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Case Study

b. Fluoxetine has a stimulant effect and may interfere with sleep if taken close to bedtime. Therapeutic effects take 4–6 weeks.
a. If someone has an undiagnosed bipolar disorder, placing them on an antidepressant without a mood stabilizer can induce mania.

Review Questions

b. The drug blocks muscarinic receptors and causes anticholinergic effects. This results in reduced salivation (xerostomia), decreased peristalsis (constipation), and relaxation of the detrusor muscle, causing urinary retention.
b. Rapid, pressured speech is a classic sign of mania. If the drug level is considered subtherapeutic, this means it is not working favorably. The other options indicate the manic behavior is being well managed.
c. This demonstrates the child’s ability to remain focused on the task at hand.
c. The brain has to adapt to these types of drugs. Although a person can feel some benefit in 2 weeks, full effects can take 4–6 weeks. It is important to emphasize this to the client or else they will simply stop taking the drug.
b. Tremors, pseudoparkinsonism, and akinesia are extrapyramidal side effects that can occur with haloperidol.
d. Whole milk and aged cheeses are high in tyramine and therefore should be avoided.
c. Clozapine can cause a significant decrease in the neutrophil count, increasing the risk of infection. Also, abrupt discontinuation of clozapine can result in significant complications for client treatment. To ensure the client does not have a gap in the treatment, this is a modification to the REMS program.
c. This is a norepinephrine dopamine reuptake inhibitor. SSRIs, SNRIs, and MAOIs all cause some degree of sexual dysfunction.
a. Zolpidem is useful for initiating sleep (sleep latency) and ensuring the client stays asleep during the night.
a. Because this drug is a stimulant, it should not be taken near the evening or it will interrupt sleep.

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