Nursing Implications

Question 1

Monitor drug plasma levels to adjust dosage, monitoring adherence, determining the cause of lost seizure control, and identifying the cause of toxicity

Answer 1

Antiepileptic Drugs (AEDs)

Question 2

___________ accounts for nearly half of all treatment failures. To promote adherence, educate patients about the importance of taking AEDs exactly as prescribed.

Answer 2

Nonadherence

Question 3

Abrupt discontinuation of AEDs can lead to _____ _________; medication must be slowly discontinued (over 6 weeks to several months).

Answer 3

status epilepticus

Question 4

Most AEDs cause ___ _________, and small risk of suicidal thoughts and behavior. Screen for _________ before starting treatment.

Educate patients, families, and caregivers about signs that may precede suicidal behavior (eg, increased anxiety, agitation, mania, or hostility).

Answer 4

CNS depression

suicidality

Question 5

▪ All traditional AEDs (and some newer AEDs) can ____ the developing fetus.

Answer 5

harm

Question 6

Anti-seizure meds induce hepatic drug-metabolizing enzymes. Dosages of ________ and ____ ______________ may need to be increased.

Answer 6

warfarin

oral contraceptives

Question 7

AED

What Drug:
Obtain baseline tests of liver function.

Answer 7

Valproic Acid

Question 8

Monitor for suicide risk especially with children and young adults.

Answer 8

Nursing Implications of Depression/Mania Drugs

Question 9

Inform the patient that antidepressant effects develop over - weeks. Premature discontinuation of therapy can result in relapse.

Answer 9

Nursing Implications of Depression/Mania Drugs

Question 10

Assess patients for improvement in symptoms, especially depressed mood and loss of interest or pleasure in usual activities.

Answer 10

Nursing Implications of Depression/Mania Drugs

Question 11

Watch for symptoms of Serotonin Syndrome: agitation, confusion, disorientation, anxiety, hallucinations, poor concentration, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever. Avoid concurrent use of _____.

Answer 11

SSRI/SNRI

MAOIs

Question 12

May cause GI bleed through impaired platelet aggregation, hyponatremia, bruxism.

Answer 12

SSRI/SNRI

Question 13

Drugs that inhibit CYP2D6 can raise levels of SSRIs and SNRIs, and can thereby pose a risk of ________.

Answer 13

toxicity

Question 14

Use _____ with caution in patients with cardiac disorders, elevated intraocular pressure, urinary retention, hyperthyroidism, seizure disorders, and liver or kidney dysfunction.

Answer 14

TCAs

Question 15

Inform patients about symptoms of hypotension, possible anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia).

Answer 15

TCAs

Question 16

Sedation is most intense during the first weeks of therapy and declines with continued drug use. Giving at bedtime minimizes daytime sedation and promotes sleep.

Answer 16

TCAs

Question 17

_____ decrease seizure threshold. Exercise caution in patients with seizure disorders.

Answer 17

TCAs

Question 18

_____ interact adversely with many other drugs: contraindicated with SSRIs. Indirect-acting sympathomimetics (eg, ephedrine, methylphenidate, amphetamines, cocaine) may precipitate *hypertensive crisis.

__________ can produce hyperthermia in patients taking _____ and hence should be avoided.

Answer 18

MAOIs

Meperidine

MAOIs

Question 19

Dietary ______ and indirect-acting sympathomimetics (eg, amphetamine, methylphenidate, ephedrine, cocaine) can precipitate a hypertensive crisis in patients taking MAOIs. Provide patients with a list of specific foods to avoid.

Answer 19

tyramine

Question 20

Avoid chlorpromazine, thioridazine, haloperidol, and pimozide in patients with risk factors for torsades de pointes and for those taking drugs that prolong the QT interval.

Answer 20

Nursing Implications of Antipsychotics

Question 21

Watch for Early Extrapyramidal symptoms EPS: Acute Dystonia, Parkinsonism, and Akathisia: develop within hours to months after starting treatment, greatest risk with high-potency _ _ _. (eg, muscle spasm of tongue, face, neck, or back; tremor; rigidity; restless movement.)

Watch for Late Extrapyramidal symptoms EPS: Tardive Dyskinesia: develops after months or years of continuous therapy, risk is equal with all _ _ _. (eg, fine, worm-like movements of the tongue).

Answer 21

FGA’s

First Generation Antipsychotics

Question 22

Watch for anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia, suppression of sweating). Avoid other anticholinergics, including antihistamines and over-the-counter sleep aids.

Answer 22

Nursing Implications of Antipsychotics

Question 23

Avoid use of alcohol and all other drugs with CNS depressants (eg, barbiturates, opioids, antihistamines, benzodiazepines).

Answer 23

Nursing Implications of Antipsychotics

Question 24

All _ _ _—and especially clozapine and olanzapine—can promote weight gain, which can lead to diabetes and dyslipidemia . Obtain baseline measurements of weight, waist circumference, fasting blood glucose, and fasting lipid levels.

NOT Testable information, just good information to have

Answer 24

SGAs

Second Generation Antipsychotics

Question 25

These drugs:

Cimetidine
Haloperidol
Paroxetine
Fluxetine

inhibit what?

Answer 25

CYP2D6