Unit 2 Mental Health Meds

Benzodiazepines Meds

Diazepam

Alprazolam

Lorazepam

Clonazepam

Diazepam Alprazolam Lorazepam Clonazepam Indications

Anxiety, Seizures, Skeletal Muscle Spasm, Insomnia

Diazepam Alprazolam Lorazepam Clonazepam Admin

PO, IV, IM, PR

Diazepam Alprazolam Lorazepam Clonazepam Adverse Effect

·      CNS depression

·      Drowsiness

·      Respiratory depression

·      Hypotension/ Dizziness

·      Risk of dependency

Diazepam Alprazolam Lorazepam Clonazepam Nursing Considerations

·      Monitor respiratory status

·      Avoid alcohol

·      Use caution when operating heavy machinery

·      Monitor CBC, LFT

·      Do not stop abruptly

·      Teach addictive potential

Diazepam Alprazolam Lorazepam Clonazepam Antidote

Flumazenil (IV)

Non-Benzodiazepines Medication 

Buspirone, Hydroxyzine (antihistamine)

Buspirone, Hydroxyzine (antihistamine) Indications

Anxiety

Buspirone, Hydroxyzine (antihistamine) Admin

PO

Buspirone Side Effects

·      Dizziness/light headedness

·      Drowsiness

·      Nausea

·      Paradoxical excitement or euphoria

·      Hypotension/ palpitations

Hydroxyzine (antihistamine) Side Effects

Sedation (including deep sleep)

Dizziness

Buspirone Nursing Considerations 

·      Rise slowly from sitting

·      Take with food

·      May take 2-4 weeks to reach full strength

·      Use caution when operating heavy machinery

Hydroxyzine (antihistamine) Nursing Considerations 

·      Use caution when operating heavy machinery

·      Rise slowly from sitting

Substance Abuse Medications

Disulfiram, Methadone, Chlordiazepoxide (Benzo derivative)

Disulfiram, Methadone, Chlordiazepoxide (Benzo derivative) Admin 

PO

Disulfiram Indications

Maintains abstinence from alcohol

Disulfiram Side Effects

Adverse reaction if drinking alcohol:

·      N&V

·      Flushing/pallor

·      Coughing,

·      Difficulty breathing

·      Anxiety

Disulfiram Nursing Considerations 

Avoid products with alcohol (Ex: beverages, mouth wash, OTC meds such as cough med)

Methadone Indications

Maintains abstinence from heroin

Methadone Side Effects

·      Dizziness/light-headedness

·      Sedation

·      N & V

·      Facial flushing

Methadone Nursing Considerations

·      Observe for respiratory depression and dependance

·      Take exactly as prescribed

·      Take with food

·      Encourage small, frequent meals, high-bulk foods, and fluids

Chlordiazepoxide (Benzo derivative) Indications

Alcohol withdrawal

Chlordiazepoxide (Benzo derivative) Side Effects

·      Dizziness

·      Respiratory depression

·      Lethargy

·      Hang-over sensation (HA, N&V)

Chlordiazepoxide (Benzo derivative) Nursing Considerations

Monitor VS

Monitor LOC/respiratory status

Selective Serotonin Reuptake Inhibitors (SSRI) Medications

o   Fluoxetine

o   Paroxetine

o   Sertraline

o   Citalopram

Fluoxetine, Paroxetine, Sertraline, Citalopram Indications

Anxiety, Depression, Obsessive Compulsive Disorder (OCD)

Fluoxetine, Paroxetine, Sertraline, Citalopram Admin

PO

Fluoxetine, Paroxetine, Sertraline, Citalopram Side Effects

·      GI upset

·      Dizziness

·      Drowsiness/insomnia

·      Headache

·      Diaphoresis

• Serotonin Syndrome (tachycardia, HTN, dilated pupils, +DTR)

Fluoxetine, Paroxetine, Sertraline, Citalopram Nursing Considerations 

·      Assess for suicide risk

·      Contraindicated with MAOIs

·      Do not stop abruptly

• Use caution when operating heavy machinery

Cyclic Antidepressants Medications

Amitriptyline Doxepine Imipramine

Amitriptyline Doxepine Imipramine Indications 

Depression

Amitriptyline Doxepine Imipramine Admin 

PO

Amitriptyline Doxepine Imipramine Side Effects

·      Drowsiness/sedation

·      Anticholinergic effects

·      Orthostatic hypotension/ Dizziness

·      Photosensitivity

·      GI upset

Amitriptyline Doxepine Imipramine Nursing Considerations

·      Assess for suicide risk

·      Rise slowly from sitting

·      Ensure adequate hydration

·      Encourage sugar free beverages & hard candy

·      Do not stop abruptly

Atypical Antidepressants Medications 

o   Duloxetine

o   Bupropion

o   Trazodone

 Duloxetine, Bupropion, Trazodone Indications 

Depression

 Duloxetine, Bupropion, Trazodone Admin

PO

 Duloxetine, Bupropion, Trazodone side Effects

Dry mouth

Drowsiness

GI upset

Dizziness

 Duloxetine, Bupropion, Trazodone Nursing Considerations

·      Taper before stopping

·      Assess for suicide risk

·      Avoid alcohol/other CNS depressants

·      Change positions slowly

·      Use caution when operating heavy machinery

Duloxetine, Bupropion, Trazodone Possible toxicity

N&V, diarrhea, decreased coordination, drowsiness, muscle weakness, slurred speech

Herbals Medications 

St. John’s Wort

St. John’s Wort Indication

Depression

St. John’s Wort Admin

PO

St. John’s Wort Side Effects

Dizziness, hypertension, allergic skin reactions, phototoxicity

St. John’s Wort Nursing Considerations

Avoid use of MAOIs within 2 weeks of taking, do not use alcohol, contraindicated in pregnancy, avoid sun/use sunscreen, discontinue within 1-2 weeks of surgery