Psych Drug Names And Classes Flashcards
What is the action of Imipramine (Tofranil)?
Blocks reuptake of norepinephrine and serotonin.
Tricyclics
Imipramine (Tofranil)
What are adverse effects of Imipramine (Tofranil)?
Orthostatic hypotension Anticholinergic effects Sedation Tachycardia Seizures Hypomania Confusion
What is patient teaching for imipramine (Tofranil)?
Change positions slowly Increase fluids and fiber Tips for dry mouth Effects take 1-3 weeks Don't stop drug suddenly Drowsiness may occur
Things to report: imipramine (Tofranil)
Report palpitations, urinary retention, blurred vision.
Do not drink alcohol or use other cns depressants
Family: report worsening depression, suicidal thoughts.
Confusion, hypomania
Monoamine oxidase inhibitors (MAOIs)
Action
Monoamine oxidase converts NE, S, and DA into inactive products. Also inactivates tyramine found in many foods.
MAOIs
Phenelzine (Nardil)
What happens when pt taking MAOI eats tyramine?
Hypertensive crisis from increase in NE.
Causes vasoconstriction, n/v, ha, increase p and bp
Foods containing tyramine
Aged cheese, red wine
Smoked/pickled/fermented meat, fish, poultry
Patient teaching with MAOIs
Avoid vasopressors (amphetamines, epinephrine, caffeine) Drug interactions: tricyclics or SSRI antidepressants.
Selective serotonin reuptake inhibitors (SSRIs)
Action
Selective inhibition of serotonin reuptake
SSRI uses
Depression, hot flashes, anxiety disorders
SSRI pharmacokinetics
Half life=7 days.
Takes 4 weeks to achieve steady plasma level
SSRI common adverse effects.
Nausea, ha, fatigue, insomnia, anxiety.
Decreased libido, anorgasmia, delayed ejaculation.
SSRI example
Sertraline (Zoloft)
What is serotonin syndrome?
Too much serotonin in the cns.
Causes disorientation, confusion, agitation, mania
Rigidity, ataxia, hyperactivity, hyperreflexia.
Shivering, hyperthermia, hypertension, tachycardia, diaphoresis
SNRIs- serotonin norepinephrine selective reuptake inhibitors.
Examples
Mirtazapine (remeron)
Buproprion (Wellbutrin)
SNRI action
Potentiate effects of both serotonin and norepinephrine
SNRI side effects
Similar to SSRI
Nausea, ha, fatigue, insomnia, anxiety
Decreased libido, anorgasmia, delayed ejaculation
Buproprion-no weight gain, decreased sexual effects.
SNRI nursing implications
Assess for suicidal ideation
Teach length of time needed to see improvement.
Keep taking meds 6-12 months to prevent relapse
Asians and Hispanics need smaller doses than Caucasians
Do not stop abruptly.
St. John’s wort
Perennial herb used to treat depression
Leaves and flowers can be brewed as tea.
No well established doses.
May inhibit production of MAO
Increases mood, promotes sleep
Adverse effects: GI symptoms, allergic reaction, fatigue
Anti-manic drugs
Lithium carbonate (eskalith) Valproic acid (depakote) Gabapentin (neurontin)
Uses for anti-manic drugs
Mania associated with bipolar illness
Recurrent major depressive disorder
Schizoaffective disorder
Long term prophylaxis.
Lithium carbonate
Action
Alters sodium transport in nerve cells.
Affects metabolism of NE, DA, S
Lithium carbonate side effects
Fine hand tremor, h/a, lethargy, drowsiness, dizziness.
Cholinergic effects, v/d, polyuria, hypotension, weight gain or anorexia.
Lithium carbonate- narrow therapeutic window
Toxic side effects
Mild: <1.5 mEq/L
N/v/d, polyuria, hand tremors, slurred speech and muscle weakness.
Moderate: 1.5-2 mEq/L
Persistent GI upset, course hand tremor, confusion, lack of coordination, sedation, EKG changes.
What is severe lithium toxicity?
2.0-2.5 mEq/L
Ataxia, giddiness, very dilute urine, serious EKG changes, hypotension, seizures and possible death.
Lithium nursing implications
Monitor blood levels
0.6-1.2 maintenance range.
Look for clinical signs of toxicity
Monitor kidney/thyroid function and electrolytes.
Contraindicated in 1st trimester of pregnancy
Lithium pt. teaching
Take as prescribed Importance of monitoring blood levels-keep appointments. Maintain adequate fluid intake Maintain adequate sodium intake Take with meals.
