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Teaching strategies for clients on antidepressants
Take medication as prescribed, compliance is important; full effectiveness may not be evident until 1 to 2 weeks after start of therapy; encourage to keep appointments; do not consume alcohol or CNS depressants because of their addictive effects; many herbal products interact with antidepressants, esp MAOIs and SSRIs; do not drive or be involved in potentially dangerous mechanical activity until stabilization of the drug dose has been est; do not abruptly dc the drug, should be gradually decreased; consult with prescriber if planning pregnancy; and take with food if upsets GI
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Food interaction with MAOIs
- Following foods may cause a hypertensive crisis: cheese, bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, italian green beans, liver, yeast, and soy sauce.
- Increased blood pressure may result from an increased intake of brewer's yeast
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Anxiolytics (antianxiety drugs)
Used to treat anxiety, insomnia (short-term), seizures and status epilepticus, alcohol withdrawal, skeletal muscle spasms, and as a preop med.
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Common side effects of anxiolytics
Sedation, diziness, headaches, dry mouth, blurred vision, rare urinary incontinence and constipation
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Adverse reactions of anxiolytics
- Leukopenia (decreased WBC count) with syptoms of fever, malaise, and sore throat
- Tolerance to the drug dosage with continuous use
- Physical dependency.
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To dc use of anxiolytics
Should be gradually decreased over a period of days depending on dose or length of time on the drug. Withdrawal symptoms include: paranoia, delirium, panic, hypertension, and status epilepticus.
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Nonpharmacoligic methods for dealing with anxiety
Relaxation technique, psychotherapy, or support groups.
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Contraindications for anxiolytic therapy
- Increases CNS depression with consumption of alcohol, CNS depressants, and anticonvulsants;
- Cimetidine increases lorazepam plasma levels, increases phenytoin levels;
- Decreases levodopa effects;smoking decreases antianxiety effects.
- Kava kava my potentiate sedation.
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Antidote for benzodiazepine
flumazeni (Romazicon) IV
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Therapeutic safety range for lithium therapy
- 0.5 to 1.5 mEq/L
- Serum levels above 1.5 to 2 are toxic.
- (Should be monitored biweekly until therapeutic level has been obtained, and then monthly on a maintenance dose.)
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Necessary lab values for clients on lithium therapy
Lithium serum level as well as sodium levels as lithium tends to deplete sodium
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Signs of lithium toxicity
- Early symptoms: diarrhea, drowsiness, loss of appetite, muscle weakness, nausea, vomiting, slurred speach, trembling
- Late symptoms: blurred vision, confusion, increased urination, convulsions, severe trembling, and unsteadiness.
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Drug interactions with lithium therapy
Diuretics, NSAIDs, tetracyclinldopa, and probenecid decrease renal clearance of lithium, causing drug accumulation.
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Dietary guidelines for clients on lithium
- Client should avoid caffeine products because they can aggravate the manic phase of bipolar.
- The client also needs to maintain adequated sodium intake
- Avoid crash diets that affect the physical and mental health.
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Teaching for Client on lithium therapy
Take med as prescribed; must be compliant with dosage, lab tests, and follow-up visits; check with health care provider before taking OTC meds; should not drive or operate heavy machinary until stable lithium level is established; advise to maintain adequate fluid intake (2 to 3 L/d initially and then 1 to 2 L/d maintenance and should be increased in hot weather); take med with meals to decrease gastric irritation; effectiveness may not be evident until 1 to 2 weeks after the start of therapy; client planning pregnancy should contact health care provider; should wear or carry ID tag or bracelet to indicate the drug taken.
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