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Standards and Consid

From ANCC Review

ethical and legal considerations make accurate diagnosis and identify target symptoms. phase of illness is important determine prior personal and family history of response to certain drugs consider risk to benefit ratio monitor response and side effects document
these things are important to document informed consent patients understanding of target symptoms benefits risks alternatives
Prescribing should be done in accordance with state and federal regulations and based on clinical indicators
Monitoring includes that the effect of the medication is evaluated by target symptom remission
Managing includes this provides information on risks, benefits and adverse effects, treat SE when necessary
Evaluating includes this evaluate therapeutic and potential adverse effects of medication. Make changes in treatment based on evidence.
Pharmocologic Interventions includes Prescribing Monitoring Managing Evaluating
Pediatric diagnoses can be atypical, constantly changing and unusually comorbid with other psychiatric disorders
With kids be aware of this psychosocial aspects related to drug taking
Hepatic capacity, glomerular filtration and fatty tissue for children greater hepatic capacity more GFR less fatty tissue
Kids are less able to store drugs in fat so they have quicker elimination and shorter half lives
Lithium and anticonvulsants in kids may take longer to work and are not effective
Most malformations in pregnancy occur during this period embryotic period
the embryotic period occurs at 3rd to 8th week of gestation
positive pregnancy tests are possible at weeks 4-7 may be past window of teratogenic risk
No behavioral toxicity found in children exposed to this prenatally fluoxetine
Depakote in pregnancy leads to neural tube defects
Lithium in pregnancy leads to Epstein's Anomaly
Epstein's Anomaly is congenital defect displacing tricuspid valve
these may be safer than mood stabilizers atypical antipsychotics but they are not well studied
To prevent 1st trimester exposure, recommend this birth control
Recommend to pregnant women avoid substances of abuse encourage iron and folate
During 3rd semester, consider this antidepressant prophylaxis against postpartum depression in women with a history of depression
This antidepressant is Preganancy Category D
Question to ask with tx of women what are you using for birth control
These psychotropics are secreted in breast milk ALL OF THEM
Postpartum time period is within 4 weeks of delivery
Postpartum time is a high risk time for onset or relapse of psychiatric illnesses
Postpartum: NPs should watch for and consider watch for psychosis: risk of harm consider impact of untreated illness on maternal infant attachment
These medications are good for use with postmenopausal women Estrogen replacement plus SSRI or SNRI effective for maintenance and prevention of recurrence of depression Menopause is another risk period
Why are geriatric patients susceptible to adverse effects cardiovascular disease and reduced cardiac output can affect both renal and hepatic drug clearance lower cholinergenic output results in an increased risk for anticholinergic toxicity
Which risks are the highest for geriatric pts cardiovascular risks - increases risk when using drugs with cardiovascular effects - TCAs, increased risk of orthostatic hypotension and falls
Consider this for elderly More susceptible to adverse effects metabolize drugs more slowly and require lower doses have other medical problems and therefore potential drug interactions
Why do elderly people need lower doses and metabolize drugs slowly lean body mass decreases and body fat increases lipid soluble psych drugs are distributed more widely in fat tissue so the drugs action can be unexpectedly prolonged
Elderly people may have GI issues GI disease and decreased gastric acid secretion may slow absorption
Hypertensive crisis in elderly is associated with MAOI and tyramine ingestion
This is used with to treat hypertensive crisis phentolamine (Regitine) alpha adrenergic blocker
Created by: jonquil