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2015-02-18 15:28:00
Exam 2
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  1. 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
  2. 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
  3. 3 phases of Major depressive disorder
    • Acute
    • Continuation
    • Maintenance
  4. What is light therapy, what does is usually treat?
    • Seasonal affective disorder
    • inhibits nocturnal secretion of melatonin
  5. What medications block the reuptake of norepinephrine and serotonin in the synaptic space which intensifies the effects of these transmitters
  6. What is the major side effects of TCA
    antichonlinergic effects
  7. 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
  8. When should patient take TCA
    at night to minimize daytime sleepiness
  9. What medications should be avoided for a person on TCA
    • MAOI
    • Antihistamines
    • Alcohol/Benzo/Opiods
  10. Name some symptoms of serotonin syndrome
    • confusion
    • agitation
    • sweating
    • fever
    • tremors
  11. What medications/herbs are contraindicated in people on SSRI
    • MAOI
    • TCA
    • St Johns Wort
    • Warfarin
    • Lithium
    • NSAIDS
  12. When should Fluoxetine be discontinued if switching to MAOI
    5 weeks before
  13. What dietary precautions should be taken for person on MAOI
    tyramine restriction
  14. What are manifestations of hypertensive crisis (MAOI + too much tyramine) and how is it treated
    • Increased BP & HR, HA, Nausea
  15. What medications/herbs should be avoided for people on MAOI
    • OTC decongestants and cold remedies
    • TCA
    • Antihypertensives (careful)
    • Tyramine
    • Vasopressors (caffiene)
  16. What medication inhibits dopamine uptake
    Welbutrin (atypical antidepressant)
  17. What does the nurse monitor for signs of toxicity with TCAs? When should it be taken?
    • cardiac dysrhytmias
    • at bedtime
  18. When should SSRI be taken? How should they be taken? What should be monitored?
    • morning
    • with food sodium
  19. How should clients be instructed to take bupropion fpr seasonal depression
    autumn q yr and taper off till spring
  20. How should lithium be taken?
    with food or milk to prevent GI upset
  21. What interventions can be taken for fine hand tremors of those on lithium
    • Propranolol
    • Divided doses
  22. How is polyuria managed for lithium side effects
    • potassium sparing diuretic
    • fluid intake 2L/day
  23. How can hypothyroidism be managed for side effect of lithium
    • yearly blood draw and prior to treatment
    • observe for sx
    • take synthroid
  24. Early indication toxicity level and symptoms
    • <1.5
    • n/v/d
    • polyuria
    • muscle weakness
    • tremors
    • slurred speach
  25. Steps for early detection of lithium toxicity
    • STOP taking
    • Notify PCP
    • Lithium/sodium blood draw
    • dose adjustment
  26. Advanced indication of lithium toxicity and symptoms
    • 1.5-2
    • confusion
    • coarse tremor
    • GI distress
    • poor coordination
  27. Severe toxicity level and symptoms of lithium
    • 2-2.5
    • polyuria w/ dilute urine
    • blurred vision
    • ataxia
    • seizures
    • hyptotension >coma
  28. What interventions are necessary for severe lithium toxicity
    • Emetic to alert client
    • gastric lavage
    • urea, mannitol, aminophylline to excrete
  29. If lithium level is over 2.5 what are the symptoms and treatment
    • coma and death
    • hemodialysis
  30. What meds should be avoided with lithium
    • diuretics
    • NSAID
    • Anticholinergic
  31. 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
  32. During initial treatment of a manic episode, what should lithium level be
  33. During maintenance phase of bipolar, what should lithium level be
  34. What lithium plasma levels result in toxicity
  35. How many doses daily should lithium be taken
    2-3 divided dose
  36. When do effects of lithium begin
    7-14 days
  37. When should tegretrol be taken
    at bedtime
  38. What is a side effect of tegretrol
  39. Interventions when taking tegretrol to monitor for thrombocytopenia
    Baseline CBC
  40. When on valproic acid (depakote) what should be monitored and how often
    • liver
    • q 2 months for first 6 months of treatment
  41. What food/meds are contraindicated with Carbamazapine (tegretrol)
    • oral contraceptive
    • warfarin
    • grapefruit juice
    • phenytoin