psychiatric medications Flashcards
meds
SSRI: selective serotonin reuptake inhibitors (they increase the level of serotonin in the brain (It doesn’t let the brain take the serotonin, it lets it stay in the body to help the individual, so they can help someone with
mild depression, anxiety/panic, compulsion, PTSD.
what are some SSRI meds (name all 7) and 4 side effects of SSRI
-put on index card when you buy
**: MOST COMMON
Sertraline ** (remember for sexual dysfunction)
Citalopram **
Escitalopram **
paroxetine
fluoxetine
fluvoxamine
Vilazodone
side effects: mood (happiness/mental stability), emotions, memory, sleeping (insomnia), appetite (weight gain) gi digestion, sexual dysfunction
SSRI: serotonin reuptake inhibitors patient education
S: Symptoms improve in 1 - 1.5 months. take time to work, side effects starts to ease after this time.
S: slowly taper off w/ provider assistance
R: risk of suicidal thoughts or self-harm, assess pt’s plan if current pregnancy or plans to have a baby
I: interaction w/ other medications
(be careful for serotonin syndrome,
avoid: MAOIS, opiods, OTC cold meds (dextromethorphan, alcohol, migraine meds (triptans), st johns worst)
discontinuation syndrome (STOP): when they stop med suddenly
S: stomach pain w/ diarrhea/nausea
T: trouble sleeping
O: off balance (dizzy/ataxia)
P: peculiar sensations (electrical shocks, tingling, numbling)
SSRI, serotonin syndrome side effects (if serotonin levels are too high)
sweating (shivers)
high temp (hyperthermia)
high hr (tachycardia)
rigidity of muscles, overactive reflexes
tremors (seizures)
pupil dilation
nausea, vomiting, diarrhea
irritable/confused
nervousness (anxiety)
SSRI general side effects
gi disturbances (n/v)
low libido or ED
weight gain
insomnia (take in the morning)
dry mouth
SSRI, SNRI, TCA, MAOI
Antidepressants
NCLEX test on safety and needs of patients. will not ask about mechanism of action
4 rules of antidepressants, this is rule #1
antidipressants: inc. risk of suicide,
inc. suicide thoughts: in the first few weeks of treatments. gives pt energy to carry out the plan
notify the provider if any suicidal thoughts
clarify any new prescription. monitor for
1. new thoughts of suicide
2. unusual behavior
3. worsening depression
4. sudden change in mood: more energy without change in depression.
rules #2 antidepressants
slow onset and slow taper off
takes couple weeks or 1 month to start working
antidepressants, rules #3
never mix SSRI w/ st john’s wort
never mix with MAOI (avoid TCA, SSRI, SNRI) –> could lead to deadly serotonin syndrome
takes at least 2 weeks to taper off and never mix
rule #4 (SSRI): antidepressants
all psych drugs decrease the blood pressure, slow changes
changes in weight gain, mostly weight gain
antipsychotic - first generation
name which disease for and name a adverse effect
what about the second generation of antipsychotic
1st gen antipsychotics: haloperidol
schizophrenia, tourettes
haldol may be combined w/ lorazepam (a benzo) to control aggressive behavior
adverse effect: neuroleptic malignant syndrome
high fever, diaphoresis, change in mental status, muscle rigidity, tremors
hold haldol, assess pt, notify provider immediately
2nd gen antipsychotic
clozapine: ususally given when other meds don’t work. side effects: weight gain, hyperglycemia, hyperlipidemia. adverse: neutropenia, immediate follow up, inc. risk of infection
tranylcypromine (an MAOI)
contraindications
can’t take it w/ benzo, an maoi
anxiolytics
benzo (end in lam and pam, (not pram, pram are ssri (for depression), not benzos (for anxiolytics)
barbituates
buspirones
benzo and barbituates are sedative (given for anxiety and seizure), may vitals low and slow. works fast, within minutes. highly addictive and hard to come off, taper
ex: end in lam and Pam: midazolam, alprazolam, temazepam, Clonazepam.
buspirones: not a sedative. long term treatment for anxiety. you can drive the BUS while you take this medication, it doesn’‘t act as fast as benzo. its not dangerous
mirtazapine
antidepressant
helps w/ sleep
bipolar medications
talk about them (3)
carbamazepine
ind: bipolar, seizure, treatment for trigeminal neuralgia (neuropathic pain)
side effects: leukopenia (low WBC): inc. risk for infection. report FEVER & SORE THROAT
accidental pregnancy: oral contraceptives are ineffective, will need other forms of protection to prevent pregnancy
VaLproic acid: pay attention to the LLLLLs, also used to treat epilepsy (long term, but is not the gold standard
Liver toxic: monitor for jaundice & AST/alt, etc..
Low platelets: thrombocytopenia
lithium (in next slide)
lithium
narrow therapeutic range, side effects are common
lithium: treats bipolar disorder, a mood stabilizer
toxic levels above: 1.5 meq/L
actual: 0.6 - 1.2
toxicity; is caused by fluid loss (risk for dehydration, pt may be thirsty). encourage patient to stay hydrated.
hyponatremia: low sodium can cause lithium toxicity (serum lithium inc. with low sodium)
but higher sodium may Dec. lithium levels.
adjust dose w/ renal failure, Dec. kidney function, since that can cause lithium toxicity, lithium will not excrete. lithium also inc. risk for Dec. kidney function.
lithium also contraindicated w/ NSAID
thiazide diuretic cannot be taken w/ lithium (since thiazide diuretic may cause dehydration, low sodium
early sign of lithium toxicity: GI distress (vomiting, nausea, diarrhea. this is not an expected side effect but a sign for early toxicity.
don’t administer next dose of lithium if pt is vomiting
late sign of toxicity: nerve issues: seizure, confusion, loss of coordination etc..
lithium is teratogenic don’t take it while pregnant
what medications may cause agitation, shaky, restless as an adverse effect
second gen antipsychotic may cause this as adverse patient. patient will need to tell healthcare provider immediately
these med may cause extrapyrimidal symtoms.
antipsychotic may cause drowsiness, other sedating effects (hypersomnia). but also some cause insomnia, orthostatic hypotension
ex: end in pine or done. clozapine, olanzanpine, quetiapine, risperidone, zelapidone, etc..
what suffix 2nd gen antipsychotic med end in
done, pine
clozapine, olanzanpine, quetiapine, risperidone, zelapidone
patients w/ mania
what to prioritize
physiological need
mania patients may need eat or sleep. due to high energy they may feel like they don’t need to
offer high calorie snacks to client while doing activities, etc..
physiological needs is top priority, for anorexia pt as well
becoming more withdrawn indicates
depression
its ok to reassure the client that they are in a safe environment
alzeihmers and delirium both causes
memory impairments, speech changes, hallucinations
but delirium is reversible and acute
while alzeihmers is not
pt did ask me about the client in the TV and if I had talk to her and what did she tell me? and its like he was asking me if I heard them talk
alzeihmers caregiver
can redirect their spouse when they refuse care
they can sleep in the same room as the client. client can be agitated, irritated at nighttime so they should be monitored.
tactile vs auditory hallucinations
tactile hallucinations: sensation of being touch
I feel this thing crawling under my skin.
grann nana feeling like a guy was aka living with her
auditory hallucinations: the TV told me that they’re going to kill me
there’s also persecutory/paranoid delusion: they feel like they’re being threatened in some way. they’re trying to poison me
typical antipsychotic (1st gen) meds like haldol,
may cause anticholinergic symptoms such as
blurred vision, urinary retention, constipation, dry eyes, dry tears, tachycardia, decrease interest in sex.
these findings would not require follow up.
atypical antipsychotic (2nd gen) antipsychotic (name 4), thint think of the 2 common suffix and the first second gen antipsychotic
also name s/s they may cause
risperidone was the first second generation antipsychotic.
other meds: clozapine, olanzapine, aripiprazole.
suffix is pine and done
expected s/s: akathisia (slow or absence in mvt), twitches around the mouth.
adverse effects: neuropleptic malignant syndrome: high fever or feeling hot, muscle rigidity
all antipsychotic may cause insomnia, sedation, etc.
