Psych/Comm Meds

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ashlynn4787
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288667
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Psych/Comm Meds
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2014-11-29 16:58:59
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Psych and comm meds
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  1. SSRIs
    • -Lexapro, Celexa, Zoloft, Luvox, Paxil, Prozac
    • -First line of treatment for depression
    • -Have a better side-effect profile than other antidepressants
    • -Take 2-6 weeks to reach full therapeutic effect
    • -MOA- prevents reuptake of serotonin into nerve terminal, which means more serotonin is available at synaptic cleft to bind with the receptor sites
    • -Common side effects:
    • N/V
    • Diarrhea
    • tremor
    • insomnia
    • dry mouth
    • weight loss/anorexia
    • sexual dysfunction
    • -If a client is on a MAOI, they must be off the drug for 14 days before starting an SSRI.  If the ct is not off the MAOI and begins taking an SSRI, they can have an increased level of serotonin.  This increase in serotonin level can cause serotonin syndrome (this syndrome is very rare).

  2. Serotonin syndrome
    • Increased level of serotonin.
    • Symptoms include:
    • Confusion
    • irritability
    • seizures
    • diarrhea
    • respiratory depression
    • hypotension
    • delirium
    • ataxia
    • diaphoresis
    • tachycardia
    • cyanosis
    • hypertension
    • agitation
    • tremors
    • N/V
    • hyperthermia
    • coma
  3. Celexa
    SSRI
  4. Lexapro
    SSRI
  5. Zoloft
    SSRI
  6. Luvox
    SSRI
  7. Prozac
    SSRI
  8. Paxil
    SSRI
  9. Trazodone (Desyrel)
    • Antidepressant
    • SE: Priapism
  10. Bupropion (Wellbutrin)
    • Antidepressant
    • Blocks DA reuptake
  11. Venlajaxine (Effexor)
    • Antidepressant
    • Blocks serotonin and NE reuptake
  12. Nefazodone (Serazone)
    Antidepressant
  13. Mirtazapine (Remeron)
    Antidepressant
  14. Monoamin oxidase inhibitors (MAOIs)
    • For depression
    • Prevents metabolism of neurotransmitters (MAO inactivates norepinephrine (NE), serotonin and dopamine (DA)
    • Used less then TCAs
    • SE: abnormal HR
    • orthostatic hypotension
    • drowsy and insomnia
    • dizzy and vertigo
    • Hypertensive Crisis: MAOIs interact with tyramine, a substance that inhibits the  enzyme which breaks down tyramine
    • An accumulation of tyramine triggers release of norepinephrine which may cause hypertensive crisis.
    • Hypertensive crisis S/S: increased BP, HA, diaphoresis, dilated pupils, increased HR, intracereberal hemorrhage

    AVOID FOOD WITH TYRAMINE: cheese, beer, salmon, liver, avocados, all fruits (esp dried and overripe), eggplant, figs, wine, chocolate, many meats,  soy products: soy sauce, tofu, miso, teriyaki sauce
  15. Tricyclic antidepressants (TCAs)
    • elavil, pamelor, trofronil, sinequine
    • For depression
    • Lethal in increased doses –client safety: only provide 1-week supply at a time if a suicide risk/hx of recent suicide attempt
    • 2-3 weeks to see results: Tell ct If you don’t feel better right away keep on taking the medication. Initial mechanism in 1-4 weeks, maximum response in 6-8 weeks.
    • MOA: Increases levels of neurotransmitters (serotonin or norepinephrine) in synaptic cleft (area between nerve endings) (need neurotransmitter for synapse to fire)
    • SE: dry mouth
    • blurred vision
    • constipation
    • orthostatic hypotension (watch when taking antihypertensives)
    • tachcardia
    • urinary retention (contradicted with BPH)
    • decreased seizure threshold (seizure precautions)
    • weight gain
  16. elavil
    TCA
  17. pamelor
    TCA
  18. trofronil
    TCA
  19. sinequine
    TCA
  20. Tegretol
    • Mood stabilizer
    • Anticonvulsant for depression/bipolar
  21. Depakote
    • Mood stabilizer
    • Anticonvulsant for depression/bipolar
  22. Neurontin
    • Mood stabilizer
    • Anticonvulsant for depression/bipolar
  23. Lamictal
    • Mood stabilizer
    • Anticonvulsant for depression/bipolar
  24. Topamax
    • Mood stabilizer
    • Anticonvulsant for depression/bipolar
  25. Clonazepam (Klonopin)
    • Benzodiapine
    • Withdrawal symptoms include: irritability, insomnia, tremors and sweating; abrupt withdrawal results in these symptoms of hyperarousal
  26. Lithium Carbonate
    • For Bi-polar/ depression
    • Very low therapeutic range, pts need to monitored for toxicity
    • S/S of toxicity: moderate toxicity can result in coarse hand tremor, diarrhea, vomiting, lethargy and confusion.
    • If pt has s/s of toxicity, hold med until blood results return, notify MD
    • Metabolized in body but is excreted in kidneys. *Chemically similar to Na*
    • Instruct pt to avoid excessive use of beverages containing caffeine (↓ hyperactivity), maintain consistent Na intake (Na depletion will ↓ renal excretion of lithium, causing accumulation and toxicity) and consume 6-8 glasses of water each day (2500-3000cc/day).
    • Too much Na can ↓ lithium level and pt can become manic.


  27. Therapeutic range of Lithium
    • 0.6-1.2 mEq/L (for maintenance)
    • 1.0-1.5 mEq/L (acute mania)
    • Monitor weekly at first, then monthly: 12 hours after last dose
  28. Toxicity of Lithium
    • 1.5-2 mEq/L- blurred vision, ataxia, tinnitus, N/V, diarrhea
    • 2.0-3.5 mEq/L- increases urinary output, tremors, confusion
    • 3.5 mEq/L or greater- seizures, MI, coma, oliguria/ anuria, giddy
  29. Typical Antipsychotics
    • Older medications: helps positive symptoms, not used often (except Haldol); cause a lot of EPS
    • Chlorpromazine (thorazine)
    • Mellaril
    • Stelazine
    • fluphenazine (Prolixin)
    • Prolixin decanoate
    • Haldol
    • Inapsine
  30. Chlorpromazine (Thorazine)
    • Typical antipsychotic
    • For schizophrenia/psychosis
    • blocks post synaptic dopamine receptors
    • can cause extrapyramidal SE
  31. fluphenazine (Prolixin)
    • Typical antipsychotic
    • dry mouth and blurred vision caused by: cholinergic blockade, Prolixin administration produced blockade of cholinergic receptors giving anticholinergic effects such as dry mouth, blurred vision, constipation, etc.
  32. Prolixin decanoate
    • typical antipsychotic
    • long acting
  33. Haldol
    • Typical antipsychotic
    • most commonly used
    • may give with mania to decrease psychosis
    • increases photosensitivity, use sunscreen
    • give Haldol deconate IM q2weeks if pt is noncompliant with PO form
  34. Inapsine
    • Typical antiosychotics
    • antiemetic
  35. Atypical antipsychotics
    • Schizophrenia/psychosis
    • newer medications: help positive and negative SE
    • Produces less D2 blockade.
    • Rarely causes EPS and TD
    • Zyprexa
    • Clozaril
    • Risperdal
    • Seroquel
    • Geodon
    • Abilify
    • Some meds can be injected and administered every other week
    • Pos: increased compliance, nurse monitors admin, don't have to take everyday
    • Neg: getting pt to come back every other week to get shot
  36. Clozaril
    • Does not cause EPS ut puts people at risk for agranulocytosis (extreme drop in WBC count) leuopenia, fever, malaise, sore throat
    • Assess CBC weekly, give week supply at a time
  37. Risperdal
    • blocks dopamine and serotonin
    • EPS at higher doses
  38. Antipsychotics (neuroleptics)
    • Schizophrenia/ psychosis
    • used to decrease agitation and psychotic symptoms; all are dopamine blockers
    • SE: anticholinergic effects
    • Nausea; GI upset
    • skin rash
    • sedation
    • Orthostatic hypotension-take care when taking beta blockers; teach fall prevention in elderly; caused by alpha-adrenergic blockade
    • photosensitivity
    • decreased libido
    • retrograde ejaculation
    • gynecomastia
    • amenorrhea
    • weight fain
    • reduction in seizure threshold
    • agranulocytosis
    • extrapyramidal symptoms
    • trardice dyskinesia
    • neuroleptic malignant syndrome- *number one sign is fever! Fever is primary concern for anyone taking antipsychotic
  39. Extrapyramidal side effects (EPS)
    • Thought to be caused by overactive dopminergic pathways= too much dopamine
    • EPS may occur 1-5 days after treatment begins
    • usually treated with artane, cogentin (anticholerginic), Benadryl
    • symptoms go away after medicaiton is stopped
    • Akinesia, Akathisia, Dystonia, Oculogyric crisis, Pseudoparkinsonism
    • antiparkinsonian agents may be perscribed to counrtact EPS caused by antipsychotics
  40. Tardive Dyskensia (TD)
    • Tardive (meaning may continue after drug
    • is taken) Dyskinesia (involuntary, purposeless movements) (TD) – may last years, usually long-term and high doses, no treatment for TD
    • o Facial and tongue movements, stiff neck, trouble swallowing
    • o All clients on long term therapy at risk
    • o May be irreversible
    • o Drug is stopped
    • o  Abnormal involuntary movement scale (AIMs scale) is used to asses for TD
    • o Lip smacking, blinking, grimacing, choreiform movements of limbs and trunk

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