Week 10: Psychotherapeutic Drugs

Question 1

Mood Stabilizers

lithium

Used for?
Adverse effects? CV
Neuro?

Answer 1

Used for Bipolar disorders

Adverse effects:
cardiac dysrhythmias
hypotension

NEURO:
tremor
confusion
drowsiness, somnolence
impaired memory
seizure

Question 2

Lithium

Narrow therapeutic range?
Monitor what?
Educate clients to avoid what?
Also avoid what?
lithium toxicity signs?

Answer 2

**Narrow therapeutic range:
0.6-1.2 mEq/L!!!!!!

Monitor lithium and serum sodium levels

Educate client to avoid excessive amounts of coffee, tea, and cola b/c of it’s diuretic action

Avoid activities that cause excess sodium loss (heavy exertion, exercise in hot weather, sauna)

fine tremors and thirst

Question 3

Tricyclic Antidepressants

Amitriptyline
(Ami tripped at CHS high school)

Used for?
Adverse effects?**
what can this med cause?

Answer 3

depression, chronic pain syndromes

**cardiac dysrhythmias
**hypotension
**Suicidal thoughts

Weight gain

Question 4

Amitriptyline

Antidote?
Can also try?
Assess for

Answer 4

No antidote for toxicity; administer activated charcoal if the ingestion occurred 2 hours before treatment

Can also try sodium bicarbonate

**Assess for suicidal tendencies, especially during EARLY therapy!!!!

Question 5

Amitriptyline

Full therapeutic effects take?
May cause?
Implement?
Can cause?

Answer 5

Full therapeutic effects may be seen 2-6 weeks after initiating therapy

May cause drowsiness and blurred vision

Implement fall precautions, esp. in geriatric clients

Can cause weight gain

Question 6

Tetracyclic Antidepressants

Mirtazapine

Used for?
Can cause?***

Answer 6

major depressive disorders

Suicidal thoughts!!!!!

Question 7

Monoamine Oxidase Inhibitor (MAOI)

Phenelzine
(phenelzine HO)

Used for?
Can cause?***
asses for what?
Drug interactions?

Answer 7

major depressive disorders

**hypertensive crisis/emergency
**orthostatic hypotension

Suicidal thoughts!!!!!
assess during early therapy

Almost everything!!!

Question 8

Foods & Drinks to AVOID when on MAOI?? 6

foods high in tyramine?
Assess for what?

Answer 8

-Aged mature cheese
-Smoked or pickled meats
-Aged or fermented meats
-Yeast extracts
-Red wines
-Italian broad beans

Assess mood for suicidal tendencies, especially during early therapy

Question 9

2nd Generation

SSRIs

Used for?
Adverse effect?
Drug interactions? 4

Answer 9

depression

**QT prolongation!!!!
Suicidal thoughts
Apathy
Insomnia

Drug interactions:
Warfarin, Phenytoin

MAOIs: fatal reactions

Linezolid, methylene blue, and St. John’s wort

QT prolongation drugs

Question 10

SSRI
Drug profile and Nursing considerations

Citalopram

Asses for? 2
Monitor?

Answer 10

Assess mood for suicidal tendencies, especially during early therapy

Assess for serotonin syndrome

Monitor serum potassium and magnesium levels for clients at risk for electrolyte imbalances prior to and periodically during therapy

Question 11

SSRI

Fluoxetine

Can also treat?
Asses for?
Administer when?
SSRIs may cause?

Answer 11

Can also treat bulimia, OCD, panic disorder and PMDD

Assess mood for suicidal tendencies, especially during early therapy

Assess for serotonin syndrome

Administer in the morning

decreased libido and sexual dysfunction

Question 12

2nd Generation

SSNRI

Adverse effects?

Answer 12

**orthostatic hypotension
**increased BP

Drug interaction:
MAOIs: fatal reactions**
TCAs, SSRIs, Linezolid,
methylene blue, and St. John’s wort

Question 13

SSNRIs

Duloxetine

Used for?
Monitor what?
May cause? 2

Answer 13

depression and general anxiety disorder
chronic pain and diabetic peripheral neuropathic pain

-Monitor BP
-May cause drowsiness
-may cause decreased libido and sexual dysfunction

Question 14

Herbal- St. John’s wort

Used for?
Contraindications?
Potential drug interactions?

Answer 14

Used for depression, anxiety, sleep disturbances, & nervousness

clients w/ bipolar, schizophrenia, Alzheimer’s, & dementia

ALOT

Question 15

Drug to Treat Psychotic
Disorders

First generation?
Second generation?

Answer 15

First generation
* haloperidol

Second generation
* clozapine
* risperidone
* aripiprazole

Question 16

All of the 1st and 2nd generation drugs to treat psychotic disorders can

cause increased?
may cause?
need to implement?
may also cause?
tx of PO overdose?
If giving PO?

Answer 16

***suicidal tendencies in children, adolescents, and young adults and increased risk of death in elderly clients

*** weight gain

***fall safety for ALL of these medications

***extrapyramidal symptoms

*** activated charcoal

*** ensure medication is taken and not cheeked/hoarded

Question 17

1st Generation Antipsychotic:

Haloperidol

Does what in the brain?
Used for?
Adverse effects?
Ensure that?
Monitor client for what?
What safety?

Answer 17

Alters the effects of dopamine in the CNS

Long-term treatment of psychosis

***QT prolongation, hypotension
extrapyramidal symptoms

ensure that medication is actually taken and not hoarded

Monitor client for cues of akathisia (restlessness, desire to keep
moving)

Fall safety

Question 18

2nd Generation Antipsychotic:

Clozapine

Used for?
monitor??

Answer 18

Schizophrenia unresponsive to or intolerant of standard therapy w/ other antipsychotics

***Monitor WBC (weekly monitoring for 1st 6 months)

Question 19

2nd Generation Antipsychotic:

Risperidone

used to treat?
drug interactions?
may decrease?
what decreases the metabolism?

Answer 19

Schizophrenia

Increased CNS depression w/ other CNS depressants, kava, valerian, and chamomile

May decrease the antiparkinsonian effects of levodopa or other dopamine agonists

Clozapine decreases the metabolism and may increase effects of risperidone

Question 20

2nd Generation Antipsychotic

Aripiprazole

Used for?
Increased risk of what?**

Answer 20

-Schizophrenia,
-Bipolar disorder
-Major depressive disorder
-Agitation associated with autistic disorders

*** increased risk of suicide in children & young adult;
increased risk of death in elderly!!!