Chapter 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 + evaluation
Continuous monitoring. Assess, we ask the patient how the med is working for them. Whether its helping at all.
Patient education considerations
Use everyday language
Remember it is imperative to assess education level, 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
How is dopamine different in Parkinson’s & schizophrenia?
Increased: Schizophrenia
Decreased: Parkinson’s
Anti-Anxiety agents: Indications
Anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epileptics, and pre operative sedation.
Anti-Anxiety agents: Action
Depression of the CNS (CNS exception: Buspirone)
Anti-Anxiety agents: contra & caution
Contraindicated: In known hypersensitivity, in combination 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. Bentos 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 (Transxene)
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 starts 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
Dysthymia, 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 do norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, heterocyclic, SSRIs, SNRIs) or by inhibiting the release of Monoamines 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 hyper trophy.
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 thyramine 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.
- Tranylcyclopromine (Parnate)
- Phenelzine (Nardil)
- Isocarboxazid (Marplan)
The MAOI Selegline (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 with SSRIs & Tricyclic meds
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
With all classes: dry mouth, sedation, nausea
Discontinuation syndrome
Most common with tricyclines + heterocyclic:
Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, 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. John’s. Wort + SSRI could cause it because the OTC med and antidepressant both have serotonin or block its reuptake
Immediately take person off serotonin elated 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
