Studied by 10 people
What are the different psychological disorders?
Anxiety, trauma, stress related disorders
Depressive disorders
Bipolar disorders
Psychotic disorders
Substance use disorders
Types of disorders under the umbrella terms of Anxiety, Trauma, Stress, and Depression?
Generalized anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Social anxiety disorder
Post-traumatic stress disorder (PTSD)
Depression
The practice of giving medications to treats these disorders is known as the -- approach
biomedical
With any class of anti-depressant medications you are NOT allowed to -- them with each other
combine/mix
If you want to switch anti-depressant medications you must…
slowly taper use of current medication
What is the main priority with anti-depressant medications?
SAFETY
What are different safety protocols we can perform with anti-depressant medications?
make sure that the environment is completely free of anything that the patient can harm themselves with
no curtains, strings, glass items
do NOT round on a regular interval because the patient may being to time when you are leaving and how long they have before you return - this may be the time they try to harm themselves
If a patient starts to show signs of medication effectiveness with anti-depressants (talking more, perky, upbeat), watch out for….
suicide attempts
Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressant medications?
paroxetine
sertraline
fluoxetine
citalopram
escitalopram
SSRIs perform which action?
Inhibits serotonin reuptake, allowing more serotonin to stay at the junction of neurons
Produces CNS stimulation
GOAL: increase serotonin levels
Educate patient to take SSRI medications in the…
morning
Educate patient that SSRI medications need -- to become effective
4 weeks
patients may wonder why the effects are not occurring
SSRIs can be used to treat…
generalized anxiety
panic disorder
OCD
depressive disorders (primary use)
PTSD
Initial complications of SSRIs?
nausea
fatigue
tremors
Other complications of SSRIs?
weight gain
GI bleeding
protect patient from trauma or invasive procedures
hyponatremia
clients on diuretics
messes up neuromuscular function
serotonin syndrome
bruxism
grinding teeth
suppression of platelet aggregation
increased bleeding risk
What is serotonin syndrome and what do we see with it?
An accumulation of serotonin in the brain stem or brain tissues
Leads to a hyperstimulation of the body
increased BP, PR, Temp
Fever or Tremors seen
This condition will usually subside on its own but if it does not, administer benzodiazepine
What is the antidote for serotonin syndrome?
Cyproheptadine
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) medications?
Venlafaxine
Duloxetine
What is the action of SNRIs?
They block reuptake of norepinephrine and serotonin
What disorders are SNRIs used for?
Major depression
Generalized anxiety disorder
Social anxiety disorder
Panic disorder
Pain due to fibromyalgia, osteoarthritis, low back pain, diabetic neuropathy
Tricyclic Antidepressant medications?
amitriptyline
nortriptyline
imipramine
What is the action of Tricyclic Antidepressants?
blocks reuptake of norepinephrine and serotonin
Advantage of Tricyclic Antidepressants?
it works quicker than SSRIs
10-14 days before it takes effect
maximum effects in 4-8 weeks
What are Tricyclic Antidepressants used for?
Depression
Depressive episodes of bipolar disorder
Neuropathic pain
Fibromyalgia
ADHD
Complications of Tricyclic Antidepressants?
Orthostatic Hypotension
Anticholinergic Effects
dry mouth, constipation, urinary retention
How to prevent orthostatic hypotension?
move slowly with the patient
do not make abrupt changes in position
monitor VS
How to minimize anti-cholingeric effects?
chew sugarless gum
increase fluids
2-3L/day
6-8 glasses/day is normal amount so we want >8 glasses of water/day
eat foods high in fiber
wear sunglasses outside
Monoamine Oxidase Inhibitor (MAOI) medications?
phenelzine
isocarboxazid
selegiline (transdermal)
MAOI action on the brain?
Blocks MAO in the brain; thus increasing amount of norepinephrine, dopamine, serotonin and tyramine available for impulse transmission
used less frequently d'/t its SE
What are MAOIs used for?
depression
bulimia
panic disorder
social anxiety disorder
OCD
PTSD
Complications of MAOIs?
CNS Stimulation:
anxiety
agitation
mania
hypertensive crisis
HA
tachycardia
-- is the most common sign of an increase in BP
HA
With MAOI medications, it can be dangerous to give them to patients with a history of…
HTN
heart disease
angina
stroke
Be careful with -- rich foods because they can trigger a hypertensive crisis in patients using MAOIs
tyramine
cheese
pepperoni
salami
avocados
figs
soups
soy sauce
red wine
protein supplements
Atypical or 2nd Generation Antidepressant medications?
bupropion
helps with smoking cessation
mirtazapine
causes sedation and is an appetite stimulant
nefazodone
trazodone
can help with depression and insomnia especially in older adults
vilazodone
vortioxetine
Contraindications to the use of Bupropion?
patients with seizure disorders
lowers the seizure threshold which puts patients at increased risk for status epilepticus
MAOIs
do not administer the two medications together
Trazodone can cause --
priapism - painful sustained erection (hardening of penis)
Evaluating effectiveness of Atypical or 2nd Generation Antidepressant medications?
Verbalizing improvement in mood
Increased hopefulness and desire to live
Ability to perform ADLs
Improved sleeping and eating habits
Increased interaction with peers
Benzodiazepine medications for anxiety?
alprazolam (Xanax)
diazepam (Valium)
lorazepam (Ativan)
lonazepam
Benzodiazepines induce -- and reduce --
sleep; anxiety
they enhance the inhibitory effects of GABA in the CNS
Benzodiazepines are used for…
general anxiety disorder
panic disorder
PTSD
insomnia
alcohol withdrawal
Complications of Benzodiazepines?
sedation
lightheadedness
ataxia
difficulty walking
decreased cognitive function
paradoxical response
opposite effect
patient will be hyper
We want to avoid giving Benzodiazepines with…
CNS depressants
alcohol
opioid analgesics
What do we see with acute toxicity from Benzodiazepines?
Respiratory depression
Hypotension
Cardiac/respiratory arrest
Nursing considerations with benzodiazepines?
Take as prescribed
Taper the dose when discontinuing
Administer at bedtime if possible
Keep in a secure place
What is the antidote for Benzodiazepines?
Flumazenil
Atypical Non-barbiturate Anxiolytic medication?
Buspirone
Buspirone binds to…
serotonin and dopamine receptors
Advantages to the use of Buspirone?
less dependency than benzodiazepines
less sedation
Buspirone can be used for…
panic disorders
social anxiety disorder
OCD
PTSD
What things interact with Buspirone and why is this a bad thing?
Erythromycin
Ketoconzazole
St. John’s Wort
Grapefruit juice
All of these things can cause an increase of medication levels in the blood!!
S&S of Bipolar Disorder?
Erratic behavior
Great mood
Rapid speech
Irritability
Inability to complete tasks
Trouble at work
Flight of ideas
Depression
Alcohol or drug use
Difficulty sleeping
Bipolar disorder medications are known as --
“mood stabilizers”
Actions of Mood Stabilizers?
Promote sleep
Decrease anxiety and agitation
Manage psychomotor agitation
Useful during the depressive phase
Mood Stabilizing medication for Bipolar disorder?
Lithium carbonate
prevents episodes of acute mania or return of mania/depression
Lithium carbonate blocks…
serotonin receptors
Complications of Lithium Carbonate?
GI distress
Fine hand tremors
Polyuria, mild thirst
Weight gain
Renal toxicity
perform a renal function assessment before and during administration
Goiter/hypothyroidism
Lithium toxicity
monitor levels
Watch for sodium balance
overhydration (low Na)
dehydration (high Na)
If a patient has hyponatremia while on lithium carbonate, this will…
increase their risk for toxicity
If a patient has hypernatremia while on lithium carbonate, this will…
reduce the effectiveness of the medication
sodium and lithium carbonate both “attach” to the same receptors
Lithium carbonate has a very narrow…
TI
Maintenance level for Lithium carbonate?
0.6-1.0 mEq/L
1.1 or 1.3 is still okay
Lithium carbonate becomes toxic once it is over…
1.5 mEq/L
There is no antidote for lithium carbonate so -- is used instead and is done -- times daily
hemodialysis; 2-3x
Mood Stabilizing Anti-epileptic drugs?
carbamazepine
valproic acid
lamotrigine
What is the action of Mood Stabilizing Anti-epileptic drugs?
Slows re-entrance of sodium and calcium back into the neuron: extends the time it takes for the nerve to return to its active state
Potentiates inhibitory effects of GABA
Inhibits CNS excitation
Mood Stabilizing Anti-epileptic drugs are used for…
Treatment and prevention of relapse of mania and depressive episodes
Also: mixed mania and rapid cycling bipolar disorders
Evaluation of effectiveness of Mood Stabilizing Anti-epileptic drugs?
Relief of acute manic symptoms or depressive symptoms
Mood stability
Ability to perform ADLs
Improved sleeping and eating habits
appropriate interaction with peers
Psychotic Disorders: Schizophrenia spectrum disorders are?
psychotic disorder of thought process
Positive symptoms of Schizophrenia?
agitation
bizarre behavior
delusions
hallucinations
flight of ideas
illogical thinking patterns
Negative symptoms of Schizophrenia?
social withdrawal
lack of emotion
lack of energy
flat affect
decreased motivation
decreased pleasure in usual activities
Cognitive symptoms of Schizophrenia?
attention and focus deficit
Delusion is a…
belief
it is caused by an external stimulation
if someone sees a shadow they may interpret it differently
Hallucination is…
an alteration in thought process
there is no specific stimulation
comes from within
Goals of Schizophrenia therapy?
Suppress acute episodes
Prevent acute recurrences
Maintain the highest possible level of functioning
Typical First generation Antipsychotic medications?
chlorpromazine
thiordiazine
thiothixene
haloperidol (Haldol)
fluphenazine
First generation Antipsychotic medications will typically decrease the -- symptoms in patients
positive
First generation Antipsychotic medications action on the brain?
They block dopamine, acetylcholine, histamine and norepinephrine receptors in brain and periphery
Since First generation Antipsychotic medications block dopamine receptors this can cause…
Pseudoparkinsonism
patients will mimic actions seen in parkinson disease
First generation Antipsychotic medications are used for…
Acute and chronic psychotic disorders
Schizophrenia spectrum
Bipolar syndrome
Tourette syndrome
Agitation
Violent or aggressive behavior - specifically haloperidol
Complications seen with first generation antipsychotic medications?
Extrapyramidal side effects (EPSs)
can fall, choke, or aspirate
Akathisia
unable to stand still or sit, continually paced and agitated
Tardive dyskinesia
involuntary movement of tongue & lips
Anticholinergic SE
constipation, dry mouth, hypotension
Photosensitivity
protect skin; sun screen, hats, wear long sleeves
Jaundice
pay attention to LFTs
Agranual cytolysis
will see recurring sore throat or infection
Neuroleptic malignant syndrome
fever, tremors, tachycardia
-- can be given for management of Tardive dyskinesia
Valbenazine
Atypical 2nd and 3rd generation Antipsychotic medications?
risperidone
olanzapine
quetiapine
clozapine
aripiprazole
Atypical 2nd and 3rd generation Antipsychotic medications block…
serotonin, dopamine, norepinephrine, histamine and acetylcholine receptors
typically first line treatment since they have less SE
Atypical 2nd and 3rd generation Antipsychotic medications decrease both…
positive and negative symptoms
Atypical 2nd and 3rd generation Antipsychotic medications can be used for…
Schizophrenia spectrum
Psychotic episodes induced by levodopa therapy
Bipolar disorders
Impulse control disorders
Atypical 2nd and 3rd generation Antipsychotic medications can cause -- disorders
blood
can mess up platelets or WBCs
want to monitor blood levels to prevent anemia, bleeding, or infection
Substance use disorders include abuse towards…
alcohol
caffeine
cannabis
hallucinogens
inhalants
opioids
sedatives/anxiolytics
stimulants
tobacco
steroids
Withdrawal symptoms include…
GI distress
behavioral changes
cardiovascular changes
increase in VS - PR
seizures
First -- hours after a person comes in with alcohol withdrawal, they may experience --
72
hallucinations and acute changes in mental status
Medications to support acute alcohol withdrawal?
benzodiazepines
chlordiazepoxide
helps to maintain VS, decrease seizures and withdrawal symptoms
carbamazepine
clonidine
propanolol
atenolol
“banana bag”
IV infusion
combination of thiamine, folate, and multivitamins
for hangovers
Medications to support maintenance alcohol withdrawal?
disulfiram
makes you nauseous if you drink alcohol
don’t give mouthwash because it has alcohol base properties in it
naltrexone
suppresses craving for alcohol
Medications supporting Opioid withdrawal/OD?
methadone
narcotic which doesn’t get the client high
clonidine
decreases autonomic hyperactivity but not the craving
buprenorphine
safer than methadone due to decreased risk of dependence
naloxone (Narcan): Antidote
blocks the effects of opioids and reverses the overdose; available in nasal spray and IV in in patient settings
Medications to support smoking withdrawal?
Antidepressant: buproprion
Varenicline
reduces cravings for nicotine by blocking the desired effects; also helps with withdrawal symptoms
Nicotine replacement (relieves physical withdrawal symptoms so client can focus on the emotional aspect)
lozenge (limit quantity to 20 QD
Gum (limit: 6 months)
patch (3 step)
nasal spray (not for asthmatics)
Inhaler (gradually taper)
Use caution with -- patients when giving Bupropion or Varenicline
cardiovascular
can makes things worse
Note
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