Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)?
- A. Avoid foods and beverages that contain tyramine.
- B. Monitor the patient for extrapyramidal symptoms.
- C. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
- D. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.
- E. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision.
- F. Cogentin is often also prescribed to reduce the adverse effects that may occur.
Correct Answer: C,D
Rationale: During SSRI therapy, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.
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The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants?
- A. SSRIs have fewer sexual side effects.
- B. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions.
- C. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
- D. SSRIs cause a therapeutic response faster than tricyclic antidepressants.
Correct Answer: C
Rationale: Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.
Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class?
- A. Aspirin
- B. Warfarin
- C. Diuretics
- D. Nonsteroidal anti-inflammatory drugs
Correct Answer: B
Rationale: Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed.
A patient has been taking lithium for 1 year, and the most recent lithium level is 0.5 mEq/L. What concern will the nurse have, if any?
- A. The level is too low, indicating a subtherapeutic dose.
- B. The level is within the therapeutic range.
- C. The level is too high, indicating a toxic dose.
- D. No concerns, as lithium levels do not need monitoring.
Correct Answer: A
Rationale: Therapeutic lithium levels are typically between 0.6 and 1.2 mEq/L for maintenance therapy. A level of 0.5 mEq/L is subtherapeutic, which may reduce the effectiveness of the treatment. Monitoring lithium levels is critical due to its narrow therapeutic index.
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern?
- A. Hypertension
- B. Renal failure
- C. Cardiac dysrhythmias
- D. Gastrointestinal bleeding
Correct Answer: C
Rationale: Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines?
- A. I can't sleep at night
- B. I feel hungry all the time.
- C. Look at how red my hands are.
- D. My mouth has been so dry lately.
Correct Answer: D
Rationale: Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.
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