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Questions and Answers

A patient with bipolar disorder is prescribed lithium carbonate. What is the most likely mechanism of action (MOA) of this drug?

  • Inhibiting monoamine oxidase, preventing the breakdown of monoamine neurotransmitters.
  • Potentiating serotonergic neurotransmission. (correct)
  • Blocking the reuptake of norepinephrine, increasing its concentration in the synaptic cleft.
  • Directly stimulating dopamine receptors in the brain.

A patient on long-term lithium therapy should be monitored for which of the following potential adverse effects?

  • Hypothyroidism (correct)
  • Hyperthyroidism
  • Increased white blood cell count
  • Renal failure

Which of the following drug classes is LEAST likely to be used in combination with lithium for managing bipolar disorder?

  • Benzodiazepines
  • Antipsychotic drugs
  • Neuromuscular blockers (correct)
  • Antiepileptic drugs

A patient taking a tricyclic antidepressant (TCA) is also being treated for nocturnal enuresis. Which TCA is MOST likely being used for this purpose?

<p>Imipramine (C)</p> Signup and view all the answers

A patient presents with symptoms of nausea, vomiting, tremor, and confusion. Their medication history reveals they are taking lithium. Which of the following is the MOST important initial step to manage this situation?

<p>Checking lithium levels and assessing for potential toxicity. (C)</p> Signup and view all the answers

Which of the following combinations of medications could potentially increase the risk of serotonin syndrome?

<p>An SSRI and a triptan. (A)</p> Signup and view all the answers

A patient taking an SNRI reports experiencing dizziness, drowsiness, and frequent headaches. Which of the following nursing actions is most appropriate?

<p>Advise the patient to avoid alcohol and other liver-damaging substances. (B)</p> Signup and view all the answers

A patient is prescribed an MAOI for depression. What dietary education is crucial for this patient to prevent a hypertensive crisis?

<p>Avoid foods high in tyramine. (C)</p> Signup and view all the answers

Which of the following symptoms indicates a potential diagnosis of Serotonin Syndrome?

<p>Myoclonus and hyperthermia. (C)</p> Signup and view all the answers

A patient taking Venlafaxine (Effexor) is also prescribed a medication for migraine headaches. What potential interaction should the healthcare provider be most concerned about?

<p>Increased risk of serotonin syndrome. (A)</p> Signup and view all the answers

A patient on Phenelzine (Nardil) is admitted to the hospital. Which of the following medications should be avoided due to the risk of a dangerous interaction?

<p>Anticonvulsants (A)</p> Signup and view all the answers

If a patient taking Duloxetine (Cymbalta) reports new-onset eye pain and blurred vision, what is the most appropriate initial action?

<p>Schedule an immediate ophthalmologic examination. (C)</p> Signup and view all the answers

Which assessment finding would be most concerning in a patient taking an MAOI?

<p>A blood pressure reading of 160/100 mm Hg. (B)</p> Signup and view all the answers

Why is it important to consult a healthcare provider before using herbal treatments, especially when taking prescription antidepressants?

<p>Herbal treatments can have interactions with prescription antidepressants. (C)</p> Signup and view all the answers

Which of the following is NOT a primary type of psychotherapeutic drug?

<p>Antihistamine drugs (D)</p> Signup and view all the answers

A patient with schizophrenia is prescribed an antipsychotic drug. Which mechanism of action is most likely associated with the therapeutic effects of this medication?

<p>Blocking dopamine receptors in the brain (B)</p> Signup and view all the answers

Which of the following adverse effects is NOT typically associated with conventional antipsychotic drugs like haloperidol?

<p>Metabolic Syndrome (D)</p> Signup and view all the answers

Haloperidol (Haldol) is contraindicated in patients with Parkinson’s disease primarily due to which of the following reasons?

<p>Exacerbation of motor symptoms. (B)</p> Signup and view all the answers

Which of the following atypical antipsychotics requires frequent monitoring of WBC counts?

<p>Clozapine (Clozaril) (B)</p> Signup and view all the answers

A patient with schizophrenia has difficulty adhering to a daily oral medication regimen. Which of the following antipsychotic formulations would be most appropriate to improve adherence?

<p>Risperdal Consta (long-acting injectable) (B)</p> Signup and view all the answers

Aripiprazole (Abilify) is described as a quinolinone atypical antipsychotic. What distinguishes Aripiprazole from other atypical antipsychotics?

<p>It is used for Schizophrenia, bipolar disorder, major depressive disorder, and agitation associated with autistic disorder. (C)</p> Signup and view all the answers

A patient prescribed bupropion (Wellbutrin) for depression should be cautioned against concurrent use of which medication due to potential interactions?

<p>An azole antifungal (C)</p> Signup and view all the answers

Why are patients taking MAOIs instructed to avoid tyramine-containing foods?

<p>Tyramine can precipitate a hypertensive crisis when combined with MAOIs. (A)</p> Signup and view all the answers

Why is it important for patients on tricyclic antidepressants to wear a medication ID badge?

<p>To inform healthcare providers of the medication in case of emergency, especially due to potential interactions with anesthetic drugs. (B)</p> Signup and view all the answers

What is a key difference between second-generation antidepressants and other antidepressants regarding drug interactions?

<p>Second-generation antidepressants have very few drug–drug or drug–food interactions. (B)</p> Signup and view all the answers

A patient taking an antidepressant reports experiencing insomnia. Which of the following interventions is MOST appropriate?

<p>Consult the healthcare provider to explore adjusting the dose or changing the medication; insomnia is a known adverse effect. (D)</p> Signup and view all the answers

Why are patients typically advised to discontinue herbal products like Ginkgo biloba and St. John's Wort 1 to 2 weeks before surgery?

<p>To minimize the risk of excessive bleeding or interactions with anesthesia during surgery. (D)</p> Signup and view all the answers

Which of the following foods should be avoided by a patient taking a monoamine oxidase inhibitor (MAOI)?

<p>Aged cheddar cheese (D)</p> Signup and view all the answers

What indicates that an antidepressant medication is having a therapeutic effect?

<p>Improved sleep patterns and increased feelings of self-esteem (B)</p> Signup and view all the answers

A patient is prescribed lorazepam (Ativan) for anxiety. What is an important consideration for its administration, especially in acutely agitated patients?

<p>It can be given intravenously (IV push) for rapid calming effects. (C)</p> Signup and view all the answers

A patient with a history of hepatic dysfunction is prescribed an anxiolytic. Which benzodiazepine should be avoided due to its metabolic pathway?

<p>Diazepam (Valium) (A)</p> Signup and view all the answers

A patient who is currently taking an SSRI is to be started on an anxiolytic medication. Which of the following medications would require careful monitoring for potential drug interactions that could lead to serotonin syndrome?

<p>Buspirone (Buspar) (D)</p> Signup and view all the answers

An elderly patient is prescribed an anxiolytic medication. Which of the following nursing implications is most important to consider?

<p>Monitoring closely for oversedation and profound CNS depression. (C)</p> Signup and view all the answers

Which of the following anxiolytics is administered on a scheduled basis rather than as needed (PRN)?

<p>Buspirone (Buspar) (B)</p> Signup and view all the answers

A patient is experiencing anxiety associated with depression. Which of the following benzodiazepines is specifically indicated for this condition?

<p>Alprazolam (Xanax) (A)</p> Signup and view all the answers

A patient taking oral contraceptives is prescribed diazepam (Valium) for anxiety. What potential interaction should the patient be aware of?

<p>Increased sedative effects of diazepam (C)</p> Signup and view all the answers

A patient taking MAOIs is prescribed an anxiolytic. Which anxiolytic is contraindicated?

<p>Buspirone (Buspar) (C)</p> Signup and view all the answers

A patient taking antipsychotics reports tremors, nausea, and uncontrollable muscle shaking. Which nursing intervention is most appropriate?

<p>Instruct the patient to report these symptoms to their physician. (A)</p> Signup and view all the answers

Why is it important to assess a patient's liver and renal function before starting antipsychotic therapy?

<p>To identify any contraindications and potential drug interactions. (D)</p> Signup and view all the answers

A patient is prescribed an oral antipsychotic. What instruction should the nurse provide to minimize gastrointestinal upset?

<p>Take the medication with meals. (D)</p> Signup and view all the answers

Which of the following is the priority nursing intervention when initiating antipsychotic therapy in an acutely agitated patient?

<p>Assessing the patient's level of consciousness and potential for injury to self or others. (B)</p> Signup and view all the answers

A patient who has been prescribed an anxiolytic drug should be educated about which of the following potential side effects?

<p>Drowsiness, dizziness, or fainting. (A)</p> Signup and view all the answers

Which instruction is most important for a nurse to give to a patient who is starting on phenothiazines?

<p>Wear sunscreen due to increased photosensitivity. (D)</p> Signup and view all the answers

A patient with generalized anxiety disorder (GAD) is prescribed an anxiolytic. How do these medications work to reduce anxiety?

<p>By reducing overactivity in the central nervous system (CNS). (D)</p> Signup and view all the answers

A patient is being discharged on an antipsychotic medication. What is the most important instruction regarding discontinuation of the drug?

<p>Avoid abrupt withdrawal from the medication. (B)</p> Signup and view all the answers

Flashcards

Mood Stabilizers

Drugs used to stabilize mood, particularly in bipolar disorder, and in altered mood states and mania.

Affective Disorders

Changes in mood ranging from abnormally elevated emotions (mania) to abnormally reduced emotions (depression).

Bipolar Disorder

A mood disorder that is characterized by episodes of both mania and depression.

Lithium MOA

Potentiates serotonergic neurotransmission, impacting various body systems.

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TCAs Mechanism

Block reuptake of neurotransmitters, increasing their concentration.

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Serotonin Syndrome

Potentially life-threatening condition resulting from too much serotonin activity in the central and peripheral nervous systems.

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SNRIs Mechanism

Increase serotonin and norepinephrine levels by inhibiting their reuptake by nerves.

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SNRI Side Effects

Dizziness, drowsiness, headache, GI upset, anorexia, and potential liver damage.

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SNRI Interactions

Combining with SSRIs or triptans increases the risk of serotonin syndrome; alcohol increases liver injury risk.

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Serotonin Syndrome Symptoms

Delirium, agitation, tachycardia, sweating, myoclonus, hyperreflexia, and tremors.

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MAOIs Mechanism

Inhibit the enzyme monoamine oxidase, increasing levels of neurotransmitters.

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MAOI Major Risk

Potential to cause hypertensive crisis when taken with tyramine.

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Tyramine Risks w/ MAOIs

Hypertensive crisis may lead to cerebral hemorrhage, stroke, coma, or death.

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Psychotherapeutic Drugs

Drugs used to treat serious mental illnesses like schizophrenia, anxiety, and mood disorders.

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Psychotic Illness indication

Serious mental illness, most commonly schizophrenia.

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Antipsychotic MOA

Block dopamine receptors in areas of the brain associated with emotion, cognition, and motor function.

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Antipsychotic Adverse Effects

Agranulocytosis, hemolytic anemia, CNS effects, insulin resistance, weight gain, changes in serum lipid levels, metabolic syndrome

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Conventional Antipsychotic

A first-generation antipsychotic.

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Haloperidol (Haldol) Indications

Long-term treatment of psychosis with schizophrenia or BPD to reduce hallucinations and delusions.

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Risperidone (Risperdal) Indication

Schizophrenia, including negative symptoms.

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Clozapine (Clozaril) MOA

Selectively blocks dopaminergic receptors in the mesolimbic region of the brain.

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Tyramine-containing foods

Aged cheeses (cheddar, bleu, Swiss), smoked or pickled meats, yeast extracts, red wines, and fava beans.

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Bupropion (Wellbutrin)

An atypical antidepressant used for depression, smoking cessation, and seasonal affective disorder.

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Bupropion Adverse Effects

Seizures and suicidal ideation

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Bupropion Contraindication

Seizure disorder

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Bupropion MOA

Inhibits the reuptake of dopamine and norepinephrine.

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Second-Generation Antidepressant Adverse Effects

Insomnia, weight gain, and sexual dysfunction.

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Tricyclic Antidepressant (TCA) Implications

Encourage patients to wear medical ID badges and avoid caffeine/smoking during therapy.

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Therapeutic Effects of Antidepressants

Improved sleep, increased self-esteem, decreased hopelessness, and interest in activities.

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Depot Antipsychotic

A long-acting injectable antipsychotic, effective for one month.

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Pre-Antipsychotic Assessment

Routine checks to determine current mental and physical health status

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Postural Blood Pressure

Blood pressure assessment while standing and sitting

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Antipsychotic Withdrawal

Gradual discontinuation of medication to prevent withdrawal symptoms.

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Photosensitivity

Increased sensitivity to the sun's rays.

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Therapeutic Effects of Antipsychotics

Improved mood, reduced psychosis, and better coping skills.

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Anxiolytic Drugs

Medications used to reduce anxiety.

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Anxiolytic Mechanism

Works by reducing overactivity in the central nervous system (CNS).

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Benzodiazepines

Drugs that depress activity in the brainstem and limbic system; examples include Alprazolam, Diazepam, and Lorazepam.

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Buspirone (Buspar)

A miscellaneous anxiolytic drug that is non-sedating and non-habit forming.

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Alprazolam (Xanax) Indications

Generalized anxiety disorder, short-term relief of anxiety symptoms, panic disorder, and anxiety associated with depression.

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Diazepam (Valium) Indications

Anxiety, alcohol withdrawal, reverses status epilepticus, pre-op sedation, adjunct for skeletal muscle spasms.

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Lorazepam (Ativan) Indications

Anxiety, can be given by IV push; useful for acutely agitated patients and can be used for alcohol withdrawal.

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Alprazolam (Xanax) Adverse Effects

May cause confusion, ataxia, headache, and other CNS effects.

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Buspirone (Buspar) Adverse Effects

Paradoxical anxiety, blurred vision, headache, and nausea.

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Buspirone (Buspar) Administration

Administered on a scheduled basis and lacks the sedative properties.

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Study Notes

  • There are three main emotional and mental disorders: anxiety, affective disorders, and psychoses.
  • Mood-stabilizing drugs, antidepressants, and anxiolytic drugs are types of psychotherapeutic drugs.

Affective Disorders (Mood Disorders)

  • Mood changes range from mania, abnormally pronounced emotions, to depression, abnormally reduced emotions.
  • Bipolar disorder is when some patients exhibit both mania and depression.

Mood Stabilizers

  • Mood stabilizers' indications include bipolar illness, altered moods, and mania.
  • Prototypes of mood stabilizers are Lithium carbonate and Lithium citrate.
  • Cariprazine (Vraylar) is a new agent used as a mood stabilizer.
  • Other drugs used with lithium include benzodiazepines, antipsychotics, antiepileptic drugs, and dopamine receptor agonists.

Lithium

  • Lithium (salts) possibly potentiates serotonergic neurotransmission.
  • Adverse effects of lithium include cardiac dysrhythmia, drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements, ataxia, and hypotension.
  • Long-term treatment with lithium may cause hypothyroidism.
  • Symptoms of toxicity include GI discomfort, N/V, tremor, confusion, somnolence, seizures, and possibly death.
  • Keeping the NA level in the normal range (135 to 145 mEq/L) helps maintain therapeutic lithium levels.

Antidepressants

  • Types include Tricyclic antidepressants (TCAs), Selective serotonin reuptake inhibitors (SSRIs), Serotonin norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants, and Monoamine oxidase inhibitors (MAOIs).
  • There is a higher risk of suicide among both the adult and pediatric population with antidepressant use.

Tricyclic Antidepressants (TCAs)

  • TCAs block the reuptake of neurotransmitters to correct the abnormally low levels that lead to depression.
  • Indications for TCAs: Depression, Childhood enuresis (imipramine), Obsessive-Compulsive Disorders (clomipramine), Adjunctive analgesics for chronic pain conditions such as trigeminal neuralgia, and anorexia nervosa.
  • Adverse effects of TCAs: Drowsiness, Impotence, and Orthostatic hypotension
  • Use TCAs with caution in older patients due to the potential for dizziness, postural hypotension, constipation, delayed micturition, edema, and muscle tremors.

Tricyclic Antidepressants (TCAs) Overdose

  • TCAs overdose are lethal.
  • CNS and cardiovascular systems are mainly affected by TCAs overdose.
  • There is no specific antidote for TCAs overdose.
  • Activated charcoal is given if within 2 hours of TCAs ingestion for overdose.
  • Speed the elimination with alkalinizing urine or manage seizures and dysrhythmias following a TCAs overdose.
  • Provide basic life support following a TCAs overdose.
  • Death from a TCAs overdose results from seizures or dysrhythmias.

Amitriptyline (Elavil)

  • Amitriptyline (Elavil) is a TCA.
  • Indications for amitriptyline include depression, insomnia, neuropathic pain.
  • Contraindications for amitriptyline include pregnancy and recent myocardial infarction.
  • Adverse effects of amitriptyline include dry mouth, constipation, blurred vision, urinary retention, dysrhythmias, and drowsiness.

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Fluoxetine (Prozac) is a prototypical SSRI.
  • Indications for SSRIs include depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder.
  • Contraindications for SSRIs include concurrent MAOI therapy and several drug interactions.
  • Adverse effects include anxiety, dizziness, drowsiness, insomnia, sexual dysfunction-low libido, and tremor.
  • There is potential for serotonin syndrome with SSRIs.

Escitalopram (Lexapro)

  • Indications: Depression, anxiety disorder.
  • MOA: Unknown
  • Side effects include CNS effects, euphoria, amnesia, anticholinergic effects, weakness, diarrhea, and anorexia.
  • Adverse effects include tachycardia, seizure, HTN, and serotonin syndrome.
  • Use escitalopram with caution when taking MAOIs, CNS depressants, anticoagulation therapy, and with renal and hepatic impairment, pregnancy and lactation, narrow-angle glaucoma, seizures, hypokalemia, hyponatremia, hyperthyroidism, MI, and heart failure.

Fluoxetine (Prozac) Interactions

  • Fluoxetine interacts with grapefruit juice, alcohol, and CNS depressants, aspirin, NSAIDs, anticoagulants, MAOIs, SSRIs, and St. John's Wort.
  • Grapefruit juice can lead to toxicity.
  • Alcohol and CNS depressants increase the effects on CNS and respiratory depression.
  • Aspirin, NSIADs, and Anticoagulants increase bleeding potential.
  • MAOls and SSRIs increase the risk of serotonin syndrome.
  • St. John's Wort increases risk of serotonin syndrome and increases effects of hypoglycemia.

Escitalopram (Lexapro) Drug-Lab-Food-CAM Interactions

  • Alcohol and CNS depressants increase effects of CNS, respiratory depression, and hypotension.
  • Anticoagulants and aspirin increase bleeding.
  • Taking with other SNRIs, SSRIs increase risk for NMS.
  • MAOIs cause hypertensive crisis and death.
  • St. John's wort causes serotonin syndrome.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

  • Venlafaxene (Effexor) and Duloxetine (Cymbalta and others) are SNRIs.
  • Indications include depression, GAD, diabetic peripheral neuropathy, and fibromyalgia.
  • SNRIs increase serotonin and norepinephrine levels by inhibiting the reuptake by nerves.
  • Adverse effects include dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity.
  • Interactions include SSRIs and triptans which increase risk of serotonin syndrome, and alcohol, which increases the risk of liver injury.
  • SNRIs can worsen uncontrolled angle-closure glaucoma.

Serotonin Syndrome

  • Serotonin Syndrome can be caused by second-generation antidepressants.
  • Common symptoms include delirium, agitation, tachycardia, sweating, myoclonus (muscle spasms), hyperreflexia, shivering, course tremors, and extensor plantar muscles (sole of foot) response.
  • More severe cases of serotonin syndrome include hyperthermia, seizures, rhabdomyolysis, renal failure, cardiac dysrhythmias, and disseminated intravascular coagulation DIC.

Monoamine Oxidase Inhibitors (MAOIs)

  • Phenelzine (Nardil), isocarboxazid, tranylcypromine, and selegiline (transdermal patch) are MAOIs.
  • Indications include depression, social phobia, and panic disorder and parkinson's disease.
  • An adverse effect: Potential to cause hypertensive crisis when taken with tyramine.
  • Interactions: other antidepressants and anticonvulsants.

MAOIs and Tyramine

  • Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death. Foods to avoid:
    • Aged, mature cheeses (cheddar, bleu, Swiss)
    • Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
    • Yeast extracts
    • Red wines (Chianti, burgundy, sherry, vermouth)
    • Italian broad beans (fava beans)

Atypical Antidepressant

  • Bupropion is an atypical antidepressant.
  • Indications include depression, smoking cessation, and seasonal affective disorder.
  • Adverse effects include seizures and suicidal ideation.
  • Contraindications include seizure disorder.
  • Interactions include CNS depressants and azole antifungals.
  • Zyban is approved for smoking cessation treatment and was the first nicotine-free prescription medicine used to treat nicotine dependence.

Nursing Implications Antidepressants

  • AVOID Herbs such as St. John's Wort, commonly used for anxiety or depression.
  • It takes about 4 to 6 weeks to reach maximum clinical effectiveness with antidepressants.
  • Second-generation antidepressants are used for other than depression.
  • There are very few drug-drug or drug-food interactions.
  • Adverse effects include insomnia/reduced rapid eye movement, weight gain, and sexual dysfunction.
  • Antidepressants are highly protein-bound.

Nursing Implications

  • Tricyclics may interact with anesthetic drugs.
  • Monitor for adverse effects and discuss with patients.
  • Encourage patients to wear medication ID badges naming the drugs being taken.
  • Caffeine and cigarette smoking may decrease the effectiveness of medication therapy.
  • With MAOIs, instruct patients and family regarding tyramine-containing foods and signs and symptoms of hypertensive crisis.
  • Monitor for therapeutic effects-For antidepressants: improved sleep patterns and nutrition, increased feelings of self-esteem, decreased feelings of hopelessness, increased interest in self and appearance, increased interest in daily activities and fewer depressive manifestations or suicidal thoughts.

Complementary and Alternative Therapy for Depression

  • Ginkgo biloba and St. John's wort are used.
  • Discontinue use of herbal products 1 to 2 weeks before surgery.
  • Check with the health care provider before taking herbal treatments.
  • Do not take it with prescription antidepressants.

Psychotherapeutic Drugs

  • Indications: Serious mental illness, Psychotic illness, most commonly schizophrenia, anxiety, mood disorders, and BPD.
  • MOA: Block dopamine receptors in the brain in areas associated with emotion, cognitive function, and motor function to decrease Dopamine levels in the CNS, and has a tranquilizing effect in psychotic patients.
  • Adverse effects: Agranulocytosis, hemolytic anemia, CNS effects, Insulin resistance, Weight gain, Change in serum lipid levels, and Metabolic syndrome.
  • Conventional, or first-generation drugs: phenothiazines.

Haloperidol (Haldol)

  • Long-term treatment of psychosis with schizophrenia or BPD to reduce hallucinations and delusions.
  • Contraindications include hypersensitivity, Parkinson's disease, and in patients taking large amounts of CNS depressants.
  • Side effects: Extrapyramidal.
  • Useful in treating patients with schizophrenia who were nonadherent with their drug regimen

Atypical Antipsychotics

  • Atypical Antipsychotics include Clozapine(Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone(Invega), Iloperidone (Fanapt), Asenapine (Saphris), Lurasidone (Latuda), and Brexpiprazole (Rexulti)

Atypical Antipsychotics

  • Aripiprazole (Abilify) and Brexipiprazole (Rexulti): Quinolinone atypical antipsychotic used for schizophrenia, bipolar disorder, major depressive disorder, agitation associated With autistic disorder.
    • Adverse effects: similar to other atypical antipsychotics.
    • Abilify comes in oral and extended-release IM injection.
  • Clozapine (Clozaril): selectively blocks Dopaminergic receptors in the mesolimbic region of Brain.
    • Associated with minor or no EPS.
    • Adverse effects: blood dyscrasias.
    • Monitor WBC counts frequently throughout the beginning of therapy.
  • Risperidone(Risperdal): It has an Indication for schizophrenia, including negative symptoms.
    • Adverse effects: minimal EPS at therapeutic dosages of 1 to 6 mg/day.
    • Risperdal Consta is in long-acting injectable form, and lasts 2 weeks.
    • Invega Sustenna is long-acting injection, and lasts 1 month.

Nursing Implications for Antipsychotics:

  • Before beginning therapy, assess the physical and emotional status.
  • Obtain baseline VS, including postural BP, liver and renal function tests.
  • Complete Suicide Assessment Scale
  • Assess possible contraindications to therapy and potential drug interactions.
  • Assess the level of consciousness, and the potential for injury to self and others.
  • Check the patient's mouth to see that oral doses are swallowed and dispense a few at a time.
  • Advise patients to avoid abrupt withdrawal and to change position slowly.
  • The simultaneous use of these drugs with alcohol or other CNS depressants can be fatal.

More Nursing Implications for Antipsychotics:

  • Typical Antipsychotics - phenothiazines
  • Instruct patients to wear sunscreen because of photosensitivity.
  • Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician.
  • Oral forms may be taken with meals to decrease GI upset.
  • Some drugs may cause drowsiness, dizziness, or fainting; change positions slowly
  • Monitor for therapeutic effects-antipsychotics of improved mood and affect, alleviation of psychotic symptoms and episodes, and decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope

Anxiety

  • Six major anxiety disorders include obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder, social phobia (social anxiety disorder), and simple phobia

Anxiolytic Drugs

  • Reduce anxiety by reducing overactivity in the central nervous system (CNS).
    • Benzodiazepines Depress activity in the brainstem and limbic system
      • Alprazolam (Xanax)
      • Diazepam (Valium)
      • Lorazepam (Ativan)
    • Miscellaneous drug: Buspirone (Buspar)
      • Non-sedating and non-habit-forming
      • May have a drug interaction with selective serotonin reuptake inhibitors (SSRIs) and cause serotonin syndrome
      • Do not administer with MAOIs

Anxiolytic Drugs - Benzodiazepines

  • Alprazolam (Xanax) is used for GAD, short-term relief of anxiety symptoms, panic disorder, and anxiety associated with depression.
    • Adverse effects: confusion, ataxia, headache, and others.
    • Interactions: alcohol, oral contraceptives, and others.
  • Diazepam (Valium): Used for Anxiety, alcohol withdrawal, reverses status epilepticus, pre-OP sedation, and adjunct for skeletal muscle spasms.
    • Avoid use in patients with hepatic dysfunction
    • Adverse effects: headache, confusion, slurred speech
    • Interactions: alcohol, oral contraceptives, and others
  • Lorazepam (Ativan): Can be given by IV push; for acutely agitated patients or used for continuous infusion for agitated patients who are on mechanical ventilation.
    • Used to treat or prevent alcohol wIithdrawal

Miscellaneous Anxiolytic

  • Buspirone (Buspar)
    • MOA: Unknown
    • Administered on a scheduled basis non as needed.
      • Lacks sedative properties and dependency potential as other benzodiazepines
    • Adverse effects:
      • Paradoxical anxiety
      • Blurred vision
      • Headache
      • Nausea

Nursing Implications - Anxiolytics

  • In elderly patients, monitor closely for oversedation and found CNS depression.
  • Monitor for therapeutic effects of improved mental alertness, cognition, and mood.
    • Fewer anxiety and panic attacks
    • Improved sleep patterns and appetite
      • Less tension and irritability; fewer feelings of fear, impending doom, and stress
      • More interest in self and others

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