EX 1 PSYCH MEDS (Comprehensive)

What is the expected pharmacological action of stimulant medications

They raise levels of norepinephrine and dopamine in the CNS.

What are example stimulant medications (prototype and others)?

Methylphenidate (prototype); amphetamine mixture; dextroamphetamine; dexmethylphenidate; lisdexamfetamine dimesylate.

What are the therapeutic uses of stimulant medications?

ADHD in children and adults.

What are the complications/adverse effects of stimulant medications?

Insomnia and restlessness;

weight loss and growth suppression due to reduced appetite;

cardiovascular effects: dysrhythmias, chest pain, and high blood pressure,

increased risk of sudden death in clients with heart abnormalities.

What are the drug interactions of stimulant medications?

Caffeine can increase CNS stimulant effects; MAOIs can cause a hypertensive crisis.

What client education/nursing actions relate to caffeine intake and weight/growth monitoring for stimulants?

Instruct clients to decrease caffeine intake (coffee, tea, cola, chocolate);

monitor height and weight and compare to baseline;

consult the provider about a medication "holiday."

What are the nursing actions for transdermal stimulant patch application?

Apply the patch to one hip daily in the morning and leave in place no longer than 9 hr; alternate hips daily; flush the patch down the toilet after removal.

What are the contraindications for CNS stimulants?

History of substance use disorder, cardiovascular disorders, severe anxiety, and psychosis.

What are the symptoms of CNS stimulant toxicity?

Dizziness, palpitations, hypertension, hallucinations, and seizures.

What is the expected pharmacological action of atomoxetine?

Blocks reuptake of norepinephrine at synapses in the CNS; it is a selective norepinephrine reuptake inhibitor, not a stimulant.

What are the therapeutic uses of atomoxetine?

ADHD in children and adults.

What are the complications/adverse effects of atomoxetine?

Appetite/growth suppression and weight loss;

GI effects (nausea, vomiting, upper abdominal pain);

Hepatotoxicity

What client education should be provided for atomoxetine?

Report yellowing of eyes, abdominal pain, and flu-like symptoms (e.g., malaise);

decrease caffeine intake (coffee, tea, cola, chocolate);

monitor height and weight and compare to baseline;

administer with or after meals (decreases GI discomfort)

What are the drug interactions of atomoxetine?

MAOIs can cause a hypertensive crisis.

What are example TCA (tricyclic antidepressant) medications?

Desipramine, imipramine, clomipramine, amitriptyline.

What is the expected pharmacological action of TCAs?

Block reuptake of norepinephrine and serotonin in the synaptic space, intensifying the effects of these neurotransmitters.

What are the therapeutic uses/indications of TCAs?

Depression, autism, ADHD.

What are the complications/adverse effects of TCAs?

Orthostatic hypotension;

anticholinergic effects

weight gain;

sedation (the biggest concern);

lethal toxicity in overdose.

What are the anticholinergic effects of TCAs?

dry mouth, blurry vision, photophobia, urinary retention, constipation, tachycardia

What client education should be provided for TCAs?

Minimize anticholinergic effects by chewing sugarless gum and sipping water;

sedation should diminish over time

avoid hazardous activities like driving if sedation is excessive

take medication at bedtime;

change positions slowly to minimize dizziness from orthostatic hypotension.

What are the therapeutic uses of MAOIs?

Treatment of depression.

What are the complications/precautions of MAOIs?

• Numerous medication interactions and risk of hypertensive crisis

• avoid tyramine-containing foods (ripe avocados or figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer and wine, and protein dietary supplements) due to risk of hypertensive crisis.

What medications should be avoided without provider approval while taking MAOIs?

avoid all medications, including OTC drugs (e.g., TCAs, SSRIs, SNRIs, CNS stimulants), without first discussing with the provider;

What are example atypical antipsychotic medications?

Risperidone, olanzapine, aripiprazole, clozapine, and quetiapine.

What is the expected pharmacological action of atypical antipsychotics?

Mainly block serotonin and, to a lesser degree, dopamine receptors; also block receptors for norepinephrine, histamine, and acetylcholine.

What are the therapeutic uses of atypical antipsychotics?

Autism spectrum disorder, relief of psychotic manifestations, conduct disorder.

What are the complications/adverse effects of atypical antipsychotics?

Diabetes mellitus, weight gain, hypercholesterolemia

orthostatic hypotension

anticholinergic effects

very mild EPS effects (such as tremors).

What nursing interventions/patient education are associated with atypical antipsychotics?

Monitor glucose levels/obtain baseline fasting blood glucose (diabetes);

Encourage a low-calorie diet and regular exercise and monitor weight gain;

Monitor cholesterol/triglycerides (hypercholesterolemia).

What are example SSRI medications?

Paroxetine, fluoxetine, sertraline, fluvoxamine, citalopram, escitalopram.

What are the therapeutic uses/indications of SSRIs?

Anxiety, panic disorders, OCD, depression, intermittent explosive disorder, eating disorders, autism spectrum disorders.

What are the early adverse effects of SSRIs?

diaphoresis

nausea

tremors

fatigue, drowsiness

What are the later adverse effects of SSRIs after 5 to 6 weeks of therapy?

sexual dysfunction (impotence, delayed or absent orgasm/ejaculation, decreased sexual interest)

weight gain

headache

What are other general adverse effects of SSRIs?

Hyponatremia

Bruxism

Serotonin Syndrome

GI effects: nausea, constipation or diarrhea, dry mouth

CNS stimulation: agitation, anxiety, sleeplessness, tremors

What patient education should be provided for SSRIs?

• Medication takes 4-6 weeks to work; do not stop abruptly

• be aware of possible nausea, headache, CNS stimulation (agitation, insomnia, anxiety) and bruxism;

• report intolerable sexual dysfunction;

• watch for and report manifestations of serotonin syndrome and withhold the medication if they occur;

• avoid concurrent use of St. John's wort;

• report suicidal ideation;

• Follow a healthy diet and exercise regimen because weight gain can occur with long-term use.

What are example SNRI medications?

Venlafaxine, duloxetine.

What are the therapeutic uses of SNRIs?

Major depression, panic disorders, and generalized anxiety disorder (GAD).

What is the expected pharmacological action of SNRIs?

They block the reuptake of serotonin and norepinephrine.

What are the complications/adverse effects of SNRIs?

Headache, nausea,

agitation, anxiety, sleep disturbances, hypertension

sexual dysfunction

anorexia resulting in weight loss

dry mouth,

What are example benzodiazepine medications?

Diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam, clonazepam.

What are the therapeutic uses/indications of benzodiazepines?

Anxiety/GAD, panic disorders, alcohol withdrawal, insomnia.

What are the complications/adverse effects of benzodiazepines?

Anterograde amnesia (difficulty forming new memories after taking the medication);

CNS depression (sedation, lightheadedness, ataxia, decreased cognitive function);

acute toxicity

withdrawal effects (anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, seizures).

acute oral toxicity — manifestations

(drowsiness, lethargy, confusion)

acute IV toxicity — manfiestations

respiratory depression, severe hypotension, cardiac arrest;

diazepam and lorazepam are used IV

What patient education should be provided for benzodiazepines?

Keep in a secure place due to potential for misuse;

dependency can develop during and after treatment — notify the provider of withdrawal symptoms;

relief from anxiety occurs rapidly after administration.

What are the contraindications/precautions for benzodiazepines?

Contraindicated in clients with sleep apnea or respiratory depression;

generally used short-term due to risk of dependence;

assess fall risk in older adults;

use cautiously in clients with liver disease or a history of substance use disorder.

What are the drug interactions of benzodiazepines?

CNS depressants (alcohol, barbiturates, opioids) can cause respiratory depression;

instruct clients to avoid alcohol/other CNS depressants and avoid hazardous activities such as driving or operating heavy machinery.

What are the therapeutic uses of St. John's Wort?

An unregulated herbal product used by some individuals to relieve manifestations of mild depression.

What are the complications of St. John's Wort?

Can cause serotonin syndrome when taken alongside an SSRI/SNRI.

What medications/interactions can cause serotonin syndrome?

Concurrent use of TCAs, MAOIs, or St. John's wort (also SSRIs/SNRIs).

What is the onset and what are the manifestations of serotonin syndrome?

Can begin 2-72 hr after starting treatment and can be lethal. Manifestations: confusion, agitation, poor concentration, hostility, disorientation, hallucinations, delirium, seizures leading to status epilepticus, tachycardia leading to cardiovascular shock, labile blood pressure, diaphoresis, fever leading to hyperpyrexia, incoordination, hyperreflexia, muscle rigidity, GI symptoms (nausea, vomiting, diarrhea, abdominal pain), and coma leading to apnea and possible death.

What client education applies to ALL antidepressants?

Do not discontinue suddenly;

therapeutic effects can take several weeks or more;

avoid hazardous activities (driving, operating heavy machinery) due to sedation;

notify the provider of suicidal thoughts;

avoid alcohol.

What are example cholinesterase inhibitor medications?

Donepezil, rivastigmine, galantamine.

What are the therapeutic uses of cholinesterase inhibitors?

Used in patients with mild-to-moderate Alzheimer's disease to slow cognitive deterioration.

What are the contraindications/precautions of cholinesterase inhibitors?

Use with caution in clients with pre-existing asthma or other obstructive pulmonary disorders, since increased acetylcholine can cause bronchoconstriction.

What are the therapeutic uses of memantine?

Approved for moderate to severe stages of Alzheimer's disease.

What are the therapeutic uses of lithium?

Treatment of bipolar disorder; controls acute mania episodes, helps prevent the return of mania or depression, and decreases the incidence of suicide.

What is the therapeutic range for lithium levels?

0.6 to 1.2 mEq/L

At what lithium level does toxicity begin?

Above 1.5 mEq/L

What are the manifestations of a slightly elevated lithium level (less than 1.5 mEq/L)?

Fine hand tremors, diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, slurred speech, and lethargy

What should patients be educated about regarding manifestations at slightly elevated lithium levels?

These manifestations often improve over time

What is the lithium level range for early toxicity?

1.5 to 2.0 mEq/L

What are the manifestations of early lithium toxicity (1.5-2.0 mEq/L)?

Mental confusion, sedation, poor coordination, coarse tremors, and ongoing GI distress including nausea, vomiting, and diarrhea

What is the lithium level range for advanced toxicity?

2.0 to 2.5 mEq/L

What are the manifestations of advanced lithium toxicity (2.0-2.5 mEq/L)?

Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, and stupor leading to coma and possible death

What lithium level is considered severe toxicity?

Greater than 2.5 mEq/L

What happens at severe lithium toxicity levels (greater than 2.5 mEq/L)?

Rapid progression of manifestations leading to coma and death; hemodialysis may be warranted

What are the general complications of lithium?

Fine hand tremors

renal toxicity (monitor I&O, BUN/creatinine, and kidney function)

lithium toxicity.

What are the drug interactions of lithium?

Diuretics decrease sodium and thus decrease lithium excretion, leading to toxicity;

NSAIDs should be avoided to prevent toxic lithium accumulation.

What patient education should be provided for lithium?

Maintain a diet adequate in sodium and drink 1.5 to 3 L/day of water.

What is lamotrigine used for and what is its major complication?

An antiepileptic/mood-stabilizing medication;

major complication is Stevens-Johnson syndrome.

What are the therapeutic uses of valproic acid/valproate?

An antiepileptic/mood stabilizer used for bipolar disorder; treats and prevents relapse of manic and depressive episodes.

What is the therapeutic blood level range for valproic acid/valproate?

50 to 120 mcg/mL.

What are the complications for valproic acid/valproate?

Hepatotoxicity (jaundice, abdominal pain, anorexia, nausea, vomiting, fatigue);

Valproic acid/Valproate — Nursing Interventions

assess baseline liver function and monitor regularly (at least every 2 months during the first 6 months of treatment).

CARBAMAZEPINE: drug interactions and client education

Interacts with oral contraceptives and warfarin;

instruct clients to use an alternate form of birth control.

What medications are used for bipolar disorder?

Mood stabilizers (lithium); mood-stabilizing antiepileptics (carbamazepine, valproate, lamotrigine); antipsychotics (for restraining purposes).

What medications are used for ADHD?

CNS stimulants (e.g., amphetamines); selective norepinephrine reuptake inhibitors (e.g., atomoxetine, non-stimulant); TCAs.

What medications are used for anxiety/GAD?

SSRIs, SNRIs, benzodiazepines (typical anxiolytics), buspirone (atypical anxiolytic).

What medications are used for depression?

Antidepressants: TCAs, MAOIs, SSRIs, SNRIs.

What medications are used for neurocognitive disorders?

Cholinesterase inhibitors (rivastigmine, galantamine, donepezil) for mild-moderate disease; memantine for moderate-severe disease; antipsychotics for hallucinations/delusions used as a last resort due to many adverse effects.

What medications are used for autism?

SSRIs.