Classes of Psychiatric Medications

Question 1

Lithium Indications

Answer 1

Mania, depressive episodes of bipolar illness, irritability, aggression, antidepressant augmentation

Question 2

Lithium Monitoring

Answer 2

-Therapeutic window= 0.6- 1.4 mEq/L Toxic over 1.5
-Need to monitor plasma drug levels 2-3 days initially, then weekly to monthly to every 3 months
-BUN, creatinine
-CBC every 6 mo
-Thyroid panel

Question 3

Lithium Toxicity Signs

Answer 3

-Mild 1.5-2.0= dehydration, diarrhea, vomiting, anorexia, lack of coordination, mild ataxia
-Moderate 2.0-2.5= Course tremor, confusion, unsteadiness, slurred speech, delirium, pronounced ataxia
-Severe 2.5-3.0= altered consciousness, muscle twitches, seizure, coma, death

Question 4

Serotonin Syndrome Symptoms

Answer 4

Mental status changes (agitation, pressure speech), autonomic instability (tachycardia, shivering, diaphoresis, diarrhea, mydriasis), neuromuscular problems (NVD)

Question 5

SSRI

Answer 5

Selective Serotonin Reuptake Inhibitor
-Side effects: GI issues, anxiety, sedation, insomnia, sexual dysfunction, sweating
-Inc suicidal ideation in children and teens
-Full effect in 4-6 weeks
-Discontinuation syndrome if abruptly stopped
-Risk of serotonin syndrome when used with MAOIs, TCAs, St. Johns Wort

Question 6

TCA Action

Answer 6

-Increase NE and Serotonin, sodium channel blockage
-More serious side effects than SSRIs

Question 7

TCA Side Effects

Answer 7

Sedation, Orthostatic Hypotension, anticholinergic effects, cognitive blunting, weight gain, anticholinergic effects, photosensitivity in eyes

Question 8

TCA nursing considerations

Answer 8

-Lethal in overdose- monitor for suicidal ideation
-Many interactions, avoid OTC meds
-Contraindicated with MAOI
-Take med at bedtime (SE less severe)
-TO limit anticholinergic effects: high fiber, more exercise, sunglasses outdoors, chewing gum, sipping water, void before med

Question 9

Monoamine Oxidase Inhibitor Action

Answer 9

Inhibition of MAO enzyme, leading to increased serotonin and norepinephrine activity in the synapse
-MAO enzyme also blocks re-uptake of tyramine– if combined with tyramine rich foods can lead to hypertensive crisis

Question 10

MAOI Side Effects

Answer 10

Dizziness, headache, insomnia, dry mouth, blurred vision*, constipation *, nausea, peripheral edema, urinary hesitancy *, muscle weakness, forgetfulness, weight gain, sexual dysfunction

Question 11

Benzodiazepines Action and Use

Answer 11

Anti anxiety
- enhances effect of neurotransmitter GABA
-Short term anxiety relief for severe anxiety, not maintenance

Question 12

Non benzo Anxiolytic Action and Uses

Answer 12

Buspirone
-Action: increases SE, partial agonist
-Effective for GAD without the CNS depressive effects, without rebound anxiety, without potential for abuse and withdrawal
-Effects are not immediate- take 4-5 weeks
-Not effective for panic disorders, more for long term treatment

Question 13

Non Benzo Anxiolytic Side Effects and Considerations

Answer 13

-Dizziness, drowsiness, nausea, excitement, headache
-BID or TID due to short half life
-Contraindicated with MAOI
-Not PRN- needs to be taken consistently for results
-Often used to taper off benzos but does not cushion withdrawal symptoms

Question 14

Stimulants Action and Indication

Answer 14

• ADHD, ADD, narcolepsy, depression
• increases dopamine, increase alertness, wakefulness

Question 15

Antipsychotics Action

Answer 15

-Blocks the effects of dopamine (also Ach, HIT, NE)
-Indications: schizophrenia, mania, aggression in autism, psychosis symptoms