Mental Health Medications

Question 1

Serotonin

Answer 1

Serotonin (happiness hormone)
Sleep
Emotion
Remember
Goes all over the brain, starts (focal point is hippo campus)

Question 2

Dopamine

Answer 2

Dopamine
Determination
Obsession
Pleasure

Frontal cortex is most affected by dopamine
Dopamine in the brain is way different than dopamine in the body

Question 3

Norepinephrine

Answer 3

Norepinephrine
No hesitation
On alert
Recall memory
Cognitive alertness

Stress hormone
Turns on sympathetic nervous system - activates fight or flight mode
turns of PNS (turns off digestion)
Last line drugs to increase blood pressure

Question 4

Antidepressants

Answer 4

SSRI
SNRI
TCA
MAOI

Question 5

4 rules of antidepressants

Answer 5

Increased risk of suicide
Antidepressants can increase suicidal thoughts in the first few weeks of treatment
Notify the provider of any suicidal thoughts
Clarify any new prescription
Monitor for:
New thoughts of suicide
Unusual behaviour
Worsening depression
Sudden change in mood

slow onset and slow tapper off
Never stop abruptly

Never mix
SSRI + st johns wort
MAOI + antidepressant (TCA, SSRI, SNRI)

All psych drugs
Decreased. BP (slow position changes)
weight gain

Question 6

SSRI

Answer 6

Selective, Serotonin, Reuptake Inhibitors

Sertraline
Citalopram
Escitalopram
Paroxetine
fluoxetine

Given for depression, anxiety and PTSD

Side effects:
usually improve after 3 months
Weight gain
Sexual dysfunction
cause insomnia
increase suicide risk - high risk sage 18-24, report more energy without change in depression

Slow onset and slow taper off 2-4 weeks to reach full effect

Question 7

Serotonin Syndrome

Answer 7

Serotonin Overdose
Never mix:
St John’s wort
MAOI
Tramadol

Sweaty and hot fever (never cold or clammy)
Rigid muscles + restlessness and agitation
Tremors, hypereflexia Not decreased DTRs.
Increases heart rate (tachycardia)

Question 8

SNRI

Answer 8

Duloxetine
given for depression and pain
Helps with chronic pain and improves sleep in patients with fibromyalgia
if patient refuses medication: educate patent on why they are prescribed this med

Question 9

TCA

Answer 9

Amitriptyline
Imipramine
Depression and anxiety helps with neuropathy

Side affects: Anticholinergic affects
Cant see, can’t pee, can’t spit, can’t poop
Uriianry retention = priority
Sweating
seizures
Drowsiness and dizziness

Drink lots of fluids
Wear sunglasses and eyedrops
Chew gum for dry mouth
Fibre for constipation

May causes orthostatic hypotension = slow position changes
Never take with MAOI - two week wash out period

Question 10

MAOI

Answer 10

Phenelzine brand: nardil
Selegiline
Isocarboxazid

first and oldest antidepressants used for
depression
Panic disorder
Social phobia
Increases norepinephrine, serotonin and dopamine in the brain

Key points
Massive hypertension risk
key sign = massive headache
Avoid tyramine: amino acid that helps regulate BP and trigger hypertension crisis
no fermented alcohol
no fermented fruit
no meats
No chocolate

No over the counter drugs could contribute to hypertensive crisis
Calcium
Antacids
Acetaminophen
NSAIDS

Avoid other antidepressants
SSRI, SNRIs, TCAs these could trigger serotonin syndrome. (2 week wash out period) Fully tapper off meds
No escitalopram
No imipramine

Increases suicide risk
Assess: further expressions of hopelessness, despair, suicidal thoughts, thoughts of self harm

Question 11

Which medication has the most potential risk for injury
*looking for sedating meds

Answer 11

Amitriptyline
Diphenhydramine
Alprazolam

Question 12

Which combination of drugs should the nurse question

Answer 12

Sertraline with selegiline
Lithium with ketorolac

Question 13

Which has the most potential for injury

Answer 13

Amitriptylne to treat fibromyalgia pain
Headache while on phenelzine
Taking st johns wort with sertraline
Discontinuing escitalopram the day before taking isocarboxazid
Report sore throat, fatigue and low grade fever while on clozapine

Question 14

Atypical antidepressant

Answer 14

Trazodne and Bupropion

Tazadone: sleep aid and treats depression
Avoid ETOH and other sedatives - take at night, may causes othrostatic hypotension

Bupropion
brand: Wellbutrin
depression and aid to stop smoking
Side effect: insomnia, headache and weight loss
never double up on doses
nicotine gym may be prescribed
SR: sustained release
XL: extended release
Never crush, chew, cut

Question 15

Anxiolytics

Answer 15

Used for anxiety and seizures
Benzodiazepines - sedative
Barbiturates - sedative
Buspirone - not a sedative

Question 16

Benzodiazepines

Answer 16

Alprazolam
Midazolam
Temazepam
Clonazepam

Highly addictive not safe for long term use
anxiety and seizures
Alcohol withdrawal and sedation

Increases gaba =. very sedating
everything is low and slow
suppression of ABCs
take a bedtime
don’t skip doses
tapper off never suddenly stop
No alcohol
DOnt operate dangerous machines

Antidote benzos: Flumazenil

Question 17

Barbiturates

Answer 17

Lasts longer int he body 3-5 days
Take longer to get out of the body - higher risk for toxicity

Question 18

Buspirone

Answer 18

Not sedating
Atypical anxiolytic
No depressant effect
Takes a long time to kick in 2-4 weeks for full effect
No withdrawn symptoms
Safe for long term use

Driving is okay!
Not for acute attacks - usually taken on a regular basis

Question 19

Patient teaching for diazepam

Answer 19

Avoid valerian root
avoid muscle relaxants
report history of reaction to midazolam

Question 20

Client on phenobarbital which of the following should the nurse do

Answer 20

Assess for respiratory depression
Assess for low blood pressure
Teach sedation is an early side effect