Psychiatric Treatment Considerations Quiz
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Questions and Answers

Which class of antidepressants is preferred over others due to less adverse effects?

  • SNRIs
  • Tricyclic antidepressants
  • MAOIs
  • SSRIs (correct)

    • Which adverse effect is characteristic of tricyclic antidepressants?

  • Orthostatic hypotension (correct)
  • Hyperhidrosis
  • Nervousness
  • Tachycardia

    • Which condition is a contraindication for the use of MAOIs?

  • Major depressive disorder
  • Unresponsive to other anti-depressive therapy
  • Hypertension (correct)
  • Tyramine-induced hypertensive crisis

    • Which adverse effect is associated with atypical antipsychotic drugs?

    <p>Extrapyramidal effects</p> Signup and view all the answers

    Which neurotransmitters are affected by SNRIs?

    <p>Serotonin and norepinephrine</p> Signup and view all the answers

    Which condition is treated with tricyclic antidepressant Amitriptyline?

    <p>Major depression and neuropathy</p> Signup and view all the answers

    What is the therapeutic level range for lithium?

    <p>0.6 to 1.5</p> Signup and view all the answers

    What are the signs of lithium toxicity?

    <p>Tremor, Vomiting/Diarrhea, Blurred vision and speech</p> Signup and view all the answers

    How do CNS stimulants help in ADHD?

    <p>Increase stimulation of an immature RAS for more selective response to stimuli</p> Signup and view all the answers

    What are the modifiable risk factors for CAD?

    <p>Tobacco use, Sedentary lifestyle, Diabetes mellitus</p> Signup and view all the answers

    What is the action of nitroglycerin?

    <p>Causes relaxation and vasodilation</p> Signup and view all the answers

    What is the recommended route for administering nitroglycerin in acute angina?

    <p>Sublingual</p> Signup and view all the answers

    What is the mechanism of action of dobutamine?

    <p>Increases cardiac output and myocardial contractility without much change in heart rate</p> Signup and view all the answers

    What are the common adverse effects of dopamine?

    <p>Watch for extravasation of IV site causing necrosis</p> Signup and view all the answers

    What is the main goal of pharmacologic therapy for hypovolemic shock?

    <p>Decrease ineffective tissue perfusion</p> Signup and view all the answers

    What are the adverse effects of norepinephrine (Levophed)?

    <p>Watch for arrhythmias</p> Signup and view all the answers

    What is the mechanism of action of calcium channel blockers?

    <p>Inhibit calcium from moving across cell membranes, decrease contraction and contractility</p> Signup and view all the answers

    What is the indication for low dose dopamine?

    <p>Increases blood flow to the kidneys, preventing diminished renal blood supply</p> Signup and view all the answers

    What are the adverse effects of PDE-5 inhibitors?

    <p>CV: Hypotension, tachycardia</p> Signup and view all the answers

    What is the mechanism of action of norepinephrine (Levophed)?

    <p>Increases contractility and heart rate, causes vasoconstriction</p> Signup and view all the answers

    Match the following medication with its mechanism of action:

    <p>Calcium channel blockers = Inhibit calcium from moving across cell membranes Norepinephrine (Levophed) = Increases contractility and heart rate; causes vasoconstriction Dopamine = Stimulate receptors of the SNS causing vasoconstriction and increased heart rate Dobutamine = Increases cardiac output and myocardial contractility without much change in heart rate</p> Signup and view all the answers

    Match the following medication with its adverse effects:

    <p>Norepinephrine (Levophed) = Watch for arrhythmias; watch blood pressure Dopamine = Watch for extravasation of IV site causing necrosis Calcium channel blockers = Hepatotoxicity; hypotension; bradycardia; peripheral edema; heart block; dizziness; headache; fatigue Dobutamine = Caution: don’t give with beta blockers</p> Signup and view all the answers

    Match the following medication with its patient monitoring considerations:

    <p>Norepinephrine (Levophed) = All given as a titrated drip via IV pump; constantly monitor to prevent hypertensive state Dopamine = All given as a titrated drip via IV pump in an ICU; watch for extravasation of IV site; given as a titrated drip via IV pump Calcium channel blockers = Monitor blood pressure; take apical pulse before and after; monitor headache and give Tylenol; assist with gradual changes in position Dobutamine = Nurse needs to watch blood pressure and turn med down; constant monitoring and dosage adjustment needed; start at low dose</p> Signup and view all the answers

    Match the following medication with its indications for use:

    <p>Norepinephrine (Levophed) = Used to treat hypotension and shock Dopamine = Generally used to treat hypotension and shock; decreased or ineffective tissue perfusion Calcium channel blockers = Used to treat angina, unstable angina, and acute MI Dobutamine = Used to treat heart failure</p> Signup and view all the answers

    Match the medication with its primary action:

    <p>Lithium = Inhibit release of norepinephrine and dopamine, but not serotonin from stimulated neurons Methylphenidate (Ritalin) = CNS stimulants act at the cortex and RAS, increasing stimulation of an immature RAS which leads to more selective response to incoming stimuli Nitroglycerin = Act directly on vessel smooth muscle causing relaxation and depress muscle tone Dopamine = Not serotonin from stimulated neurons</p> Signup and view all the answers

    Match the medication with its primary use:

    <p>Lithium = Bipolar disorder Methylphenidate (Ritalin) = ADHD Nitroglycerin = Acute and chronic angina Dopamine = Hypovolemic shock</p> Signup and view all the answers

    Match the medication with its route of administration:

    <p>Nitroglycerin = Sublingual: Acute angina Must dissolve completely (Don’t chew) Can give every 5 mins up to a max of 3 Will burn/tingle under tongue Methylphenidate (Ritalin) = Oral tablet: ADHD or Narcolepsy Lithium = Oral tablet: Bipolar disorder Dopamine = IV: Hypovolemic shock</p> Signup and view all the answers

    Match the medication with its contraindication:

    <p>Nitroglycerin = NO VIAGRA. Methylphenidate (Ritalin) = Marked anxiety, tension, and agitation Lithium = Sodium depletion, sweating, diarrhea, diuretic use, metabolic disorders Dopamine = Pheochromocytoma</p> Signup and view all the answers

    Match the medication with its adverse effects:

    <p>Nitroglycerin = Hypotension Methylphenidate (Ritalin) = Nervousness, insomnia, dizziness Lithium = Tremor, V/D, blurred vision and speech Dopamine = Tachycardia, dysrhythmias</p> Signup and view all the answers

    Match the medication with its patient monitoring requirement:

    <p>Nitroglycerin = Watch BP hypotension Special IV tubing design Infusion pump Methylphenidate (Ritalin) = Monitor weight especially in children Daily weights Lithium = Blood levels should be checked by nurses Sodium Monitor Dopamine = Continuous ECG monitoring</p> Signup and view all the answers

    Match the following antidepressants with their primary use:

    <p>SSRIs = Depression, Bulimia, Panic disorder, OCD SNRIs = Treatment for major depressive disorder Tricyclic antidepressants = Predominately for major depression and occasionally for milder situational depression, Neuropathy, Fibromyalgia MAOIs = Unresponsive to other anti-depressive therapy or in whom other anti-depressive therapy is contraindicated</p> Signup and view all the answers

    Match the following antidepressants with their adverse effects:

    <p>SSRIs = Headache, Sexual dysfunction, Nervousness, N/V/D, Dry mouth, Anorexia, sweating, Serotonin Syndrome SNRIs = N/V, constipation, Hyperhidrosis, erectile dysfunction, Tachycardia, abnormal bleeding, Angle closure glaucoma Tricyclic antidepressants = Orthostatic hypotension, Dysrhythmias, Sedation, Weight gain, Anticholinergic effects Dry mouth, dry eyes, blurred vision, constipation MAOIs = Hypertensive crisis Caused by: Tyramine Antidote (calcium channel blocker) Caused by release of NE causing acute hypertension Symptoms: Headache, hypertension, sweating, dilated pupils, tachycardia, chest pain</p> Signup and view all the answers

    Match the following antidepressants with their patient teaching:

    <p>SSRIs = Will take 3-4 weeks to achieve full therapeutic effect, Should be weaned off slowly over 2-4 weeks, SSRIs are preferred over other classes due to less adverse effects SNRIs = Assess for worsening depression, suicidality, bipolar disorder, Impaired liver or renal function, Should only be taken when benefits outweigh the risks, Will take 3-4 weeks to achieve full therapeutic effect Tricyclic antidepressants = Monitor patient for suicide risk, Slow position changes, Watch for cardiac problems for up to 5 days, Overdose: Heart block, dysrhythmias, tachycardia, hypotension, seizure, coma, Use activated charcoal, Na bicarb, gastric lavage MAOIs = Do not take with OTC medication without consulting with provider, Monitor blood pressure, Low tyramine diet, Monitor CBC</p> Signup and view all the answers

    Match the following typical vs atypical antipsychotic drugs with their use:

    <p>Typical antipsychotic (e.g., haloperidol) = IV kicks in fast, lots of AE, Block dopamine receptors, preventing the stimulation of postsynaptic neurons by dopamine Atypical antipsychotic (e.g., olanzapine) = PO, Given regularly, Both block dopamine and serotonin receptors</p> Signup and view all the answers

    Match the following typical vs atypical antipsychotic drugs with their adverse effects:

    <p>Typical antipsychotic (e.g., haloperidol) = IV kicks in fast, lots of AE, Block dopamine receptors, preventing the stimulation of postsynaptic neurons by dopamine Atypical antipsychotic (e.g., olanzapine) = PO, Given regularly, Relieve hallucinations, Both block dopamine and serotonin receptors</p> Signup and view all the answers

    Match the following typical vs atypical antipsychotic drugs with their patient teaching and monitoring:

    <p>Typical antipsychotic (e.g., haloperidol) = IV kicks in fast, lots of AE, Block dopamine receptors, preventing the stimulation of postsynaptic neurons by dopamine Atypical antipsychotic (e.g., olanzapine) = PO, Given regularly, Both block dopamine and serotonin receptors</p> Signup and view all the answers

    Tricyclic antidepressants block the reuptake of __________ and __________

    <p>serotonin, norepinephrine</p> Signup and view all the answers

    MAOIs are contraindicated with certain OTC medications that contain __________

    <p>tyramine</p> Signup and view all the answers

    Typical antipsychotic drugs like haloperidol may cause extrapyramidal effects, which include involuntary facial movements, restlessness, tremor, and __________

    <p>stiffness</p> Signup and view all the answers

    Atypical antipsychotic drugs like olanzapine may lead to sedation and __________ hypotension

    <p>orthostatic</p> Signup and view all the answers

    SSRIs inhibit the reuptake of __________ to increase the amount that circulates in the brain

    <p>serotonin</p> Signup and view all the answers

    SNRIs decrease neuronal reuptake of both __________ and __________

    <p>serotonin, norepinephrine</p> Signup and view all the answers

    Low dose dopamine is indicated to increase blood flow to the ______

    <p>kidneys</p> Signup and view all the answers

    Calcium channel blockers inhibit calcium from moving across cell membranes, leading to a decrease in ______

    <p>contraction and contractility</p> Signup and view all the answers

    The main goal of pharmacologic therapy for hypovolemic shock is to address decreased or ineffective tissue ______

    <p>perfusion</p> Signup and view all the answers

    Norepinephrine (Levophed) causes vasoconstriction and is used to treat hypotension and ______

    <p>shock</p> Signup and view all the answers

    Dobutamine increases cardiac output and myocardial contractility without much change in heart ______

    <p>rate</p> Signup and view all the answers

    Phentolamine is an agent for ______

    <p>extravasation</p> Signup and view all the answers

    Dopamine stimulates receptors of the SNS, causing vasoconstriction and increasing heart ______

    <p>rate</p> Signup and view all the answers

    Vasopressors are used to treat hypotension and ______

    <p>shock</p> Signup and view all the answers

    Stimulants, how they work to help ADHD o CNS stimulants act at the cortex and RAS, increasing stimulation of an immature RAS which leads to more selective response to incoming stimuli ▪ Helps them focus on specific stimuli

    <p>Reticular Activating System</p> Signup and view all the answers

    Age related considerations for medication administration o Children, adolescents, and young adults (ages 18 to 24) are at greater risk for suicidal ideation o Increases risk of suicide

    <p>Suicidal Ideation</p> Signup and view all the answers

    CAD/MI Modifiable and nonmodifiable risk factors for CAD o Modifiable: ▪ Tobacco use Vasoconstrictor ▪ Sedentary lifestyle ▪ Obesity ▪ Diabetes mellitus Causes inflammation + increased risk for atherosclerosis ▪ HTN ▪ High cholesterol o Non-Modifiable: ▪ Age ▪ Race ▪ Gender

    <p>Atherosclerosis</p> Signup and view all the answers

    What is ADHD o Characterized by developmentally inappropriate behaviors involving difficulty in paying attention or focusing on tasks ▪ Characterized by poor attention span, behavior, control issues, and hyperactivity

    <p>Hyperactivity</p> Signup and view all the answers

    What is the main goal of pharmacologic therapy for hypovolemic shock?

    <p>Restore Blood Volume</p> Signup and view all the answers

    Teaching: ▪ Importance of taking med as directed ▪ Do not stop abruptly o Pt. Monitoring: ▪ Monitor for involuntary movement ▪ Monitor for orthostatic hypotension Lithium: Use, Action, Therapeutic Levels, Pt. Teaching, Pt. Monitoring, signs of lithium toxicity o Use: o Action: ▪ Bipolar disorder ▪ Inhibit release of norepinephrine and dopamine, but not serotonin from stimulated neurons o Therapeutic Level: ▪ 0.6 to 1.5 Desired ▪ 1.5 to 2 Mild to Mod toxicity ▪ 2 to 2.5 Mod to Severe toxicity ▪ > 2.5 Life threatening o Pt. Teaching: ▪ Excreted from the kidneys (95%), sweat, and feces The kidneys treat lithium and sodium similarly, which is the reason sodium depletion can significantly elevate lithium ▪ Avoid: Dehydration Sodium depletion Sweating Diarrhea Diuretic Metabolic disorders o Pt. Monitoring: ▪ Lithium Levels Blood levels should be checked by nurses ▪ Sodium ▪ Monitor o Signs of toxicity: ▪ Early: Tremor, V/D, blurred vision and speech ▪ Late: Seizure, coma, arrythmia o Over 1.5 ▪ Lethargy, slurred speech, muscle weakness, N/V complex multiorgan toxicity = death

    <p>Multiorgan Toxicity</p> Signup and view all the answers

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