ATI mental health meds Flashcards
Mood stablizer used for Bipolar mania & depression. Narrow therapeutic range
Lithium carbonate
lithium common adverse effects
diarrhea, N/V, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy
Lithium toxicity symptoms:
mental confusion, sedation, coarse tremors, extreme polyuria (dilute urine), jerking movements, blurred vision, tinnitus, coma, convulsions
lithium therapeutic range and level for toxicity:
therapeutic = 0.6-1.2
toxic = >1.5
lithium complications and nursing action:
-Gi distress (administer meds with -meals)
-fine hand tremors (an increase means toxicity)
-polyuria, thirst (maintain good fluid intake)
- weight gain (exercise regimen)
- renal toxicity (assess baseline kidney labs)
- hypothyroidism (monitor for cold, dry skin, decreased HR, weight gain)
-hypotension/electrolyte imbalance (maintain adequate fluid and sodium intake)
do not administer these meds with Lithium:
diuretics, NSAIDS, anticholinergics
class of antidepressant that inhibits reuptake of serotonin. used for depression, anxiety, OCD and eating disorders
SSRI
common SSRI meds:
sertaline (Zoloft)
citalopram (Celexa)
escitalopram (lexapro)
paroxetine (Paxil)
fluoxetine (Prozac)
commons SSRI side effects
sexual dysfuntion, weight gain, insomnia, GI distress
serotonin syndrome symtoms:
agitation, mental changes, delirium, hallucinations, seizures, tachycardia, labile BP, diaphoresis, fever, hyperreflexia, difficulty walking, N/V, coma leading to apnea
SSRI nursing considerations:
-up to 4 weeks for therapeutic effect
-take med in morning (sleep disturbances)
-do not use with MAOIs, TCAs, or St. John’s wort (serotonin syndrome)
-increased risk for suicide! watch for increased energy
- TAPER! (withdrawal syndrome)
-NO paroxetine if PREGNANT
-risk for bleeding if taken with NSAIDs an d anticoagulants
class of antidepressant that inhibits reuptake of serotonin AND norepinephrine. for major depression, panic disorders, generalized anxiety
SNRIs
common side effects SNRI’s
nausea, insomnia, weight gain, diaphoresis, sexual dysfunction
nursing considerations for SNRI’s
- all SNRI’s are teratogenic
-up to 4 weeks for therapeutic effect - do not take with MAOIs or St. John’s Wort
-no duloxetine for liver disease or alcoholics
-TAPER!
-CNS depression with alcohol, opiods, antihistamines, sedatives
-do not take NSAIDS or anticoagulants – monitor for bleeding
common tricyclic antidipressants:
ammitripyline
education for amitriptyline
- therapeutic effects can take several weeks
-orthostatic hypotension (change positions slowly)
-anticholinergic effects - chew gum, increase fluid intake, high fiber diet
class of antidepressant that blocks monoamine oxidase. used for depression
MAOi
MAOI client education
-risk of hypertension crisis! avoid foods with tyramine (ripe avocado, figs, fermented/smoked meats, liver, dried/cured fish, most cheese, beer and wine, protein supplements)
- avoid all OTC meds without talking to provider first – do not take with decongestants (pseudoephedrine)
-discontinue for 2 WEEKS prior to starting other antidepressants
symptoms of hypertensive crisis from MAOIs:
headache, stiff neck, N/V, fever, dilated pupils
common MAOIs:
phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)
common Tricyclic antidepressants
amitriptyline, amoxapine, clomipramine, protriptyline, nortriptyline
class of anxiety medication used for short term treatment. increases GABA. used for generalized anxiety, alcohol withdrawal, insomnia, seizure disorders, amnesia prior to surgery
benzodiazepines
common benzodiazepines:
alprazolam (xanax)
diazepam (valium)
lorazepam (ativan)
chlordiazepoxide
clorazepate
oxazepam
clonazepam (klonopin)
benzodiazepam complications/contraindications/precautions
-CNS depression! it is a sedative!! (avoid alcohol, avoid hazardous activities, long half-life) FLUMAZENIL is antidote
-withdrawal effects (TAPER! after regular use)
- risk for dependence/substance abuse
-risk for falls
- teratogenic
antidote to benzodiazepines
flumazenil
atypical anti-anxiety medication that is a non-sedative and good for long term use
Buspirone
mood-stablilizing anti-epileptic meds that treat bipolar disorders: (3)
carbamazepine
Valproate
Lamotrigine
carbamazepine complications and teaching
-CNS effects (nystagmus, double vision, vertigo, staggering gait, headache)
-blood dyscrasias (leukopenia, thrombocytopenia, anemia). – MONITOR FOR INFECTION! and bruising/bleeding!
-skin disorders – dermatitis and steven johnson syndorme (wear sunscreen)
-hypo-osmolarity (risk for fluid overload! monitor sodium, edema, hypertension, i&Os)
-do not use when pregnant
-use alternative form of birth control
- no grapefruit juice (inhibits metabolism of drug)
lamotrigine complications and teaching
-SKIN RASH! (steven johnson syndrome)
-blurred vision, dizziness, N/V
-use alternate form of birth control
Valproate complications/ teaching
-LIVER toxic! monitor liver function (AST, ALT, LDH)
-pancreatitis
-thrombocytopenia (low platelets, watch for bruising)
- do not take if pregnant
- gi effects (nausea, vomiting, indigestion)
first generation anti-psychotics that treat schizophrenia, manic phase of bipolar, acute/chronic psychotic disorders
haloperidol (haldol)
fluphenazine
loxapine
thiothixene
perphenazine
complications of first-generation anti-psychotics
-agranulocytosis (watch for infection!)
- anticholinergic (maintain fluid intake, gum, sunglasses for photophobia, high fiber diet)
-EPS effects (acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia)
-neuroleptic Malignant syndrome (NMS)
-orthostatic hypotension
-sedation
-seizures
-dysrhythmias
-sexual dysfunction
-photosensitivity
-liver impairment
extrapyramidal symptoms:
-acute distonia
-pseudoparkinsonism
-akathisia
-tardive dyskinesia
what is acute dystonia
severe spasm of the tongue, neck, face, back
what is acute pseudoparkinsonism
bradykinesia, rigidity, shuffling gait, drooling, tremors, mask-like face
what is akathisia
inability to sit/stand still, pacing, agitation
what is tardive dyskinesia?
LATE EPS - involuntary movement of tongue and face, arm, legs, and trunk. lip smacking
neuromalignant syndrome (NMS)
adverse effect of first generation anti-psychotics.
medical emergency!
sudden, HIGH fever
blood pressure fluctuations
diaphoresis
tachycardia
muscle rigidity
decreased LOC
coma
nursing actions for NMS
stop medication
monitor vitals
cooling blanket
antipyretic
administer muscle relaxant and antiarrhythmia
atypical antipsychotics that treat positive and negative symptoms of schizophrenia
risperidone
asenapine
clozapine
iloperidone
lurasidone
olanzapine
paliperidone
quetiapine
ziprasidone
aripiprazole
second generation psychotics complications:
-agranulocytosis (watch for infection!)
-metabolic syndrome (new onset of diabetes and loss of glucose control)
- orthostatic hypotension
-anticholinergic effects
- mild EPS (tremors)
- elevated prolactin levels
- sexual dysfunction
-agitation, dizziness, sedation, sleep disruption
a medication that counteracts these extrapyramidal symptoms
Benztropine
patient teaching for disulfiram for management of alcohol dependence
read all labels! do not consume anything with alcohol, even trace amounts
medication for a client who has moderate to severe Alzheimer’s disease. an NMDA receptor agonist, is shown to slow the progression of manifestations and to improve cognitive function.
Memantine
med used to prolong the client’s ability to function in the early stages of the alzheimer’s. administer this medication at bedtime to reduce the risk for injury due to bradycardia and syncope.
donepezil
