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Mood DisordersPsychiatric Nursing: Contemporary Practice

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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.
What is serotonin syndrome?
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It is a adverse effect of drug combinations of MAOIs, SSRIs, or TCAs with other drugs that impact serotonin levels. It develops within hours or days of initiating, increasing dosages or adding a drug.
What are the signs and symptoms of serotonin syndrome?
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Altered mental status, agitation, myoclonus (spasms of muscle groups), hyperreflexia, fever, shivering, diaphoresis, ataxia and diarrhea.
What non-serotogenic drugs or substances have been associated with the development of serotonin syndrome?
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Pertussin and Demerol, alcohol (especially red wine), or street drugs like Ecstasy, LSD or MMDA.
What should you do if you suspect a patient has overdosed on a medication?
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Stop use of the drug, notify the doctor, provide necessary supportive care (give fluids, antipyretics, coolong blankets, etc.)
What anti-serotogenic agent can be used to treat a patient with severe symptoms from serotonin syndrome?
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Cyproheptadine
What are the most common side effects of SSRIs?
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Insomnia and activation, headaches, GI symptoms, weight gain, diminished libido
How are mild symptoms of serotogenic crisis typically treated?
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Discontinue the substances and prescribe propranolol or lorazepam.
What are concerns associated with the atypical antidepressant nefazodone/Serzone?
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It raises hepatic enzymes potentially causing hepatic failure.
What adverse effects have been associated with the atypical antidepressant trazodone/Desyrel?
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ED and priaprism
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What adverse effect is a concern for a patient on bupropion/Wellbutrin?
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Seizures, particularly in a patient at risk for seizures and psychosis
Why should schizophrenic patients not be prescribed bupropion/Wellbutrin?
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It has been known to cause psychosis due to it's dopaminergic properties
What adverse effect is a concern for a patient prescribed venlafaxine/Effexor?
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It can cause blood pressure increases which appear to be dose specific.
You have a patient on Luvox and theophylline. What adjustments should be made to the patient's dosages?
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The theophylline dosage should be lowered to prevent toxicity.
What substance may require a patient to be prescribed a larger than normal dose of an antidepressant like Luvox?
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Nicotine and/or caffeine. Smoking and caffeine can reduce the activity of the drug
What dosage adjustment should be made for a patient on a TCA and an SSRI?
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The TCA dosage should be reduced to prevent toxicity. Frequent blood monitoring is a priority.
What dosage adjustment should be made for a patient on an SSRI and a benzodiazepine?
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The benzodiazepine dosage should be reduced.
How long should a patient remain on an antidepressant if it was prescribed for a major depressive episode?
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The medication should continued at least 6-12 months after a patient achieves complete remission of the symptoms.
What medications classes of medications shouldn't be taken with St. John's Wort?
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Antidepressants, nasal decongestants, hay fever or asthma meds with monoamines, or amino acid supplements containing phenylalanine or tyrosine. Any of those combinations can cause HTN.
Who are candidates for ECT (electroconvulsive therapy)?
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Patients who are intolerant or unresponsive to traditional medicinal treatments or patients who are severely ill that require rapid treatment.
Who should NOT receive ECT to treat depression?
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Patients with increased intracranial pressure, recent hx of myocardial infarction, cerebrovascular accident, retinal detachment or a patient who has pheochromocytoma.
  
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