NURS6550 / NURS 6550 Final Exam Review (Latest 2021): Advanced Practice Care of Adults in Acute Care Settings I - Walden

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NURS 6550 Advanced Practice Care of Adults in Acute Care Settings I Final Exam Review NURS 6550 - Advanced Practice Care of Adults in Acute Care Settings I NURS 6550 Final Exam Review ... PSYCHOLOGICAL HEALTH CONDITIONS Phone Question: Anxiety treatment – all patients can have anxiety attacks * What would you do if current treatment is not working, what is the second step? TREATMENT: 1. First Line: SSRI are the recommended first-line drugs for treatment of anxiety based on strength of evidence and acceptable tolerability. • Start at low dose and titrate to effective dose • Switch medications or add adjunctive agents if not effective after 4-6 weeks at optimal dose • Continue medications for at least 12 months before tapering dose • EX: Paroxetine, Sertraline, Escitalopram, 2. Second Line: Strength of evidence is sometimes very high for alternative treatments, but tolerability/ side-effects/concerns regarding abuse potential preclude them from first line • Serotonin-Norepinephrine Reuptake Inhibitors: Venlafaxine (Effexor) ▪ Excellent first-line agent with good efficacy, and generally well tolerated in Anxiety Disorder Duloxetine (Cymbalta) ▪ Has not been evaluated for use in Generalized Anxiety Disorder • Benzodiazepines are best limited to short-term Anxiety Management • Consider in severe anxiety while bridging to long-term strategies (e.g. SNRI and CBT) • Long-term use risks dependency and abuse . Short-acting Benzodiazepines Lorazepam (Ativan) ▪ Indicated when a Benzodiazepine cannot be avoided in the elderly or with decreased Creatinine Clearance Avoid Alprazolam ▪ Higher risk of abuse and withdrawal (rapid onset, short half-life) • Long Acting Benzodiazepines o Clonazepam (Klonopin) ▪ Less abused than the shorter acting agents (but still, abuse is common) • Tricyclic antidepressants: increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter restoring the balance in these neurotransmitters in the brain o Ex. imipramine (II), Amitriptyline • MAOI’s (3rd line treatment -
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