Keltner: Psychiatric Nursing, 7th Edition

Chapter 12: Introduction to Psychotropic Drugs

Answer Key - Critical Thinking Exercises

1. Some nurses might have little knowledge about some drugs they administer. Do
you consider this unethical, unprofessional, unsafe, or simply a reality of the nursing
profession? Because no one can know every drug, what basic information should a
nurse know before giving medication?

This question is a discussion point for the student.

2. As stated, most psychotropic drug interactions occur as a result of the effects on

the CYP-450 system. If an inhibitor of the CYP-450 3A4 enzyme is given (e.g.,
grapefruit juice), which psychotropic drugs would be affected? What is the effect?
(Refer to Box 12-2 to answer this question.)

If P450 3A4 is inhibited, the nurse can expect higher serum levels and thus a more
pronounced effect from drugs that are substrates of this enzyme. For example, the
antidepressants (e.g., sertraline and bupropion), antipsychotics (e.g., clozapine,
haloperidol, and quetiapine), and benzodiazepines (e.g., alprazolam and diazepam)
metabolized by 3A4 should have a more intense effect. See Table 12-2 for more drug
interactions.

3. Prozac has a half-life of approximately 10 days or longer (when including its

active metabolite, norfluoxetine). How long is the washout period? If a drug known to
interact with Prozac is to be given, how long should the interval be between stopping
Prozac and beginning the new drug?

Prozacs washout period would be 4 half-lives after the drug has been stopped. In the
case of Prozac, it would be about 6 to 8 weeks. The time interval to begin a drug that
interacts with Prozac would be the same length of time. If replacing another drug with
Prozac, the time interval is calculated by determining the washout period for the other
drug. For most drugs, this is much shorter than the washout period for Prozac.

4. In this chapter, we state that the nurse should use balance when giving
information to a patient about a drug. What is the balance between arousing unneeded
apprehension in a patient who is vulnerable to suggestion (i.e., giving complete
information) and treating that adult patient as a child (i.e., withholding information to

Copyright 2015, 2011, 2007, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Answer Key - Critical Thinking Exercises 12-2

protect the patient)?

In your role as student and later as nurse, you would not want to do either. This is a
tough question. Just like a cancer specialist wants to give hope, we should give hope
to our patients that a drug they are prescribed will be effective. Nonetheless, patients
need to be aware of serious side effects. Thus, in the authors opinion we need to lean
a little bit more to the side of giving information than the side of not scaring people.

Copyright 2015, 2011, 2007, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc.