N342 exam 2 medications - mood disorders & schizo

What are the first-line antidepressant drug classes?

First-line classes are SSRIs and SNRIs.

What are the second-line antidepressant drug classes?

Second-line classes are TCAs and MAOIs.

What is the black-box warning for all antidepressants?

Increased risk of suicidal thinking, feeling, and behavior, especially early in treatment.

What are the three hallmark drug-specific reactions for antidepressants?

SSRI/SNRI/MAOI can cause Serotonin Syndrome; MAOIs can cause Hypertensive Crisis; TCAs can cause lethal overdose.

What dietary restriction is mandatory for patients taking MAOIs?

A strict tyramine-free diet, avoiding aged cheese and cured/smoked meats.

What are examples of SSRI medications?

fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram.

What is the mechanism of action of SSRIs?

They block serotonin reuptake to increase serotonin levels.

What are the adverse effects of SSRIs?

Agitation, anxiety, nausea, dizziness, blurred vision, decreased libido, and serotonin syndrome.

What are the age guidelines for fluoxetine and escitalopram?

Fluoxetine is for patients 8 years and older, while escitalopram is for patients 12 years and older.

What are the signs of Serotonin Syndrome listed in the SSRI section?

Agitation, fever, and rigidity.

What are examples of SNRI medications?

venlafaxine (Effexor) and duloxetine (Cymbalta).

What is the mechanism of action of SNRIs?

They block the reuptake of both serotonin and norepinephrine.

What are the adverse effects of SNRIs?

Nausea, diarrhea, decreased libido, erectile dysfunction (ED), weight gain, dizziness, drowsiness, headache, insomnia, and serotonin syndrome.

What specific nursing interventions are required for SNRIs?

Monitor blood pressure (BP) and do not stop abruptly (taper the dose).

What are examples of TCA medications?

amitriptyline (Elavil) and nortriptyline (Pamelor).

What is the mechanism of action of TCAs?

They affect serotonin, norepinephrine, and other neurotransmitters.

What are the adverse effects of TCAs?

Anticholinergic effects (dry mouth, blurred vision, constipation), orthostatic hypotension, weight gain, sexual dysfunction, EKG changes (QRS/QTc), and increased risk of seizures.

Why are TCAs dangerous for suicidal clients?

They have a narrow therapeutic index and are deadly in overdose.

What are the nursing considerations for TCAs?

Limit the quantity dispensed to at-risk clients, monitor cardiac function, and teach patients to rise slowly.

What are examples of MAOI medications?

phenelzine (Nardil) and tranylcypromine (Parnate).

What is the mechanism of action of MAOIs?

They block the breakdown of norepinephrine, serotonin, dopamine, and tyramine to increase their levels.

What are the adverse effects of MAOIs?

Orthostatic hypotension, dizziness, drowsiness, insomnia, sexual dysfunction, weight gain, hypertensive crisis, and serotonin syndrome.

What triggers a hypertensive crisis in an MAOI patient and what should be avoided?

Tyramine foods like aged cheese, cured/smoked meats, and fermented foods. They should also not be mixed with SSRIs/SNRIs.

What is the primary nursing intervention when switching a patient to or from an MAOI?

Ensure a proper wash-out period when switching agents.

What are examples of atypical antidepressants?

bupropion (Wellbutrin) and mirtazapine (Remeron).

What is the mechanism of action of bupropion and mirtazapine?

Bupropion increases dopamine and norepinephrine. Mirtazapine increases serotonin and norepinephrine.

What are the adverse effects of bupropion?

GI upset, orthostasis, weight loss, and an increased risk of seizures.

What are the nursing considerations for bupropion?

Avoid use in clients with a risk of seizures or eating disorders.

What are the adverse effects and clinical uses of mirtazapine?

Drowsiness and weight gain; sedation and increased appetite can be used to aid sleep.

How does depression present in older adults and what can it mimic?

It may show as somatic complaints, cognitive changes, or decreased function, and it can mimic neurocognitive disorders.

What is the clinical concept behind antipsychotic medications?

Dopamine blockers reduce positive symptoms; they treat symptoms, not function.

What is the benefit of long-acting injectable antipsychotics?

They last 2 to 6 months and help manage noncompliance.

What is the key difference between 1st generation and 2nd generation antipsychotics?

1st generation has a high risk of EPS. 2nd generation has a lower risk of EPS but a high risk of metabolic syndrome.

What are examples of 1st Generation (Typical) antipsychotics?

haloperidol (Haldol) and chlorpromazine (Thorazine).

What is the mechanism of action of 1st Generation antipsychotics?

Strong D2 antagonist.

What are the adverse effects of 1st Generation antipsychotics?

High EPS, sedation, and weight gain.

What are examples of 2nd Generation (Atypical) antipsychotics?

risperidone, quetiapine, olanzapine, aripiprazole, and clozapine.

What is the mechanism of action of 2nd Generation antipsychotics?

D2 & 5-HT2A antagonist.

What are the adverse effects of 2nd Generation antipsychotics?

Lower EPS but high metabolic syndrome (weight gain, increased glucose, increased lipids).

What severe adverse effect is associated with clozapine and what labs are required?

Agranulocytosis; requires routine WBC and ANC monitoring.

What is the black box warning for antipsychotics?

Increased risk of death in elderly patients with dementia psychosis.

What are the features and treatment of acute Dystonia?

Painful muscle spasm; treated with Benadryl or Cogentin (benztropine).

What are the features and treatment of Akathisia?

Internal restlessness or pacing; treated with a beta-blocker.

What are the features and treatment of Pseudoparkinsonism?

Tremor, shuffling gait, and rigidity; treated with an anticholinergic.

What are the features and treatment of Tardive Dyskinesia?

Involuntary facial movements like lip-smacking; treated by stopping and switching the drug (may be permanent).

What is the clinical presentation of Neuroleptic Malignant Syndrome (NMS)?

High fever, severe (lead-pipe) rigidity, autonomic instability, altered mental status, and increased CPK.

What is the immediate nursing action for suspected NMS?

Hold the drug and call the provider (this is an emergency where a dose IS held).

What does the acronym "FEVER" stand for in NMS?

Fever, Encephalopathy, Vitals unstable, Enzymes increased (CPK), Rigidity.

What is the therapeutic window for Lithium?

0.6–1.2 mEq/L.

What lithium serum levels are considered sub-therapeutic, toxic, and severe?

Sub-therapeutic is

What are the early signs of lithium toxicity?

Fine tremor, nausea, polyuria, and thirst.

What are the moderate signs of lithium toxicity?

Coarse tremor, confusion, and unsteadiness.

What are the severe signs of lithium toxicity?

Seizures, coma, arrhythmia, and death.

What are the main long-term risks or adverse effects of lithium therapy?

Hypothyroidism and kidney damage.

What is the sodium–lithium link that a nurse must teach?

Low sodium (Na⁺) or dehydration causes the kidneys to retain lithium instead of excreting it, leading to toxicity.

What factors or conditions can accidentally push a patient's lithium level into the toxic range?

Sweating, vomiting, diuretics, and low-salt diets.

What is the mechanism of action of valproic acid (Depakote)?

It increases GABA (↑ GABA) levels.

What are the common adverse effects of valproic acid (Depakote)?

Nausea/vomiting, tremor, hair loss, weight gain, drowsiness, and dizziness.

What is the black box warning for valproic acid (Depakote)?

Hepatotoxicity and pancreatitis (requires routine serum monitoring).

What is the mechanism of action of carbamazepine (Tegretol)?

It acts as a sodium-channel blocker.

What are the adverse effects of carbamazepine (Tegretol)?

Dizziness, drowsiness, and nausea/vomiting.

What is the black box warning for carbamazepine (Tegretol)?

Agranulocytosis, Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) (requires routine serum monitoring).

What is the mechanism of action of lamotrigine (Lamictal)?

It inhibits sodium channels.

What are the adverse effects of lamotrigine (Lamictal)?

Dizziness, headache, nausea, drowsiness, and diplopia/blurred vision.

What is the black box warning for lamotrigine (Lamictal) and the corresponding nursing priority?

Stevens-Johnson Syndrome (SJS); patients must report any skin rash immediately.

What is the purpose or action of adjunct antipsychotics like aripiprazole, quetiapine, or olanzapine?

They are used to augment antidepressants when those medications are insufficient.

What are the metabolic and extrapyramidal adverse effects of adjunct antipsychotics?

Weight gain, increased glucose, metabolic syndrome, increased lipids, tremor, akathisia, dystonia, and sedation.

What is the black box warning for adjunct antipsychotics?

They are not indicated for dementia psychosis due to an increased risk of death in elderly patients.