Psychiatric Drugs

Question 1

Antipsychotics

Answer 1

Indication: For psychosis and agitation and to augment tx of bipolar disorder

Adverse Effects:

• extrapyramidal s.e. (EPS),
• neuroleptic malignant syndrome (NMS) - which can cause rabdomylosis
• agranulocytosis (clozapine/Clozaril),
• photosensitivity,
• cardiac problems (ziprazidone/Geodon- QT prolongation)
• Agranulocytosis: clozapine/Clozaril especially
• Photosensitivity
• Orthostatic hypotension
• Sedation
• Anticholinergic effects
• Substantial weight gain, diabetes, increased cholesterol,
• metabolic syndrome
• Seizures
• Prolactin levels can increase

Patient teaching (Nursing Implications/Lab):
· A.I.M.S. test done on a regular basis
· Don’t mix with other sedating meds, drugs of abuse, OTC, alcohol
· Don’t withdraw abruptly
· Cautious use if pregnant
· Check for agranulocytosis every 2 wks with clozapine (Clozaril)
· Antacids reduce absorption, caffeine also may reduce effects

Question 2

Antipsychotics - Older meds

Answer 2

MOA: Block dopamine
· chlorpromazine (Thorazine)
· haloperidol (Haldol)

Older work best on “positive” symptoms such as hallucinations, delusions.

Question 3

Antipsychotics - Newer meds

Answer 3

MOA: work on serotonin and/or dopamine
·         clozapine (Clozaril)
·         risperidone (Risperdal)
·         olanzapine (Zyprexa)
·         ziprasidone (Geodon)
·         aripiprazole (Abilify)

Newer also work on “negative or deficit” sx such as apathy, social withdrawal.

Question 4

EPS

Answer 4

dystonia
akathisia
pseudoparkinsonism
tardive dyskinesia (TD)-irreversible and involuntary

T: Tardive Dyskinesia: Uncontrollable facial movements
A: Akathisa: Restlessness/Fidgeting
A: Acute Dystonia: Tongue, neck, face, and back spasms
P: Pseudo Parkinsonism: Shuffling gait, pill rolling

Question 5

Antidepressants

Answer 5

Indication:
Mostly for depression, but also for anxiety disorders and many other problems

MOA: Regulate serotonin, norepinephrine, and/or dopamine to varying degrees. Takes weeks to month(s) to work.

S/S:

• Depressive mood
• Anhedonism (decreased attention and enjoyment from previously pleasurable activities)
• Weight change
• Change in sleep pattern
• Agitation or psychomotor retardation
• Tiredness
• Worthlessness or guilt inappropriate to situation (possibly delusional)
• Difficulty thinking, focusing, or making decisions
• Hopelessness, helplessness and/or suicidal thoughts

Question 6

Antidepressants - SSRIs

Answer 6

MOA: block reuptake of serotonin

Prototypes:
·         fluoxetine (Prozac)
·         sertraline (Zoloft)
·         paroxetine (Paxil)
·         citalopram (Celexa)
·         escitalopram oxalate (Lexapro)

AEs:

• sexual problems!
• anxiety
• agitation
• akathisia (motor restlessness)
• nausea
• insomnia

Do not mix MAOI and SSRI or SSNRI within 2-5 weeks of each other, can cause Serotonin Syndrome (can be confused with NMS)

Question 7

Antidepressants - Tricyclics

Answer 7

MOA: block the reuptake of norepinephrine primarily and block serotonin to some degree/block cholinergic receptors

Prototype:
· aminotriptyline (Elavil)

AEs (think how it’s blocking cholinergic receptors:

• cardiac problems!
• dry mouth
• constipation
• urinary hesitancy or retention
• blurred near vision
• agitation
• delirium
• orthostatic hypotension

TCA’s : Should not be used within 2 weeks of MAOI’s (hypotension and tachycardia).

Question 8

Antidepressants - MAOIs:

Answer 8

MOA: interfere with enzyme metabolism

Prototype:
· phenelzine (Nardil)
Adhere to low tyramine diet to prevent hypertensive crisis

AEs:

• hypertensive crisis if not on low tyramine
• daytime sedation
• insomnia
• weight gain
• dry mouth
• orthostatic hypotension
• sexual dysfunction

Question 9

Antidepressant - Other Meds

Answer 9

Other:
· bupropion (Wellbutrin or Zyban) - (seizures, anorexia),
Meds that regulate serotonin and norepinephrine:
· venlafaxine (Effexor) (loss of appetite, nausea, agitation)
· duloxetine (Cymbalta)

Question 10

Mood stabilizers - Lithium

Answer 10

MOA:
normalizes the reuptake of certain neurotransmitters such as certain, norepinephrine, acetylcholine, dopamine; it also reduces the release of norepinephrine though competition with calcium and produces its effects intracellularly rather than within neuronal synapses

Info:
-1.0 mEq/L is good
-Range is 0.8-1.2
-toxic above 1.5
-avoid diuretics, and dehydration in summer and do NOT restrict salt.
Lithium requires good renal function, close monitoring of lithium levels, and essential fluid balance and normal salt intake. Long term problems can be thyroid, goiter, or renal. Dehydration will lead to lithium toxicity. Takes a week to reach therapeutic levels.

Adverse Effects:

• Milder side effects: Fine tremor, increased thirst, increased urination, weight gain.
• Severe side effects: Coarse tremors, confusion, oliguria, seizures, coma, death.
• Lithium levels should be drawn about 12 hours post last dose.

Question 11

Mood stabilizers - Anticonvulsant

Answer 11

Prototypes:

• carbamazepine (Tegretol)
• valproic acid (Depakote)
• gabapentin/Neurontin
• topiramate/Topamax
• lamotrigine/Lamictal

MOA: anticonvulsants

Some AEs:
blood dyscrasias
agranulocytosis with Tegretol
liver problems and weight gain with Depakote

Question 12

Antianxiety/anxiolytics

Answer 12

Prototype:
Benzos:
· chlordiazepoxide (Librium)
· lorazepam (Ativan)

MOA: benzos mediate the actions of amino acid GABA (which is the major inhibitory transmitter of the brain)

Indications:
Anxiety disorders
Insomnia
Detox. of chemical dependency

AEs:
- Withdrawal symptoms/addictive potential:
This is the only psychotropic med category with truly addictive potential.
- Mild withdrawal sx: related to CNS depress - drowsiness, dedication, poor coordination, impaired memory
- Severe withdrawal sx: Seizures

Patient teaching/Nursing implications/Lab:
- Don’t mix with other sedative drugs.