Mental Health Theory Pharm Flashcards

What are the side effects, mechanism of action, and key considerations for SSRI medications?

Medication Names: Sertraline, fluoxetine, escitalopram, paroxetine.

Mechanism of Action: Decreases the reuptake of serotonin, allowing it to stay in the synapse for longer and improve mood. Used for anxiety and depression.

Side Effects: GI symptoms (N/V/D), weight change, insomnia/anxiety (CNS), sleep disturbances, sex dysfunction.

Key Considerations: Do not suddenly stop to prevent withdrawal symptoms (flu-like symptoms). Takes 4-6 weeks to work properly. Black box warning for risk of suicidal behavior. Can cause serotonin syndrome if taken with other medications that increase serotonin.

What are the side effects, mechanism of action, and key considerations for SNRI medications?

Medication Names: Venlafaxine, duloxetine

Mechanism of Action: Decreases the reuptake of serotonin and norepinephrine, allowing it to stay in the synapse for longer and improve mood. Used for anxiety and depression.

Side Effects: GI symptoms (N/V/D), weight change, insomnia/anxiety (CNS), cardiac symptoms, sleep disturbances, sex dysfunction.

Key Considerations: Do not suddenly stop to prevent withdrawal symptoms (flu-like symptoms). Takes 4-6 weeks to work properly. Black box warning for risk of suicidal behavior. Can cause serotonin syndrome if taken with other medications that increase serotonin.

What is the difference between serotonin syndrome and neuroleptic malignancy syndrome?

Serotonin Syndrome: Movement based. Occurs when multiple medications increasing serotonin levels causes life-threatening symptoms. This reaction can happen in as little as 2 hours after dosage. This causes mental status changes (anxiety, confusion), abnormal muscle movements (clonus, hyperreflexia), and autonomic problems (increased vitals, diaphoresis, dilated pupils).

Neuroleptic Malignant Syndrome: Rigidity based. Occurs as a fatal side effect of taking antipsychotic medications; through dosage or medication change. This causes FALTER: fever, autonomic instability (^ VS), leukocytosis, tremor, elevated waste products (CPK, LFT, MGU), and rigidity of muscles. Treated with muscle relaxants, dopaminergic agents, cooling blankets, up to ECT. Almost all antipsychotics have this side effect, but less common in second generation.

What are the side effects, mechanism of action, and key considerations for atypical antidepressants?

Medication Names: Bupropion, Mirtazapine

Mechanism of Action: Bupropion blocks reuptake of dopamine and norepinephrine for MDD, ADHD, smoking cessation, and obesity. Mirtazapine is a serotonergic agent and a serotonin and norepinephrine antagonist used for insomnia and weight loss.

Side Effects: Bupropion may cause weight loss, seizures in high dosages.

Key Considerations: Bupropion contraindicated in patients with seizure and eating disorders.

What are the side effects, mechanism of action, and key considerations for tricyclic antidepressants?

Medication Names: Amitriptyline, clomipramine, imipramine.

Mechanism of Action: Blocks serotonin and norepinephrine reuptake, along with adrenergic, cholinergic, and histamine receptors.

Side Effects: Cholinergic symptoms (retention, dry mouth, blurred vision, memory problems, tachycardia), histamine symptoms (sedation, weight gain), and adrenergic symptoms (OHTN).

Key Considerations: Requires regular serum monitoring from toxicity risk, may contribute to cardiotoxicity in overdose. Contraindicated with post MI patients. Avoid sudden withdrawal. This medication is also non-refillable due to this risk, with no more than a weeks’ medication at a time.

What are the side effects, mechanism of action, and key considerations for monoamine oxidase inhibitors?

Medication Names: Phenelzine, selegiline.

Mechanism of Action: MAO inactivates neurotransmitters in the liver, so this inhibits them, allowing neurotransmitters to stay activated for longer and increase norepinephrine and serotonin levels.

Side Effects: Cholinergic symptoms (retention, dry mouth, blurred vision, memory problems, tachycardia), orthostatic hypotension, and liver enzyme elevation. Can cause confusion in older adults; paresthesia.

Key Considerations: Do not consume with tyramine-foods to prevent hypertensive crisis (symptoms within 60 minutes) or within 2 weeks after stopping medication; monitor BP frequently. Observe for serotonin syndrome due to frequent drug interactions. Used when other antidepressants don’t work.

What are the symptoms of hypertensive crisis? How is it treated?

Hypertensive Crisis: Patients report “full” feeling of head, flushed face, and explosive headaches. All vital signs will increase (risk of severe hyperthermia) except for respirations (CNS depression). Patients may have alteration in mental status. May experience N/V and diaphoresis. Seizures and coma in severe instances.

• Treatment: Elevation of head, VS, fluid therapy, nitro, hold MAOI.

What are the side effects, mechanism of action, and key considerations for lithium?

Medication Names: Lithium.

Mechanism of Action: Blocks the reuptake of glutamate, blocks binding of serotonin to its receptors, and alters ion transport in nerve and muscle cells. Lower receptiveness to atypical BD.

Side Effects: Cardiac symptoms (bradycardia, arrhythmia), CNS symptoms (tremor, fatigue, headache, memory problems), GI symptoms (N/V/D), polyuria and polydipsia.

Key Considerations: Can affect thyroid and kidney labs (acts like salt in body). Narrow therapeutic index (0.6-1.2 mEq/L), requiring regular (AM) lab monitoring and toxicity warning. ECG monitoring needed for cardiac sx. Maintain consistent sodium and fluid intake. Teratogenic. Avoid NSAIDs and caffeine.

Dosage Considerations: Typically given in 300-600mg increments; do not exceed 2400mg per day.

• Normal maintenance is 0.6-0.8, unless someone is experiencing mania, then it’s 0.7-1.2.

What are the signs of lithium toxicity? What is the treatment?

• Mild (1.5-2 mEq/L): N/V, confusion, change in mood, muscle weakness and ataxia.

• Moderate (2.0-2.5 mEq/L): Worsened N/V, blurry vision, delirium, convulsions, stupor.

• Severe (>2.5 mEq/L): Convulsions, renal failure, and death.

  • Treatment: MSE and VS, Hold next lithium dosage, monitor labs and EKG, push fluids.

What are the differences in function and side effects between the anticonvulsants valproic acid, carbamazepine, and lamotrigine?

• Valproic Acid (Depakote): Prevents mania; mood stabilizer for schizophrenia. Increases GABA while blocking Na/Ca. Serum level maintenance (45-125mcg/mL). Causes sedation, weight gain, and hepatotoxicity. Teratogenic.

• Carbamazepine (Tegretol): Prevents mania; mood stabilizer for schizophrenia. Reduces glutamate while mediating Na/Ca. Serum level maintenance (6-12mcg/mL). Causes sedation, GI symptoms, SJS, and blood disorders (anemia, agranulocytosis). Teratogenic. Will decrease in effectiveness over time due to inducing its own metabolism, so do not give with grapefruit juice or antibiotics.

• Lamotrigine (Lamictal): Works best for hypomania. Reduces glutamate while mediating Na/Ca. Risk of SJS and toxic epidermal necrolysis (life-threatening rash). Teratogenic.

• Neurontin (Gabapentin): Off-label usage for mental health disorders. Can cause fatigue, sleepiness, tremors, blurry vision. In extreme cases, results in suicidality and DRESS syndrome (organ shutdown). Withdrawals may ensure.

What are the side effects, mechanism of action, and key considerations for buspirone?

Medication Names: Buspar

Mechanism of Action: Partial serotonin agonist used in long-term treatment for anxiety.

Side Effects: Generally well tolerated; not tolerated well if previous benzodiazepines used.

Key Considerations: Lag period of 7-10 days. Provide consistent administration with or without food.

What antihypertensives are used for anxiety?

1. Prazosin (minipress) is an alpha 1 receptor blocker that is primarily used in the treatment of nightmares for post-traumatic stress disorder.

2. Propranolol (inderal) is a beta 1 and beta 2 receptor blocker that is primarily used in the treatment of social/performance anxiety through lowered heart rate and tremors. This should be given 1 hour before the triggering event.

3. Clonidine (catapres) is an alpha 2 agonist that reduces autonomic symptoms in patients with anxiety by reducing sweating and palpitations.

What medications help with sleep?

1. Benzodiazepines (alprazolam, lorazepam, diazepam) are CNS depressants that intensify the effects of GABA, producing anxiolytic effect that reduce insomnia. These medications have a risk of abuse/dependence/withdrawal (Schedule IV). It may also cause patients to develop cognitive difficulty and excess sedation, making it riskier to take in older adults (caution with driving, machinery, activity). They also have a high risk for respiratory depression.

2. Z-Drugs (zolpidem, zalpelon, eszopiclone) are medications that are non-benzodiazepine hypnotics. Zolpidem and zalpelon are used for short-term insomnia, causing drowsiness within 1 hour, with symptoms of sedation, dizziness, ataxia, amnesia, nervousness, parasomnias, and hallucinations as side effects. These are not absorbed well with food. Eszopiclone is safer for long-term use.

   1. The dosage for women is half that of men due to high risks of morning impairment.

1. Trazodone is a depression, anxiety, and insomnia medication that can cause sedation, ataxia, and feelings of intoxication.

2. Antihistamines (diphenhydramine, hydroxyzine) can cause sleepiness, with benadryl causing drug-induced parkinsonism at times. These can also be used for anxiety, like in the case of hydroxyzine.

3. Melatonin.

What are the differences between first generation and second-generation antipsychotics?

First Generation: These medications block dopamine receptors, which primarily target positive symptoms. These are often given in the short-term to relieve aggression and hostility. Causes EPS, TD, anticholinergic effects, high prolactin, photosensitivity, weight gain, cardiovascular effects, and NMS.

Second Generation: These are dopamine antagonists that also affect serotonin receptors (for negative symptoms). Can cause metabolic syndrome along with similar effects to first generation antipsychotics without the risk of NMS.

What is the initial response to antipsychotic medication?

Sedation, hypotension, and restlessness are the first side effects, which may be misinterpreted as "worsening” their condition. It can take 4-6 weeks to resolve psychosis but may take longer for individuals who have had multiple previous episodes.

What are the four types of extrapyramidal symptoms?

1. Acute Dystonia: Causes involuntary muscle contraction of the face, arms, legs and neck. Laryngospasms in the throat may be fatal.

2. Akathisia: Restlessness and trouble sitting still, leading to pacing and agitation.

3. Parkinsonism: Causes Parkinson’s-like symptoms (tremor, mask-face, slurred speech, pill-rolling).

4. Tardive Dyskinesia: Involuntary movements that primarily affect the face.

What happens to the body when you block dopamine?

Dopamine (D2): Blocking dopamine reduces psychosis symptoms and helps to regulate movement (balanced with acetylcholine). Imbalance produces extrapyramidal symptoms, requiring anticholinergics (benztropine, diphenhydramine) to restore balance.

What happens to the body when you block histamine?

Histamine (H1): Blocking histamine causes a calming effect and increases appetite, which is useful for agitation, insomnia, and anxiety. However, this can cause excess sedation, weight gain, and metabolic syndrome as a result.

What happens to the body when you block alpha 1 receptors?

Alpha 1 (A1): Blocking alpha 1 dilates vessels, decreasing blood pressure and providing a calming sensation through a reduction in the autonomic nervous system (producing ‘calm’). Dilation of the veins may cause dizziness and hypotension, especially in vulnerable populations.

What happens to the body when you block muscarinic receptors?

Muscarinic (M1): Blocking muscarinic receptors help withs activating the parasympathetic nervous system responses for the body (cognition, memory, movement, salivation) which also blocks acetylcholine and reduces EPS.

What happens to the body when you block serotonin?

• Serotonin (5-HT2A): Serotonin helps to influence mood, providing relief for the negative symptoms of schizophrenia while increasing dopamine in certain areas of the brain. This may cause sedation.

  • Nigrostriatal Pathway: Reduces EPS.

  • Mesocortical Pathway: Improves negative symptoms directly, along with cognition and general mood.

  • Mesolimbic Pathway: Reduces positive symptoms.

What are the side effects, mechanism of action, and key considerations for clozapine?

Medication Names: Clozaril

Mechanism of Action: Helpful for treatment resistant schizoaffective disorder and schizophrenia through increased cognition, motivation, and mood.

Side Effects: Sedation, high weight gain (15-30lbs), seizures, tachycardia (myocarditis), neutropenia (agranulocytosis)., OHTN.

• Affinity: H1, A1, M1.

Key Considerations: Lab testing may be needed to check for cholesterol levels. Avoid if seizure disorder present or taking other medications that lower blood cell production.

What are the side effects, mechanism of action, and key considerations for Ziprasidone?

Medication Names: Geodon.

Side Effects: Nausea, akathisia, and weight gain (in some cases). May contribute to OHTN, and TD.

Key Considerations: Give with a meal to be absorbed properly. Lab testing may be needed to check for cholesterol levels. Contributes to cardiac arrhythmia.

What are the side effects, mechanism of action, and key considerations for Olanzapine?

Medication Names: Olanzapine.

Side Effects: Large amounts of weight gain (increased appetite), anticholinergic symptoms, akathisia, TD, and OHTN. NMS risk.

• Affinity: H1, M1.

Key Considerations: Alcohol and medications can prevent from working. Lab testing may be needed to check for cholesterol and prolactin levels.

What are the side effects, mechanism of action, and key considerations for Risperidone?

Medication Names: Risperidone.

Side Effects: Some weight gain and restlessness. OHTN and TD. NMS risk.

• Affinity: 5-H2TA, A1, D2.

Key Considerations: Alcohol and medications can prevent from working. Lab testing may be needed to check for cholesterol and prolactin levels.

What are the side effects, mechanism of action, and key considerations for Quetiapine?

Medication Names: Seroquel.

Mechanism of Action: Used for schizophrenia, bipolar disorder, PTSD, insomnia, GAD, OCD, autism, and dementia.

Side Effects: Some weight gain and restlessness. OHTN and TD. NMS risk.

• Affinity: H1, A1.

Key Considerations: Alcohol and medications can prevent from working. Lab testing may be needed to check for cholesterol and prolactin levels. Increased risk of mortality in dementia patients and risk of SI in children.

What are the side effects, mechanism of action, and key considerations for Aripiprazole?

Medication Names: Aripiprazole

Side Effects: Akathisia and weight gain (from increased glucose). NMS risk.

Key Considerations: Alcohol and medications can prevent from working. Lab testing may be needed to check for cholesterol and prolactin levels. Risk of compulsive gambling.

What are the side effects, mechanism of action, and key considerations for Chlorpromazine?

Medication Names: Chlorpromazine

Side Effects: EPS (TD), anticholinergic symptoms, OHTN, cardiac arrhythmia, skin and ocular changes, seizures. NMS risk.

• Affinity: A1.

Key Considerations: Give with a meal to be absorbed properly. Avoid many substances (alcohol, caffeine, grapefruit, st. john’s wort, nicotine). Lab testing may be needed to check prolactin levels.

What are the side effects, mechanism of action, and key considerations for Haloperidol?

Medication Names: Haloperidol

Side Effects: EPS (TD), anticholinergic symptoms, cardiac arrhythmia, and blood dyscrasias. NMS risk.

Key Considerations: Give with a meal to be absorbed properly. Avoid many substances (alcohol, caffeine, grapefruit, st. john’s wort, nicotine). Lab testing may be needed to check prolactin levels.

What are the side effects, mechanism of action, and key considerations for Lurasidone?

Medication Names: Latuda

Side Effects: Nausea, akathisia, and weight gain (in some cases). May contribute to OHTN, high prolactin, and TD. NMS risk.

Key Considerations: Give with a meal to be absorbed properly. Lab testing may be needed to check for glucose (diabetes) and cholesterol levels. Do not give with grapefruit juice.

What nursing interventions are useful for patients experiencing side effects from antipsychotic medications?

• For dizziness, divide doses throughout the day, and rise slowly.

• For constipation, laxatives may be needed. For diarrhea, loperamide.

• For drooling, use a waterproof pillow.

• For dry mouth, avoid caffeine, drink lemon water, or use xylitol gum.

• For nausea, take medication after a meal and ginger capsules.

• For akathisia, propranolol, b6, gabapentin, and other medications can be used to reduce restlessness.

What are the key considerations and mechanism of action for naltrexone?

Mechanism of Action: Opioid antagonist that reduces the pleasurable effects of alcohol.

Key Considerations: Do not take opioids alongside this medication. Can cause naltrexone hypersensitivity. Caution in pregnancy, renal and liver disease.

What are the side effects, mechanism of action, and key considerations for disulfiram?

Medication Names: Antabuse.

Mechanism of Action: Inhibits enzyme called aldehyde dehydrogenase that breaks down alcohol, causing severe withdrawal symptoms and promoting abstinence.

Side Effects: Headache, N/V, flushing, tachycardia, dyspnea, sweating, chest pain, dizziness, burning sensation. May cause severe withdrawal symptoms (resp. depression and death). May cause psychotic reactions and peripheral neuropathy.

Key Considerations: Lasts 30-60 minutes or more. Avoid all alcohol sources. Carry a card, and do not take within 12 hours of drinking. Reactions can occur 14 days after last dosage.