Pharm Mental Health Module 5

Therapeutic use of LITHIUM

- bipolar disorder
- mood stabilizer

Adverse effects of LITHIUM

GI DISTRESS, fine hand TREMORS, POLYURIA, mild thirst, weight gain, bradydyrhythmias

Nursing action for LITHIUM

- increase fluid
- increase sodium
- obtain blood levels in the morning, 10-12 hrs after the last dose

Common adverse effect of lithium

- below 1.5
- N/V/D, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy

Lithium toxicity early indications

- 1.5 to 2
- gi distress: N/V/D; mental confusion, poor coordination, tremors, sedation
- withhold med
- promote excretion, give based on lithium blood and sodium levels

Lithium toxicity advanced indications

- 2 to 2.5
- extreme polyuria, blurred vision, ataxia, seizure, severe hypotension
- prescribe whole bowl irrigation

Lithium toxicity severe indications

- 2.5>
- oliguria, seizures, rapid progression leading to coma and death
- prescribe hemodialysis

s/sx if taking LITHIUM too long

goiter and hypothyroidism

Lithium drug interactions

diuretics, nsaids (use aspirin), anticholinergic

When should the nurse/pt hold lithium

toxicity: diarrhea, vomiting, excessive sweat

What puts pt at risk for lithium toxicity

hot weather or diarrhea

Contraindications for lithium

pregnancy

Pt edu for nicotine replacement therapy

do not use w/nicotine products

Therapeutic use of METHYLPHENIDATE

ADHD
- narcolepsy and conduct disorder

Adverse effects of METHYLPHENIDATE

- insomnia
- decreased appetite
- weight loss
- chest pain
- hypertension
- hallucination (treat w/ chlorpromazine)
- tolerance / withdrawal reaction

Pt edu for METHYLPHENIDATE

dysrhythmias, do not stop suddenly, do not give caffeine

What cannot be taken w/methyphenidate

pseudoephedrine

What other drug treats adhd

"amphetamine"

Depressive disorder/antidepressant drugs

sertraline, paroxetine, and fluoxetine

Complications of SSRI/antidepressants

- weight change
- gi bleed
- hyponatremia
- serotonin syndrome
- ginding teeth
- withdrawal syndrome
- postural hypotension
- suicidal ideation

Early effects of SSRI

nausea, diaphoresis, tremor, fatigue, drowsiness

Later effects of SSRI

insomnia, headache, and sexual dysfunction

What is serotonin syndrome

fever, seizures, and hyperreflexia

Which drug treats anxiety?

benzodiazepines: alprazolam (xanax) and diazepam (valium)

suffixes for benzodiazepines

lam and pam

s/sx of benzodiapeines

euphoria, resp. dep, addictive, dizziness, drowsiness, lethargy

po and iv benzodiazepines

po: anxiety
iv: seizure

diaphoresis

cold sweats

hyperreflexia

your muscles have an increased or overactive reflex response