Chapter 20 Psychotropic Medications, Alcohol, and Drug Abuse

Any substance that acts on the mind is referred to as a ___________

psychotropic

The stimulant medication used to treat neonatal apnea is caffeine _____________

citrate

For clients who are pregnant, consumption of food, beverages, and medications containing ____________ should be avoided or limited.

caffeine

Strattera is a selective norepinephrine reuptake inhibitor and the first ___________ , noncontrolled drug approved for the treatment of ADHD

nonstimulant

You should not chew or crush __________-release tablets.

sustained

Depression can result from the deficiency of the neurotransmitters norephinephrine, dopamine, and _______________

serotonin

Clients for whom tricyclics are prescribed should be informed that it will be 2- ____ weeks before these medications are fully active.

4

The monoamine oxidase inhibitors are usually reserved for use with clients who have __________ or atypical depression.

refractory

Selective serotonin reuptake inhibitors (SSRIs) may take from 1 to __ weeks before clients experience symptomatic relief.

4

Clients who have __________ disorder should be carefully monitored if they take selective serotonin reuptake inhibitors (SSRIs).

bipolar

Clients who take lithium must have serum levels drawn initially and every few _______ to ensure therapeutic levels are maintained.

months

Anxiolytics are useful for the short-term treatment of _________ disorders, some psychosomatic disorders, insomnia, and alcohol withdrawal.

anxiety

The MOST serious side effect of midazolam (Versed) is depressed ___________

respirations

Clients receiving antipsychotic medications should be assessed for tardive dyskinesia when treatment is started and at least every ___ month(s).

6

Tardive dyskinesia may become ________ and irreversible

permanent

When Mike talked with his physician, she mentioned that there is a stimulant given for shift-work sleep disorder which she stated testing had shown Mike to suffer from. What stimulant is the physician most likely to prescribe?

a. Cafcit

b. Ritalin

c. Adderall

d. Provigil

d

Vyvanse

lisdexamfetamine

Cafcit

caffeine citrate

Provigil

modafinil

Adderall

amphetamine mixtures

Maria's physician is likely to prescribe ___________

BuSpar

Ativan

Lorazepam

Valium

Diazepam

Vistaril

Hydroxyzine

BuSpar

Buspirone

xanax

Alprazolam

Spine, skunk, fake weed

synthetic cannabinoids

THC

active agent in marijuana

Pseudoephedrine

OTC agent used to make illegal meth

Lysergic acid

active ingredient in a powerful hallucinogen

Crystal, ecstasy, crank

illegally produced amphetamines

A teenage client who is obese visits her health care provider's office for her annual physical exam. While the health care practitioner is taking the client's blood pressure and collecting pertinent data, the client asks about the use of Ritalin, a CNS stimulant, for weight loss. How can the health care practitioner BEST respond to her question?

a. Ritalin is a CNS depressant and may cause fatigue.

b. Going on a diet is an obvious remedy.

c. Ritalin is the most frequently recommended medication for weight loss.

d. While Ritalin may decrease the appetite, it is not recommended, because it can lead to physical and psychological dependence.

d

A young client was recently started on Ritalin LA, a CNS stimulant, for treatment of attention deficit/hyperactivity disorder (ADHD). His mother tells the health care practitioner that she is concerned because her son has had difficulty sleeping after he started taking the medication. What information can the health care practitioner share with her?

a. Insomnia may be a side effect from the methylphenidate and is sometimes remedied by taking the medication, as prescribed, early in the day.

b. You can try cutting the pill in half and giving half the dosage instead of the whole pill.

c. There is no need to report this, as it is an expected side effect.

d. Parents of children with ADHD need to be strict and set firm limits by enforcing an early bedtime.

a

A health care practitioner is educating a client about the side effects of atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor (SNRI) for ADHD. What are some side effects of SNRIs?

a. Dry mouth, reduced appetite, fatigue, and dyspepsia

b. Blurred vision, headache, and dizziness

c. Nervousness, insomnia, and irritability

d. Habituation and possibility of dependence with prolonged use

a

A client with depression was started on fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI). After one month, she reports that her mood has improved. The client asks the health care practitioner if she can stop taking the medication now that she is feeling better. How should the health care practitioner respond?

a. Clients should expect to continue antidepressant therapy for the rest of their lives.

b. There is no need to continue antidepressant therapy after symptoms are ameliorated.

c. It is generally advisable to counsel clients to continue antidepressant therapy for 6 to 12 months to prevent relapse.

d. Clients should be advised to continue antidepressant therapy for 6 to 12 weeks after symptoms have improved.

c

A client with severe depression is placed on imipramine (Tofranil), a tricyclic antidepressant (TCA), after a careful history of suicidal ideation has been ruled out. When educating the client about the side effects of tricyclics, what anticholinergic side effects should the health care practitioner discuss?

a. Anorexia, weight loss, and alopecia

b. Blurred vision, dryness of the mouth, and urinary retention

c. Nausea, vomiting, and diarrhea

d. Drooling, lactation, and urinary frequency

b

A client has been prescribed phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI), for depression. What foods should the client avoid?

a. Foods containing fiber, such as whole grains, nuts, and celery

b. Foods containing tyramine, such as pickled herring, wine, salami, and cheese

c. Foods containing iron, such as almonds, spinach, and kale

d. Foods containing sugar, such as cookies, cake, and candy

b

What potentially lethal side effect can occur if the client consumes foods containing tyramine, tryptophan, or tryptamine while taking an MAOI?

a. Postural hypotension

b. Orthostatic hypotension

c. Hyperthyroidism

d. Hypertensive crisis

d

A young adult male client recently started sertraline (Zoloft), a SSRI for depression. He returns to the clinic for his one-month follow-up visit. When the health care practitioner asks him how he is doing, he responds that he cannot take the medication anymore because it "is not good" for him and refuses to explain in more detail upon further questioning. Of the known side effects of SSRIs, which side effect might the health care practitioner consider exploring further?

a. Insomnia

b. Anorexia

c. Anxiety

d. Sexual dysfunction

d

A client with the manic type of bipolar disorder is taking lithium carbonate. What advice should the health care practitioner give her client about taking lithium?

a. Avoid foods that contain vitamin B.

b. Take medication only when symptoms occur.

c. Watch for signs of dependency and habituation.

d. Comply with routine blood level monitoring.

d

A client is admitted to the hospital with a reported history of taking diazepam (Valium), a benzodiazepine, for the treatment of anxiety. What should the attending health care practitioner be aware of regarding diazepam?

a. Diazepam has a short half-life and can be stopped abruptly without residual effects.

b. Sudden withdrawal after prolonged use can result in seizures.

c. The client can bring his or her own supply of diazepam from home and take it as needed.

d. Diazepam has little potential for dependence and does not require monitoring.

b

An older adult client's daughter expresses concern to the health care practitioner that her mother went to the emergency room with symptoms of dementia-related psychosis and was treated with antipsychotic medication. She asks the health care practitioner if the medication is safe. How should the health care practitioner respond?

a. Antipsychotic medications are not FDA approved for the treatment of clients with dementia-related psychosis.

b. Antipsychotic medication is the gold standard treatment for dementia-related psychosis.

c. The Alzheimer's Society highly recommends the use of antipsychotics for dementia-related psychosis.

d. No research studies exist supporting or denying the safety of using antipsychotics for dementia-related psychosis.

a

Clients receiving antipsychotic medications should be assessed for tardive dyskinesia (TD) at the start of treatment and at least every six months with which of the following tools?

a. Wong-Baker Pain Scale

b. Falls risk assessment

c. Abnormal Involuntary Movement Scale (AIMS)

d. Spiritual assessment tool

c

A client is started on ziprasidone (Geodon), an antipsychotic, for the treatment of schizophrenia. The health care practitioner has ordered a baseline electrocardiogram (EKG) prior to starting the medication. The client asks the health care practitioner why this test is being ordered. Which of the following responses is BEST?

a. EKGs are ordered to assess brain activity prior to starting any antipsychotics.

b. The EKG will enhance the efficacy of ziprasidone.

c. An EKG has been ordered to rule out psychoneurosis.

d. When taking ziprasidone, there is a greater risk of cardiac disorders; therefore, a baseline test of cardiac function is indicated.

d

A client with refractory treatment of chronic schizophrenia has been treated with many antipsychotic medications with little effect. The treatment team has made a decision to start the client on clozapine (Clozaril), an atypical antipsychotic. What information should the health care practitioner share with the client regarding clozapine?

a. Dryness of the mouth is a common side effect.

b. It is important to remain in a supine position for a half-hour after taking the medication.

c. There is a potential for psychological dependence with prolonged use.

d. The white blood count (WBC) requires close monitoring due to the rare side effect of developing agranulocytosis.

d

A client admitted to the hospital for schizophrenia has recently started taking quetiapine (Seroquel), an atypical antipsychotic. As with many antipsychotic medications, what should the health care practitioner educate the client about?

a. Take with food to avoid GI upset.

b. Quetiapine may cause insomnia if taken at night.

c. Avoid grapefruit juice, as it may potentiate the effects of the medication.

d. Rise slowly because of the potential for orthostatic hypotension.

d

A health care practitioner is trying to convince her client that mood-altering substances are dangerous to the client and others around her. Which of the following mood-altering substances accounts for nearly 100,000 deaths per year and is directly responsible for more than half of traffic accidents (one-third of all U.S. fatalities)?

a. Crack/cocaine

b. Alcohol

c. Heroin

d. Marijuana

b

A young adult male client arrives at the clinic and the health care practitioner notices that his breath smells of alcohol, his skin is cold and clammy, and he appears to be in a stupor. His friend reports that they were at the park celebrating his 21st birthday. The health care practitioner reports this to the physician and knows that these symptoms could be signs of what?

a. Noncompliance with medication

b. Alcohol poisoning

c. Fatigue

d. Myocardial infarction

b

A client receiving treatment at an intensive inpatient rehabilitation program for alcoholism is placed on disulfiram (Antabuse). What should the health care practitioner explain to the client about taking disulfiram in conjunction with alcohol as part of a behavior modification program?

a. The client is at a greater risk of having a child with fetal alcohol syndrome (FAS) if she drinks while taking disulfiram.

b. Delirium tremens (DTs) may occur if even the smallest amount of alcohol is ingested.

c. Disulfiram is a controlled substance and can potentiate the effects of alcohol when consumed together.

d. Expect an unpleasant reaction (e.g., headache, vomiting), if even a small amount of alcohol is ingested.

d

A client's spouse calls the clinic with concerns that the client may be taking amphetamines. The spouse asks the health care practitioner what signs and symptoms to look for with amphetamine use. What are some signs of amphetamine intoxication that the health care practitioner can share with the client's spouse?

a. Social withdrawal and decreased appetite

b. Conjunctivitis or yellowing of skin

c. Increased pain tolerance

d. Increased social activity and increased appetite

a

A health care practitioner frequently comes to work late exhibiting poor hygiene and has been increasingly irritable and argumentative with the staff and clients. In addition, her pupils appear to be pinned (constricted) and when approached, she seems confused. The staff suspect substance abuse. What is their responsibility regarding her behavior?

a. Cover for the impaired health care practitioner by giving her a lighter duty, so that she does not place clients in danger.

b. Recognize drug abuse, and report any observed drug abuse to the proper individual in authority.

c. Ensure safety by seeing that the health care practitioner is fired, as she may be incompetent to treat the client while impaired.

d. Try to talk to the health care practitioner to determine whether something is causing increased stress in her life.

b