week 4 pharm

Question 1

Lithium

Answer 1

*range 0.5 to 1.2 mEq/L

• inverse relationship w sodium
• first line of treatment for acute mania & depression
  -prevents manic & depressive episodes
• mood stabilizer that prevents mood cycling (3-6 weeks)

*interacts w NSAIDS & diuretics & anticholinergics & antidepressants

Question 2

expected side effects of Lithium

Answer 2

sedation
acne
nausea
excessive thirst
hand tremors
weight gain

Question 3

early lithium toxicity

Answer 3

1.2 - 1.5
* hold med & call dr

n/v/d
muscle weakness
slurred speech

Question 4

advanced lithium toxicity

Answer 4

> 1.5

-excess sweating
-vomiting
-diarrhea

EEG changes
-hand tremor
- muscle hyper-irritability
- GI upset
- confusion
-incoordination

*stupor
*blurrred vision

*affects KIDNEYS

**treated w normal saline bolus

Question 5

long term effects of Lithium

Answer 5

hypothyroidism - goiter
kidney dysfuction

weight gain
*assess levels every 6 months

Question 6

Anticonvulsants

Answer 6

1st line of treatment mood stabilizer – bipolar mania, hypomania, mixed states, cycling

*ValPROic Acid
*DivalPROex
*ValPROate

Question 7

Expected side effects of valPROic Acid

Answer 7

*anticonvulsant

tremor
sedation
GI pain
hair loss
weight gain

blood dyscarias – anemia & thrombocytosis
hepatotoxicity
pancreatitis

*taken in patients w kidney dysfunction

Question 8

lithium affects ____ buut anticonvulsants affect _____

Answer 8

lithium = kidneys

anticonvulsants = liver

Question 9

anticonvulsant therapeutic levels & toxicity symptoms

Answer 9

*ValPROic Acid
*DivalPROex
*ValPROate

85 - 125 ug/mL
toxic = intentional overdose
- ataxia (loss of body movement)
- confusion
- somnolence
-coma

Question 10

Carbamazepine

Answer 10

anticonvulsant

treats bipolar disorder, rapid cycling, mixed states

treats & prevents acute mania

*MONITOR FOR RASHES

Question 11

Adverse effects of Carbamazepine

Answer 11

*anticonvulsant = mood stabilizer
- hyponatremia & fluid overload
- decreases effectoveness of birth control
- blood dyscrasias
- hepatic disease

RASH
*fatigue & nausea
*diplopia (double vision)
*ataxia

Question 12

Lamotrigine treats ___ & adverse effects

Answer 12

**anticonvulsant = bipolar depression–acute &maintenance

• monitor for FEVER = aseptic meningitis
• lower birth control effectiveness
• Steven Johnsons

Question 13

Anxiolytics are

Answer 13

Benzodiazepenes = Clonazepam & Lorazepam

given when concerned about heart or delirium

adjunctive agents for acute mania & psychomotor agitation

Question 14

second - generation antipsychotics are best for

Answer 14

non-compliance for acute mania, bipolar depression, & their prevention

Question 15

first-generations antipsychotics

Answer 15

Chlorpromazine
Loxapine
Fluphenazine
Haloperidol

• treat POSITIVE symptoms
• used less = adverse effects

Question 16

extrapyramidal symptoms of first-generation antipsychotics

Answer 16

*PSEUDOPARKINSONISM - fall risk

*ACUTE DYSTONIA - (muscle & laryngeal symptoms - concern for airway)

*AKATHISIA- (restless feet & extreme stress- suicide risk)

*TARDIVE DYSKINESIA - (face droop- irreversible)

Question 17

other side effects of 1st gen antipsychotics

Answer 17

lowered seizure threshold
orthostatic hypotension
sedation
increased prolactin = sex dysfunction, amenorrhea, galactorrhea

*high fall risk

Question 18

adverse effects of first gen antipsychotics

Answer 18

*METABOLIC SYNDROME
*prolonged QT interval
*anticholinergic toxicity
*neuroleptic malignant syndrome

Question 19

metabolic syndrome presents as..

Answer 19

weight gain, hypertension, diabetes, & dyslipidemia

Question 20

anticholinergic toxicity presents with..

Answer 20

*dry mouth
*urinary retention
anxiety, hallucinations, hyperactivity, seizures, & delirium

symptoms disappear w stop of first gens

Question 21

Neuroleptic Malignant Syndrome presents as

Answer 21

*high fever (103-105)
*muscle rigidity (monitor DVT & rhabdomyolysis)
*increased vitals
*altered mental status

Question 22

Second & Third Generation Antipsychotics

Answer 22

*CLOZAPINE - last resort
*ARIPIPRAZOLE - sedating
*RISPERIDONE - stroke risk
*LURASIDONE
*OLANZIPINE - gain weight
*QUETIAPINE - high street value & homeless

treat NEGATIVE & POSITIVE

Question 23

when using clozapine

Answer 23

*monitor for FEVER
*AGRANULOCYTOSIS - WBC’s

drooling
mycarditis
*last-resort

Question 24

Injectable Antipsychotics

Answer 24

Haldol
Aripriprazole
Risperidone
Olanzipine
Ziprasidone
*must be stable on PO verison first

Question 25

when evaluation antipsychotic medication effectiveness the nurse should ask about..

Answer 25

*have the symptoms LESSENED *medication ADHERENT *support system

Question 26

lithium levels during a manic episode

Answer 26

0.8 to 1.4 okay to administer next dose if patient is within the range

Question 27

a client's lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? 1. Perform immediate gastric lavage 2. Prepare the client for hemodialysis 3. Administer an additional oral dose of lithium 4. Request a stat repeat of the lab test

Answer 27

1. Perform immediate gastric lavage

Question 28

when a client has a lithium level of 2.5 mEq/L the nurse should..

Answer 28

prepare the client for hemodialysis

Question 29

When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? 1. Avoid the use of acetaminophen for headaches 2. restrict intake of foods rich in sodium 3. decrease fluid intake to less than 1,500 ml daily 4. limit aerobic activity in hot water

Answer 29

4. limit aerobic activity in hot water --- avoid activities that have the potential to cause sodium & water depletion

Question 30

a nurse is caring for a client who has a new prescription for valproic acid. the nurse should instruct the client to have which of the following laboratory tests completed periodically? sap 1. thrombocyte count 2. glucose 3. amylase 4. liver function tests 5. potassium

Answer 30

1. thrombocyte count 3. amylase (pancreatitis) 4. liver function tests

Question 31

a nurse is assessing a client who recently egan taking haloperidol. which of the following findings in the priority to report to the provider? 1. shuffling gait 2. neck spasms 3. drowsiness 4. sexual dysfunction

Answer 31

2. neck spasms *acute dystonia=respiratory insufficiency

Question 32

a nurse is providing teaching for a client who is to begin taking risperidone. which of the following instructions should the nurse include? 1. "add extra snacks to your diet to prevent weight loss. " 2. "notify the provider if you have trouble sleeping." 3. "you may begin to have mild seizures while taking this medication." 4. "this medication is likely to increase your libido."

Answer 32

2. "notify the provider if you have trouble sleeping."

Question 33

a nurse is following up witha client who takes chlorpromazine for treatment of schizophrenia. the nurse should expect to find the greatest improvement in which of the following manifestations? sap 1. disorganized speech 2. bizarre behavior 3. impaired social interactions 4. hallucinations 5. decreased motivation

Answer 33

1. disorganized speech 2. bizarre behavior 4. hallucinations chlorptomazine = 1st gen = positive manifestations