Wednesday, January 13, 2021

Chapter 15: antidepressant drugs

A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will
signi cantly increase the availability of which neurotransmitter
a. GAB
b. Glutamat
c. Serotoni
d. Norepinephrin
d. Norepinephrin

Secondary amines increase the availability and enhance the action of norepinephrine

Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression and
insomnia. Bene ts speci c to use of nortriptyline would include
a. regular bowel movements
b. improved sleep pattern
c. weight loss
d. anhedonia
b. improved sleep pattern

Nortriptyline is a secondary amine with a good side effect pro le. It has a minimal tendency to
cause orthostatic hypotension, meaning the risk of falls is low. It is somewhat sedating, which is
helpful to patients with insomnia. The other options are either undesirable or nonspeci c
outcomes

Priority assessments for a patient beginning amitriptyline (Elavil) include

a. nausea, diarrhea, and irritability
b. seizures, agranulocytosis, and insomnia
c. headache, sexual dysfunction, and weight loss
d. history of falls, arrhythmias, and blurred vision
d. history of falls, arrhythmias, and blurred vision

Tricyclic antidepressants (TCAs) produce anticholinergic (blurred vision) and antiadrenergic

(orthostatic hypotension leading to falls and arrhythmias) side effects. Gastrointestinal
symptoms, sexual dysfunction, and weight variations are related to selective serotonin reuptake
inhibitor (SSRI) therapy. Seizures are seen with bupropion therapy. Agranulocytosis is not
considered a major problem with any of the groups of antidepressants

A 75-year-old patient with a long history of depression begins amitriptyline (Elavil) 100 mg/day.
The patient also takes a diuretic daily for hypertension. The highest priority nursing diagnosis is
risk for
a. falls related to dizziness and orthostatic hypotension
b. ineffective thermoregulation related to anhidrosis
c. infection related to suppressed white blood cell count

1
fi
:

fi
e

fi
.

fi
?

fi
 Wednesday, January 13, 2021
d. constipation related to slowed peristalsis
a. falls related to dizziness and orthostatic hypotension

Amitriptyline is a TCA that has a high risk of producing orthostatic hypotension. The patient is
placed at even greater risk because of older age and diuretic therapy, which reduces uid volume.
The other options are either unassociated or are remote possibilities

A depressed patient prepares for discharge. The patient is prescribed desipramine (Norpramin)
and will have outpatient visits. The patient reports, "They gave me only a 1-week supply of my
medicine." Select the nurse's best reply
a. "Federal law limits the amount you may be given at any one time.
b. "It will save you money if the drug doesn't work well for your symptoms.
c. "This is a way of ensuring that you will come in for your follow-up appointment.
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety.
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety.

Desipramine is an activating antidepressant, and it might provide a patient who has suicidal
ideation with the energy to make an attempt. Because the therapeutic dose and lethal dose are not
widely separated, TCA overdose is an often-used suicide plan. Because desipramine appears to
be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug in
a suicide attempt. The other options are either less relevant or incorrect

Evaluation of a patient's response after 1 week of tricyclic antidepressant therapy would be

expected to show
a. no change in objective or subjective symptoms
b. increased appetite and weight gain
c. decreased suicidal ideation
d. improved mood and affect
b. increased appetite and weight gain

Improved appetite might be caused by the antihistaminic effect of the drug. Improvement in
mood might not occur for 2 to 4 weeks. Suicidal ideation might not improve for 2 to 4 weeks

A patient diagnosed with depression who has reported vague suicidal ideation will stay at home,
have close family supervision, and make weekly visits to the health care provider. Bupropion
(Wellbutrin) is prescribed. What is the bene t of bupropion in this scenario
a. It has antianxiety properties as well as antidepressant effects
b. It lowers the seizure threshold to a lesser extent than TCAs
c. There is reduced potential for lethal overdose
d. It stimulates appetite and weight gain
c. There is reduced potential for lethal overdose

Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment
of depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or

2
:

fi
.

"

"

"

fl
"

"

 Wednesday, January 13, 2021

monoamine oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures,
anorexia, and weight loss

A patient with depression has taken an SSRI for 1 month. The nurse should use direct questions
to evaluate which potential side effect
a. Aggressive impulse
b. Sexual dysfunctio
c. Paranoid delusion
d. Weight gai
b. Sexual dysfunctio

SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses
about anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in
reporting sexual problems. The nurse might need to ask directly to elicit this information.
Patients are more willing to discuss the other options

A patient prescribed uoxetine (Prozac) is being changed to tranylcypromine (Parnate). The

nurse schedules a time lapse between the last dose of uoxetine and the rst dose of
tranylcypromine of at least
a. 7 days
b. 14 days
c. 3 weeks
d. 6 weeks
d. 6 weeks

Drugs that have a high probability for serious interactions (e.g., MAOIs) will need to be withheld
for up to 6 weeks or more as uoxetine is washing out of the system. The remaining options are
too short an interval

A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him
impotent. The nurse can be most helpful by saying
a. "Your doctor wants you to continue taking your medication.
b. "Have you talked with your therapist regarding your feelings about sex?
c. "Let's talk with your doctor. Changing your medication might be a possibility.
d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks.
c. "Let's talk with your doctor. Changing your medication might be a possibility.

SSRIs commonly cause sexual dysfunction. Sertraline is a widely marketed SSRI and was the
second drug of this class to be used in the United States. Sertraline can also be given once daily
(morning or evening) with or without food. Sertraline causes sexual dysfunction in men and
women. Sexual function typically returns to normal 2 to 3 days after drug cessation. Changing to
another type of antidepressant or adding bupropion in small doses can be helpful. The other
options are not compassionate or therapeutic

3
.

fl
s

fl
?

fl
"

fi
"

"

"

"

 Wednesday, January 13, 2021

A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him
impotent. The nurse can be most helpful by saying
A TCA is prescribed for a patient newly diagnosed with depression. What information should be
included in patient teaching
a. "Take this medication on an empty stomach.
b. "Do not eat aged cheese while using this medication.
c. "You might experience sweating, tremors, and excessive urination.
d. "It might be 2 weeks or more before you notice the effects of this medicine.
d. "It might be 2 weeks or more before you notice the effects of this medicine.

Antidepressant effects might take several weeks to be noticeable. Avoidance of tyramine (as is
present in aged cheeses) is necessary for MAOI therapy but not for TCAs. It is not necessary to
take TCAs on an empty stomach. Sweating, tremors, and urination problems are not commonly
experienced with TCA therapy

Patients taking TCAs exhibit more side effects than patients taking SSRIs, because TCAs
a. inhibit reuptake of norepinephrine and serotonin
b. selectively inhibit dopamine reuptake
c. selectively block serotonin uptake
d. block enzymatic breakdown
a. inhibit reuptake of norepinephrine and serotonin

TCAs inhibit the reuptake of both norepinephrine and serotonin and because of their
nonselectivity produce many side effects. The other options are incorrect statements about the
action of TCAs

The nurse cares for four patients receiving SSRIs. Which assessment nding warrants the nurse's
priority attention
a. Dry mouth and stuffy nos
b. Malaise and frontal headach
c. Confusion, agitation, and hyperthermi
d. Constipation, photophobia, and anhidrosi
c. Confusion, agitation, and hyperthermi

The correct response suggests serotonin syndrome, an acute medical problem requiring
immediate medical and nursing attention. The distracters are examples of anticholinergic effects
and are not considered emergencies

When teaching about the MAOI tranylcypromine (Parnate), the nurse should consider it a
priority to
a. provide a list of tyramine-rich foods
b. instruct the patient to avoid direct sunlight
c. advise the patient to manage fever with acetaminophen

4
:

"

"

"

fi
"

"

 Wednesday, January 13, 2021

d. direct the patient to report dry mouth and blurred vision
a. provide a list of tyramine-rich foods

MAOIs and ingested tyramine interact to produce hypertensive crisis, a life-threatening medical
emergency, so it is necessary to teach the patient foods to avoid. The other options are unrelated
to tranylcypromine therapy

A patient for whom phenelzine (Nardil) is prescribed complains of a sudden headache and
palpitations. The nurse observes dilated pupils and diaphoresis. The nurse's rst action should be
a. assess for cogwheel rigidity
b. notify the health care provider
c. assess the patient's blood pressure
d. withhold the morning dose of phenelzine
c. assess the patient's blood pressure

The patient's symptoms are suggestive of hypertensive crisis. It is vital to know whether or not
the blood pressure is elevated, so obtaining the blood pressure is the necessary rst action. The
most probable reason for the reaction would be drug-food interaction. The nurse may notify the
health care provider and withhold the morning dose as subsequent actions. Cogwheel rigidity is
associated with antipsychotic medications

What is the nurse's highest priority when caring for a patient after a TCA overdose
a. Frequently monitor blood pressure and heart rate/rhythm
b. Monitor for skin rashes, particularly on the torso
c. Measure and record intake and output every 12 hours
d. Institute cooling blankets for hyperthermia
a. Frequently monitor blood pressure and heart rate/rhythm

It is necessary to assess cardiovascular function, because cardiovascular reactions can occur

suddenly, even several days after the TCA overdose, and can result in acute heart failure. The
other options are not as closely aligned with cardiovascular problems

The nurse's priority assessment for a patient taking an antidepressant medication is for the
presence of
a. suicidal ideation
b. antiadrenergic side effects
c. anticholinergic side effects
d. symptoms of sexual dysfunction
a. suicidal ideation

Antidepressant medication tends to energize depressed patients, possibly giving them the
impetus to act on suicidal ideation that has been present related to the depression. This
complication is particularly applicable to adolescents. Some suggest that suicidal ideation might
be the actual result of antidepressant therapy. In either case the implication for nursing is clear:
patients should be carefully assessed for the presence of suicidal ideation, suicidal plans, and

5
:

fi
fi
?

 Wednesday, January 13, 2021

means for carrying out the plans. This option is related to patient safety and takes priority over
the other options

A pregnant patient took SSRI antidepressants during the third trimester of pregnancy. The
newborn will be carefully assessed for neonatal
a. temperature dysregulation
b. serotonin syndrome
c. seizure disorder
d. diabetes
b. serotonin syndrome

The neonate whose mother has received SSRIs might experience respiratory depression,
hypoglycemia, tremor, and low birth weight as part of neonatal serotonin syndrome. The disorder
normally is resolved within 2 weeks of birth. The other options are not usually seen as a result of
in utero exposure to SSRIs

A nurse teaches a patient taking an MAOI antidepressant about important dietary guidelines.
Which nutritional choices by the patient indicate that the teaching was effective? Select all that
apply
a. Sausag
b. Avocado
c. Pork chop
d. Strawberrie
e. Chocolate chip cookie
c. Pork chop
d. Strawberrie

The patient must avoid foods high in tyramine so as to prevent a hypertensive crisis. Sausage,
avocados, and chocolate contain signi cant amounts of tyramine

6
.

fi
: