Podcast
Questions and Answers
What should be avoided when taking this medication to prevent harmful interactions?
What should be avoided when taking this medication to prevent harmful interactions?
Which symptom of depression is NOT likely to improve with the use of this medication?
Which symptom of depression is NOT likely to improve with the use of this medication?
What is a key step to take when discontinuing this medication?
What is a key step to take when discontinuing this medication?
How does this medication primarily work in the body?
How does this medication primarily work in the body?
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Which of the following is NOT a teaching point for patients taking this medication?
Which of the following is NOT a teaching point for patients taking this medication?
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What should be assessed at baseline and periodically for patients taking certain medications?
What should be assessed at baseline and periodically for patients taking certain medications?
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What is an important instruction for women of child-bearing age taking teratogenic medications?
What is an important instruction for women of child-bearing age taking teratogenic medications?
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Which laboratory value should be monitored if a patient shows symptoms of infection while on anticonvulsants?
Which laboratory value should be monitored if a patient shows symptoms of infection while on anticonvulsants?
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What should a patient do if they experience symptoms of blood dyscrasias while on medication?
What should a patient do if they experience symptoms of blood dyscrasias while on medication?
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What should parents of patients receiving anticonvulsants be educated about regarding serum drug levels?
What should parents of patients receiving anticonvulsants be educated about regarding serum drug levels?
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What is vital information to provide to patients regarding appointments for blood tests?
What is vital information to provide to patients regarding appointments for blood tests?
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What potential side effect must be monitored when assessing for critical signs and symptoms in a patient on anticonvulsants?
What potential side effect must be monitored when assessing for critical signs and symptoms in a patient on anticonvulsants?
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What is the normal range for RBC count that should be monitored in these patients?
What is the normal range for RBC count that should be monitored in these patients?
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What is the mechanism of action of the medication selegiline?
What is the mechanism of action of the medication selegiline?
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Which of the following dietary restrictions is crucial for patients taking selegiline?
Which of the following dietary restrictions is crucial for patients taking selegiline?
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What is a common symptom that should improve with the use of selegiline?
What is a common symptom that should improve with the use of selegiline?
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What is the expected time frame for a patient to see the full effects of selegiline?
What is the expected time frame for a patient to see the full effects of selegiline?
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What action should a patient take if they experience increased blood pressure while on selegiline?
What action should a patient take if they experience increased blood pressure while on selegiline?
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What type of depression is selegiline primarily used to treat?
What type of depression is selegiline primarily used to treat?
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What self-monitoring practice is recommended for patients taking selegiline?
What self-monitoring practice is recommended for patients taking selegiline?
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What is an adverse reaction associated with selegiline that patients need to be aware of?
What is an adverse reaction associated with selegiline that patients need to be aware of?
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Which symptom may indicate a serious reaction to selegiline?
Which symptom may indicate a serious reaction to selegiline?
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Which hazard is associated with combining selegiline with other serotonin-boosting agents?
Which hazard is associated with combining selegiline with other serotonin-boosting agents?
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What is a critical assessment that should be performed while a client is on anticonvulsants used as mood stabilizers?
What is a critical assessment that should be performed while a client is on anticonvulsants used as mood stabilizers?
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Which of the following should clients be educated about regarding the intake of anticonvulsants?
Which of the following should clients be educated about regarding the intake of anticonvulsants?
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What vitamin level should be monitored in clients taking anticonvulsants, as it may be depleted?
What vitamin level should be monitored in clients taking anticonvulsants, as it may be depleted?
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What important precaution should clients take regarding medication interactions while on anticonvulsants?
What important precaution should clients take regarding medication interactions while on anticonvulsants?
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Which statement about the use of anticonvulsants in pregnancy is accurate?
Which statement about the use of anticonvulsants in pregnancy is accurate?
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Which of the following side effects is associated with the use of antipsychotics?
Which of the following side effects is associated with the use of antipsychotics?
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What is the primary purpose of metabolic monitoring every three months for patients on antipsychotics?
What is the primary purpose of metabolic monitoring every three months for patients on antipsychotics?
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Which of the following is an important client education point regarding dry mouth as a side effect of antipsychotics?
Which of the following is an important client education point regarding dry mouth as a side effect of antipsychotics?
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Which of these is a critical assessment when monitoring for agranulocytosis in patients taking antipsychotics?
Which of these is a critical assessment when monitoring for agranulocytosis in patients taking antipsychotics?
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What should a patient do if they experience symptoms of acute dystonia?
What should a patient do if they experience symptoms of acute dystonia?
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Which condition warranting treatment can occur as a side effect of increased prolactin levels in antipsychotic users?
Which condition warranting treatment can occur as a side effect of increased prolactin levels in antipsychotic users?
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What should patients be educated about regarding the consumption of alcohol while on antipsychotic medication?
What should patients be educated about regarding the consumption of alcohol while on antipsychotic medication?
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What is an appropriate nursing intervention for a patient experiencing akathisia?
What is an appropriate nursing intervention for a patient experiencing akathisia?
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Which of the following should not be recommended to a patient taking antipsychotics due to potential interactions?
Which of the following should not be recommended to a patient taking antipsychotics due to potential interactions?
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What common symptom should patients self-monitor for when taking antipsychotic medications?
What common symptom should patients self-monitor for when taking antipsychotic medications?
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Study Notes
Anticonvulsants Used as Mood Stabilizers
- Stevens-Johnson Syndrome - Assess for skin rash, hold medication and contact prescriber immediately.
- Hepatotoxicity - Liver function tests at baseline and periodically. Teach importance of keeping appointments for tests.
- Teratogenic - Childbearing age women should have a pregnancy test at baseline and periodically. Inform them about the risk and advise them to use birth control.
- Drug Toxicity - Serum drug levels may be monitored, teach importance of keeping appointments for tests.
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Blood Dyscrasias - Monitor Complete Blood Count (CBC) at baseline and periodically. CBC includes:
- White blood cell count (WBC) - Assess for symptoms of infection, normal range is 4,000 to 11,000.
- Red blood cell count (RBC) - Assess for symptoms of anemia and low oxygenation, normal range is 4.5 to 5.7.
- Platelet count - Assess for signs and symptoms of bleeding, normal range is 150,000 to 400,000.
Client Education
- Monitor for symptoms of blood dyscrasias - Hold the medication and contact the prescriber if you experience symptoms.
- Important food and drug interactions - Avoid other medications or products that boost serotonin. Avoid alcohol, grapefruit products, and caffeine.
- Not a cure - Anticonvulsants are not a cure for mood disorders.
- Abruptly stopping medication - Do not stop taking the medication abruptly. Work with your prescriber to taper off the medication to avoid discontinuation syndrome.
- Childbearing age women - Plan healthy pregnancies with your doctor after your clinical condition is stable.
Tricyclic Antidepressants
- Mechanism of Action - Block the re-uptake of norepinephrine and some serotonin.
- Use - Used for moderate to severe depression, not for suicidal clients.
- Symptom Relief - Elevate mood, reduce negative thoughts, improve concentration, promote feeling of well-being, increase appetite, stimulate interest in activities of daily living, reduce preoccupation with somatic complaints, and promote healthy sleep-wake cycles.
- Time to Take Effect - Takes weeks to see relief from depression symptoms, months for full effect.
MAOI Antidepressants (Monoamine Oxidase Inhibitors)
- Mechanism of Action - Inhibit monoamine oxidase (MAO). This prevents MAO from breaking down norepinephrine, serotonin, and dopamine, making these neurotransmitters more readily available.
- Tyramine Interaction - MAO also metabolizes tyramine. When MAO is inhibited, tyramine builds up and can cause a hypertensive crisis. Tyramine is found in aged, processed, preserved, pickled, smoked, fermented, and cured foods.
- Use - Used for moderate to severe depression.
-
Symptom Relief - Similar to tricyclic antidepressants, including:
- Elevate mood
- Reduce negative thoughts
- Increase appetite
- Promote feeling of well-being
- Improve concentration
- Stimulate interest in activities of daily living
- Reduce preoccupation with somatic complaints
- Promote healthy sleep-wake cycles
MAOI Client Education
- Monitor blood pressure - Monitor your blood pressure and contact your prescriber if it increases.
- Hypertensive crisis - A hypertensive crisis is a potential fatal reaction. Hold the next dose of medication and seek immediate medical attention, including a doctor, urgent care, or the emergency department.
- Tyramine - Learn what tyramine is, how to avoid it, and why it is important to avoid tyramine.
- Serotonin syndrome - Do not take other serotonin-boosting agents, such as other antidepressants.
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Serotonin syndrome symptoms - Hold next dose and seek immediate medical attention if you experience these:
- Agitation
- Diaphoresis
- Increased body temperature
- Increased heart rate
- Decreased blood pressure
- Muscle rigidity
- Hyperreflexia
- Wash-out period - There is a 5-week wash-out period to avoid the risk of serotonin syndrome if you switch from another MAOI to another medication.
Antipsychotics
-
Metabolic Syndrome - Monitor for metabolic syndrome (prediabetes and cardiovascular disease). This includes monitoring:
- Lipid panel - Cholesterol, HDL, LDL, and triglycerides
- Blood sugar - Blood glucose and Haemoglobin A1c
- Body mass index (BMI)
- Waist circumference
-
Client education for metabolic syndrome - Focus on lifestyle changes to manage this, including:
- Nutrition - Low fat, low carbohydrate, high fiber diet
- Exercise - Daily exercise
- Weight management - Watch your weight
Antipsychotic Side Effects and Client Education
Extrapyramidal Symptoms
- Symptoms - Dystonia, akathisia, and pseudoparkinsonism.
- Treatment - Contact prescriber and they may add medication to address these symptoms, such as benztropine for pseudoparkinsonism or propranolol for akathisia.
Anticholinergic Side Effects
- Symptoms - Dry eyes/blurred vision, dry mouth, urinary retention, constipation, orthostatic hypotension, and sexual dysfunction.
- Treatment - Self-monitor symptoms and contact prescriber for potential dose changes.
Increased Prolactin Levels
- Symptoms - Gynecomastia, lactation, and discomfort.
- Treatment - Self-monitor and report to prescriber to monitor prolactin levels.
Client Education for Antipsychotics
- Photosensitivity - Avoid prolonged exposure to sunlight.
- Seizure threshold - Antipsychotics can lower the seizure threshold.
- Abruptly stopping medication - Do not stop taking the medication abruptly. Work with your prescriber to taper off the medication to avoid discontinuation syndrome.
- Long-acting injectable forms available - Some antipsychotics are available in long-acting injectable forms which can improve compliance.
- Not a cure - Antipsychotics are not a cure for mental illness.
- Important food and drug interactions- Avoid alcohol and grapefruit products. Check with your prescriber or pharmacist before taking any other medications or over-the-counter remedies.
- Other laboratory tests - Liver function tests are often monitored and renal function may be monitored as needed.
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Description
This quiz covers key considerations when using anticonvulsants as mood stabilizers. Topics include monitoring for Stevens-Johnson Syndrome, hepatotoxicity, teratogenic effects, drug toxicity, and blood dyscrasias. Understanding these factors is crucial for safe medication management in psychiatric settings.
