PSYCHOTHERAPEUTIC DRUGS
What drug is most commonly prescribed for bi-polar disorder?
(If you get this correct, 100 more points will be added)!
Lithium
What are important nursing considerations for patients taking Lithium?
- Therapeutic dose is close to toxic levels (start low, monitor levels).
- Levels must be monitored 2-3 times per week until mania controlled and then every 3 months.
- Do not make drastic changes in sodium intake
- Renal and Liver function must be adequate
--- Normal range for Lithium is 0.5-1.2 mEq
What electrolyte should be monitored when taking Lithium?
sodium
(1) What are the signs and symptoms of Lithium toxicity?
(2) What are important teaching points to share with patients taking Lithium?
(If you get these correct, 500 more points will be added)!
(1)
- Cardiac dysrhythmias
- GI upset
- Hand Tremor
-Confusion
-Seizures
-Metallic taste
- polyuria
(2)
- Take as directed. Do not alter dose when symptoms subside.
- Lithium therapy may be lifelong
- Keep appointments to get levels checked and do not take morning dose until blood sample is drawn.
- Do not take diuretics because you will lose water and sodium which can cause toxicity.
- Maintain regular salt intake, stop taking lithium and contact provider immediately
- Take with food or milk or soon after a meal to decrease GI upset.
- Do not alter dietary salt intake.
- Avoid excessive intake of caffeine.
- Drink 8-12 glasses of fluids daily.
(1) What are the names of 5 drugs used to treat Psychosis?
(2) What are potential adverse effects seen with the use of anti-psychotic drugs?
(If you get these correct, 500 more points will be added)!
(1)
- Chlorpromazine (Thorazine,
- Prochlorperazine (Compazine)
- Haloperidol (Haldol)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
-Aripiprazole (Abilify)
(2)
- Tardive dyskinesia (Abnormal repetitive movement that you will see in pts that take Haloperidol).
What is the Black box warning associated with the use of SSRIs?
--VERY IMPORTANT!!
-Increased risk of suicidal ideations and aggression, especially in children
What are differences between SSRIs and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)?
SNRIs block reuptake of serotonin + norepinephrine while SSRIs block reuptake of only serotonin.
Why do some patients prefer taking Bupropion over an SSRI?
-It does not cause sexual dysfunction.
What are the nursing considerations when administering anti-depression medications?
(If you get this correct, 300 more points will be added)!
- Major depression is associated with impaired ability to function in usual activities and relationships
- SSRIs are first-line medications for depression
- MAO inhibitors are used only if other antidepressants are not effective
- Serotonin Syndrome may occur if anti-depressants are given in combinations.
- It takes drugs in this class 2-4 weeks before the depressive symptoms improve
- Black box warning for increased risk of suicidal ideations in pediatric population.
- Antidepressant Discontinuation syndrome can occur with abrupt discontinuation
- Scientists agree that not enough evidence to support the use of St. John’s wort for treatment of depression.
- Black box warning bupropion for serious neuropsychiatric reactions when given to stop smoking.
- Lithium drug of choice for bipolar disorder has a narrow therapeutic index (0.5-1.2 mEq/L is the normal range).
- Lithium and sodium concerns.
What are the important patient teaching points when educating patients taking anti-depression medications?
- Report any paradoxical symptoms immediately
- Some patients may experience a suicidal thought. Report these symptoms immediately.
- It can take 1-3 weeks for effects to develop
- Take your medication as prescribed. Do not abruptly stop taking your medication.
SSRI’s:
-Possible sexual dysfunction may occur.
- Possible dizziness and fatigue may occur.
-Report any rash that appears.
TCA’s:
- This medication can cause hypotension, anticholinergic effects, and sedation.
MAOI’s
- MAOIs can cause hypertensive crisis if taken with high tyramine foods.
Why do MAOI medications interact with so many other medications?
- MAOIs prevent the breakdown of serotonin in the presynaptic nerve terminal and TCAs block the reuptake of serotonin in the synaptic cleft. Thus, combining the two medications is thought to lead to an increase in serotonin levels in the brain and, if such levels become toxic, precipitate serotonin syndrome.
What happens if a patient takes too much Amitriptyline?
-Toxicity and Overdose
What is the brand name of Bupropion?
- Wellbutrin
What are the indications for Bupropion?
-Adult depression
-Seasonal Affective Disorder
-Smoking cessation
(1) How is St. John Wort used in the treatment of depression?
(2) What should the nurse consider if a patient is taking St. John Wort?
(1) the herb acts similar to an SSRI, increasing the availability of the brain chemicals serotonin, dopamine, and norepinephrine. These neurotransmitters help improve mood.
(2) - Do not combine with other antidepressant drugs for increased risk of serotonin syndrome.
What is Serotonin Syndrome and how is it treated?
“SHIVERS”
-Shivering sweating
-Hyperreflexia
-Increased temperature
-Vital sign instability (HTN, tachycardia, tachypnea)
-Encephalopathy (altered LOC)
-Restlessness and rigid muscles
-Seizures
- Most cases of serotonin syndrome are mild and will resolve with the removal of the offending drug alone. After stopping serotonergic drugs, management is largely supportive and aimed at preventing complications Patients frequently require sedation, which is best facilitated with benzodiazepines.
What is Discontinuation Syndrome related to SSRIs?
-Abruptly stop SSRIs, FINISH, Restart drugs
“FINISH”
-F- flu like symptoms
-I- insomnia with vivid dreams
-N- nausea
-I- imbalance from dizziness
-S- sensory disturbance (tingling, burning)
-H- hyperarousal (anxiety, tremors, aggression)
What is the adverse effect that can occur if a patient taking an MAOI eats a lot of food high in Tyramine?
-Hypertensive Crisis (When taking with stimulants or foods containing Tyramine can shoot the BP up really high)!
What are the names of 3 Tricyclic Antidepressant drugs?
- Amitriptyline
- Clomipramine
- Desipramine
What are the most commonly seen adverse effects of Tricyclic Antidepressant drugs?
- Tachycardia
- Cardiac effects
- Anticholinergic effects
- Sedation sexual dysfunction
What are SSRIs (Selective Serotonin Reuptake Inhibitors) and how do they work?
-SSRIs (Selective Serotonin reuptake inhibitors)
-- Exert action by inhibiting the reuptake of Serotonin, thereby increasing serotonin activity. Unlike other classes of antidepressants, SSRI’s have little effect on other neurotransmitters, such as dopamine and norepinephrine.
What are the potential adverse effects that can be seen in patients taking SSRIs?
-Suicidal thoughts
-Insomnia
-Weight gain
-Sexual dysfunction
-Serotonin Syndrome
-Discontinuation Syndrome
-Withdrawal Syndrome
-GI upset
-Increased risk of bleeding
What are the names of 5 SSRI medications?
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Vortioxetine (Brintellix)
What are the names of 4 SNRI drugs?
-Desvenlafaxine (Pristiq)
-Duloxetine (Cymbalta)
-Levomilnacipran (Fetzima)
-Venlafaxine (Effexor) (MEMORIZE)!!!!!
What are the names of 3 MAOIs (Manoamine Oxidase Inhibitors)?
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Parnate) (MEMORIZE)!!!