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NCLEX-RN® > NCLEX-RN (6) Mental Health > Mental Health Meds > Flashcards

Mental Health Meds Flashcards

Review the most common psych meds, side effects, adverse reactions, and nursing considerations.

1
Q

What are “Downers”?

A

Medications that cause the central nervous system to be sedated.

They are also called “Sedatives”.

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2
Q

What types of medications and substances are “Downers”?

A
  • Antidepressants
  • Anxiolytics
  • Antipsychotics
  • Antiallergy drugs / Antihistamines
  • Barbiturates
  • Benzodiazepines
  • Muscle relaxers
  • Opioids
  • Alcohol
  • Marijuana
  • St. John’s wort
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3
Q

What will the pupils look like if a client has overdosed on a “downer” medication such as too many anxiolytics or opioids?

A

Pinpoint pupils.

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4
Q

Adverse reactions and nursing considerations:

Downers

A
  1. advise client to avoid taking too many Downers at once - client can become sedated, overdose, and die
  2. implement safety and fall precautions
  3. assess for suicide

Hold med and notify HCP if client has a decreased level of consciousness.

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5
Q

What is the treatment for CNS depressant (“downer”) overdose?

A
  • induce vomiting or gastric lavage (pump the stomach)
  • give activated charcoal
  • flumazenil IV for benzodiazepine overdose
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6
Q

What are “Uppers”?

A

Medications that cause the central nervous system to be stimulated.

They are also called “Stimulants”.

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7
Q

Indication:

Amphetamines (a CNS stimulant)

A

To treat ADD or ADHD.

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8
Q

Generic names:

Amphetamines

CNS stimulant

A
  • dextroamphetamine, lisdexamfetamine
  • methylphenidate
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9
Q

What types of medications and substances are “Uppers”?

A
  • Amphetamines - methylphenidate
  • Cocaine
  • Caffeine
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10
Q

What will the pupils look like if a client has overdosed on an “upper” medication such as amphetamines?

A

Dilated pupils.

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11
Q

Side effects and nursing considerations:

Uppers

A

Increased heart rate, flushing, sweating, dysrhythmias - advise client to use caution with cardiovascular disorders

Hold med and notify HCP if client experiences chest pain or dysrhythmia.

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12
Q

Indication:

Antidepressants

A

To treat a variety of conditions:

  • depression
  • fibromyalgia
  • nerve pain
  • chronic pain
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13
Q

Adverse reactions and nursing considerations:

Antidepressants

A
  • takes up to four weeks to work: assess for risk of suicide
  • some are nephrotoxic and/or hepatotoxic: check liver and kidney labs
  • some cause pancyotopenia: check WBC, RBC and H&H levels
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14
Q

Side effects and nursing considerations:

Antidepressants

A
  1. sedation
    • take in the evening to prevent falls
    • avoid taking other CNS depressants at same time
  2. decreased BP, weight gain, decreased libido and dry mouth
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15
Q

Generic names:

SSRI Antidepressants

(Selective serotonin reuptake inhibitors)

A
  • citalopram, escitalopram
  • fluoxetine, paroxetine
  • vilazodone
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16
Q

Generic names:

SSNRI Antidepressants

(Selective serotonin norepinephrine reuptake inhibitors)

A
  • desvenlafaxine, venlafaxine
  • duloxetine
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17
Q

Generic names:

MAOI Antidepressants

(Monamine oxidase inhibitor)

A

TIP:

  • tranylcypromine
  • isocarboxazid
  • phenelzine
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18
Q

Side effects and nursing considerations:

MAOI Antidepressants

(Monamine oxidase inhibitor)

A
  1. avoid tyramine containing foods - can cause a hypertensive crisis
  2. do not take within 2 weeks of other antidepressants or uppers - can cause serotonin syndrome
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19
Q

Food-med interaction:

MAOI Antidepressants

A

Avoid “aged foods”

  • aged cheese and meats
  • smoked, cured and processed meats like sausage
  • coffee/tea (drinks with caffeine)
  • soy sauce
  • beer and wine
  • BAR: Bananas, Avocado, Raisins

Taking together can cause a hypertensive crisis (BP >180/120).

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20
Q

Generic names:

Tricyclic Antidepressants

A

amitriptyline, nortriptyline

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21
Q

What color can the urine become when a client is taking tricyclic antidepressants?

A

A bluish-green color.

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22
Q

Indication:

bupropion

A
  • treat depression
  • prevent desire to use tobacco
23
Q

Indication:

Antianxiety/Anxiolytics/Benzodiazepines

A

They are given to treat a variety of conditions:

  • anxiety
  • insomnia
  • alcohol withdrawal
  • relax muscles
  • fibromyalgia
  • prevent seizures
24
Q

Generic names:

Antianxiety/Anxiolytics/Benzodiazepines

A

alprazolam, clonazepam, diazepam, lorazepam, temazepam, chlordiazepoxide, midazolam

They all end in -pam or -lam or have “diaze” in the name.

25
What medication is given for **conscious sedation**?
Midazo***lam***: a benzodiazepine
26
# Indication: **Cannabis sativa** ## Footnote Also known as marijuana or weed
* nausea/vomiting associated with chemotherapy * chronic pain ## Footnote It can be taken as oil, smoked, pill/tablet, in food.
27
# Side effects and nursing considerations: **Cannabis sativa**
* **Increases appetite:** provide healthy snack options * **lethargy, unmotivated and memory loss**: encourage life goals and hobbies
28
# Immediate complication What is **serotonin syndrome**?
Serotonin syndrome is when a client's **serotonin level increases to dangerous levels.** ## Footnote *It is caused by taking too many antidepressants or antidepressants and opiods at once.*
29
What are the **early symptoms** and **treatment** for serotonin syndrome?
* **early symptoms:** agitation, muscle twitching, rapid heart rate, sweating and ataxia * **treatment:** medication is held and dose is adjusted. Symptoms may go away and no additional treatment is needed.
30
What are the **late symptoms** and **treatment** for serotonin syndrome? | (Immediate complication)
* **late symptoms:** muscle rigidity, high fever, seizures, coma * **treatment:** muscle relaxers, serotonin blocking drug (benzodiazepines), oxygen, IV fluids, ventilator
31
What is **antidepressant discontinuation syndrome**?
When a client **experiences symptoms from abruptly stopping an antidepressant**. ## Footnote Medication is usually taken for about 6 weeks before symptoms can occur.
32
What are the **symptoms** and **treatment** for antidepressant discontinuation syndrome?
* **symptoms:** nausea/vomiting/diarrhea, strange behavior such as sensory disturbances and abnormal movements * **treatment:** no treatment; symptoms usually stop within 1-2 weeks and are not life-threatening
33
# Indication: **Antipsychotics**
To treat **bipolar syndrome,** **schizophrenia**, and **acute aggression**.
34
# Generic names: **1st generation/typical Antipsychotics**
haloperidol
35
# Generic names: **2nd generation/Atypical Antipsychotics**
* aripiprazole * olanza**_pine_**, quetia**_pine_** * risperi**_done_**, lurasi**_done_**
36
# Side effects: **Antipsychotics**
* anticholinergic side effects * weight gain * orthostatic hypotension * low white blood cell count
37
# Nursing considerations: Antipsychotics: **anticholinergic side effects**
1. **causes blurry vision**: implement safety / fall precautions 2. **causes urinary retention**: monitor intake and output 3. **causes dry mouth**: give candy or ice chips 4. **causes constipation**: encourage fluids/fiber/walking ## Footnote "can't see, can't pee, can't spit, can't shit"
38
# Nursing considerations: Antipsychotics: **weight gain**
* teach about healthy diet and exercise * assess for onset of diabetes mellitus
39
# Nursing considerations: Antipsychotics: **orthostatic hypotension**
* teach to sit at side of bed for a few minutes before getting up * implement safety and fall precautions
40
# Nursing considerations: Antipsychotics: **low white blood cell count**
Assess for signs of **infection**.
41
What are **extrapyramidal symptoms (EPS)**?
**Early side effects of Antipsychotics** caused by a decrease in dopamine.
42
What are the **symptoms** and **treatment** for extrapyramidal symptoms (EPS)?
**Symptoms:** Parkinson-like symptoms. * tremor, shuffling gait, muscle rigidity **Treatment:** Give an antiparkinson: benztropine. * This will increase dopamine for better muscle control.
43
What is **tardive dyskinesia**?
**Side effects** from **long term use** of antipsychotics.
44
What are the **symptoms** and **treatment** for tardive dyskinesia?
* **Symptoms:** bizarre facial and tongue movements, lip smacking, stiff neck, and difficulty swallowing * **Treatment:** Stop or taper the current psych medications. Symptoms can become permanent.
45
What is **neuroleptic malignant syndrome**? | (Immediate complication)
Neuroleptic malignant syndrome is a **rare and fatal reaction to antipsychotics.**
46
What are the **symptoms** and **treatment** for neuroleptic malignant syndrome? | (Immediate complication)
**Symptoms:** * severe muscle rigidity, drooling, difficulty swallowing, very high fever, tachycardia, tachypnea, rapid decrease in LOC, seizures, coma **Treatment:** * antipyretics, seizure precautions, cooling blanket * meds: dantrolene or bromocriptine to increase dopamine, which helps with muscle control
47
What **EKG finding** should prompt the nurse to avoid giving antipsychotics or antidepressants? | (Immediate complication)
**Prolonged QT.** ## Footnote It can lead to life-threatening cardiac dysrhythmias.
48
# Indication: **lithium**
* to treat acute mania in bipolar disorder * to treat long-term control of bipolar disorder
49
# Toxicity adverse effects: **lithium**
* **muscle and neuro symptoms:** slurred speech, decreased muscle coordination, and twitching, drowsiness * **GI symptoms:** nausea/vomiting/diarrhea ## Footnote Hold med and notify HCP if experiences these side effects.
50
# Nursing considerations: **lithium**
**Prevent toxicity:** * avoid dehydration by drinking 6 - 8 glasses of water daily * keep salt intake and exercise consistent ## Footnote Lithium is a "salt" like sodium; changes in sweating and fluid intake can cause toxicity.
51
**therapeutic level** of lithium
**0.6 - 1.2** ## Footnote 2 or greater is considered toxicity.
52
# Indication: **disulfiram**
To **prevent clients from drinking alcohol** by causing severe nausea and vomiting when the client drinks alcohol.
53
# Nursing considerations: **disulfiram**
* client must abstain from alcohol for at least 12 hours before the first dose is administered * if alcohol is consumed, effects will begin within several minutes to 30 minutes * avoid alcohol for at least 14 days after disulfiram is discontinued

NCLEX-RN (6) Mental Health (5 decks)

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