TEST 2 Flashcards
Clozaril - Side effects, nursing assessment, labs associated with Clozaril
SIDE EFFECTS- AGRANULOCYTOSIS (Extreme drop in WBC); Leukopenia NMS, seizures, Myocarditis
NURSING ASSESSMENT- Monitor for signs of myocarditis, institute seizure precautions for pt with hx of seizures
LABS - A baseline WBC count and absolute neutrophil count (ANC) must be taken before initiation of treatment with clozapine and weekly for the first 6 months of treatment.
How often should serum lithium levels be monitored during the initiation of LITHIUM therapy?
Twice weekly
Pt education regarding LITHIUM toxicity?
- Decreases sodium levels will make more receptor sites available to lithium and increase the risk for lithium toxicity.
- significant increases in dietary sodium intake may reduce the effectiveness of lithium because sodium will bind at more receptor sites and lithium will be excreted.
- Other drugs that increase serum sodium levels also have an impact on lithium levels.
Pts using LITHIUM should report signs of hyponatremia which include …….? and Drink _____-_____ ml/day?
- Episodes of nausea, vomiting, headache, muscle weakness, confusion, seizures, since these may be signs of hyponatremia.
- 2,000 - 3,000 ml/day
When monitoring serum levels of LITHIUM , when should blood levels be drawn ?
- Blood levels should be drawn 12 hours after the last dose.
What are signs and symptoms of lithium toxicity?
-vomiting, diarrhea, slurred speech, decreased
coordination, drowsiness, muscle weakness, or twitching).
Medications used for treatment of EPS
Anticholinergic agents such as
- Benztropine (Cogentin)
Side effects of DONEPEZIL?
-Insomnia, dizziness, gastrointestinal upset, fatigue, and headache
Mechanism of action? Indications for Donepezil?
Action: Anticholinesterase drugs block the action of the enzyme acetylcholinesterase preventing the breakdown of the neurotransmitter acetylcholine.
- Alzheimer’s
What are the symptoms of the EPS side effect PSEUDOPARKINSONISM?
—tremor, shuffling gait, drooling, rigidity—may appear 1 to 5 days following initiation of antipsychotic medication. This side effect occurs most often in women, the elderly, and dehydrated clients.
What are the symptoms of the EPS side effect AKATHISIA? (Type of EPS). Which sex is most often affected?
- Continuous restlessness and fidgeting, or akathisia,
- Occurs most often in women and may manifest 50 to 60 days after therapy begins.
What are the symptoms of the EPS side effect DYSTONIA? Who is typically affected? Why is this a medical emergency?
—involuntary muscle spasms in the face, arms, legs, and neck
—occurs most often in men and those younger than age 25.
- Dystonia should be treated as an emergency situation because laryngospasm follows these symptoms and can be fatal.
What are the symptoms of the EPS side effect OCULOGYRIC CRISIS?
Uncontrolled rolling back of the eyes, or oculogyric crisis, is a symptom of acute dystonia and can be mistaken for seizure activity. As with other symptoms of acute dystonia, this side effect should be treated as a medical emergency.
What are the symptoms of the EPS side effect TARDIVE DYSKINESIA?
- bizarre face and tongue movements, stiff neck, and difficulty swallowing.
- *Symptoms are potentially irreversible.
- earliest signs of tardive dyskinesia (usually vermiform movements of the tongue)
Side effects of TRICYCLICS?
- POSTURAL HYPOTENSION
- Sexual dysfunction
- Sedation
- weight gain
- Dry mouth, constipation, blurred vision, -
urinary retention - tachycardia (α1)
SERTRALINE (zoloft)
Classifications?
Indications?
- Antidepressant
- SSRI
- Depression, Panic disorder, OCD, PTSD, PMDD
Assessment of a patient who took an extra dose of an SSRI?
Assess for serotonin syndrome which may include the following Symptoms
- diarrhea, nausea, vomiting,
- tremors, headache, agitation,
- restlessness, diaphoresis,
- Severe cases - muscle rigidity, high fever, irregular heartbeat, seizures, unconsciousness and death, if left untreated.
Treatment for TARDIVE DYSKINESIA?
- valbenazine (Ingrezza)
- Drug is typically discontinued
- Symptoms are potentially irreversible
Lithium levels for Acute Mania/Maintenance levels?
For acute mania: 1.0 to 1.5 mEq/L
For maintenance: 0.6 to 1.2 mEq/L
What is the therapeutic/Pharmacologic class for Donepezil, Galantamine, Rivastigmine (they are all in the same class)?
- Anti-Alzheimer agent
- Cholinergic; cholinesteraseinhibitor
How does Donepezil, Galantamine, Rivastigmine (same therapeutic/pharm class)
Improves cholinergic function, which is lacking in clients with Alzheimer’s, by inhibiting acetylcholinesterase, thus prolonging the effect of acetylcholine.
What are the cholinergic side effects associated with Donepezil, Galantamine, Rivastigmine ? (remember SLUDGE)
S salivation L lacrimation U urination D diarrhea G GI distress E emesis
Most common side effects of Most common side effects of Donepezil, Galantamine, Rivastigmine ?
Most common side effects include dizziness, gastrointestinal upset, fatigue, and headache.
What does a person with LITHIUM intoxication look like?
Looks like a person who is inebriated, with ataxia, slurred speech and drowsiness
Side effects of LITHIUM ? What should patients report immediately?
- Arrhythmias, EKG changes
- Palpitations and SOB
Which SSRI has been approved to treat depression in children aged 8 and older?
- Fluoxetine (prozac)
The combination of Fluoxetine and __________ is approved for treatment of bipolar disorder?
- Olanzapine
Indications for Fluoxetine?
- Depression
- General Anxiety
- Eating disorders
- Panic disorders
- PMDD
- OCD
Client outcomes diagnosed with bipolar disorder: manic episode ?
- Exhibits no evidence of physical injury
- Has not harmed self or others
- Is no longer exhibiting signs of physical agitation
- Eats a well-balanced diet with snacks to prevent weight loss and maintain nutritional status
- Verbalizes an accurate interpreta
Patient education regarding tricyclics?
- Best taken at bedtime b/c sedating effects
- May cause Orthostatic Hypotension
- Use sunscreen and protective clothing
What Anticholinergic effects should a person using Tricyclic Antidepressants look for?
- Hot as a hare
- Dry as a bone
- Red as a beet
- Mad as a hatter
- blind as a bat
Treatments for manic episodes besides LITHIUM?
- ECT has been known to be as effective as Lithium
- Quetiapine
- Olanzapine
- Valproic Acid
Bipolar I disorder
- Client is or has experienced a manic episode or has a history of one or more manic episodes.
- The client may also have experienced episodes of depression.
- This diagnosis is further specified by the current or most recent behavioral episode experienced. The specifier might be single manic episode or current episode manic, hypomanic, mixed, or depressed. Psychotic or catatonic features may also be present.
Bipolar II Disorder
- characterized by recurrent bouts of major depression with episodic occurrence of hypomania.
- may present with symptoms (or history) of depression or hypomania.
- client may never experience full manic episode
Cyclothymic Disorder
** essential feature of cyclothymic disorder is a chronic mood disturbance of at least 2 years’ duration
- Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either BP1 or BP2
- The individual is never without the symptoms for more than 2 months.
Diagnostic Criteria for Manic Episode
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
- During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-
goal-directed activity). - Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying
sprees, sexual indiscretions, or foolish business investments).
- The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
- The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) another medical condition.
Affective symptoms of PDD/dysthymia
- SAD, DOWN IN DUMPS
- essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years