Mental Healh Drugs

Antidepressants uses

Anxiety, OCD, depression, PTSD, eating disorders

Antidepressant pt education

-Long duration to efficacy

-2 weeks to see initial effects, 4-6 weeks to see full effects

-Withdrawal syndromes if abruptly stopped

-Black box warning for suicidal thoughts-> especially in early tx with children and adolescents

-Serotonin syndrome

Serotonin syndrome S/S

Hyperreflexia, tremor, clonus, increased bowel sounds, agitation, autonomic instability, hypertensive, tachycardia, diaphoresis

SSRIS

Fluoxetine, Sertraline, Citalopram

Fluoxetine, Sertraline, Citalopram side effects

Selectively block serotonin reuptake in the CNS, resulting in more synaptic serotonin

Fluoxetine, Sertraline, Citalopram therapeutic use

Depression, anxiety disorders

Panic disorders

OCD

Fluoxetine, Sertraline, Citalopram side effects

Sexual dysfunction, nausea, HA, anxiety, insomnia

Serotonin Syndrome

Fluoxetine, Sertraline, Citalopram nursing considerations

Oral

Generally well-tolerated

SNRI drugs

Venlafaxine

Duloxetine

Venlafaxine and Duloxetine MOA

Blocks both serotonin and norepinephrine reuptake, resulting is more synaptic serotonin and norepinephrine

Venlafaxine and Duloxetine

Depression, anxiety disorders

Panic disorders

OCD

Venlafaxine and Duloxetine

Nausea, somnolence, HA, wt loss, sweating

Venlafaxine and Duloxetine

Oral

Side effects are more common than with SSRIs

MAIOS drugs

Selegiline and Phenelzine

Selegiline and Phenelzine

inhibits MAO an enzyme that breaks down serotonin and norepinephrine, resulting in more synaptic serotonin and norepinephrine

MAO is also produced by the liver to break down tyramine

Selegiline and Phenelzine

Depression, anxiety disorders

Panic disorders

OCD

Selegiline and Phenelzine

sSrious drug-food interaction with tyramine-containing food → causes hypertensive crisis

Selegiline and Phenelzine

Highest-risk class of antidepressants

Tyramine-containing foods: fermented foods (cheeses, processed meats, alcohol, chocolate, soy sauce, pickles, sourdough, etc.)

Atypical drugs

Bupropion (Wellbutrin)

Bupropion MOA

Unknown, believed to be related to blocking dopamine and norepinephrine reuptake

Bupropion therapeutic use

Depression, anxiety disorders

Panic disorders

OCD

Can also be effective in smoking cessation

Bupropion side effects

Wt loss, HA, dizziness, tremor, insomnia

Rare: psychosis, hallucinations, seizures

Bupropion nursing considerations

Does not cause sexual dysfunction unlike other antidepressant classes

Mood stabilizer drug

Lithium

Lithium MOA

Believed to alter glutamate uptake, binding to serotonin receptors, or inhibiting neuron glycogen synthesis

Lithium therapeutic use

Mood disorders

Mania

Bipolar disorder

Also inhibits the antidiuretic hormone

Lithium side effects

Polydipsia, dehydration, sodium depletion, fatigue, nephrotoxicity

Lithium toxicity:

Altered mental status, memory impairment, tremor, agitation, leukocytosis, N/V, diarrhea, bradycardia

Lithium nursing considerations

Lithium level monitoring is essential due to the narrow therapeutic index

Consuming enough salt is essential

Low sodium is contraindicate

Consuming enough salt is essential

Low sodium is contraindicated

Lithium toxicity

Altered mental status, memory impairment, tremor, agitation, leukocytosis, N/V, diarrhea, bradycardia

Lithium contraindications

Hyponatremia, renal impairment, ACE inhibitor use, NSAID use, polydipsia

Antipsychtotics

Several serious side effects that do not go away and get worse with time

-More common with 1st generation than 2nd generation

Autonomic dystonia

-Minutes to days

-Muscle spasms, face, tongue, neck, back

Extrapyramidal symptoms (EPS; psudoparkinsonsm)

-5-30 days

-Tremor, gait instability, bradykinesia

Tardive dyskinesia

-Months to years

-Smacking the lips and tongue repetively

Neuroleptic malignant syndome

-Early in tx

-Muscle rigidity, fever, sweating, autonomic dysregulation, seizures

Antipsychotic drugs

Haloperidol, Olanzapine

Quetiapine

Haloperidol MOA

First generation antipsychotic

Haloperidol therapeutic use

Schizophrenia, severe agitation, agitated delirium

Haloperidol side effects

Cardiac arrhythmia: QTc prolongation

Sexual dysfunction

Gynecomastia

Menstrual irregularities

Anticholinergic side effects

Haloperidol route

Oral, IM, IV

Olanzapine and Quetiapine MOA

Second generation antipsychotic

Olanzapine and Quetiapine therapeutic use

Schizophrenia, severe agitation, agitated delirium

Olanzapine and Quetiapine side effects

Fatigue, drowsiness (usually improves)

Wt gain

Hyperlipidemia

Insulin resistance: Type II diabetes

Olanzapine and Quetiapine route

Oral, IV/IM (olanzapine only)

Stimulant drugs

Methylphenidate and Dextroamphetamine

Methylphenidate and Dextroamphetamine MOA

Promotes norepinephrine and dopamine release, inhibits norepinephrine and dopamine reuptake

Methylphenidate and Dextroamphetamine therapeutic use

Attention deficit hyperactivity disorder (ADHD)

Narcolepsy

Methylphenidate and Dextroamphetamine

Appetite suppression, wt loss, insomnia, mood swings

Methylphenidate and Dextroamphetamine

Short and long-acting drug forms

Can be helpful to track sleep and wt

Medication holidays can be considered if wt loss in problematic