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 (A)</p> Signup and view all the answers

Which neurotransmitters are affected by SNRIs?

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

Which condition is treated with tricyclic antidepressant Amitriptyline?

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

What is the therapeutic level range for lithium?

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

What are the signs of lithium toxicity?

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

What are the modifiable risk factors for CAD?

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

What is the action of nitroglycerin?

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

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

<p>Sublingual (C)</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 (C)</p> Signup and view all the answers

What are the common adverse effects of dopamine?

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

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

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

What are the adverse effects of norepinephrine (Levophed)?

<p>Watch for arrhythmias (C)</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 (A)</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 (D)</p> Signup and view all the answers

What are the adverse effects of PDE-5 inhibitors?

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

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

<p>Increases contractility and heart rate, causes vasoconstriction (B)</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 â–ª 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: â–ª Tobacco use Vasoconstrictor â–ª Sedentary lifestyle â–ª Obesity â–ª Diabetes mellitus Causes inflammation + increased risk for atherosclerosis â–ª HTN â–ª High cholesterol o Non-Modifiable: â–ª Age â–ª Race â–ª 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 â–ª 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: â–ª Importance of taking med as directed â–ª Do not stop abruptly o Pt. Monitoring: â–ª Monitor for involuntary movement â–ª Monitor for orthostatic hypotension Lithium: Use, Action, Therapeutic Levels, Pt. Teaching, Pt. Monitoring, signs of lithium toxicity o Use: o Action: â–ª Bipolar disorder â–ª Inhibit release of norepinephrine and dopamine, but not serotonin from stimulated neurons o Therapeutic Level: â–ª 0.6 to 1.5 Desired â–ª 1.5 to 2 Mild to Mod toxicity â–ª 2 to 2.5 Mod to Severe toxicity â–ª > 2.5 Life threatening o Pt. Teaching: â–ª 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 â–ª Avoid: Dehydration Sodium depletion Sweating Diarrhea Diuretic Metabolic disorders o Pt. Monitoring: â–ª Lithium Levels Blood levels should be checked by nurses â–ª Sodium â–ª Monitor o Signs of toxicity: â–ª Early: Tremor, V/D, blurred vision and speech â–ª Late: Seizure, coma, arrythmia o Over 1.5 â–ª 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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