Mental Health Medications

Question 1

What is a cultural implication of Diazepam?

Answer 1

Diazepam undergoes different metabolic pathways in the Chinese and Japanese population. Approximately 20% of these individuals metabolize diazepam poorly resulting in rapid drug accumulation. Lower doses will obviously prevent possible toxicity. Nurses should watch these individuals more closely for sedation, over dosage and other adverse reactions to diazepam.

Question 2

List clinical indications for benzodiazepines.

Answer 2

Anxiety disorders: Benzodiazepines are commonly prescribed for the short-term treatment of generalized anxiety disorder, panic disorder, and social anxiety disorder.
Insomnia: They may be used for short-term relief of insomnia due to their sedative effects.
Seizure disorders: Benzodiazepines can be used as an adjunctive treatment for the management of seizures, especially in emergency situations.
Muscle spasm: Benzodiazepines can help relieve muscle spasms and spasticity associated with conditions like multiple sclerosis or spinal cord injuries.
Alcohol withdrawal: They can be used to alleviate symptoms of alcohol withdrawal, such as anxiety, agitation, and tremors.
Sedation and anesthesia: Some benzodiazepines are used to induce sedation or amnesia before surgical procedures or medical interventions.

Question 3

Half lives of Benzodiazepines range from 2-60 hours, think about how knowledge of the half life will determine the choice of benzodiazepine prescribed.

Answer 3

The choice of benzodiazepine prescribed can be influenced by the half-life of the medication. Short-acting benzodiazepines (e.g., midazolam, triazolam) have a shorter duration of action and are suitable for acute situations or for those requiring rapid onset of action. Long-acting benzodiazepines (e.g., diazepam, clonazepam) have a more extended duration of action and are often preferred for chronic conditions requiring continuous control of symptoms.

Question 4

When benzodiazepines are taken with other CNS depressants the result is an enhanced sedative and CNS depressant effects. What other CNS depressants should patients be educated to avoid.

Answer 4

When taking benzodiazepines, patients should be educated to avoid the concurrent use of other CNS depressants, as it can lead to enhanced sedative and CNS depressant effects. Examples of CNS depressants to avoid include alcohol, opioids (e.g., codeine, oxycodone), sedative-hypnotics (e.g., zolpidem, eszopiclone), and certain antihistamines.

Question 5

Are there any other activities that a patient should avoid when taking a benzodiazepine.

Answer 5

Patients taking benzodiazepines should also be cautious when engaging in activities that require mental alertness, such as driving or operating machinery. Benzodiazepines can impair cognitive and motor functions, which may pose a risk for accidents or injuries

Question 6

People can become physically dependent on benzodiazepines therefore these are usually prescribed for short-term use only. List some common symptoms of benzodiazepine withdrawal.

Answer 6

Symptoms of benzodiazepine withdrawal may include:

Anxiety
Insomnia
Irritability
Tremors
Sweating
Headaches
Nausea and vomiting
Muscle aches and stiffness
Rebound anxiety or insomnia
Seizures (in severe cases)

Question 7

Why should benzodiazepines be used with greater caution in the elderly

Answer 7

Benzodiazepines should be used with greater caution in the elderly due to age-related changes in drug metabolism and increased sensitivity to the sedative effects of these medications. Older adults are at a higher risk of experiencing falls, confusion, and cognitive impairment when using benzodiazepines.

Question 8

What are the main differences between the first (typical) and second generation (atypical) antipsychotics?

Answer 8

Pharmacological profile: First-generation antipsychotics primarily block dopamine D2 receptors in the brain. Second-generation antipsychotics not only block dopamine receptors but also have varying affinities for other receptors, such as serotonin (5-HT2A) receptors.

Side effect profile: First-generation antipsychotics are associated with a higher risk of extrapyramidal side effects (EPS) such as dystonia, akathisia, and parkinsonism. Second-generation antipsychotics have a lower propensity for causing EPS but are associated with metabolic side effects such as weight gain, dyslipidemia, and glucose dysregulation.

Treatment of negative symptoms: Second-generation antipsychotics are considered to be more effective in treating negative symptoms of schizophrenia (e.g., social withdrawal, blunted affect) compared to first-generation antipsychotics.

Diversity of indications: Second-generation antipsychotics have expanded indications beyond schizophrenia and are also used for bipolar disorder, depression, and various off-label uses. First-generation antipsychotics are primarily used for schizophrenia.

Question 9

Why are atypical preferred when compared with typical antipsychotics?

Answer 9

Atypical antipsychotics are generally preferred over typical antipsychotics for several reasons:

Better tolerability: Atypical antipsychotics have a lower risk of causing EPS compared to typical antipsychotics, making them more tolerable for patients.

Improved treatment of negative symptoms: Atypical antipsychotics have demonstrated greater efficacy in addressing negative symptoms of schizophrenia, which are often challenging to treat.

Reduced risk of tardive dyskinesia: Tardive dyskinesia (involuntary repetitive movements) is less common with atypical antipsychotics compared to typical antipsychotics.

Broader spectrum of action: Atypical antipsychotics have additional effects on serotonin receptors, which may contribute to their efficacy in treating mood disorders and other psychiatric conditions beyond schizophrenia.

Question 10

What is meant by the term extrapyramidal adverse effect?

Answer 10

Extrapyramidal adverse effects (EPS) refer to a group of movement-related side effects caused by the blockade of dopamine receptors in the basal ganglia. These effects can include acute dystonia (sustained muscle contractions), parkinsonism (rigidity, tremors, bradykinesia), and akathisia (subjective restlessness). These side effects are more commonly associated with typical antipsychotics but can also occur with some atypical antipsychotics.

Question 11

Clozapine has the potential to cause agranulocytosis, what is this, and what strategies help to avoid it?

Answer 11

Agranulocytosis is a potentially life-threatening condition characterized by a severe decrease in the number of granulocytes (a type of white blood cell) in the bloodstream. Clozapine, an atypical antipsychotic, has a higher risk of causing agranulocytosis compared to other antipsychotics. To minimize this risk, regular monitoring of absolute neutrophil count (ANC) is essential. If agranulocytosis is detected, clozapine must be discontinued immediately, and appropriate medical intervention is required to manage the condition.

Question 12

What is metabolic syndrome?

Answer 12

a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes. It is characterised by a combination of factors including abdominal obesity, high blood pressure, high blood sugar levels, high triglyceride levels, and low levels of high-density lipoprotein (HDL) cholesterol.

Question 13

What is Neuroleptic Malignant Syndrome (NMS)?

Answer 13

a rare but potentially life-threatening condition that can occur as a reaction to certain medications, particularly antipsychotic medications. It is characterized by a severe reaction of the central nervous system and is marked by symptoms such as high fever, muscle rigidity, altered mental status, autonomic dysfunction (e.g., high or low blood pressure, rapid or irregular heartbeat), and elevated levels of creatine phosphokinase (CPK), a muscle enzyme.

Question 14

What is serotonin syndrome? + include symptoms

Answer 14

a potentially life-threatening condition that occurs due to excessive serotonin activity in the brain. When serotonin levels become too high, it can lead to an overstimulation of serotonin receptors in the brain and throughout the body.

The symptoms of serotonin syndrome can vary in severity and may include agitation, restlessness, confusion, rapid heart rate, high blood pressure, dilated pupils, sweating, tremors, muscle rigidity, high body temperature, and in severe cases, seizures or loss of consciousness.

Question 15

What are the signs and symptoms of Neuroleptic Malignant Syndrome?

Answer 15

FEVER
Fever, Encephalopathy (disease/damage to the brain), Vitals unstable, Elevated enzymes (elevated CPK), and Rigidity of muscles.

Question 16

What baseline recordings should be taken prior to someone starting on an antipsychotic medication?

Answer 16

Baseline recordings prior to starting an antipsychotic medication typically include a thorough medical history, physical examination, baseline weight, blood pressure, heart rate, complete blood count (CBC), liver function tests, lipid profile, and fasting blood glucose.

Question 17

What information would you include in an education session for someone who is prescribed clozapine?

Answer 17

In an education session for someone prescribed clozapine, important information to include would be the need for regular blood tests to monitor white blood cell count and absolute neutrophil count, the risk of agranulocytosis, potential side effects such as sedation, constipation, and weight gain, and the importance of adhering to prescribed dosage and follow-up appointments.

Question 18

What are some nursing interventions that will help with medication adherence?

Answer 18

Nursing interventions that can help with medication adherence include providing education about the importance of medication, addressing concerns or misconceptions about the medication, simplifying the medication regimen if possible, using reminder systems or alarms, involving family or support systems in medication management, and regular follow-up and assessment of medication adherence.

Question 19

Antidepressants can take several weeks to take effect. Why is this?

Answer 19

Antidepressants can take several weeks to take effect because they work by increasing the availability of certain neurotransmitters, such as serotonin, in the brain. It takes time for these neurochemical changes to occur and for the brain to adapt to the new levels of neurotransmitters.

Question 20

Tricyclic antidepressants were once the first choice in the treatment of depression but this is no longer the case, why is this?

Answer 20

Tricyclic antidepressants are no longer the first choice in the treatment of depression due to their potential for serious side effects, including cardiac toxicity, sedation, anticholinergic effects, and overdose risk. Newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have a more favorable side effect profile, greater safety in overdose situations, and comparable effectiveness in treating depression.

Question 21

An adverse effect of taking SSRI’s in conjunction with other antidepressants is the potential for serotonin syndrome. Describe this

Answer 21

Serotonin syndrome can occur when SSRIs are taken in conjunction with other antidepressants, particularly monoamine oxidase inhibitors (MAOIs). Serotonin syndrome is characterized by an excess of serotonin in the brain and can lead to symptoms such as agitation, confusion, rapid heart rate, high blood pressure, tremors, and in severe cases, seizures or loss of consciousness. It is important to avoid combining SSRIs with MAOIs or other serotonergic medications to prevent the risk of serotonin syndrome.

Question 22

Certain foods can interact with MAO inhibitors, why is this? List some of these foods

Answer 22

MAO inhibitors (MAOIs) interact with certain foods because they inhibit the activity of an enzyme called monoamine oxidase, which is responsible for breaking down tyramine, a substance found in various foods. When MAOIs are taken alongside foods high in tyramine, it can lead to a sudden increase in blood pressure, known as a hypertensive crisis. Foods rich in tyramine include aged cheeses, cured meats, fermented or pickled foods, certain alcoholic beverages (such as red wine), and certain fruits (such as bananas and avocados). Avoiding these foods or following dietary restrictions is crucial when taking MAOIs to prevent adverse interactions.

Question 23

What are the three main categories of antidepressants?

Answer 23

Selective serotonin re-uptake inhibitors (SSRIs), Tricyclic antidepressants (TCAs), and Monoamine oxidase inhibitors (MAOIs).

Question 24

What are mood stabilisers?

Answer 24

Mood stabilisers are used in the treatment of bipolar affective disorder and schizo-affective disorders. Mood stabilisers are used for the treatment of manic episodes and the prevention of future episodes.

Question 25

What is the drug of choice for treatment of acute mania and ongoing maintenance?

Answer 25

Lithium

Question 26

What assessments should be conducted prior to commencement of each of lithium and atypical antipsychotics for antimanic treatment?

Answer 26

Prior to the commencement of lithium medication for antimanic treatment, assessments should include a comprehensive medical history, physical examination, baseline kidney and thyroid function tests, serum electrolyte levels, and a pregnancy test for women of childbearing age.

For atypical antipsychotics used for antimanic treatment, assessments should include a comprehensive medical history, physical examination, baseline weight, blood pressure, fasting blood glucose levels, lipid profile, and an evaluation of cardiovascular risk factors.

Question 27

What patient education would you need to undertake for each of the categories of medication outlined?

Answer 27

Patient education for lithium should include information about the importance of regular blood tests to monitor lithium levels and kidney function, the need for adequate hydration and avoiding excessive sodium intake, signs and symptoms of lithium toxicity, and the importance of adherence to prescribed dosage and follow-up appointments.

Patient education for atypical antipsychotics should include information about potential side effects such as weight gain, metabolic changes, sedation, and movement disorders, as well as the importance of adherence to prescribed dosage, regular follow-up appointments, and reporting any concerning symptoms to the healthcare provider.