NR293_ Pharmacology for Nursing Practice Week 6 Concepts, Intracranial Regulation CNS Depressants Ch

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CNS Depressants Prepare: CNS Depressants

CNS Depressants Central Nervous System (CNS) Depressants are drugs that result in a calming effect by inhibiting the transmission of nerve impulses to the CNS. Subclass of CNS Depressants Barbiturates are the subclass of CNS Depressants which inhibit nerve impulses by acting on the brainstem and GABA receptors resulting in the inhibition of nerve impulses in the cerebral cortex.

Black Box Warning Benzodiazepines carry a black box warning regarding what?

The combination of all opioids with all benzodiazepines can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death).

The use of benzodiazepines while driving can cause severe sleepiness.

The dosage of benzodiazepines.

The use of benzodiazepines in patients with a history of depression.

Self-Check: CNS Depressant

CNS Depressant Choose the correct CNS Depressant (sedatives, hypnotics, or sedative-hypnotic) based on the degree to which it causes the inhibition of nerve impulses in the CNS. Sedatives produce a sense of calm, reduce nervousness, excitability, and irritability without causing sleep unless given in a large enough dose.

Hypnotics cause sleep with a much more potent CNS effect than sedatives.

Sedative-Hypnotics can act as either a sedative or a hypnotic depending on the dose and patient responsiveness. In low doses, they calm the CNS without causing sleep. In high doses, they calm the CNS and cause sleep.

Self-Check: Sedative-hypnotics

Sedative-hypnotics Sedative-hypnotics, the group of CNS depressants that have either a sedative or hypnotic effect, or both, dependin on various factors, are broken into 3 groups based on their chemical makeup. Which of them carries the highest ri for dependence and are therefore used less?

Barbiturates Sedative-hypnotics Benzodiazepines Hypnotics

Self-Check: Barbiturates: Safety Considerations

Barbiturates: Safety Considerations Barbiturates carry with them many contraindications, risk for dependence and overdose, as well as many drug-dru interactions.

Drag the statements below that apply to barbiturates and drop them to the right side column:

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Self-Check: Benzodiazepines Benzodiazepines Choose all the statements below that are correct regarding Benzodiazepines. (Select all that apply.) alprazolam, lorazepam, and temazepam are long-acting benzodiazepines Produce more REM suppression than barbiturates Affect the hypothalamic, thalamic, and limbic systems of the brain (GABA receptors) Induce relaxation of skeletal muscles clonazepam, diazepam, and flurazepam are short-acting benzodiazepine Reduce excessive sensory stimulation which induces sleeps

Self-Check: Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines act on the CNS and act very much like benzodiazepines. Orexin Receptor Antagonists (also called hypocretins) act on the CNS and act very much like benzodiazepines.

Reflect: CNS Depressant

CNS Depressants Pentobarbital is a short- acting barbiturate now used for preoperative anxiety and to produce sedative effects, to treat symptoms of withdrawal from other barbiturates and nonbarbiturates, control status epilepticus, and to prevent hyperbilirubinemia in neonates.

Phenobarbital is a long- acting barbiturate used to prevent generalized tonic-clonic seizures and fever-induced convulsions as well as treatment of hyperbilirubinemia in neonates. It is no longer used as a sedative or hypnotic.

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Sedative-hypnotics Stuvia.com - The Marketplace to Buy and Sell your Study Material Choose the correct statement(s) below regarding sedative-hypnotics. (Select all that apply.)

Prolonged use of sedative-hypnotics can cause REM interference resulting in daytime fatigue.

Discontinuation of a sedative-hypnotic can cause REM interference resulting in daytime fatigue.

Discontinuation of a sedative-hypnotic can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams.

Prolonged use of sedative-hypnotics can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams.

Sedative-hypnotic Drugs Which of the following are currently the more frequently prescribed sedative-hypnotic drugs?

Nonbenzodiazepines Long-acting barbiturates Ultrashort-acting barbiturates Benzodiazepines

CNS Depressants Select the true statement(s) regarding CNS depressants. (Select all that apply.)

Herbal supplements kava and valerian have CNS stimulant effects.

There are significant drug-drug interactions with benzodiazepines, especially with other CNS Depressants, due to th intensity of benzodiazepines and the combined CNS depressant effects.

There is a black box warning regarding the combination of all opioids with all benzodiazepines which can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death).

Alcohol should not be used with these CNS Depressants because the combination multiples the CNS depressive effects.

Barbiturates Which of the following statements are true regarding barbiturates? (Select all that apply.)

The long-term use of barbiturates can lead to harmful effects on sleep due to the deprivation of REM sleep.

Increased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers.

Overdose of barbiturates typically leads to respiratory arrest, coma, and death.

MAOIs (antidepressants) result in a longer duration of action of barbiturates.

Barbiturates are a type of sedative-hypnotic.

Decreased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers.

The long-term use of barbiturates can lead to harmful effects on sleep due to the prolongation of REM sleep.

Sedative-hypnotics Select the true statement below regarding sedative-hypnotics.

Sedatives at low doses calm the CNS and cause sleep.

Hypnotics at high doses calm the CNS and cause sleep.

Hypnotics at low doses calm the CNS without causing sleep.

Sedatives at high doses calm the CNS without causing sleep.

Barbiturates Match each barbiturate drug to its common use.

Use

methohexital and thiopental

pentobarbital and secobarbital

butabarbital

phenobarbital and mephobarbital

induction of anesthesia

prevent hyperbilirubinemia in neonates

sedation

prevention of seizures

Sedative-hypnotics Match the sedative-hypnotic CNS Depressant medication to its subclass.

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IF CAN’T READ Intermediate-acting benzodiazepines - alprazolam, lorazepam, temazepam Long-acting benzodiazepines - clonazepam, diazepam, flurazepam Short-acting barbiturates - pentobarbital, secobarbital, pentobarbital Long-acting barbiturates – phenobarbital, mephobarbital, phenobarbital GABA receptor antagonist that is the antidote to benzodiazepines – flumazenil Long-acting benzodiazepine most commonly used to treat for status epilepticus - diazepam benzodiazepine most commonly used for preoperative anxiety and for moderate sedation - midazolam Non-benzodiazepine, a short-acting hypnotic with a relatively low incidence of daytime sleepiness - zolpidem

Intermediate Acting Benzodiazepines (alprazolam) Prepare: Intermediate Acting Benzodiazepines (alprazolam) Which of these medications is an intermediate-acting benzodiazepines used for its anxiolytic effects? zolpidem butabarbital diazepam alprazolam Benzodiazepines are contraindicated in pregnancy and lactation because they: (Select all that apply.)

Cause CNS depression May cause sedation and respiratory issues in newborns Cross into breastmilk May cause anxiety in the mother Benzodiazepines are most often used for which of these effects?

Barbiturate Anxiolytic Sedative Hypnotic

Self-Check: Intermediate Acting Benzodiazepines Intermediate-acting benzodiazepines are so called because: There onset and duration of action takes much longer than those of short-acting benzodiazepines They sometimes have an increased CNS depressive effect when taken with barbiturates In relation to short- and long-acting benzodiazepines, their onset and duration of action take place over a period of time that is neither fast nor slow They are sometimes less effective when taken with other CNS Depressants Benzodiazepines Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Benzodiazepines are contraindicated in pregnancy because they cause CNS depression. This can subsequently lead to Stuvia.com - The Marketplace to Buy and Sell your Study Material respiratory issues in the neonate.

Self-Check: alprazolam Which of these are indications for the use of alprazolam? (Select all that apply.)

Generalized anxiety disorder (GAD) Anxiety associated with depression Panic disorder Sedative to induce and maintain sleep Adjunct in the treatment of acute mania and acute psychosis Prevention of alcohol withdrawal alprazolam is administered Oral (PO) alprazolam is a/an oral benzodiazepine used for its anxiolytic effects by reducing anxiety.

Reflect: Intermediate Acting Benzodiazepines (alprazolam) alprazolam: Indications for Use Identify the applicable indications for the use of alprazolam:

alprazolam In administering alprazolam to a client with COPD which of the following is a concern?

Anxiety and panic attacks can induce hyperventilation Alprazolam is contraindicated with medications used to treat COPD Alprazolam is a CNS depressant Someone who has anxiety is more likely to have an exacerbation of a respiratory illness CNS Depressants and Drug Interactions Which of the following items have CNS depressive effects and should be used with caution in patients taking alprazolam? (Select all that apply.) caffeine antipsychotics muscle relaxants alcohol benzodiazepines flumazenil anxiolytics opioids

Dosage of alprazolam How might the dosage of alprazolam be adjusted in an elderly patient and why?

Elderly patients are less sensitive to benzodiazepines and therefore higher doses may be used in this population.

Elderly patients have a much lower risk for dependency to benzodiazepines and therefore higher doses may be use in this population.

Elderly patients have a great risk for dependency to benzodiazepines and therefore lower doses may be used in this population.

Elderly patients are sensitive to benzodiazepines and therefore lower doses may be used in this population.

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Nicotine Nicotine causes increased benzodiazepine metabolism which causes the medication to be less effective. For a patient who a smoker and is also taking alprazolam for generalized anxiety disorder, this could mean that their symptoms of anxiety do not improve. alprazolam: Classifications Which of the following characteristics describe alprazolam?

CNS Depressant Sedative-hypnotic CNS Stimulant Barbiturate Intermediate-acting benzodiazepine Nonbenzodiazepine Anxiolytic

Benzodiazepines Which of the following is the most accurate statement related to the increased risk for dependence and addiction when benzodiazepines (such as Xanax) are taken with other CNS Depressants?

Benzodiazepines have a long-acting duration causing the user to remain sedated for a long period of time when tak with other CNS Depressants.

Benzodiazepines administered to patients who have uncontrolled severe pain will cause an increased risk for dependency, especially when taken with other CNS Depressants.

Benzodiazepines administered to patients who have never taken them before pose the greatest risk for addiction, especially when taken with other CNS Depressants.

Benzodiazepines typically peak and trough quickly causing the user to crave more and more when taken with other CNS Depressants.

CNS Depressant A patient taking alprazolam, or any CNS Depressant, should avoid which of the following? (Select all that apply.)

Grapefruit juice Valerian root Green tea Kava

Nursing Application: CNS Depressants Prepare: Nursing Application: CNS Depressants

Nursing Assessment A nurse is completing an assessment of a patient taking a CNS Depressant medication. The nurse will monitor for symptom of CNS depression such as respiratory depression associated with the inhibition of nerve impulse transmission to the CNS. pentobarbital: Indications You are the nurse caring for a patient taking pentobarbital, a short-acting barbiturate. Based on your knowledge of the indications for this medication, you know that this patient may have a history of seizures Risks of CNS Depressants In educating clients taking benzodiazepines with other CNS depressants, the nurse indicates this may put the client at risk toxicity.

Self-Check: Nursing Assessment Nursing Assessment As the nurse caring for a patient taking a CNS Depressant. Which adverse effect does the nurse need to consider when assessing a client prescribed a CNS depressant?

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Excessive sedation Hypertension Nausea and vomiting Insomnia

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Patient Education When reviewing a client’s medications for discharge, she asks you if she can continue to take kava for her insomnia. You understand that kava causes CNS depression.

Self-Check: Nursing Assessment: Specific Medications Barbiturates You are caring for a patient for whom you have an order to administer a barbiturate. Based on your knowledge of this subclass and its contraindications, you check the patient’s lab results to ensure that she is not pregnant.

Self-Check: Nursing Interventions

You are the nurse caring for a patient who has been prescribed zolpidem, a hypnotic CNS Depressant. You plan to adminis this medication at this time in order to maximize its sleep-inducing effectiveness: 30-60 minutes before bedtime Nursing Interventions As the nurse caring for the patient taking a CNS Depressant, you are planning nursing interventions used to minimize some of the risks associated with this drug class, such as: (Select all that apply.)

Teaching the patient to stop taking the medication once he’s feeling better To avoid driving while taking this medication Assistance with ambulation Teaching the patient to minimize alcohol use when taking this medication

Reflect: Nursing Application: CNS Depressants Nursing Assessment In reviewing benzodiazepine use in an elderly client, you anticipate: (Select all that apply.)

Insomnia and tachycardia Decreased CNS depressive effects Risk of low respiratory rate and excessive sedation Increased CNS depressive effects

Nursing Interventions You are the nurse caring for a 24-year-old patient who is recovering from a surgical procedure. He has recently bee admitted to your unit from the post-anesthesia care unit and is recovering well and is tolerating drinking liquids. Y were told in a report that he received diazepam for sedation during the procedure as an adjunct anesthetic to aid in intubation. You enter the room to check his vital signs and notice that his mom is handing him a drink she brought from home and notice that it is grapefruit juice.

Based on your knowledge of this interaction, your first action is to: Advise him not to drink citric beverages.

Advise him not to have food or beverages from home as they may interact with his medications.

Assess his sedation level, respiratory effort, and vital signs.

Prepare to administer flumazenil, the antidote to benzodiazepines.

Patient Teaching You are the nurse caring for Stephanie, a 42-year-old woman for whom you are completing discharge instructions and patie teaching. She has been prescribed a nonbenzodiazepine. However, she mentioned to you during your conversation that sh is allergic to acetylsalicylic acid. You tell Stephanie that those with an allergy to acetylsalicylic acid are more likely to have a allergy to nonbenzodiazepines.

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Nursing Interventions Stuvia.com - The Marketplace to Buy and Sell your Study Material You are the nurse caring for Sara, a 25-year-old female patient for whom suvorexant is prescribed. Based on your knowled of this medication, you are aware that she may experience: An increased risk for daytime sleepiness

Priority of Assessment You are caring for a patient taking a CNS Depressant. You are considering your plan of care for this patient based o the subjective and objective data you have collected, as well as your knowledge of this drug class. You choose the following as the priority focus for your nursing care: Risk for injury Respiratory depression Drug dependence Confusion

Patient Education You are the nurse caring for Steven, a 72-year-old male who is being discharged home. He has been prescribed a barbiturate to treat seizures. His medical record indicates that he suffers from seasonal allergies for which he take over-the-counter medication, drinks alcoholic beverages on occasion, and has a history of Deep Vein Thrombosis (DVTs) and depression. You discuss with the patient the adverse effects that may result in particular when taken w other CNS depressive substances.

Which of the following statements do you include in your patient's education regarding barbiturates in regard to hi particular medical history?

Contraindications You are the nurse caring for Ed, a 51-year-old man with a history of hypertension, glaucoma, and Deep Vein Thrombosis (DVTs). He has been prescribed a benzodiazepine. Based on your knowledge of Ed’s medical history, this drug class and its possible contraindications and drug-drug interactions, you know that: (Select all that apply.)

Benzodiazepines interact with anticoagulants causing an increased risk for Deep Vein Thrombosis (DVTs).

Benzodiazepines are contraindicated in patients with narrow-angle glaucoma.

Benzodiazepines are contraindicated in patients with hypertension.

Verapamil and diltiazem are antihypertensives that cause a decrease in benzodiazepine metabolism.

CNS Depressant Safety Considerations The nurse is preparing discharge instructions for a client being sent home with a prescription for a benzodiazepine Match the following instructions to the potential risks of this medication class.

Discharge Instructions

Risk for Injury

Risk for Sedation

•Avoid driving or operating heavy machinery •May be higher risk for falls •Can cause confusion or memory loss

•Do not use with kava or valerian root •Do not use with alcohol or opioids •Do not use with sleep aids

Risk for Dependence

•Do not stop taking abruptly after prolonged use •Many CNS depressants are controlled substances

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Prepare: Muscle Relaxants Stuvia.com - The Marketplace to Buy and Sell your Study Material Muscle relaxants are categorized by their mechanism of action.

Muscle Relaxants: Indications for Use Muscle relaxants and other CNS Depressants have different indications for use including insomnia and sedation.

Abused Drug Carisoprodol has become a commonly abused drug, in particular in combination with an opioid and a benzodiazepine.

Self-Check: Muscle Relaxants Muscle Relaxants Most muscle relaxants work on the CNS and ____. (Select all that apply.) act directly on the excitation-contraction coupling of skeletal muscle fibers. are known as central acting. are known as direct-acting. decrease the force of muscle contraction and relax strained, stiff and weakened muscles. have no direct effects on the muscles or conduction of nerves. decrease the amount of calcium released. decrease the muscle’s response to stimuli.

Muscle Relaxants Muscle relaxants are found to be the most effective when combined with physical therapy.

Self-Check: Safety Considerations Muscle Relaxant Overdose The reversal drug for muscle relaxant overdose is which of the following? flumazenil zolpidem temazepam muscle relaxants do not have a specific antidote or reversal drug for an overdose Adverse Effects Which words/phrases describe the primary adverse effects of muscle relaxants that work on both the central nervous system and directly on skeletal muscles? Select all that apply.

Drowsiness Gastrointestinal upset Euphoria Fatigue Tachycardia Headaches

Self-Check: Common Muscle Relaxants Direct-acting Muscle Relaxants Which of the following is a direct acting skeletal muscle relaxant? dantrolene baclofen tizanidine cyclobenzaprine

Reflect: Muscle Relaxants Muscle Relaxants: Drug Name Which of these muscle relaxants in IV form is used to treat skeletal muscle spasms caused by malignant hyperthermia?

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cyclobenzaprine baclofen methocarbamol dantrolene

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Muscle Relaxant Drugs Match the drug to the correct category of muscle relaxant:

Drug Names

Centrally-acting Skeletal Muscle Relaxants

Direct-acting Skeletal Muscle Relaxant

chlorzoxazone / carisoprodol / baclofen / cyclobenzaprine

dantrolene

Muscle Relaxants: Indications for Use Muscle relaxants are indicated for the use of: (Select all that apply.)

Low back strain Arthritis Insomnia Multiple sclerosis Treatment of withdrawal symptoms Anxiety-related depression Pre-operative adjunct to anesthesia Parkinson's Disease Cerebral palsy Muscle Relaxants: Mechanism of Action Match the mechanism of action to the correct category of muscle relaxant:

Mechanism of Action

Centrally-acting Skeletal Muscle Relaxants

Direct-acting Skeletal Muscle Relaxants

•Provide sedative effects •Act directly on the CNS •Have no direct effects on the muscles •Have no effect on conduction of nerves •Act at the level of the brainstem and thalamus •Decrease the force of muscle contraction •Relax strained, stiff and weakened muscles

•Small group of muscle relaxants •Act directly on skeletal muscle •Decrease the muscle’s response to stimu •Decrease the amount of calcium released

Muscle Relaxants Effects For which of these muscle relaxants is marked sedation a common result of use? cyclobenzaprine carisoprodol dantrolene baclofen Muscle Relaxants Which of the following muscle relaxants is used to treat muscle spasms and can be used in an implantable pump device? cyclobenzaprine dantrolene metaxalone baclofen

Commonly Abused Drug Which of these muscle relaxants is commonly abused in combination with an opioid and a benzodiazepine, togeth referred to as “The Holy Trinity”, producing a heroin-like effect?

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chlorzoxazone dantrolene carisoprodol cyclobenzaprine

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Muscle Relaxant Interactions As with all CNS Depressants, there is a potential for adverse effects and toxicity or overdose when muscle relaxants are taken with other CNS depressive substances and drugs. Muscle relaxant overdose requires more aggressive treatment tha does an overdose of other CNS Depressants. The priority is the ABCs, including airway maintenance, heart rhythm monitoring, and IV fluids.

Nursing Application: Muscle Relaxants Prepare: Nursing Application: Muscle Relaxants Nursing Assessment The nurse caring for a patient prescribed a muscle relaxant is aware that, in addition to most of the side effects associated with all CNS Depressants, the assessment of this patient will include awareness of muscle function, pain, and range of motion.

Nursing Implications The nurse caring for a patient prescribed a muscle relaxant is aware that there are two categories, each with a mechanism action and subsequent nursing implications that are unique to this subclass.

Side Effects As the nurse caring for a patient taking a muscle relaxant, you are aware of the side effects general to all CNS depressants and those specific to muscle relaxants such as muscle spasticity, pain and stiffness.

Self-Check: Nursing Assessment

Nursing Assessment You are the nurse caring for a patient taking dantrolene for malignant hyperthermia resulting from a recent surgica procedure. Your assessment of this patient will include areas specific to this drug’s mechanism of action and malignant hyperthermia. These areas include cardiovascular depression associated with all CNS depressants. respiratory depression associated with all CNS depressants. successful induction of sleep associated with the hypnotic effects of dantrolene. relief of muscle rigidity associated with malignant hyperthermia.

Nursing Assessment You are the nurse caring for a patient taking a muscle relaxant. Although you know that muscle relaxants are used for the treatment of muscle spasms and pain, they are still types of CNS depressants. For this reason, you assess for some of the effects of CNS depressants in which of these situations?

Relief of muscle spasm associated with malignant hyperthermia Sedative effects such as drowsiness and dizziness if taking dantrolene Relief of insomnia if taking baclofen Sedative effects such as drowsiness, dizziness if taking cyclobenzaprine

Self-Check: Nursing Implementation Patient Teaching As the nurse caring for a patient taking cyclobenzaprine, a centrally acting muscle relaxant, you ensure that you teach the patient which of the following in preparation for discharge?

If they experience any of the side effects discussed, it is best to stop taking the medication immediately.

They should see how they do on cyclobenzaprine for a few days before they go back to driving.

They should reach maximum therapeutic benefits from this medication in the next 1-2 days.

They will be taking this medication for the next few years.

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Nursing Implementation You are the nurse caring for a patient taking cyclobenzaprine, a centrally acting skeletal muscle relaxant. He asks you why he must not drink alcohol while taking this medication. Your response is that ___________ alcohol causes issues with the liver which can be impaired by this medication. alcohol can cause insomnia. alcohol and this medication both cause CNS depression. alcohol makes this medication less effective.

Nursing Implementation You are caring for a patient hospitalized for muscle spasms associated with multiple sclerosis. Her health care provider is prescribing baclofen for long term use. Based on your knowledge of this medication, which of the following you would consider? (Select all that apply.) prepare to administer a test dose as ordered by the health care provider. prepare the patient for an implantable baclofen pump device. explain to this patient that she is being administered a medication that will cause her to feel agitated and excitable. begin closely monitoring the patient’s temperature.

Reflect: Nursing Application: Muscle Relaxants

Nursing Assessment You are the nurse caring for Tammy, a 35-year-old woman who has just arrived at your unit from post-op. She is exhibiting signs of malignant hyperthermia and her health care provider has ordered a direct acting skeletal muscl relaxant for treatment. Based on your knowledge of this type of medication and its indication for this use, you ____ prepare to administer dantrolene and monitor her sedation level, heart rhythm, vital signs, electrolyte levels, and urin output continuously. prepare to administer cyclobenzaprine and monitor her sedation level, heart rhythm, vital signs, electrolyte levels, an urine output continuously. prepare to administer baclofen and monitor her heart rhythm, vital signs, electrolyte levels, and urine output continuously. prepare to administer dantrolene and monitor her heart rhythm, vital signs, electrolyte levels, and urine output continuously.

Patient Education You are the nurse caring for a patient who is taking cyclobenzaprine following an injury. You are completing discharge teaching with your patient which includes information regarding his medication. You explain to him that ________ insomnia is a common side effect. sedation is a common side effect. he may need to increase the dosage over time as tolerance develops. this medication only works for about 2 hours at a time.

Nursing Assessment You are the nurse caring for Martha, an 80-year-old patient with arthritis who has started taking cyclobenzaprine.

Your nursing assessment pays special attention to ________ (Select all that apply.)

2 Martha’s urine output.

Martha’s body temperature.

Martha’s fall risk.

Martha’s sedation level.

Patient Teaching As the nurse caring for Martha the 80-year-old patient with arthritis taking cyclobenzaprine you ensure that you teach her which of the following in preparation for her discharge?

(Select all that apply.)

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Do not stand up from a seated position too quickly so that you don’t get dizzy.

Stuvia.com - The Marketplace to Buy and Sell your Study Material She should make sure to not stop taking this medication abruptly.

That we should see how she does on cyclobenzaprine for a few days before she goes back to driving.

This medication can cause painful urination so she should drink lots of fluids and let her health care provider know i this occurs.

Nursing Assessment You are the nurse caring for Sara, a 34-year-old patient who has come to the ER with complaints of confusion, restlessness and an increase in muscle spasms. In completing her admission history and assessment, you note th included in her medication list is cyclobenzaprine. Aside from this change in neurological status, her physical assessment is within normal limits. Based on this information and your knowledge of this drug class, you suspect that ________ Sara is experiencing alcohol withdrawal brought on by the cyclobenzaprine.

Sara stopped taking her cyclobenzaprin abruptly.

Sara has mixed her cyclobenzaprine with another CNS depressant.

Sara has taken an overdose of cyclobenzaprine.

Nursing Assessment You are caring for a patient who has been brought to the ER with the following symptoms: hypotension, bradypnea diminished reflexes, and extreme drowsiness. Her husband discusses her medical history and medication list with the healthcare team. He reports that she has been taking a muscle relaxant prescribed for a chronic musculoskele condition. Based on this information and your knowledge of this drug class, you ______ (Select all that apply.) inquire whether or not she has consumed alcohol recently. inquire whether or not she has been taking any herbal or non-prescription supplements and, if so, which ones. inquire how much caffeine she consumes daily. inquire if she stopped taking the medication suddenly.

Nursing Assessment You are the nurse caring for a patient who has been diagnosed with Parkinson’s disease and is prescribed a centrally actin skeletal muscle relaxant. Based on your knowledge of this drug class and its indications for use, you assess the patient for therapeutic affects such as reduction of the rigidity associated with Parkinson's disease.

Muscle Relaxants You are caring for a patient who has come into the ER with complaints of muscle spasms and pain following an injury. He h been discharged yesterday for the same complaint with a prescription for a muscle relaxant. Based on your knowledge of th drug class, you know that the patient has not allowed enough time for the medication to take effect.

CNS Stimulants Prepare: CNS Stimulants

Medical Purpose for Stimulants Which medical condition(s) is/are central nervous system (CNS) stimulants approved to treat? (Select all that apply Obesity Attention deficit/hyperactivity disorder (ADHD) Narcolepsy Post traumatic stress disorder Anorexia Medication Purpose A new nurse is admitting a patient who has received doxapram. The nurse recognizes that this is which type of medication?

Postanesthetic respiratory stimulant Inhaled respiratory stimulant Long-acting narcotic Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Narcotic antagonist

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Adverse Effect A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effec Bradycardia Nervousness Mental clouding Drowsiness at night

Self-Check: Analeptics Treatment for Apnea A newborn patient is in respiratory distress. The nurse anticipates preparation for which medication to be given? armodafinil theophylline amphetamine modafinil

Self-Check: Narcolepsy Narcolepsy Which of the following medications would you anticipate prescribed for a patient with narcolepsy? Select all that apply. dextroamphetamine methylphenidate Methamphetamine biculline strychnine

Self-Check: Side Effects

Side Effects A patient at a weight management clinic who was given a prescription for orlistat calls the clinic hotline complainin of a "terrible side effect." The nurse suspects that the patient is referring to which problem?

Fecal incontinence Sexual dysfunction Nausea Urinary incontinence

Self-Check: CNS Stimulants Medication Uses Which of the following medications are used to treat ADHD? Benzphetamine Atomoxetine Phendimetrazine Modafinil Methylphenidate

Reflect: CNS Stimulants Medication Purpose The patient has a history of migraines, depression, and hypertension and has been started on phenterminetopiramate. For which condition is phentermine-topiramate used?

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Medication Administration To maintain the half-life of methylphenidate, how often should this medication be taken?

Twice a day Daily Every other day Three times per day Medication Usage Which of the following medications are used to treat obstructive sleep apnea?

Benzphetamine Modafinil Phendimetrazine Methylphenidate Atomoxetine Patient Teaching The patient has been prescribed methylphenidate for narcolepsy. The patient also has migraines and takes amitriptyline as a preventive. What should the nurse advise the patient to do before starting the new medication?

"Have baseline lab work drawn to assess liver function.”

"Increase fluid intake with the next meal.”

“Contact your primary health care provider to verify compatibility."

"Immediately stop taking the amitriptyline."

Narcolepsy Treatment The patient has been prescribed methylphenidate for the treatment of narcolepsy. What priority teaching consideration(s) should be included for this patient? (Select all that apply.)

Caffeine should be avoided Take the medication before meals Nervousness and tremors may occur Report any weight gain Avoid operating hazardous equipment Medication Use A patient is interested in losing weight. The nurse anticipates which medication to be prescribed? amphetamine modafinil armodafinil theophylline Medication Administration A patient has a new prescription for sumatriptan. The nurse providing patient teaching on self-administration will include which information?

Take no more than 4 doses in a 24-hour period Take the medication before the headache worsens Correct technique for IM injections Allow at least 30 minutes between injections

ADHD Medication Treatment The patient is being treated with methylphenidate for ADHD. What common side/adverse effect(s) should the patien and family be informed might occur? (Select all that apply.)

Irritability Orthostatic hypotension Vomiting

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Headache Hypertension Euphoria

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Nursing Application: CNS Stimulants Prepare: Nursing Application: CNS Stimulants

Medication Risk Factors/Contraindications The nurse works in a pediatric psychiatry unit. Methylphenidate 5 mg 3 times daily is commonly prescribed for ma of the clients. The nurse recognizes this drug needs to be used cautiously in which of the following children?

A 6-year-old patient who takes montelukast daily A 7-year-old patient with a history of sickle cell anemia A 12-year-old patient with a history of scoliosis An 8-year-old patient with a history of cardiovascular disease

Drug Interactions The nurse is caring for a patient who takes dextroamphetamine. The nurse should be most concerned by which of the following patient statements?

“I seem to be able to focus better and I’m less distracted now.”

“I started taking St. John’s wort this week to help with my depression.”

“I forgot to take my medication in the morning last week so I took it at lunch time.”

“I’ve been having some trouble falling asleep at night lately.”

Drug Interactions The nurse is providing care to a 9-year-old boy admitted with a broken tibia. The child takes amphetamine/dextroamphetamine 20 mg/day. The healthcare provider has prescribed meperidine 25 mg IM every 4 hours as needed for pain. Which of the following actions by the nurse is best?

Hold the meperidine and contact the healthcare provider.

Hold the adderall.

Give the meperidine if the child complains of pain.

Notify the charge nurse.

Self-Check: Medication Teaching Medication Teaching The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (Select all that apply.)

"Be sure to contact the physician right away if you notice expression of suicidal thoughts."

"Be sure to have your child blow his nose before administering the nasal spray."

"This medication is used only when symptoms of ADHD are severe.”

"We will need to check your child's height and weight periodically to monitor physical growth.”

"The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep.”

"If adverse effects become severe, stop the medication for 3 to 4 days."

Medication Teaching The nurse is teaching a patient to self-administer medications. The nurse knows that which drugs can be used to treat narcolepsy? (Select all that apply.)

Lisdexamfetamine Modafinil Methylphenidate Atomoxetine

Self-Check: Nursing Assessment Drug Risks/Side Effects The 18-year-old patient is brought to the emergency room department by her roommates. Her blood pressure is Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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220/136 mm Hg, heart rate 142 beats/minute, and respiratory rate 20 breaths/minute. She is responsive only to dee Stuvia.com - The Marketplace to Buy and Sell your Study Material pain. Her roommates say she has been trying to lose weight and has been taking "these pills she gets over the Internet." What will the nurse consider as the most likely cause for this patient's symptoms?

Pregnancy-induced hypertension Food poisoning Hemorrhagic stroke Cardiac arrest anorexiant The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate?

Sleep deprivation Impaired memory Deficient fluid volume Imbalanced nutrition, less than body requirements

Self-Check: Contraindications Contraindications CNS stimulants are absolutely contraindicated for patients with a history of which condition(s)? (Select all that apply.)

Coronary artery disease Hypothyroidism Diabetes Hypertension Liver failure

Reflect: Nursing Application: CNS Stimulants Medication Effects Which statements are true of methylphenidate? (Select all that apply.)

Insulin will be more effective The effects of anticoagulants may increase Hyperglycemia may occur There may be increased effects if taken with caffeinated beverages If taken with monoamine oxidase inhibitors (MAOIs), it may increase a hypertensive crisis Medication Indication Preterm apnea is the clinical indication for theophylline.

Medication Teaching The pediatric patient has been started on methylphenidate for ADHD. What information should the nurse include in the health teaching?

Counseling should be combined with medication Constipation is a common side effect Weight gain is to be expected This medication will only be used for a few weeks

ADHD A child with ADHD is prescribed atomoxetine. What negative side effects would the nurse assess closely for? (Sele all that apply.)

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Suicidal thoughts

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Drug Safety Safety of a drug is determined by the degree between: Side and adverse effects Therapeutic and toxic doses Subtherapeutic and toxic levels Potency and efficacy

Medication Purpose The patient is born at 28 weeks gestation and is scheduled to receive caffeine citrate 20 mg IV shortly after birth. T patient's mother asks, "Why are you giving my baby stuff that is in coffee?" What is the nurse's best response?

"Caffeine can help your baby breathe better."

"The baby's temperature will be warmer with caffeine.”

"This isn't the same substance that is in coffee.”

"It will help your baby gain weight faster."

Contraindication The nurse is reviewing the history of a patient who will be starting triptan sumatriptan (Imitrex) as part of treatmen for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy?

Diabetes mellitus type 2 History of renal calculi Cardiovascular disease Chronic bronchitis Nursing Diagnosis The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate?

Impaired memory Imbalanced nutrition, less than body requirements Deficient fluid volume Sleep deprivation

Antiepileptic Drugs Prepare: Antiepileptic Drugs Antiepileptics Antiepileptics are used for the long-term maintenance treatment of what condition?

Uncontrolled coughing Fluid overload Pyrexia Seizures Causes of Seizures Which of the following can cause seizures? (Select all that apply.)

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Seizures are treated with hydantoins.

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Self-Check: Seizures Classification Match the terms with the definitions.

Neuronal activity that originates from both hemispheres

Generalized onset seizure

Neuronal activity that originates from one hemisphere or location

Focal onset seizure

Neuronal activity that causes full body contractions then transitions to alternating contractions and relaxation

Tonic-clonic seizures

Seizures Match each definition given on the right side with the term given on the left side. Drag the definitions to place them in the correct order.

Brief events of abnormal electrical activity in nerve cells of the brain.

Seizure

Involuntary spasmodic contractions voluntary muscles throughout the body.

Convulsion

Chronic, recurrent brain activity, that causes seizures.

Epilepsy

Self-Check: Neurotransmitters GABA (gamma- aminobutyric acid) is an inhibitory neurotransmitter. Glutamate (glutamic acid) is an excitatory neurotransmitter.

Self-Check: Safety Considerations Which of the following should be monitored with patients prescribed antiepileptic drugs (AED)? (Select all that apply.)

Gait Plasma concentration and effectiveness Adherence to drug therapy Urinary issues Toxicity

Self-Check: Antiepileptic Drugs Identify which drugs are antiepileptic drugs. (Select all that apply.) carbamazepine phenytoin celecoxib fosphenytoin

Reflect: Antiepileptic Drugs Drug Interaction Which drugs can affect the antiepileptic drugs (AED) if they are taken together? (Select all that apply.)

Proton pump inhibitors (PPI) Psyllium Chewable vitamins Antacids Drug Risk A client’s drug level for an antiepileptic drug (AED) was found to be very high. The client is at risk for drug toxicity.

Patient Teaching Which statement indicates more patient teaching is needed?

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“I cannot chew or crush this medication.”

Stuvia.com - The Marketplace to Buy and Sell your Study Material “I cannot take this medication with an antacid.”

“When my seizures stop for at least a month, I can stop taking the medication.”

“I will need to have my blood drawn at certain intervals.”

Nursing Action A pediatric patient is on antiepileptic drug therapy for seizures. The patient’s mom states that she has been lethargic, confused, and sleepy.

What should be your next course of action?

Be sure she drinks a lot of water with the mediation.

It is normal for kids to have these side effects. She will grow out of it.

Reduce her dose by 1/2 and call the neurologist to make a follow up appointment.

Contact the healthcare provider immediately.

Drug Level Which of the following is true about a high plasma level of antiepileptic drug (AED)?

A high antiepileptic drug (AED) level may indicate the patient is not compliant and is not taking their medications.

A high antiepileptic drug (AED) level may indicate the patient is severely dehydrated.

A high antiepileptic drug (AED) level may indicate the drug is not being excreted, the dose is too high, or more of the drug is being metabolized.

A high antiepileptic drug (AED) level may indicate the patient is not drinking enough water.

Antiepileptic Drug (AED) Therapy What is the overall goal of antiepileptic drug (AED) therapy? (Select all that apply.)

Prevent nausea Prevent/ control seizures Prevent drug toxicity Prevent syncopal episodes Seizures Why is it important to try to control seizure activity with one drug therapy if possible? (Select all that apply.)

Reduce side effects and adverse effects Prevent toxicity Prevent euphoric episodes Decreased administration times Increase compliance Therapeutic Drug Levels Drag the correct drug to match with the therapeutic levels given below:

Therapeutic drug level

Drug Name

10 to 20 mcg/mL

phenytoin

10 to 40 mcg/mL

phenobarbital

4-12 mcg/mL

carbamazepine

50-100 mcg/mL

valproic acid

Hydantoins (phenytoin) Prepare: Hydantoins (phenytoin) phenytoin Phenytoin is classified as a hydantoin.

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Side Effects Stuvia.com - The Marketplace to Buy and Sell your Study Material What is a side effect of phenytoin?

Coughing Gout Rash Hiccups phenytoin Phenytoin is prescribed for partial seizures.

Self-Check: phenytoin Phenytoin prevents seizures by blocking sodium channels from recovering from the inactivated state.

Self-Check: Side Effects and Adverse Reactions Side Effects What are side effects of phenytoin? (Select all that apply.)

Irritability Nystagmus Ataxia Drowsiness Adverse Reactions What is an adverse reaction of phenytoin? (Select all that apply.)

Coughing Suicidal ideation Rash Edema

Self-Check: Therapeutic Range Therapeutic Range What is the therapeutic range for phenytoin?

5-10 mcg/mL 10-20 mcg/mL 20-30 mcg/mL 20-25 mcg/mL

Self-Check: Metabolism of Other Drugs

Metabolism of Other Drugs Phenytoin does effect the metabolism of other drugs that utilize the hepatic micro-somal cytochrome P-450 enzymes system

Reflect: Hydantoins (phenytoin) Intravenous (IV) phenytoin When administering phenytoin intravenously (IV) what should be assessed and monitored? Select all that apply.

IV infusion site Cardiac rhythm Vision Blood pressure

Phenytoin Phenytoin is available in Intravenous (IV) , tablets, chewable capsules, and liquid forms. Chewable tablets and capsules are not bioequivalent. In addition liquid suspensions should be shaken prior to pouring.

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Signs and Symptoms Stuvia.com - The Marketplace to Buy and Sell your Study Material What are signs and symptoms of phenytoin toxicity? (Select all that apply.)

Ataxia Slurred speech Confusion Memory loss

phenytoin The client called the clinic and reported that phenytoin was causing a skin rash. What is the nurse’s best response Skin rash is a side effect. Double up on your dose just in case you regurgitate.

Skin rash is a side effect. Split your pill in half and take a half dose.

Skin rash is an adverse effect. Your healthcare provider will follow-up with you for further instructions.

Skin rash is an adverse reaction. Stop taking the medication. phenytoin Teaching Which statement by the client indicates that more teaching is needed about phenytoin?

“My oral contraceptive may not be as effective.”

“Any mood changes, erratic behavior, suicidal ideation is a normal side effect.”

“I need to practice good oral hygiene.”

“I may feel drowsy. It is a common side effect.”

Contraindications What condition is a contraindication of phenytoin?

Dysphagia Pregnancy Anosmia Cardiac disease phenytoin Therapy Which laboratory value should be monitored during phenytoin therapy?

White blood cells count Carbamazepine levels Coagulation factors Albumin levels

phenytoin Level The client is taking phenytoin. They had a routine blood draw in the clinic and the partial results have returned. The client was found to have very low albumin level from the previous blood draw. You are waiting for the phenytoin levels to return fro the lab.

You expect the phenytoin levels to be high.

Iminostilbenes (carbamazepine) Prepare: Iminostilbenes (carbamazepine) carbamazepine When receiving carbamazepine therapy for seizures, blood levels are required to monitor therapeutic effectiveness. carbamazepine Carbamazepine is classified as iminostilbenes.

Prescribing Carbamazepine Carbamazepine is prescribed for partial seizures.

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carbamazepine Stuvia.com - The Marketplace to Buy and Sell your Study Material Carbamazepine prevents neuron excitation by blocking sodium channels from recovering from the inactivated state.

Self-Check: Side Effects and Adverse Reactions Side Effects What are the side effects of carbamazepine? (Select all that apply.)

Cough Fatigue GI irritation Ataxia Adverse Reactions What is an adverse reaction of carbamazepine? (Select all that apply.)

Coughing Slurred speech Rash Suicidal ideation

Self-Check: Therapeutic Range What is the therapeutic range for carbamazepine?

20-30 mcg/mL 20-25 mcg/mL 2-10 mcg/mL 4-12 mcg/mL

Self-Check: Metabolism of Other Drugs Carbamazepine does effect the metabolism of other drugs that utilize the cytochrome P-450 enzyme system.

Reflect: Iminostilbenes (carbamazepine) carbamazepine Carbamazepine is prescribed for partial seizures. Carbamazepine is not usually used in absence seizures.

Client Education Which statement by the client indicates more teaching is needed about carbamazepine?

“I can stop taking carbamazepine when I finish this bottle.”

“I will get an ID bracelet that has my seizure status.”

“I can take with food if carbamazepine causes GI irritability.”

“I should avoid drinking alcohol while taking this medication.”

Carbamazepine A client has a new order for carbamazepine for seizure management. The nurse is correct when recognizing auto induction as which response?

Toxic levels of carbamazepine Higher than expected drug levels Lower than expected drug levels Cessation of seizure activity Signs and Symptoms What are signs and symptoms of carbamazepine toxicity? (Select all that apply.)

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Side Effects The client called the clinic and complained that carbamazepine was causing nausea. What is the best follow up response?

Nausea is a side effect. Double up on your dose just in case you regurgitate.

Nausea is an adverse reaction. Stop taking the medication.

Nausea is a side effect. Split your pill in half and take a half dose.

Nausea is a side effect. Try taking your medication with meals.

Carbamazepine Half-Life Carbamazepine half-life is 12 hours. carbamazepine Contraindications What is a contraindication of carbamazepine?

Neuropathic pain Lung cancer Pregnancy Heart disease Food to Avoid Which food item should not be taken with carbamazepine?

Orange juice Grapefruit Apples Smoked meats & cheeses

Miscellaneous Antiepileptics (valproic acid) Prepare: Miscellaneous Antiepileptics (valproic acid)

valproic acid The client’s medication list has valproic acid. The client has no history of seizures. The client is taking valproic aci for which condition?

Liver disease Bipolar disorder Acne Exfoliation Prescribing Valproic Acid Valproic acid is prescribed for partial seizures. valproic acid What is valproic acid indicated for?

Depression Head injury Generalized seizures Nausea

Self-Check: Side Effects and Adverse Effects Side Effects What are the side effects of valproic acid? (Select all that apply.)

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Adverse Reaction What is an adverse reaction of valproic acid?

Edema Aphasia Suicidal ideation Coughing

Self-Check: Therapeutic Range Therapeutic Range What is the therapeutic range for valproic acid?

50-125 mcg/mL 10-20 mcg/mL 20-30 mcg/mL 20-25 mcg/mL

Self-Check: Valproic Toxicity valproic acid Adverse Reactions What are possible adverse reactions of valproic acid? (Select all that apply.)

Drowsiness Coughing Weight gain Dizziness GI upset

Self-Check: Blood Plasma Protein Blood Plasma Protein Valproic acid has a high affinity for blood plasma protein.

Reflect: Miscellaneous Antiepileptics (valproic acid) Monitoring and Assessment What should be assessed and monitored on a patient taking valproic acid? (Select all that apply.)

Signs and symptoms of pancreatitis Mental health Hepatic function Vision Patient Education Which statement by the client indicates that more teaching is needed about valproic acid?

“I need to take all my meds as directed.”

“I may feel drowsy. It is a common side effect.”

“I cannot drive until my doctor releases me.”

“Any mood changes, erratic behavior, or suicidal ideation is normal and will go away.”

Therapeutic Range Which level below is in the therapeutic range for valproic acid?

4 mcg/mL 90 mcg/mL 10 mcg/mL 20 mcg/mL Laboratory Monitoring What laboratory findings should be monitored while on valproic acid? (Select all that apply.)

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phenytoin levels Complete blood count Urinalysis Liver enzymes

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Contraindications What are the contraindications for valproic acid? (Select all that apply.)

Hepatic Impairment Manic episodes Osteoporosis Pregnancy Liquid Suspensions Valproic acid is available in Intravenous (IV) , tablets, chewable capsules, and liquid forms. In addition, liquid suspensions should be shaken prior to pouring.

Peak Plasma Concentration What is the peak plasma concentration of valproic acid?

1-4 hours 24 hours 4-8 days 12 hours

GI Irritation The client called the clinic and complained that valproic acid was causing minor GI upset. What should be the best follow up response?

“GI irritation is a side effect. Double up on your dose just in case you regurgitate.”

“GI irritation is an adverse reaction. Stop taking the medication.”

“GI irritation is a side effect. Try taking your medication after meals.”

“GI irritation is a side effect. Split your pill in half and take a half dose.”

Nursing Application: Antiepilectic Drugs Prepare: Antiepiletpic Drug Therapy

Drug Interaction A client presents to the clinic and reports taking several over the counter medications, in addition to their prescrib valproic acid. Which over the counter medication is contraindicated when taking valproic acid?

Vitamin C Claritin Fibercon Aspirin Black Box Warning What is the black box warning for all clients prescribed antiepileptic drugs?

Kidney stones Suicidal ideations Memory loss Respiratory failure Actions of Antiepileptics Which actions of antiepileptic medications reduce seizure activity? Select all that apply.

Suppress the transmission of nerve impulses.

Increase effects of gamma aminobutyric acid (GABA).

Suppress nerve response to stimulation.

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Enhance the transmission of nerve impulses.

Stuvia.com - The Marketplace to Buy and Sell your Study Material Decrease effects of gamma aminobutyric acid (GABA).

Self-Check: Case Study: Nursing Implications Case Study: Patient Care An elderly female was in the emergency department for generalized tonic-clonic seizures.

An intravenous line was started.

The client was prescribed diazepam 8 mg IV push, STAT. The seizures stopped and the client was transferred to a medical-surgical unit.

The client was further assessed on the unit, labs were drawn, and diagnostic tests were ordered.

The client medication list included: protonix, warfarin, furosemide, multi-vitamins Question 1 / 3 The nurse was caring for a client experiencing a tonic-clonic seizure. The healthcare provider prescribed intravenous diazepam.

Which of the following are appropriate actions by the nurse? Select all that apply.

You may use a drug reference guide for assistance.

Administer the medication as quickly as possible.

Monitor the client vital signs closely.

Administer the medication slowly over at least 1 minute per 5 milligrams.

Avoid administering the medication into small veins.

Question 2 / 3 What laboratory and diagnostic tests would the nurse anticipate for the client with seizures? (Select all that apply.

Brain magnetic resonance imaging (MRI) Electrocardiogram (ECG) Xray of right patella Electroencephalogram (EEG) Liver enzymes Serum cholesterol Computerized tomography (CT) of the sinuses Question 3 / 3 The client was prescribed phenytoin. Based on the client's medication list, which medication may have a negative drug interaction? You may use a drug reference guide for assistance.

Protonix Warfarin Multi vitamin Furosemide Assessment Finding The nurse is completing an assessment of the client who was admitted to the hospital after having a tonic-clonic seizure. The client is prescribed phenytoin. Which assessment finding is most concerning to the nurse?

Heart rate 70 Client reports nausea Blood pressure 74/50 Client reports being drowsy

Nurse’s Action A nurse administered a client's phenytoin via an intermittent intravenous infusion. The client complained of burnin at the infusion site. Which is the nurse's priority action?

Notify the healthcare provider.

Insert a new intravenous catheter in a larger vein.

Assess the intravenous catheter insertion site.

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Slow the rate of the intravenous infusion.

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Reflect: Antiepiletpic Drug Therapy

Antiepilectic Drugs: Drowsiness The client complained that their antiepilectic drug (AED) caused them to be tired during the day. What should be th nurse's next response?

Take your medication at night.

Stop taking the medication due to toxic effects.

Drink more water during the day.

Split your tablet and take half in the morning and half a pill at night.

Teaching Plans The nurse is preparing a teaching plan for a client newly prescribed an antiepileptic drug. Which of the following is priority?

If you feel sleepy when taking the drug, decrease the dose by half.

Call your healthcare provider if you experience suicidal ideations.

Take the drug on an empty stomach.

Patients with epilepsy are not able drive or hold a job. valproic acid Which of the following foods should be avoided while taking oral formulations of valproic acid?

Bananas Milk Leafy greens Smoked meats Phenytoin IV Monitoring The patient is receiving phenytoin intravenously (IV). What should be carefully monitored? Select all that apply.

CNS depression Hypotension Blurred vision Electrocardiogram (ECG) Side Effects The nurse is caring for a client prescribed valproic acid. Which are common side effects? Select all that apply.

Nausea Insomnia Severe weight loss Sedation Phenytoin Levels A client who has been taking phenytoin has their repeat phenytoin level monitored with a result of 4 mcg/ml.

What should the nurse do next? (Select all that apply.)

Ask the client to take the medication on an empty stomach.

Ask the client if they are taking the medication as prescribed.

Ask the client to double up on the dose.

Ask the client if they are taking any new over the counter medication not prescribed.

Phenytoin Medication Instructions A client is receiving phenytoin medication instructions during discharge planning and is asking why monitoring laboratory values in needed.

The nurse’s best response is: We are checking the therapeutic levels of the medication.

We are checking to see how well the proteins are working in your body.

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We are checking if the diet is affecting the medication.

Stuvia.com - The Marketplace to Buy and Sell your Study Material We are checking nutrition status with the medication.

Treatment of Seizures Which are advantages to using fosphenytoin over the use of phenytoin in the treatment of tonic-clonic and focal seizures? Select all that apply.

Fosphenytoin can be given as an intramuscular injection.

Fosphenytoin can be administered faster than phenytoin.

Fosphenytoin requires is less expensive than phenytoin.

Fosphenytoin causes less irritation to veins than phenytoin.

Antiparkinson Drugs Prepare: Antiparkinson Drugs Parkinson's Disease Parkinson's disease is the deficit of a dopamine neurotransmitter.

Antiparkinson Drugs Match the drugs to the correct categories: Direct-acting Dopamine Receptor Agonists

ropinirole

Indirect-acting Dopaminergic

rasagiline

Medication Side Effects Drag the correct side effects to match with the medications given below:

Side Effects

rasagiline

ropinirole

Dizziness / Insomnia / Nausea

Fatigue / Edema / Syncope

Self-Check: Antiparkinson Drugs Direct-acting dopamine receptor agonists are effective in the early states of Parkinson’s diseases.

Indirect-acting dopaminergic drugs such as MAO inhibitors are given to decrease the needed dose of levodopa.

Indirect-acting dopaminergic drugs such as MAO inhibitors enzymes main purpose is the breakdown of catecholamines.

Self-Check: Drug Effects Medication Selegiline is used alone or in conjunction with carbidopa-levadopa in early stages of the disease to help with symptom fluctuations.

Medication Effect Selegiline stimulates dopamine receptors in the brain.

Reflect: Antiparkinson Drugs Medication Effects When giving ropinirole watch out for somnolence which means the patient can fall asleep during regular activities.

Drug Side Effects What are the side effects of selegiline? Select all that apply.

Ataxia Coughing Dizziness Confusion

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Drug Effect Stuvia.com - The Marketplace to Buy and Sell your Study Material Ropinirole will affect the activity of any drug utilizing the cytochrome p450 enzymes system.

Drug Adverse Effects What are some adverse effects of ropinirole? (Select all that apply.)

Syncope Insomnia Edema Orthostatic hypertension GI upset Drug Duration Ropinirole's duration is 8 hours.

Drug Interaction Do not consume large amounts of tyramine containing foods when taking selegiline.

Contraindication Sally, a 57-year-old female, is newly diagnosed with Parkinson’s. She has a history of atrial fibrillation and is currently taking warfarin daily. Which of the following medications would be contraindicated for Sally to take to tre her Parkinson's symptoms? codeine selegiline hydrocodone ropinirole Medication Which should be included when educating clients about antiparkinson medications? (Select all that apply.)

Extended release formulations of the medications may be crushed if the pills are hard to swallow.

Do not to abruptly stop taking the prescribed medication.

A decrease in Parkinson symptoms is a therapeutic response.

Take the medication exactly as ordered to maintain consistent blood levels.

Nursing Application: Antiparkinson Drugs Prepare: Nursing Application: Antiparkinson Drugs Treating Parkinson’s Disease What is the goal of drug therapy in treating Parkinson's disease?

Slow the progression of the disease Decrease dopamine levels and increase acetylcholine levels Eliminate symptoms of the disease Increase dopamine levels Medication Types Select the correct medication type used to treat Parkinson's disease based on their descriptions.

Description

Medication Type

Entacapone is taken with levodopa and begins its effect with the first dose. It benefits patients who experience the wearing-off effect of levodopa and facilitates a lower dose of levodopa being used.

COMT inhibitor

Benztropine mesylate is indicated as adjunct pharmacotherapy to manage debilitating motor effects (cogwheel rigidity, muscle tremors, pill-rolling movements, and bobbing of the head) of Parkinson's disease.

Anticholinergic

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Amantadine is indicated for the early stages of- The Parkinson's is StudyDopamine modulator Stuvia.com Marketplacedisease to Buy and and Sell your Material usually only effective for 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and rigidity.

Carbidopa-levodopa has side effects, such as nausea, vomiting, dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis.

Dopamine replacement

Bromocriptine nondopamine works by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain.

Dopamine receptor agonist

Ropinirole's drug action increases dopamine presynaptic receptors in the brain. It is indicated for early and late state Parkinson's disease.

Nondopamine dopamine receptor agonist

Selegiline is used in combination with levodopa to reduce the dosage MAO-B inhibitor needed for symptom control. Adverse effects appear with doses greater than 10 mg.

Treating Dyskinesia Which of the client's prescribed medications is used to treat dyskinesia related to their medication therapy for Parkinson's disease?

Salagen Benztropine Amantadine Carbidopa-levodopa

Self-Check: Antiparkinson Drugs: Bill's Case Study

Antiparkinson Drugs Bill’s Case Study Let’s explore the nursing application of antiparkinson’s through Bill’s case study.

Bill, 55-year-old, retired, male, soccer coach has had Parkinson’s disease for 5 years. Bill has been taking his antiparkinsons medications for several years.

Review the information and answer the question that follows.

Question 1 / 3 Bill started taking selegiline for Parkinson's disease. What should be included in the discharge directions about th medication?

Urinary retention is a side effect Drink water to avoid constipation Take with food to decrease GI upset Sit down if you feel palpitations Question 2 / 3 Bill is preparing to attend a holiday party with his family. The nurse realizes that since Bill is taking carbidopalevodopa and selegiline there may be a need for education regarding the consumption of which of the following: (Select all that apply.)

Can vegetables Smoked fish Smoked meat Sourdough bread Smoked cheese Canned meats (i.e. Crab meat) Tomatoes Question 3 / 3 selegiline is given to decrease the needed dose of levodopa.

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Self-Check: Antiparkinson Drugs

Assessment Finding The nurse is caring for a client with Parkinson's disease who is prescribed tolcapone. Which assessment finding i most concerning?

Client has yellowing of eyes and skin Client has discolored urine Client reports worsening of tremors Client reports orthostatic hypotension Parkinson’s Disease What is the wearing off phenomenon related to Parkinson’s disease?

When Parkinson’s disease medications are stopped for surgery When Parkinson’s disease medications are at maximum doses and the drug loses its effectiveness When Parkinson’s disease medications are at their minimum dose and the onset takes longer When Parkinson’s disease medications become more effective, the dose is lowered

Reflect: Nursing Application: Antiparkinson Drugs

Client Teaching The client is taking carbidopa-levodopa for Parkinson’s disease. The nurse just reviewed the discharge instruction with the client and family.

Which statement by the client indicates more teaching is needed?

“I am going to carefully monitor and time my protein intake.”

“I can stop taking the medicine once the tremors stop.”

“I will take a dose based on my bedtime because the medication can cause insomnia.”

“I am going to ask my family to help me move around the house.”

Nursing Implications The client is receiving discharge instructions on carbidopa-levodopa. When should the nurse tell the family to noti the healthcare provider immediately?

Violent outburst Weight gain of 2 lbs in 24 hours Significant behavior changes Diuresis

Selegiline The nurse is reviewing the medication history of a client diagnosed with Parkinson's disease who is prescribed selegiline. Which other medication prescription on the client’s medication list is the most concerning to the nurse?

Docusate sodium Multi-vitamins Insulin glargine Meperidine Nursing Implications During the start of antiparkinson medications therapy, the patient will most likely need assistance with walking.

Client Education Which statement(s) by the client indicate further education regarding their antiparkinson medication is needed?

Select all that apply.

"I may experience dry mouth because of the anticholinergic, so I will chew sugarless gum."

"I can drink alcohol as long as it is no more than 1 time per week."

"I will increase my fluid and fiber intake, to prevent constipation."

"If I forget a dose of medication, I will take it as soon as I remember."

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Client Teaching Stuvia.com - The Marketplace to Buy and Sell your Study Material A client is prescribed benztropine, an anticholinergic. Which teaching point(s) should the nurse include when providing client education? Select all that apply.

Anticholinergics can cause dry mouth, urinary retention, and constipation.

The client should take this medication at the same time as other medications.

It may take up to several weeks for the client to have an improvement in tremors.

Anticholinergics block the effect of acetylcholine.

Client Education Which statement by the client regarding a prescription of controlled-release carbidopa-levodopa requires further education by the nurse?

"Sometimes I have trouble swallowing the pill, so I crush it and put it in applesauce."

"I know it is preferred that I take my carbidopa-levidopa on an empty stomach, but I do take it with a small snack to prevent nausea."

"My carbidopa-levodopa is a dopamine replacement drug."

"I love steak and fish and I take my medication at least an hour after I eat it.”

Selegiline What should be included as discharge instructions for the client who received a new prescription for selegiline?

You may take herbal supplements with this medication.

You may experience palpitations when taking this medication.

Hallucinations are normal and will go away.

Notify your healthcare provider if you have a severe headache.

Week 6 Concepts: Drugs Affecting the Autonomic Nervous System Drugs That Affect the Adrenergic System Prepare: Drugs That Affect the Adrenergic System Adrenergic Drugs Adrenergic drugs produce effects similar to which nervous system?

Central nervous system Parasympathetic system Sympathetic nervous system Somatic nervous system Adrenergic Receptors There are three types of adrenergic receptors in the body.

Receptors Dopaminergic receptors receptors ONLY respond to dopamine.

Self-Check: Types of Receptors Adrenergic Receptor Types Drag the correct adrenergic receptor type to match with the descriptions.

Alpha1-adrenergic receptors

Alpha2-adrenergic receptors

●

● Located on postsynaptic effector cells The cell, muscle, or organ that the nerve stimulates ●

The nerve that stimulates the effector cells ● Located on presynaptic nerve terminals

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Self-Check: Adrenergic Drugs Classes

Adrenergic drugs can be classified as selective or nonselective based on their action.

Self-Check: Types of Sympathomimetic Select the correct type of sympathomimetic to match with its description in this table.

Direct-acting sympathomimetic ●

Indirect-acting sympathomimetic

Binds directly to the receptor and causes a physiologic response

●

●

Causes release of catecholamine from storage sites (vesicles) in nerve endings Catecholamine then binds to receptors and causes a physiologic response

Mixed-acting sympathomimetic ● ●

Directly stimulates the receptor by binding to it AND Indirectly stimulates the receptor by causing the release of stored neurotransmitters from vesicles in the nerve endings

Self-Check: Catecholamines Naturally occurring catecholamines include which of the following? (Select all that apply.) epinephrine seratonin norepinephrine dopamine

Self-Check: Adrenergic Drugs Which medication interferes with most adrenergic drugs?

MAO Inhibitors Selective Serotonin Reuptake Inhibitors ACE Inhibitors Calcium Channel Blockers

Reflect: Drugs That Affect the Adrenergic System Adrenergic Drug Effect When someone is taking an adrenergic drug, which physical finding is expected?

Increased heart rate Constricted pupils Increased intestinal peristalsis Bronchial constriction Types of Receptors Adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?

Alpha1 adrenergic Dopaminergic Beta1 adrenergic Beta2 adrenergic epinephrine Epinephrine is appropriate for cardiac arrest.

Administration Route Which is the correct technique for administering dopamine?

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Drug Effects Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.)

Dilation of bronchioles Constricted pupils Increased heart rate Dilated pupils Glycogenolysis Decreased heart rate Constriction of bronchioles Drug Summary Select the correct drug to match with their summary in the table below:

Drug Name

Summary

dobutamine and dopamine

A naturally occurring catecholamine neurotransmitter. It is a potent dopaminergic as well as beta1- and alpha1-adrenergic receptor activity.

epinephrine

An endogenous vasoactive catecholamine that acts directly on both the alpha- and beta-adrenergic receptors of tissues innervated by the SNS.

mirabegron

beta3 agonist that targets receptors in urothelium and detrusor muscles which results in the relaxation of the detrusor muscle and increased bladder capacity.

norepinephrine

Produces vasoconstriction and myocardial stimulation, which may be required after adequate fluid replacement in the treatment of severe hypotension and shock. Stimulates alpha-adrenergic receptors located mainly in blood vessels, causing constriction of both capacitance and resistance vessels.

phenylephrine

Management of hypotension associated with shock that may persist after adequate fluid replacement.

Management of hypotension associated with anesthesia. Anesthesia adjunct: Prolongation of the duration of spinal anesthesia. Localization of the effect of regional anesthesia. Constricts blood vessels by stimulating alpha-adrenergic receptors.

Drug Effects What medication class may negate the therapeutic effect is taken with vasoactive adrenergics?

MAO Inhibitors Histamine blockers Calcium Channel blockers Beta blockers Drug Interactions Using most adrenergic drugs with MAO inhibitors may lead to what serious complication?

Malignant hyperthermia Steven’s Johnson Syndrome Anaphylaxis Hypertensive crisis

Drugs That Affect the Cholinergic System Prepare: Drugs That Affect the Cholinergic System Cholinergic Drugs Use What are cholinergic drugs used for? (Select all that apply.)

To stimulate the bladder when a patient has postsurgical urinary retention To constrict the pupil causing decreased intraocular pressure In general anesthesia

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To decrease gastric motility Stuvia.com - The Marketplace to Buy and Sell your Study Material To relax the bladder when a patient has postsurgical urinary retention To dilate the pupil causing increased intraocular pressure To reverse general anesthesia To increase gastric motility Cholinergic Agonists Direct-acting cholinergic agonists bind to cholinergic receptors which results in activation of those receptors.

Cholinergic-blocking Drugs Cholinergic-blocking drugs are drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system. They are also known as anticholinergics and antimuscarinic drugs. They are competitive antagonists. When these drugs bind to receptors, they inhibit nerve transmission at these receptors.

Self-Check: Cholinergic Agonists: Mechanism of Action (MOA)

2 Indirect-acting cholinergic agonists, also known as cholinesterase inhibitors, inhibit the enzyme acetylcholinesterase resulti in more ACh available at the receptors.

After binding to the receptor site, permeability of the cell changes allowing flow of calcium and sodium into the ce which results in what?

Repolarization of cell membrane and inhibition of the effector organ.

Depolarization of cell membrane and stimulation of the effector organ.

Repolarization of cell membrane and stimulation of the effector organ.

Depolarization of cell membrane and inhibition of the effector organ.

Self-Check: Cholinergic Crisis Treatment of cholinergic crisis depends on how early it is caught and the severity of the reactions.

Self-Check: Anticholinergic Drugs Acetylcholine neurotransmitter is blocked or inhibited by cholinergic-blocking or anticholinergic drugs.

Self-Check: Cholinergic Blockers Uses Cholinergic Blockers: Uses What are cholinergic blockers used to treat? (Select all that apply.)

Exercise-induced bronchospasms Asthma Chronic bronchitis Chronic obstructive pulmonary disease Upper respiratory infections

Reflect: Drugs That Affect the Cholinergic System Cholinergic Crisis What are the early signs of cholinergic crisis? (Select all that apply.)

Transient complete heart block Abdominal cramps Persistent syncope Dyspnea Flushing of the skin Nausea, and vomiting Lack of salivation Hypotension Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Receptors Types Select the correct receptor associated with the information: At recommended doses, cholinergics primarily affect muscarinic receptors At high doses, cholinergics stimulate nicotinic receptors Desired effects are from stimulation of muscarinic receptors Many undesirable effects are caused by stimulation of nicotinic receptors

scopolamine When going on a cruise, a scopolamine patch can be worn behind the ear to help prevent motion sickness. When should the patch be placed on the skin before disembarkation (leaving the port)?

24 hours before 6 hours before 72 hours before 4 hours before atropine Which finding would be consistent with an atropine overdose?

Miosis Urinary retention Moist skin Bradycardia Drug Summary Match the correct drug to the summary.

IF CAN'T READ Bethanechol Direct-acting cholinergic agonist used in the treatment of acute postoperative and postpartum nonobstructive urinary retent and for the management of urinary retention associated with neurogenic atony of the bladder.

Donepezil Cholinesterase inhibitor that works centrally in the brain to increase levels of ACh by inhibiting acetylcholinesterase used in the treatment of mild to moderate Alzheimer’s disease.

Atropine Naturally occurring antimuscarinic used to treat bradycardia, ventricular asystole, antidote for anticholinesterase inhibitor toxicity or poisoning, and preoperatively to reduce salivation and GI secretions.

Dicyclomine Synthetic antispasmodic cholinergic blocker used for functional disturbances of GI motility such as irritable bowel syndrome Glycopyrrolate Synthetic antimuscarinic drug that blocks receptor sites in the autonomic nervous system that control the production of

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secretions. It is used preoperatively to reduce salivation and excessive secretions in the respiratory and GI tracts.

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Scopolamine Naturally occurring cholinergic blocker and one of the principal belladonna alkaloids used to prevent motion sickness and to help prevent postoperative, postanesthesia nausea and vomiting.

Effects of Cholinergic Drugs A person has been taking a cholinergic drug for 3 days. They have flushed skin and orthostatic blood pressure changes and is complaining of abdominal cramps and nausea. What are they most likely experiencing?

An allergic reaction to the drug Late signs of a cholinergic crisis Expected adverse effects Early signs of a cholinergic crisis Treatment of Cholinergic Crisis Treatment of cholinergic crisis depends on how early it is caught and the severity of the reactions. Treatment in the early phase consists of atropine which is a cholinergic antagonist. If severe cardiovascular or bronchoconstriction is present, epinephrine should be used which is an adrenergic agonist.

Drug Classification Drag the drug name to the correct classification.

Drug Names

Cholinergic

Anticholinergic

bethanechol / donepezil

glycopyrrolate / atropine / scopolamine / dicyclomine

Nursing Application: Adrenergic, Adrenergic-Blocking, Cholinergic, and Cholinergic-Blocking Drugs Prepare: Nursing Application - Adrenergic, Adrenergic-Blocking, Cholinergic, and Cholinergic-Blocking Drugs Monitoring for Cholinergic Crisis When monitoring for cholinergic crisis, what acronym can guide this assessment?

ACID PQRST RICE SLUDGE Cholinergic Drugs Cholinergic drugs can result in what hemodynamic state that can result in the need to sit or stand slowly?

Positional hypotension Positional hypertension Postural hypotension Postural hypertension Administering Two Adrenergic Drugs Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension

Self-Check: High Doses What can happen with high doses of cholinergics?

Cholinergic Crisis Adrenal Crisis

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Seratonin Storm SARS

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Self-Check: Implementation Considerations

When administering anticholinergic drugs, the nurse should consider the following implementation considerations Select the correct option from the drop down menu for each of the nursing action provided below: When giving levodopa, Monitor older adults carefully for confusion, orthostatic hypotension, and anorexia Observe clients for dry mouth, decreased salivation, reduced gastrointestinal motility resulting in constipation, and dilated pupils interfering with visual acuity Encourage clients for hydration, the use of hard candy, and a high fiber diet Advise clients for reporting any changes in vision

Self-Check: Dobutamine Drip

A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first?

Slow the intravenous infusion.

Notify the health care provider.

Inject the area with phentolamine.

Stop the intravenous infusion.

Self-Check: Therapeutic Effects Classify each therapeutic effect below between cardiovascular uses and asthma.

Therapeutic Effects

Cardiovascular Uses

Asthma

Decreased edema / Increased urinary output / Increased LOC / Return to normal vital signs / Improved skin color and temperature

Increased air exchange / Improved blood gases / Less dyspnea / Increased activity tolerance / Return to normal respiratory rate / Decreased cough / Improved breath sounds, fewer crackles

Self-Check: Alpha Blockers

When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for t development of what adverse effect?

Blood dyscrasia Renal failure Hypotension Dysrhythmias

Reflect: Nursing Application of Adrenergic, Adrenergic-Blocking, Cholinergic, and Cholinergic-Blocking Drugs

Low-Dose Dobutamine Drip A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 beats/min, and her blood pressu is 150/98 mm Hg (increased from previous readings of 86 beats/min and 120/80 mm Hg). What is the nurse’s immediate concern for this patient?

She is experiencing normal adverse effects of dobutamine therapy.

The dosage of the dobutamine needs to be increased to control the symptoms better.

She may be experiencing an allergic reaction to the dobutamine.

The medication may be causing a worsening of a preexisting cardiac disorder.

Inhalers

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A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one Stuvia.com - The Marketplace to Buy and Sell your Study Material would be appropriate for treatment at this time?

Fluticasone Salmeterol Salmeterol and fluticasone combination (Advair Diskus) Albuterol

Drug Categories One of the rights of medication administration is giving the right medication. To do this, we need to be familiar wit what medications do, so we can confirm we are giving the right drug for the right condition. Match the drug category to the correct descriptor.

Alpha Blockers A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

Discolored urine Orthostatic hypotension Decreased urine flow Increased blood pressure

Nebulizer Treatments A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulize treatment with albuterol. What is the nurse’s immediate assessment priority?

Monitor the child’s temperature.

Provide education on asthma management.

Determine the time of the child’s last meal.

Monitor oxygen saturation with a pulse oximeter.

Tamsulosin The teaching for a patient who is taking tamsulosin to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these?

Take the medication with breakfast to promote the maximum effects of the drug.

Fluids need to be restricted while on this medication.

Blood pressure must be monitored because the medication may cause hypertension.

Get up slowly from a sitting or lying position.

Dobutamine Drips A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before What will the nurse do first?

Increase the infusion rate.

Check the infusion site for possible extravasation.

Order an electrocardiogram.

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Check the patient’s vital signs.

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Intravenous Penicillin A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which dru will the nurse expect to use to treat this condition?

Phenylephrine Ephedra Pseudoephedrine Epinephrine

Week 6 Concepts: Mood and Affect Mood-Stabilizing Drugs Prepare: Mood-Stabilizing Drugs Medication Classes Which medication class is used most frequently for acute mood stabilization?

Anticonvulsants Antidepressants Beta blockers Anxiolytics Mood Stabilizing Medications Which of the following conditions is treated by mood stabilizing medications?

Bipolar disorder Schizophrenia Panic disorder Major depressive disorder Chronic Mood Stabilization Which of the following medications is used for chronic mood stabilization?

Lithium Fluoxetine Haloperidol Diazepam

Self-Check: Mood Disorder Medications Mood Stabilizing Medications Which medication can make someone with a mood disorder like bipolar disorder worse?

Anxiolytic Anticonvulsant Antipsychotic Antidepressant

Self-Check: Lithium Which condition is usually treated with lithium?

Major depression disorder Schizophrenia Maintenance of bipolar disorder Acute mania

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Self-Check: Valproic Acid

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John is started on an anticonvulsant called valproic acid for a recent manic episode. Which of the following is important for his safety?

Monitor his valproic acid level to ensure the correct dose.

Do not use this medication with a second-generation antipsychotic.

Change his medication dosage based on his symptoms.

Stop the medication immediate when the symptoms go away.

Self-Check: Side Effects Which side effects are common with all mood stabilizing medications?

Weight gain Improved appetite Tachycardia Nausea Sedation

Self-Check: Mood Stabilizing Medications Which medication can make someone with a mood disorder like bipolar disorder worse?

Anticonvulsant Antidepressant Anxiolytic Antipsychotic

Reflect: Mood-Stabilizing Drugs

valproic acid Lisa is started on valproic acid for bipolar mania. She is home for about 1 week and comes into the office today. H recent lab test from yesterday shows a valproic acid level of 10 (therapeutic level is 50-100mg/dl). Which are the most likely causes? (Select all that apply.)

She may not be taking her medication as directed.

Her dosage needs to be decreased.

Her medication is not at a therapeutic level after 7 days.

She may be taking medication that interacts with this drug.

Her dosage needs to be increased.

valproic acid You are visiting Alfred to discuss a project. You know he has bipolar disorder and has been taking valproic acid fo acute mania. He mentions that his valproic acid level yesterday was 165 (Therapeutic range is 20-100mg/dl). Wha symptoms would you expect him to have? (Select all that apply.)

No symptoms Sedation Tremor Diarrhea Nausea and vomiting Liver Toxicity Which of the following suggests that the patient is experiencing liver toxicity from their medications?

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Maria started olanzapine about 2 months ago for her bipolar disorder. She says that she has noticed some facial Stuvia.com - The Marketplace to Buy and Sell your Study Material twitching that occurs intermittently. Which of the following things could this be attributed to?

Dehydration Muscle spasm Tardive dyskinesia Electrolyte imbalance Drug Interactions John says that he usually has a glass of wine in the evenings after taking his medications. He currently is taking valproic acid. Which of the following possible drug interactions should you be concerned about? (Select all that apply.)

Constipation Sedation Liver toxicity Kidney damage Agitation Tardive Dyskinesia Which is an accurate statement about tardive dyskinesia?

It is sometimes permanent and may continue after the medication is stopped.

It is treated with an antipsychotic medication.

It always stopped when the medication is discontinued.

It will eventually go away with no treatment

Bipolar Disorder Lisa has been arrested for assault. At the correctional facility you meet with her. She is disheveled, speaks rapidl and quickly jumps from one topic to another. She appears agitated and out of control. The local psychiatrist suspects bipolar disorder. Which of the following medications is likely to be used in this acute phase of the condition?

Phenytoin Amitriptyline Lithium Lorazepam Valproic acid

valproic acid Beth is meeting you for lunch. She has a history of bipolar disorder and is currently on valproic acid. At lunch you notice that she orders a beer. Which of the following statements is accurate?

One beer won’t be a problem with her medication.

Alcohol reduces the effectiveness of her medication.

She can hold today’s dose of medication, so it won’t interact.

The beer will interact with her medication and should not be consumed.

Lithium Salts (lithium) Prepare: Lithium Salts Lithium Lithium is indicated and used for which of the following conditions?

Panic attacks Bipolar disorder Major depressive disorder Acute mania Safety Considerations Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Which of the following safety considerations is most important to prevent lithium toxicity?

Stuvia.com - The Marketplace to Buy and Sell your Study Material Monitor valproic acid levels to ensure therapeutic use.

Encourage fluids, particularly water.

Take medication with food.

Periodically draw lithium lab levels to ensure therapeutic use.

Lithium Toxicity When client’s lithium levels are in the toxic range, which of the following symptoms are most common? (Select all that apply.)

Chest pains Nausea Vomiting Constipation Diarrhea

Self-Check: Lithium Treatment Lithium is indicated for the treatment of which disorders? (Select all that apply.)

Augmentation (second) medication for major depressive disorder Schizophrenia that is not responding to other medications Bipolar disorder Acute anxiety disorder Major depressive disorder

Self-Check: Increased Lithium Levels Which of the following can lead to increased lithium levels? (Select all that apply.)

Constipation Tardive dyskinesia Dehydration Renal disease Sodium imbalance

Self-Check: Sudden Death What is the most likely cause of sudden death in a patient taking lithium with conflicting medications?

Severe nausea and vomiting Dehydration Prolonged QT interval Constipation

Self-Check: Lithium Toxicity When client’s lithium levels are in the toxic range, which of the following symptoms are most common? (Select all that apply.)

Chest pains Constipation Diarrhea Nausea Vomiting

Self-Check: Tardive Dyskinesia Which of the following could be a symptom of tardive dyskinesia?

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Lip smacking Tremor of the right arm

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Reflect: Lithium Salts Dehydration How does dehydration affect lithium levels?

Decreases them Increases them Has no effect

Lithium Lithium works on bipolar disorder by decreasing dopamine levels, decreasing norepinephrine levels, and increasing seroton levels. Lithium is primarily used for the chronic treatment of this disorder.

Tardive Dyskinesia Which of the following statements about tardive dyskinesia is accurate? (Select all that apply.)

It goes away without treatment It is a potential side effect of lithium Some symptoms include lip smacking and uncontrolled tongue movement It’s caused by agonistic effect of the D2 (dopamine) receptor It is always permanent

Signs of Lithium Toxicity Signs of lithium toxicity include which of the following? (Select all that apply.)

Tremors Constipation Diarrhea Chest pain Vomiting Medication Classes Match the following classes with a generic medication name, and it’s interaction with lithium: Generic Medication Name

Interaction With Lithium

Non-steroidal anti-inflammatories

ibuprofen

Increase lithium levels

Anticoagulant

warfarin

No interaction

Antibiotic

levofloxacin

Increase QT interval

Antidiabetic

glipizide

Variable glucose levels

Antidepressant

citalopram

Serotonin syndrome

Laboratory Levels Which laboratory levels are most important to monitor to prevent lithium toxicity? (Select all that apply.)

Thyroid level Valproic acid level Lithium level Complete blood count Sodium level Lithium Levels At what level can you expect symptoms of lithium toxicity to occur?

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0.6 mEq/L 0.8 mEq/L 1.5 mEq/L 1.9 mEq/L

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Treating Major Depressive Disorder Treating major depressive disorder with lithium can cause which of the following?

No improvement Increased cycling between depression and mania Decreased suicidal ideation Improvement in depression

Nursing Application: Mood-Stablizing Drugs Prepare: The Nursing Application of Mood Stabilizing Drugs Lithium and Neurotransmitters What affect does lithium have on neurotransmitters in the brain?

It increases norepinephrine levels It decreases dopamine levels It increases dopamine levels It decreases serotonin levels Neurotransmitters What are the three neurotransmitters that almost all mood stabilizers affect? (Select all that apply.)

Beta-adrenergic Norepinephrine Serotonin Dopamine Epinephrine Estrogen Medication Which medication is used most frequently for chronic mood stabilization? carbamazepine lithium venlafaxine valproic acid

Self-Check: Monitoring Electrolytes Which electrolyte needs to be monitored closely when taking lithium?

Sodium Magnesium Calcium Potassium

Self-Check: Valproic Acid

You are visiting Alfred to discuss a project. You know he has bipolar disorder, and has been taking valproic acid fo acute mania. He mentions that his valproic acid level yesterday was 15 (Therapeutic range is 20-100mg/dl). What symptoms would you expect him to have? (Select all that apply.)

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Self-Check: Valproic Acid

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Julie drinks one vodka drink at night before bedtime. She is taking valproic acid. Which of the following interactions should you be concerned about (Select all that apply.)?

Kidney damage Hypertension Constipation Sedation Liver toxicity

Self-Check: Low Lithium Levels Sara has an abnormally low lithium level suggesting which of the following? (Select all that apply.)

She could be taking her medication as directed.

She may be taking medication that interacts with this drug.

Her dosage needs to be decreased.

Her dosage needs to be increased.

She may not be taking her medication as directed.

Self-Check: Over Medicating Dennis is your patient for today. You know he has bipolar disorder, and is very drowsy and difficult to arouse.

Which one of these medications is he getting too much of?

Lisinopril Ibuprofen Lithium Valproic acid

Reflect: Nursing Application of Mood Stabilizing Drugs

Bipolar Disorder Laurie is brought into the emergency department by her sister. She is disheveled, speaks rapidly, and quickly jum from one topic to another. She appears agitated and out of control. She has a history of bipolar disorder but is no taking any medications at this time.

The nurse knows that the psychiatrist may prescribe which medications for Laurie? (Select all that apply.)

Lithium Valproic Acid Olanzapine Fluoxetine Lorazepam

Patient Instruction The psychiatrist decides to start Laurie on the following medication with a request to follow-up in the office in thre days. ● Valproic Acid 250mg three times daily ● Lithium 300mg three times daily Which instructions should be given to Laurie and her sister? (Select all that apply.)

Notify the psychiatrist if you have any nausea and vomiting.

It is ok to have one beer with these.

Don’t mix these with alcohol.

Get a lithium and valproic acid level drawn before your office visit.

If you have any reactions to these you should stop them immediately.

This medication can cause liver toxicity.

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During the discharge process Laurie’s sister asks the nurse about her role in her sister’s care. What is the best Stuvia.com - The Marketplace to Buy and Sell your Study Material response by the nurse?

“She should be fine on her own, you can call her periodically.”

“Leave her alone until she gets more reasonable.”

“You should not leave her side for even a moment.”

“You should stay with her for now to make sure she is safe.”

Sedation Laurie’s sister calls the health provider’s office and says that her sister seems really drowsy and it is difficult to wake her up. The nurse understands that which statement below is most likely the cause of Laurie’s drowsiness?

She is likely not taking her medications.

She could have lithium toxicity.

She could have valproic acid toxicity.

This is a sign her mania is now under control.

Medication Levels The nurse is reviewing Laurie’s medication level results from earlier in the day. ● Valproic acid – 120 mcg/dL (reference range: 50-100 mcg/dL) ● Lithium level – 0.04 mmol/L (reference range: 0.06-1.2 mmol/L) Question 1 / 2 How does the nurse interpret these results?

The valproic acid level is toxic and the lithium level is too low. You anticipate that the psychiatrist will want to decrease the valproic acid, and increase the lithium.

Question 2 / 2 Based on these results, what does the nurse anticipate Laurie will say about how she is feeling?

“I have been really tired and it is difficult to stay awake.”

“I have had some twitching and muscle spasms.”

“I have been feeling great with no problems.”

“I have been non-stop vomiting and I have diarrhea.”

Side Effects Laurie is in the office for follow-up. She is less disheveled and talks in more complete sentences without jumping from one topic to another rapidly. She says that she doesn’t like being on these medications due to the side effect Which side effects can she expect with the valproic acid and the lithium?

Tremor Headaches Constipation Fatigue Increased appetite Weight gain Lithium Laurie says that her dad may benefit from lithium as he also has been diagnosed with bipolar disorder. The use of lithium is contraindicated with which medical conditions? Select all that apply.

Chronic obstructive pulmonary disease Liver disease Renal disease Hypertension Cardiovascular disease

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Prepare: Antidepressant Drugs Stuvia.com - The Marketplace to Buy and Sell your Study Material Common Suffix What is a common suffix used for many generic named antidepressants?

-ine -olol -pril -pam Neurotransmitters What are the three neurotransmitters that almost all antidepressants affect? (Select all that apply.)

Serotonin Epinephrine Estrogen Norepinephrine Beta-adrenergic Dopamine Selective Serotonin Reuptake Inhibitors (SSRIs) What affect do selective serotonin reuptake inhibitors (SSRIs) have on neurotransmitters in the brain?

They decrease serotonin levels They adjust dopamine levels They increase norepinephrine levels They increase serotonin levels

Self-Check: Antidepressant Drug Effect Selective Serotonin Reuptake Inhibitor: How It Works How does a selective serotonin reuptake inhibitor(SSRI) increase serotonin levels at the synaptic cleft?

Destroys the enzyme that breaks down serotonin Increases norepinephrine levels Guides more serotonin into the cleft through active transport Makes extra serotonin

Self-Check: Antidepressant Drugs Why is amitriptyline called a “tricyclic” antidepressant?

It takes three weeks to work It needs to be stopped for a week every third week It was the next medication developed after bicyclic medications It works on the three main neurotransmitters

Self-Check: Serotonin Receptors Where are serotonin receptors located? (Select all that apply.)

Large muscle groups Blood vessels Platelets Gastrointestinal tract Peripheral nervous system

Self-Check: Indications for Antidepressants Besides depression, for which other conditions are antidepressants are prescribed? (Select all that apply.)

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Seizures Pneumonia Insomnia Panic disorder

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Self-Check: Safety Considerations High in Tyramine Which of the following foods are high in Tyramine?

Cream cheese Home brew beer Parmesan cheese Pickles Pasta Safety Concerns What are some safety concerns that need monitoring after starting an antidepressant? (Select all that apply.)

They become hypertensive There is no improvement in one week They become suicidal Their depression improves Depressive symptoms become worse

Self-Check: Serotonin Syndrome What causes serotonin syndrome?

Another medication interacts causing increased serotonin in the brain Enzyme activity at the synaptic cleft breaks down too much serotonin A patient takes their antidepressant as prescribed Serotonin is decreased to a dangerous level in the brain

Reflect: Antidepressant Drugs Effect on Neurotransmitters Select the appropriate option for each neurotransmitter for the given subclasses of antidepressants.

Sub-Class

Serotonin

Norepinephrine

Dopamine

Tricyclic

Increase

Increase

Increase

Selective Serotonin Reuptake Inhibitor

Increase

No change

No change

Serotonin and Norepinephrine Reuptake Inhibitor

Increase

Increase

No change

Monoamine oxidase Inhibitor

Increase

Increase

Increase

Atypical (Bupropion or Wellbutrin)

No change

Increase

Increase

Antidepressant Drug Actions Select the correct action for the given medications.

Generic Name

Action

fluoxetine

Selective Serotonin Re-Uptake Inhibitor

selegiline

MAO Inhibitor

citalopram

Selective Serotonin Re-Uptake Inhibitor

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amitriptyline

Tri-Cyclic Stuvia.com - The Marketplace to Buy and Sell your Study Material

venlafaxine

Serotonin Norepinephrine Re-Uptake Inhibitor

duloxetine

Serotonin Norepinephrine Re-Uptake Inhibitor

escitalopram

Selective Serotonin Re-Uptake Inhibitor

nortriptyline

Tri-Cyclic

phenelzine

MAO Inhibitor

sertraline

Selective Serotonin Re-Uptake Inhibitor

sertraline A client has been experiencing some depressive symptoms. Last week she went to her healthcare provider and wa diagnosed with major depressive disorder (MDD). She was started on sertraline. She now says that she feels like h depression is worse. Which of the following statements apply? (Select all that apply.)

She should not stop taking the medication without consulting her provider.

She should call her provider immediately and let them know about her worsening symptoms.

She should follow-up with her provider next week as scheduled instead of calling.

It can take 4 to 6 weeks for antidepressants to start working.

It should be working already.

Drug Interaction You are a pharmacy manager reviewing some of your customers recent medication purchases. Review the purchases below and identify which ones require a call to the patient or healthcare provider to warn about a possib interaction. (Select all that apply.)

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Side Effects Judy is starting an antidepressant and is wondering about what side effects she might expect. What are some of t common side effects of antidepressants? (Select all that apply.)

Weight loss Weight gain Nausea Increased appetite Dry mouth Drowsiness bupropion Besides being used as an antidepressant, bupropion is indicated by the FDA for smoking cessation.

Food High in Tyramine While on a monoamine oxidase inhibitor, which condition is caused by ingesting foods that are high in tyramine?

Enhanced effects of the antidepressant Hypertensive crisis Reduced effects of the antidepressant Serotonin syndrome Safety Considerations Which antidepressants are safe to take before eating steak and cheese? (Select all that apply.) selegiline Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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venlafaxine wellbutrin phenelzine amitriptyline

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Tricyclics (amitriptyline), SSRIs (escitalopram), and SNRIs (venlafaxine) Prepare: Tricyclics (amitriptyline), SSRIs (escitalopram), and SNRIs (wenlafaxene) Neurotransmitter Which neurotransmitter do amitriptyline, venlafaxine, and escitalopram all increase?

Acetylcholine Beta-Adrenergic Dopamine Serotonin Norepinephrine Side Effects While it is a common side effect of amitriptyline, which condition is this medication also used to treat?

Insomnia Weight gain Nausea Anxiety Allergic reaction Drug Effects Alice was prescribed venlafaxine for major depressive disorder. When can she expect to start feeling better?

This week Next week Six months 4 to 6 weeks

Self-Check: Medication Mechanism of Action Medication Effect Which of the following medications increases norepinephrine and serotonin, but not dopamine?

Phenelzine Amitriptyline Venlafaxine Escitalopram

Self-Check: Medication Indication Which of the following medications is indicated by the Federal Drug Administration for bed-wetting (nocturnal enuresis)? amitriptyline venlafaxine phenelzine escitalopram Medication Sub-classes Match the following medications with their medication sub-class.

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Selective serotonin Stuvia.com Serotonin norepinephrine Monoamine oxidase - The Marketplace to Buy and Sell your Study Material reuptake inhibitor reuptake inhibitor inhibitor Medications

Escitalopram

Venlafaxin

Phenelzine

Tricyclic antidepressant Amitriptyline

Self-Check: Safety Considerations Adverse Effects A patient who is taking venlafaxine starts experiencing some confusion, difficulty concentrating, and a headache.

What potential adverse reaction could be causing these symptoms?

Aplastic Anemia Hyponatremia Hypermagnesemia Migraines Escitalopram Sally wants to stop taking her escitalopram. Which of the following statement is accurate?

It is not safe to stop the medication until it can be replaced with another.

The medication should be discontinued slowly.

The medication should be continued regardless of the side effects.

It is safe to stop taking the medication.

Self-Check: Drug Interactions and Side Effects Drug Interactions When giving amitriptyline, which medications are known to interact with this medication? (Select all that apply.)

Warfarin St. John's Wort Fluoxetine Phenytoin Nortriptyline Side Effects What are some common side effects of venlafaxine?

Weight gain Decreased salivation Constipation Weight loss Increased salivation

Reflect: Tricyclics (amitriptyline), SSRIs (escitalopram), and SNRIs (wenlafaxene)

Safety Considerations Alice is 73 years old. She has been taking venlafaxine for the last two years. She is on her way to the lab to get blo drawn because her healthcare provider thinks she is dehydrated. Which of the following sodium levels is most likely? (Remember the sodium reference range is 135 to 145 mEq/L.) 148 145 139 127 Drug Interactions John is on escitalopram, which he has been taking for about three months. He says he also has been taking St. John’s Wort which he buys at his local grocery store. Which of the following symptoms would you be concerned about when taking this combination? (Select all that apply.)

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Decreased respirations Constipation Slow heart rate Rapid heartbeat Muscle twitching

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Medical Conditions Douglas is currently taking amitriptyline, but he says that his healthcare provider is not giving it to him for major depressive disorder. He is being treated for fibromyalgia.

Safety Considerations Your sister is taking venlafaxine for major depressive disorder. She ran out of her medication yesterday and canno pick up her new prescription for several days. Which of the following concerns you the most?

After not taking for several days, the anti-depressant effect will wear off.

She might be in danger of experiencing serotonin syndrome and should call her provider immediately.

She might have withdrawal symptoms from this medication and should not stop it abruptly.

She should be fine and can just restart her medication when she gets the prescription filled.

Side Effects of Amitriptyline Select the common side effects for amitriptyline.

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Medication Names and Sub-Classes Complete the following table by dragging and dropping the correct options below: Generic

Brand

Sub-Class

Amitriptyline

Elavil

Tricyclic Antidepressant (TCA)

Venalafxine

Effexor

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Escitalopram

Lexapro

Selective Serotonin Reuptake Inhibitor (SSRI)

Medication Effects Which of the following medications increases serotonin levels only?

Venlafaxine Wellbutrin Amitriptyline Escitalopram Amitriptyline Which neurotransmitters does amitriptyline increase? (Select all that apply.)

Acetylcholine Dopamine Norepinephrine Beta-Adrenergic Serotonin

MAOIs (phenelzine) Prepare: MAOIs (phenelzine) Neurotransmitters Affected Which neurotransmitters do monoamine oxidase inhibitors increase? (Select all that apply.)

Serotonin Beta-Adrenergic Norepinephrine Dopamine Acetylcholine Monoamine Oxidase Inhibitors Monoamine oxidase inhibitor medication related hypertension results from an increase in TyramineZZZ amino acid.

Tyramine Which of the following foods is high in tyramine?

Decaffeinated soda Fresh turkey Aged cheese Lettuce

Self-Check: Monoamine Oxidase Enzymes Which neurotransmitters do MAO inhibitors selective to the MAO-enzyme B increase?

Serotonin Dopamine Norepinephrine Acetylcholine

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Self-Check: MAOIs Actions Stuvia.com and Indications - The Marketplace to Buy and Sell your Study Material Actions on Neurotransmitters Match the following chemicals with their action on neurotransmitters in the brain.

MAO-A enzyme

Decreases serotonin, norepinephrine, and dopamine

MAO-B enzyme

Decreases dopamine

MAO-A selective inhibitor

Increases serotonin, norepinephrine, and dopamine

MAO-B selective inhibitor

Increases dopamine

Drug Indications Which of the following indications for phenelzine is approved by the Federal Drug Administration?

Restless leg syndrome Parkinson’s disease Panic disorder Social phobias Major depressive disorder

Self-Check: Safety Considerations

Adverse Effect A patient who is taking phenelzine starts experiencing some headaches and a pounding heart beat. What potential adverse reaction could be causing these symptoms?

Hypermagnesemia Migraines Aplastic Anemia Hypertension Tyramine Vegan diet is least likely to contain foods high in tyramine.

Self-Check: Drug Side Effects and Interactions Side Effects What are some common side effects of phenelzine?

Weight loss Weight gain Increased salivation Decreased salivation Constipation Drug Interactions When giving phenelzine, which medications are known to interact with this medication? (Select all that apply.)

St. John's Wort Phenytoin Fluoxetine Nortriptyline Warfarin

Reflect: MAOIs (phenelzine) Drug Uses Douglas is currently taking phenelzine, but he says that his healthcare provider is not giving it to him for Major Depressive Disorder. Which of the following conditions is he being treated for?

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Hypersomnia Fibromyalgia

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Common Side Effects Select the common side effects for phenelzine.

Neurotransmitters Which neurotransmitter is increased by a MAO Inhibitor but not an SSRI or SNRI? Dopamine Beta-Adrenergic Serotonin Acetylcholine Norepinephrine

Drug Interactions John is on phenelzine which he has been taking for about three months. He says he also has been taking St. John Wort which he buys at his local grocery store. Which of the following symptoms would you be concerned about when taking this combination? (Select all that apply.)

Sweating Constipation Muscle twitching Decreased respirations Rapid heartbeat Slow heart rate Drug Names Complete the following table.

Generic

Brand

Phenelzine

Nardil

Selegiline

Carbex

Tranylcypromine

Parnate

Drug Effect Alice is 73 years old. She has been taking phenelzine for the last two weeks. Which of the following statements would concern you?

“I have not noticed an improvement after starting this medication.”

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“I find that this medication with my nightly Vodka drink seems to relax me.”

Stuvia.com - The Marketplace to Buy and Sell your Study Material “I have been avoiding those specialty cheeses I get from the grocery store.”

“My depression seems to be improving.”

Safety Considerations Your sister is taking phenelzine for major depressive disorder. She ran out of her medication yesterday and canno pick up her new prescription for several days. Which of the following concerns you the most?

After not taking for several days, the anti-depressant effect will wear off.

She might have withdrawal symptoms from this medication and should not stop it abruptly.

She might be in danger of experiencing serotonin syndrome and should call her provider immediately.

She should be fine and can just restart her medication when she gets the prescription filled.

Foods with MAOIs While on a MAO inhibitor, which of the following foods should be avoided?

Atypical Antidepressants Prepare: Atypical Antidepressants Atypical antidepressant: Indications What other common condition is bupropion, an atypical antidepressant, used for?

Appetite control Weight loss Smoking cessation Hypertension Neurotransmitters What are the three neurotransmitters that almost all atypical antidepressants increase? (Select all that apply.)

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Serotonin Dopamine Norepinephrine Epinephrine Estrogen Beta-adrenergic

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Serotonin What affect does the neurotransmitter serotonin have?

Has no effect on depression Causes bipolar disorder Increases depressive symptoms Decreases depressive symptoms

Self-Check: How It Works Bupropion: How It Works Why is bupropion used in some patients instead of a different antidepressant class? (Select all that apply.)

Weight gain is not usually a side effect.

It mostly increases serotonin levels.

The patient smokes.

It’s least expensive to use.

This medication is always used before the other classes.

Bupropion: How It Works How does bupropion help smoking cessation?

Increases dopamine levels in the brain Decreases dopamine levels in the brain Is a potent dopamine receptor antagonist Increases serotonin levels

Self-Check: Indications and Side Effects Indications For which of the following conditions is bupropion indicated?

Neuropathic pain Weight loss Seizure disorders Attention deficit disorder Migraines Smoking cessation Side Effects What are some common side effects associated with bupropion?

Nausea Insomnia Drowsiness Constipation Diarrhea

Self-Check: Safety Considerations Which antidepressant should not be used if someone is currently being treated for a seizure disorder?

Phenelzine Amitriptyline

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Reflect: Atypical Antidepressants Neurotransmitter Bupropion primarily increases dopamine neurotransmitter in the brain.

Side Effects Which of the following are side effects of bupropion? (Select all that apply.)

Insomnia Diarrhea Tremors Headaches Excessive salivation Constipation Bupropion Effects A friend of yours has started bupropion. He says that his depression has gotten worse. Which of the following statements is correct?

Depression should be better within one to two weeks of starting this medication.

It is important to contact the healthcare provider in this situation.

It is normal for depression to be worse for the first week or two.

Stop the medication.

Side Effects Identify common side effects associated with bupropion.

Safety Considerations Which of the following is usually recommended for someone taking bupropion? (Select all that apply.)

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Don’t drive as this medicine may make you drowsy.

Stuvia.com - The Marketplace to Buy and Sell your Study Material It is safe to take this medication with a seizure disorder.

Don’t stop the medication abruptly.

This medication can conflict with blood thinners like warfarin.

This medication is sometimes used to treat nerve pain.

Drug Brand Name Wellbutrin is a brand name for bupropion.

Adverse Effects Which adverse reactions are associated with bupropion use? (Select all that apply.)

Muscle paralysis Suicidal ideation Depression Weight gain Seizures Attention deficit disorder Drug Indications For what other common conditions is bupropion, an atypical antidepressant, used? (Select all that apply.)

Smoking cessation Seasonal depression Attention deficit disorder Hypertension Weight loss

Nursing Application: Antidepressant Drugs Prepare: Nursing Application: Antidepressant Drugs Neurotransmitters Antidepressants work by increasing levels of which neurotransmitters in the brain? (Select all that apply.)

Norepinephrine Beta-adrenergic Estrogen Serotonin Dopamine Epinephrine

Antidepressant Effects The nurse is caring for a new patient who just started taking an antidepressant. Which of the following indicates a good understanding of this medication?

"I shouldn't expect this to help my depression.”

"This will fix my depression as soon as I take it.”

"I should worry if my depression becomes worse for a short time.”

"This may take 4 to 6 weeks for the medication to really work.”

Medications Indications The nurse is reviewing a patient's medication and notes the recent addition of an antidepressant. Which of the following medications does the nurse recognize as the most focused approach to treating major depressive disorder?

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Self-Check: Nursing Assessment

Patient Education Which statement by Rudy, a 27-year-old male recently prescribed bupropion requires further education from the nurse? ”My wife will be so glad that I finally asked for help to quit smoking.”

“I will have lots more energy while taking this medication.”

“This medication should be taken when I feel like I want a cigarette.”

“I should notify my health care provider if I notice tremors.”

Side Effects The nurse is reviewing Wendy's medication and notes she is on Amitriptyline 150 mg daily for her major depressiv disorder. Which of the following side effects could the nurse expect the patient to have? (Select all that apply.)

Diarrhea Increase saliva Drowsiness Lightheadedness when standing suddenly Weight gain

Self-Check: Nursing Diagnosis and Planning

Drug Interactions While reviewing Jose's new orders the nurse notes that warfarin has been prescribed. The nurse is concerned that the warfarin's effectiveness may be impacted by which of his current medications? (Select all that apply.) amitriptyline venlafaxine escitalopram bupropion fluoxetine

Medication Considerations Joanne is a 53-year-old women who has been taking venlafaxine 225mg daily for the last two years. She has noted gain of 20 pounds over the last year, which makes her more depressed. She stopped taking the antidepressant two days ago. Which of the following statements are accurate? (Select all that apply.)

She may sleep better as this medication can cause insomnia.

She may experience withdrawal symptoms from stopping this medicine abruptly.

Her weight gain is unrelated to this medication.

Her depression is likely cured, it is probably time to stop the medicine anyways.

If discontinuing, this medication should be tapered down slowly.

Self-Check: Nursing Implementation and Evaluation

Nursing Action The nurse is reviewing Sara's medication list. Sara is taking phenelzine 30mg tablets every eight hours. Sara's bloo pressure is 190/110. Which of the following nursing actions is most important?

Encourage Sara to lie down for a few minutes and relax.

Document elevated blood pressure and continue with her visit.

Review Sara's dietary intake recently.

Encourage Sara to take her blood pressure daily at home.

Reflect: Nursing Application: Antidepressant Drugs

Medication Considerations The nurse is reviewing Betty's current medication list in preparation for discharge teaching on bupropion, a newly prescribed medication. Which of Betty's current medications causes the nurse to be concerned?

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Aspirin 81mg 1 tablet daily for stroke prevention Stuvia.com - The Marketplace to Buy and Sell your Study Material Atenolol 20mg 1 tablet daily for high blood pressure Multivitamin 1 tablet daily Carbamazepine 800mg twice daily for seizures Singular 10mg 1 tablet daily for seasonal allergies Tylenol 500mg 1 tablet three times daily as needed for pain Nursing Diagnosis The nurse is reviewing Esmerelda's medication and notices that she is taking Amitriptyline (Elavil) 25mg at night.

Noting the dosage that is ordered, the nurse conclude which of the following?

She should have a glass of water at bedside to sip occasionally at night.

This dosage is too low to treat depression.

She is taking this medication for her major depressive disorder.

Weight loss is a common side effect.

She takes it at night because it causes drowsiness.

Nursing Assessment The nurse is reviewing Beth's medication history. Beth was on Celexa for three years but recently switched to Cymbalta because her depression was getting worse. Which statement shows the nurse's understanding of this medication?

She may have more side effects due to the increase in dopamine levels.

Cymbalta will increase serotonin and norepinephrine levels which may help her depression.

Cymbalta increases serotonin levels only, which may help her depression.

She will likely have less side effects because Cymbalta only increases serotonin levels.

Patient Teaching Donald was recently started on an Ensam (selegiline) patch which he changes daily. In the office for a follow-up he brings his food diary in for review. The nurse recognizes that he needs further medication teaching based on whic entries? Select all that apply from his daily plan given below:

Nursing Evaluation Lucy is here for follow-up after starting sertraline (Zoloft) two weeks ago. She says that her depression is getting worse and she just wants to end it all. Which response by the nurse is most appropriate?

We should notify your health care provider and let them know about your feelings.

Work through this, the medication should start working in two more weeks.

Let’s talk to your healthcare provider about increasing the dose.

You need to stop this medication and try something different for your depression.

Drug Interactions While the nurse is reviewing Julie's medication Julie tells her that a new medication, fluoxetine (Prozac), is not on the list. The nurse is concerned about interactions between the fluoxetine and which of Julie's current medications Select all the medications that apply from this list below:

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Drug Names Match the generic medication with a brand name and sub-class.

Nursing Diagnoses Josephine is a 71-year-old patient being seen in the office. The nurse is reviewing the chart and notes she is takin fluoxetine. Which of the following can the nurse expect as being caused by this medication? Select all that apply.

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