329 signature meds Flashcards
fluoxetine, paroxetine and vortioxetine are apart of what class of medications
SSRIs
what class is sertraline apart of
SSRIs
citalopram and escitalopram are apart of what class of medications
SSRIs
what class is vilazodone apart of
SSRIs
what drugs are SNaRIs
venlafaxine
duluxetine
what drugs are SSRIs
fluoxetine, paroxetine, vortioxetine
citalopram, escitalopram
sertraline
vilazodone
desvenlafaxine is what class of medications
SNRIs
SRIs side effects
blurred vision, dry mouth, sexual problems,
tension headache
drowsiness, N/D, insomnia, nervousness/agitation/restlessness, dizziness
SRI nursing considerations
Medication effectiveness takes 4-8 weeks.
Most side effects diminish in 4-6 weeks.
Monitor for suicidal ideation, extreme agitation, fever, increased blood pressure, manic symptoms
Sleep hygiene
Avoid caffeine if anxious
Teach relaxation techniques
Abrupt discontinuation may be mild or severe
serotonin syndrome sx: mental status changes
agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations
serotonin syndrome sx: ANS
diaphoresis, flushing, fever, tachycardia, mydriasis
serotonin syndrome sx: neuromuscular
myoclonus ( muscle twitching or jerks), hyperreflexia, tremors
serotonin syndrome sx: GI
N/V/D
how to treat serotonin syndrome
-stop or reduce medications
-benzodiazepines
-oxygen
-IV fluids
-sx & supportive care (like HR & BP meds)
should resolve in 24 hrs but can take weeks to fully go away
what drugs are benzos
diazepam
lorazepam
why are benzos given for serotonin syndrome
to help control agitation, seizures and muscle stiffness
what drugs are given for tachycardia or hypertension when seen in serotonin syndrome
esmolol
nitroprusside
what drugs are given for hypotension when seen in serotonin syndrome
phenylephrine
epinephrine
what drug can we give if treatments aren’t working fro serotonin syndrome
cyproheptadine HCL to block serotonin production
what drugs are tricyclic antidepressants (TCA)
imipramine
desipramine
doxepin
amitriptyline
imipramine and desipramine are within what class of medication
TCA
doxepin is in which drug class
TCA
amitriptyline is in which drug class
TCA
what antidepressants has an increased risk of death by overdose
TCA
SE of TCAs
anticholinergic effects
nursing considerations for TCA
check ECG for cardiac disorder
check for hx of seizure disorderes
TCA symptoms during early treatment
early morning awakening, feeling worse in am, some worry and anxiety
anticholinergic SE
increased temperature
dry mouth, eyes; urinary retention; constipation
mydriasis/dilated pupils/ blurred vision
flushed face
confusion; delirium
+sedation & wt gain
TCA nursing interventions to decrease sx
Dry mouth: sugar-free hard candy/gum
GI upset: take med with food
Diarrhea: eat frequent small meals
Constipation: increase fiber/fluids in diet/exercise
Insomnia: Sleep hygiene/change dosing time of med; if causes insomnia take in am
Orthostasis: keep hydrated; get up slowly
Sexual side effects: erectile dysfunction medications
Urinary hesitancy: run water while voiding; measure amount
what drugs are MAOIs
phenelzine
isocarboxazid
tranylcypromine
selegiline (Emsam) Transdermal patch
common SE of MAOIs
Dry mouth
Nausea
Diarrhea or constipation
Headache
Drowsiness
Insomnia
Dizziness or lightheadedness
Skin reaction at patch site
MAOIs nursing considerations
dietary restriction of tyramine rich foods to prevent hypertensive crisis
-aged cheese, overripe fruits & vegetables, beans, soy cause & bouillon cubs, beers/ales/liquors/red wine
-avoid high caffeine consumption
-avoid using w/ demerol
how to treat a hypertensive crisis
phentolamine
sublingual nifedipine
symptomatic & supportive
what classes are recognized as antidepressants + other drugs
SRIs
TCA
MAOIs
+
trazodone
bupropion
mirtazapine
bupropion (NDRI)
Contraindicated in eating disorders and hx of seizures
Less sexual side effects
Considered “energizing”
Used in smoking cessation (Zyban)
trazodone
often given at bedtime for sedative effect as adjunct with another antidepressants
mirtazapine
good for sleep
general antidepressant medication education
May not see symptom improvement until 4-6 weeks
Physiological symptoms improve before psychological symptoms with increased energy danger of SI
Look for improved sleep; less daytime fatigue and crying; & increased frustration tolerance
Side effects may occur but handled by adjusting dosage or switching to different med in same class
Discontinuing meds as soon as you feel better may result in relapse. Meds usually needed for 6-9 months past symptom relief- up to 12 -24 months
Antidepressants are not addictive
Abrupt stopping of meds will result in withdrawal- nausea, anxiety, insomnia, flu-like symptoms
Do not drink alcohol
when can antidepressants be prescribed
- depressive disorders
- depressive phases of bipolar disorder
- sx of dysphoria, anhedonia, difficulty concentrating, hopelessness
- anxiety disorders (SSRIs esp used)
what drugs are typical antipsychotics
chlorpromazine
haloperidol
antipsychotic long acting injections
haloperidol decanoate (typical)
risperidone (atypical)
paliperidone palmitate (atypical)
what drugs are atypical antipsychotics
clozapine, olanzapine
questiapine
risperidone
aripiprazole
what drugs are anticholinergic medications used for schizophrenia
benztropine
trihexyphenidyl
side effects of antipsychotic medications
- EPS: acute dystonic rx, akathisia, pseudoparkinsonism, tardive dyskinesia
- anticholinergic effects
- neuroleptic malignant syndrome
-metabolic syndrome
typical antipsychotics
chlorpromazine, haloperidol
reduce positive sx & little to no effect on negative sx
disadvantages to typical antipsychotics
Extrapyramidal side effects (EPS)
Anticholinergic side effects
Sedation, weight gain, metabolic syndrome, neuroleptic malignant syndrome (NMS), sexual dysfunction, endocrine disturbances, cardiovascular issues (orthostatic hypotension and arrhythmias), increased risk of seizures
atypical antipsychotics
clozapine, olanzapine, questiapine, risperidone, aripiprazole
improves positive and negative symptoms
less SE
atypical antipsychotics disadvantages
tendency to cause significant weight gain; risk of metabolic syndrome; may be more costly than the typical antipsychotics
atypical antipsychotics SE
Sedation
Major weight gain and changes in a person’s metabolism leading to metabolic/endocrine problems including diabetes and hyperprolactinemia
Potential for cardiac dysrhythmias / even sudden cardiac death
Sexual dysfunction
when is clozapine used
Has been effective in treating refractory Schizophrenia, or schizophrenia that doesn’t respond to normal treatment
The use of clozapine has resulted in decreased negative symptoms, increased impulse control, reduced violence to self and others, and improved quality of life
side effect of clozapine
potentially fatal side effect of agranulocytosis -> reduction in the number of circulating granulocytes and decreased production of granulocytes that limit one’s ability to fight off infection
when are long acting injectable medications used
when patients that are at risk for non-adherence
