Psychotropic Medications Flashcards
Antidepressants
*SSRIs:
- fluoxetine/Prozac
- sertraline/Zoloft
- paroxetine/Paxil
- citalopram/Celexa
- escitalopram/Lexapro
(HA, dry mouth, sexual probs)
- SNRIs:
- duloxetine/Cymbalta
- venlafaxine/Effexor
*TCAs:
- amitriptyline/Elavil - MOA: Potentiates the effect of serotonin and norepinephrine in the CNS.
(cardiac probs, OD)
*MAOIs:
- phenelzine/Nardil
(low tyramine diet, interacts with lots of meds…don’t give 2 weeks before or after other meds)
- Atypicals:
- bupropion/Wellbutrin (seizures, anorexia),
- mirtazapine/Remeron
- trazadone/Desyrel (priapism)
Antipsychotics
- Older antipsychotics block dopamine
- Haloperidol/Haldol
- Chlorpromazine/Thorazine (old phenothiazine)
- Long acting forms (aka “depot” meds)
- Fluphenazine/Prolixin & haloperidol/haldol “decanoates”
- Risperidone/risperdal “consta”
- Paliperidone/Invega sustenna
- Newer, atypical antipsychotics regulate serotonin, norepinephrine, dopamine
- Clozaril/Clozaril, risperidone/Risperdal, olanzapine/Zyprexa, quetiapine/Seroquel, aripiprazole/Abilify, ziprazidone/Geodon
- Substantial weight gain
- Aripiprazole/Abilify and ziprazadone/Geodon do not tend to cause wt gain
- Geodon can cause cardiac problems (QT prolongation leading to sudden death) and Abilify can cause some akathisia
- Newest: paliperidone/Invega, lurazidone/Latuda
Mood stabilizers
*Lithium
*Various anticonvulsants
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Gabapentin (Neurontin)
Iamotrigine (Lamictal)
Topiramate (Topamax)
Clonazepam (Klonopin)
Antianxiety meds
Benzodiazepines:
- chlordiazepoxide/ Librium
- lorazepam/Ativan
- alprazolam/Xanax
- oxazepam/Serax
Used for anxiety, alcohol detox, insomnia
Major withdrawal symptom is seizures
Potentiate GABA
Potentially addictive
Specifics on Lithium
- Salt contained in the body
- Requires serum monitoring for therapeutic range
- Route: PO (Tablet, Capsule, Liquid, Sustained-release)
- Daily dosages: 900-3600 mg
- Serum Lithium Levels
- 1.0 mEq/L is good
- Therapeutic: 0.5 – 1.5 mEq/L
- Toxic: anything > 1.5 mEq/L
- Thyroid function test at baseline and every 6 months
- Renal function should also be assessed at baseline and periodically
- Client must be aware of fluid intake and output
- Client needs to limit use of table salt in diet and keep consistent
Side Effects:
- Milder side effects: Fine tremor, increased thirst, increased urination, weight gain, Nausea, diarrhea
- Severe side effects: Coarse tremors, confusion, oliguria, seizures, coma, death.
Lithium levels should be drawn about 12 hours post last dose.
EPSE: Extra Pyramidal Side Effects
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
Nursing Considerations for Anti-Psychotics - OLDER
Monitor I & O: Due to Anti-cholinergic effects
Take with food to avoid GI upset
Stop Smoking- Shortens ½ life of drug
LABS: Liver (BUN and CREATENIN) Glucose (hyperglycemia), A.I.M.S Test
Watch VS: BP, HTN (Due to the teeter-totter effect of blocking adrenergic and anti-cholinergic effects from blocking AcH.
Antacids and Caffeine may reduce absorption/ effectiveness
Nursing Considerations for Anti-Psychotics - NEWER
Patient Education/Nursing Considerations:
Watch for 3P’s, can have a lack of blood sugar control with these drugs. Higher incidences of diabetes.
May cause significant Weight Gain or DIABETES
Vital Signs: Can have an increase in BP and HR due to minimal anti-cholinergic effect.
Orthostatic HTN changes/ DIZZYNESS/ Fall Risk
Competitive effect it taking Levadopa for Parkinson’s
Newer works on both positive and negative symptoms.
Watch for agranulocytosis with CLOZARIL
Antacids and Caffeine may reduce absorption/ effectiveness
Neuroleptic Malignant Syndrome
hyperthermia with extrapyramidal and autonomic disturbances that may result in death, following the use of neuroleptic agents
Serotonin Syndrome
Symptoms occur on a spectrum and may include agitation, confusion, diaphoresis, diarrhea, fever, shivering, tremor, myoclonus, rigidity, trismus, opisthonus, seizures, drowsiness, hallucinations, and coma. Autonomic signs include abdominal pain, diarrhea, flushing, hypertension, mydriasis, salivation, tachycardia, and tachypnea.
Treatment for EPS
First three types of EPS can be treated with:
- benztropine/Cogentin (an anticholinergic, antiparkinsonian med)
- diphenhydramine/Benadryl, p.o. or i.m.
