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Nursing Pharm - Mood, Psych, Neurodegenerative

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olanjones's version from 2016-06-13 03:51

Depression

Question Answer
What is a major concern with the use of meds for emotional and mood disorders (FDA black box warning)?Suicidal ideation (esp in children), evaluations should occur at initiation of therapy and be ongoing
What are PE points for antidepressants in regards to therapeutic effect?Effects may sometimes take a month or more, strict adherence is crucial; Depression is due to neurotransmitter dysfunction, meds do not completely restore balance
What is the action of Tricyclic Antidepressants (prototype- imipramine/Tofranil)?Inhibition of NE and serotonin uptake
Side effects of imipramine include orthostatic hypotension and sedation, what PE points would the nurse give?Change positions slowly, use at bedtime if sedation occurs, abstain from driving until effects are known (other SE include sweating and anticholingeric effects)
TCAs are contraindicated in what conditions?history of cardiovascular disease and seizure disorders
Although Selective serotonin reuptake inhibitors (prototype- sertaline/Zoloft) have fewer SE than many types of antidepressants what SE may still occur?N&V, diarrhea, sexual dysfunction, weight gain, insomnia/fatigue
What PE points may the nurse give when patient is prescribed sertaline?Take in AM with food to avoid GI upset and insomnia, use calorie restriction and exercise to avoid weight gain, do not stop med abruptly, do not use ETOH/CNS depressants
Serotonin syndrome (SES) is associated with the use of SSRIs, when can this occur?As little as 2 hours after first dose or several weeks after *CAN BE FATAL* (s/s: mental status change, HTN, tremors, sweating, hyperpyrexia, ataxia)
Why are Monoamine oxidase inhibitors (prototype- phenelzine/Nardil) often the last choice in antidepressant therapy?Many drug-drug and drug-food (tyramine, caffeine) interactions, can also be hepatotoxic
What can occur when a patient taking an MAOI ingests foods with tyramine?Hypertensive crisis, patients on MAOIs should monitor for signs of CVA/MI and wear a medic alert bracelet
What are Atypical antidepressants?Antidepressants with unique chemical structures, can include SNRIs which inhibit resorption of serotonin & NE (duloxetine, venlafaxine), drugs with similar action (bupropion, mirtazapine), or herbals (St. John's Wort)
Because St. John's Wort is available OTC, what is a PE point for a patient who has been prescribed an antidepressant?SES can occur if used with TCAs, SSRIs, MAOIs; If using only St. John's Wort let them know therapeutic effect can take up to 2 months
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Mood Disorders

Question Answer
What is the goal of drug therapy for bipolar disorder?Moderate extreme shifts, meds are used to stabilize mood (may need to include use of antidepressants during depressed stage and benzodiazepine during manic stage)
Why is compliance (key to successful tx) often difficult with bipolar disorder?Clients may not see the manic stage as a problem or may be willing to undergo depressed stage to keep manic stage
The drug lithium (prototype- Mood stabilizer) is often used in bipolar treatment, what is a major NC associated with it?Low therapeutic index (closely monitor serum levels -every 1-3 days at the beginning and every 2-3 months thereafter)
Because dehydration (sodium loss) can cause lithium toxicity, what PE points would the nurse give?Avoid excessive sweating, drink fluids (be consistent), report any increase in urination, diarrhea, or fever
Is Attention Deficit Hyperactivity Disorder actually a mood disorder?NO, it is a behavioral disorder - characterized by difficulty focusing and concentrating, typically seen in children (but may be present in adulthood)
What is the nurse's role in treatment of ADHD?May be involved in screening, education, or follow-up
The SE of methylphenidate/Ritalin (prototype- CNS stimulant) can include weight loss, what PE points would the nurse give?Monitor weight weekly, notify PCP of losses; eat high-calorie, nutritious meals
Because of the high potential for abuse/dependence, methylphenidate is a Schedule II drug, what are the PE points in regards to this?Keep med in a secure location, Do not stop taking suddenly (need to be tapered off)
Because methylphenidate is a CNS stimulant, use contraindicated in what conditions?CVD, HTN, hyperthyroidism, seizure disorder
What is the purpose of a "drug holiday" from CNSTo assess current state of condition (unmedicated) and to help prevent drug tolerance
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Psychoses

Question Answer
What symptoms may be present in acute or chronic psychosis?Delusions, Hallucinations, Illusions, Paranoia, Lack of interest, motivation, responsiveness (behavior may range from total inactivity to combativeness)
What is the goal of drug therapy for psychoses?reduction of s/s to improve ability for self-care and relationships (drugs can control symptoms but often have severe SE)
Neuroleptic malignant syndrome and Extrapyramidal SE often occur with antipsychotics, what are s/s of each?NMS (can be fatal)- increased temp, sweating, unstable BP, dyspnea, muscle rigidity, incontinence. EPS- dystonia, akathisia, parkinsonism, tardive dyskinesia
What are the conventional antipsychotics?Phenothiazaines (prototype- chlorpromazine/Thorazine) and Nonphenothiazines (prototype- haloperidol/Haldol)
How do conventional antipsychotics work?They block the excitement of positive s/s (halluncination, delusion, disorganized thought/speech)
How do phenothiazines and nonpehnothiazines differ?Phenothiazines are first-generation drugs, vary in potency and SE, Nonphenothiazines have slightly fewer SE (somewhat less sedation/anticholingeric) but same efficacy & action as phenothiazines
Drugs like chlorpromazine block dopamine and serotonin receptors in the brain, what NC are associated with this?Possible development of EPS (can be permanent), NMS may develop as a toxic reaction, PE on s/s and to report IMMEDIATELY
Drugs like haloperidol/Haldol still carry a risk for EPS and NMS, what NC are associated with this?Contraindication for use in those with Parkinson's disease, alcoholism, seizure disorder, CNS depression, children < 3 years
What is the advantage of drugs like risperidone/Risperdal (prototype- Atypical Antipsychotic)?Fewer SE (therapeutic doses do not produce EPS), Control both positive and negative (lack of interest/pleasure in daily activities) s/s
What SEs of risperidone may lead to non-adherence in patients?weight gain (obesity), DM, increased triglycerides, CVA risk
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Parkinson's Disease

Question Answer
Why is diligent assessment & evaluation of pharmocotherapy for treatment of neurodegenerative disorders so important?Drug therapy outcomes are related to progression of disease process, SE are often similar to s/s of the disease
What is the goal of drug therapy for Parkinson's?Increase the client's ability to perform ADLs, restore balance between neurotransmitters dopamine and Ach in the corpus striatum
How do drugs like levodopa/Larodopa (prototype- Dopaminergic) work?By restoring dopamine synthesis or by stimulating receptors via dopamine agonists (CONTRAINDICATED in narrow-angle glaucoma)
What is a NC of levodopa that can be very frustrating for patient's and may lead to non-adherence?Full therapeutic effect may take form weeks to 6 months, increased s/s may require dose adjustments, abrupt withdrawal may cause acute Parkinsonism
Why is it important for patients to report new blepharospasm (eye twitches), tremors, & symptoms?This may signal an "on-off" syndrome which may require hospitalization to determine reason for exacerbation
SE of levodopa include orthostatic hypotension, dyskinesias, and psychosis, what is less dangerous SE that the patient may find embarrassing?Darkening of perspiration and urine which can stain clothing (consider use of dress shields)
How do drugs like benztropine/Cogentin (prototype- Anticholinergic) work?By inhibiting the over-activity of Ach, often used in early treatment (or in those who do not tolerate levodopa) for CNS effects rather than autonomic actions
Because of the anticholinergic effects of benztropine what PE points would the nurse discuss?Avoid overheating in hot weather (risk for heat stroke), Wear sunglasses in bright light, Increase fiber & fluids, Sugarless gum/candy for dry mouth, Be aware of s/s of anticholinergic crisis (fever, visual changes, difficulty swallowing, agitation)
What is it especially important for older patients to report mental status changes, agitation, and drowsiness?Those over age 60 have more risk for SE d/t cognition and mental alertness
What is an antidote for a benztropine OD?physostigmaine salicylate
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Alzheimer's Disease & Multiple Sclerosis

Question Answer
How do drugs such as donepezil Hcl/Aricept (prototype- Acetylcholinesterase inhibitor) act as indirect parasympathomimetics?By intensifying Ach effects at the receptor, decreasing rate of degradation of Ach
What is the goal of drug therapy for Alzheimer's?Improve ADLs, cognition and behavior, slow progression of the disease
Hypotension is a SE of donepezil that can increase risk for falls, what other SE pose a threat to patients?Worsening of ulcers and GI bleeding; urinary or intestinal blockage (PE- report blood in vomitus or stools, avoid NSAIDs)
How can a patient avoid the unpleasant SE of diarrhea, N&V that can accompany donepezil?Take with food or milk to decrease GI upset
What two types of drug are often used to treat MS?Immunomodulators (can decrease severity of symptoms) and Immunosuppressants (suppress T-cell function, decrease inflammatory response)
What SE are commonly associated with Immunomodulators?flu-like symptoms, local injection site reactions
What SE are commonly associated with Immunosuppressants?Toxicity, cardiac effects, fetal effects
Both Immunomodulators and Immunosuppressants have NC of potential for bone marrow suppression, risk for liver & kidney damage, what PE points would the nurse give?Report unusual bleeding, jaundice; Keep lab appts; No live vaccines during tx; avoid crowds & potential for infection.
The Immunomodulator, interferon, can increase risk of depression and suicidal ideation, what PE points would the nurse give?Report s/s of depression, suicidal thoughts to PCP
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