Ch. 4 Pharm: Anti-Anxiety & Antidepressants Flashcards
Historical perspectives
- Psychotropic drugs are meant to be an adjunct to individual or group psychotherapy
- Meds aren’t everything, they’re a useful tool
- As a nurse, don’t always jump to meds first
Extra notes from class relating to mental health treatments
- Electrical therapy is a thing. It works well. Safe.
- Ice baths –> helpful for manic states
Role of the nurse
- Must understand legal ethical implications
- Right to refuse (EXCEPT IN EMERGENCY SITUATIONS)
- Emergency: danger to self or others.
Assessment + pharm
- H&P, EKG, waist circumference
- Cultural considerations (Table 4-1, pg 63) like Many asians are more sensitive to certain meds
Med admin + eval
- Continuous monitoring. Assess. We ask the patient how the med is working for them. Wether its helping at all.
Patient education considerations
- Use everyday language
- Remember it is imperative to assess edu levle, 1st language, dev. stage, literacy
- Always give reading info on meds
How do psychotropics work?
- Affects neurotransmission
- Antipsychotics may block receptors / leave chem out there to do its job
Random: how is dopamine different in parkinsons & schiziophrenia
- Increased: Schizophrenia
- Decreased: Parkinsons
Anti-Anxiety agents: Indications
Anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation.
Anti-Anxiety agents: Action
Depression of the CNS (CNS exception: Buspirone)
Anti-Anxiety agents: contra & caution
- Contraindicated: In known hypersensitivity, in combo with other CNS depressants, in pregnancy and lactation, narrow angle glaucoma, shock, and coma
- Caution: with elderly & debilitated clients, clients with renal or addiction, and those who are depressed or suicidal
Anti-Anxiety agents: Lecture notes
- Benzodiazepines used a lot. Can sometimes be in higher doses. We want a chill sedation not a coma (which it can cause)
- Deadly combos possible
- Don’t give to pt with history of addiction. Benzos are VERY ADDICTIVE.
- INTERACTS –> with Alcohol & Niquil
Anti-Anxiety agents: Interactions (Increased vs Decreased)
- Increased effects when taken with alcohol, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidien, disufiram, kava kava, or valerian root (& other herbal depressants)
- Decreased effects with cigarette smoking & caffeine consumption
Anti-Anxiety agents common meds: Clorazepate (Tranxene)
Long acting. Effective for anxiety disorders. Short term use only.
Anti-Anxiety agents common meds: Chlorodiazepoxide (Tranxene)
Used for alcohol withdrawal
Anti-Anxiety agents list of common ones
- Diazepam (Valium)
- Clonezepam (Klonopin)
- Lorazepam (Ativan)
- Alprazolam (Xanax)
The other Anti-Anxiety agents slide: one you need to know
- Buspirone (BuSpar)
- Doesn’t addict or depress CNS.
- Takes weeks to start working
Anti-Anxiety agents: Monitor for
- Safety!
- Think about tolerance. Think about risk for falls related to lethargy & CNS depression.
- Sometimes paradoxical reactions occur. Where we get the opposite effect of what the med should do.
Antidepressants: Indications
Dysthmia, major depressive disorder, depression associated with organic disease, alcoholism, Schiziophrenia, intellectual disability, depressive phase of bipolar disorder, and depression paired with anxiety
Antidepressants: Action
Increase concentration of norepenephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, heterocyclics, SSRIs, SNRIs) or by inhibiting the release of monoamine oxidase (MAOIs)
Antidepressants: Contraindications & Caution
- Caution in elderly. very sensitive. Have to monitor.
- Doesn’t mean don’t give
- Contraindicated: In known hypersensitivity, acute recovery from MI & in angle closure glaucoma, and concomitant with MAOIs
- Caution: pts with hepatic, cardiac, or hypertrophy. Hist of seizures.
Antidepressants: Classifications (5 of them)
- MAOI’s (monoamine oxidase inhibitor). Many S/E and dietary restrictions.
- Tricyclics antidepressants (TCAs). Work really well. Can cause Heart probs. Could be used for suicide if whole bottle is ingested.
- Serotonin Reuptake inhibitors (SSRIs)
- Serotonin/Norepinephrine reuptake inhibitors (SSRIs). Sometimes called S-SNRIs.
- Heterocyclics
Antidepressants: MAOIs extra precaution
- Can’t have certain foods because the interaction can kill you if the food has tyramine in it.
- If taking standardized test: EX –> Best thing for MAOI taking pt to eat? FRESH IS BEST. Baked chicken over aged salami meat.
Antidepressants: MAOIs & ICAs (names of 4 MAOIs)
- MAOIs: could be a kaplan question related to them.
1. Tranylcyclopromine (Parnate)
2. Phenelzine (Nardil)
3. Isocarboxazid (Marplan) - The MAOI Selegiline (Emsam) is almost always a path. No dietary restriction cause of it.
- TCA’s: Could be used for chronic pain + depression
Antidepressants: List of older SSRIs that could be on Kaplan
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Vilazodone (Viibryrd)
Antidepressants: Heterocyclines (3 names + detail)
- Bupropion (Wellbutrin)
- Mirtazapine (remeron)
- Trazadone
- Bupropion is a Great antidepressant. Also used for smoking cessation. S/Es possible.
Antidepressants: Common S/E w/ SSRIs & Tricyclic meds (noted from deanna)
- SSRIs: sexual dysfunction can cause many people to stop use.
- Tricyclic meds: urinary retention. But can be used for Bed-wetting cessation.
Antidepressants: Monitor for these S/E
- w/ all classes: Dry mouth, sedation, nausea
- discontinuation syndrome
- Most common with tricyclines + heterocyclics: blurred vision, constipation, urinary retention, orth. hypotension, reduction of seizure threshold, tachycardia, arrythmias, photosensitivity, weight gain
Antidepressants: Common S/E for SSRIs & SNRIs
Insomnia,
weight loss,
agitation,
headache,
sexual dysfunction,
serotonin syndrome
Antidepressants: Common S/E for MAOIs & uncommon misc. S/E
- Hypertensive crisis (can be fatal)
- Site reactions (selegiline transdermal system)
- Misc: Priapism, Hepatic failure
Antidepressants: Serotonin syndrome. What is it?
- When there is too much serotonin in the body. Related to antidepressants because they usually increase the freely available serotonin.
- St. Johns. wort + SSRI could cause it because the OTC med and antidepressant both have serotonin or block its reuptake.
- Immediately take person off serotonin related meds + get them to clear + usually they recover
Antidepressants: S&S of serotonin syndrome
- Restlessness, agitation
- Confusion
- Tachycardia
- High BP
- Dilated pupils
- Muscle rigidity
- Loss of muscle coordination
- Diarrhea
- Sweating
