Mental Health Nursing- Medications

Benzodiazepines
Main type of anti-anxiety medication. Relieves symptoms of anxiety-related disorders quickly.
Most popular ones:
*Clonazepam (Klonopin)
*Alprazolam (Xanax)
*Diazepam (Valium)
*Lorazepam (Ativan)

All addictive. For short term use only. DO NOT STOP ABRUPTLY, patients must be weaned off these meds or they will have SEIZURES.

Buspirone (BuSpar)
Secondary type of Anti-Anxiety med. NOT A BENZO!
This med does NOT give the tranquilizer effect that the benzodiazepines do.
BuSpar’s action is unknown.
*Takes 2 weeks to take effect
*Side effects are slurred speech and dizziness
Beta Blockers
Another type of anti-anxiety medication. Not a benzo. USED PRN.
PROPRANOLOL (Inderal) (common one)
*Typically used to treat heart conditions and hypertension, but sometimes used to control “performance anxiety”
CHECK PATIENT’S BP and PULSE before administering
Antidepressants
Not uppers
*6-8 weeks to take effect, continued for 6-12 months (or more)

THREE main groups of antidepressants:
1.Tricyclic
2.Monoamine Oxidase Inhibitors (MAOIs) MY FAVE!!!!!!!!!
3.Selective Serotonin reuptake inhibitors (SSRIs)

Tricyclic Antidepressants
* Raise the level of epinephrine and serotonin in the brain by slowing the rate at which they are reabsorbed by nerve cells.
* SIDE EFFECTS: anticholinergic in nature (dry mouth, constipation), blurred vision, dizziness, drowsiness, tachycardia, dysrhythmias, hypotension, increased suicide risks the first few weeks of therapy

THE MEDS:
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Imipramine (Tofranil)

anticholinergic side effects
Dizziness, headaches, excitement, cough, urinary retention, dry mouth, irritability, delayed GI motility
Monoamine Oxidase Inhibitors (MAOIs)
Block the action of monoamine oxidase and prevent breakdown of norepinephrine and serotonin.

The MEDS:
Phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)

Side effects: anticholinergic effects, dry mouth, orthostatic hypotension, headache

DO NOT TAKE THESE MEDS WITH NASAL DECONGESTANTS or with FOOD CONTAINING high levels of TYRAMINE (a precursor to norepinephrine)

AVOID THESE FOODS: AGED CHEESE, AVACADOS, YOGURT, SOUR CREAM, CHICKEN & BEEF LIVERS (DAMMIT!), pickled herring, corned beef, bean pods, bananas, raisins, figs, smoked & processed meat, yeast supplements, chocolate (NOOOOOOOOO!), MSG, soy sauce, beer, red wines, & caffeine (depressed just reading these!)

Hypertensive crisis & DEATH can occur if patient cosumes these foods. Signs: stiff neck, nausea, vomiting

When this med is stopped, wait @ WEEKS before starting any new meds.

Selective Serotonin Reuptake Inhibitors (SSRIs)
Block the reabsorption of serotonin.

THE MEDS:
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
escitalopram (Lexapro)
citalopram (Celexa)
fluvoxamine (Luvox)

Side effects: excitation, n & v, decreased libido, anorexia & weight loss, increased suicide risk first few weeks of therapy

Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
The MEDS:
Effexor
Cymbalta
Pristiq

Side Effects: anxiety, abnormal dreams, dizziness, nervousness

Antipsychotics/ neuroleptics
MAJOR TRANQUILIZERS
Used to treat bipolar, psychoses, agitation, schizophrenia

The Meds:
chlorpromazine (Thorazine)
Haloperidol (Haldol)
Fluphenazine (Prolixin)
thioridazine (Mellaril)
thiothixine (Navane)
trifluoperazine (Trilafon)
trifluoperazine (Stelazine)

****They block DOPAMINE RECEPTORS in the brain (which are the immediate precursors to norepinephrine). These affect neurotransmitters that allow for communication between nerve cells.

Adverse reactions: hypotension, dizziness, fainting, dry mouth, possible impotence in men, photosensitivity, blood dyscrasias (abnormal values)

THERE ARE MORE ADVERSE REACTIONS! SEE NEXT CARD!

Extrapyramidal Symptoms (EPS) (more adverse reactions from antipsychotics/neuroleptics)
These types of symptoms appear to be dose related and are the most frightening to patient:
1. Dystonia: difficult or bad muscle tone in head & neck, swallowing problems, tongue sticks out

2.Akathisia- inability to sit down. restlessness.

3. Pseudo-Parkinsonism: side effects like tremors & “stiff face” that resemble Parkinson’s disease. Occur a few weeks to a few months after therapy. May be controlled by anti-Parkinsonism med.

4.Tardive Dyskinesia: rhythimical, involuntary movements of tongue, face, mouth, jaw, trunk, extremities. No effective tratment.

5.NEUROLEPTIC MALIGNANT SYNDROME (NMS): uncommon reaction to neuroleptics, but could cause death. Muscle rigidity, hyperpyrexia (fever), fluctuations in BP, altered or loss of consciousness. NEEDS IMMEDIATE MEDICAL CARE!

Atypical Antipsychotics
Block multiple dopamine & serotonin receptors.
The MEDS:
clozapine (Clozaril) (lowers WBC count (agranulocytosis), monitor blood work every 1-2 weeks)
risperidone (Risperdal)
planzapine (Zyprexa)
aripiprazole (Abilify)
Paliperidone (Invenga)
Antimanic Agent (calms patients in manic phase)
The Med:
LITHIUM

used for bipolar disorder, calms patient in manic phase
Controls flight of ideas, restlessness, etc

LITIUM IS A SALT, maintain a diet with NORMAL sodium intake, restricting sodium INCREASES Litium toxicity. Have patients monitor selves for edema, regular weights!

Side effects: Thirst, nausea, vomiting, hair loss, tremors, weight gain, hypothyroidism

NARROW THERAPEUTIC RANGE INCREASES LIKELIHOOD OF TOXICITY!
******THERAPEUTIC RANGE OF LITHIUM: .5-1.5 mEq/L******

Anticonvulsants
Action not clear. Affects GABA receptors, which casuses a calming effect. Are used to stabilize the manic episodes in bipolar disorder.

The Meds:
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Valporic Acid (Depakote)

Side effects: nausea, vomiting, indigestion, drowsiness, dizziness, prolonged bleeding, headache, confusion

These meds should NOT be stopped abruptly
These patients should avoid ETOH (ALCOHOL!)

Therapeutic Blood Levels:
+Tegretol: 6-12 mcg/ml
+Depakene & Depakote: 50-100 mcg/ml

Stimulants
Directly stimulate the CNS, used to promote alertness, diminish appetite, combat narcolepsy. Also used to treat ADHD

The Meds:
methylphenidate (Ritalin)

Side effects: increased or irregular heart rate, hypertension, hyperactivity, dry mouth, hand tremor, rapid speech, diaphoresis, confusion, depression, seizures, suicidal ideation, insomnia

DO NOT GIVE TO PATIENTS WITH ALCOHOLISM, MANIA or display suicidal or homicidal thoughts
DO NOT USE with heart disease or glaucoma
MAY impair judgement, drive with caution
DO NOT USE with MAOIs ( may cause hypertensive crisis)
Take at least 6 hours before sleep to avoid sleep disturbances

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