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Mood DisordersPsychiatric Nursing: Contemporary Practice

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What are the major goals in the biologic domain for treating depression?
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To establish normal sleep patterns, healthy nutrition, increase levels of activity and exercise.
How are pharmacological interventions selected to treat patients with major depressive disorder?
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They are selected primarily on an individual's target symptoms, genetic responses r/t cultural, racial and/or ethnic influences and an indvidual's side effect profile.
What are the phases of pharmacological clinical management of psychiatric disorders?
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Acute phase: symptom reduction/remission, Continuation phase: decrease the risk for relapse (4-9 months), Maintenance phase: duration is unknown, maintain dosages, Discontinuation: based on the same factors to initiate treatment
What are the nursing responsibilities during the acute phase of pharmacological treatment of major depression?
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Careful monitoring and follow-up are essential. Assess the patient's response to medications, adjust dosages if necessary, identify and address side effects, and provide support and education.
Lexapro, Prozac, Zoloft, Paxil, Luvox, and Celexa are what class of antidepressant medication therapy?
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Selective Serotonin Reuptake Inhibitors (SSRI's)
Effexor, Serzone and Cymbalta are what class of antidepressant medication therapy?
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Serotonin norepinephrine reuptake inhibitors (SNRIs)
Nardil, Parnate and Emsam are examples of what class of drugs used to treat depression?
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Monoamine Oxidase Inhibitors (MAOIs)
How does Wellbutrin/bupropion treat depression?
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It is a norepinephrine dopamin reuptake inhibitor.
How do second generation antidepressants differ from first generation ones?
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They SELECTIVELY target the neurotransmitters and receptors thought to be associated with depression, resulting in fewer side effects and adverse events.
What conditions respond better to MAOI's than second generation antidepressants?
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Atypical depression, depression with panic symptoms, social phobias, or conditions that haven't responded to typical antidepressants.
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What should be monitored by a nurse with respect to medications and why?
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Ensure the patient isn't pocketing/cheeking medications (saving medication for a suicide attempt is common), be aware of boxed warnings for children/adolescents, monitor physiological responses (labs, vitals, etc.), evaluate compliance and monitor toxicit
What should be obtained by the nurse prior any initiation of medication?
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Orthostatic vital signs
What adjustments are recommended for elderly or pediatric patients when prescribed TCA's, MAOIs, or venlafaxine?
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The dosages should be lowered to accommodate the physiologic state of the individual
For a patient prescribed TCA's, what should you keep in mind when drawing blood for plasma levels?
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Blood samples should be drawn as close as possible to 12 hours away from the last dose. For example, if they had a dose at 9:00 AM, the blood should be drawn at 9:00 PM, prior to administering the next dose.
What are the most common side effects associated with TCA's?
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Sedation & weight gain (antihistaminc side effects), blurred vision, dry mouth,constipation, urinary retention, sinus tachycardia, and decreased memory (anticholinergic effects).
Who should NOT be prescribed TCA's?
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A patient at risk for suicide because TCAs are very toxic and it would take only 1 g of the drug to be potentially fatal.
When would you expect symptoms of TCA overdose to occur and what should be done if you suspect it?
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Symptoms will have manifested within 12 hours and it is treated with inducing vomiting, gastric lavage and cardiorespiratory supportive care.
What are the signs and symptoms of TCA overdose?
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Dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, urinary retention, drowsiness, agitation, possibly coma.
What are common side effects of MAOIs?
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Headaches, drowsiness, dry mouth, constipation, blurred vision and orthostatic hypotension.
What substance can trigger a hypertensive crisis when ingested along with an MAOI?
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Tyramine (found in aged cheese, beers, red wine, etc.)
What are the signs and symptoms of a hypertensive crisis in a patient taking MAOIs?
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Sudden, severe pounding headache, racing pulse, flushing, stiff neck, chest pain, n/v, and profuse sweating.
  
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