Mental Health Medications

Identify the class of these medications:

• venlafaxine

• duloxetine

Serotonin Norepinephrine Reuptake Inhibitor

Identity the class of these medications:

• Paroxetine

• Sertraline

• Fluoxetine

Selective serotonin reuptake inhibitors

What class of medication is buspirone?

Atypical anxiolytic

Identify the class of these medications:

• Diazepam

• Lorazepam

• Midazolam

• Alprazolam

• Chlordiazepoxide

Benzodiazepine

Identify the class of these medications:

• Amitriptyline

• Clomipramine

• Imipramine

Tricyclic antidepressants

Identify the class of these medications:

• Phenelzine

• Tranylcypromine

• Isocarboxazid

• Selegiline

Monoamine oxidase inhibitors

Identify the class of these medications:

• Bupropion

• Trazadone

Atypical antidepressants

What are benzodiazepines used for?

To treat, anxiety, muscle spasms, seizures, alcohol withdrawal, induction and maintenance of anesthesia

What are key side effects of benzodiazepines?

• sedation

• respiratory depression

• dependence and withdrawal

• amnesia

What is the reversal for benzodiazepines?

flumazenil

Why can buspirone be used for long-term?

it does not cause sedation

What are side effects of buspirone?

• nausea

• dizziness

• headache

Patient teaching for buspirone

• take with same amount of food to prevent change in absorption level

• avoid grapefruit juice

• full effect may take several weeks

What disorders do SSRIs treat?

• OCD

• PTSD

• depression

• anxiety

Why do you need to avoid St. John’s Wort with serotonin medications?

it can increase the risk of serotonin toxicity

What the symptoms of serotonin syndrome?

• muscle rigidity

• agitation

• fever

• tachycardia

• nausea & vomiting

• diaphoresis

What disorders can SNRIs treat?

• anxiety

• depression

• neuropathic pain

What are the side effects of SNRIs?

• insomnia

• GI upset

• nausea

• constipation

• decreased libido

What are tricyclic antidepressants used for?

• depression

• neuropathy

• fibromyalgia

• anxiety

• insomnia

What are key side effects of tricyclic antidepressants?

• sedation

• orthostatic hypotension

• anticholinergic effects, such as urinary retention, constipation, dry mouth, photophobia, and tachycardia

• sweating

• seizures

• arrhythmias

What are patient teaching for tricyclic antidepressants?

• change positions slowly

• chew gum or suck on hard candy for dry mouth

• increase fluid and fiber intake

What are key side effects of MAOIs?

• anxiety

• agitation

• orthostatic hypotension

• hypertensive crisis

What food do you need to avoid when taking MAOIs?

• pepperoni & salami

• red wine

• chocolate

• aged cheese

• avocados & bananas

What medications interact with MAOIs and need to avoided?

• SSRIs, SNRIs, TCAs

•  Meperidine (opioid)

• Tramadol

• Dextromethorphan (cough meds.)

• St. John’s wort

What do you need to do before switching to a different medication if you are taking MAOIs?

wait 2 weeks

Which mood stabilizer medication is used in treatment of bipolar disorder?

lithium

What are key side effects of lithium?

• nephrotoxicity

• polyuria

• fine hand tremors

• increased thirst

• hypothyroidism

• electrolyte imbalances

• leukocytosis

• GI upset

• weight gain

• fatigue

What is the therapeutic level of lithium?

0.6 - 1.2 mEq/L

At which level, does lithium becomes toxic?

greater than 1.5 mEq/L

What are the signs and symptoms of lithium toxicity?

• coarse hand tremors

• confusion

• hypotension

• seizures

• tinnitus

Why do you need to monitor sodium levels when taking lithium?

if sodium levels go down, lithium levels go up

Which medications are contraindicated when taking lithium?

• NSAIDs

• Diuretics

Identify the class of these medications:

• Carbamazepine

• Valproic acid

Anticonvulsants/Mood stabilizers

What are key side effects of carbamazepine?

• blood dyscrasias

• anemia

• leukopenia

• thrombocytopenia

• decreased in RBCs, WBCs, platelets

• vision issues

• serious rashes

What are key side effects of valproic acid?

• hepatotoxicity

• pancreatitis

• thrombocytopenia

What is the reversal for tricyclic antidepressants?

sodium bicarbonate

Identify the class of these medications:

• chlorpromazine

• haloperidol

• droperidol

first generation (typical) antipsychotics

What are some serious side effects of first generation antipsychotics?

• extrapyramidal symptoms (EPS)

• neuroleptic malignant syndrome (NMS)

• agranulocytosis

• orthostatic hypotension

• anticholinergic effects

• sedation

• seizure

What are characteristics of EPS?

• dystonia - involuntary muscle contraction

• akathisia - restlessness and repetitive movements

• parkinson’s symptoms - muscle rigidity, tremors, and shuffling gait

• tardive dyskinesia - involuntary movements of tongue, neck, and facial muscles

What medication can be used to control EPS?

benztropine

What are nursing interventions for pt experiencing neuroleptic malignant syndrome?

• administer dantrolene

• implement cooling measures

• stabilize electrolyte levels

Identity the class of these medications:

• risperidone

• olanzapine

• clozapine

second generation (atypical) antipsychotics

What does second generation antipsychotics help with?

help control positive and negative symptoms associated with schizophrenia

what are some serious side effects on second generation antipsychotics?

• risk for type 2 diabetes

• weight gain

• elevated cholesterol

• anticholinergic effects

• decreased libido

• sedation

• seizures

• neutropenia

• agranulocytosis

Identity the class of these medications and what they are used for.

• methylphenidate

• amphetamine mixtures

• CNS stimulants

• Used for ADHD, conduct disorder, narcolepsy

What are key side effects of CNS stimulants like methylphenidate?

• insomnia

• arrhythmias

• decreased appetite

• weight loss

What do you need to monitor when taking methylphenidate?

• monitor weight and growth

• never administer at night due to insomnia

Identify the what this medication is used for?

• disulfiram

alcohol use disorder

What does disulfiram cause?

causes unpleasant side effects, such as flushing, throbbing headache, sweating, nausea, and vomiting, hypotension, palpitations

What is naltrexone used for?

to reduce alcohol craving and decrease relapse rate

What is acamprosate used for?

to decrease alcohol abstinence symptoms, such as anxiety or insomnia

Identify what these medications are used for.

• buprenorphine

• methadone

used to decrease opioid withdrawal symptoms and cravings

What are side effects of buprenorphine and methadone?

• sedation, confusion, respiratory depression, hypotension, constipation

• potential for addiction and abuse

What is varenicline used for?

smoking cessation by decreasing cravings and withdrawal symptoms

What are varenicline side effects?

• insomnia

• anxiety

• muscle pain

• GI upset

• serious neuropsychiatric events

What is CNS Stimulant used for?

• ADHD

• Conduct disorder

• Narcolepsy

Identify the class of these medications:

• Methylphenidate

• Amphetamine mixtures

CNS Stimulants

What are key side effects of CNS stimulants?

• insomnia

• arrhythmias

• decreased appetite

• weight loss