Psychotherapies

Question 1

What is the main drug used for anxiety?

Answer 1

Lorazepam (benzodiazepine)

Question 2

Benzodiazepines mechanism of action:

Answer 2

Enhance the effects of GABA resulting in reduced neuronal excitability and depress CNS activity.

Question 3

What is the main adverse effect of BZDs?

Answer 3

Decreased CNS activity (drowsiness, loss of coordination, dizziness, confusion)

Question 4

What is the prototype of SSRIs used for depression?

Answer 4

Sertraline

Question 5

What is the advantage of SSRIs over TCAs and MAOIs?

Answer 5

they cause less effect on the cardiovascular system

Question 6

What are the 2 major side effects of SSRIs?

Answer 6

weight gain and sexual dysfunction

Question 7

What is the prototype of SNRIs used for depression?

Answer 7

Venlafaxine

Question 8

Which drugs are considered 2nd line for the treatment of depression?

Answer 8

TCAs

Question 9

What are two examples of TCAs used for depression ?

Answer 9

Amitriptyline and Imipramine

Question 10

Low doses of amitriptyline can be used for?

Answer 10

palliative (neuropathic) pain and migraine prevention

Question 11

TCAs block both….?

Answer 11

serotonin and NE reuptake

Question 12

which TCA is used for childhood enuresis?

Answer 12

Imipramine

Question 13

some of the adverse effects of TCAs (sedation, confusion and motor incoordination) will wear off in?

Answer 13

1-2 weeks

Question 14

TCAs have _______ effects

Answer 14

anticholinergic

Question 15

what are the anticholinergic effects of TCAs?

Answer 15

blurred vision, constipation, urinary retention, dry mouth and tachycardia

Question 16

What is the most dangerous adverse effect of TCAs?

Answer 16

dysrhythmias

Question 17

Are TCAs lethal in overdose?

Answer 17

yes, 70-80% of people die before reaching the hospital

Question 18

What can you do for a TCA overdose?

Answer 18

there is no antidote for acute toxicity, but you can give activated charcoal to decrease drug absorption

Question 19

Which antidepressants are used when depression is not responsive to other drugs?

Answer 19

MAOIs

Question 20

What is the cheese effect?

Answer 20

a hypertensive crisis that occurs when MAOIs are taken with tyramine

Question 21

What is the most common side effect of MAOIs?

Answer 21

orthostatic hypotension

Question 22

What must happen if a patient is switching from an SSRI to an MAOI?

Answer 22

there must be a 2-5 week wash out (drug free) period in between

Question 23

how long must the diet restriction be maintained when quitting MAOIs?

Answer 23

for 2 weeks

Question 24

the nurse should inform clients that it may take up to _______ to see therapeutic effects

Answer 24

2-4 weeks

Question 25

What is considered first line treatment for bipolar disorder?

Answer 25

Lithium

Question 26

what is important to note about lithium?

Answer 26

it has a very narrow therapeutic range

Question 27

Serum levels of lithium should range between?

Answer 27

0.4 to 0.5 mmol/L and less than 1.5 mmol/L

Question 28

When does lithium toxicity occur?

Answer 28

when serum lithium levels are more than 1.5 mmol/L

Question 29

What is a sign of lithium toxicity?

Answer 29

CNS effects

Question 30

Which drugs used for epilepsy are also used in bipolar disorder?

Answer 30

valproate and carbamazepine

Question 31

what is the hallmark of psychosis?

Answer 31

loss of contact with reality

Question 32

Antipsychotics are always used with?

Answer 32

caution

Question 33

What is an example of a first generation antipsychotic?

Answer 33

chlorpromazine (largactil)

Question 34

What is an example of a second generation antipsychotic?

Answer 34

Clozapine

Question 35

All typical antipsychotics are?

Answer 35

dopamine receptor antagonists

Question 36

What is the most serious adverse effect of typical antipsychotics?

Answer 36

motor disturbances (EPS)

Question 37

Why do atypical antipsychotics have less motor disturbances?

Answer 37

they have less effect on DA receptors than typical antipsychotics

Question 38

What is a serious adverse effect of clozapine?

Answer 38

agranulocytosis

Question 39

SSRIs have _______ properties

Answer 39

stimulant

Question 40

TCAs can cause?

Answer 40

sedation

Question 41

What is the most common adverse effect of TCAs?

Answer 41

Orthostatic Hypotension

Question 42

All antidepressants initially increase the risk for?

Answer 42

Suicide. All patients should be monitored for worsening mood and signs of suicidal ideation.

Question 43

In patients with bipolar disorder, SSRIs should not be used alone because?

Answer 43

the can induce mania

Question 44

when serum sodium level is reduced...?

Answer 44

lithium excretion is also reduced, and lithium accumulates

Question 45

Lithium levels above ____ should be reported

Answer 45

1.5 mEq/L

Question 46

What is a safe analgesic to use with lithium?

Answer 46

Aspirin (ASA)

Question 47

Why shouldn't NSAIDS be used with lithium?

Answer 47

they can increase lithium levels by up to 60%

Question 48

Can diuretics be used with lithium?

Answer 48

No, diuretics can increase lithium levels by reducing the serum sodium level

Question 49

Can Benadryl be used with lithium?

Answer 49

Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

Question 50

Early lithium toxicity is evidenced by

Answer 50

diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.