Discussion Topics, Chapter 21, Antidepressant Agents

Discussion Topics

Learning Objective(s)

1. The clinical instructor has assigned a group of students to work with patients on a special nursing unit that treats women with postpartum depression. The instructor assigns the following questions as part of the preclinical preparation.

a. What is depression, and what is the current biogenic theory for the causes of depression?

b. Describe the actions of these classes of antidepressant in a single sentence.

• TCA

• MAO inhibitors

• SSRI

 

2. Ms. Jones has been taking MAO inhibitors for several weeks when she calls the clinic because she has developed a severe headache, heart palpitations, dilated pupils, tachycardia, chest pain, and sweating after attending a wine and cheese tasting event.

a. These symptoms are common in what adverse condition in patients taking MAO inhibitors? What type of immediate treatment is required?

b. What adverse drug-food interactions involving MAO inhibitors can occur?

 

3. Your neighbor calls you and begins to discuss her child's recent change in behavior. She states that he recently was started on the SSRI Fluoxetine (Prozac) for the treatment of depression. He is now less talkative and spending more time sleeping. She states that the dose may be too low.

a. How should you respond?

 

 

Discussion Topics, Chapter 22, Psychotherapeutic Agents

Discussion Topics

Learning Objective(s)

1. Juan Carlos, an 8-year-old, has received a diagnosis of attention deficit disorder and will be taking methylphenidate (Concerta) once a day. Juan Carlos' mother wants to know how methylphenidate works and how to give the medication.

a. Develop a teaching plan for Juan Carlos and his mother on the administration and use of methylphenidate.

b. What are the adverse reactions associated with methylphenidate (Concerta)?

c. How does methylphenidate (Concerta) act to improve concentration in children with attention deficit disorder?

 

2. Mrs. Smith is a 76-year-old who has been taking lithium for over 40 years to prevent manic episodes. She presents with a concern that she is feeling "high" and is concerned that her lithium level is low. Nursing assessment reveals that Mrs. Smith has been taking psyllium that was recommended as an alternative treatment for constipation.

a. What effects does psyllium have on patients taking lithium, and what patient teaching should be done?

b. Explain the adverse effects seen in patients with the following lithium levels.

• Serum level < 1.5 mEq/L

• Serum level 1.5 to 2 mEq/L

• Serum level 2 to 2.5 mEq/L

• Serum level > 2.5 mEq/L

 

 

Discussion Topics, Chapter 23, Antiseizure Agents

Discussion Topics

Learning Objective(s)

1. James is 5 years old and was diagnosed with new onset of tonic-clonic seizures. He will be sent home on Dilantin 240 mg PO b.i.d and Diastat 10 mg PR (rectal Valium) for breakthrough seizures.

a. What are the priority teaching needs for James and his parents?

b. How does Dilantin prevent seizures, and why is it a good choice for James?

c. What is Diastat (rectal Valium) and how should it be given?

 

2. Molly is seen in the clinic for routine blood levels to monitor her seizure medications. Her new boyfriend is accompanying her today. She is currently taking carbamazepine (Tegretol) 400 mg PO t.i.d and has recently started on Lamictal 250 mg PO b.i.d after developing breakthrough seizures on the maximum dose of Dilantin. During her exam, she admits to being sexually active with her boyfriend.

a. What teaching does Molly need concerning her medications and sexual activity?

b. Why would Lamictal be added to Molly's medications?

 

 

 

 Discussion Topics, Chapter 24, Antiparkinsonism Agents

Discussion Topics

Learning Objective(s)

1. Mr. Jones has received a diagnosis of Parkinson's disease and is going to start on the combination drug levodopa/carbidopa (Sinemet) and entacapone (Comtan). Mr. Jones and his wife are nervous and upset by this diagnosis and ask if the medications will cure the disease.

a. How would you explain Parkinson's disease and the role of medications in treating the disease to this couple?

b. How do levodopa/carbidopa (Sinemet) and entacapone (Comtan) help patients with Parkinson's disease?

 

2. Mr. Lin has been on Thioridazine, which is a phenothiazine. He has now developed drug-induced parkinsonism and will be started on biperiden (Akineton). He is very concerned that this new medication will "cause me more problems."

a. What are the risks of a drug-drug interaction between Thioridazine and biperiden?

b. How will biperiden (Akineton) affect/improve Mr. Lin's symptoms?

 

 

 Discussion Topics, Chapter 25, Muscle Relaxants

Discussion Topics

Learning Objective(s)

1. Mr. Smith is a 35-year-old recreational bicyclist who has been diagnosed with a severe muscle tearing of the right ankle after a wreck while riding. He is being sent home with a splint and a prescription for cyclobenzaprine (Flexeril) and ibuprofen (an NSAID).

a. How will the cyclobenzaprine and ibuprofen work to help Mr. Smith's ankle injury heal?

b. What other measures can be taken to help alleviate the muscle spasms and pain from Mr. Smith's injury?

c. In one sentence, explain the difference between muscle spasm and muscle spasticity.

 

2. Mrs. Jones presented to the ALS (amyotrophic lateral sclerosis) clinic for a routine follow-up visit. She reports that the spasticity in her legs has increased and is worse at night. The health care provider prescribes dantrolene (Dantrium) to help improve those symptoms.

a. Mrs. Jones is currently taking birth control pills that contain estrogen for relief of premenstrual syndrome. What are the drug-drug interaction concerns with this combination, and what action should the nurse take?

b. What is the difference between the muscle relaxants dantrolene and baclofen?

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