Mental Health Medications (Part 2)

True or False: Lithium can be given for disorders other than bipolar disorder.

False

what drug classification is lithium?

mood stabilizer

what must those taking lithium do in regards to water and salt consumption?

consume same amounts as before medication

what must be avoided in lithium patients to avoid dehydration?

excess sweating

normal lithium levels

0.5 - 1

N/V, diarrhea, altered coordination & speech, neuro changes, muscle weakness (lithium toxicity level)

lithium level: 1.5 - 2

agitation, blurry vision, twitching, rash, major confusion (lithium toxicity level)

lithium level: 2 - 3

dysrhythmias, loss of consciousness, seizures, coma (lithium toxicity level)

lithium level: 3+

what do you do for lithium toxicity levels 1.5 - 2?

hold dose, call doctor

what do you do for lithium toxicity levels 2 -3?

IV fluids, NG tube to flush out

what do you do for lithium toxicity levels 3+?

dialysis, keep alive

carbamazepine, divalproex, gabapentin, lamotrigine, topiramate, & oxcarbazepine (drug class)

anticonvulsants

drowsiness, dizziness, sedation, fatigue, low BP & RR (side effects)

anticonvulsants

True or False: Give anticonvulsants with food.

True

why should you tell an anticonvulsant patient to get up and sit down slowly?

orthostatic hypotension

why can amitriptyline be used to treat anorexia?

it increases appetite

what non-pharmacological treatment is used for major depressive disorder?

electroconvulsive therapy (ECT)

what does an ECT do to the brain?

increases norepinephrine & serotonin

what complication can occur from ECT?

short-term memory loss

True or False: Electroconvulsive therapy requires patient to be NPO before procedure.

True

amitriptyline, imipramine, desipramine, nortriptyline (drug class)

tricyclic antidepressants

venlafaxine, desvenlafaxine, bupropion, mirtazapine, duloxetine (drug class)

atypical antidepressants

dry mouth, constipation, sedation, orthostatic hypotension, blurry vision (side effects)

tricyclic antidepressants

what med class is given at bedtime?

tricyclic antidepressants

what should you do for a tricyclic antidepressant patient that has blurry vision?

report to provider

what atypical antidepressant requires liver function tests such as AST, ALT?

venlafaxine

high BP, sweating, dizziness, N/V (side effects)

atypical antidepressants

what med class must be given with food and at night?

atypical antidepressants

isocarboxazid, phenelzine, tranylcypromine (drug class)

MAOI antidepressants

why are MAOI antidepressants no longer given to patients very often?

they are dangerous

what med class is given with food in the morning?

MAOI antidepressants

headaches, n/v, diarrhea, weight gain/loss, dry mouth, urinary retention, orthostatic hypotension (side effects)

MAOI antidepressants

what med class takes 4 weeks to get in or out of the body system?

MAOI antidepressants

what are MAOI antidepressants contraindicated for?

most drugs

what can MAOI antidepressant patients not eat while taking it?

tyramine foods

examples of tyramine foods

red wine, aged meat, aged cheese, smoked meat, deli meat

if someone is in hypertensive crisis, has occipital headache, chills, dilated pupils, restlessness, and agitation, what are they likely experiencing?

MAOI interaction emergency

what cures an MAOI interaction emergency?

phentolamine mesylate IV

fluoxetine, sertraline, paroxetine, citalopram, excitalopram (drug class)

SSRIs

what do SSRIs do?

stops reuptake of serotonin (stops serotonin from fizzling out and going away)

what is the most commonly used new antidepressant with minimal side effects?

SSRIs

headaches, N/V, diarrhea, sedation, drowsiness, dry mouth, constipation, weight gain/loss, sexual dysfunction (side effects)

SSRIs

how does serotonin syndrome occur?

when mixing SSRIs; serotonin builds up in system

what do symptoms of altered mental state, muscle rigidity, sluggishness, tremors, muscle paralysis, high HR, high RR, & hyperthermia indicate?

serotonin syndrome

what would be given as treatment for serotonin syndrome?

IV fluids, cooling blanket, antipyretics, & benzodiazepines (for tremors)

True or False: SSRIs do not have to be given with food.

False

what time of day is fluoxetine given?

in the morning

what time of day are SSRIs typically given?

at night

what cannot be mixed with SSRIs?

St. John’s Wort

after how long is there a huge risk of suicide when taking any antidepressant?

4-6 weeks