adherence
  • Do not stop taking abruptly
  • Consider potential harm during pregnancy
  • Do not use St. Johns wart
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13
Q

Why shouldn’t St. Johns wart be taken with Tricyclic antidepressants ?

A

Can enhance the effects of the medication (cause an overall excessive increase in serotonin or dopamine?)

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14
Q

what are examples of Selective Serotonin Reuptake Inhibitors (SSRI’s) ?

A
  • Prozac
  • Zoloft
  • Paxil
  • Celexa
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15
Q

SSRI’s have _____ adverse effects ?

A

Few

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16
Q

True or False: SSRI’s are safe for the elderly ?

A

True

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17
Q

What is the most commonly used Antidepressant ?

A

SSRI’s

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18
Q

With SSRI’s the risk of lethal dose is what ?

A

Minimized

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19
Q

What are side effects of SSRI’s ?

A
  • Agitation
  • Insomnia
  • Headache
  • N/V
  • Sexual dysfunction
  • Hyponatremia
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20
Q

What should you assess for in patients taking SSRI’s ?

A
  • 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
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21
Q

Cymbalta is considered what type of Antidepressant ?

A

Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s)

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22
Q

What are the most common side effects of SNRI’s ?

A
  • Nausea
  • Dry mouth
  • Dizziness
  • Headache
  • Excessive sweating
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23
Q

What are signs and symptoms of Serotonin Syndrome ?

A
  • Anxiety
  • Agitation
  • High fever
  • Sweating
  • Confusion
  • Tremors
  • Restlesness
  • Lack of coordination
  • Major changes in BP and rapid HR
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24
Q

What assessments should you monitor for in pt’s taking SNRI’s ?

A
  • Serotonin syndrome

- Black Box Warning: increased SI thoughts/behaviors, especially in first few weeks or with dosage change

25
Q

what are examples of second generation antidepressants ?

A
  • Wellbutrin

- Effexor

26
Q

What are side effects of Second generation antidepressants ?

A
  • Constipation
  • Diarrhea
  • Dizziness
  • Headache
  • Insomnia
  • Nausea
  • Sexual dysfunction
  • Somnolence
27
Q

What type of Bipolar Disorder medication is rarely used now ?

A

MAOI’s

28
Q

What are examples of MAOI’s ?

A
  • Marplan (isocarboxazid)
  • Nardil (phenelzineu)
  • Parnate (tranylcypromine)
29
Q

With what Biopolar Disorder drug, should you avoid foods high in tyramine ?

A

MAOI’s

30
Q

What are examples of foods high in tyramine ?

A
  • Aged cheeses
  • fermented foods
  • chocolate
  • liver
  • bean pods
  • yeast
  • sausage
  • bologna
  • beer
  • certain wines
31
Q

What are side effects of MAOI’s ?

A
  • insomnia
  • nausea
  • agitation and confusion
  • hypertensive crisis
32
Q

MAOI’s are at high risk for what ?

A

drug interactions

33
Q

Taking MAOI’s and foods high in tyramine, can cause what ?

A
  • Severe hypertensive crisis that can lead to death
34
Q

What kind of drug is Lithium ?

A

Mood stabilizer

35
Q

What are examples of Lithium names ?

A
  • Eskalith
  • Lithobid
  • Lithotabs
36
Q

What assessments/labs should you check prior to starting Lithium ?

A

Thyroid, cardiac, and renal function

37
Q

What are side effects of Lithium ?

A
  • Tremors
  • Lethargy
  • Polyuria
  • Thirst
  • Weight gain
  • Fatigue
38
Q

True or False: Lithium levels must be monitored when taking Lithium drugs ?

A

True

39
Q

With which Bipolar Disorder drug must the pt. drink sufficient water ?

A

Lithium

40
Q

A pt. taking lithium should notify the physician if the client has persistent what ?

A

Vomiting and diarrhea

41
Q

True or False: Lithium has many contraindications ?

A

True

42
Q

True or False: Lithium can lead to toxicity ?

A

True

43
Q

What are s/s of Lithium toxicity ?

A
  • vomiting
  • diarrhea
  • lethargy
  • muscle twitching
  • ataxia
  • slurred speech
  • coma
  • seizure
  • cardiac arrest
44
Q

MAOI’s are contraindicated in patients taking what classification of Bipolar Disorder drugs ?

A

SSRI”s

45
Q

MAOI’s need to be used cautiously in pt’s taking what Bipolar Disorder drugs ?

A

Tricyclic Antidepressants

46
Q

Second generation antipsychotics (atypical) contain what type of properties ?

A

Mood stabilizing properties

47
Q

What are side effects of Second Generation antipsychotics (atypical) ?

A
  • Sedation during the early phase of treatment

- Serious SE’s stem from a tendency toward weight gain (insulin resistance, DM, dyslipidemea, cardiovascular impairment)

48
Q

Serious side effects from Second generation antipsychotics (atypical) , stem from what ?

A

A tendency toward weight gain…

  • insulin resistance
  • DM
  • Dyslipidemia
  • cardiovascular impairment
49
Q

What are Names of Anticonvulsants ?

A
  • Valporate
  • Carbamazepine
  • Lamotrigine
50
Q

What are side effects of Anticonvulsants ?

A
  • Liver damage
  • N/V
  • Double vision
  • Loss of coordination
  • Drowsiness
  • Headache
51
Q

True or False: with anticonvulsants you should monitor for toxicity ?

A

True

52
Q

With Anticonvulsants, what should you assess/monitor for ?

A

SI thoughts/behaviors

53
Q

What teaching should be provided in regards to Anticonvulsants ?

A
  • Take as directed
  • Be safe if drowsiness occur
  • Avoid alcohol or other CNS depressants
  • Carry ID card
54
Q

What drug classification is not usually given alone, since manic episodes may then appear ?

A

Antidepressants

55
Q

What are Names of Antidepressants ?

A
  • SSRI’s
  • SNRI’s
  • TCA’s
  • Atypical antidepressants
  • MAOI’s
  • Newer medications
56
Q

What are side effects of Antidepressants ?

A
  • Nausea
  • Increased appetite & weight gain
  • Fatigue
  • drowsiness
  • Insomnia
  • Dry mouth
  • Constipation
  • Dizziness
  • Agitation, restlessness, anxiety
  • Sexual side effects
  • Heart related side effects
  • Genetic variations
57
Q

What should you monitor for in patients taking Antidepressants ?

A
  • Monitor mental status and affect & SI thoughts/behaviors
58
Q

True or False: you should monitor for toxicity in pt’s taking Antidepressants ?

A

True

59
Q

What teaching should be given to pt’s taking Antidepressants ?

A
  • 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

J2 - Mental Health (15 decks)

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