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jwhughes
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What is characterized by a single or recurrent episode of unipolar depression (not associated with mood swings) resulting in significant change in a person's normal functioning
Major Depressive Disorder
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How many symptoms should the patient have and how often to be diagnosed with Major Depressive Disorder
- 5
- almost q day for 2 weeks lasting most of the day
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3 phases of Major depressive disorder
- Acute
- Continuation
- Maintenance
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What is light therapy, what does is usually treat?
- Seasonal affective disorder
- inhibits nocturnal secretion of melatonin
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What medications block the reuptake of norepinephrine and serotonin in the synaptic space which intensifies the effects of these transmitters
TCA
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What is the major side effects of TCA
antichonlinergic effects
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What instructions can you provide the patient on TCA's to do to help with the anticholinergic effects
- Chew sugarless gum
- Sip water
- Wear sunglasses outdoor
- Eat high fiber foods
- Exercise
- Fluid intake 2L/day
- Void before medication
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When should patient take TCA
at night to minimize daytime sleepiness
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What medications should be avoided for a person on TCA
- MAOI
- Antihistamines
- Alcohol/Benzo/Opiods
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Name some symptoms of serotonin syndrome
- confusion
- agitation
- sweating
- fever
- tremors
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What medications/herbs are contraindicated in people on SSRI
- MAOI
- TCA
- St Johns Wort
- Warfarin
- Lithium
- NSAIDS
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When should Fluoxetine be discontinued if switching to MAOI
5 weeks before
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What dietary precautions should be taken for person on MAOI
tyramine restriction
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What are manifestations of hypertensive crisis (MAOI + too much tyramine) and how is it treated
- Increased BP & HR, HA, Nausea
- PHENTOLAMINE or NIFEDIPINE
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What medications/herbs should be avoided for people on MAOI
- OTC decongestants and cold remedies
- TCA
- Antihypertensives (careful)
- Tyramine
- Vasopressors (caffiene)
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What medication inhibits dopamine uptake
Welbutrin (atypical antidepressant)
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What does the nurse monitor for signs of toxicity with TCAs? When should it be taken?
- cardiac dysrhytmias
- at bedtime
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When should SSRI be taken? How should they be taken? What should be monitored?
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How should clients be instructed to take bupropion fpr seasonal depression
autumn q yr and taper off till spring
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How should lithium be taken?
with food or milk to prevent GI upset
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What interventions can be taken for fine hand tremors of those on lithium
- Propranolol
- START LOW
- Divided doses
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How is polyuria managed for lithium side effects
- potassium sparing diuretic
- fluid intake 2L/day
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How can hypothyroidism be managed for side effect of lithium
- yearly blood draw and prior to treatment
- observe for sx
- take synthroid
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Early indication toxicity level and symptoms
- <1.5
- n/v/d
- polyuria
- muscle weakness
- tremors
- slurred speach
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Steps for early detection of lithium toxicity
- STOP taking
- Notify PCP
- Lithium/sodium blood draw
- dose adjustment
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Advanced indication of lithium toxicity and symptoms
- 1.5-2
- confusion
- coarse tremor
- GI distress
- poor coordination
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Severe toxicity level and symptoms of lithium
- 2-2.5
- polyuria w/ dilute urine
- blurred vision
- ataxia
- seizures
- hyptotension >coma
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What interventions are necessary for severe lithium toxicity
- Emetic to alert client
- gastric lavage
- urea, mannitol, aminophylline to excrete
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If lithium level is over 2.5 what are the symptoms and treatment
- coma and death
- hemodialysis
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What meds should be avoided with lithium
- diuretics
- NSAID
- Anticholinergic
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How often should lithium be monitored and what time should blood be drawn
- q 2-3 days after treatments started till stable
- q 1-3 months
- MORNING, 12 hrs after last dose
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During initial treatment of a manic episode, what should lithium level be
0.8-1.4
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During maintenance phase of bipolar, what should lithium level be
0.4-1
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What lithium plasma levels result in toxicity
>1.5
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How many doses daily should lithium be taken
2-3 divided dose
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When do effects of lithium begin
7-14 days
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When should tegretrol be taken
at bedtime
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What is a side effect of tegretrol
thrombocytopenia
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Interventions when taking tegretrol to monitor for thrombocytopenia
Baseline CBC
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When on valproic acid (depakote) what should be monitored and how often
- liver
- q 2 months for first 6 months of treatment
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What food/meds are contraindicated with Carbamazapine (tegretrol)
- oral contraceptive
- warfarin
- grapefruit juice
- phenytoin
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