Psych Meds Flashcards
MAO-Inhibitors (Monoamine Oxidase Inhibitors) SE and Precautions
• Tachycardia • Urinary hesitancy, constipation • Impotence • Dizziness • Insomnia • Muscle twitching • Drowsiness • Dry mouth • Fluid retention *** (Hypertensive crisis: severe hypertension, severe headache, chest pain, fever, sweating, nausea and vomiting) • Confusion ***No tricyclics or SSRI (wait 2 weeks; 5 weeks for Prozac)!!! ***No OTC Meds!!!!!!! ***Major concern is need for dietary restrictions—certain drug and food interactions can cause hypertensive crisis. • Instruct client not to eat foods with high tyramine content: aged cheese, red wine, beer, beef and chicken, liver, yeast, yogurt, soy sauce, chocolate, bananas!!!! • Teach client to use caution around machinery
Isocarboxazid: Trade Name, Class, TX?
- Marplan
- TCA
- Depression, Phobias, Anxiety
Phenelzine sulfate: Trade Name, Class, TX?
- Nardil
- TCA
- Depression, Phobias, Anxiety
Tranylcypromine sulfate: Trade Name, Class, TX?
- Parnate
- TCA
- Depression, Phobias, Anxiety
SSRIs (Selective Serotonin Reuptake Inhibitors) SE and Precautions
SE: • Drowsiness • Dizziness, light-headedness • Headache • Insomnia • Depressed appetite • Serotonin syndrome • Sexual dysfunction • Allergic reaction or rash; withhold drug if occurs • Weight gain Precautions: • Effective 2-4 weeks after treatment is initiated • No MAOI wait 2 weeks Monitor for serotonin syndrome (defined by at least 3 symptoms): → Rapid onset of altered mental states → Agitation → Myoclonus → Hyperreflexia → Fever → Shivering → Diaphoresis → Ataxia → Diarrhea • No St. John’s Wort!!!! • Must be tapered slowly if discontinuing or changing from one SSRI to another!!!!
Fluoxetine HCl: Trade Name, Class, TX?
-Prozac
-SSRI
-TX:
• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia nervosa
• OCD
Paroxetine: Trade Name, Class, TX?
-Paxil
-SSRI
-TX:
• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia nervosa
• OCD
Sertraline: Trade Name, Class, TX?
-Zoloft
-SSRI
-TX:
• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia nervosa
• OCD
Fluvoxamine: Trade Name, Class, TX?
-Luvox
-SSRI
-TX:
• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia nervosa
• OCD
Citalopram: Trade Name, Class, TX?
-Celexa
-SSRI
-TX:
• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia nervosa
• OCD
Tricyclics (TCAs) SE and Precautions
-Anticholinergic effects: dry mouth,
blurred vision, constipation, and
urinary retention
• sedation, psychomotor slowing, and poor concentration
• Cardiac: tachycardia,orthostatic, hypotension, quinidinelike
effect on the heart (assess history of myocardial infarction), prolongation of QTc interval
• GI: nausea and vomiting
• Narrow therapeutic index (can be
lethal in overdose)
Precautions:
• Administer at bedtime to minimize
sedative effect.**
• Takes 2-6 weeks to achieve
therapeutic effects
• 1-3 weeks should elapse between
discontinuing tricyclics and initiating MAO inhibitors.
• Teach client to avoid alcohol, antihypertensive drugs.
• Carefully evaluate suicide risk.
Amitriptyline HCl, Trade Name, Class, TX?
- Elavil
- TCA
- Depression
Desipramine HCl, Trade Name, Class, TX?
- Norpramin
- TCA
- Depression
Imipramine HCl, Trade Name, Class, TX?
- Tofranil
- TCA
- Depression
Nortriptyline HCl, Trade Name, Class, TX?
- Aventyl
- TCA
- Depression
Protriptyline HCl, Trade Name, Class, TX?
- Vivactil
- TCA
- Depression
Maprotiline, Trade Name, Class, TX?
- Ludiomil
- TCA
- Depression
Escitalopram, Trade Name, Class, TX?
-Lexapro
-SSRI
-• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia
nervosa
• OCD
Vilazodone, Trade Name, Class, TX?
-Viibryd
-SSRI
-• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia
nervosa
• OCD
Trazodone, Trade Name, Class, TX?
-Desyrel
-Mixed SSRI (Atypical Antidepressant)
-• Depression
• With trazodone:
insomnia,
dementia with
agitation
(• Safer than tricyclics and MAO
inhibitors in terms of side effects)
**Priapism (rare but med. emergency)
S/NRIs (Serotonin/Norepinephrine Reuptake Inhibitors) SE and Precautions
Same As SSRI SE EXCEPT (Sweating and No dizziness)
**Same As SSRI teaching EXCEPT
• Take baseline blood pressure and
monitor periodically (can cause slight drop in BP).
• Monitor for worsening of pretreatment symptoms and
inform client of possibility.
Duloxetine, Trade Name, Class, TX?
-Cymbalta
-SNRI
-• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia
nervosa
• OCD
• Management of
diabetic neuropathic
pain
Venlafaxine, Trade Name, Class, TX?
-Effexor
-SNRI
-• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia
nervosa
• OCD
• Management of
diabetic neuropathic
pain
Desvenlafaxine, Trade Name, Class, TX?
-Pristiq
-SNRI
-• Depression
• Anxiety
• Panic disorder
• Aggression
• Anorexia
nervosa
• OCD
• Management of
diabetic neuropathic
pain
Bupropion, Trade Name, Class, TX? + SE Precautions?
-Wellbutrin/Zyban
-Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)
-depression, ADHD, and smoking cessation
-Anxiety and sleep disturbances
**SE/Precautions
*Insomnia, tremor, anorexia and
weight loss, dry mouth
• Sleep disturbances, poor appetite,
pain, sexual dysfunction, sedation
*Lowers seizure threshold
*No Alcohol
*No Herbs Ephedra (HTN )
Benzodiazepines SE and Precautions
* Sedation • Drowsiness • Ataxia • Dizziness • Irritability • Blood dyscrasias • Habituation and increased tolerance *Take at bed time, no operating machinery, no alcohol, or other sedatives, must be tapered down, short term use only!!!
Which (non Benzo) drug is Approved for long-term
treatment of insomnia?
Ramelteon (Rozerem)
Clorazepate dipotassium Trade Name, Class, TX? + SE Precautions?
-Tranxene
-Benzodiazepine
• Reduce anxiety
• Induce sedation, relax muscles,
inhibit convulsions
• Treat alcohol and drug
withdrawal
symptoms
• Safer than sedative-hypnotics
List 3 Nonbenzodiazepine Sleep Aids
Buspirone (BuSpar) (Anxiety)
Zolpidem (Ambien) (Short term insomnia)
Ramelteon (Rozerem) (Long term Insomnia)
Lithium carbonate (Carbolith) SE
• Nausea, fatigue, thirst, polyuria,
and fine hand tremors
• Weight gain
• Hypothyroidism
Lithium carbonate (Carbolith) Toxicity Signs?
Early signs of toxicity: diarrhea,
vomiting, drowsiness, muscle
weakness, lack of coordination
HESI HINT:
Monitor serum lithium levels carefully.
The therapeutic and toxic levels are very close to each
other on the readings. Signs of toxicity are evident when
lithium levels are more than 1.5 mEq/L. Blood levels
should be drawn 12 hours after last dose.
Lithium carbonate (Carbolith) Precautions and Med Education?
• Lithium is excreted by the kidney. Maintain
adequate serum levels. 0.6-1.2 mEq
• Assess electrolytes, especially sodium.
• Baseline studies of renal, cardiac and thyroid
status must be obtained before lithium
therapy is begun.
• Teach client early symptoms of lithium toxicity.
If drug is continued, coma, convulsions,
and death may occur.
• Instruct client to keep salt usage consistent.
• Use with diuretics is contraindicated.
Diuretic-induced sodium depletion can
increase lithium levels, causing toxicity.
Phenothiazines (Typical Antipsychotic Drugs) SE (Most Phenothiazine drugs have “AZINE” at the end!!!)
• Drowsiness • Orthostatic hypotension • Weight gain • Anticholinergic effects • Extrapyramidal effects → Pseudo-parkinsonism → Akathisia → Dystonia → Tardive dyskinesia • Photosensitivity • Blood dyscrasias: granulocytosis, leukopenia • Neuroleptic malignant syndrome
Phenothiazines (Antipsychotic Drugs) Precautions and Teachings
• Extrapyramidal effects are major concern. • Monitor older clients closely. • Takes 2-3 weeks to achieve therapeutic effect • Keep client supine for 1 hour after administration and advise to change positions slowly because of effects of orthostatic hypotension. • Teach client to avoid: → Alcohol → Sedatives (potentiate effect of CNS depressants) → Antacids (reduce absorption of drug)
List 3 Nonphenothiazines and SE
• Haloperidol (Haldol) • Thiothixene HCl (Navane) • Pimozide (Orap) **Orap is used only for Tourette’s syndrome!!!! SE's • Severe extrapyramidal reactions • Leukocytosis • Blurred vision • Dry mouth • Urinary retention
List 2 Long Acting Typical Antipsychotics (Hint: Decanoate at the end)
- Fluphenazine decanoate (Prolixin Decanoate)
* Haloperidol decanoate (Haldol Decanoate)
List Extrapyramidal effects and Characteristics
• Parkinsonism 1-4 weeks • Akathisia 1-6 weeks • Dystonia 1-2 days • Tardive dyskinesia: develops late in treatment Characteristics: • Rigidity, shuffling gait, pill-rolling hand movements, tremors, dyskinesia, masklike face • Restlessness, agitation, and pacing; • Limb and neck spasms; uncoordinated, jerky movements • Involuntary tongue and lip movements
What is Neuroleptic malignant
syndrome and list effects
life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs: high fever, tachycardia, stupor, increased respirations, severe muscle rigidity
Neuroleptic malignant
syndrome Nursing Interventions
• Increased risk with phenothiazines
• Early recognition is important; transfer to medical
facility for hydration, nutritional support, and treatment
of possible respiratory failure and renal failure.
What is Serotonin syndrome and list effects and Nursing Interventions
Serotonin syndrome occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body. • Confusion, disorientation, autonomic dysfunction • Notify health care provider, stat. • Provide systems support.
List 3 Anticholinergic Drugs
Trihexyphenidyl HCl (Artane) • Benztropine mesylate (Cogentin) • Amantadine (Symmetrel) (Acts on the extrapyramidal system to reduce disturbing symptoms) ***Usually given in conjunction with antipsychotic drugs
Anticholinergic effects and Nursing Interventions for it
Dry mouth, blurred vision, tachycardia, nasal congestion, constipation, urinary retention, orthostatic hypotension Interventions: • Encourage sips of water, chewing sugarless gum or hard candy. • Increase fiber in diet. • Change positions slowly to avoid dizziness. • Report urinary retention to physician. • Tolerance to these side effects will usually occur.
What is Disulfiram used for?
AKA Antabuse • Treatment of alcoholism; aversion therapy • Interferes with breakdown of alcohol causing an accumulation of acetaldehyde (a byproduct of alcohol in the body) Severe side effects occur if alcohol is consumed: • Nausea and vomiting • Hypotension, headaches • Rapid pulse and respirations • Flushed face and bloodshot eyes • Confusion • Chest pain • Weakness, dizziness
What is Acamprosate used for?
AKA Campral • Treatment of alcohol dependence by reducing anxiety and unpleasant effects that trigger resuming drinking • Balances GABA and glutamate neurotransmitters
