Podcast
Questions and Answers
What is the primary mechanism of action (MOA) of buspirone?
What is the primary mechanism of action (MOA) of buspirone?
Which statement about the administration of buspirone is correct?
Which statement about the administration of buspirone is correct?
Which of the following is a common adverse effect of buspirone?
Which of the following is a common adverse effect of buspirone?
What must be monitored when administering buspirone with MAOIs?
What must be monitored when administering buspirone with MAOIs?
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What nursing consideration should be taken with buspirone regarding clients with renal insufficiency?
What nursing consideration should be taken with buspirone regarding clients with renal insufficiency?
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What is a common characteristic of antidepressants in terms of response time?
What is a common characteristic of antidepressants in terms of response time?
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Which class of antidepressants prevents the reuptake of serotonin?
Which class of antidepressants prevents the reuptake of serotonin?
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What serious condition can occur due to excessive serotonergic activity?
What serious condition can occur due to excessive serotonergic activity?
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What is an important nursing consideration when administering Tricyclic Antidepressants?
What is an important nursing consideration when administering Tricyclic Antidepressants?
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Which of the following is a common adverse effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?
Which of the following is a common adverse effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?
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What is a primary characteristic of Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?
What is a primary characteristic of Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?
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What withdrawal symptoms can occur if a patient stops an SNRI suddenly?
What withdrawal symptoms can occur if a patient stops an SNRI suddenly?
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What should patients be educated about when taking SSRIs and SNRIs regarding the onset of effects?
What should patients be educated about when taking SSRIs and SNRIs regarding the onset of effects?
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Which patient condition requires caution when prescribing Tricyclic Antidepressants?
Which patient condition requires caution when prescribing Tricyclic Antidepressants?
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Which of the following is a serious condition associated with the use of MonoAmine Oxidase Inhibitors (MAOIs)?
Which of the following is a serious condition associated with the use of MonoAmine Oxidase Inhibitors (MAOIs)?
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What should be monitored when a patient is taking Tricyclic Antidepressants?
What should be monitored when a patient is taking Tricyclic Antidepressants?
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In patients prescribed bupropion, what adverse effect requires careful monitoring?
In patients prescribed bupropion, what adverse effect requires careful monitoring?
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What is a common use for Atypical Antidepressants?
What is a common use for Atypical Antidepressants?
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What dietary substance should patients on MAOIs avoid to prevent adverse reactions?
What dietary substance should patients on MAOIs avoid to prevent adverse reactions?
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Which group of patients should NOT take MonoAmine Oxidase Inhibitors?
Which group of patients should NOT take MonoAmine Oxidase Inhibitors?
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What is a key nursing consideration when prescribing an SNRI?
What is a key nursing consideration when prescribing an SNRI?
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Which medication can increase blood levels of SNRIs when taken concurrently?
Which medication can increase blood levels of SNRIs when taken concurrently?
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What effect does bupropion have that distinguishes it from other antidepressants?
What effect does bupropion have that distinguishes it from other antidepressants?
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Which assessment should be prioritized for patients receiving treatment with SSRIs/SNRIs?
Which assessment should be prioritized for patients receiving treatment with SSRIs/SNRIs?
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What is a potential consequence of abruptly stopping an SNRI?
What is a potential consequence of abruptly stopping an SNRI?
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What is a characteristic symptom of schizophrenia?
What is a characteristic symptom of schizophrenia?
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Which antipsychotic is categorized as a first-generation antipsychotic?
Which antipsychotic is categorized as a first-generation antipsychotic?
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What is the primary mechanism of action for second-generation antipsychotics?
What is the primary mechanism of action for second-generation antipsychotics?
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Which of the following is an extrapyramidal symptom associated with first-generation antipsychotics?
Which of the following is an extrapyramidal symptom associated with first-generation antipsychotics?
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What is the duration for first-generation antipsychotics to take effect?
What is the duration for first-generation antipsychotics to take effect?
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Which symptom is least likely to be caused by second-generation antipsychotics?
Which symptom is least likely to be caused by second-generation antipsychotics?
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What adverse effect is associated with both first-generation and second-generation antipsychotics?
What adverse effect is associated with both first-generation and second-generation antipsychotics?
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Which medication is a prototype for second-generation antipsychotics?
Which medication is a prototype for second-generation antipsychotics?
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What is a key nursing consideration when administering first-generation antipsychotics?
What is a key nursing consideration when administering first-generation antipsychotics?
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Which condition is a contraindication for the use of first-generation antipsychotics?
Which condition is a contraindication for the use of first-generation antipsychotics?
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What common adverse effect should patients be educated about with second-generation antipsychotics?
What common adverse effect should patients be educated about with second-generation antipsychotics?
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What is the first-line goal of therapy for patients with schizophrenia?
What is the first-line goal of therapy for patients with schizophrenia?
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Which drug interaction can decrease the effectiveness of risperidone?
Which drug interaction can decrease the effectiveness of risperidone?
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Which of the following is a negative symptom of schizophrenia?
Which of the following is a negative symptom of schizophrenia?
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Study Notes
Psychotherapeutic Drugs - Part 1
- Covers ATI Chapters 6-10
- Focuses on psychotropic drugs.
Antipsychotics for Schizophrenia
- ATI Chapter 9
- Chronic psychotic illness impacting thoughts and feelings
- Etiology likely a combination of genetic, neurobiological, and non-genetic factors
- Three symptom types: positive, negative, cognitive
- Diagnosis involves acute episodes with periods of remission/semi-remission
- Chronic schizophrenia is a distinct characteristic
Review of Schizophrenia
- Positive symptoms: hallucinations, delusions, agitation, disorganized speech, bizarre behaviors
- Negative symptoms: social withdrawal, poor self-care, lack of motivation, poverty of speech, blunted affect
- Cognitive symptoms: disorganized thinking, lack of focus, learning disability, memory problems
Two Main Classes of Antipsychotics
- First-Generation Antipsychotics (FGAs):
- Pharmacology is generally similar
- Efficacy is comparable across
- Adverse effects and tolerance are variable
- Second-Generation Antipsychotics (SGAs):
- Similar pharmacology, but different efficacy
- Varied adverse effects and tolerance
First-Generation Antipsychotics (FGAs)
- Prototype: Chlorpromazine (Haloperidol, thiothixene)
- Mechanism of Action (MOA): Blocks dopamine, acetylcholine, histamine, norepinephrine receptors in the CNS
- Takes several weeks, and sometimes months to fully exert effects
- Best at inhibiting positive symptoms
- Classified by potency (low, medium, high)
- Administration: Typically given with food, whole tablets, IM into large muscle with patient lying down.
FGAs Adverse Effects (Extrapyramidal Symptoms)
- Acute Dystonia: Muscle spasms in the tongue, face, neck, or back (hours to days)
- Parkinsonism: Parkinson's Disease like symptoms (tremor, rigidity, shuffling, drooling) (within 1 month)
- Akathisia: Restlessness, pacing, needing to move constantly (within 2 months)
- Tardive Dyskinesia: Involuntary, twisting, writhing movements (months to years) progressing to difficulty speaking/swallowing
Other FGA Adverse Effects
- Neuroleptic Malignant Syndrome: "Lead pipe" rigidity, sudden, high fever, labile BP, dysrhythmias
- Anticholinergic effects: Orthostatic hypotension
- Neuroendocrine effects: Gynecomastia & galactorrhea
- Sedation
- Seizures
- Sexual dysfunction
- Agranulocytosis
- Dysrhythmias
- Photosensitivity
FGA Contraindications, Precautions, and Interactions
- Contraindications (prevent): Alcohol withdrawal, bone marrow suppression, CNS depression, pregnancy/lactation
- Precautions: COPD, glaucoma, diabetes, hypertension, prostatic hypertrophy, thyroid/cardiac/liver disorders
- Interactions: Anticholinergic drugs, CNS depressants, levodopa/direct dopamine receptor agonists
Second-Generation Antipsychotics (SGAs)
- Prototype: risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon).
- MOA: blocks dopamine and serotonin receptors.
- Takes 2-4 weeks, several months to fully effect.
SGA Adverse Effects
- Extrapyramidal Symptoms; (less frequent)
- Neuroleptic Malignant Syndrome;
- Metabolic effects: Weight gain, Diabetes, Hyperlipidemia
- Myocarditis (rare)
- Anticholinergic effects: Orthostatic hypotension
- Neuroendocrine effects: Gynecomastia & galactorrhea
- Sedation
- Seizures
- Sexual dysfunction
- Agranulocytosis
- Dysrhythmias
- Photosensitivity
SGA Contraindications, Precautions, and Interactions
- Contraindications: Breastfeeding (lactating), severe CNS disorders, ECG abnormalities, psychosis, increased risk for CVA/stroke
- Precautions: Clients frequently exposed to sunlight/tanning beds, children under 13, older adults, liver/renal/disorders, hypertension, seizure disorders.
- Interactions: Phenytoin, Rifampin (decreasing SGA levels), Antiparkinson's drugs (increasing Parkinson's symptoms).
Nursing Considerations for Psychotherapeutic Drugs
- Educate patients on symptom recognition, and to notify the provider immediately.
- Provide strategies for managing anticholinergic, and orthostatic hypotension effects;
- Advise patients to take meds at bedtime if sedation.
- Promote safe environments and encourage regular check-ups
Goals of Therapy
- Suppress acute episodes
- Prevent exacerbations
- Promote high quality of life and function
Antidepressants
- Shared properties: Response takes several weeks; initial response in 1-3 weeks, maximal therapeutic response in 12 weeks; same efficacy across classes, but different adverse effects/interactions; drug choice based on tolerability & safety
- Types: TCAs, SSRIs, SNRIs, MAOIs, Atypical
- Depression is the most common psychiatric disorder.
Tricyclic Antidepressants (TCAs)
- Amitriptyline (Elavil)
- Mechanism of Action: Prevents reuptake of norepinephrine and serotonin; additionally blocks histamine, acetylcholine, and norepinephrine receptors
- Uses: Depression, insomnia, pain
- Administration: PO, at bedtime, well-absorbed. Must be tapered and not stopped abruptly.
- Risk for overdose (dysrhythmias, confusion, seizures)
- Interactions: MAOIs, Sympathomimetics, Anticholinergics, CNS depressants, Herbal supplements, H2 blockers
TCAs Adverse Effects
- Orthostatic hypotension, sedation, anticholinergic effects, diaphoresis, QT prolongation, seizures, hypomania, and suicide risk.
Nursing Considerations for TCAs
- Monitor BP
- Advice for night-time dosing, and anticholinergic effects
- Monitor EKG & Seizures
- Monitor for thoughts of suicide
- Contraindications: children under 12, recent MI, cardiac dysrhythmias, patients taking MAOIs
- Caution: Glaucoma, prostatic hypertrophy, urinary retention, liver/renal disorders, respiratory disorders, diabetes, alcoholism
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil)
- MOA: Prevents reuptake of serotonin
- Uses: Depression, panic disorder, OCD, premenstrual dysphoric disorder and bulimia
- Administration: PO, well-absorbed, 94% protein bound; typically taken once daily
- Metabolism: Initially converted to norfluoxetine, an active metabolite; total half-life approximately 9 days
SSRIs Interactions and Adverse Effects
- Interactions: any drug that increases serotonin activation, TCAs & lithium, antiplatelets & anticoagulants, NSAIDS
- Adverse Effects: Nausea, insomnia, sexual dysfunction, weight gain, hyponatremia, Withdrawal syndrome, Serotonin syndrome, suicide ideation
Nursing Considerations for SSRIs
- Education that effects will build slowly.
- Advise not stopping meds abruptly (especially those on SNRI)
- Monitor for headaches and weight.
- Monitor BP and serum sodium levels.
- Caution for patients with liver disease, peptic ulcer disease, or diabetes.
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
- Venlafaxine (Effexor XR)
- MOA: Blocks uptake of serotonin and norepinephrine.
- Uses: Major depression, social anxiety, generalized anxiety
- Adverse Effects: Similar to SSRIs (e.g., Nausea), anorexia, and hypertension.
Nursing Considerations for SNRIs
- Start low and titrate dose
- Do not stop abruptly; taper slowly
- Monitor for serotonin syndrome & suicidal ideation
- Avoid concurrent use of MAOI
Monoamine Oxidase Inhibitors (MAOIs)
- Phenelzine (Nardil)
- MOA: Irreversibly inhibits MAO enzymes, allowing more uptake of norepinephrine and serotonin
- Uses: Depression, OCD
- Administration: PO, well-absorbed; a patch is also available
- Interactions: TCAS, SSRIs, meds for HTN, dietary tyramine
- Adverse effects: CNS stimulation, orthostatic hypotension, GI symptoms (nausea, vomiting, constipation), hypertensive crisis (due to dietary tyramine)
Nursing Considerations for MAOIs
- Monitor patients for CNS stimulation, BP, suicide ideation.
- Education on foods to avoid, and s/s of hypertensive crisis.
- Contraindications: older clients & children, those taking another medication such as an SSRI, and history of glaucoma, alcohol use, drug addiction, or mania.
- Use with caution in patients with epilepsy, DM, schizophrenia, or mania.
Atypical Antidepressants
- Bupropion (Wellbutrin)
- MOA: Prevents norepinephrine and dopamine reuptake
- Uses: Depression, smoking cessation aid
- Administration: PO, well absorbed; XR formulations; do not crush or chew
- Metabolism: CYP450 enzymes
- Benefits: Weight loss, increased libido
- Adverse Effects: Seizures, CNS stimulation, nausea, increased risk of psychosis and suicidal ideation in young people,
- Interactions: SSRIs (CYP enzymes), MAOIs
- Nursing Considerations: Monitor for seizures, thorough health history, medication should be administered with food. Monitor weight (anorexia), CNS effects
- Contraindications: none listed
Anxiety Disorders
- Includes: Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder, Post-Traumatic Stress Disorder (PTSD)
Anxiety Disorder Treatment
- Cognitive Behavioral Therapy (CBT)
- Medications:
- Serotonin Reuptake Inhibitors (SSRIs),
- Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs),
- Benzodiazepines (caution, not first line),
- Anxiolytic drug: buspirone
Anxiolytic: Buspirone (Buspar)
- MOA: Unclear yet thought to interact with serotonin & dopamine receptors. Not a CNS depressant.
- Administration: PO, daily. Needs to be taken consistently for results; 2-4 weeks before tapering off Benzodiazepines
- Uses: anxiety control.
- Interactions: grapefruit juice, erythromycin, ketoconazole; need for caution with MAOIs
- Adverse effects: Nausea, HA, dizziness/lightheadedness, possible sedation in some
Nursing Considerations for Buspirone
- Educating clients to report potential paradoxical, GI, or CNS effects
- Suggest taking Buspar with food.
- Suggest OTC analgesics to address headaches.
- Advise slow positional changes for patients
- Caution for clients with liver/kidney insufficiency
- Contraindicated (avoid) concurrent use of MAOIs
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