Mental Health Meds Flashcards

Review the most common psych meds, side effects, adverse reactions, and nursing considerations.

1
Q

What are “Downers”?

A

Medications that cause the central nervous system to be sedated.

They are also called “Sedatives”.

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2
Q

What types of medications and substances are “Downers”?

A
  • Antidepressants
  • Anxiolytics
  • Antipsychotics
  • Antiallergy drugs / Antihistamines
  • Barbiturates
  • Benzodiazepines
  • Muscle relaxers
  • Opioids
  • Alcohol
  • Marijuana
  • St. John’s wort
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3
Q

What will the pupils look like if a client has overdosed on a “downer” medication such as too many anxiolytics or opioids?

A

Pinpoint pupils.

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4
Q

Adverse reactions and nursing considerations:

Downers

A
  1. advise client to avoid taking too many Downers at once - client can become sedated, overdose, and die
  2. implement safety and fall precautions
  3. assess for suicide

Hold med and notify HCP if client has a decreased level of consciousness.

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5
Q

What is the treatment for CNS depressant (“downer”) overdose?

A
  • induce vomiting or gastric lavage (pump the stomach)
  • give activated charcoal
  • flumazenil IV for benzodiazepine overdose
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6
Q

What are “Uppers”?

A

Medications that cause the central nervous system to be stimulated.

They are also called “Stimulants”.

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7
Q

Indication:

Amphetamines (a CNS stimulant)

A

To treat ADD or ADHD.

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8
Q

Generic names:

Amphetamines

CNS stimulant

A
  • dextroamphetamine, lisdexamfetamine
  • methylphenidate
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9
Q

What types of medications and substances are “Uppers”?

A
  • Amphetamines - methylphenidate
  • Cocaine
  • Caffeine
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10
Q

What will the pupils look like if a client has overdosed on an “upper” medication such as amphetamines?

A

Dilated pupils.

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11
Q

Side effects and nursing considerations:

Uppers

A

Increased heart rate, flushing, sweating, dysrhythmias - advise client to use caution with cardiovascular disorders

Hold med and notify HCP if client experiences chest pain or dysrhythmia.

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12
Q

Indication:

Antidepressants

A

To treat a variety of conditions:

  • depression
  • fibromyalgia
  • nerve pain
  • chronic pain
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13
Q

Adverse reactions and nursing considerations:

Antidepressants

A
  • takes up to four weeks to work: assess for risk of suicide
  • some are nephrotoxic and/or hepatotoxic: check liver and kidney labs
  • some cause pancyotopenia: check WBC, RBC and H&H levels
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14
Q

Side effects and nursing considerations:

Antidepressants

A
  1. sedation
    • take in the evening to prevent falls
    • avoid taking other CNS depressants at same time
  2. decreased BP, weight gain, decreased libido and dry mouth
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15
Q

Generic names:

SSRI Antidepressants

(Selective serotonin reuptake inhibitors)

A
  • citalopram, escitalopram
  • fluoxetine, paroxetine
  • vilazodone
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16
Q

Generic names:

SSNRI Antidepressants

(Selective serotonin norepinephrine reuptake inhibitors)

A
  • desvenlafaxine, venlafaxine
  • duloxetine
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17
Q

Generic names:

MAOI Antidepressants

(Monamine oxidase inhibitor)

A

TIP:

  • tranylcypromine
  • isocarboxazid
  • phenelzine
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18
Q

Side effects and nursing considerations:

MAOI Antidepressants

(Monamine oxidase inhibitor)

A
  1. avoid tyramine containing foods - can cause a hypertensive crisis
  2. do not take within 2 weeks of other antidepressants or uppers - can cause serotonin syndrome
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19
Q

Food-med interaction:

MAOI Antidepressants

A

Avoid “aged foods”

  • aged cheese and meats
  • smoked, cured and processed meats like sausage
  • coffee/tea (drinks with caffeine)
  • soy sauce
  • beer and wine
  • BAR: Bananas, Avocado, Raisins

Taking together can cause a hypertensive crisis (BP >180/120).

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20
Q

Generic names:

Tricyclic Antidepressants

A

amitriptyline, nortriptyline

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21
Q

What color can the urine become when a client is taking tricyclic antidepressants?

A

A bluish-green color.

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22
Q

Indication:

bupropion

A
  • treat depression
  • prevent desire to use tobacco
23
Q

Indication:

Antianxiety/Anxiolytics/Benzodiazepines

A

They are given to treat a variety of conditions:

  • anxiety
  • insomnia
  • alcohol withdrawal
  • relax muscles
  • fibromyalgia
  • prevent seizures
24
Q

Generic names:

Antianxiety/Anxiolytics/Benzodiazepines

A

alprazolam, clonazepam, diazepam, lorazepam, temazepam, chlordiazepoxide, midazolam

They all end in -pam or -lam or have “diaze” in the name.

25
Q

What medication is given for conscious sedation?

A

Midazolam: a benzodiazepine

26
Q

Indication:

Cannabis sativa

Also known as marijuana or weed

A
  • nausea/vomiting associated with chemotherapy
  • chronic pain

It can be taken as oil, smoked, pill/tablet, in food.

27
Q

Side effects and nursing considerations:

Cannabis sativa

A
  • Increases appetite: provide healthy snack options
  • lethargy, unmotivated and memory loss: encourage life goals and hobbies
28
Q

Immediate complication

What is serotonin syndrome?

A

Serotonin syndrome is when a client’s serotonin level increases to dangerous levels.

It is caused by taking too many antidepressants or antidepressants and opiods at once.

29
Q

What are the early symptoms and treatment for serotonin syndrome?

A
  • early symptoms: agitation, muscle twitching, rapid heart rate, sweating and ataxia
  • treatment: medication is held and dose is adjusted. Symptoms may go away and no additional treatment is needed.
30
Q

What are the late symptoms and treatment for serotonin syndrome?

(Immediate complication)

A
  • late symptoms: muscle rigidity, high fever, seizures, coma
  • treatment: muscle relaxers, serotonin blocking drug (benzodiazepines), oxygen, IV fluids, ventilator
31
Q

What is antidepressant discontinuation syndrome?

A

When a client experiences symptoms from abruptly stopping an antidepressant.

Medication is usually taken for about 6 weeks before symptoms can occur.

32
Q

What are the symptoms and treatment for antidepressant discontinuation syndrome?

A
  • symptoms: nausea/vomiting/diarrhea, strange behavior such as sensory disturbances and abnormal movements
  • treatment: no treatment; symptoms usually stop within 1-2 weeks and are not life-threatening
33
Q

Indication:

Antipsychotics

A

To treat bipolar syndrome, schizophrenia, and acute aggression.

34
Q

Generic names:

1st generation/typical Antipsychotics

A

haloperidol

35
Q

Generic names:

2nd generation/Atypical Antipsychotics

A
  • aripiprazole
  • olanzapine, quetiapine
  • risperidone, lurasidone
36
Q

Side effects:

Antipsychotics

A
  • anticholinergic side effects
  • weight gain
  • orthostatic hypotension
  • low white blood cell count
37
Q

Nursing considerations:

Antipsychotics: anticholinergic side effects

A
  1. causes blurry vision: implement safety / fall precautions
  2. causes urinary retention: monitor intake and output
  3. causes dry mouth: give candy or ice chips
  4. causes constipation: encourage fluids/fiber/walking

“can’t see, can’t pee, can’t spit, can’t shit”

38
Q

Nursing considerations:

Antipsychotics: weight gain

A
  • teach about healthy diet and exercise
  • assess for onset of diabetes mellitus
39
Q

Nursing considerations:

Antipsychotics: orthostatic hypotension

A
  • teach to sit at side of bed for a few minutes before getting up
  • implement safety and fall precautions
40
Q

Nursing considerations:

Antipsychotics: low white blood cell count

A

Assess for signs of infection.

41
Q

What are extrapyramidal symptoms (EPS)?

A

Early side effects of Antipsychotics caused by a decrease in dopamine.

42
Q

What are the symptoms and treatment for extrapyramidal symptoms (EPS)?

A

Symptoms: Parkinson-like symptoms.

  • tremor, shuffling gait, muscle rigidity

Treatment: Give an antiparkinson: benztropine.

  • This will increase dopamine for better muscle control.
43
Q

What is tardive dyskinesia?

A

Side effects from long term use of antipsychotics.

44
Q

What are the symptoms and treatment for tardive dyskinesia?

A
  • Symptoms: bizarre facial and tongue movements, lip smacking, stiff neck, and difficulty swallowing
  • Treatment: Stop or taper the current psych medications. Symptoms can become permanent.
45
Q

What is neuroleptic malignant syndrome?

(Immediate complication)

A

Neuroleptic malignant syndrome is a rare and fatal reaction to antipsychotics.

46
Q

What are the symptoms and treatment for neuroleptic malignant syndrome?

(Immediate complication)

A

Symptoms:

  • severe muscle rigidity, drooling, difficulty swallowing, very high fever, tachycardia, tachypnea, rapid decrease in LOC, seizures, coma

Treatment:

  • antipyretics, seizure precautions, cooling blanket
  • meds: dantrolene or bromocriptine to increase dopamine, which helps with muscle control
47
Q

What EKG finding should prompt the nurse to avoid giving antipsychotics or antidepressants?

(Immediate complication)

A

Prolonged QT.

It can lead to life-threatening cardiac dysrhythmias.

48
Q

Indication:

lithium

A
  • to treat acute mania in bipolar disorder
  • to treat long-term control of bipolar disorder
49
Q

Toxicity adverse effects:

lithium

A
  • muscle and neuro symptoms: slurred speech, decreased muscle coordination, and twitching, drowsiness
  • GI symptoms: nausea/vomiting/diarrhea

Hold med and notify HCP if experiences these side effects.

50
Q

Nursing considerations:

lithium

A

Prevent toxicity:

  • avoid dehydration by drinking 6 - 8 glasses of water daily
  • keep salt intake and exercise consistent

Lithium is a “salt” like sodium; changes in sweating and fluid intake can cause toxicity.

51
Q

therapeutic level of lithium

A

0.6 - 1.2

2 or greater is considered toxicity.

52
Q

Indication:

disulfiram

A

To prevent clients from drinking alcohol by causing severe nausea and vomiting when the client drinks alcohol.

53
Q

Nursing considerations:

disulfiram

A
  • client must abstain from alcohol for at least 12 hours before the first dose is administered
  • if alcohol is consumed, effects will begin within several minutes to 30 minutes
  • avoid alcohol for at least 14 days after disulfiram is discontinued