Psychotropic Medications

Antipsychotics

Medications that are used to treat psychosis symptoms such as hallucinations/delusions and help stabilize mood

What are the generations for antipsychotics?

First Generation (Typical) and Second Generation Antipsychotics (Atypical)

What are First Generation Psychotics?

• Haloperidol, Chlorpromazine, and fluphenazine

• Helps managed positive symptoms of Schizophrenia (Hallucinations/Delusions) by blocking dopamine receptors

• Think Hallucinations = Haloperidol

What are Second Generation Psychotics?

• Risperidone, olanzapine (Zyprexa), quetiapine (Seroquel)

• Helps manage positive and negative symptoms of schizophrenia ( Metabolic Effects: weight gain, insulin resistance = High Glucose, elevated cholesterol, orthostatic hypotension, etc)

• Clozzapine = Schizophrenia; NOT CLONIDINE!!

What are the Side/Adverse effs of Antipsychotics?

Extrapyramidal Symptoms

• Medication-Induced Movement Disorders

• Akathisia - Inability to stay still (Uncontrollable compulsion to move)

• Dystonia - Involuntary, repetitive, muscle contractions or postures
  
  

Tardive Dyskinesia

• Repetitive, rhythmic, Movements in the face, arms, and legs (Smacking, Chewing, Rapid Blinking, Tapping Feet, Etc)

Neuromalignant Syndrome

• Life-threatening emergency due to dopamine-blocking agents

• High Fever, Severe Rigidity, Altered Mental Status

• HOLD ANTIPSYCHOTICS, notify HCP, and administer urgent medical treatment

What’s the difference between First Gen and Second Gen Antipsychotics?

• First gen treats ONLY Positive symptoms while Second Gen treats BOTH Positive and Negative Symptoms

• Second gen antipsychotics also has fewer Extrapyramidal Symptoms and lower risk of Tardive Dyskinesia

• First Generation of Antipsychotics have a higher risk of EPS!!

Antidepressants

Medications that are used to treat Depression

• SSRIs/SNRIs, TCAs. MAOIs, and atypical antidepressants

Considerations for Antidepressants

• Takes 2-6 weeks to work in the system!

• BBW of Suicidal Ideation (Important to Monitor!!)

• NEVER STOP ABRUPTLY!! Wean off slowly

Selective Serotonin Reuptake Inhibitors

• Prototype - fluoxetine
  - escitalopram, sertraline, paroxetine

• First-line tx for Depression and Anxiety

Side/Adverse Effects of SSRIs

S’s of SSRIs

• Sexual Dysfunction (Decreased libido, ED, difficult to orgasm)

• Stomach Issues (GI Upset)

• Swollen (Weight Gain)

• Serotonin Syndrome
  - Excess serotonin in the brain that leads to muscle rigidity, Mental changes, increased HR/BP, and Hyperreflexia

Considerations for SSRIs

• Take in the morning to prevent disrupted sleep!

• Don’t combine with MAOIs or TCAs due to the risk of Serotonin Syndrome

Tricyclic Antidepressants

• Second-Line tx for depression and can treat neuropathic pain & fibromyalgia

• Imipramine, amitriptyline, nortriptyline, desipramine (“-triptyline” and “-pramine”)

• Increases serotonin and norepinephrine

• “Amy is walking along in the desert and trips over a tricycle”

Side/Adverse effects of TCAs

• Orthostatic Hypotension

• Anticholinergic Effs: Can’t see, spit, poop (Blurry Vision, Urinary Retention, Dry Mouth, Constipation)

• Dysrhythmias, seizures, and sweating

Monoamine Oxidase Inhibitors (MAOI)

• Treats depression by blocking the monoamine oxidase enzyme, resulting in increased levels of serotonin, norepinephrine, and dopamine

• phenelzine, selegiline

• Third-line tx for depression (Last Resort) due to food and medication interactions

Side/Adverse Effects of MAOIs

• drowsiness/dizziness

• sexual dysfunction

• Hypertensive Crisis (Due to intake of Tyramine)

Considerations for MAOIs

• Take in the Morning!! (Prevents insomnia; makes it difficult to sleep if taken later in the day)

• Do not take SSRIs or TCAs while on MAOIs (Serotonin Syndrome!! Buildup of serotonin)
  - Washout Period = Wait 14 days before taking SSRIs or TCAs so the MAOI can clear out of system

• Avoid aged cheese/yogurt, preserved meats (charcuterie), fermented foods, soy sauce, dried/overripe fruits (figs, raisins, etc), alcohol, and chocolate!!

Lithium (Lithobid)

• Used for the treatment of Bipolar Disorder

• Has a relationship with Sodium

What is the normal range and Toxicity level for Lithium?

• 0.5 - 1.2 = Normal Range

• > 1.5 = Lithium Toxicity

What is the relationship between Sodium and Lithium?

• Hyponatremia = Lithium Toxicity

• Hypernatremia = Decreased Lithium Therapeutic Effect

Causes of Lithium Toxicity

• Dehydration (Lithium is a salt and needs water to be dissolved)

• Diet low in Sodium (Low Sodium = decreased excretion of Lithium)

• Decreased Renal Function (Kidneys can’t filter Lithium effectively)

Signs of Lithium Toxicity

Mild

• GI Upset (nausea, vomiting, diarrhea)

• Tremors

• Lethargy

Moderate

• Confusion/delirium

• Agitation

• Hypertonia (Muscle Stiffness/Rigidity)
  
  

Severe

• Dry Mouth

• Hyperthermia

• Coma

• Seizures

Considerations/Teaching for Lithium

• Monitor therapeutic range!! Stop medication if signs of lithium toxicity occur!!

• Hydrate 2000 - 3000 mL of water per day