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89 Cards in this Set
- Front
- Back
what are the 4 main groups of antidepressants? |
1) SSRIs (Selective serotonin inhibitors)
2) Atypical antidepressants 3) Tricylic antidepressants (TCAs) 4) MAOIs (monoamine oxidase inhibitors) |
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when a depressive client is admitted to the hospital and before the therapeutic effects have taken place what does the nurse want to do? |
put client on suicide watch |
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what are the SSRIs used to treat depressive disorders? |
1) fluoxetine (Prozac) 2) citalopram (Celexa) 3) escitalopram (Lexapro) 4) paroxetine (Paxil) 5) sertraline (Zoloft) 6) vilazodone (Viibryd) |
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Citalopram |
Celexa |
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cilazodone |
Viibryd |
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therapeutic uses of fluoxetine |
major depression, OCD, bulimia nervosa, premenstrual dysphoric disorders (PMDD), panic disorders, postraumatic stress disorder |
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what are the adverse effects of fluoxetine? |
1) sexual dysfunction 2) CNS stimulation 3) weight loss early in treatment, possible weight gain late in treatment 4) serotonin syndrome 5) withdrawal syndrome 6) hyponatremia 7) rash 8) sleepiness, faintness, lightheadedness 9) GI bleeding 10) bruxism |
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what are the symptoms of the adverse effects CNS stimulation when taking fluoxetine? |
inability to sleep, agitation, anxiety |
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what are the nursing interventions for the adverse effects of fluoxetine? |
1. sexual dysfunction -- inform of effects and tell provider, can manage sexual dysfunction through lower dosage, med holiday, and using adjunct medications 2) cns stimulation -- notify provider dose made need to be lowered, take dose in morning, advise against caffeinated drinks, teach relaxation techniques to promote sleep 3) weight changes -- monitor weight, regular exercise and healthy diet 4) serotonin syndrome -- observe for manifestations, notify provider and withhold med 5) withdrawal syndrome -- taper dose 6) hyponatremia -- baseline, monitor 7) rash -- treatable with antihistamine or withdrawal of med 8) sleepiness etc -- advise not common but can occur, advise avoid driving/heavy machinery 9) GI bleeding -- hx of GI problems/taking coagulant meds 10) bruxism -- report to provider, mouth guard, change or add low dose buspirone |
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What Pregnacy Risk Category are most SSRIs? which 2 increase the risk of birth defects? late in pregnancy what can SSRIs do? |
C; fluoxetine and paroxetine; increases risk of withdrawal symptoms or pulmonary hypertension in the newborn |
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when taking fluoxetine with __________, risk of serotonin syndrome is increased |
MAOIs, TCAs, and St. John's wort |
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fluoxetine can increase levels of __________ |
TCAs and lithium |
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med/food interactions of fluoxetine |
1. MAOIs, TCAs, and St. John's wort increases risk of serotonin syndrome 2. fluoxetine can displace warfarin from bound proteins resulting in increased warfarin levels 3. fluoxetine can increase levels of TCAs and lithium 4. fluoxetine can supress platelet aggregation and increase risk of bleeding when used with NSAIDs or anticoagulants |
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if fluoxetine is given with warfarin (Coumadin) what are nursing interventions? |
monitor the client's PT (prothrombin time) and INR (international normalized ratio) levels; asess for indications of bleeing and need for dosage adjustment |
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how long should an MAOI be discontinued before starting an SSRI? |
14 days |
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how long should the client wait to start taking an MAOI when on fluoxetine? |
5 weeks |
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what is the selected prototype medication for atypical antidepressants? |
bupropion HCL (Wellbutrin) |
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bupropion HCL |
Wellbutrin |
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MOA of bupropion HCL (Wellbutrin) |
not fully understood, likely inhibits dopamine uptake |
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therapeutic usess of bupropion HCL (Wellbutrin) |
depression treatment, alternative to SSRI for clients unable to tolerate sexual dysfunction side effects of SSRIs, aid to quit smoking, prevention of seasonal pattern depression |
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which meds can aid with the adverse effect of fluoxetine that causes exual dysfunction |
sildenafil (Viagra) and buspirone (BuSpar), also bupropion (Wellbutrin) is an antidepressant with fewer sexual side effects |
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sildenafil |
Viagra |
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adverse effects of bupropion HCL (Wellbutrin) |
1. headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, and insomnia 2. supresses appetite and often causes weight loss 3. seizures |
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nursing interventions for the adverse effects of buproprion HCL (Wellbutrin) |
1. headache etc -- observe for effects, notify physician, treat headache with mild analgesic, advise to sip on fluids to treat dry mouth and increase dietary fiber to prevent constipation 2. supressed appetite/weight loss -- monitor weight/food intake 3. seizures -- avoid admnistering to clients at risk for seizures such as a client whose had a head injury, monitor for seizures/treat accordingly |
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buproprion HCL (Wellbutrin) is a Pregnancy Risk Category ______ |
B |
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buproprion HCL (Wellbutrin) is contraindicated in clients taking ______ (how do they interact, what is the nursing intervention) |
MAOIs; MAOIs such as phenelzine increase the risk of toxicity; MAOI should be discontinued 2 weeks prior to beginning treatment with bupropion |
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duloxetine |
Cymbalta |
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mirtazapine |
Remeron |
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reboxetine |
Edronax |
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trazadone |
Desyrel |
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what are the atypical antidepressants for depressive disorders? |
1. venlafaxine (Effexor) 2. duloxetine (Cymbalta) 3. mirtazapine (Remeron) 4. reboxetine (Edronax) 5. trazodone (Desyrel) |
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MOA of venlafaxine (Effexor) and duloxetine (Cymbalta) |
inhibit serotonin and norepinephrine reuptake thereby increasing amount of neurotransmitters available in brain for impulse transmission; also minimal amount of dopamine blockade |
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MOA of mirtazapine (Remeron) |
increases release of serotonin and norepinephrine and thereby increases amount available for impulse transmission |
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MOA of reboxetine (Edronax) |
selectively inhibits reuptake of norepi increasing amount available for impulse transmission |
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MOA of trazodone (Desyrel) |
moderate selective blockade of serotonin receptors which allows more serotonin to be available for impulse transmission |
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adverse effects symptoms for venlafaxine (Effexor) and duloxetine (Cymbalta) |
headache, nausea, agitation, anxiety, and sleep disturbances |
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nursing implication for venlafaxine (Effexor) and duloxetine (Cymbalta) |
1) inform of adverse effects 2) monitor for hyponatremia especially in older adults 3) monitor for weight loss 4) discuss way to manage interference with sexual functioning 5) advise not to discontinue abruptly |
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nursing implications of mirtazapine (Remeron) |
1) therapeutic effects may occur sooner with less sexual dysfunction than SSRIs 2) mirtazapine generally well tolerated, may experience sleepiness that can be exacerbated by other CNS depressants (alcohol, benzodiazepines), weight gain, elevated cholesterol |
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nursing implications of reboxetine (Edronax) |
1. similar results as SSRIs 2. generally well tolerated but may experience adverse effects 3. weight gain and sleepiness do not occur 4. med should not be combined with MAOI |
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adverse effects of reboxetine (Edronax) |
dry mouth, decreased BP, constipation, sexual dysfunction, urinary hesitancy/retention |
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nursing implications of trazodone (Desyrel) |
1) usually used with another antidepressant, sedation is a potential problem, may be indicated for a client who has insomnia caused by an SSRI 2) priapism is a potential adverse effect, instruct to seeks immediate medical advice |
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priapism |
when erect penis does not return to flaccid state |
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name the TCAs (tricyclic antidepressants) for depressive disorders |
1. amitriptyline (Elavil) 2. imipramine (Togranil) 3. Doxepin (Sinequan) 3. nortiptyline (Aventyl) 4. amoxapine (Asendin) 5. trimipramine (Surmontil) |
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what is the MOA of amitriptyline (Elavil) |
blocks reuptake of norepi and serotonin in the synaptic space, thereby intensifying effects of neurotransmitters |
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what are the therapeutic uses of amitriptyline (Elavil) |
depression, depressive episodes of bipolar disorders |
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what are the adverse effects of amitriptyline (Elavil)? |
1. othostatic tension 2. anticholinergic effects 3. sedation 4. toxicity 5. decreased seizure threshold 6. excessive sweating |
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what are the anticholinergic effects of amitriptyline (Elavil) |
dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation, tachycardia |
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toxicity as a result of amitriptyline when treating depressive disorder can result in _____ EVB ___________ |
result in cholinergic blockade and cardiac toxicity as evidenced by dysrhythmias, mental confusion and agitation (followed by seizures, coma and possible death) |
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nursing implications for the adverse effect orthostatic hypotension of amitriptyline when treating a depressive disorder |
1. orthostatic hypotension -- instruct about effects of postural hypotension (lightheadedness, dizziness)l if occur advise client to sit or lie down, ortho hypo is minimized by changing position slowly 2. monitor BP and HR for clients in hospital for orthostatic changes before admin and 1 hour after; significant decrease in BP or increase in HR means don't admin and notify provider |
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nursing implications for the adverse effect anticholinergic effects of amitriptyline when treating a depressive disorder |
ways to minimized anticholinergic effects 1. chewing sugarless gum 2. sipping on water 3. wearing sunglasses when outdoors 4. eating foods high in fiber 5. participating in regular exercise 6. increasing fluid intake to at least 2 to 3L a day from beverages and food sources 7. voiding just before taking medication (notify provider if persists) |
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nursing implications for the adverse effects sedation, toxicity, decreased seizure threshold, excessive sweating of amitriptyline when treating a depressive disorder |
1. sedation -- effect usually diminishes over time, advise to avoid hazardous activities like driving/heavy machinery, advise to take at bedtime to minimize daytime sleepiness/promote sleep 2. toxicity -- obtain clients' baseline ECG, monitor vitals and signs of toxicity, notify provider 3. decreased seizure threshold -- monitor clients with seizure disorders 4. excessive sweating -- change linens frequently |
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TCAs are Pregnancy Risk Category _________ |
C |
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use amitriptyline (TCAs?) cautiously in clients who have __________________ |
coronary artery disease, diabetes, liver/kidney/respiratory disorders, urinary retention/obstruction, angle-closure glaucoma, benign prostatic hyperplasia, and hyperthyroidism |
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when using amitriptyline (TCAs?) with a client with an increased risk for suicide, what is important to know |
should receive a 1-week supply of medication at a time due to the lethality of overdose |
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TCAs contraindicated for patients with ________ disorders |
seizure |
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med/food interactions of amitriptyline (Elavil) when treating depressive disorders |
1. MAO/St. Jonh's wort (increased serotonin syndrome) 2. antihistamines/other anticholinergic agents have additive anticholinergic effects 3. increased effects of epi and dopamine (direct-acting sympathomimetics) because uptake into nerve terminal blocked by TCA and remain longer in synaptic space 4. TCAs decrease effects of ephedrine, aphetamine (indirect-acting sympathomimetics) because uptake into nerve terminals is blocked and are unable to reach site of action 5. aclohol, benzodiazepines, and antihistamines caused additive CNS depression |
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name the MAOIs (monoamine oxidase inhibitors) |
1) phenelzine (Nardil) 2) isocarboxazid (Marplan) 3) tranylcypromine (Parnate) 4) selegiline (Emsam) |
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phenelzine |
Nardil |
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isocarboxazid |
Marplan |
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tranylcypromine |
Parnate |
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selegiline |
Emsam |
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how is selegiline (Emsam) administered? |
transdermally |
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MOA of MAOIs |
bloack MAO in the brain increasing amount of norepi, dopamine, and serotonin available for transmission so impulses; increased amount of these neurotrans at nerve endings intensifies responses and relieves depression |
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therapuetic uses of phenelzine (Nardil)/MAOs |
depression, bulimia |
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adverse effects of phenelzine (Nardil) when treating depressive disorders |
1. CNS stimulation 2. orthostatic hypotension 3. hypertensive crisis resulting from intake of dietary tyramine 4. local rash with transdermal preparation |
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how does a hypertensive crisis result as an adverse effect of phenelzine (Nardil)? what occurs in the body? what are the symptoms? |
intake of dietary tyramine; severe hypertension as a result of intensive vasoconstriction and stimulation of the heart; client experience headache, nausea, increased HR and BP |
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nursing interventions for adverse effects of phenelzine (Nardil) when treating depressive disorders |
1. cns stimulation -- advise of effects/notify provider 2. orthostatic hypotension -- monitor BP and HR, hold med and notify provider of changes, client change positions slowly 3. hypertensive crisis -- administer phentolamine (Regitine) IV which is a rapid-acting alpha-adrenergic blocker or administer nifedipine (Procardia) SL (sublingual) ; provide continuous cardiac monitoring and respiratory support as indicated 4. rash -- choose clean, dry area for application, apply a topical glucocorticoid on the affected area |
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MAOIs are Pregnancy Risk Category _____ |
C |
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MAOIs are contraindicated in clients who ___________ |
are taking SSRIs, have pheochromocytoma, heart failure, cardiovascular/cerebral vascular disease, and severe renal insufficiency |
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use MAOIs cautiously in clients who ________ |
have diabetes, seizure disorders, or taking TCAs |
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transdermal selegiline is contraindicated in clients who are taking _____ (why?) |
are taking carbamazepine (Tegretol) or oxcarbazepine (Trileptal) which may increase blood levels of MAOIs |
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what are the symptoms of CNS stimulation by phenelzine (Nardil)? |
anxiety, agitation, mania or hypomania |
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med/food interactions of phenelzine (Nardil) |
1. indirect-cating sympathomimetic meds (ephedrine, amphetamine) which promote release of norepi and leads to hypertensive crisis 2.TCAs -> hypertensive crisis 3. SSRIs -> serotonin syndrome 4. antihypertensives -> additive hypotensive effect 5. meperidine (Demerol) -> hyperpyrexia 6. tyramine-rich foods -> hypertensive crisis 7. concurrent use of vasopressors (phenylethylamine, caffeine) -> hypertension |
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nursing interventions for med/food interactions of phenelzine (Nardil) |
1. indirect-acting sympathomimetic meds -> instruct to acoid OTC decongestants and cold remedies which frequently contain drugs with sympathomimetic action 2. TCAs - use cautiously concurrently 3. SSRIs -> avoid concurrent use 4. antihypertensives -> monitor BP, notify provider if BP drops significantly, reduced dosage of antihypertensive may happen 5. meperidine (Demerol) -- alternative analgesic 6. tyramine-rich foods -- assess ability to follow diet, inform client of manifestations to notify provider, provide with written instructions regarding foods/drinks to avoid, advise to avoid taking ANY meds/herbals without provider's approval 7. vasopressors - advise client to avoid foods with these agents |
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which foods are rich in tyramine |
aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine |
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which foods are rich with vasopressors |
caffeinated beverges, chocolate, fava beans, ginseng |
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what are two types of vasopressors |
caffein, phenylethylamine |
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phentolamine |
Regitine |
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nifedipine |
Procardia |
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first therapeutic effects of MAOIs can take up to ________ to onset; full therapeutic effects can take up to how long? |
1-3 weeks; 2-3 months |
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remember about MAOIs..... |
take as prescribed on daily basis to establish therapeutic plasma levels, don't discontinue when effects reached as can result in relapse |
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therapy with MAOIs can continue for _________ months after resolution of symptoms and may continue for ____________ |
6 months, a year or longer |
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asses clients for risk of _______ when taking MAOIs b/c _________ |
suicide, antidepressant meds can increase client's risk for suicide particularly during initial treatment |
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antidepressant-induced suicide is mainly associated with clients younger than age ________ |
25 |
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overview nursing administration (3 things) for SSRIs |
1. advise to take med in morning to minimize sleep disturbances 2. advise client to take meds with food to minimize GI disturbances 3. obtain baseline sodium levels for older clients taking diuretic, monitor periodically |
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overview nursing admin (2 things) for atypical antidepressants |
1. AVOID use with MAOIs 2. advise clients taking bupropion for prevention of seasonal pattern depression to take med beginning in autumn each year and gradually taper dose to discontinue in spring |
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overview nursing admin (2 things) for TCAs |
1. monitor toxicity manifested by cardiac dysrhythmias 2. administer at bedtime due to sedation and risk for orthostatic hypotension |
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overview nursing admin (2 things) for MAOIs |
1. give client list of tyramine-rich food so hypertensive crises can be avoided 2. advise to avoid taking other prescription/nonprescription drugs unless approved by provider |
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Nursing eval of medication effectiveness of treatments for depressive disorders |
1. verbalizing improvement in mood 2. ability to perform ADLs 3. improved sleeping and eating habits 4. increased interaction with peers |