Psychiatric Meds

Question 0

Anti-anxiety
Benzodiazepines
Common examples:
Diazepam (Valium), Lorazepam (Ativan), Alprazolam (Xanax)

Answer 0

Anxiety disorders, seizures, pre-op sedation, alcohol withdrawal

• Contraindicated in patients with narrow angle glaucoma.
• Adverse effects include drowsiness, dizziness, sedation, retrograde amnesia, hypotension, GI complaints and HA.

Question 1

Anti-anxiety
Antihistamines
Common examples: Hydroxyzine (Vistaril)

Answer 1

Anxiety disorders, pre and post-op sedation, nausea and vomiting.

• Administer IM, deep in large muscle. Do Not give IV or subq *Monitor for sedative effects.
• Adverse effects include HA, hypotension, dry mouth, dizziness and hives.

Question 2

Antipsychotics
Phenothiazines
Chlorpromazine (Thorazine), Fluphenazine (Prolixin)

Answer 2

Psychotic disorders, schizophrenia, mania, Tourette’s syndrome.

• Multiple adverse effects, choose the agent with the least adverse effects for a given patient.
• Thorazine may produce pronounced orthostatic hypotension
• Adverse effects include: extrapyramidal reactions, neuroleptic malignant syndrome, seizures, anorexia, urinary retention, dry mouth, leukopenia, agranulocytosis, sedation and tardive dyskinesia after prolonged use.

Question 3

Antipsychotics
NonPhenothiazines
Haloperidol (Haldol)

Answer 3

Acute and chronic psychoses, schizophrenia resistant to other medications, Tourette’s syndrome, children with severe behavior problems who are combative, to suppress narcotic withdrawal

• Contraindicated with narrow angle glaucoma, severe hepatic, renal, or cardiovascular disease, or Parkinson’s disease
• Serious or life-threatening adverse reactions include: tachycardia, seizures, urinary retention, respiratory depression, laryngospasm, neuromalignant syndrome, and dysrhythmias

Question 4

Atypical antipsychotic

Risperidone (Risperdal), Quetiapine (Seroquel), Aripiprazole (Abilify)

Answer 4

Psychotic disorders, schizophrenia, bipolar mania

• Less likely to cause extrapyramidal effects, neuroleptic malignant syndrome and tardive dyskinesia than the phenothizines.
• Adverse effects include sedation, drowsiness, appetite stimulation with weight gain, orthostatic hypotension, HA, dry mouth, agitation and anxiety.

Question 5

Atypical antipsychotic

Lithium (Lithane, Lithobid)

Answer 5

Mania, bipolar disorder

• Therapeutic range: 1-1.5mEq/L, toxic at levels of 2.0mEq or >
• Contraindicated in children < 12 years or patients with thyroid disease
• Toxic effects include tremor, confusion, seizures, possible death.
• Long-term therapy may cause hypothyroidism.
• Monitor serum Na+ levels. Normal serum Na+ helps to maintain therapeutic lithium levels.

Question 6

SSRIs

Fluoxetine (Prozac), Paroxetine (Paxil), Escitalopram (Lexapro), Citalopram (Celexa), Sertraline HCl (Zoloft)

Answer 6

Depression, bipolar disorder, eating disorders, obsessive- compulsive disorder, panic attacks, premenstrual dysphoric disorder and anxiety disorder

• Adverse effects include insomnia, weight gain, sexual dysfunction, palpitations, HA, seizures, diaphoresis, and GI complaints.
• Do not give with MAO inhibitors. Wait 14 days after stopping MAOIs to administer
• Monitor liver functions.
• Withdrawal should be gradual.

Question 7

MAOIs

Phenelzine (Nardil), Tranylcypromine (Parnate)

Answer 7

Severe depression, psychosis and panic disorders when other agents have not been effective.

• Adverse effects include: dizziness, orthostatic hypotension, constipation, diarrhea, tremors, seizures, coma, tachycardia, diaphoresis, sexual dysfunction, weight gain.
• Teach to avoid tyramine containing foods and beverages (pickled, aged, fermented or caffeinated). Hypertensive crisis can be triggered by foods rich in tyramine.
• Contraindicated with concurrent use of meperidine, barbiturates, tricyclic antidepressants, antihistamines, CNS depressants, and OTC cold medicines.
• Teach client to not take any other medications without checking with healthcare provider when taking an MAOIs

Question 8

Tricyclic antidepressants

Amitryptyline (Elavil), Nortriptyline (Pamelor), Imipramine (Tofranil)

Answer 8

Depression, depression related to alcohol and cocaine withdrawal, chronic pain syndromes, anxiety, panic disorder, obsessive-compulsive disorder

Tofranil indicated for adjunctive treatment of childhood enuresis.

• Adverse effects include: Orthostatic hypotension, HA, dry mouth, sedation, urinary retention, dysrhythmias and impotence.
• Overdose is generally lethal.
• Cautious use in patients with suicidal ideations.
• Contraindicated with history of seizures or chronic cardiac disease.