Neuro System - Drugs to treat mental health disorders Flashcards
benzodiazepines prototype and other drug names
Diazepam (Valium) and Alprazolam (Xanax)
Others: lorazepam, clonazepam (Klonopin), midazolam (Versed)
Benzos EPA
enhance inhibitory effects of gamma-aminobutyric acid (GABA)
benzos administration
Alprazolam oral only, diazepam PO/IV: admin IV slowly/monitor IV site
benzos therapeutic uses
generalized anxiety disorder (GAD) and panic disorder
benzos ADRs
CNS depression, hypotension, tachycardia, respiratory depression, tolerance and physical dependence (especially with alprazolam)
- Overdose/toxicity: possibility life-threatening sedation, hypotension, respiratory depression, cardiac arrest
benzos contraindications and interactions
Pregnancy - teratogenic
Glaucoma
Respiratory and/or CNS depression
Concurrent use of CNS depressants
benzos RN intervention and client education
Monitor for withdrawal symptoms: insomnia, anxiety, tremors, diaphoresis, hypertension, seizures
Monitor for phlebitis
assess/monitor for falls
Regular vital signs
Do not stop abruptly
Assess CNS and resp depression
Antidote: Flumazenil (Anexate, Romaxicon)
Non-benzodiazepines/mics. Anxiolytic prototype
buspirone (BuSpar)
Non-benzos EPA
binds to serotonin and dopamine receptors, agonistic action on dopamine
Non-benzos admindstration
PO, give 2-4 weeks before tapering Benzodiazepines. Can take 2-4 weeks to take effect
non-benzos therapeutic use
short term treatment of GAD
non-benzos ADRs
paradoxical effects: insomnia, anxiety, restlessness, headache, dizziness, GENERALLY well tolerated
non-benzos contraindications and interactions
MAO inhibitors - HTN
Grapefruit juice, ketoconazole, erythromycin - inc. blood levels
non-benzos RN intervention and client education
Monitor for paradoxical effects
assess/monitor falls
Avoid contraindicated meds/grapefruit juice
*Does not cause sedation so no risk for abuse/dependence
Tricyclic Antidepressants (TCA) prototype and other drug names
Amitriptyline (Elavil)
Other: Imapramine (Torfranil), Nortriptyline (Aventyl)
TCA EPA
Block norepinephrine reuptake pump and serotonin reuptake pump in synaptic space - boosts the availability of serotonin, norepinephrine, acetylcholine, dopamine
TCA administration
admin PO at bedtime due to sedative effects. Takes several weeks to take effect
TCA therapeutic use
treatment of major depression. 2nd line drug
TCA ADRs
MANY. Anticholinergic effects; sedation, inc risk for suicide (child/adolescent); abrupt discontinuation can cause withdrawal (anxiety, headache, muscle pain, nausea); high risk for overdose (life-threatening dysrhythmias, confusion, seizure
TCA contraindications and interactions
Avoid use of MAOIs
Avoid anticholinergics
Avoid CNS depressants
Cardiac dysrhthmias
Seizure d/o
Recent MI
TCA RN intervention and client education
Give at bedtime
Monitor orthostatic VS
Monitor for increases in depression and suicidal ideation
Initiate suicide precautions when appropriate
Taper the drug over 2 weeks to prevent or minimize withdrawl
Assure that clients have no more than a 1 week supply of the drug
SSRIs Prototype and other drugs
Fluoxetine (Prozac)
others: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
SSRIs EPA
block reuptake of serotonin - strengthened transmission of serotonin at serotonergic synapses
SSRIs administration
admin PO in morning due to CNS excitation. Takes 4-6 weeks to take effect
SSRIs therapeutic uses
many indications! Depression, anxiety, OCD, bulimia nervosa, PMDD
SSRIs ADRs
insomnia, nervousness, sexual dysfunction, weight gain, inc risk for GI bleeding, hyponatremia (older adults and those taking diuretics), increased fisk for suicidal ideation (children and young adults), serotonin syndrome
*Serotonin syndrome: HTN crisis, hyperpyrexia, agitation - coma, muscle rigidity, seizure
SSRIs contraindications and interactions
MAOIs
St johns wort
Ibuprofen
May decrease glucose control in clients w/ DM
SSRIs RN interactions and client education
Monitor for insomnia, anxiety, HA
Monitor for decreased libido and/or impotence
Monitor weight gain
Monitor periodic sodium levels
Monitor for inc depression or suicidal ideation
Monitor for s/sx serotonin syndrome
Do not stop abruptly
Notify the provider if you develop persistent HA
SNRIs prototype and other drug names
Vanlafaxine (Effexor XR)
Duloxetine (Cymbalta)
SNRIs EPA
block neuronal reuptake of serotonin AND norepinephrine - inc amount of serotonin/norepinephrine available
SNRIs administration
PO. Start with low dose and gradually titrate up
SNRIs therapeutic use
major depression, social anxiety disorder, generalized anxiety disorder (GAD)
SNRIs ADRS
very similar to SSRI. sexual dysfunction less common than w/ SSRI and can cause HTN
SNRIs contraindications and interactions
MAOIs
First gen antipsychotics/typicals
ibuprofen
SNRIs RN intervention and client education
Take in the morning with food
Monitor for insomnia
Monitor for dec libido and/or impotence
Monitor weight gain
Monitor periodic sodium levels
Monitor for inc depression or suicidal ideation
Monitor for s/sx serotonin syndrome
Do not stop abruptly
Monitor BP periodically
MAOI Prototype and other drug names
phenelzine (Nardil)
Isocarboxazid (Marplan)
MAOIs EPA
blocks monoamine oxidase-A and monoamine oxidase-B
MAOIs administration
PO. start with low dose possible
MAOIs therapeutic uses
depression that hasn’t responded to other meds, depression in bipolar
MAOIs ADRs
CNS stimulation, constipation, dry mouth, nausea, weight gain, sexual dysfunction, orthostatic hypotension, HTN crisis when eating foods with tyramine (aged cheese, meats, yeast, chocolate, alcohol)
MAOIs Contraindications and interactions
Renal failure
Liver disease
Cardiac disease
Clients >60
SSRIs
glaucoma
MAOIs RN intervention and client education
Monitor VS and BP
Provide client a list of foods to avoid
Instruct client to report severe anxiety, insomnia, and agitation to provider
Atypical Antidepressants prototype
bupropion (Wellbutrin)
atypical antidepressants EPA
inhibits dopamine reuptake thereby inc dopamine availability
atypical antidepressants administration
PO
Atypical antidepressants therapeutic uses
depression, seasonal affective disorder, adjunctive to smoking cessation
Atypical antidepressants ADRs
N/V, weight loss, appetite suppression, inc risk for seizure. CNS stimulation: insomnia, agitation, tremor, headache. Inc risk for psychosis/hallucination, SI
Atypical antidepressants contraindications and interactions
Hx of an eating disorder
Seizure disorder
MAOI
Head trauma or tumor in CNS
Interacts with many meds
atypical antidepressants RN intervention and client education
Give w/ food
Give in the morning
Weekly weights
Assess for ADRs
Assess for inc depression of SI
Mood stabilizer prototype
lithium carbonate (Lithobid)
mood stabilizer EPA
not well understood. Changes to transport of sodium ions in nerve cells and alters metabolism of catecholamines (fight or flight) in response to stress. This is thought to dec mania assoc with bipolar
mood stabilizer administration
PO. Give with milk or food to reduce GI upset
mood stabilizer therapeutic uses
controls acute mania and acute manic episodes assoc with bipolar disorder. Used prophylactically to prevent recurrence of mania or depression
mood stabilizer ADRs
therapeutic levels: GI distress, fatigue, confusion, muscle weakness, memory impairment. Polyuria, dec secretion of thyroid hormone - goiter or hypothyroidism. Fine hand tremors
mood stabilizers contraindications and interactions
pregnancy/lactation
Moderate-severe cardiac disorders
Dehydration
Hyponatremia
Renal insufficiency
Many drug interactions
Avoid NSAIDS
mood stabilizers RN intervention and client education
Narrow therapeutic range
Monitor lithium levels. Desired serum plasma levels = 0.6-0.8 mEq/L
Regular bloodwork
- Electrolytes (sodium) and CBC
- Thyroid function - hypothyroidism
- Renal function
Monitor for s/sx of toxicity and other ADRs
Drink 2-3 L of fluid per day
Avoid caffeine and stressors
Consume foods with sodium
First generation antipsychotics (FGA) prototype and other drug names
Chlorpromazine
Other: Haloperidol (Haldol)
FGA EPA
Block several receptors: norepinepherine, acetylcholine, dopamine, hsitamine
FGA administration
PO, IV, IM, Rectal
FGA therapeutic uses
suppresses symptoms of schizophrenia. Acute manic phase of bipolar disorder
FGA ADRs
Extrapyramidal symptoms (EPS): abnormal muscle contraction/posturing and acute dystonia
Neuroleptic malignant syndrome: fever, stiffness of muscles, altered mental status, change in BP rep. failure
Akathisia (inability to sit still)
Anticholinergic symptoms (dry mouth, dizziness, urinary retention, etc)
Parkinsonism
Orthostatic hypotension
Cardiac arrhythmias - prolonged QT interval
Liver failure
FGA contraindications and interactions
Alcohol and other CNS depressants
Caution with meds that activate dopamine receptors (levodopa)
SSRIs - increase levels of serotonin - serotonin syndrome
Hyponatremia
Antihypertensives
pregnancy/lactation
Parkinsons disease, bone marrow depression
FGA RN intervention and client education
Monitor for ADRs
Wear gloves when handling
Have client report:
- Muscle rigidity, tremors, and sluggish movements, drooling, and shuffling gait
- Severe spasms of the neck and body
- Involuntary movements of tongue, face, limbs, trunk
- Palpitations, fainting spells, other cardiac symptoms
- Avoid sun exposure, use sunscreen, wear protective clothing, wear sunglasses
- Sudden fever immediately to provider
Second Generation Antipsychotics (SGA) prototype and other drug names
risperidone (Risperdal)
Others: olanzapine (Zyprexa), quetiapine (Seroquel), apriprazole (Ability), clozapine (Clozaril)
SGA EPA
block receptors for dopamine and serotonin. Dopamine blockade is less than conventional antipsychotics thus fewer EPS occur
SGA administration
PO - instructions vary by drug
SGA therapeutic uses
treat symptoms of schizophrenia and bipolar disorder
SGA ADRs
dizziness, sedation, hypotension (blockade of alpha adrenergic receptors), metabolic syndrome: wt gain, diabetes, dyslipidemia: arrhythmias, agranulocytosis (Clozapine), liver and kidney dysfunction; severe constipation. Extrapyramidal symptoms when given high doses
SGA contraindications and interations
Prolonged QT
Severe CNS depression
Psychosis related to dementia in order adults
pregnancy/lactation
Drugs to treat parkinsons disease
Many drug interactions
SGA RN interventions and client education
Very similar to FGAs/typocals
Weekly blood tests (CBC)
Periodic blood glucose monitoring
Report lethargy/flu like symptoms
Notify provider if you become pregnant
Notify provider if you have increased HR
BLACK BOX WARNING - don’t give to elderly clients with dementia
