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Collab Therapies 2 > Psychotherapeutic Drugs > Flashcards

Psychotherapeutic Drugs Flashcards

1
Q

Thé nurse is caring for a pt experiencing ethanol withdrawal. The nurse expects to administer which medication class as treatment for this condition?

A) lithium
B) benzodiazepines
C) buspirone
D) antidepressants

A

B

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2
Q

The nurse is teaching a pt receiving MAOI. What food product should the nurse reach the pt to avoid?

A) orange juice
B) milk
C) shrimp
D) Swiss cheese

A

D
Avoid thyramine containing foods

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3
Q

The nurse calls a pt to schedule a follow up visit after the pt has been treated for depression for 4 weeks. What concern will the nurse assess for during the conversation with the patient?

A) weakness
B) hallucinations
C) suicidal ideation
D) difficulty with urination

A

C

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4
Q

The nurse is giving meds to a pt. Which drug or drug class when administered with lithium, increases the risk for lithium toxicity?
A) thiazides
B) levofloxacin
C) calcium citrate
D) b blocker

A

A

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5
Q

The nurse is teaching a pt about treatment with an SSRI antidepressant (sertraline). Which teaching considerations are appropriate. Select all that apply.

A) the pt should be told to avoid thyramine containing foods
B) the pt should be instructed to use caution when standing up from a sitting position
C) the pt should not take any products that contain the natural health product St. John wort
D) this medication should not be stopped abruptly
E) drug levels may become toxic if dehydration occurs
F) the pt should be told to check with the health care provider before taking any OTC meds

A

B, C, D, F

E would be appropriate for lithium
A would be appropriate for phenelzine sulfate the MAOI antidepressant

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6
Q

What are the three main emotional/ mental disorders?

A
  1. Psychoses
  2. Affective disorders
  3. Anxiety
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7
Q

What are the two type of psychoses?

A
  1. Schizophrenia
  2. Deppressive/ drug induced psychoses
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8
Q

What are the three types of affective disorders?

A
  1. Mania
  2. Depression
  3. Bipolar disorder
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9
Q

What are some nursing implications for the psychotherapeutic antidepressant drugs?

A

Monitor for therapeutic effects:
- improved sleep patterns and nutrition
- increased feelings of self esteem
- decrease feeling of loneliness
- increased interest in self and appearance
- increased interest in daily activities
- fewer suicidal thoughts

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10
Q

What are some signs of therapeutic effects with the psychotherapeutic drug antipsychotics?

A
  • improved mood
  • alleviation of psychotic symptoms and episodes
  • decrease in hallucination, paranoia, delusions, inability to cope
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11
Q

What are some signs of therapeutic effects with the psychotherapeutic drugs anxiolytics?

A
  • improved mental alertness, cognition and mood
  • fewer anxiety and panic attacks
  • improved sleep patterns and appetite
  • less irritability, fewer feelings of fesr
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12
Q

A hospitalized pt is reporting having difficulty sleeping.
Which action will the nurse take first to address this problem?

A) administer a sedative-hypnotic drug of ordered
B) offer tea made with herbal preparation valerian
C) encourage the pt to exercise by walking up and down the halls a few times if tolerated
D) provide an environment that is restful and reduce loud noises

A

D

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13
Q

Which considerations are important for a nurse to remember when administering a benzodiazepine as a sedative-hypnotic drug? Select all that apply
A) these drugs are intended for long term management of insomnia
B) the drugs can be administered safely with other CNS depressants for insomnia
C) the dose needs to be given about 1hr before the pt’s bedtime
D) the drug is used as a first choice for tx of sleeplessness
E) the pt needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken

A

C, E

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14
Q

A pt has been admitted to the emergency department because of an overdose of an oral benzodiazepine. He is extremely drowsy but still responsive. The nurse will prepare for which immediate intervention?
A) hemodialysis to remove the medication
B) administration of flumazenil
C) administration of naloxone
D) intubation and mechanical ventilation

A

B

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15
Q

An older pt had been given a barbiturate for sleep induction, but the night nurse noted that the pt was awake most of the night, watching TV and reading in bed. The nurse documents that the pt has had which type of reaction to the medication?
A) allergic
B) teratogenic
C) paradoxical
D) idiopathic

A

C
Paradoxical = rebound disinhibition

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16
Q

Why are benzodiazepines usually preferred from barbiturates as anti-anxiety drugs?

A

Because they usually don’t suppress REM sleep as much as barbiturates do

17
Q

What are the two prototype for benzodiazepines medications ? And what are their classification? What are they usually used for?

A
  • lorazepam (Ativan)
  • diazepam (Valium)

Are CNS depressants

Are classified as either:
- sedative hypnotics or
- anxiolytics

Uses:
- acute anxiety
- panic disorders
- tx seizures
- sedation

18
Q

What are the possible AE of lorazepam (Ativan) the benzodiazepines anti anxiety drug?

A
  • drowsiness
  • dizziness
  • ataxia
  • orthostatic hypotension
  • loss of coordination
  • hangover effect
  • hypotension
  • bradycardia (due to sedative effect)
  • nausea
  • constipation
  • dry mouth
  • visual disturbances
  • fatigue

In older adults:
- paradoxical reactions, rebound disinhibition

19
Q

What are contraindications to lorazepam (Ativan)?

A
  • elder, pregnant and lactating women
  • narrow angle glaucoma
  • impaired liver or kidney
  • KDA
20
Q

What are possible food and drugs interactions with lorazepam (Ativan) ?

Benzodiazepines
Anxiolytic
Sedative hypnotics

A
  • increase CNS depression with: opioids, muscle relaxants, alcohol, barbiturates,

Food:
- chamomile
- ETOH
- grapefruit juice

21
Q

When and how should lorazepam (Ativan) be taken?

A
  • should be taken 30-60min before bedtime
  • take with light snack or meal to decrease GI upset
  • avoid grapefruit juice, avoid chamomile, avoid alcohol
22
Q

What are some pt teaching to be done when starting lorazepam (ativan) therapy?

A
  • change position slowly due to risk of orthostatic hypotension
  • remove all clutters that could make you trip at night
  • don’t drive
  • no alcohol
  • no grapefruit juice
  • use with caution in older adults can cause hangover effect,
  • take at bedtime (30-60min before)
  • don’t double dose
  • don’t stop abruptly (can cause rebound anxiety)
  • not to be take as long term tx as can cause dépendance
  • ## avoid drugs that increase CNS depression
23
Q

What are some S&S of benzodiazepines overdose? And what is it’s usual treatment?

Benzodiazepines:
- lorazepam (Ativan)
- diazepam (Valium)

A

S&S:
- somnolence
- coma
- confusion
- diminished reflexes
- resp. Depression
- hypotension

Treatment:
Antidote: flumazenil will antagonize benzodiazepines effect on the CNS

24
Q

Which medication is usually administered for status epilepticus and alcohol withdrawal?

A

Diazepam (Valium)

25
Q

What are some contrain to the use of diazepam (valium)?

The benzodiazepines
CNS depressant
Sedative hypnotics
Anti anxiety

A
  • pregnancy
  • coma
  • closed angle glaucoma
  • myesthenia gravis
  • hepatic disease
  • acute alcohol intoxication
26
Q

What are some possible drug and food interactions with diazepam (valium) ?

A

Drug:
- increased effect with: CNS depressants, SSRIs, alcohol, opioids
- Decreased effect: barbiturates

Food:
- increased effect and toxicity: grapefruit

27
Q

What are possible AE with diazepam (valium) ?

A
  • drowsiness
  • hypotension and orthostatic hypotension
  • blurred vision
  • tinnitus
  • neutropenia
  • hallucinations
  • ataxia
28
Q

How and when should diazepam (valium) be taken?

A
  • best taken on empty stomach for absorption but high GI upset so take with light snack or meal
  • take 30-60min before bed
  • change position slowly
  • avoid grapefruit juice
  • avoid alcohol consumption
  • warn about possible rebound insomnia
  • no driving
  • not for long term therapy
  • no use of heavy machinery
29
Q

What are patient tips to relieve dry mouth related to benzodiazepines therapy?

Lorazepam and diazepam

A
  • sips of water
  • suck hard candy
  • sugar free gum
30
Q

What is the prototype medication for CNS depressant barbiturates?
And what are its indications?

A

Phenobarbital

Indications:
- sedative hypnotics
- anticonvulsant
- adjunct to anesthesia for procedures
- seizures
- CNS depressant

31
Q

What are possible AE with phenobarbital the barbiturate CNS depresssant?

A
  • drowsiness
  • somnolence
  • hypotension
  • increased risk of falls in older adults
  • agranulocytosis
  • resp depression
  • Steven Johnson syndrome
  • CNS depression
  • coma
  • death
  • decrease REM sleep
  • hangover effect
32
Q

How and when should phenobarbital be given?

A

if IV:
- infuse slowly ( if too fast = resp depression and hypotension)
Monitor IV site — can cause tissue necrosis with extravasation

Po:
- Take with food

33
Q

What are drug interactions with phenobarbital?

A
  • increase CNS depression: alcohol, antihistamines , benzodiazepines, opioids, tranquilizers
  • decrease metabolism: MAOI = longer effect of barbiturates
  • increase metabolism : warfarin (possible clot formation)
34
Q

What are the S&S of barbiturates overdose?
What is the treatment for barbiturates overdose?

(Phenobarbital overdose)

A

S&S of overdose:
- cold clammy skin
- hypothermia
- fever
- tachycardia
- hypotension
- resp depression
- seizures

Treatment:
- Cardiopulmonary support
- charcoal to absorb drug molecules in GI tract for elimination
- phenobarbital is acidic and can be eliminated more quickly by kidneys SO add sodium bicarb to IV solution —- forced diuresis with furosemide

35
Q

What is something that ALL psych drugs have in common?

  • antidepressants
  • antipsychotics
  • antiepileptics
  • anxiolytics
  • CNS depressants
    Etc
A

They all suppress BP so slowly get up and change position to prevent orthostatic hypotension

36
Q

A pt is on lorazepam (Ativan) for her anxiety and her psychiatrist may also suggest which type of medication ?

A) sertraline (Zoloft)
B) lithium
C) quetiapine
D) haloperidol

A

A

37
Q

A pt is experiencing an overdose of phenobarbital. Select the treatment the nurse anticipates will be administered?

A) sodium bicarb IV alkalinized urine allows phenobarbital to be excreted
B) activated charcoal Iv binds to the phenobarbital and allows it to be excreted
C) flumazenil Iv will be administered
D) naloxone IV will be given

A

A

38
Q

When administering certain antipsychotics drugs, the nurse monitors for extra pyramid effect such as: (select all that apply)

A) tremors
B) elation and sense of well being
C) painful muscle spasms
D) motor restlessness
E) bradycardia

A

A, C, D

39
Q

A pt has been taking antipsychotics medication for years and his wife has noticed he has had some new physical symptoms. She describes him as having odd facial movements , sticking out his tongue, and having movement of his arms that he cannot seem to control. The nurse suspects that the pt is exhibiting symptoms of which condition?

A) hypomania
B) serotonin syndrome
C) tardive dyskinesia
D) neuroleptic malignant syndrome

A

C

Collab Therapies 2 (28 decks)

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