Psych Drugs Flashcards by M. B.

What is the most serious adverse effect of tricyclic antidepressant (TCA) overdose is..

Cardiac arrhythmias

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the nurse is caring for a client who intentionally overdosed on amitriptyline. What action should the nurse prioritize?

Obtain a 12 lead electrocardiogram

It is a TCA, has cardiac effects

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What to watch oout for with TCAs

What is it for

Tachycardia, Cardiac effects (arrhythmias, prolonged QT interval), anticholinergic effects, sedation/sexual dysfunctions)

TCAs are for depression, prevents re-uptake of norepinephrine and serotonin)

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What are MAOs

Isocarboxazid, phenelzine

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What are nursing considerations with MAOIs

Avoid foods that are high in tyramine (ages cheeses, wine, pickled meats)
Side effect - hypertensive crisis

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What are mood stabilizers

LITHIUM

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Indication of manic phase

Lithium

Caalm down transmitters, promote GABA(calming)

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Nsg consideration with lithium

***do not administer NSAIDs

Encourange fluid intake

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What is the therapeutic level of lithium

What are signs of toxicity?

0.6-1.2 mEq/L

Seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors

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What are antipsychotics?

First gen? 2nd gen?

1st gen: haloperidol

2nd gen: quetiapine, olanzapine

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Nsg considerations with HALOPERIDOL

What does it do

Extrapyramidal effects(grimacing),
tardive dyskinesia,
neuroleptic malignant syndrome(high fever** can cause organ damage),
prolong QT interval (grab weekly ECG- can go into TOursaudds ),
contraindicated in pregnancy

It inhibits the effects for dopamine to treat Schizom mania, aggressive behaviour, agitation

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action of haloperidol

For what

Inhibits effects of dapamine

Indicated to treat Schizo, mania, aggressive behaviour, agitation

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Diphenhydramine

Indicate?
Action?
Nsg consideration?

Allergy,. Anaphylaxis, sedation

Anatagonizes effects

Drowsiness, anticholinergic effects

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Short acting benzo

Midazolam

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Long acting benzo

Diazepam

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Benzo. Rapid IV, intermediate PO

Lorazepam

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Therapeutic class: antianxiety agent

Indication: anxiety, sedation, seizures

Action: general CNS depression

Nursing Considerations:
● Avoid alcohol
● Monitor for respiratory depression
● Antidote - ﬂumazenil

LORAZEPAM

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What is the antidote for Lorazepam

Flumazenil

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What classes are considered antidepressants?

● SSRIs
○ Fluoxetine
○ Sertraline
○ Escitalopram

● TCAs
○ Amitriptyline
○ Nortriptyline
○ Protriptyline

● MAOIs
○ Isocarboxazid
○ Phenelzine

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Give 3 SSRIs

Fluoxetine, Sertraline, Escitalopram

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Give 3 TCAs

Amitriptylone, Nortriptyline, Protriptyline

What are MAOIs?

Isocarboxazid, Phenelzine

Indication: Depression

Action: Prevent reuptake of serotonin increasing the availability of serotonin in the body.

Nursing Considerations:
● Monitor for serotonin syndrome
○ Hypertension, confusion, anxiety, tremors, ataxia, sweating.
● Suicide precautions important for 2-3 weeks
○ When the client’s mood starts to improve, they are are an inreased risk for suicide
○ Why? They now have the energy to follow through with a plan.

Selective Serotonin Reuptake Inhibitors - SSRIs

Examples: Fluoxetine, Sertraline, Escitalopram

What are nursing considerations in taking SSRIs??? (Fluoxetine, Sertraline, Escitalopram)

Monitor serotonin syndrome: htn, confusion, anxiety, tremors, ataxia, sweating
Suicide precautions for 2-3 weeks: when he client’s mood starts to improve, they are an increased risk for suicide

Give examples of SSRIs

Fluoxetine, Sertraline, Escitalopram

Indication: Depression Action: Prevents the reuptake of norepinephrine and serotonin increasing these transmitters in the body Side effects: Tachycardia, Cardiac events (arrhythmias, prolonged DT interval), Anticholinergic effects, Sedation/Sexual dysfunction

Tricyclic Antidepressants - TCA’s Examples: Amitriptyline, Nortriptyline, Protriptyline

Give examples of Tricyclic Antidepressants - TCA’s

Amitriptyline, Nortriptyline, Protriptyline

What are side effects of TCAs

Tachycardia Cardiac arrhythmias (arrhythmias, prolonged QT interval) Anticholinergic effects Sedation/Sexual dysfunction

What meds do we avoid foods that are high in tyramine (such as aged cheeses, wine, pickled meats)???

Monoamine Oxidase Inhibitors - MAOIs Examples: isocarboxazid, phenelzine

Indication: Depression Action: blocks monoamine oxidase enzymes to increase the levels of ALL neurotransmitters ( dopamine, norepinephrine, epinephrine, serotonin) Nursing Considerations: ● Avoid foods that are high in tyramine. ○ Aged cheeses ○ Wine ○ Pickled meats ● Side effect - hypertensive crisis

Monoamine Oxidase Inhibitors - MAOIs Examples: isocarboxazid, phenelzine

Mood Stabilizer

Lithium

What is Lithium’s therapeutic level

0.6 - 1.2 mEq/L

Indication: Mania Action: Inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission. Nursing Considerations: ● Do not administer with NSAIDS ● Monitor drug levels: ○ Therapeutic level - 0.6-1.2 mEq/L ● Encourage adequate ﬂuid intake ● Side effects: ○ Seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors

LITHIUM

What are Antipsychotics

● First generation ○ Haloperidol ● Second generation ○ Quetiapine ○ Olanzapine

Indication: Schizophrenia, mania, aggressive behavior, agitation Action: Inhibits the effects of dopamine Nursing Considerations: ● Monitor for extrapyramidal side effects ● Tardive dyskinesia ● Neuroleptic malignant syndrome ● Can prolong the QT interval ○ Weekly EKG ● Contraindicated in pregnancy

Haloperidol Therapeutic class: Antipsychotic

What are nursing considerations for Haloperidol?

● Monitor for extrapyramidal side effects ● Tardive dyskinesia ● Neuroleptic malignant syndrome ● Can prolong the QT interval ○ Weekly EKG ● Contraindicated in pregnancy

What are antihystamine examples

● Histamine-1 blocker → block H1 receptors in CNS - stopy allergies! ○ Diphenhydramine ● Histamine-2 blocker → block production of stomach acid! ○ Famotidine ○ Ranitidine

Indication: Allergy, anaphylaxis, sedation Action: Antagonizes effects of histamine, CNS depression Nursing Considerations: ● Monitor for drowsiness ● Anticholinergic effects

Diphenhydramine Therapeutic class: Antihistamine

It is a mood stabilizer and antiepileptic This mediction is indicated for bipolar disorder and epilepsy Thos medication MAY adversely cause Steven-Johnson Syndrome (SJS), manifested by tender skin lesions that appear as blisters This skin eruptions may also involve the eys and mouth. Prompt treatment is necessary because of the risk os sepsis that may result from skin erosion. These lesions often spread fast, underslying the necessety of prompt treatment. If this should occur, the offending agent should be withdrawn.

LAMOTRIGINE (antiepileptic, class: phenyltriazine)

Seizure medication Therapeutic level: 10-20 Toxic level: >20

DILANTIN (PHENYTOIN)

Breakdown product of Red Bloos Cells Always tested in the Newborns on the NCLEX *In Newborns bilirubin is much higher than in adults — elevated level: 10 to 20 — toxicity: > 20

Bilirubin

When bilrubin is around _______ in newborn, consider hospitalization

14 - 15

What to do when newborn bilirubin is 10 - 13

Can be Tx at home with sunlight, fluids

Bilirubin in the brain In the cerebral spinak fluid, meninges

Kernicterus

Bilirubin in skin

Jaundice

When level of bilirubin in blod gets >20, gets ________ In the brain, it may cause aseptic (steril) meningitis or encepalopathy It can be deally

Kernicterus

looks like possession in harry potter • Position the newborn assume due to irritation of the meninges from kernicterus • Presentation: hyperextended posture … (Is a medical emergency)

Opisthotonos

In what position do you place an opisthotonic newborn?

Put newborn on the side

It is a drug most commonly indicated for ADHD

Methylphenidate

Is s serotonergic drug used in the treatment of depressive and anxiety disorders

Citalopram

It is an anticonvulsant indicated for bipolar disorders as it has mood-stabilizing effect.

Carbamezrpine

What class of medications causes neuroleptic malignant syndrome (NMS)? What are signs of NMS?

Both typical and atypical antipsychotics Typical: haloperidol, flupenazine, thiothixene, chlorpromazine Atypical: Ziprasidone, olanzapine, clozapine, risperidone NMS is a life threatening neurologic condition characterized by high fever, mental status change, dysautonomia, and muscle rigidity.