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CHAPTER 27 PHARMACOLOGY IN PSYCHIATRIC CARE part four

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wipimebe's version from 2015-09-25 00:33

Section

28. Which of the following signs and symptoms BEST represent the anticholinergic side effects most often associated with antipsychotic medications?

 

a. agitation, pacing, slurred speech, and sedation
b. blurred vision, constipation, dry mouth, and urinary hesitancy
c. tremors, spasms of the tongue, pacing, and shuffling gait
d. double vision, insomnia, headache, and urinary frequency

 

ANS: B
The anticholinergic side effects most often associated with antipsychotic medications are blurred vision, constipation, dry mouth, and urinary hesitancy. Anticholinergic drugs are most often used to treat movement disorders caused by medication. In addition, they are given along with antipsychotics to prevent neurological symptom development.

 

PTS: 1 DIF: Application REF: Antipsychotic Drugs| Adverse Effects

 

29. Which side effect of antipsychotic medications involves a neurological disorder often characterized by involuntary movements of the tongue and lips?

 

a. akathisia
b. dystonia
c. neuroleptic malignant syndrome
d. tardive dyskinesia

 

ANS: D
Tardive dyskinesia is a neurological disorder often characterized by involuntary movements of the tongue and lips. The most common movements of this disorder are lip smacking, sucking movements, and grimacing. Slow and irregular movements that diminish when relaxed and disappear during sleep occur when the disorder affects the trunk and extremities.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Adverse Effects

 

30. Which serious side effect of antipsychotic medications involves sudden fever, rigidity, tachycardia, hypertension, and decreased levels of consciousness?

 

a. akathisia
b. dystonia
c. neuroleptic malignant syndrome
d. tardive dyskinesia

 

ANS: C
Neuroleptic malignant syndrome is a possible side effect of all antipsychotics and is associated with sudden fever, hypertension, rigidity, tachycardia, and decreased levels of consciousness. Individuals experiencing this are normally mistaken for having infectious conditions. In such cases, antibiotic treatment and unnecessary investigations can result in a delay of diagnosis.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Neuroleptic Malignant Syndrome

 

31. One of your assigned clients has been taking one of the phenothiazine antipsychotic medications for some time and is now showing involuntary tongue movements, grimacing, sucking, and lip-smacking movements. Which of the following would you MOST expect the provider to order to deal with these symptoms?

 

a. benztropine (Cogentin)
b. diphenhydramine (Benadryl)
c. observation for symptoms to diminish
d. decrease the Thorazine dose

 

ANS: D
The most likely course of action that a provider would take to deal with these symptoms would be to decrease the clientÕs Thorazine dose. The client may be experiencing a possible side effect of the antipsychotic, known as tardive dyskinesia. Tardive dyskinesia is a neurological disorder often characterized by involuntary movements of the tongue and lips, including grimacing, sucking, and lip smacking.

 

PTS: 1 DIF: Analysis REF: Antipsychotic Drugs| Adverse Effects

 

32. When you go to administer a clientÕs dose of chlorpromazine (Thorazine), you note that he has developed a high fever and rapid heart rate. Which of the following actions would be BEST on your part?

 

a. Observe and give cool sponge baths.
b. Give medication and repeat vital signs in 4 hours.
c. Hold his medication and call the provider.
d. Administer an anti-inflammatory prn drug.

 

ANS: C
If the client has developed a high fever and rapid heart rate, the best course of action would be to hold his medication and call the provider. The client may be suffering from neuroleptic malignant syndrome. Neuroleptic malignant syndrome is a possible side effect of all antipsychotic medications and has symptoms of fever, rigidity, tachycardia, hypertension, and decreased levels of consciousness.

 

PTS: 1 DIF: Analysis
REF: Antipsychotic Drugs| Neuroleptic Malignant Syndrome

 

33. Which is NOT a category of medication for treatment of major depression?

 

a. mood stabilizers
b. monoamine oxidase (MAO) inhibitors
c. selective serotonin reuptake inhibitors (SSRIs)
d. tricyclic and related antidepressants

 

ANS: A
Mood stabilizers are not a category of medication to treat major depression. Mood stabilizers are used to treat mania. The medications to treat major depression include tricyclic antidepressants, SSRIs, and monoamine oxidase inhibitors (MAOIs). However, there are an increasing number of agents that fall outside of these categories.

 

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

 

34. A provider MOST often bases the prescription of a cyclic antidepressant medication for a specific client on which of the following?

 

a. the cost per dose coupled with the anticipated length of treatment
b. the amount of sedation, anxiety reduction, or psychostimulation desired
c. to which pharmaceutical advertisements the client has recently been exposed
d. color and size of the tablets or capsules and ease of swallowing

 

ANS: B
Providers base the prescription of a cyclic antidepressant on the amount of sedation, anxiety reduction, or psychostimulation desired. Concern must also be given to choosing medication in an effort to minimize side effects. The provider normally starts with a low initial dosage prescription. Over a period of 1 to 4 weeks, the dosage is increased gradually, until there is clinical improvement for the client.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants

 

35. Most antidepressants affect the levels of which brain neurotransmitters?

 

a. dopamine 1 and 4
b. histamine
c. norepinephrine or serotonin
d. acetylcholine

 

ANS: C
Most antidepressants affect the levels of norepinephrine or serotonin neurotransmitters. Some affect both; others affect the levels of one or the other. For example, SSRIs have negligible effects on norepinephrine neurotransmitters but are specific moderators of brain serotonin levels.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Indications and Evidence for Effectiveness

 

36. The first antidepressants in clinical use were the:

 

a. mood stabilizers
b. monoamine oxidase (MAO) inhibitors
c. selective serotonin reuptake inhibitors (SSRIs)
d. tricyclic and related antidepressants

 

ANS: D
Tricyclic and related antidepressants were the first antidepressants in clinical use. Even today, these drugs still have important roles in treating mood disorders. Despite the large variety of tricyclic drugs available, there are few differences between them.

 

PTS: 1 DIF: Knowledge
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants

 

37. A client is started on an antidepressant medication. The client calls up a week later to complain that Òthe new medication isnÕt working.Ó The nurseÕs response to the client is based on the knowledge that the antidepressant effects of antidepressant drugs are often not seen until:

 

a. 1 to 2 hours
b. 1 to 2 days
c. 1 to 2 weeks
d. 1 to 2 months

 

ANS: D
The antidepressant effects of antidepressant drugs are not often seen until 1 to 2 months after the beginning of treatment. Initially dosages are usually quite low. Over a period of 1 to 4 weeks the dosage is increased gradually, until there is clinical improvement for the client.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Dose/Administration

 

38. A nurse teaches a client about the metabolism of the clientÕs tricyclic antidepressant medication. The statement that MOST indicates a need for corrective instruction is:

 

a. ÒIf I have a particularly bad day, IÕm supposed to take an extra dose the next morning.Ó
b. ÒThe medication stays working in me even though I just take it once a day.Ó
c. ÒIf I get mixed up and accidentally take a double dose, I need to call the doctor.Ó
d. ÒThe medication would be harmful to my baby if I were to get pregnant while taking it.Ó

 

ANS: A
Clients stating that they should take an extra dose the next morning if they have a bad day is indicative of the need for corrective instruction. The most critical adverse effect of these medications occurs in cases of accidental or intentional overdose. In some cases, there may be a fatal overdose with the ingestion of only a few daysÕ supply of the drug. Clients should not increase their dosage without being instructed to by their health care provider and should notify their provider if they accidentally ingest a double dosage.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Adverse Effects

 

39. The use of nortriptyline requires careful monitoring of blood levels because:

 

a. levels above 2 are toxic
b. antidepressant effects are not seen below 50 ng/ml or above 150 ng/mL
c. levels of this drug in the blood rise and fall dramatically and erratically
d. the level of this drug in the blood must never be above 100 ng/mL

 

ANS: B
The use of nortryptiline requires careful monitoring of blood levels because antidepressant effects are not seen below 50 mg/mL or above 150 mg/mL. For most other medications, therapeutic dosages range between 100 and 200 mg daily.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Dose/Administration

 

40. Which side effect is due to the antihistaminic effects of antidepressants?

 

a. blurred vision
b. dizziness
c. galactorrhea
d. weight gain

 

ANS: D
Weight gain is a side effect that is caused by the antihistaminic effects of antidepressants. Other antihistaminic effects include sedation and interaction with other drugs that result in central nervous system depression. Blurred vision is caused by the anticholinergic effects of antidepressants, while dizziness is caused by the alpha-adrenergic effects of antidepressants.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Side Effects

 

41. Which one of the following cyclic antidepressants is classified as category B (no evidence of risk in humans during pregnancy)?

 

a. maprotiline (Ludiomil)
b. desipramine (Norpramin)
c. nortriptyline (Tofranil)
d. amitriptyline (Elavil)

 

ANS: A
Maprotiline is classified as a category B antidepressant. Category B antidepressants show no evidence of risk to humans. All other cyclic antidepressants either show a positive evidence of risk toward humans (category D) or the evidence of risk cannot be ruled out (category C).

 

PTS: 1 DIF: Knowledge
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Use During Pregnancy/Lactation

 

42. When a pregnant woman is judged to require antidepressant treatment, the medication is usually selected from which of the following groups of antidepressants?

 

a. MAO inhibitors
b. tricyclic antidepressants
c. SSRIs
d. aminoketones

 

ANS: C
SSRIs are usually selected for pregnant women who are judged to require antidepressants. This is because there is enough experience with treating pregnant women with SSRIs to determine that the benefits of the medication outweigh the risks. In contrast, almost all cyclic antidepressant medications, except one (maprotiline), either show evidence of risk to humans or cannot have the evidence of risk be ruled out.

 

PTS: 1 DIF: Application
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Use During Pregnancy/Lactation

 

43. Which of the antidepressants has been identified as causing priapism in men, and although this occurs rarely, is not prescribed for men?

 

a. nefazodone (Serzone)
b. trazodone (Desyrel)
c. bupropion (Wellbutrin)
d. venlafaxine (Effexor)

 

ANS: B
Trazodone, in rare cases, causes priapism in men and is not prescribed for men. Priapism is a sustained, painful erection. When it does occur, it typically occurs during the first weeks of treatment. This may require surgery to treat and can result in permanent impotence.

 

PTS: 1 DIF: Comprehension
REF: Drugs for Treating Mood Disorders| Tricyclic and Related Antidepressants| Adverse Effects

 

44. Which statement about SSRIs is correct?

 

a. SSRIs have a narrower margin of safety in overdose compared to older cyclic antidepressants.
b. SSRIs have fewer side effects than selective monoamine oxidase-A inhibitors (MAO-AIs).
c. SSRIs were previously more expensive than older cyclic antidepressants.
d. SSRIs are associated with more contraindications than are nonselective, nonreversible MAO inhibitors.

 

ANS: C
Most SSRIs are now available with generic alternatives or through pharmacy prescription discount programs. This significantly decreases the monthly cost of the medication for clients. Previously, SSRIs were significantly more expensive than the older cyclic medications.

 

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

 

45. Serotonergic syndrome, a rare interaction between SSRI and MAO inhibitor medications, dictates which of the following number of days for a washout period before administration of a MAO inhibitor after the person has been on an SSRI?

 

a. 2 days
b. 2 weeks
c. 2 months
d. 6 weeks

 

ANS: D
Due to risk of serotonergic syndrome, a 6-week washout period is required after a person has taken an SSRI, before he or she can take an MAO inhibitor.

 

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

 

46. The effect of the interaction between SSRIs and cimetidine is to:

 

a. raise SSRI levels due to impaired hepatic metabolism
b. decrease SSRI levels by binding to the medication
c. neutralize the effects of SSRIs
d. potentiate the effects of cimetidine

 

ANS: A
The interaction between cimetidine and SSRIs results in SSRI levels rising due to impaired hepatic metabolism. Cimetidine is also known as Tagamet and is available over-the-counter or by prescription. It is often used to treat dyspepsia.

 

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