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71 Cards in this Set
- Front
- Back
when treating children/adolescents, parents should understand that pharmacological management is most effective when accompanied by _____________ |
techniques to modify behavior |
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what are the type of meds used to treat children/adolescents with mental health issues? |
1. TCAs 2. antipsychotics 3. nonbarbiturate/atypical anxiolytics 4. CNS stimulants 5. norepinephrine selective reuptake inhibitors |
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name the CNS stimulants and their co rresponding short-acting, intermediate-acting, or long-acting brands |
1. methylphenidate (short: Ritalin, Methylin; intermediate: Ritalin SR, Methylin ER; long-acting Ritalin LA, Concerta, Daytrana) 2. dexmethylphenidate (short: Focelin; long: Focalin XR) 3. dextroamphetamine (short: Dexedrine; long: Dexedrine spansule) 4. amphetamine mixture (short: Adderall; long: Adderall XR) 5. lisdexamfetamine dimesylate (long: Vyvanse) |
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MOA of CNS stimulants |
raise levels of norepinephrine, serotonin, and dopamine into the CNS |
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what are the therapeutic uses of CNS stimulants |
1. ADHD 2. Conduct disorder |
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what are the adverse effects of CNS stimulants? |
1. CNS stimulation 2. weight loss 3. cardiovascular effects 4. development of psychotic manifestations 5. withdrawal reaction 6. hypersensitivity skin reaction to transdermal methylphenidate |
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how is methylphenidate normall administered? |
transdermal patch |
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what are the adverse CNS stimulation effects of CNS stimulants? |
insomnia, restlessness |
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what are the cardiovascular effects of CNS stimulants? |
dysrhythmias, chest pain, high BP; may increase risk of sudden death in clients who have heart abnormalities |
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what are the adverse psychotic manifestations of CNS stimulants? |
hallucinations, paranoia |
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what manifestations occur with a hypersensitivity reaction due to transdermal methylphenidate? |
hives, papules |
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what are the nursing interventions for the adverse effects of CNS stimulants? |
1. cns stimulation -> effects and notify, adminster last dose before 4 pm 2. weight loss -> monitor weight and compare to baseline height/weight; admin med immediately before or after meals; promote good nutrition in children; encourage children to eat at regular meal times and avoid unhealthy foods for snacks 3. cardiovascular effects -- monitor vital signs and ECG; effects notify 4. psychotic manifestations --report manifestations immediately and discontinue med 5. withdrawal -- advise not stop taking med suddenly, doing so may lead to depressions and severe fatigue 6. hypersensitivity -- remove patch and notify provider |
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what are the contraindications for CNS stimulants? |
clients who have a history of substance use disorder, cardiovascular disorders, severe anxiety, and psychosis |
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med/food interactions of CNS stimulants and corresponding nursing interventions |
1. with MAOIs can cause hypertensive crisis -- avoid concurrent use 2. with caffeine may increase CNS stimulant effects -- avoid food with caffeine 3. methylphenidate inhibits metabolism of phenytoin (Dilantin), warfarin (Coumadin) and phenobarbital leading to increased serum levels -- monitor for adverse effects (CNS depression, indications of bleeding); with these meds with caution 4. OTC cold and decongestant meds with sympathomimetic action can increase CNS stimulant effects -- instruct clients to avoid use of OTC meds |
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when taking sustained-release tablets who, what should you advise client to do? |
to not chew or crush the tablets |
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when using the transdermal med Daytrana, what should you advise the client to do? |
place patch on one hip daily in morning and leave it in place no longer than 9 hr.; alternate hips daily |
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which medication cures ADHD? |
no medication can cure ADHD; management is with an overall treatment plan of family therapy, cognitive therapy etc |
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what does federal law dictate about CNS stimulants? |
special handling procedures -- handwritten prescriptions are required for med refills |
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CNS stimulants have a high potential for _____ |
substance use disorder, especially in adolescents |
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nursing evaluation for CNS stimulants |
1. improvement of ADHD manifestations such as increased ability to focus and complete tasks, interact with peers and manage impulsivity 2. improved ability to stay awake |
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what is the select norepinephrine selective reuptake inhibitor? |
atomoxetine (Strattera) |
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atomoxetine |
Strattera |
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MOA of norepinephrine selective reuptake inhibitor (NSRI) |
blocks reuptake of norepinephrine at synapses in the CNS, atomoxetine is not a stimulant medication |
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what are the therapeutic uses of norepinephrine selective reuptake inhibitors? |
ADHD |
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what are the adverse effects/nursing interventions of atomoxetine? |
***atomoxetine is usually tolerated well 1. appetite suppression, weight loss, growth suppression (monitor weight and compare baseline height/weight); administer med right before meals; encourage children to eat at regular meal times and avoid unhealthy food/snacks 2. GI effects (nausea vomiting) -- advise client to take food if these occur 3. suicidal ideation (in children/adolescents) -- monitor for indications of depression, advise client to report change in mood, excessive sleeping, agitation, and irritability 4. hepatotoxicity -- advise to report indications of liver damage |
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what are the indications of liver damage from hepatotoxicity from atomoxetine? |
flu-like manifestations, yellowing skin, abdomnial pain |
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us atomoxetine (Strattera) cautiously in clients who _______ |
have cardiovascular disorders |
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med/food interactions of atomoxetine (Strattera) plus nursing interventions |
1. concurrent use of MAOIs may cause hypertensive crisis -- avoid concurrent use 2. Paroxetine (Paxil), fluoxetine (Prozac) or quinidine gluconate (Quinidine duratabs) inhibit hepatic metabolizing enzymes, thereby increasing levels of atomoxetine -- teach about symptoms of increased atomoxetine, dosage of atomoxetine may need ot be altered |
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nursing administration for atomoxetine (Strattera)/norepinephrine selective reuptake inhibitors |
1. note changes in child's behavior related to dosing and timing of med 2. administer med in daily dose in the morning or in two divided doses, morning and afternoon with or without food 3. instruct clients that therapeutic effects may take at 1 to 3 weeks to fully develop |
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nursing evaluation of atomoxetine (Strattera)/norepinephrine selective reuptake inhibitors |
1. improvement of manifestations of ADHD such as increase in ability to focus and complete tasks, interact with peers, and manage impulsivity |
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name the tricyclic antidepressants (TCAs) for children and adolescents with mental health issues |
1. desipramine (Norpramin) 2. imipramine (Tofranil) 3. clomipramine (Anafranil) |
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desipramine |
Norpramin |
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imipramine |
Tofranil |
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MOA of TCAs |
block reuptake of the monoamine neurotransmitters norepinephrine and serotonin in the synaptic space, thereby intensifying the effects that these neurotransmitters produce |
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therapeutic uses in children for TCAs |
1. depression 2. autism spectrum disorder 3. ADHD 4. panic, school phobia, separation anxiety disorder 5. OCD |
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what are the dverse effects of desipramine (Norpramin) |
1. orthostatic hypotension 2. anticholinergic effects 3. weight gain 4. sedation 5. toxicity 6. decreased seizure threshold 7. excessive sweating |
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what are the adverse anticholinergic effects of desipramine (Norpramin) |
dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia |
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define the type of toxicity that can arise as an adverse effect of desipramine (Norpramin) |
toxicity resulting in cholinergic blockade and cardiac toxicity EVB dysrhythmias, mental confusion and agitation followed by seizures and coma |
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nursing interventions for adverse effects of desipramine (Norpramin) |
1. orthostatic hypotension -- monitor BP with first dose, instruct client to change positions slowly 2. anticholinergic effects -- to minimize anticholinergic effects... a. chewing sugarless gum b. sipping on water c. avoiding hazardous activities d. wearing sunglasses when outdoors e. eating food high in fiber f. participating in regular exercise g. increasing fluid intake to at least 2 to 3 L/day from beverages or food sources h. voiding just before taking med (advise of manifestations/notify provider if) 3. weight gain -- monitor cleint weight, encourage regular exercise/follow healthy, low-calorie diet 4. sedation -- advise adverse effects diminish over time, avoid hazardous activities such as driving, take at bedtime to minimized daytime sleepiness and to promote sleep 5. toxicity -- give acutely ill clients a 1 week supply of medication, obtain clients baseline ECG, monitor vital signs frequently, monitor/notify 6. seizure threshold -- monitor clients who have seizure disorders 7. sweating -- inform of effect/change bed linens |
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use desipramine (Norpramin) cautiously in clients who have _________ |
seizure disorders, diabetes, liver, kidney/respiratory disorders, and hyperthyroidism |
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med/food interactions of desipramine (Norpramin) plus nursing interventions |
1. concurrent use of MAOIs cause hypertension 2. antihistamines and other anticholinergic agents have additive anticholinergic effects 3. TCAs bock uptake of epinephrine and norepi (direct-acting smpathomimetics) in the synaptic space, leading to decreased intensity of their effects 4. TCAs inhibit uptake of ephedrine and amphetamine (indirect-acting sympathomimetics) and reduce their ability to get to the site of action in the nerve terminal, leading to decreased responses to these meds 5. alochol benzodiazepines, opiods, and antihistamines cause additive CNS depression when used concurrently -- avoid CNS depressants |
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nursing administration of desipramine (Norpramin)/norepinephrine selective reuptake inhibitors |
1. instruct to take as prescribed on daily basis 2. may take 1 to 3 weeks to experience effects, 2 to 3 months for full effects 3. sudden discontinuation can result in relapse 4. give only a week's worth of med at a time for an acutely ill client |
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nursing evaluation of medication effectiveness for norepinephrine selective reuptake inhibitors/desipramine (Norpramin) |
1. depression -- verbalizing improvement in mood, improved sleeping/eating habits, increased interaction with peers 2. autism spectrum disorder -- decreased anger and compulsive behavior 3. ADHD -- less hyperacitivity, greater ability to pay attention |
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name the alpha2-adrenergic agonists for children and adolescents with mental health issues |
1. guanfacine (Intuniv) 2. clonidine (Kapvay) |
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MOA of alpha2-adrenergic agonists |
not completely understood however known to activate presynaptic alpha2-adrenergic receptors within the brain |
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what are the therapeutic uses of alpha2-adrenergic agonists? |
1. ADHD |
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what are the adverse effects of guanfacine (Intuniv) plus nursing interventions |
1. CNS effects -- monitor, notify, avoid hazardous activities 2. cardiovascular effects -- monitor BP and pulse especially during initial treatment, advise client not to abruptly discontinue medication which can cause rebound hypertension 3. weight gain -- monitor weight, regular exercise/healthy diet |
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what are the adverse CNS effects of guanfacine (Intuniv) |
sedation, drowsiness, fatigue |
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what are the adverse cardiovascular effects of guanfacine (Intuniv) |
hypotension, bradycardia |
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extended-release clonidine is contraindicated for which clients |
children less than 6 years old |
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which alpha2-adrenergic agonist is contraindicated for children less than 6 years old |
extended-release clonidine |
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use alpha2-adrenergic agonists cautiously with which clients? |
those who have cardiac disease |
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med/food interactions of guanfacine (Intuniv) plus nursing interventions |
1. CNS depressant like alcohol can increase CNS effects -- avoid use 2. antihypertensives can worsen hypotension -- avoid use 3. foods with high-fat content will increase guanfacine absorption -- avoid taking meds with high-fat meal |
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nursing administration for alpha2-adrenergic agonists in children and adolescents with mental health issues |
1. asses use of alcohol/CNS depressant especially in adolescents 2. instruct not to chew/crush/split extended release preparations 3. monitor BP and pulse at baseline with initial treatment and each dosage changes 4. advise to avoid abrupt discontinuation can result in rebound hypertension, med should be tapered to discontinue |
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nursing evaluation for alpha2-adrenergic agonists in children and adolescents with mental health issues |
1. improvemnt of ADHD manifestations wuch as increase in ability to focus and complete tasks, interact with peers and manage impulsivity |
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name the antipsychotics (atypical) to treat children/adolescents with ,mental health issues |
1. risperidone (Risperdal) 2. olanzapine (Zyprexa) |
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MOA of atypical antipsychotics for children/adolescents with mental health issues |
block serotonin and to a lesser degree dopamine receptors; meds block receptors for norepi, histamine, and acetylcholine |
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therapeutic uses for atypical antipsychotics for children/adolescents with mental health issues |
1. autism spectrum disorder 2. conduct disorder 3. PTSD 4. relief of psychotic manifestations |
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adverse effects of atypical antipsychotics for children/adolescents with mental health issues |
1. new onset of diabetes or loss of glucose control in clients who have diabetes 2. weight gain 3. hypercholesterolemia 4. orthostatic hypotension 5. anticholinergic effects 6. agitation, dizziness, sedation, and sleep disruption 7. may cause mild extrapyramidal adverse effects such as tremor |
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hypercholesterolemia as an adverse result from atypical antipsychotics for children/adolescents can increase risk for _________ |
hypertension and other cardiovascular diseases |
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what are the adverse anticholinergic effects of atypical antipsychotics/risperidone (Risperdal) for children/adolescents |
urinary hesitancy or retention, dry mouth |
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nursing interventions for the adverse effects of risperidone (Risperdal) for children/adolescents |
1. diabetes -- baseline fasting blood glucose and monitor throughout, instruct to report indications liek increased thirst, urination and appetite 2. weight gain -- diet/exercise, monitor weight 3. hypercholesterolemia -- monitor cholesterol, triglycerides, and blood glucose if weight gain is more than 14 kg (30lbs) 4. orthostatic hypotension -- monitor BP with first dose, instruct client to change positions slowly 5. anticholinergic effects -- monitor/notify; encourage client to use measures to relieve dry mouth such as sipping fluids 6. agitation etc -- monitor/notify, administer an alternative medication if prescribed 7. exrapyramidal adverse effects -- monitor/teach to recognize, ***usually dose related |
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what should the nurse be aware of when an child/adolescent client is taking atypical antipsychotics? |
use of alcohol, especially with adolescents |
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uses atypical antipsychotics cautiously in clients with _________ |
cardiovascular disease, seizures, DM (obtain baseline fasting glucose for DM clients and monitor carefully) |
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med/food interactions of risperidone (Risperdal)/atypical antipsychotics plus nursing interventions |
1. alcohol opioids and antihistamines cause additive CNS depressant effects -- avoid use, avoid hazardous effects 2. levodopa activates dopamine receptors and counteracts effects of antipsychotics -- avoid use of levodopa and other direct dopamine receptor agonists 3. TCAs, amiodarone (Cordarone) and clarithromycin (Biaxin) prolong QT interval and increase risk of cardiac dysrhythmias -- avoid concurrent use 4. barbiturates and phenytoin (Dilantin) promote hepatic drug-metabolizing enzymes, thereby decreasing drug levels of quetiapine -- monitor med effectiveness 5. medications that inhibit CYP3A4 such as fluconazole (Diflucan) inhibit hepatic drug-metabolizing enzymes thereby increasing drug levels of aripiprazole, quetiapine, and ziprasidone -- monitor adverse effects |
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what medication inhibits CYP3A4 |
fluconazole (Diflucan) |
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which atypical antipsychotic are affected if CYP3A4 is inhibited? inhibition of CYP3A4 causes what? the affected atypical antipyschotics, what happens to them? |
1. aripiprazole, quetiapine, and ziprasidone 2. causes inhibition of hepatic drug-metabolizing enzymes 3. increased drug levels |
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what forms does risperidone (Risperdal) come in? |
oral solution and quick-dissolving tablets |
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which forms does olanzapine (Zyprexa) come in? |
orally disintegrating tablet for ease in administration |
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how is dosage done for atypical antipsychotics for children/adolescents? |
intially low doses are given and then gradually increased |
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nursing evaluation of atypical antipsychotics for children/adolescents |
1. autism spectrum disorder: reduction of hyperactivity and improvement in mood 2. conduct disorder -- decrease in aggresiveness 3. PTSD -- decrease in aggresiveness and reduction of flashbacks, improvement of psychosis (prevention of acute psychotic manifestations and absence of hallucinations, delusions, anxiety and hostility); improvement in ability to perform ADLs; improvement in ability to interact socially with peers 6. improvement of sleeping and eating habits |