mental meds Flashcards
Selective serotonin reuptake inhibitors (SSRIs) meds (5)
Fluoxetine, Paroxetine, Sertraline, Citalopram, Escitalopram
SSRIs MOA
Blocks the reuptake of serotonin
SSRI common side effects (6)
anxiety, insomnia, sedation, akathisia, sexual dysfunction, increased risk of suicide
What is serotonin syndrome?
Serotonin syndrome occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body.
How can MILD serotonin syndrome be fixed?
Milder forms of serotonin syndrome may go away within a day of stopping the medications that cause symptoms and, sometimes, after taking drugs that block serotonin.
Serotonin syndrome side effects
agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, confusion, coma and death.
SSRI nursing considerations
- Takes 4 weeks for full therapeutic effect. Some improvement in 2-3 weeks.
- Take w/ food to minimize nausea
- Sedation, take at bedtime
Tricyclic antidepressants (2)
Amitriptyline, and Imipramine
Tricyclic antidepressants MOA
Block reuptake of norepinephrine and serotonin to some degree
Tricyclic antidepressant side effects
- Weight gain
- Anticholinergic side effect such as, dry mouth, urinary retention, constipation, vision changes
Tricyclic antidepressant nursing considerations
These medications take 4-6 weeks for full effectiveness
TETRAcyclic antidepressants (1)
Mirtazapine
TETRAcyclic antidepressants MOA
antagonizes alpha-2 adrenergic and serotonin 5-HT2 receptors
TETRAcyclic antidepressants COMMON side effects
somnolence (drowsiness/sleepy), xerostomia (dry mouth), increased appetite, and weight gain
TETRAcyclic antidepressants SERIOUS side effects
agranulocytosis (low WBC), serotonin syndrome, orthostatic hypotension, seizures, akathisia, torsade de points and Steven-Johnson syndrome
What is torsade de points? What side effect medication is it associated with?
TETRAcyclic antidepressants
-polymorphic ventricular tachycardia characterized by a gradual change in amplitude and twisting of the QRS complexes around an isoelectric line on the electrocardiogram.
What is Steven-Johnson’s syndrome?
SJS is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms
What are the symptoms of SJS?
Flu-like symptoms, fever, rash, blisters, peeling of skin and rhabdomyolysis (muscle break-down)
TETRAcyclic antidepressants nursing considerations
LABS: CBC, liver function tests (LFTs), blood glucose, cholesterol
monitor weight and suicide risk
TETRAcyclic antidepressants nursing considerations
LABS: CBC, liver function tests (LFTs), blood glucose, cholesterol
monitor weight and suicide risk
Serotonin norepinephrine reuptake inhibitors (SNRIs) drugs (3)
Venlafaxine, Duloxetine, Atomoxetine
-ine endings
SNRIs MOA
Block reuptake of norepinephrine and serotonin
SNRIs SERIOUS side effects
suicide, serotonin syndrome, HTN, EPS, seizures
SNRIs COMMON side effects
insomnia, abnormal dreams, anxiety, sexual dysfunction, anorexia, n/v, and weight loss
SNRIs monitor labs…
creatinine at baseline, lipid panel if on long term
SNRIs monitor for ?
suicide, BP, monitor height/weight in children
Atomoxetine (SNRI) is used for?
ADHD, not a stimulant
Miscellaneous antidepressants (2)
Burpoprion and Trazodone
Miscell. antidepressants are?
Norepinephrine dopamine reuptake inhibitors (NDRIs)
NDRIs MOA
inhibits uptake of norepinephrine and dopamine
NDRIs SERIOUS side effects
suicide, HI, HTN, arrhythmias, MI, hepatotoxicity, seizures
NDRIs COMMON side effects
Xerostomia, diaphoresis, abnormal dreams, insomnia, tinnitus, anorexia, weight loss and anxiety.
NDRIs monitor for?
suicide and BP
NDRIs labs
creatinine at baseline
MAOI drugs (2)
phenelzine, tranylcypromine
MAOIs MOA
interfere with metabolism of enzyme
MAOI side effects
sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction
MAOI SERIOUS side effect
HTN crisis due to tyramine ingestion
Tyramine sources:
aged cheeses, aged meats/cold cuts , tofu, avocado, tap/microbrew beer, soy sauce, yogurt, sour cream, brewers yeast and MSG
Mood stabilizer drug (1)
Lithium
Lithium MOA
Normalizes reuptake of serotonin, norepinephrine, acetylcholine, and dopamine
Lithium side effects
anorexia, nausea, hand tremors, polydipsia/uria, metallic taste in mouth, fatigue, weight gain, acne
Lithium toxicity
severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination, coma/death
Lithium labs:
1.5 or HIGHER is lithium toxicity.
safe range: 0.6 - 1.2
monitor everyday for 2-3 days then monthly
Anticonvulsant mood stabilizers (2)
Valproic acid and carbamapezine
Valproic acid and carbamapezine MOA
unknown, increase levels of GABA. Inhibits kindling process of seizures
Valproic acid and carbamapezine side effects
drowsiness, sedation, dry mouth, blurred vision, rashes, orthostatic hypotension, weight gain, alopecia and hand tremors
Valproic acid and carbamapezine labs:
liver function at baseline periodically (3-6 months)
requires blood levels
take with meals to decrease nausea
Sensitizing agent for alcohol
disulfiram
Disulfiram MOA
inhibits enzyme aldehyde dehydrogenase, needed for ethanol metabolism
disulfiram COMMON side effects
rash, drowsiness, impotence, headache, acne, metallic taste
disulfiram SERIOUS side effects
hepatoxicity, psychosis, peripheral neuropathy, optic neuritis
disulfiram labs
liver functions at baseline
after 10-14 days, CBC, serum chemistries
disulfiram teaching
all sources of alcohol in diet, mouthwash, aftershave, cologne, cough preparations, vanilla, and to READ LABELS