anxiety, mood, affect & attention

benzodiazepines

indications are anxiety, insomnia, seizure disorders; pre-operatively to treat muscle spasms and alcohol withdrawal

driving

avoid this while taking benzodiazepines due to sedation effects

flumazenil

benzodiazepine antagonist

alprazolam

used for short term relief in acute anxiety attacks

lithium

used for mood stabilization long term in bipolar

acute anxiety

do not use an SSRI or SNRI due to taking a few weeks to see a response

tardive dyskinesia

smacking lips or tongue movements; non-reversible complication of lithium - hold medication/notify HCP

restlessness and hand tremors

mild side effects of lithium

withdrawal syndrome

abrupt discontinuation of an SSRI can cause this with dizziness, HA, nausea, sensory disturbances, tremor, anxiety, and dysphoria

fluoxetine

SSRI that can have nausea as a side effect; decrease or goes away in 2-4 weeks

persistent pulmonary hypertension

seen in newborns whose mothers took prozac during pregnancy

serotonin

neurotransmitter that SSRI affects

serotonin and norepinephrine

neurotransmitters that SNRI affects

diabetic neuropathy and fibromyalgia

other conditions that SNRI’s can treat

serotonin syndrome

occurs when too many drugs that affect serotonin levels are used together or in high doses; diagnosed through physical exams and review of medications

mild serotonin syndrome

nervousness, insomnia, diarrhea, N/V, dilated pupils, tremor, agitation, restlessness, and increased HR and BP; resolve in 24 to 72 hours of stopping medications

severe serotonin syndrome

high fever above 106 F, seizure, muscle rigidity, and unconsciousness

Hunter criteria

used to help diagnose serotonin syndrome; history of recent exposure to serotonergic drug, and at least one other symptom

spontaneous clonus

involuntary muscle contractions

neuroleptic malignant syndrome

a rare but life-threatening emergency caused by a reaction to dopamine-blocking medications or the rapid withdrawal of dopaminergic drugs; high fever, severe "lead pipe" muscle rigidity, altered mental status, and autonomic instability

atropine

speeds HR

adenosine

slows HR

quetiapine

antipsychotic with the largest pregnancy safety data but can often cause metabolic complications; used for mood disorder

prolong QT interval

can be caused by the use of quetiapine for mood disorder; requires evaluation telemetry readings

imipramine

tricyclic antidepressant that can cause weight loss/gain, dry mouth, GI upset, excessive yawning; report to provider if palpitations occurs

clomipramine

yawning induced poragasm

torsade de pointes

tricyclic overdose can cause a risk for this lethal heart rhythm

sodium

when there are low levels of this in the body, lithium excretion by the kidneys is effected; lithium toxicity may occur

venlafaxine

antidepressant SNRI

st. john’s wort

the use of this supplement increases the clients risk of serotonin syndrome and neuroleptic malignant syndrome

tyramine

avoid foods with high levels of this when taking an MAOI; figs, nuts, beans, aged cheese, ripe bananas, beer, fermented or smoked meats

2 to 3 weeks

how long it takes for antidepressant medication to take effect

4 to 9 months

how long treatment with antidepressants should last before weaning the patient off of them

suicidal ideations

may increase when begin taking a SSRI due to more energy to carry out tasks and thoughts

bupropion

reduces the seizure threshold