ATI MENTAL HEALTH PROCTORED EXAM 2020/2021 Q&A REVIEW
Therapeutic uses for tricyclic antidepressants include , neuropathic pain, fibromyalgia, anxiety
... [Show More] disorders, insomnia, and bipolar disorder.
Depressive disorders
Anticholinergic effects of Tricyclic antidepressants dry mouth
blurred vision photophobia
urinary hesitancy or retention constipation
tachycardia
Sedation is an adverse effect usually diminishes over time when taking . tricyclic antidepressants (Amitripyline)
Advise the client to take at bedtime to minimize daytime sleepiness and to promote sleep.
tricyclic antidepressants (amitripyline/Elavil)
With give no more than 1 week supply of medication to client who are acutely ill due to the high risk of lethality with overdose.
tricyclic antidepressants (Amitripyline)
With tricyclic antidepressants (Amitripyline) monitor clients who have a seizure disorder because the seizure is decreased.
threshold
Clients will have an appetite with tricyclic antidepressants (amitripyline). Instruct the clients to weight weekly and encourage good nutrition/exercise.
increased
The use of TCAs with alcohol, benzodizepines, opioids, and can result in additive CNS depression.
antihistamines
SSRIs are a first line treatment for . depression
Complications with SSRIs for depression disorders Sexual Dysfunction
CNS stimulation: insomnia, agitation, anxiety Weight changes (initial loss then gain) Serotonin syndrome
Withdrawal syndrome
Hyponatremia esp in older adults on diuretics Rash
Sleepiness, faintness, lightheadedness GI bleeding
Bruxism esp c citalopram
Warn the client of possible sexual dysfunction and to notify the provider if they become intolerable when taking for depression disorders.
SSRIs
Inform the client that the provider can prescribe an atypical antidepressant instead of SSRIs with fewer sexual dysfunction adverse effects, such as .
bupropion.
CNS stimulation such as insomnia and agitation can occur when taking for depression. SSRIs
Weight loss early in therapy that can be followed by weight gain with long term treatment when taking
. SSRIs
Discontinue MAOIs 14 days prior to starting an . SSRI
(or before having surgery) MAOIs therapeutic uses depression
bulimia nervosa
first-line treatment for atypical depression
MAOIs can cause so monitor blood pressure and HR for orthostatic changes. orthostatic hypotension
crisis can occur with MAOIs when there is an intake of dietary tyramine (aged foods, cheeses, fava beans, wine, avocado)
hypertensive
When taking avoid taking OTC decongestants and cold remedies. MAOIs
This class of medications is used PRN for anxiety, but also for ETOH withdrawal, seizures, and as an adjunct for surgery/procedure
benzodiazepines
ETOH withdrawal: used for acute withdrawal, used for long-term maintenance chlordiazepoxide (Librium)
disulfiram (Antabuse) Teaching for disulfiram?
avoid all sources of ETOH, including mouthwashes, aftershave, Nyquil, vanilla extract (which seems a little OTT; as if a teaspoon of vanilla divided between 24 cookies and baked is going to do anything, but whatever: so saith ATI)
will continue to make you feel like hell for a couple weeks after d/c'ing, so don't think you can skip your dose that day to go party that night, you're going to have to plan ahead to fall off the wagon
don't mix benzos with...
- other CNS depressants like ETOH (can kill you)
- CNS stimulants like caffeine (kinda cancel each other out) benzos that can be administered IV
diazepam (Valium) lorazepam (Ativan)
benzo with short duration? lorazepam (Ativan)
benzo with highest risk of addiction? alprazolam (Xanax)
antidote to benzos flumazenil (Romazicon) benzo withdrawal s/s:
CNS excitation, from withdrawing the CNS depressant:
- anxiety
- insomnia
- diaphoresis
- tremor
- lightheaded
- seizures
this is why they're supposed to be short term if longer term, taper off [Show Less]