Antidepressant, Antimanic & Anticonvulsant Review

Education for the patient who is taking an MAOI should include which of the following?

• Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity

• Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks

• Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment

• Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification

There is a very narrow margin between the therapeutic and toxic levels of lithium carbonate. Symptoms of toxicity are most likely to appear if the serum levels exceed which of the following levels?

• 0.15 mEq/L

• 1.5 mEq/L

• 15 mEq/L

• 150 mEq/L

Answer explanation

The therapeutic range for lithium is 0.5-1.5 mEq/L.

Initial symptoms of lithium toxicity include which of the following?

• Constipation, dry mouth

• Dizziness, thirst

• Vomiting, diarrhea

• Anuria, arrhythmias

Answer explanation

Symptoms of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, and vision changes.

Which statement below best describes the mechanism of action of how SSRIs work?

• "SSRIs inhibit the reuptake of GABA by blocking the reuptake of serotonin from the pre-synaptic neuron."

• "SSRIs enhance the reuptake of GABA by amplifying the action of the serotonin receptors found on the post-synaptic neuron."

• "SSRIs inhibit the reuptake of the neurotransmitter serotonin by the pre-synaptic neuron."

• "SSRIs enhance the reuptake of serotonin by the receptors on the post-synaptic neuron."

A nurse provides instructions to a client taking fluoxetine (Prozac) a selective serotonin reuptake inhibitors (SSRI) antidepressant. The nurse tells the client to take the medication:

• In the morning

• At lunchtime

• At dinnertime

• At bedtime

Answer explanation

SSRIs can cause insomnia thus should be taken in the morning.

A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent lithium toxicity:

• Avoid becoming dehydrated during exercise.

• Instruct the client to change positions slowly.

• Restrict salt intake in the diet.

• Limit fluid intake.

Answer explanation

Lithium toxicity usually occurs during chronic treatment because of reduced drug excretion (dehydration, worsening renal function, concurrent infections, and drug interactions).

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply.

• Antidepressants

• Anticonvulsants

• Anticholinergics

• Antispasmodics

Answer explanation

Antidepressants and anticonvulsants can be used to treat bipolar disorder.

Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do?

• Withhold the drug.

• Record the client’s response.

• Encourage the client to tell the doctor.

• Suggest that it takes a while before seeing the results.

Answer explanation

The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached.

Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include:

• Advising the client to watch the diet carefully.

• Suggesting that the client take the pills with milk.

• Reminding the client that a CBC must be done once a month.

• Encouraging the client to have blood levels checked as ordered.

Answer explanation

Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.

Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, “I will avoid:

• Citrus fruit, tuna, and yellow vegetables.

• Chocolate milk, aged cheese, and yogurt.

• Green leafy vegetables, chicken, and milk.

• Whole grains, red meats, and carbonated soda.

Answer explanation

These high-tyramine foods, when ingested in the presence of an MAOI, cause a severe hypertensive response. MAOIs prevent the breakdown of tyramine found in the body as well as certain foods, drinks, and other medications. Patients that take MAOIs and consume tyramine-containing foods or drinks will exhibit high serum tyramine level. A high level of tyramine can cause a sudden increase in blood pressure, called the tyramine pressor response. Even though it is rare, a high tyramine level can trigger a cerebral hemorrhage, which can even result in death.