Psychiatric Medication

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Example of SSRIs

Back 1

Prozac (fluoxetine)
Zoloft (sertaline)
Paxil (paroxetine)
Celexa (escitalpram)
Lexapro (escitalpram)

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Nursing Interventions for SSRIs

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Monitor for therapeutic effects and side effects
SSRIs lower the seizure threshold
Increased risk of Serotonin Syndrome when used in conjunction with or within 2 weeks of MAOIs
Lowering the dose or changing the medication can treat the side effects

Front 3

Side Effects of SSRIs

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headache, nausea, GI upset, diarrhea, sexual dysfunction, long-term weight gain, agitation, nervousness, dizziness, dry mouth, insomnia, hypomania, tremors, somnolence

Front 4

Off Label Use for SSRIs

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OCD and Menstrual related mood problems

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Serotonin Syndrome

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A potentially life threatening complications most often seen when 2 or more serotonergic drugs are given concurrently.
Symptoms: confusion, hypomania, myoclonus, hyperflexia, diaphoresis, shivering, tremor, incoordination and hyperthermia

Front 6

Examples of Tricyclics

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(Not commonly used as inpatient)
Elavil (amitriptyline)
Anafranil (clomipramine)
Pamelor (nortriptyline)
Sinequan (doxepin)

Front 7

Nursing Interventions for Tricyclics

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Not addictive but abrupt cessation causes withdrawal symptoms
Monitor for orthostatic hypotension and instruct patient to rise slowly from a lying position. Usually improves in a few days, but does not resolve completely.

Front 8

Side Effects of Tricyclics

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constipation, weight gain, diarrhea, nausea, dizziness, drowsiness, dry mouth, headache, nervousness, blurred vision, insomnia, tremors, sexual dysfunction, urinary retention

Occasionally: arrhythmias, hypomania, liver irritation and seizures

Front 9

Notes on Tricyclics

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Elavil causes the most sedation adn orthostatic hypotension
Toxic in large quantities
The antidepressant effects of TCAs begin in about 2 weeks, with full effect in 4-6 weeks. Side effects can begin immediately.

Front 10

Examples of MAOIs

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(not common on inpatient)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)

Front 11

What does MAOI stand for?

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Monoamine Oxidase Inhibitors

Front 12

Side Effects of MAOIs

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orthostatic hypotension, nervousness, insomnia, tremors, convulsion

Occasionally: hepatoxicity, blood dyscrasias, severe headache, fatal hypertension crisis

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Notes on MAOIs

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Hypertension crisis can be fatal.
These cannot be used in conjunction with any other antidepressant.
St. John's Wart mimics MAOIs.

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Nursing Interventions for MAOIs

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Requires a tyramine-free diet (no yogurt, cheese, smoked or pickled meat, beer, wine, raisins and figs) to avoid a hypertension crisis

Front 15

Examples of Atypicals

Back 15

Cymbalta (duloxetine)
Desyrel (trazadone)
Effexor (venlafaxine)
Effexor XR (venlafaxine)
Remeron (mirtazapine)
Trazedone (desyrel)
Wellbutrin (bupropion)

Front 16

Nursing Interventions for Atypicals

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SNRI: Serotonin and norepinephrine reuptake inhibitor
Often used as a sedative
Oftend used for severe insomnia or to cause weight gain

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Side Effects of Atypicals

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nausea, dry mouth, constipation, decreased appetite, fatigue, drowsiness, dizziness, priapism (with Trazedone only), weight gain, weight loss

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Notes on Atypicals

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Never give to patients with anorexia or bulemia.
Use with caution in patients with convulsion disorder

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What Antidepressants are used to treat.

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Used to treat: Major Depression, Depressive Phase of Bipolar, ADD, OCD, Panic Disorder, PTSD, Cocaine withdrawal and Bulimia Nersosa
With any anti-depressant, as the energy level of patients receiving antidepressants begins to increase, they must be monitored closely for suicide, as their energy level may increase to the point they are physically capable of committing suicide before their mood improves.

Front 20

Seven Rights of Medication Administration

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Right Time
Right Drug
Right Patient
Right Route
Right Dose
Right Response
Right Documentation (2 patient identifiers)

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Lexicomp Online

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The only approved patient medication education via command intranet.

Front 22

What Antipsychotics (Neuroleptics) Medications are used to treat.

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Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Mood Disorders with Psychotic Features, Brief Reactive Psychosis, Atypical Psychosis
Also used to treat the following symptoms: agitation, severe anxiety, delusions, hallucinations, illusions, and drug/alcohol withdrawal

Front 23

Typical Antipsycotic Medications

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Haldol (haloperidol)
Mellaril (thioridazine)
Navane (thiothixene)
Prolixin (fluphenazine)
Thorazine (thorazine)
Stelazine (trifluroperazine)

Front 24

Atypical Antipsycotic Medications

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Clozaril (Clozapine)
Risperdal (risperidone)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Geodon (ziprazadone)
Abilify (aripiprazole)

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Nursing Interventions for Antipsychotics

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Assess for mental status changes
Sore throat, fever, bruising may be indicative of blood dyscrasias
Tilts measuring for orthostatic hypotension
Assess for EPS and Tardive Dyskinesia
Provide sunscreen for outdoors
Anticholingergic side effects typically decrease in 1-2 weeks and are usually treatable
Treatment of mild side effects include having patient suck on hard candy, drink more water, and eat more fiber
Monitor for neuroleptic malignant syndrome

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Neuroleptic Malignant Syndrome

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Elevated body temperature, muscle rigidity, cogwheel rigidity, dysphagia, hypertension, tachycardia, tachypnea and diaphoresis

Treatment: Notify MO, Stop all antipsychotics and anticholinergic medications, decrease temperature, monitor vital signs, and administer skeletal muscle relaxants as ordered

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Side effects of Antipsychotics

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Common: drowsiness, sedation, seizures, syncope, light-headedness
Anticholinergic: dry mouth, constipation, blurred vision, tachycardia, insomnia, agitation, anxiety, and mental confusion
Extrapyramidal side effects: acute dystonia, akathesia, pseudoparkinsonian symptoms, tardive dsykinesia, and neuroleptic malignant syndrome
Respiratory depression, agranulocytosis, mentrual irregularities, breast enlargement, lactation, changes in libido, nausea, constipation, drowsiness and rash

Front 28

Define Acute Dystonia.

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Involuntary contractions of upper body muscle groups resulting in grimacing, tongue protrusions, abnormal posturing, eyes rolling upwards into head and neck twisting

Front 29

Define Akathesia.

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Unpleasant restlessness, inability to stand still and uncontrollable pacing

Front 30

Define Pseudoparkinsonian symptoms.

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Tremors of the hands and feet, rigid or shuffling gait, drooling, mask-like face, pill-rolling movement of the fingers

Front 31

Define Tardive Dyskinesia.

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Irreversible. involuntary sucking, chewing, licking, pursing movements of the tongue and mouth. May also cause muscle jerks and pill rolling.

Front 32

What is the specific side effect of clozaril?

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Agranulocytopenia: Also known as Agranulosis or Granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, causing a neutropenia in the circulating blood.
Treatment: Baseline CBC before administration and then weekly

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What does Anxiolytic Medications Treat?

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Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, PTSD, Phobic Disorders, Sleep Disturbances, ETOH withdrawal, Akathesia, and as an anticonvulsant

Front 34

Examples of Benzodiazepines.

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Ativan (lorazepam)
Klonopin (clonazepam)
Librium (chlordiazepoxide)

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Nursing Interventions with Benzodiazepines.

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Drowsiness and dizziness may make person unsteady on feet
Monitor for withdrawal if medication abruptly discontinued.
Treatment consists of instructing patients about the side effects and cautioning them against driving or operating equipment
Patients should be monitored for signs of drug abuse or dependence
Medication should be discontinued in tapering dosages adn patients monitored for withdrawal symptoms

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Side Effects of Benzodiazepines.

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Central nervous system drowsiness, ataxia, muscle weakness, confusion, fatigue, syncope, headache, vivid dreams, and reversible dementia in elderly, atropine like side effects, dry mouth, blurred visions, sexual dysfunction, menstrual irregularities, changes in appetite, libido, constipation, photosensitivity, and addiction

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Notes on Benzodiazepines.

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Some people develop central nervous system stimulation consisting of restlessness, sleep distrubance, talkativeness, generalized hyperactivity and excitement.

Front 38

Examples of Nonbenzodiazepines.

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Atarax (hydroxyzine)
Buspar (buspirone)

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Nursing Implications for Nonbenzodiazepines

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Atarax is a antihistamine that has a sedative effect. Sometimes prescribed to help with anxiety or agitation.

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Side Effects with Nonbenzodiazepines.

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Drowsiness, ataxia, dry mouth, blurred vision but less sedation than benzodiazepines.

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Notes on Nonbenzodiazepines

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Buspar has no anticonvulsant muscle relaxant or sedating effects. It is non addictive and abrupt cessation does not cause withdrawal or psychomotor impairment.

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What are Mood Stabilizer Medications used for?

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Acute mania and ongoing management of Bipolar Disorder, Seizure Disorder, Schizophrenia and other psychoses

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Examples of Mood Stablizer Medications

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Depakote (valproic acid or divalproex sodium)
Lithium (lithium carbonate)
Tegretol (carbamazepine)
Lamictal (lamotrigene)
Neurontin (gabapentin)

Front 44

Nursing Interventions and Side Effects with Depakote

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Blood levels need to monitored for therapeutic range (50-100mcg/ml)
Depakote toxicity: slurred speech, sedation, and seizures

drowsiness, nausea, weight gain, hair loss, liver toxicity, pancreatitis

Front 45

Nursing Interventions and Side Effects with Lithium

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Monitor for toxicity symptoms before each dose using lithium flowsheet. Therapeutic range (0.5-1.5meq/ml)

drowsiness, nausea, constipation, diarrhea, weight gain, anxiety, dizziness, hair loss, headache, tremors, pancreas problems,

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Nursing Interventions and Side Effects with Neurontin

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Notify physician immediately if any type of rash or skin blimish develops. Even a small rash may develop into a fatal skin reaction called Steven Johnson's syndrome

Fatigue, dizziness, blurred vision and fatigue

Front 47

Side Effects with Lamictal

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Drowsiness, nausea, weight gain, liver toxicity, slurred speech, sediation and seizures

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Side Effects with Tegretol

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Fatigue, slurred speech, muscle weakness, tremors

Front 49

Examples of Anti-Cholingergic

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Benadryl (diphenhydramine)
Cogentin (benzotropin)
Artane (trihexyphenidyl)
Inderal (propanolol)

Front 50

Nursing Interventions with Anti-Cholingergics

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Used to treat EPS symptoms of anti-psychotics medication

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Side Effects of Anti-Cholingergics

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drowsiness, lethargy, inactivity, dry mouth, nasal congestion, blurred vision, urticaria, photosensitivity, phototoxicity, constipation, urinary retention