Mental Health Pharm Key Points NUR3 Flashcards
Antipsychotics
-Treats psychotic disorders, psychosis, schizophrenia
-SE: anticholinergic, skin rash, sedation, photosensitivity, hormonal effects (including gynecomastia in men), seizures, water intoxication, salivation, agranulocytosis, EPS, Tardive Dyskinesia, Neuroleptic Malignant Syndrome
-Oral= first treatment; IM (Rotate sites; use large gauge needle in large muscle and do not massage; use within 15 minutes of preparation); IV for life-threatening emergencies
-Long-acting injections: Used for oral noncompliance; has to be done in healthcare setting every 30 days and client has to have a responsible party with them
-If skin rash occurs, stop taking medication and notify HCP
-New consent has to be signed every time new medication is started because of major side effects
-Sedative side effects will eventually decrease
-Urine may turn pink to red brown color
-May take 2-6 weeks for therapeutic effect
-Avoid alcohol, narcotics, and other CNS depressants
-Do not abruptly stop medication
-Elderly and children need smaller doses
Tricyclic antidepressants
-Contraindicated in clients with heart problems and/or seizure disorders.
-SE: anticholinergic, sedation, arrythmia/EPS(rare), weight gain, sexual dysfunction
-Avoid taking with Phenothiazines, Haloperidol, Barbiturates, anticonvulsants, alcohol
Antiparkinsonians
-Treats EPS; Short term treatment of anxiety, restlessness, agitation, insomnia, tremors
-SE: anticholinergic, dizziness/drowsiness, nausea/GI upset
Anxiolytics
-Short term treatment of anxiety, acute alcohol withdrawal, skeletal muscle spasm, convulsive disorders, and preoperative sedation
-SE: Tolerance/dependency, sedation, confusion, worsening depression, paradoxical excitement, anticholinergic, sleep disturbances, hallucinations
-Contraindicated in drug abusers and pregnancy/breastfeeding
-Avoid smoking, Kava Kava, antacids, and caffeine
-Can cause withdrawal if stopped abruptly (develops in 2-10 days and can last several weeks; symptoms: tremors, agitation, sweating, insomnia)
-Buspirone: Has fewer side effects and fewer dependency side effects, takes 1-2 weeks for therapeutic effect, avoid grapefruit juice
Tardive Dyskinesia
-Involuntary facial and tongue movements, stiff neck, difficulty swallowing
-Treat immediately. Do not leave patient alone. Have another nurse call HCP
-Administer Benzotropine IV or IM
Neuroleptic Malignant Syndrome
-First sign: Fever over 103
-Excessive sweating, tremors, incontinence, tachycardia, unstable BP, AMS, dilated pupils
-Progression is rapid (24-72 hours)
-Do not leave patient alone. Stop med and start IV fluids. Apply cooling blanket and then administer antipyretic. Have another nurse contact HCP. Administer Bromocriptine or Dantrolene (muscle relaxers).
-Prepare for transfer to ICU
Extrapyramidal Syndrome
-Pseudoparkinsonism, akinesia, akathisia, dystonia, oculogyric crisis, pill-rolling motion of the hand, stooped posture
-Dystonia and oculogyric crisis= emergency. Give Benzotropine IM or IV
Pseudoparkinsonism
Tremor, shuffling gait, drooling, rigidity
Akinesia
Absence or slowed movements, muscle weakness
Akathisia
Restlessness or inability to sit still
Dystonia
Involuntary muscular movements of face, arms, legs, and neck
Oculogyric crisis
Uncontrolled rolling back of the eyes
SSRI Antidepressants
-Treats depression, OCD, bulimia, migraines, panic disorder. (Blocks serotonin)
-May take 4 weeks for therapeutic effect
-SE: Nervousness, insomnia, tremors, seizures, suicidal ideation, sexual dysfunction, serotonin syndrome. Side effects usually decrease within 2-4 weeks
-Avoid alcohol and other CNS depressants
-If client is suicidal, they receive only 7 days worth of medication at a time so that a new psychosocial exam can be performed weekly
Serotonin Syndrome
-AMS, tachycardia, sweating, shivers, tremors
-DC med immediately and contact HCP
SNRI Antidepressants
-Treats major depression, generalized anxiety disorder, and social anxiety disorder, fibromyalgia, smoking cessation, weight loss (Affects serotonin and norepinephrine)
-Avoid St. John’s Wort (especially if taking Venlafaxine) due to risk of serotonin syndrome and neuroleptic malignant syndrome
-SE: drowsiness/dizziness, HA, euphoria, blurred vision, photosensitivity, ejaculation dysfunction
-AE: Hyponatremia, bleeding, HTN, suicidal ideation, Steven-Johnson’s Syndrome
Steven Johnson’s Syndrome
Rare, severe skin reaction that causes widespread blistering and peeling of the skin and mucous membranes
MOA Inhibitor Antidepressants
-Treats depression not controlled by other antidepressants
-Avoid Tyramine in diet, vasoconstrictions, cold medications due to risk of hypertensive crisis; avoid OTC drugs with stimulant activity such as decongestants and weight loss meds
-SE: restlessness/agitation, anticholinergic, orthostatic hypotension, hypertensive crisis
-AE: Steven Johnson’s Syndrome
-Has to be discontinued (“washed out”) for 2 weeks before client is able to start a new antidepressant medication
Tyramine containing foods
Some cheeses, creams, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, red wine
aged or fermented foods/beverages, overripe fruit, pickled, processed, or smoked meats
Lithium toxicity
-Persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmias, seizures
-Lithium toxicity screening has to be done weekly for the first month, then monthly, then every 6 months, then every year
Sedative/Hypnotics
-Short term management of anxiety and insomnia
-Contraindications: Elderly, suicidal, drug abusers, hepatic or renal dysfunction
-Used after all other nonpharmacological therapies have proven unsuccessful
-SE: Tolerance/dependence, paradoxical excitement, anticholinergic, GI upset, worsening depression, cognition and behavioral changes
-Very addictive
ADHD meds/CNS Stimulants
-Treats ADHD, ADD< exogenous obesity, and ADHD
-Contraindicated in clients with previous addictions
-Bupropion is the only one that is not a stimulant but is still highly addictive
-SE: Anticholinergic, weight loss, HTN, tachycardia, insomnia, palpitations, decreased growth and development in children, tolerance/dependency, new or worsened psychiatric symptoms, seizures, rebound syndrome
-Avoid caffeine
-Requires routine drug screening
Mood Stabilizers/Anti-convulsants
*Lithium Key points: Treats bipolar disorder and manic episodes
-Monitor Lithium levels, renal function tests, and sodium levels every 1-2 months
-Encourage fluids 2L/day
-Wear med alert bracelet
-May take 1-2 weeks for therapeutic effect
-Avoid caffeine, crash diets, NSAIDS, diuretics
-Has serious teratogenic effects
-Has metallic taste
-Can cause edema of hands and ankles
-Lithium levels greater than 1.5-2 is toxic
-Has to be discontinued for 3-6 months before becoming pregnant
-Contraindicated in clients with renal disease, cardiovascular disease, dehydration, sodium depletion, brain damage, pregnancy/breastfeeding
SE: GI upset, hand tremors, polyuria, polydipsia, weight gain, lithium toxicity, edema of hands and feet, muscle weakness hypotension
-Continue with same sodium containing diet. Do not increase or decrease sodium in diet
-Notify HCP of herbals
