329 signature meds

Question 1

fluoxetine, paroxetine and vortioxetine are apart of what class of medications

Answer 1

SSRIs

Question 2

what class is sertraline apart of

Answer 2

SSRIs

Question 3

citalopram and escitalopram are apart of what class of medications

Answer 3

SSRIs

Question 4

what class is vilazodone apart of

Answer 4

SSRIs

Question 5

what drugs are SNaRIs

Answer 5

venlafaxine
duluxetine

Question 6

what drugs are SSRIs

Answer 6

fluoxetine, paroxetine, vortioxetine

citalopram, escitalopram

sertraline

vilazodone

Question 7

desvenlafaxine is what class of medications

Answer 7

SNRIs

Question 8

SRIs side effects

Answer 8

blurred vision, dry mouth, sexual problems,
tension headache
drowsiness, N/D, insomnia, nervousness/agitation/restlessness, dizziness

Question 9

SRI nursing considerations

Answer 9

Medication effectiveness takes 4-8 weeks.

Most side effects diminish in 4-6 weeks.

Monitor for suicidal ideation, extreme agitation, fever, increased blood pressure, manic symptoms

Sleep hygiene

Avoid caffeine if anxious

Teach relaxation techniques

Abrupt discontinuation may be mild or severe

Question 10

serotonin syndrome sx: mental status changes

Answer 10

agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations

Question 11

serotonin syndrome sx: ANS

Answer 11

diaphoresis, flushing, fever, tachycardia, mydriasis

Question 12

serotonin syndrome sx: neuromuscular

Answer 12

myoclonus ( muscle twitching or jerks), hyperreflexia, tremors

Question 13

serotonin syndrome sx: GI

Answer 13

N/V/D

Question 14

how to treat serotonin syndrome

Answer 14

-stop or reduce medications
-benzodiazepines
-oxygen
-IV fluids
-sx & supportive care (like HR & BP meds)
should resolve in 24 hrs but can take weeks to fully go away

Question 15

what drugs are benzos

Answer 15

diazepam
lorazepam

Question 16

why are benzos given for serotonin syndrome

Answer 16

to help control agitation, seizures and muscle stiffness

Question 17

what drugs are given for tachycardia or hypertension when seen in serotonin syndrome

Answer 17

esmolol
nitroprusside

Question 18

what drugs are given for hypotension when seen in serotonin syndrome

Answer 18

phenylephrine
epinephrine

Question 19

what drug can we give if treatments aren’t working fro serotonin syndrome

Answer 19

cyproheptadine HCL to block serotonin production

Question 20

what drugs are tricyclic antidepressants (TCA)

Answer 20

imipramine
desipramine
doxepin
amitriptyline

Question 21

imipramine and desipramine are within what class of medication

Answer 21

TCA

Question 22

doxepin is in which drug class

Answer 22

TCA

Question 23

amitriptyline is in which drug class

Answer 23

TCA

Question 24

what antidepressants has an increased risk of death by overdose

Answer 24

TCA

Question 25

SE of TCAs

Answer 25

anticholinergic effects

Question 26

nursing considerations for TCA

Answer 26

check ECG for cardiac disorder check for hx of seizure disorderes

Question 27

TCA symptoms during early treatment

Answer 27

early morning awakening, feeling worse in am, some worry and anxiety

Question 28

anticholinergic SE

Answer 28

increased temperature
 dry mouth, eyes; urinary retention; constipation
 mydriasis/dilated pupils/ blurred vision
 flushed face
 confusion; delirium +sedation & wt gain

Question 29

TCA nursing interventions to decrease sx

Answer 29

Dry mouth: sugar-free hard candy/gum GI upset: take med with food Diarrhea: eat frequent small meals Constipation: increase fiber/fluids in diet/exercise Insomnia: Sleep hygiene/change dosing time of med; if causes insomnia take in am Orthostasis: keep hydrated; get up slowly Sexual side effects: erectile dysfunction medications Urinary hesitancy: run water while voiding; measure amount

Question 30

what drugs are MAOIs

Answer 30

phenelzine isocarboxazid 
 tranylcypromine
 selegiline (Emsam) Transdermal patch

Question 31

common SE of MAOIs

Answer 31

Dry mouth Nausea Diarrhea or constipation Headache Drowsiness Insomnia Dizziness or lightheadedness Skin reaction at patch site

Question 32

MAOIs nursing considerations

Answer 32

dietary restriction of tyramine rich foods to **prevent hypertensive crisis** -aged cheese, overripe fruits & vegetables, beans, soy cause & bouillon cubs, beers/ales/liquors/red wine -avoid high caffeine consumption -avoid using w/ demerol

Question 33

how to treat a hypertensive crisis

Answer 33

phentolamine sublingual nifedipine symptomatic & supportive

Question 34

what classes are recognized as antidepressants + other drugs

Answer 34

SRIs TCA MAOIs + trazodone bupropion mirtazapine

Question 35

bupropion (NDRI)

Answer 35

Contraindicated in eating disorders and hx of seizures Less sexual side effects Considered “energizing” Used in smoking cessation (Zyban)

Question 36

trazodone

Answer 36

often given at bedtime for sedative effect as adjunct with another antidepressants

Question 37

mirtazapine

Answer 37

good for sleep

Question 38

general antidepressant medication education

Answer 38

May not see symptom improvement until 4-6 weeks Physiological symptoms improve before psychological symptoms **with increased energy danger of SI** Look for improved sleep; less daytime fatigue and crying; & increased frustration tolerance Side effects may occur but handled by adjusting dosage or switching to different med in same class Discontinuing meds as soon as you feel better may result in relapse. Meds usually needed for 6-9 months past symptom relief- up to 12 -24 months Antidepressants are not addictive Abrupt stopping of meds will result in withdrawal- nausea, anxiety, insomnia, flu-like symptoms Do not drink alcohol

Question 39

when can antidepressants be prescribed

Answer 39

- depressive disorders - depressive phases of bipolar disorder - sx of dysphoria, anhedonia, difficulty concentrating, hopelessness - anxiety disorders (SSRIs esp used)

Question 40

what drugs are typical antipsychotics

Answer 40

chlorpromazine haloperidol

Question 40

antipsychotic long acting injections

Answer 40

haloperidol decanoate (typical) risperidone (atypical) paliperidone palmitate (atypical)

Question 41

what drugs are atypical antipsychotics

Answer 41

clozapine, olanzapine questiapine risperidone aripiprazole

Question 42

what drugs are anticholinergic medications used for schizophrenia

Answer 42

benztropine trihexyphenidyl

Question 43

side effects of antipsychotic medications

Answer 43

- EPS: acute dystonic rx, akathisia, pseudoparkinsonism, tardive dyskinesia - anticholinergic effects - neuroleptic malignant syndrome -metabolic syndrome

Question 44

typical antipsychotics

Answer 44

**chlorpromazine, haloperidol** reduce positive sx & little to no effect on negative sx

Question 45

disadvantages to typical antipsychotics

Answer 45

Extrapyramidal side effects (EPS) Anticholinergic side effects Sedation, weight gain, metabolic syndrome, neuroleptic malignant syndrome (NMS), sexual dysfunction, endocrine disturbances, cardiovascular issues (orthostatic hypotension and arrhythmias), increased risk of seizures

Question 46

atypical antipsychotics

Answer 46

**clozapine, olanzapine, questiapine, risperidone, aripiprazole** improves positive and negative symptoms less SE

Question 47

atypical antipsychotics disadvantages

Answer 47

tendency to cause significant weight gain; risk of metabolic syndrome; may be more costly than the typical antipsychotics

Question 48

atypical antipsychotics SE

Answer 48

Sedation Major weight gain and changes in a person’s metabolism leading to metabolic/endocrine problems including diabetes and hyperprolactinemia Potential for cardiac dysrhythmias / even sudden cardiac death Sexual dysfunction

Question 49

when is clozapine used

Answer 49

Has been effective in treating **refractory Schizophrenia**, or **schizophrenia that doesn’t respond to normal treatment** The use of clozapine has resulted in decreased negative symptoms, increased impulse control, reduced violence to self and others, and improved quality of life

Question 50

side effect of clozapine

Answer 50

potentially fatal side effect of agranulocytosis -> reduction in the number of circulating granulocytes and decreased production of granulocytes that limit one’s ability to fight off infection

Question 51

when are long acting injectable medications used

Answer 51

when patients that are at risk for non-adherence