After Class

🧠 What is Lithium?

• First-line medication for bipolar disorder.

• Helps stabilize mood swings by affecting neurotransmitters (↓ dopamine & norepinephrine, ↑ serotonin).

• Taken orally and has a narrow therapeutic range (0.6–1.2 mmol/L).

⚠ Lithium Toxicity – Watch For:

• Caused by high dose, kidney issues, dehydration, or interactions (e.g. NSAIDs, diuretics, ACE inhibitors).

• Early signs: Thirst, nausea, vomiting, diarrhea, slurred speech, muscle weakness, lethargy.

• Severe signs: Seizures, confusion, ataxia, hyperreflexia, coma.

🚫 Contraindications

• Pregnancy & breastfeeding

• Age under 12

• Kidney or liver impairment

• Cardiac disease

• Schizophrenia or organic brain syndrome

• Dehydration or low sodium levels

• Interaction with NSAIDs, ACE inhibitors, diuretics

🧪 Pre-Administration Checks

• Medication/supplement history

• Renal function (BUN, creatinine), electrolytes

• Liver function tests, thyroid (TSH)

• Mental status

• Negative pregnancy test (if applicable)

✅ Client Education

• Take exactly as prescribed – don’t skip or crush tablets

• Take with food or milk to reduce nausea

• Stay hydrated and keep salt intake consistent

• Monitor for signs of toxicity and report immediately

• Avoid dehydration, vomiting, diarrhea, or extreme heat

• Expect regular blood tests (especially early in therapy)

🧍‍♀ Nurse Responsibilities

• Educate about safe use and side effects

• Monitor mood and lithium serum levels

• Watch for signs of toxicity or hypothyroidism

• Reinforce the need for fluid/sodium consistency

• Coordinate follow-up and lab testing

🧠 What Are SSRIs and SNRIs?

• SSRIs (e.g. fluoxetine, sertraline): Block serotonin reuptake.

• SNRIs (e.g. venlafaxine, duloxetine): Block serotonin & norepinephrine reuptake.

• Used to treat:

  • Major depressive disorder (MDD)

  • Anxiety disorders (OCD, PTSD, panic disorder)

  • Bulimia (SSRIs)

  • Neuropathic pain (SNRIs)

⚠ Common Side Effects

🧨 Serotonin Syndrome Symptoms

• Flushing, high fever, agitation, tremors, muscle rigidity

• Seizures, altered mental status, possible coma

🚫 Contraindications & Cautions

• Do NOT use with MAOIs

• Use caution with:

  • Pregnancy or breastfeeding

  • Renal/hepatic impairment

  • QT prolongation risk

  • Glaucoma

  • Diabetes

  • History of MI or suicidal thoughts

✅ Nursing Considerations

Before Administration:

• Assess depression severity and suicide risk

• Review vital signs, electrolytes, liver/kidney function

• Confirm negative pregnancy test if applicable

Patient Education:

• Take in the morning to reduce insomnia

• Takes 2–4 weeks to feel effect

• Do not stop abruptly

• Maintain birth control during use

• Report signs of serotonin syndrome or suicidal thoughts

• Sexual side effects are common—encourage communication with provider

• Avoid driving if dizzy or drowsy

Special SNRI Tips:

• Empty bladder before dose (urinary retention)

• Report palpitations or fast heart rate

Ongoing Monitoring:

• Mood and behavior changes

• Side effects and adherence

• Regular follow-up appointments

🔁 Quick Recap

• SSRIs/SNRIs boost mood by increasing serotonin ± norepinephrine.

• Monitor for side effects, especially suicidal ideation early in therapy.

• Nurses play a key role in education, monitoring, and safety.

🧠 What Are TCAs and MAOIs?

💊 Other Uses

• TCAs: Anxiety, OCD, panic disorder, neuropathic pain, migraines

• MAOIs: Parkinson’s disease (selegiline), treatment-resistant depression

⚠ Common Side Effects

🚨 Serious Risks

• TCAs: Cardiotoxicity (QT prolongation, arrhythmias), seizures, overdose risk

• MAOIs: Hypertensive crisis (especially with aged cheese, red wine, caffeine, chocolate), serotonin syndrome

🚫 Contraindications

👩‍⚕ Nursing Considerations

Before Administering:

• Assess mood, suicidal thoughts, sleep, appetite

• For TCAs: ECG to assess heart function

• For MAOIs: Check renal/hepatic function

Client Education:

• Do NOT stop abruptly

• May take 2–4 weeks for effect

• TCAs:

  • Take at night (sedation)

  • Drink water, chew gum (dry mouth)

  • High fiber diet, stay active (constipation)

  • Empty bladder before dose (urinary retention)

• MAOIs:

  • Avoid tyramine-rich foods (cheese, wine, beer)

  • Avoid caffeine, chocolate, and tryptophan

  • Learn symptoms of hypertensive crisis (severe headache, chest pain, sweating, fast heartbeat)

Monitor:

• Suicidal thoughts (especially first few weeks)

• BP, heart rate, ECG (for TCAs)

• Side effects, medication interactions

• Provide only 1-week supply initially

🔁 Quick Recap

• TCAs block serotonin & norepinephrine reuptake but have many side effects.

• MAOIs stop monoamine breakdown but require strict dietary restrictions.

• Monitor for suicidal ideation, serotonin syndrome, and hypertensive crisis.

• Nurses play a critical role in assessment, education, safety, and support.

🧠 What Are Antipsychotics?

• Used to treat schizophrenia, psychosis, bipolar disorder, acute mania, delirium, and OCD.

• Work by blocking dopamine D2 receptors (mostly in the mesolimbic pathway).

• Atypical (2nd gen) also block serotonin 5-HT2A receptors.

💊 Types of Antipsychotics

⚠ Common Side Effects

🚨 Serious/Life-Threatening Side Effects

• Neuroleptic Malignant Syndrome (NMS): Fever, rigidity, confusion, seizures, coma

• Tardive Dyskinesia: Irreversible facial/tongue movements

• Clozapine-specific risks: Agranulocytosis, myocarditis, seizures, bradycardia

🚫 Contraindications

• QT prolongation

• CNS depression

• Avoid alcohol and sedatives

• Caution in elderly with dementia (↑ death risk)

👩‍⚕ Nursing Considerations

Before Giving Antipsychotics:

• Explain med purpose (reduce delusions, paranoia, etc.)

• Assess baseline: mental status, ECG, weight, CBC, lipids, glucose, renal/liver function

• Review med list (avoid serotonin/QT prolongation interactions)

Education for Clients:

• Takes several weeks to work

• Take at night to reduce daytime drowsiness

• Avoid driving until adjusted

• Avoid alcohol & antihistamines

• Report abnormal movements, fever, sore throat, flu-like symptoms

• Eat well, stay hydrated, and maintain oral hygiene

Monitor Closely For:

• EPS: Dystonia, akathisia, tremors, rigidity

• NMS: Hold drug, cool body, hydrate, give dantrolene, lorazepam, or bromocriptine

• Orthostatic BP drop: Teach slow position changes

• Constipation, dry mouth: Encourage fluids, fiber, oral care

Ongoing Monitoring:

• Mood, behavior, and mental status

• Blood glucose, lipids, CBC

• Periodic ECG (QT risk)

• Infection signs (especially on clozapine)

🔁 Quick Recap

• Antipsychotics block dopamine (and serotonin in atypicals) to treat psychotic symptoms.

• Monitor for serious side effects (EPS, NMS, metabolic issues).

• Educate clients on slow onset, side effect management, and adherence.

• Nursing care includes assessment, education, labs, and safety monitoring.

🧠 What Are Anxiolytics & Sedative-Hypnotics?

Medications that depress the central nervous system (CNS) to:

• Relieve anxiety

• Treat insomnia

• Manage seizures

• Provide sedation or anesthesia

💊 Medication Classes & Examples

⚠ Common Side Effects

🚫 Contraindications

• All Classes: Avoid with alcohol or other CNS depressants

• Benzodiazepines: Avoid in pregnancy, sleep apnea, liver disease, myasthenia gravis

• Barbiturates: Avoid in hypotension, respiratory depression, rash

• ZZZ meds: Caution with abnormal sleep behaviors

• Buspirone: Caution in renal/hepatic impairment, avoid grapefruit

👩‍⚕ Nursing Considerations

Before Administering

• Assess: vitals, LOC, weight, mental health, pregnancy status, history of substance use

• Labs: CBC, liver/renal function, ECG (if indicated)

• Educate: purpose, timing (e.g., bedtime for ZZZ meds), and risk of withdrawal

During Therapy

• Monitor:

  • Sedation level, falls risk

  • Abuse potential (dose-seeking behavior)

  • Respiratory rate (especially IV)

  • IV site for infiltration (benzodiazepines/barbiturates are vesicants)

• Teach:

  • Avoid alcohol, grapefruit, and hazardous activity (e.g., driving)

  • Do not abruptly stop

  • Take with food if GI upset occurs

  • ZZZ meds: Take right before bed due to rapid onset

Special Care for Specific Meds

• Midazolam: Avoid grapefruit; high sedation risk

• Buspirone: Takes 2–4 weeks for effect; monitor for movement disorders

🛑 Watch For Emergency Symptoms

• Benzodiazepine/Barbiturate overdose: Respiratory depression, coma

• Withdrawal (especially benzos): Seizures, agitation, tachycardia

• Stevens-Johnson syndrome: Rash, fever → stop barbiturate immediately

• Abnormal sleep behaviors (ZZZ drugs): Stop & notify provider

• EPS with Buspirone: Muscle spasms, tremors, rigidity → report

🔁 Quick Recap

• CNS depressants used for anxiety, sleep, seizures, sedation

• Benzos = fast acting but risk for dependence

• Barbiturates = powerful, more dangerous

• ZZZ = non-benzos for sleep

• Buspirone = non-sedating, low-risk anxiolytic

• Monitor closely, educate clients, and ensure safety precautions