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CHAPTER 27 PHARMACOLOGY IN PSYCHIATRIC CARE part six

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wipimebe's version from 2015-09-25 00:36

Section

66. The medications that are MOST effective in the long-term treatment of post-traumatic stress disorder and generalized anxiety disorder are:

 

a. SSRIs
b. benzodiazepines
c. beta-blockers
d. sedative-hypnotics

 

ANS: A
SSRIs are the most effective medication for treating long-term post-traumatic stress disorder and generalized anxiety disorder. In particular, post-traumatic stress disorder does not respond well to benzodiazepines. Also, the tendency for prolonged use of benzodiazepines to lead to dependency makes them a less favorable medication for treating long-term anxiety issues.

 

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

 

67. A client whose work schedule is made up of unpredictable hours requests medication to be able to fall asleep quickly, yet be able to safely drive to work after 4 to 6 hours of sleep. Based on speed of onset and speed of elimination, the nurse correctly identifies the MOST appropriate medication for this client to be:

 

a. diazepam (Valium)
b. diphenhydramine (Benadryl)
c. zaleplon (Sonata)
d. zolpidem (Ambien)

 

ANS: C
Based on the speed of onset and the speed of elimination, the nurse would identify zaleplon as being the most appropriate medication. Both zaleplon and zolpidem act on the GABA receptor. However, because zaleplon is eliminated from the body quicker, it is better at inducing sleep than maintaining uninterrupted sleep. Also, there are fewer symptoms upon awakening, lessening driving impairment 4 to 6 hours after the medication has been administered.

 

PTS: 1 DIF: Analysis
REF: Drugs for Treating Anxiety and Sleep Disorders| Nonbenzodiazepine Drugs for Anxiety and Sleep Disorders| Zolpidem and Zaleplon

 

68. When administering intravenous fluids and other fluids to hydrate clients with a diagnosis of alcoholism, which of the following supplements must be given to prevent neurological damage?

 

a. vitamin A
b. zinc
c. thiamine
d. magnesium

 

ANS: C
Thiamine must be given when hydrating clients diagnosed with alcoholism, to prevent neurological damage. Alcoholics are hypoglycemic. As hydration increases the metabolization of glucose, the client has an increased requirement for thiamine due to using up existing stores of it in the body.

 

PTS: 1 DIF: Comprehension
REF: Stimulant Drugs| Nursing Alert: Thiamine and Alcohol-Induced Hypoglycemia

 

69. A client asks the nurse for information about a new medication he has heard about called buprenorphine. The nurse correctly instructs the client that buprenorphine is used:

 

a. only in an acute-care inpatient setting during acute detoxification from alcohol overdose
b. as a narcotic antagonist to counter respiratory depression from narcotic overdose
c. only in a clinic approved for the treatment of opioid addiction
d. both for detoxification and withdrawal and for outpatient ongoing maintenance therapy

 

ANS: D
Buprenorphine is used both for detoxification and withdrawal and has been approved for outpatient management of addictions. It is classified as a Schedule III narcotic and as such, can be prescribed by physicians in ordinary practice. There is insufficient evidence, at this time, to determine whether buprenorphine has any advantages over methadone.

 

PTS: 1 DIF: Application
REF: Drugs for treating substance abuse and dependancy| Substances with Little Role Outside Substance Abuse or Withdrawal| Methadone

 

70. The use of stimulant drugs such as pemoline (Cylert) and methylphenidate (Ritalin) are well documented for their use in which of the following diagnoses, in addition to their use in attention-deficit disorder?

 

a. narcolepsy
b. catatonic schizophrenia
c. dissociative disorder
d. fugue state

 

ANS: A
The use of Cylert and Ritalin are well documented for treating narcolepsy. These stimulants reduce the narcolepticsÕ chronic sleepiness, but must be given chronically. Most likely an individual treating narcolepsy with these stimulants will have to use them for the rest of his or her life.

 

PTS: 1 DIF: Comprehension REF: Stimulant Drugs

 

71. In comparison to pemoline (Cylert) and methylphenidate (Ritalin), atomoxetine (Strattera) may prove to:

 

a. be less effective in the treatment of attention-deficit disorder
b. worsen depression and cause suicidal ideation
c. have less potential for abuse in susceptible individuals
d. be more sedating and cause weight gain

 

ANS: C
Strattera may prove to have less potential for abuse than Cylert or Ritalin. However, there appears to be an increased risk of suicidal ideations and liver disease for those taking Strattera, as opposed to Cylert or Ritalin.

 

PTS: 1 DIF: Comprehension REF: Stimulant Drugs

 

72. Medications that are SSRIs include all EXCEPT which of the following?

 

a. sertraline (Zoloft)
b. fluvoxamine (Luvox)
c. trazodone (Desyrel)
d. paroxetine (Paxil)

 

ANS: C
Trazodone not an SSRI. Trazodone, while not chemically related to tricyclic antidepressants, produces similar effects. However, it is free of the direct cardiac side effects of tricyclics and is most likely safer in an overdose situation.

 

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

 

73. Medications that are benzodiazepines include all EXCEPT which of the following?

 

a. clonazepam (Klonopin)
b. zaleplon (Sonata)
c. midazolam (Versed)
d. temazepam (Restoril)

 

ANS: B
Zaleplon is not a benzodiazepine. However, it does act through the GABA receptor like benzodiazepine, but in a different manner. It is primarily a drug used to treat insomnia rather than anxiety.

 

PTS: 1 DIF: Knowledge
REF: Drugs for Treating Anxiety and Sleep Disorders| Nonbenzodiazepine Drugs for Anxiety and Sleep Disorders| Zolpidem and Zaleplon

 

74. A nurse understands that tricyclic antidepressants may be administered for illnesses other than depression. Among these are:

 

a. neuropathic pain
b. partial paralysis
c. autism
d. neurosyphilis

 

ANS: A
Tricyclic antidepressants can be used to treat neuropathic pain, such as the pain that occurs after a case of shingles (herpes zoster). In addition, it has also proven useful in preventing migraine headaches.