NR 606 Week 2 Questions and Answers

NR 606 Week 2 Questions and Answers Valproic Acid Valproic acid and its derivatives can cause leukopenia, thrombocytopenia, and hepatotoxicity. Monitor CBC and LFTs every 3 months for 1 year and then annually. Lithium Lithium has a narrow therapeutic index and should be monitored carefully. Serum levels should be evaluated 5 days after any dosage change and regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and thyroid function should be evaluated every 6 months. Carbamazepine (Tegretol) Carbamazepine can cause blood dyscrasias, hepatotoxicity, and renal failure. Oder a CBC, LFT, and renal function every 3 months for 1 year and then annually. Atypical antipsychotics Atypical antipsychotics can cause increased blood glucose and an increased risk of developing DM II. Measure HbA1C every 3 months for 1 year and then annually. Certain medications, such as Clozapine, may cause blood dyscrasias and CBC should be monitored closely. Lithium Action - alters cation transport in the nerve and muscle Indication - euphoric mania, rapid cycling, maintenance therapy Adverse Effects - GI Effects, tremor, polyuria Prescribing Pearls - Monitor plasma levels. Reduce dose in clients with renal failure. Use caution with concurrent diuretics. Use to protect against suicide. Lamotrigine (Lamictal) Action - affects sodium channel ion transport and enhances the activity of y-aminobutyric acid (GABA) Indication - maintenance therapy, monotherapy for bipolar disorder Adverse Effects - benign rash, GI effects, dizziness, headache Prescribing Pearls - This drug is equal in efficacy to lithium. Educate clients and assess for rash at each visit. Ten percent of rashes are benign. There is a risk for rare Stevens-Johnson Syndrome rash and multi-organ failure. Take at bedtime due to sedation side effect. Valproic Acid Action - affects ion transport and enhances the activity of y-aminobutyric acid (GABA) Indication - acute mania, mixed mood, comorbid substance use, multiple prior episodes Adverse Effects - GI effects, weight gain Prescribing Pearls - This drug is equal to lithium. Monitor plasma levels. If using with lamotrigine decrease valproate levels by 50%. Second Generation Antipsychotics Action - DA, NE, and 5-HT receptor antagonists Indication - acute bipolar depression, acute manic or mixed episodes, bipolar maintenance/adjunct Adverse Effects - weight gain, sedation, GI effects Prescribing Pearls - Indications vary with each medication. Check for monotherapy vs. adjunct indication. Monitor for extrapyramidal effects. XR form may improve adherence. Monthly injection may improve adherence. Select second generation antipsychotics first to decrease risk of side effects and long-term adverse effects. Carbemazepine (Tegretol) Action - glutamate voltage gated sodium and calcium channel blocker (Glu-CB) Indication - acute mania, mixed mood Adverse Effects - GI effects, sedation, hyponatremia, neutropenia, rash (Stevens-Johnson Syndrome) Prescribing Pearls - Monitor plasma levels. Consider genotyping clients with Asian ancestry; the HLA-B 2501 allele increases risk of Steven-Johnson Syndrome. Selective Serotonin Reuptake Inhibitors (SSRIs) -Action: inhibits the reuptake of serotonin -Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline -Common Side Effects: nausea, agitation, headache, and sexual dysfunction Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) -Action: inhibits the reuptake of serotonin and norepinephrine -Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine -Common Side Effects: nausea, sweating, insomnia, tremors, sexual dysfunction Tricyclic Antidepressants (TCAs) -Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors -Examples: amitriptyline, clomipramine, desipramine, doxepin -Common Side Effects: dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction Monoamine Oxidase Inhibitors (MAOIs) -Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it -Examples: isocarboxazid, phenelzine, tranylcypromine -Common Side Effects: sedation, dizziness, sexual dysfunction, and hypertensive crisis Prefrontal cortex Increased activity - anxiety Decreased activity - depression