Mental Health Meds

What should you not give with MAOIs?

Tyramine foods

• can cause hypertensive crisis

What are some examples of tyramine foods

• chocolate

• wine

• cured meats

• aged cheeses

• bananas

What is an MAOI

Monoamine Oxidase Inhibitors

• used to treat depression

• Inactivates norepi, serotonin, and dopamine

PITS (MAOI meds)

• Phenelzine

• Isocarboxaid

• Tranylcypromine

• Selegiline

What are TCAs

Tricyclic Antidepressant

PAN (TCAs)

• Protriptyline

• Amtriptyline

• Nortriptylene

I “C” TiDys (TCAs)

• Impramine

• Clomipramine

• Trimipramine

• Desipramine

2 “ox”s (TCA)

• Doxepin

• Amoxapine

What are some side effects of TCAs

Can’t pee, can’t see, can’t spit, can’t shit

What are SSRIs?

Selective Serotonin Reuptake Inhibitors

What is a similarity between SSRIs and SNRIs?

• Both the gold standard for antidepressants

• Can also be used for anxiety disorder

Flu x 2 (SSRI)

• Fluoxetine

• Fluvoxamine

-pram sisters (SSRI)

• Citalopram

• Escitalopram

Villains Stay Violating People (SSRI)

• Vilazodone

• Sertraline

• Vortioxetine

• Paroxetine

SNRIs

Serotonin norepinephrine reuptake inhibitors

DVD (SNRI)

• Desvenlafaxine

• Venlafaxine

• Duloxetine

Common side effects for SSRIs and SNRIs

• Dizziness

• Sleep disturbances

• Sexual Dysfunction

• GI irritation

• Wt. gain

SSRI & SNRI Complication: Discontinuation syndrome

• Zappers, pins, and needles'

• Flu-like symptoms

• Headache and dizziness

• Confusion

SSRI & SNRI Complication: Serotonin syndrome

• Restlessness

• diarrhea

• hyperreflexia

• fluctuating vital signs

Antidote for serotonin syndrome

Cyproheptadine

Atypical antidepressants

• Bupropion

• Mirtazapine

• Trazadone

What are some other uses for Bupropion

• Smoking cessation

• ADHD

• Cravings

What are Benzos?

• -Pams

• antianxiolytic

What should you monitor for in patients taking benzos?

Respiratory depression

Anti-manic

Lithium

Anticonvulsant

• Valproic acid/divalproex sodium

• Lamotrigine

Lithium therapeutic levels

0.8-1.2

Lithium toxicity 1.2-1.4

• Fine hand tremors

• N/V

• Slurred speech

• lethargy

• muscle weakness

Lithium toxicity 1.6-2.0

• GI upset

• confusion

• sedation

• coarse hand tremors

Lithium Toxicity >2.1

• Clonic movements

• Altered LOC

• Burred Vision

• Coma

• Death

What is an adverse side effect for Lamotrigine?

Steven Johnson’s Syndrome

• Red patches on skin

Depakote vs Depakene

Depakote is the pill form

Depakene is the liquid form

Antipsychotics: 1st Gen

• Only treats positive symptoms

• More prone to EPS (Extrapyramidal Side Effects)

• More potent side effects

1st Gen Med endings

-dol

-zine

-xene

-Loxapine

What are some examples of EPS?

• Tardive Dyskinesia (TD): Bizarre facial and tounge movements (flirty)

• Pseudoparkinsonism: Mimics parkinsosn

• Akathisia: Absence or impairment in voluntary movement

• Dystonia: Involuntary muscle spasms

Meds to give to EPS patient’s

• Anticholinergic meds

• ABC’s

Side effects of anticholinergic meds

Can’t see, pee, spit, sh!t

Antipsychotic: 2nd gen

• Treats positive and negative symptoms, less potent side effects

• More prone to wt. gain

2nd Gen. Med endings

-done

-pine

Side effects to be mindful of in 2nd gen meds

• Ziprasidone: Cardiac—>Dysrhythmias—> Prolonged QT

• Quetiapine: Orthostatic Hypotension

• Clozapine: Agranulocytosis —> risk for infection —> low WBCs

What is Neuroleptic Malignant Syndrome?

A life-threatening reaction to antipsychotic medication

Manifestations of Neuroleptic Malignant Syndrome?

• Fever

• Altered LOC

• Muscle rigidity

• Fluctuating BP

What do you give to treat Neuroleptic Malignant Syndrome?

Dantrolene:

• Muscle relaxant used to reduce severe muscle rigidity and hyperthermia

What Labs should you monitor for patients taking antipsychotics?

• Lipid panels:

  • HLD

  • LDL

  • Cholesterol

• A1C

What is depot formulation?

• Long-acting injectable: slowly releases medication into the body over an extended period

What are examples of depot formulation?

• Paliperidone

• Apriprazole

What drug tablets disintegrate to prevent cheeking?

• Risperidone

• Olanzapine