Psychiatric Medications Flashcards
Anxiety Medications
2 types
- Two main types:
- Benzodiazepine sedative hypnotic anxiolytics
- Atypical anxiolytic/non barbiturate anxiolytics
other anxiety meds
•Others:
- SSRI - Venlafaxine
- TCA
- MAOI
- CNS stimulates – Ritalin
- Antihistamines – hydroxyzine pamoate (Vistaril)
- Beta blockers – Propranolol – social phobias – off label
- Anticonvulsants – Gabapentin – off label
•
Medication Classification : Benzodiazepine
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Diazepam (Valium) -
- Chloridiazepoxide (Librium)
- Clorazepate (Tranxene)
- Oxazepam (Serax)
- Clonazepam (Klonopin)
Benzodiazepine
action
Enhances the inhibitory effect of gamma-aminobutyric acid (GABA) in the CNS – rapid and long term relief of anxiety and alcohol withdrawal
benzodiazepine
SE
Side Effects:
- CNS depression
- Addiction
- Tolerance
- Anterograde amnesia
- Toxicity
- Paradoxical response – opposite effect
Atypical Anxiolytic/Nonbarbituate
- Buspirone (Buspar) – Longer use – may take 2-3 weeks to take effect
- Mechanisms unknown – binds to serotonin and dopamine receptors.
- Less Potential for abuse – does not result in sedation
- Uses: Anxiety
Buspirone (Buspar)
contraind/caution
- Do not use with MAOI or until 14 days after MAOI DC
- Avoid use of erythromycin, ketoconazole and grapefruit juice may increase the effects of this class of medication
receptors and action
Dopamine – emotional response, movement
Serotonin – Mood, sexual desire, some social behavior
Anxiolytics – Nursing Interventions
- Monitor vital signs
- Encourage client to rise slowly to avoid dizziness
- Advise not to drive a motor vehicle or operate dangerous equipment
- Benzodiazepines are for short term use only due to risk of addiction
- Warn client not to concurrently take CNS depressants, alcohol, other anxiolytics
- Should take with meals or shortly thereafter to decrease GI discomfort
- Warn client against abrupt discontinuation of medication
- Buspar—may take a couple of weeks to be effective
Medications Classifications for Depression
Tricyclic antidepressants - norepinephrine and serotonin reuptake with anticholinergic side effects
- SSRI* – serotonin - agitation anxiety etc reactions
- MAOIs* – prevent breakdown of norepinephrine, serotonin and dopamine -
SNRI – Depression and anxiety
Atypical Antidepressants
“Start low and go slow”
Tricyclic Antidepressants (TCA)
•Block serotonin and norepinephrine making more of these transmitters available to body.
•Anticholinergic side effects common
- Dry mouth
- Constipation
- Urinary retention
- Increased appetite
- Orthostatic hypotension
- Other treatments – Neuroleptic pain, anxiety, insomnia, fibromyalgia
Tricyclic Antidepressants (TCA)
know this meds
§Amitriptyline (Elavil)
§Doxepine (Silenor)
§Trimipramine (Surmontil)
§Nortriptyline
§
Selective Serotonin Reuptake Inhibitors (SSRI)
- Blocks reabsorption of serotonin releasing more of the neurotransmitter to the body.
- Serotonin syndrome – rare but can occur
- Withdrawal Syndrome – taper dose
- Hyponatremia - < 135 mEq/L
- Bruxism – teeth grinding
- Treatment:
- Major depression Disorder
- Anxiety
- Bulimia
Selective Serotonin Reuptake Inhibitors (SSRI)
medications
citralopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)
fluoxetine (Prosac)
-Avoid grapefruit juice = increases risk of toxicity
Monoamine Oxidase Inhibitors (MAOI)
•Phenelzine
•Increase the amount of Norepinephrine, dopamine, and serotonin in the body.
•Side Effects
- Orthostatic hypotension
- CNS simulation – anxiety
- Hypertensive crisis – Limit tyramine type foods*
•Nursing Care
- Use with caution in diabetes, seizures, or TCA
- Contraindicated if taking SSRI- stop 2 weeks prior
- Treatment of depression and bulimia
Atypical Antidepressants
•Atypical antidepressants are not typical — they don’t fit into other classes of antidepressants. They are each unique medications that work in different ways from one another.
•Bupropion (Wellbutrin) – allows more dopamine into the body. – good for low energy caused by depression or to quit smoking (Zyban).
•Can worsen anxiety, HA, nausea and loss of appetite, insomnia, increased heart rate,
Atypical Antidepressants- SNRI
- Venlafaxine (Effexor)*
- Duloxetine (Cymbalta)*
- Desvenlafaxine (Pristiq)*
•Medications belongs to a group of medicines known as serotonin and norepinephrine reuptake inhibitors (SNRI).
•Side Effects
- HA, Nausea, agitation, anxiety, insomnia
- Hyponatremia
- Bleeding
- Taper all antidepressants
-Watch St. John’s wort may increase risk of serotonin syndrome
Atypical Antidepressants
•Mirtrazapine (Remeron)
•Mirtrazapine (Remeron)
- Serotonin and norepinephrine reuptake inhibitors (SNRI)
- Generally taken 30 minutes before bed because it can make you sleepy. Additional side effects, among others, may include:
•Increased appetite
•Weight gain
- Increased cholesterol and triglycerides
- Sleepiness
- Less sexual dysfunction as a side effect than with SSRI
Atypical Antidepressants
Trazodone (Desyrel)
•Trazodone (Desyrel) is used to treat depression and for sleep. It is thought to work by increasing the activity of serotonin in the brain.
• Side Effects
- Blurred vision
- Headache
- Extreme tiredness (fatigue)
- Nausea
- Muscle aches or pains
- Diarrhea
•Irregular heartbeat
•Sudden drop in blood pressure when standing (orthostatic hypotension)
Antidepressant Medications – Nursing Interventions
- Monitor vital signs
- Monitor mood for drug effectiveness
- Monitor for suicidal tendencies, seizures
- Warn about foods that contain tyramine can cause a hypertensive crisis with MAOIs
- Encourage client to take drug as prescribed – do not stop abruptly
- Avoid CNS stimulants (including alcohol), CNS depressants, cold medicines
- Warn client against driving or using dangerous mechanical equipment until drug effect is known
- Advise client that a therapeutic response usually occurs in 2-4 weeks
- Inform client that herbs (St. John’s wort, ginseng, etc) may interact with antidepressants
Antipsychotics – First Generation Conventional
meds
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
Antipsychotics – First Generation Conventional
action
Action: Block dopamine, acetylcholine, histamine, and norepinephrine receptors in brain
Antipsychotics – First Generation Conventional
uses
Uses: Acute and chronic psychotic disorders, Schizophrenia, Bipolar – manic phase, Tourette’s disorder
Prevention of nausea and vomiting through blocking or dopamine
Antipsychotics – First Generation Conventional
SE
Side Effects: Agranulocytosis < 500 ( Fever, Sore throat), Anticholinergic effects, EPS (Acute dystonia, parkinsonism, akathisia, tardive dyskinesia, NMS, orthostatic hypotension, sedation, seizures, cardiac arrhythmias(Potassium)
Typical Antipsychotics – Side Effects
- Drowsiness, anticholinergic effects
- Extrapyramidal symptoms (Parkinson’s like symptoms)
- Tremors, rigidity, pill rolling, shuffling gait, restlessness (akathisia)
- Treatment: Benztropine (Cogentin)
•Tardive Dyskinesia
- Tongue movements, foot tapping, shoulder shrugging
- Treatment: Stop the drug
•Neuroleptic Malignant Syndrome (NMS)
- High fever, ↑↑ CPK, muscle rigidity
- Life threatening!!!
- Treatment: Stop the drug; Call the physician; Supportive therapy
Antipsychotics – Second Generation (Atypical)
meds
- Risperidone (Risperdal)
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
Antipsychotics – Second Generation (Atypical)
actions
Actions: Blocking serotonin and lesser degree dopamine, they also block norepinephrine, histamine, and acetylcholine.
Antipsychotics – Second Generation (Atypical)
uses
Uses: Negative and positive symptoms of schizophrenia spectrum disorders, psychosis induced by levodopa therapy, a relief of psychotic manifestations in other disorders such as bipolar.
Antipsychotics – Second Generation (Atypical)
SE
Side Effects: Loss of glucose control, weight gain. Hypercholesterolemia and increased risk of hypertension and CV disease, anticholinergic effects, agitation, sedation, insomnia, Mild EPS tremor
Antipsychotics Nursing Interventions
- Monitor vital signs
- Monitor client for “cheeking” medications
- Give oral drugs with food or milk
- Monitor for EPS, NMS, TD
- Assess WBC with Clozaril
- Warn client that drug may take 3 to 6 weeks to achieve effectiveness – watch for thoughts of suicide
- Warn client not to combine drug with alcohol, narcotics, or other CNS depressants
- Warn against sudden discontinuation of
antipsychotics to avoid sudden recurrence of psychotic symptoms
•
Mood Stabilizer
•Lithium Carbonate – works in 7-14 days
•Action: preserves or increase the ability of brain structures involved in emotional regulation, prefrontal cortex, hippocampus and amygdala – protects. Reduces dopamine and glutamate but increases GABA
•Uses: Bipolar, alcoholism, bulimia, schizophrenia
- Side effects: GI distress, fine hand tremors, polyuria, weight gain, hypothyroidism (long term), electrolyte imbalance and hypotension
- Lithium toxicity > 1.5 (Normal range = 0.4 to 1.0 mEq/L)
- Monitor: Diuretics, NSAIDS, Anticholinergics (Antihistamines, TCA) – urinary retention and polyuria, NA and CL. Encourage 2000-3000 ml fluids a day.
Mood Stabilizer: Lithium Nursing Interventions
- Monitor vital signs, sodium levels
- Monitor for drug effectiveness, suicidal
tendencies
- Monitor urine output, renal function tests
- Encourage adequate fluid intake (1-2 L daily)
- Take with food to decrease GI irritation
- Monitor lithium levels every 1-2 months (0.5 to 1.5 mEq/L);
•Report Lithium Levels > 1.5
•Toxic side effects: persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmias, seizures
