Psychotrop Drugs

Selective Serotonin Reuptake Inhibitors are also called

SSRI's

What is the titration process of starting SSRI medication?

-Start on low doses and titrate slowly to decrease side effects. -Side effects lessen over time/Instruct against abruptly discontinuing

medication

-Can take up to 6 weeks

Citalopram (Celexa)

SSRI

Escitalopram (Lexapro)

SSRI

Fluoxetine (Prozac)

SSRI

Fluvoxamine (Luvox)

SSRI

Paroxetine (Paxil)

SSRI

Sertraline (Zoloft)

SSRI

What fluid can be contradicted when taking SSRI's?

Grapefruit juice may increase plasma levels of some SSRIs

What are common side effects of SSRI's?

Insomnia, early agitation or restlessness, sweating, GI disturbance, weight gain, sexual side effects

What is the biggest concern when using SSR's?

Black box warning - suicidal thoughts and behaviors

socarboxazid (Marplan)

MAOI

Phenelzine (Nardil)

MAOI

Tranylcypromine (Parnate)

MAOI

Selegiline (Eldepryl, Ensam)

MAOI

What are the dietary restrictions for MAOI's to avoid risk of hypertensive crisis?

Must avoid

tyramine-rich foods (aged cheese, wine, some beers, organ meats,

sausage)

What other interactions must we as nurses watch out for when using MAOI's?

Drug/drug interactions (other antidepressants,

stimulants, opiates, sympathomimetic medications)

What are reportable symptoms with MAOI's?

Severe headache, palpitations, chest pain or SOB.

What are common side effects of using MAOI's?

Common side effects: insomnia, headache, sedation, increased stimulation, dry mouth and constipation

Tricyclic Antidepressants are called...

TCAs

What is the titration process for starting TCAs?

Start on low doses and titrate slowly to decrease side effects, avoid stopping abruptly

Amitriptyline (Elavil)

TCA

Desiparamine (Norpramin)

TCA

Imipramine (Tofranil)

TCA

Nortriptyline (Aventyl, Pamelor)

TCA

What are the CARDIAC side effects that come with taking TCAs?

Cardiac side effects possible - cardiac depression and increased, electrical irritability - baseline ECG

What are the common side effects when giving TCAs?

Sedation and anticholinergic effects (constipation, dry mouth, and orthostatic hypotension)

What is the MAJOR concern when starting a patient on TCAs?

Lethal in overdose

What are Atypical Antidepressants?

The class of medication used when standard Antidepressants are not treating MDD or causing unwanted side effects

Trazodone (Desyrel)

-Atypical Antidepressants

-Also used for SLEEP!

Mirtazapine (Remeron)

Atypical Antidepressants

Nefazadone (Serzone)

Atypical Antidepressants

Vortioxetine (Trintellix)

Atypical Antidepressants

Vilazodone (Viibryd)

Atypical Antidepressants

What is Trazodone (Desyrel)s MAJOR side effect?

Possibility of priapism with use of trazodone - seek medical care with painful erection

What are common side effects of using Atypical Antidepressants?

Common side effects: fatigue, sedation, dry mouth, headache, constipation, weight gain. Alcohol will potentiate sedating effects.

Mood Stabilizers

Common medication in Bipolar Disorder

Carbamezapine (Carbatrol, Tegretol)

Mood Stabilizers

Lamotrigine (Lamictal)

Mood Stabilizers

Lithium carbonate

Mood Stabilizers

Oxcarbazepine (Trileptal)

Mood Stabilizers

Topiramate (Topamax)

Mood Stabilizers

Valproic acid (Depakote)

Mood Stabilizers

Gabapentin (Neurontin)

Mood Stabilizers

What is a Teratogenic medication?

May cause birth defects or fetal harm durning pregnancy

What issues might Mood stabilizers present?

Teratogenic and may cause decreased efficacy of hormonal

contraception

What are common side effects of Mood Stablizers?

Common side effects for class: GI disturbance, lethargy, sedation, dose-related tremor, weight gain, menstrual disturbance, rash.

What is the MAJOR risk when treating patients with Lamotrigine?

Risk for Stevens-Johnson syndrome

What is the MAJOR risk when treating patients with Carbamezapine?

Risk for agranulocytosis

Lithium requires careful monitoring of blood levels. What is the range?

0.6 - 1.2.

What are the symptoms of Lithium toxicity?

Similar to intoxication (of alcohol). Patients on lithium need to watch to toxicity if dehydrated (diarrhea, vomiting).

-A common side effect of lithium is hypothyroidism

What is Gabapentin misused for?

Often misused by opioid addicts