Mental Health Meds Flashcards
Review the most common psych meds, side effects, adverse reactions, and nursing considerations.
What are “Downers”?
Medications that cause the central nervous system to be sedated.
They are also called “Sedatives”.
What types of medications and substances are “Downers”?
- Antidepressants
- Anxiolytics
- Antipsychotics
- Antiallergy drugs / Antihistamines
- Barbiturates
- Benzodiazepines
- Muscle relaxers
- Opioids
- Alcohol
- Marijuana
- St. John’s wort
What will the pupils look like if a client has overdosed on a “downer” medication such as too many anxiolytics or opioids?
Pinpoint pupils.
Adverse reactions and nursing considerations:
Downers
- advise client to avoid taking too many Downers at once - client can become sedated, overdose, and die
- implement safety and fall precautions
- assess for suicide
Hold med and notify HCP if client has a decreased level of consciousness.
What is the treatment for CNS depressant (“downer”) overdose?
- induce vomiting or gastric lavage (pump the stomach)
- give activated charcoal
- flumazenil IV for benzodiazepine overdose
What are “Uppers”?
Medications that cause the central nervous system to be stimulated.
They are also called “Stimulants”.
Indication:
Amphetamines (a CNS stimulant)
To treat ADD or ADHD.
Generic names:
Amphetamines
CNS stimulant
- dextroamphetamine, lisdexamfetamine
- methylphenidate
What types of medications and substances are “Uppers”?
- Amphetamines - methylphenidate
- Cocaine
- Caffeine
What will the pupils look like if a client has overdosed on an “upper” medication such as amphetamines?
Dilated pupils.
Side effects and nursing considerations:
Uppers
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.
Indication:
Antidepressants
To treat a variety of conditions:
- depression
- fibromyalgia
- nerve pain
- chronic pain
Adverse reactions and nursing considerations:
Antidepressants
- 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
Side effects and nursing considerations:
Antidepressants
-
sedation
- take in the evening to prevent falls
- avoid taking other CNS depressants at same time
- decreased BP, weight gain, decreased libido and dry mouth
Generic names:
SSRI Antidepressants
(Selective serotonin reuptake inhibitors)
- citalopram, escitalopram
- fluoxetine, paroxetine
- vilazodone
Generic names:
SSNRI Antidepressants
(Selective serotonin norepinephrine reuptake inhibitors)
- desvenlafaxine, venlafaxine
- duloxetine
Generic names:
MAOI Antidepressants
(Monamine oxidase inhibitor)
TIP:
- tranylcypromine
- isocarboxazid
- phenelzine
Side effects and nursing considerations:
MAOI Antidepressants
(Monamine oxidase inhibitor)
- avoid tyramine containing foods - can cause a hypertensive crisis
- do not take within 2 weeks of other antidepressants or uppers - can cause serotonin syndrome
Food-med interaction:
MAOI Antidepressants
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).
Generic names:
Tricyclic Antidepressants
amitriptyline, nortriptyline
What color can the urine become when a client is taking tricyclic antidepressants?
A bluish-green color.
Indication:
bupropion
- treat depression
- prevent desire to use tobacco
Indication:
Antianxiety/Anxiolytics/Benzodiazepines
They are given to treat a variety of conditions:
- anxiety
- insomnia
- alcohol withdrawal
- relax muscles
- fibromyalgia
- prevent seizures
Generic names:
Antianxiety/Anxiolytics/Benzodiazepines
alprazolam, clonazepam, diazepam, lorazepam, temazepam, chlordiazepoxide, midazolam
They all end in -pam or -lam or have “diaze” in the name.
What medication is given for conscious sedation?
Midazolam: a benzodiazepine
Indication:
Cannabis sativa
Also known as marijuana or weed
- nausea/vomiting associated with chemotherapy
- chronic pain
It can be taken as oil, smoked, pill/tablet, in food.
Side effects and nursing considerations:
Cannabis sativa
- Increases appetite: provide healthy snack options
- lethargy, unmotivated and memory loss: encourage life goals and hobbies
Immediate complication
What is serotonin syndrome?
Serotonin syndrome is when a client’s serotonin level increases to dangerous levels.
It is caused by taking too many antidepressants or antidepressants and opiods at once.
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.
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
What is antidepressant discontinuation syndrome?
When a client experiences symptoms from abruptly stopping an antidepressant.
Medication is usually taken for about 6 weeks before symptoms can occur.
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
Indication:
Antipsychotics
To treat bipolar syndrome, schizophrenia, and acute aggression.
Generic names:
1st generation/typical Antipsychotics
haloperidol
Generic names:
2nd generation/Atypical Antipsychotics
- aripiprazole
- olanzapine, quetiapine
- risperidone, lurasidone
Side effects:
Antipsychotics
- anticholinergic side effects
- weight gain
- orthostatic hypotension
- low white blood cell count
Nursing considerations:
Antipsychotics: anticholinergic side effects
- causes blurry vision: implement safety / fall precautions
- causes urinary retention: monitor intake and output
- causes dry mouth: give candy or ice chips
- causes constipation: encourage fluids/fiber/walking
“can’t see, can’t pee, can’t spit, can’t shit”
Nursing considerations:
Antipsychotics: weight gain
- teach about healthy diet and exercise
- assess for onset of diabetes mellitus
Nursing considerations:
Antipsychotics: orthostatic hypotension
- teach to sit at side of bed for a few minutes before getting up
- implement safety and fall precautions
Nursing considerations:
Antipsychotics: low white blood cell count
Assess for signs of infection.
What are extrapyramidal symptoms (EPS)?
Early side effects of Antipsychotics caused by a decrease in dopamine.
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.
What is tardive dyskinesia?
Side effects from long term use of antipsychotics.
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.
What is neuroleptic malignant syndrome?
(Immediate complication)
Neuroleptic malignant syndrome is a rare and fatal reaction to antipsychotics.
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
What EKG finding should prompt the nurse to avoid giving antipsychotics or antidepressants?
(Immediate complication)
Prolonged QT.
It can lead to life-threatening cardiac dysrhythmias.
Indication:
lithium
- to treat acute mania in bipolar disorder
- to treat long-term control of bipolar disorder
Toxicity adverse effects:
lithium
- muscle and neuro symptoms: slurred speech, decreased muscle coordination, and twitching, drowsiness
- GI symptoms: nausea/vomiting/diarrhea
Hold med and notify HCP if experiences these side effects.
Nursing considerations:
lithium
Prevent toxicity:
- avoid dehydration by drinking 6 - 8 glasses of water daily
- keep salt intake and exercise consistent
Lithium is a “salt” like sodium; changes in sweating and fluid intake can cause toxicity.
therapeutic level of lithium
0.6 - 1.2
2 or greater is considered toxicity.
Indication:
disulfiram
To prevent clients from drinking alcohol by causing severe nausea and vomiting when the client drinks alcohol.
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
