Pharm - Psychotropic Medications

Another name for anxiolytic and Hypnotic Agents

CNS depressants

GABA

main inhibitory transmitter, blocks nerves impulses

what would more GABA lead to?

less nerve impulses

Examples: benzodiazepines

diazepam, lorazepam, midazolam, chlordiazepoxide

action: benzodiazepines

enhances GAPA effects in the brain

indications: benzodiazepines

anxiety, seizures, muscle spasms, alcohol withdrawal, induction/maintenance of anesthesia

side effects: benzodiazepines

sedation, amnesia, dependency/withdrawal, respiratory depression

interactions: benzodiazepines

opioids, alcohol

nursing implications: benzodiazepines

antidote is flumazenil, controlled, do not abruptly discontinue if used long term

WITHDRAWAL benzodiazepines

abdominal cramps, anxiety, depression, achy joints, shaking, agitation, seizures

examples: barbiturates

pentobarbital

action: barbiturates

increases GABA, resulting in CNS depression

indications: barbiturates

preoperative sedations, seizures, induce coma with high ICP

side effects: barbiturates

drowsiness, lethargy, hypotension, respiratory depression, constipation, GI upset

implications: barbiturates

monitor vital signs, have resuscitation equipment at the bedside, controlled

Action: Buspirone

binds to serotonin and dopamine receptors in the brain

indications: buspirone

anxiety, OCD, PTSD

side effects: buspirone

dizziness, nausea, headache

nursing implications: buspirone

does not cause sedation, dependency not likely, take with food, no grapefruit juice

examples: sleep agents

zolpidem, eszopiclone, zaleplon

action: sleep agents

increases GABA in the brain, promoting sleep/sedation

indication: sleep agents

insomnia

side effects: sleep agents

daytime sleepiness, dizziness, abnormal thinking or behavior, "Teflon brain"

nursing implications: sleep agents

allow at least 8 hours of sleep; controlled

What is the priority education to provide for a client taking lorazepam?

A. Do not work when taking this medication

B .Take with food

C. This can be addictive

D. Do not take with opioids

which medications are controlled?

A. lorazepam (Ativan)

B. zaleplon (Sonata)

C. hydrocodone

D. phenobarbital

E. buspirone

General interventions for depression

- monitor drug effectiveness
- monitor suicidal thoughts
- watch for seizures
- food interactions and drug interactions with MAOis
- adherence
- effects take 4-8 weeks
- wean off
- monitor serotonin syndrome

examples: selective serotonin reuptake inhibitors (SSRI)

fluoxetine
sertraline
paroxetine
escitalopram
citalopram

action: selective serotonin reuptake inhibitors (SSRI)

inhibit the reuptake of serotonin, increasing serotonin

side effects: selective serotonin reuptake inhibitors (SSRI)

weight gain, sexual dysfunction, insomnia, GI sx

indications: selective serotonin reuptake inhibitors (SSRI)

anxiety, depression, OCD, PTSD

contraindications: selective serotonin reuptake inhibitors (SSRI)

St. John's wort, SNRI, lithium, illicit medications, opioids, illicit drugs

nursing implications: selective serotonin reuptake inhibitors (SSRI)

watch for serotonin syndrome (agitation, hallucinations, fever, diaphoresis, tremors)

examples: serotonin norepinephrine reuptake inhibitors (SNRI)

duloxetine
venlafaxine
desvenlafaxine

action: serotonin norepinephrine reuptake inhibitors (SNRI)

inhibit serotonin and norepinephrine

indications: serotonin norepinephrine reuptake inhibitors (SNRI)

depression, anxiety, neuropathy

side effects: serotonin norepinephrine reuptake inhibitors (SNRI)

fatigue, insomnia, GI upset, decreased libido, increased blood pressure when you quit cold turkey (headache, dizziness, "shots of lightning through head")

contraindications: serotonin norepinephrine reuptake inhibitors (SNRI)

HTN, anything that increases serotonin

nursing implications: serotonin norepinephrine reuptake inhibitors (SNRI)

monitor for serotonin syndrome, monitor BP

examples: Tricyclic Antidepressants (TCA)

amitriptyline
nortriptyline
doxepin

action: Tricyclic Antidepressants (TCA)

increases serotonin and norepinephrine in CNS

indications: Tricyclic Antidepressants (TCA)

depression, neuropathy, fibromyalgia, anxiety, insomnia, enuresis

side effects: Tricyclic Antidepressants (TCA)

anticholinergic, sedation, dysrhythmias, seizures, orthostatic hypotension

interactions: Tricyclic Antidepressants (TCA)

MAOis

nursing implications: Tricyclic Antidepressants (TCA)

chew gum, wear sunglasses, increase fiber and fluid, watch overdose, give at HS, falls precaution

Examples: Atypical Antidepressants

bupropion
trazodone
mirtazapine

action: bupropion

decreases reuptake dopamine and norepinephrine

indications: bupropion

depression
smoking cessation

side effects: bupropion

headache, gi upset, weight loss, agitation, seizures,
no sexual side effects

trazodone

increases serotonin

trazodone side effects

sedation, hypotension, dry mouth

mirtazapine side effects

sedation, weight gain

examples: MAOI inhibitor

isocarboxazid
phenelzine
selegiline
tranycypromine

action: MAOI inhibitors

inhibits monoamine oxidase which increases levels of dopamine, epinephrine, norepinephrine, and serotonin

indications: MAOI inhibitors

refractory depression

side effects: MAOI inhibitors

agitation, anxiety, orthostatic hypotension, HTN crisis

nursing implications: MAOi inhibitors

FOOD RESTRICTIONS (tyramine)
LOTS of drugs (including OTC)
high tyramine foods (aged cheese, avocados, bananas, red wine, salami, pepperoni, chocolate, sauerkraut, caffeine)

Examples: typical (older) antipsychotics

chlorpromazine, fluphenazine, haloperidol, thiothixene

action: typical (older) antipsychotics

dopamine receptor blockers

indications: typical (older) antipsychotics

psychosis

side effects: typical (older) antipsychotics

extrapyramidal side effects
anticholinergic
sedation
seizures
sexual dysfunction
orthostatic hypotension

Interactions: typical (older) antipsychotics

Parkinson's disease, long QTc

nursing considerations: typical (older) antipsychotics

watch movements, administer at bedtime, fall precautions

Extrapyramidal Side Effects symptoms

pseudo-parkinsonism symptoms
acute dystonia
akathisia
tardive dyskinesia (TD)

atypical (newer) antipsychotics

risperidone
ziprasidone
aripiprazole
paliperidone
quetiapine
clozapine
asenapine
lurasidone
olanzapine

action: atypical (newer) antipsychotics

decreases serotonin and dopamine

side effects: atypical (newer) antipsychotics

weight gain, sedation, orthostatic hypotension, anticholinergic effects, menorrhagia, decreased libido

contraindications: atypical (newer) antipsychotics

other antipsychotics

nursing interventions: atypical (newer) antipsychotics

monitor blood glucose, weights, lipids

What do mood stabilizers do?

they put ceilings on the highs and basements on the lows

action: lithium

influences the reuptake or neurotransmitters

lithium can also be used as what?

antipsychotics and antiseizures

indication: lithium

bipolar disorder

side effects: lithium

GI upset, fine hand tremors, polyuria, weight gain, kidney toxicity, electrolyte imbalances, fatigue, hypothyroidism, leukocytosis

contraindications: lithium

kidney disease, diuretics, NSAIDS, anticholinergics, pregnancy

nursing implications: lithium

monitor for toxicity (course tremors, confusion, hypotension, seizures, tinnitus), levels 0.6-1.2 mEq/L, need adequate fluid and sodium intake

Examples: CNS stimulants

methylphenidate, amphetamine mixtures (Adderall), modafinil, lisdexamfetamine

Action: CNS stimulants

CNS stimulation, increases mental alertness and attention span

indications: CNS stimulants

ADHD, narcolepsy, obstructive sleep disorders, shift work sleep disorders

side effects: CNS stimulants

insomnia, dysrhythmias, decreased appetite, weight loss

drug interactions: CNS stimulants

CNS depressants

nursing implications: CNS stimulants

administer early in day, monitor weight

2 types of medications to treat substance use disorder

1. withdrawal during withdrawal - focus on stabilizing vital signs
2. long term - medication assisted treatment (MAT) for alcohol and opioid use disorder

Nicotine use treatment
*nicotine replacement

patch
gum
nasal spray
inhaler
lozenges

nicotine use treatment
PO meds

bupropion
varenicline

Alcohol use treatment
- withdrawal

CIWA protocl
benzodiazepines

alcohol use treatment
- sustained therapy treatment

disulfiram
naltrexone

disulfiram

unpleasant reaction (vomiting, sweating, palpitation, hypotension)

Naltrexone

decreases craving for alcohol
- po or IM monthly

Opioid use treatment

overdose
withdrawal
long term

long term opioid use treatment

naltrexone (opioid antagonist)
methadone (opioid agonist)
buprenorphine/naltrexone (opioid partial agonist/antagonist)

trazodone

increases serotonin