psychiatric medications

Question 1

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

Answer 1

**: 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

Question 2

SSRI: serotonin reuptake inhibitors patient education

Answer 2

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)

Question 3

SSRI, serotonin syndrome side effects (if serotonin levels are too high)

Answer 3

sweating (shivers)
high temp (hyperthermia)

high hr (tachycardia)
rigidity of muscles, overactive reflexes
tremors (seizures)
pupil dilation

nausea, vomiting, diarrhea
irritable/confused
nervousness (anxiety)

Question 4

SSRI general side effects

Answer 4

gi disturbances (n/v)
low libido or ED
weight gain
insomnia (take in the morning)
dry mouth

Question 5

SSRI, SNRI, TCA, MAOI

Answer 5

Antidepressants

Question 6

NCLEX test on safety and needs of patients. will not ask about mechanism of action
4 rules of antidepressants, this is rule #1

Answer 6

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.

Question 7

rules #2 antidepressants

Answer 7

slow onset and slow taper off
takes couple weeks or 1 month to start working

Question 8

antidepressants, rules #3

Answer 8

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

Question 9

rule #4 (SSRI): antidepressants

Answer 9

all psych drugs decrease the blood pressure, slow changes
changes in weight gain, mostly weight gain

Question 10

antipsychotic - first generation

name which disease for and name a adverse effect

what about the second generation of antipsychotic

Answer 10

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

Question 11

tranylcypromine (an MAOI)
contraindications

Answer 11

can’t take it w/ benzo, an maoi

Question 12

anxiolytics

Answer 12

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

Question 13

mirtazapine

Answer 13

antidepressant
helps w/ sleep

Question 14

bipolar medications
talk about them (3)

Answer 14

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)

Question 15

lithium

Answer 15

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

Question 16

what medications may cause agitation, shaky, restless as an adverse effect

Answer 16

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..

Question 17

what suffix 2nd gen antipsychotic med end in

Answer 17

done, pine
clozapine, olanzanpine, quetiapine, risperidone, zelapidone

Question 18

patients w/ mania
what to prioritize

Answer 18

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

Question 19

becoming more withdrawn indicates

Answer 19

depression

its ok to reassure the client that they are in a safe environment

Question 20

alzeihmers and delirium both causes

Answer 20

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

Question 21

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.

Question 22

tactile vs auditory hallucinations

Answer 22

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

Question 23

typical antipsychotic (1st gen) meds like haldol,
may cause anticholinergic symptoms such as

Answer 23

blurred vision, urinary retention, constipation, dry eyes, dry tears, tachycardia, decrease interest in sex.

these findings would not require follow up.

Question 24

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

Answer 24

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.