Create
Learn
Share

CHAPTER 27 PHARMACOLOGY IN PSYCHIATRIC CARE five

rename
wipimebe's version from 2015-09-25 00:35

Section

47. Common side effects of SSRIs include which of the following symptoms?

 

a. headache and insomnia
b. hypotension and tachycardia
c. seizures and agitation
d. slurred speech and unsteady gait

 

ANS: A
Headaches and insomnia are common side effects of SSRIs. Other common side effects include anxiety and gastrointestinal disturbance such as nausea and diarrhea. SSRIs are also especially likely to interfere with sexual functioning in both men and women.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Selective Serotonin Reuptake Inhibitors| Drug Interactions

 

48. SSRIs have been found useful in the treatment of which of the following disorders?

 

a. dissociative disorder
b. borderline personality disorder
c. antisocial personality disorder
d. obsessive-compulsive disorder

 

ANS: D
SSRIs have been found useful in treating obsessive-compulsive disorder (OCD). In particular, fluoxetine and fluvoxamine have been well documented as being effective in treating OCD. Specific SSRIs have also been shown to be helpful in treating panic disorder, bulimia, and premenstrual syndrome.

 

49. The action of MAO inhibitors occurs because the medication carries out which of the following actions?

 

a. stimulates production of MAO enzymes
b. blocks the enzyme from metabolizing monoamine neurotransmitters
c. alters the sensitivity of MAO receptors
d. is nonselective in its effects on monoamine neurotransmitters

 

ANS: B
MAOIs block the enzyme from metabolizing monoamine neurotransmitters. The enzyme's purpose is to metabolize the neurotransmitters into biologically inactive forms. The three specific neurotransmitters MAOIs block are norepinephrine, serotonin, and dopamine. The blocking of the enzyme results in an increased concentration of the neurotransmitters in neuronal cells.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Monoamine Oxidase Inhibitors| Pharmacology

 

50. Because MAO inhibitors have long-acting metabolites:

 

a. at least 2 weeks should elapse between administration of some other antidepressant
b. the half-lives of the medications are likely to be very long as well
c. they have many associated and serious side effects
d. they are the most effective of the antidepressant medications that can be administered

 

ANS: A
At least 2 weeks should elapsed between the administration of MAOIs and the administration of another type of antidepressant. Furthermore, administration of MAOIs should not be discontinued abruptly. Rather, the administration should be stopped gradually to avoid significant side effects.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Monoamine Oxidase Inhibitors| Dose/Administration

 

51. Serious side effects result when a client on a MAO inhibitor antidepressant eats which of the following foods?

 

a. overripe apricots
b. beefsteak
c. sharp cheddar cheese
d. flat bread

 

ANS: C
Serious side effects may result when a client taking an MAO inhibitor eats sharp cheddar cheese. This is due to the high levels of tyramine in aged cheeses. Other foods that have high levels of tyramine include salami and sauerkraut.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Monoamine Oxidase Inhibitors| Food and Alcohol Interactions

 

52. The symptoms produced when there is a severe interaction between MAOIs and meperidine are:

 

a. shaking, paresthesia, pill rolling
b. fever, hypertension, and coma
c. dizziness, fainting, and falls
d. nausea, vomiting, and diarrhea

 

ANS: B
Interaction between MAOIs and meperidine can lead to symptoms such as fever, hypertension, and coma. Meperidine is more commonly known as Demerol and is a narcotic analgesic. This makes surgery especially dangerous for people on MAOIs due to the potential for inadvertent administration of Demerol to manage post-operative pain.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Monoamine Oxidase Inhibitors| Drug Interactions

 

53. A client is discontinued from fluoxetine. The nurse correctly understands that a return of signs and symptoms of depression as a result of complete elimination of fluoxetine from the body will MOST likely occur:

 

a. between 1 and 2 days
b. between 1 and 2 weeks
c. between 2 and 4 weeks
d. between 1 and 2 months

 

ANS: D
Fluoxetine will be completely eliminated from the body between 1 and 2 months after administration of the medication has been discontinued. Fluoxetine's (trade name Prozac) long elimination period is seen as a benefit in situations where a client may miss taking the medication for a day or more. However, it makes it especially difficult when it is necessary to switch to another medication such as an MAOI.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Selective Serotonin Reuptake Inhibitors| Dose/Administration

 

54. An overweight client with a strong family history of obesity desires to be pharmacologically treated for depression. The antidepressant least known for causing weight gain is:

 

a. fluoxetine
b. nefazodone
c. bupropion
d. mirtazapine

 

ANS: C
Bupropion (trade names Wellbutrin and Zyban) is not known for causing weight gain. It also has no sexual side effects, unlike other antidepressants. However, a major adverse effect is that bupropion can lower a person's seizure threshold.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Miscellaneous Antidepressant Drug Categories and Drug Combinations

 

55. The use of SSRIs in the treatment of depression in children and adolescents is:

 

a. strongly warned against due to increased incidence of suicidal ideation and attempts
b. much more beneficial than individual or group psychotherapy
c. strongly advocated due to high degree of efficacy coupled with few adverse effects
d. considered a first-line treatment option

 

ANS: A
The use of SSRIs is strongly warned against when treating children with depression due to the increased incidence of suicidal ideation and attempts. While the focus of studies concerning this has been paroxetine (trade name Paxil), there is evidence that there may be an increased risk for almost all SSRIs, except possibly fluoxetine (Prozac).

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Selective Serotonin Reuptake Inhibitors| Adverse Effects

 

56. What is the only antidepressant available transdermally?

 

a. selegiline
b. lithium
c. paroxetine
d. fluoxetine

 

ANS: A
Selegiline is the only antidepressant available that can be administered transdermally. It is administered via a skin patch that is changed every 24 hours. It also likely has fewer complications from food and drug interactions.

 

PTS: 1 DIF: Knowledge
REF: Drugs for Treating Mood Disorders| Monoamine Oxidase Inhibitors| Pharmacology

 

57. One of the MOST commonly used drugs for the management of mania is:

 

a. doxepin (Adapin)
b. fluoxetine (Prozac)
c. lithium (Lithobid)
d. phenelzine (Nardil)

 

ANS: C
Lithium is one of the most commonly used drugs for treating mania. Other commonly used drugs for treating mania are carbamazepine (Tegretol), valproic acid (Depakene), and divalproex (Depakote).

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Mood Stabilizers

 

58. Which statement is true about the antimanic pharmacological actions of lithium?

 

a. Hepatic metabolism of lithium is quickly accomplished.
b. Its half-life is shorter than that of most antidepressants.
c. Only 10% of the dose of lithium is absorbed.
d. The specific pharmacological actions remain unknown.

 

ANS: D
The specific antimanic pharmacologic actions of lithium are currently unknown. This is largely due to the fact that the neurobiology of mania is still not completely understood. An amazing characteristic of lithium is that it has almost no psychotropic effects on individuals not suffering from mania.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Mood Stabilizers

 

59. Because it has a narrow therapeutic window, lithium levels above which of the following leads to toxicity?

 

a. 0.6 mEq/L
b. 1.2 mEq/L
c. 1.4 mEq/L
d. 1.5 mEq/L

 

ANS: D
Lithium levels above 1.5 mEq/L can lead to toxicity. Higher levels than this can produce toxicity symptoms such as lethargy and dizziness. Extremely high levels may result in cardiac toxicity, leading to death. Lithium levels are most commonly maintained between 0.6 mEq/L and 1.2 mEq/L.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Mood Stabilizers

 

60. Symptoms of anxiety are MOST commonly treated with which of the following types of medications?

 

a. tricyclics
b. sedatives
c. lithium
d. benzodiazepines

 

ANS: D
Anxiety symptoms are most commonly treated with benzodiazepines. Benzodiazepines are also used to treat insomnia. In addition, buspirone has been used to treat generalized anxiety, and beta blockers have been used to treat performance anxiety.

 

PTS: 1 DIF: Application REF: Drugs for Treating Anxiety and Sleep Disorders

 

61. When working with the client experiencing mania who is taking lithium, you would instruct the client and family to:

 

a. keep the clientÕs sodium intake stable and have the client drink 6 to 8 glasses of water consistently each day
b. restrict the clientÕs water intake to 3 glasses a day
c. not worry about the clientÕs salt intake at all since lithium is a salt
d. have the client use a salt substitute and not worry about water intake

 

ANS: A
The nurse would instruct the client to keep his or her sodium intake level stable and drink 6 to 8 glasses of water. Lithium and sodium share the same pathways for renal excretion. Thus, a low-salt diet could decrease the excretion of lithium and result in higher levels of lithium in the body.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Mood Stabilizers| Drug And Food Interaction

 

62. The role of atypical antipsychotic medications in the treatment of mood disorders has been demonstrated to be:

 

a. limited to the short-term treatment of psychotic symptoms or mania
b. effective as augmenting agents when combined with antidepressants
c. not appropriate except in cases of extreme, refractory psychosis
d. contraindicated due to high incidence of drug-induced mania

 

ANS: B
Atypical antipsychotic medications have been found to be effective augmenting agents when combined with antidepressants. In particular, atypical antipsychotic medications may decrease the risk of suicide. However, among the atypical antipsychotics, only Aripiprazole is approved for use as an adjunct treatment for major depressive disorder.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Miscellaneous Antidepressant Drug Categories and Drug Combinations

 

63. Most anxiolytic medications have their greatest effect by influencing which neurotransmitter?

 

a. dopamine
b. epinephrine
c. gamma-aminobutyric acid
d. serotonin

 

ANS: C
Most anxiolytic medications have their greatest effect through influencing the gamma aminobutyric acid neurotransmitter (GABA). Benzodiazepines are believed to increase the effectiveness of GABA. In addition, barbiturates augment GABA, but in a different manner than benzodiazepines. Even alcohol is believed to have anxiolytic and sedative effects partially by enhancing GABA transmission.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Anxiety and Sleep Disorders| Pharmacology

 

64. One of the greatest nursing considerations for clients who receive benzodiazepines is that the drugs:

 

a. mask symptoms of increased anxiety
b. have decidedly short half-lives
c. cause irreversible side effects
d. are associated with dependence

 

ANS: D
The nurse must always take into consideration that benzodiazepines are associated with dependence. Abrupt withdrawal, after prolonged periods of use, can result in anxiety and occasionally seizures. The withdrawal process should be conducted slowly, over a period of several weeks.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Anxiety and Sleep Disorders| Adverse Effects

 

65. The treatment team is discussing changing the medications for a client diagnosed with an anxiety disorder from diazepam to some other drug with less sedating and dependence side effects. Which drug is MOST likely to be chosen?

 

a. Ativan (lorazepam)
b. BuSpar (buspirone)
c. Inderal (propranolol)
d. Versed (midazolam)

 

ANS: B
BuSpar (buspirone) would be the most likely medication chosen when changing a anti-anxiety medication to another anti-anxiety medication that is less sedating and is less likely to lead to dependence. There is no evidence of habituation of dependency among individuals taking buspirone. However, not all individuals respond to buspirone (particularly those previously treated with benzodiazepines). In addition, buspirone is significantly more expensive than other anti-anxiety medications, although this may be alleviated as generic versions enter the market.

 

PTS: 1 DIF: Analysis REF: Drugs for Treating Anxiety and Sleep Disorders