Seizures - hold drug and report immediately.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client with treatment-resistant depression is started on bupropion. Which condition in the client's history would be a contraindication the nurse should report?
Answer: B. Bupropion lowers the seizure threshold and is contraindicated in clients with a seizure disorder or in those with eating disorders such as bulimia or anorexia (due to electrolyte risk). Mild hypertension, controlled diabetes, and seasonal allergies are not contraindications to bupropion.
Question 2 of 4
A client is started on bupropion for depression. Which item in the client's history is a contraindication the nurse should report?
Answer: A. Bupropion lowers the seizure threshold and is contraindicated in clients with a seizure disorder, as well as in those with bulimia or anorexia (electrolyte risk) and those undergoing abrupt alcohol/sedative withdrawal. A history of seizures is the key contraindication to report.
Question 3 of 4
A client taking bupropion for depression and smoking cessation should be monitored for which dose-related adverse effect?
Answer: B. Bupropion lowers the seizure threshold, and the risk of seizures rises with higher doses. It is contraindicated in clients with a seizure disorder, eating disorders such as bulimia or anorexia, or those undergoing abrupt alcohol or sedative withdrawal.
Question 4 of 4
A client taking an SSRI for several weeks reports the medication has been effective but is bothered by sexual dysfunction. What is the most appropriate nursing response?
Answer: A. Sexual dysfunction (decreased libido, delayed orgasm, erectile difficulty) is a common, often persistent SSRI side effect and a frequent reason clients stop the drug on their own. The nurse should encourage the client to discuss it with the provider, who may adjust the dose, switch agents (e.g., bupropion), or add a strategy, rather than telling the client to simply stop or tolerate it silently.
Keep the streak going with more questions like these, each with a full rationale.
What is bupropion?
It is notable for NOT causing sexual dysfunction or significant weight gain, unlike SSRIs, but it lowers the seizure threshold. It is contraindicated in patients with seizure disorders or eating disorders.
Key points to remember
- Lowers the seizure threshold; contraindicated with seizure disorders, bulimia, or anorexia.
- Does not typically cause sexual dysfunction or weight gain (often a reason it is chosen).
- Can be activating - may cause insomnia, agitation, dry mouth, and decreased appetite.
- Used for smoking cessation under the name Zyban; reduces nicotine cravings.
- Carries the antidepressant suicide black box warning; takes 2-4 weeks for full effect.
- Avoid alcohol, which further lowers the seizure threshold.
Signs & symptoms
- Insomnia, dry mouth, weight loss
- Agitation, headache, tremor
Nursing priorities
- Screen for history of seizures, eating disorders, and head injury before administering.
- Assess for suicidal ideation, especially early in therapy.
- Give the last dose earlier in the day to limit insomnia.
- Teach to avoid alcohol and not to exceed the prescribed dose (dose-related seizure risk).
- Monitor for excessive CNS stimulation or agitation.
Patient teaching
- Do not drink alcohol and do not take more than prescribed - both raise seizure risk.
- Take doses earlier in the day to reduce trouble sleeping.
- Expect 2-4 weeks for full effect; report any seizure activity at once.
- If used to quit smoking, you may use it while still smoking during the initial period as directed.
Red flags: report now
- Seizures - hold drug and report immediately.
- New or worsening suicidal thoughts.
- Do not use in patients with a seizure disorder or eating disorder.
- Severe agitation or psychosis.
References
Clinical references for this topic
