Pharm 4 - Mood DO

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MeganM
ID:
271891
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Pharm 4 - Mood DO
Updated:
2014-04-27 08:15:56
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Pharm
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TAMHSC,Pharm
Description:
Anxiety, Mood DO & Psychosis
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  1. What is used for benzodiazepine withdrawal?
    Valium (less addictive than Xanax)
  2. What is used for emergencies, or first line treatment of anxiety (not for long-term use)?
    • Lorazepam (Ativan) &
    • Alprazolam (Xanax)
    • -both benzodiazepines
  3. What should the nurse do prior to injecting Ativan?
    aspirate to make sure it's not in an artery
  4. ________ inhibits metabolism of alprazolam (Xanax).
    Grapefruit
  5. ______ doses of Xanax are given to older adults.
    smaller
  6. Drug given for low level anxiety, such as stage freight, or nursing school!
    Inderal (a BB)
  7. ________ increases the effects of BuSpar.
    Grapefruit
  8. The safest group of antidepressants. Why?
    • SSRIs
    • fewer sympathomimetic effects (HR, HTN)
    • fewer anticholinergic effects
  9. Which disorders does Zoloft treat?
    • Social anxiety
    • PTSD
    • Panic
    • OCD
  10. Which disorders does Paxil treat?
    • Social anxiety 
    • PTSD
    • GAD
    • Panic
    • OCD
  11. Which disorders does Prozac treat?
    • Panic
    • OCD
  12. Which disorders does Lexapro treat?
    GAD
  13. SSRIs (Paxil, Zoloft, Prozac, Lexapro) may cause ____ , and ______ dysfxn.
    • wt gain
    • sexual
  14. Name the SSRI drugs.
    • Paxil
    • Zoloft
    • Prozac
    • Lexapro
  15. Common AE with TCAs (Tofranil).
    • anticholinergic effects 
    • (dry mouth, blurred vision, urine retention, hypertension)
  16. Contraindications for TCAs (Tofranil).
    • Heart block or dysrhythmias
    • asthma
    • history of alcoholism
  17. What should you avoid with MAOIs (Nardil)?
    • foods with tyramine
    • caffeine
    • -also potentiates insulin (=hypoglycemia)
  18. MAOIs (Nardil) commonly cause?
    • orthostatic hypotension
    • headache
    • diarrhea
    • (high incidence of AE, rarely used)
  19. Tofranil increases the action of what?
    • NE & seratonin
    • (MAOI)
  20. Off-label common use for imipramine (Tofranil).
    overactive bladder (nocturesis)
  21. Contraindication of imipramine (Tofranil).
    • seizure DO
    • (Tofranil = TCA)
  22. Increased sedation effects from imipramine (Tofranil) if taken with what?
    • other CNS depressants
    • (alcohol, barbituates, benzos)
    • *Tofranil = TCA
  23. Decreased sedation effects from imipramine (Tofranil) if taken with what?
    • oral contraceptives
    • *clonidine (given for HTN)
    • carbamazepine
    • *Tofranil = TCA
  24. What should you NOT mix TCAs (Tofranil) with? Why?
    • MAOIs or
    • SSRIs
    • *Seratonin Syndrome!
  25. ______ are the drugs of choice for treating depression due to their LOW incidence of serious SE.
    SSRIs (Prozac, Paxil, Zoloft, Lexapro)
  26. Ataxia, weakness, restlessness, dizziness, or other motor problems can occur with ______.
    lorazepam (a benzodiazepine for anxiety)
  27. Abrubtly stopping Xanax (benzo) may cause withdrawal symptoms such as?
    • nausea,
    • vomiting,
    • abdominal cramps,
    • diaphoresis,
    • confusion,
    • tremors,
    • seizures
  28. Symptoms similar to alcohol withdrawal, such as weakness, delirium, or seizures, may occur if ________ are abruptly discontinued.
    benzodiazepines (Valium, Xanax, Ativan, Versed)
  29. Contraindications to Prozac (SSRI).
    • Bipolar
    • hypersensitivity
  30. Drug interactions for Prozac (SSRI)?
    • Serotonin Syndrome if mixed with MAOIs
    • Increased risk of bleeding with coumadin, aspirin, NSAIDS
  31. Pts on Prozac (SSRI) have an increased risk of toxicity if taken with what drugs?
    • phenytoin (Dilantin)
    • digoxin
    • carbamazepine
  32. If a pt taking an SSRI (Prozax, Paxil, Zoloft, Lexapro) develops a fever (especially with confusion & restlessness), what should you tell them?
    Stop taking the med - could be a sign of seratonin syndrome
  33. What kind of drug is Effexor?
    SNRI
  34. A contraindication with venlafaxine (Effexor)?
    • concurrent use with MAOI
    • *Effexor = SNRI
  35. Why would you not want to give venlafaxine (Effexor) to children or adolescents?
    • increased risk of suicide
    • *Effexor = SNRI
  36. The last-resort antidepressant.
    MAOI (Nardil)
  37. Contraindications of phenelzine (Nardil), an MAOI.
    • schizophrenia
    • hepatic/renal impairment
  38. Drugs that interact with phenelzine (Nardil), an MAOI.
    MANY other drugs! (take complete drug hx)
  39. Serious AE of phenelzine (Nardil), an MAOI.
    HTN crisis with tyramine foods
  40. Tell patients taking ______ NOT to change their diet, because it is an ion salt.
    Lithium
  41. Contraindications for Lithium.
    • severe dehydration
    • Na+ depletion
    • (duh, it's an ion salt!)
  42. Which drugs can increase lithium levels?
    • diuretics
    • NSAIDS
  43. Which drugs, when taken with Lithium, may result in serious side effects?
    • SSRIs
    • MAOIs
    • dextromethorphan
    • -haloperidol = increased neurotoxicity
  44. Pt has been on steady state of Lithium and a new drug is added or a dose change is made - what to assess for?
    • dysrhythmias
    • kidney impairment
    • leukocytosis
    • hypothyroidism
    • goiter
  45. Take Lithium with food or empty stomach?
    with food
  46. Depakote, Tegretal, & Lamictal - what kind of drugs?
    Antiseizure agents given for bipolar DO
  47. _______ are sometimes provided IM to relax a pt & allow initial dose of antipsychotic to be reduced.
    • benzodiazepenes
    • -lorazepam (Ativan)
  48. First-generation antipsychotics also called ________ and have ______ side effects than the 2nd-generations.
    • TYPICAL antipsychotics
    • more
  49. Drugs used to control bipolar DO.
    • antiseizure 
    • atypical antipsychotic agents, &
    • antidepressants
  50. A dopamine system stabilizer antipsychotic drug.
    abilify
  51. Symptoms of EPS.
    • AMS,
    • fever, HTN,
    • tremor, lack of muscle coordination
  52. _______ are effective at treating schizophrenia symptoms but exhibit a high incidence of AE.
    • phenothiazines (1st generation antipsychotic)
    • *Thorazine
  53. Selection of antipsychotic drugs (phenothiazines- Thorazine, Nonphenothiazine- Haldol) is determined by _________.
    severity or extent of SE
  54. Adjunct in treatment of tetanus & inretractable hiccups.
    • Thorazine (1st gen antipsychotic)
    • *Haldol (2nd gen antipsychotic)*
  55. What is Thorazine (a phenothiazine) used to treat?
    • *symptoms of schizophrenia & other psych D.O.
    • -antiemetic
    • -tetanus & hiccups
  56. What would cause additive anticholinergic SE with Thorazine?
    tricyclic antidepressants (Tofranil)
  57. What drugs would decrease serum levels of Thorazine?
    • antacids
    • barbiturates
    • lithium
  58. Which drugs would cause additive sedation with Thorazine?
    CNS depressants
  59. What drug would increase serum levels of Thorazine?
    epinephrine
  60. What drug would inhibit therapeutic effect/sedation of Thorazine?
    Levadopa
  61. Thorazine AE.
    • wt gain
    • blurred vision, dry eyes, glaucoma
    • MOST LIKELY TO PRODUCE EPS
  62. SERIOUS AE of Thorazine.
    • "mostly cardiac"
    • -tachycardia
    • -cardiac arrest
    • -respiratory depression
    • -NMS
    • -bld stuff
  63. What does Haldol treat?
    acute AND chronic psychotic DO
  64. If you take Haldol with ______ it will precipitate dementia.
    • methyldopa
    • (pts with Parkinsons)
  65. Haldol is MOST LIKELY to produce _____.
    EPS
  66. What is Risperdal used to treat?
    • schizophrenia
    • acute mania
  67. Precautions/Contraindications for Risperdal.
    • *Orthostatic hypotension
    • parkinsonism
    • hyperglycemia
  68. What is abilify?
    • atypical antipsychotic
    • dopamine system stabilizer
    • controls symptoms of schizophrenia
  69. Serious AE of abilify.
    • seizures 
    • NMS
    • tachycardia
  70. _______ should not be used by clients with seizure disorders, because it lowers the seizure threshold.
    Imipramine
  71. Full therapeutic effects of fluoxetine take ______.
    up to 1 month
  72. Persistent GI upset and confusion are signs of elevated ______ levels between 1.5 and 2.0, which signify EARLY toxicity.
    lithium
  73. ______ may occur at serum lithium levels above 2.5 but not in early stages of toxicity.
    Convulsions
  74. _____ causes fluctuations in weight.
    Prozac
  75. Lithium has been proven to decrease _______, while valproic acid has not
    suicide (the only area in which lithium is superior to valproic acid)
  76. __________ secondary to a reaction caused by the combination of an MAOI and a tyramine-containing food is the major problem with an MAOI.
    Hypertensive crisis
  77. Acute dystonia, or severe muscle spasms—especially of the back, neck, face, or tongue—may appear within hours or days of the first dose of a ________ and should be reported immediately.
    phenothiazine
  78. Tardive dyskinesia occurs late in _________  therapy, and is more common in the older adult.
    phenothiazine
  79. The _________ medications usually cause adverse effects even when taken as prescribed.
    phenothiazine
  80. The nurse expects that the client experiencing extrapyramidal symptoms during therapy with phenothiazines will be prescribed what med?
    • Benztropine (Cogentin)
    • -(it's an anticholinergic &  suppresses tremor and rigidity)
  81. EPS occurs frequently, especially at the beginning of therapy with  ________.
    haloperidol
  82. A person with _________ should not take haloperidol because they are all conditions that affect the CNS.
    • Parkinson's disease,
    • seizure disorders,
    • alcoholism, or
    • severe mental depression
  83. There is an increased risk of hyperglycemia or diabetes in clients taking ________.
    risperidone
  84. Hypotension is related to adverse reactions of _______ and must be monitored and reported if it occurs.
    risperidone
  85. Fever, tachycardia, stupor, and incontinence are symptoms of  ___________, a potentially fatal adverse effect of antipsychotics that must be diagnosed and treated immediately.
    neuroleptic malignant syndrome (NMS)
  86. Any blood dyscrasia is a contraindication to the use of _________.
    fluphenazine
  87. The risk of developing diabetes mellitus is higher with _______ than with any of the other atypical antipsychotic agents.
    olanzapine
  88. _________ is either not prescribed or discontinued if there is history of bone marrow depression, or evidence of leukemia, leukopenia, neutropenia, or blood dyscrasias.
    Clozapine (Clozaril)
  89. Clozapine may be associated with an increased risk of __________ especially during, but not limited to, the first month of therapy.
    • fatal myocarditis 
    • (an inflammation of the heart muscle)
  90. Clozapine is one of the drugs used to treat _________.
    schizophrenia

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