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Questions and Answers
Which of the following medications is contraindicated during pregnancy due to a significant risk of cleft lip/palate in the first trimester?
Which of the following medications is contraindicated during pregnancy due to a significant risk of cleft lip/palate in the first trimester?
Which complication is characterized by symptoms such as facial grimacing, eye blinking, and tongue thrusting?
Which complication is characterized by symptoms such as facial grimacing, eye blinking, and tongue thrusting?
Which antipsychotic medication is associated with weight gain and sexual dysfunction among other complications?
Which antipsychotic medication is associated with weight gain and sexual dysfunction among other complications?
In patients with cardiovascular disease, which medication should be used with caution due to potential complications?
In patients with cardiovascular disease, which medication should be used with caution due to potential complications?
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Which of the following is NOT recommended for use with clozapine due to its contraindications regarding lactation?
Which of the following is NOT recommended for use with clozapine due to its contraindications regarding lactation?
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Which stimulant is NOT advised to be taken in the evening or at night?
Which stimulant is NOT advised to be taken in the evening or at night?
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Which medication is primarily used for the prevention of withdrawal in opioid abuse treatment?
Which medication is primarily used for the prevention of withdrawal in opioid abuse treatment?
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What is a significant dietary recommendation for patients taking central nervous system stimulants?
What is a significant dietary recommendation for patients taking central nervous system stimulants?
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What is the role of disulfiram in alcohol abuse treatment?
What is the role of disulfiram in alcohol abuse treatment?
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Which medication is known to reduce nicotine cravings?
Which medication is known to reduce nicotine cravings?
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Which stimulant can cause adverse cardiovascular effects that should be reported to a provider?
Which stimulant can cause adverse cardiovascular effects that should be reported to a provider?
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What is a common therapeutic effect of SSRIs?
What is a common therapeutic effect of SSRIs?
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Which of the following is NOT a symptom of serotonin syndrome?
Which of the following is NOT a symptom of serotonin syndrome?
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Which treatment for opioid abuse carries a lower risk of respiratory depression compared to others?
Which treatment for opioid abuse carries a lower risk of respiratory depression compared to others?
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What is advised regarding the consumption of alcohol for patients prescribed stimulants?
What is advised regarding the consumption of alcohol for patients prescribed stimulants?
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What food item should be avoided by clients taking MOAIs to prevent a hypertensive crisis?
What food item should be avoided by clients taking MOAIs to prevent a hypertensive crisis?
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At what lithium level should a client be notified for confusion and poor coordination?
At what lithium level should a client be notified for confusion and poor coordination?
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Which symptom is associated with advanced lithium toxicity?
Which symptom is associated with advanced lithium toxicity?
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Which medication requires the patient to avoid grapefruit juice?
Which medication requires the patient to avoid grapefruit juice?
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What should a nurse anticipate for a patient with severe lithium toxicity greater than 2.5 mEq/L?
What should a nurse anticipate for a patient with severe lithium toxicity greater than 2.5 mEq/L?
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What is a common side effect of SSRIs related to sexual health?
What is a common side effect of SSRIs related to sexual health?
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What is the most effective treatment for Parkinson's disease among the listed options?
What is the most effective treatment for Parkinson's disease among the listed options?
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Which complication is associated with centrally acting anticholinergics?
Which complication is associated with centrally acting anticholinergics?
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What key information should be provided to a client taking barbiturates?
What key information should be provided to a client taking barbiturates?
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Which muscle relaxant mimics the actions of GABA to reduce muscle spasticity?
Which muscle relaxant mimics the actions of GABA to reduce muscle spasticity?
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What potential side effect should clients be cautious of when taking centrally acting muscle relaxants?
What potential side effect should clients be cautious of when taking centrally acting muscle relaxants?
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Which of the following antiepileptics is specifically noted for a high potential for abuse?
Which of the following antiepileptics is specifically noted for a high potential for abuse?
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What interaction should be avoided when taking anticonvulsants, especially barbiturates?
What interaction should be avoided when taking anticonvulsants, especially barbiturates?
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What is a common complication experienced by patients on antiepileptics?
What is a common complication experienced by patients on antiepileptics?
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What should a client do before taking their medication dose?
What should a client do before taking their medication dose?
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What is the recommended daily management for a client using ACE inhibitors?
What is the recommended daily management for a client using ACE inhibitors?
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Which of the following can increase the risk of digoxin toxicity?
Which of the following can increase the risk of digoxin toxicity?
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What action should the client take if they experience a cough lasting one week or more?
What action should the client take if they experience a cough lasting one week or more?
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Which of the following interactions might lower blood pressure in patients taking certain medications?
Which of the following interactions might lower blood pressure in patients taking certain medications?
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What potential complication should clients be cautious of when taking medications that can induce peripheral vascular effects?
What potential complication should clients be cautious of when taking medications that can induce peripheral vascular effects?
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Which condition requires special caution in clients receiving treatment with ACE inhibitors?
Which condition requires special caution in clients receiving treatment with ACE inhibitors?
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What is a common complication associated with loop diuretics such as furosemide?
What is a common complication associated with loop diuretics such as furosemide?
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What should clients be aware of regarding the timing of their medication doses?
What should clients be aware of regarding the timing of their medication doses?
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Which electrolyte imbalance is a concern with potassium-sparing diuretics like spironolactone?
Which electrolyte imbalance is a concern with potassium-sparing diuretics like spironolactone?
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What is an essential client education point for patients taking potassium-sparing diuretics?
What is an essential client education point for patients taking potassium-sparing diuretics?
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Which of the following is a complication associated with ACE inhibitors?
Which of the following is a complication associated with ACE inhibitors?
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Which complication is specifically noted with the use of ARBs?
Which complication is specifically noted with the use of ARBs?
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What must be monitored to avoid serious complications when administering furosemide?
What must be monitored to avoid serious complications when administering furosemide?
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Which class of medications is particularly associated with the risk of AV block?
Which class of medications is particularly associated with the risk of AV block?
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Which of the following statements about calcium channel blockers is true?
Which of the following statements about calcium channel blockers is true?
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Study Notes
SSRIs
- Fluoxetine, citalopram, escitalopram, and paroxetine are examples of SSRIs
- Therapeutic effects intensify serotonin effects
- Increased serotonin can cause:
- Neuroleptic malignant syndrome (symptoms include fever, respiratory distress, and tachycardia)
- Sexual dysfunction
- Serotonin syndrome (symptoms include agitation, fever, sweating, and tremors)
MAOIs
- Phenelzine and selegiline are examples of MAOIs
- Client education: Avoid tyramine-containing foods (aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein supplements, soups, soy sauce, beer, and red wine)
- Avoid taking over-the-counter (OTC) medications without a doctor's approval
Mood Stabilizer (Lithium)
- Therapeutic range: 0.6-1.2 mEq/L
- Lithium Toxicity:
- Early indications (1.5-2.0 mEq/L): confusion, poor coordination, coarse tremors. Hold medication and notify provider.
- Advanced indications (2.0-2.5 mEq/L): blurred vision, ataxia, seizures, hypotension. Hold medications and anticipate order for bowel irrigation.
- Severe toxicity (>2.5 mEq/L): oliguria, seizures, coma, death. Anticipate hemodialysis order.
Mood-Stabilizing Antiepileptics
- Information about mood-stabilizing antiepileptics is not included in the provided text.
Antipsychotics (1st Generation)
- Chlorpromazine, haloperidol, fluphenazine, and loxapine are examples of first-generation antipsychotics.
- Complications:
- Acute Dystonia (<12 breaths/min, respiratory depression)
- Tardive Dyskinesia (facial grimacing, eye blinking, tongue thrusting, lip smacking, involuntary hip rocking)
- Akathisia (restlessness, early sign of suicidal ideation)
- Client Education:Change positions slowly. Avoid driving until sedation is gone.
Antipsychotics (2nd & 3rd Generation - Atypical)
- Risperidone, clozapine, and aripiprazole are examples of second and third-generation antipsychotics
- Complications: Weight gain, diabetes mellitus, sexual dysfunction, anticholinergic effects, orthostatic hypotension/dizziness
- Contraindicated/Precautions:
- Pregnancy: Clozapine - client benefit > fetal risk. Risperidone - safety not established.
- Lactation: Clozapine and risperidone are contraindicated.
- General: Avoid alcohol.
Central Nervous System Stimulants
- Methylphenidate, dextroamphetamine, and amphetamine are examples of central nervous system stimulants
- Client education:
- Avoid alcohol and caffeine
- Tachycardia and palpitations: Notify provider
- Eat nutritious meals (can cause anorexic effect)
- Don't take in the evening/night
- Additional cautions: Use with caution in cardiovascular disease, seizures, or diabetes.
Alcohol Abuse
- First-line treatments (withdrawal): chlordiazepoxide, diazepam, lorazepam (benzodiazepines)
- Abstinence maintenance: disulfiram
Opioid Abuse
- Methadone: oral opioid replacement, prevents abstinence syndrome, prevents illegal dependence.
- Buprenorphine: opioid substitute, prevents withdrawal, safer than methadone (lower risk of depression), FDA approved.
Nicotine
- Varenicline ↑ dopamine stimulates pleasurable effects of nicotine, reduces relapse, ↓ Nicotine cravings.
- Buproprion: craving
Anti-Parkinson's
- Levodopa and carbidopa: Most effective; beneficial effects diminish over time.
- Complications: Nausea, vomiting, dry mouth, blurred vision, urinary retention, antihistamine effects.
- Centrally acting anticholinergics (benztropine, trihexyphenidyl): used to manage side effects.
Anti-epileptics
- Phenobarbital, phenytoin, carbamazepine, valproic acid, topiramate, gabapentin, and oxcarbazepine.
- Complications: Barbiturates (phenobarbital) can cause drowsiness, sedation, depression, paradoxical excitement, and ataxia.
- Nursing actions: Monitor plasma levels. High potential for abuse with barbiturates.
- Client education: Avoid grapefruit juice and alcohol when taking barbiturates; use other forms of birth control.
Muscle Relaxants & Antispasmodics
- Diazepam, cyclobenzaprine, and baclofen are examples of muscle relaxants and antispasmodics.
- Purpose: Mimic GABA action in spinal cord & brain; muscle spasticity.
- Therapeutic uses: Muscle spasm (injury, anxiety, panic, insomnia).
- Client education: Avoid hazardous activities (CNS depression), alcohol/opioids/antihistamines. Take with meals, increase fiber (baclofen).
Diuretics
- Loop Diuretics (furosemide):
- Complications: Hypokalemia (low potassium), dehydration, hypotension, ototoxicity
- Client education: Eat high-potassium foods; report low potassium levels, low urine output (<30ml/hr) monitor weight. Report additional symptoms/concerns.
- Electrolyte Imbalance: K+ less than 3.5 mEq/L
- Potassium-Sparing Diuretics (spironolactone)
- Complications: Hyperkalemia (high potassium)
- Client education: Avoid salt substitutes (contain potassium); monitor electrolytes (K+ greater than 5 mEq/L).
Blood Pressure
- Information about blood pressure medications is not included in the provided text.
Organic Nitrates
- Nitroglycerin (sublingual/transdermal patch)
- Purpose: Dilates veins, ↓ venous return, ↓cardiac 02 demand.
- Complications: Headache, orthostatic hypotension, reflex tachycardia, tolerance.
- Nursing interventions: Use lowest effective dose, intermittent schedule (8 drug-free hours/day).
- Client education: Address headaches (aspirin/tylenol), change positions slowly; avoid use in certain situations (i.e., avoid driving/heavy machinery), store in cool/dark place, and do not exceed 3 tablets daily. Do not stop taking the long-acting version abruptly. No more than three tablets daily in the time-sensitive event of an attack.
Statins
- Atorvastatin, simvastatin, lovastatin, and pravastatin are examples of statins.
- Interactions: Grapefruit juice, fibrates, and ezetimibe
- Complications: Hepatotoxicity, myopathy
- Nursing Interventions: Obtain baseline liver function, monitor liver function after 12 weeks, and every 6 months, monitor creatine kinase (CK) levels during treatment, and obtain cholesterol, HDL, LDL, triglyceride levels, evaluate kidney and liver.
- Client education: Report muscle aches/pain; avoid anorexia, vomiting, jaundice, and notify provider.
Bile-acid Sequestrants
- Cholestyramine, colesevelam, colestipol
- Medication Administration: Take with food containing water; use caution with other potential interacting drugs (e.g., TUMS)
- Client Education: Take medication with food and 8 ounces of water, 1 hour before or 4 hours after other medications, if applicable.
Antidysrhythmics - Class Ib
- Lidocaine (IV): electrical conduction & automaticity
- Purpose: Electrical conduction & automaticity, rate of repoarlization
Anticoagulants
- Heparin, enoxaparin, and fondaparinux are examples of anticoagulants.
- Antidotes/reversal agents: Protamine
- Complications: Toxicity, hemorrhage, epidural/spinal hematoma, heparin-induced thrombocytopenia
- Interactions: Antiplatelets + garlic, ginger, glucosamine, and ginko biloba.
- Medication Administration: Heparin - obtain baseline vitals, aPTT, CBC; check dosage with another nurse before administering; monitor rate of infusion/every 30-60 minutes, monitor aPTT every 4-6 hours; monitor injection sites for bleeding.
Vitamin K Inhibitor
- Warfarin
- Inhibits vitamin K, leading to coagulation prevention
- Complications: Hemorrhage, monitor prothrombin time (PT), monitor liver function
- Toxicity: Administer vitamin K
Antiplatelets
- Aspirin, abciximab, and clopidogrel; bleeding risk
- Complications: GI issues
- Contraindications: Internal bleeding, cerebral lesions, and prior ischemic strokes
Thrombolytics
- Alteplase and tenecteplase
- Contraindications/precautions: Hemorrhage, cerebral lesion, or internal bleeding in the last 3 months; ischemic strokes.
Non-Opioid Analgesics
- Aspirin, ibuprofen, naproxen, and meloxicam.
- Purpose: Reduce pain, inflammation, and fever.
- Complications: Gl discomfort, impaired kidney function, increased risk of MI and stroke, salicylism, and Reye syndrome; aspirin toxicity.
- Contraindications/precautions: Pregnancy risk (category D); peptic ulcers, bleeding disorders, and pediatric use.
- Client education: Take with food, milk, or 8 ounces of water, etc.
Acetaminophen
- Complications: Acute toxicity
- Nursing interventions: maximum dose 4 g/day (monitor and notify provider if contraindicated). Antedote: acetylcysteine
Opioids
- Morphine
- Medication Administration: Assess pain levels, baseline vitals, low and slow administration. Notify provider of concern.
- Antidote: Naloxone
Migraine
- Sumatriptan
- Client education: High risk for fetal harm (avoid driving/heavy machinery), may cause chest pressure.
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Description
Explore the key concepts of SSRIs, MAOIs, and mood stabilizers like Lithium in this quiz. Understand their therapeutic effects, side effects, and necessary patient education. Test your knowledge on the pharmacological management of mood disorders.
