Mental Health Exam 2 Flashcards
What is clozapine? What does it treat?
2nd generation atypical antipsychotic? Typically used to treat schizophrenia.
What are some patient teaching points for clozapine?
educate men to report nipple secretions
report fever, sore throat (s/s infection) can cause weight gain so eat a low calorie diet, monitor daily weight, regular exercise
causes sun sensitivity so wear sunscreen
What is the adverse effect for clozapine?
R/f Metabolic Syndrome
Agranulocytosis
What do you need to monitor for with agranulocytosis?
s/s of infection, ANC
What are side side effects of clozapine?
agitation, dizziness, sedation, sleep deprivation
What do you need to obtain weekly for clozapine?
(WBC) blood levels
What type of generation is a typical antipsychotic? What symptoms does this antipsychotic treat?
1st, positive
What type of generation is an atypical antipsychotic? What symptoms does this antipsychotic treat?
2nd, negative
What does positive symptoms mean?
hallucinations, illusions, delusions, bizarre behaviors
What does negative symptoms mean?
5 A’s
Affect
Alogia
Anergia
Anhedonia
Avolution
What is electroconvulsive therapy? (ECT)
induces a brief, grand Mal seizure to relieve symptoms of severe major depression or bipolar disorder in patients that have not responded to other treatments by enhancing the effects of neurotransmitters
What document do you need to obtain prior to ECT?
informed consent
What labs do you need to obtain prior to ECT?
EKG/ECG (check for dysrthmias)
Chest x-ray
blood work
What medication will you use during ECT to reduce secretions and counteract bradycardia?
atropine and glycopyrrolate
What medication will you use to put the patient to sleep during ECT?
propofol
What medication will be administered for paralytic effects during ECT?
succinylcholine and oxygen, have a crash cart ready
How long after ECT will the client become alert?
15 min
What will you need to monitor for after ECT?
memory deficits
confusion
What neurotransmitter does an SSRI act on?
serotonin
What neurotransmitter does a SNRI act on?
norepinephrine
What neurotransmitter does a MAOI act on?
norepinephrine, serotonin, dopamine
What 2 drugs can you NOT take together?
SSRI and MAOI
MAOI and TCAS
all antidepressants
What does an MAOI treat?
depression
What drugs did we talk about in the MAOI category?
Phenelzine, selegiline
What patient teaching will you need to give to a patient taking phenelzine?
move slowly
avoid OTC medications (nasal decongestants)
avoid foods high in tyramine
What can occur if a patient who is taking an MAOI ingests foods high in tyramine?
hypertensive crisis, medical emergency!!!!
What are some examples of food high in tyramine?
smoked meats, aged cheese, wine, beer, avocados
You patient taking an MAOI says they are going to go eat a peperoni pizza with Gouda cheese and an IPA. What do you tell them as the nurse?
no
What blood pressure indicates a hypertensive crisis?
180/120
How is selegilline administered?
transdermal patch
What should be done in the administration of a selegilline transdermal patch?
remove old patch before applying new one. Time and date the patch
What is contraindicated in the selegilline patch?
carbamazepine because it can increase the blood levels of the MAOI
What lab is decreased when taking selegilline?
prolactin secretion
What two meds put a patient at risk for developing metabolic syndrome?
Phenelzine, selegiline
What is sertraline?
SSRI, first line of treatment for anxiety and OCD disorders
What is a medical emergency that is caused by sertraline?
serotonin syndrome
What are some side effects of sertraline?
sexual dysfunction (low adherence) , insomnia/anxiety/agitation (avoid caffeine) , weight changes, hyponatremia, rash, GI bleeding, and bruxism (wear a mouth guard)
What is lithium?
mood stabilizer, treats bipolar
T/F : Patients should take lithium with food or milk to decrease GI upset.
TRUE
What is an adverse effect in lithium that can indicate lithium toxicity?
motor skills, displayed as hand tremors
Hand tremors are worsened by what stimulant?
caffeine
What will you give your patient taking lithium who has a goiter and s/s of hypothyroidism?
levothyroxine
What med class are you not allowed to have when taking lithium?
NSAIDS
What should the nurse do if the patients labs are above 1.9?
STOP THE MEDS, NOTIFY THE PROVIDER, get blood, lithium, and sodium levels. Anticipate doctor to change does and promote excretion
What part of the body is lithium hard on?
Thyroid
Kidneys
Lithium causes a decrease or increase in vital signs?
Decrease
If your patient has a 5 pound weight gain over a short period of time, what is the nurse’s priority action?
notify provider
What is serotonin syndrome?
can begin 2-72 hours after treatment, is deadlyw
What are some signs and symptoms of serotonin syndrome?
confusion, agitation, hallucinations, delirium, seizures, tachycardia, diaphoresis, fever, GI distress, and coma.
What are some nursing interventions for serotonin syndrome?
Cooling blanket, anticonvulsant, artificial vent if needed