PSYCHOTHERAPEUTIC MEDS + ADRs

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anxiolytics (antianxiety)

medications used to treat manifestations of anxiety. provider will consider the severity of s/s and for how long the client has been experiencing them when prescribing a med from this category. benzodiazepines are the most commonly prescribed (alprazolam, diazepam, lorazepam, chlordiazepoxide, etc.). aims to regulate the function of the neurotransmitter GABA as they bind to GABA receptor sites and cause an influx of chloride to enter the neuron, causing an inhibitory effect. cascade effects occurs when these drugs are introduced to the brain, which causes a large amount of dopamine to be released in the limbic system, which increases potential for dependence. busipirone can also be used as a partial serotonin receptor agonist and a weak dopamine receptor antagonist; it does not affect GABA receptors. effects of busiperone are not experienced for a few weeks, commonly prescribed for chronic anxiety.

benzo ADRs

ADRs include CNS depression (sedation, poor concentration, impaired memory, drowsiness) via inhibitory GABA response. clients may also experience next-day sedation in long half life forms and agitation, hallucinations, or seizures, which are paradoxical responses that prompt the provider to discontinue the medication. if necessary, nurse should place the client on fall precautions. toxicity can call for the administration of flumazenil, which can reverse sedative effects and also cause seizures in those on tricyclic antidepressants. a short half life form of this med can manage acute manifestations. nurse should evaluate clients ability to complete ADLs.

busipirone ADRs

an antianxiety drug that acts on serotonin receptors, causing side effects like sedation, nausea, headaches, and dizziness.

antianxiety education

nurse should emphasize that these medications are only treating the manifestations of anxiety and not the cause. client should be aware that benzos can potentiate the effects of alcohol and that the two should not be consumed at the same time. nurse should work with the client to plan activities accordingly as the med can be disruptive for some individuals. client should not abruptly stop benzos and should be tapered. benzos can also cause an influx of dopamine to be released in the limbic system, increasing the risk for addiction with prolonged use.

antidepressants

used to treat a variety of manifestations that present in depression and anxiety (MDD, bipolar, GAD, PTSD, etc.). best when combined with psychotherapy. includes MAOIs, TCAs, SSRIs, and SNRIs. anyone beginning or increasing the dosage of any of these should be watched closely for worsening depression or unusual behavior, including increased risk for suicide. client should know that it can take a few weeks to experience relief of manifestations. client should take at night if they experience sedation.

monoamine oxidase inhibitors (MAOIs)

a type of antidepressant in which the mechanism of action inhibits the function of the enzyme monoamine oxidase, which increases the amount of time that monoamine transmitters, like serotonin and dopamine, can function before being degraded. ex:these drugs would cause higher concentrations of serotonin to be released into the synaptic gap for neurotransmission, relieving depression manifestations. ex. include phenelzine. common ADRs include weight gain, daytime sedation, s3xual dysfunction, and insomnia. client should refrain from eating foods that contain tyramine, as these inhibit the degradation of tyramine. this can put them at risk for a hypertensive crisis. ex include dried or overripe fruits (raisins, prunes, bananas), smoked or processed meats (hot dogs, bacon, sausage), red wine, beer, aged cheeses (swiss and blue), chocolate, avocado, sauces (teriyaki, fish, shrimp, soy), and soy products like tofu. client should also avoid OTCs that have ephedrine.

tricyclic antidepressants (TCAs)

a type of antidepressant in which the mechanism of action affects serotonin and norepinephrine by blocking their reuptake in presynaptic receptors. ex. include amitriptyline. ADRs include anticholinergic effects like dry mouth and constipation as well as orthostatic hypotension. clients may develop a tolerance overtime to these anticholinergic effects. can take 2-4 weeks to show improvement. client should avoid taking these alongside MAOIs.

selective serotonin reuptake inhibitors (SSRIs)

a type of antidepressant in which the mechanism of action affects serotonin by selectively blocking the reuptake of presynaptic receptors. ex. include fluoxetine. ADRs include nausea, agitation, and s3xual dysfunction. nurse should consider how the client perceives the potential for this dysfunction and consult for alternatives if needed. can take 4-6 weeks to show improvement.

serotonin norepinephrine reuptake inhibitors (SNRIs)

a type of antidepressant in which the mechanism of action affects serotonin and norepinephrine by selectively blocking the reuptake of presynaptic receptors. blocking the reuptake of serotonin and norepinephrine increases the amount of time that serotonin and norepinephrine must find a receptor on the post synaptic neuron to complete neurotransmission. for ex: improving the neurotransmission of serotonin may improve sleep regulation, while improving the neurotransmission of norepinephrine may improve manifestations of anxiety. ex. includes venlafaxine. has a unique ADR of appetite suppression.

antipsychotics

used to treat a variety of manifestations that present in schizophrenia spectrum and other psychotic-related disorders. are two generations of drugs (first and second). common for clients to be prescribed these for maintenance in a long term IM route (depot injections)

first gen antipsychotics (FGA)

work by blocking the dopamine receptors. are very potent dopamine antagonists and can be effective at treating severe manifestations of schizophrenia. potency causes concerning side effects. common ex include haloperidol, loxapine, chlorpromazine, and fluphenazine.

second gen antipsychotics (SGA)

work by blocking dopamine receptors to a lessor degree and by inhibiting the reuptake of serotonin. this leads to a different profile for the treatment of manifestations. have a lesser degree of severity in side effects. common ex are risperidone, rolanzapine, quetiapine, and clozapine. three of these, apripipazole, brexpiprazole (can help with agitation in clients with dementia), and caripraszine, are sometimes called TGAs as they are dopamine system stabilizers and work by regulating its transmission when reception is too low or too high; are used to treat a variety of manifestations exhibited in psychotic and mood related disorders.

antipsychotic ADRs

commonly shows anticholinergic effects (dry mouth, constipation, blurred vision, orthostatic hypotension, etc.). clients typically develop a tolerance for these after a few weeks. client should be on fall risk if necessary. can also show increased levels of prolactin, that may cause enlargement of breast tissue, decreased s3x drive, menstrual irregularities, and weight gain. can also show risk for extra pyramidal manifestations. metabolic side effects such as increased BG, BP, and cholesterol are more common in SGAs. nurse should use caution in those with diabetes.

antipsychotic teachings

nurse should help the client understand that there is a necessity to continue treatment even after the manifestations resolve. alternative meds can be used if side effects are intolerable. routine lab testing will be required (blood glucose and lipids with SGAs, ANC with clozapine). a support person may be necessary to keep the client accountable and help identify early s/s of relapse.

mood stabilizers

used to help relieve manifestations of mood dysregulation found in disorders like bipolar disorder. primary med is lithium, which is sometimes not well tolerated or is ineffective at relieving manifestations. anticonvulsants are also effective at treating manifestations of mood dysregulation. SGA aripiprazole as a depot injection can be effective at helping the client remain stable in the maintenance phase of treatment

lithium (mood stabilizer)

has an effect on regulating the reuptake of monoamine neurotransmitters to work as a mood stabilizer. can help prevent a relapse into a manic or major depressive episode in those with bipolar disorder. blood testing to monitor the level of this med should be performed every one to two weeks until a therapeutic level is obtained. range is 0.5-1.5 mEq/L. nurse should seek to establish baseline liver fx test when a client is taking other meds in conjunction with this one, along with kidney fx. ADRs include diarrhea, nausea, increased thirst, and fine hand tremors. weight gain is also common.

anticonvulsants

ex include carbamazepine and valproic acid. these inhibit the kindling process, or the cascading effect that causes seizure activity to increase in severity and occurrence. this process has an unknown link with producing episodes of mania, which may explain why these meds are effective in aiding mood regulation. topiramate and valproic acid also increase levels of GABA, causing an increase in inhibitory neurological effects. provider may choose to monitor serum levels of these, with samples typically being collected 12 hrs after the last does. many of these can affect liver functioning. common ADRs include sedation, dry mouth, weight loss (topiramate and lamotrigine), and weight gain (valproic acid).

mood stabilizer teachings

nurse should emphasize non pharmacological interventions in helping the client reduce stress. a relapse of manifestations is possible if the client experiences unmanageable physical and psychological stress. client should expect to have frequent bloodwork when on lithium. client should consume 2-3L of water per day to help kidneys excrete lithium and minimize the risk of toxicity.

sedative-hypnotics

often prescribed to treat the sleep wake disorder insomnia. when nonpharm sleep hygiene methods or OTC meds are not effective, these prescription meds are prescribed. there are several categories of these, including benzos, nonbenzo hypnotics, and melatonin receptor agonists. all of these meds must be used with caution due to potential adverse effects.

nonbenzo hypnotics

are used for the treatment of insomnia and act on the benzodiazepine receptor site of the GABA receptor. work similarly to benzos but have fewer adverse effects. ex include zolpidem, zaleplon, and eszopiclone. should be used for short-term treatment. common ADRs include headache, fatigue, dizziness, and nausea. more serious ADRs include sleep-driving and walking, amnesia, hallucinations, and suicidal ideation. nurse should caution the client never to take these meds prior to operating a vehicle, client should also avoid the consumption of alcohol or other CNS depressants. important that they also continue to practice good sleep hygiene habits.

stimulants

primarily used to treat manifestations of ADHD and narcolepsy. common examples include methylphenidate, amphetamine, and dextroamphetamine. when taken in excess, clients may develop a tolerance or addiction. produce their therapeutic benefit by causing the presynaptic neuron release dopamine, serotonin, and norepinephrine. in addition, the reuptake of these neurotransmitters is also inhibited. improves s/s of hyperactivity, impulsivity, and inattentiveness. can be given in an enteric coated form for sustained release.

stimulant ADRs

common ADRs include nausea, dry mouth, palpitations, and irritability. nurse should monitor for decreased appetite and weight loss. growth suppression is also possible in children if they do not consume an adequate diet. nurse should emphasize diet considerations and recommend a support person. extended release forms should not be taken after midday as they can cause nighttime restlessness.

herbal remedies

can manage manifestations of mental illness. common examples includes st. johns wort, ginseng, chamomile, and echinacea. these may interact with prescribed medications and cause harm to the client. the nurse should encourage the client to disclose the use of any of these to minimize complications with prescribed meds.

serotonin syndrome

a set of manifestations that are caused by a high influx of serotonin. causes include overdose of SSRIs, taking multiple classes of antidepressants, mixing antidepressants with migraine and pain meds, illicit use of drugs (LSD, XTCY), and when combining antidepressants with herbal remedies. s/s include restlessness, dilated pupils, tachycardia, high blood pressure, muscle rigidity, sweating, and loss of muscle coordination. nurse should stabilize vitals, sedate with benzos, and administer serotonin antagonist like cyproheptadine.

activation syndrome

can occur when a client initially starts an antidepressant. s/s include irritability, anxiety, impulsivity, aggressiveness, and agitation. can also cause suicidal thoughts in some cases. may develop within first few hours-weeks of starting treatment. nurse should monitor for client behaviors such as giving away items, calling friends to say goodbye, or requesting to write a living will.

antidepressant discontinuation syndrome (ADDS)

when a client taking an antidepressant for more than a month suddenly discontinues the meds, this can occur. s/s include difficulty sleeping, anxiety, depression, and flu-like symptoms. client may report electric shock like sensations felt in their heads that can be disruptive to their daily living. if abruptly stopping an MAOI, client may experience manifestations of psychosis. can persist for weeks. nurse should provide extensive education in regard to abrupt stoppage.

agranulocytosis

when blood has a lower-than-normal number of WBCs. common with antipsychotic meds, especially clozapine. client should have WBC count drawn before starting meds to use as baseline data. client should know weekly labs will be necessary. after a few months of treatment, the provider may decide to increase the time between testings. nurse should contact the provider immediately if the WBC value is less than 3500, who may then recommend checking the ANC. s/s include flu-like symptoms, sore throat, fatigue, fever, and muscle aches.

neuroleptic malignant syndrome (NMS)

characterized by muscle rigidity, hyperthermia, vital sign instability (increased/decreased BP and tachycardia), and elevated creatine kinase. s/s present after initial exposure or abrupt discontinuation of antipsychotic medications. clients taking FGA, especially haloperidol, carry a higher risk of developing this. nurse should immediately discontinue the antipsychotic, monitor fluid and electrolytes, initiate cooling measures, and place client on cardiac monitoring. provider may consider a dopaminergic agent like bromocriptine or a skeletal muscle relaxant like dantrolene for support.

extrapyramidal symptoms (EPS)

a set of neurological symptoms as an effect of blocking dopamine transmission from the midbrain to the brainstem. most commonly experienced by clients FGAs. client may display increased manifestations of anxiety and sometimes pain. can be releived by the administration of anticholinergic drugs unless client is experiencing tardive dyskinesia, which may call for valbenazine. TD does not typically resolve when the use of antipsychotics has been discontinued.

acute dystonia

client experiences muscle rigidity or spasms. ex: client may have difficulties opening their mouth, or it may appear as if their gaze is locked in a particular direction. in severe cases, the client may exhibit an oculogyric crisis in which they are unable to control the movement of their eyes for hours at a time. 

akathisia

severe feelings of restlessness that are not relieved by movement. clients are likely to self-discontinue or develop suicidal ideations when this is experienced. 

pseudoparkinsonism

a set of symptoms that resemble parkinson's disease, but do not have the same cause. s/s include slumped posture, shuffling gait, drooling, tremors, and pill-rolling movements of the fingers. 

tardive dyskinesia

described as permanent involuntary movements of the face, tongue, neck, and upper and lower extremities. ex:a client may begin to smack their lips, thrust their tongue, and tilt their head as they exhibit symptoms

early lithium toxicity

occurs when the serum level is greater than 1.5 mEq/L. common causes include dehydration, overdose, and concurrent use with loop diuretics. client may show s/s related to neurological dysfunction such as poor coordination, confusion, and sedation. physiological s/s include GI discomfort, nausea, coarse tremors, vomiting, and diarrhea.

advanced lithium toxicity

occurs at levels of 2.0-2.5 mEq/L. client will begin to exhibit psychological manifestations of seizures and stupor. physiological manifestations include extremely diluted urine, blurred vision, respiratory complications, tinnitus, and jerking motor movements. rate of kidney excretion may have to be increased through the admin of urea or mannitol. intentional overdose may call for gastric lavage.

severe lithium toxicity

occurs at levels greater than 2.5 mEq/L. client will begin to rapidly deteriorate with the advent of a comatose state. there may be severe respiratory complications that can lead to death. nurse should consult with the provider to initiate hemodialysis.