Mental Health Medications PDF

Bullet Point Nursing Psychiatry pharmacology Disclaimer: These notes are designed to provide the key points of each topic and may not contain all necessary information. Every effort is made to ensure this content is up to date and accurate at the time of writing. No liability is assumed for the con...

Bullet Point Nursing Psychiatry pharmacology Disclaimer: These notes are designed to provide the key points of each topic and may not contain all necessary information. Every effort is made to ensure this content is up to date and accurate at the time of writing. No liability is assumed for the content or its relation to current standards and practices. This should not replace comprehensive nursing educational resources. Pharmacotherapy notes: Dysphoria is the medical term for depression These medications should always be tapered Patients should be educated on realistic expectations and that all mental health medications take several weeks or longer to take effect Medications should be used in combination with psychotherapy Highest priority assessment is risk of suicide A complementary and alternative medication (CAM) used for mental health is St. John’s Wart o Note: This can increase serotonin levels leading to serotonin syndrome Medications that affect serotonin carry a risk of causing serotonin syndrome o Risk increases with use of multiple similar medications o Symptoms include tremors, fever, AMS Assess for depression / anxiety using the PHQ9, GAD7 or other standardized tool Drug class: Selective serotonin reuptake inhibitors (SSRI) Drugs: o Sertraline (Zoloft) o Fluoxetine (Prozac) o Escitalopram (Lexapro) o Citalopram (Celexa) o Paroxetine (Paxil) MOA: Inhibit reuptake of serotonin, thereby increasing serotonin effects Indications: Depression, anxiety Off label use: For premature ejaculation SE/AE: Insomnia and sexual dysfunction Black Box warning: Risk for suicide First line for depression and anxiety Considered relatively safe in pregnancy Drug class: Serotonin / Norepinephrine reuptake inhibitors (SNRI) Drugs: o Dulaxotine (Cymbalta) o Venlafaxine (Effexor) MOA: Inhibit reuptake of serotonin and norepinephrine, thereby increasing the effects of these Indications: Anxiety, depression, migraine prevention, fibromyalgia SE/AE: Sexual dysfunction, insomnia, HTN, orthostatic hypotension, hepatotoxicity, anorexia Bullet Point Nursing © 2024  Bullet Point Nursing Black Box warning: Risk for suicide Drug class: Tricyclic antidepressants (TCA) Drugs: o Amitriptyline (Elavil) o Nortriptyline o Doxepin o Imipramine MOA: Inhibit reuptake of serotonin and norepinephrine, thereby increasing the effects of these Indications: Depression Off label uses: Fibromyalgia, IBS, migraines, anxiety and withdrawal syndrome SE/AE: Anticholinergic effects, ECG changes, CNS depression, orthostatic hypotension, sedation, weight gain Black Box warning: Risk for suicide Not first line treatment for depression Drug class: Monoamine oxidase inhibitors (MAOI) Drug: o Phenelzine (Nardil) MOA: Monoamine oxidase inactivates norepinephrine, dopamine, epinephrine and serotonin. MAOIs block that, thereby increasing the amount of these neurotransmitters Indication: Depression Off-label use: Anxiety Black Box warning: Risk for suicide Interferes with many other medications Not first line treatment for depression Many contraindications SE/AE: Orthostatic hypotension, hypertension when interacting with tyramine, insomnia, anticholinergic effects Patient education: o Must be educated to avoid foods containing tyramine ▪ i.e. aged cheese, salami, bananas, beer and wine o May require 14 days between discontinuation and the starting of certain medications Drug name: Bupropion (Wellbutrin) MOA: Unknown – inhibits uptake of norepinephrine and dopamine Indications: Depression o Sold under the brand Zyban for smoking cessation Off label uses: ADHD, bipolar disorder SE/AE: Risk for seizures (Highest with high doses or rapid titration) and insomnia Black Box warning: Risk for suicide and neuropsychiatric events Drug name: Trazadone (Oleptro) Bullet Point Nursing © 2024  Bullet Point Nursing MOA: Inhibits reuptake of serotonin, increasing serotonin effects. Blocks histamine and alpha one adrenergic receptors Indication: Depression Off label uses: Aggression / agitation related to dementia and insomnia SE/AE: Dizziness, drowsiness, dry mouth, ECG changes, orthostatic hypotension Black Box warning: Risk for suicide Drug name: Buspirone (Buspar) MOA: Unknown Indication: Anxiety Off-label use: Depression SE/AE: Sexual dysfunction and EPS Drug class: Benzodiazepines Drugs: o Lorazepam (Ativan) o Diazepam (Valium) o Midazolam (Versed) o Alprazolam (Xanax) o Clonazepam MOA: GABA agonist. GABA is an inhibitory neurotransmitter Indications: Seizure disorder, insomnia, anxiety, sedation, muscle relaxant SE/AE: Muscle weakness, hypotension, sedation, respiratory depression Black box warning: Do not mix with other CNS depressants. Can cause addiction and dependency Controlled substance (Schedule IV) First line for cessation of acute generalized seizure Several benzodiazepines are contraindicated in pregnancy due to teratogenic effects Patient education: Do not take with alcohol or other CNS depressants Has an approved reversal agent for benzodiazepine overdose called flumazenil Another drug used for anxiety is propranolol that can help test anxiety and other situational anxiety that presents with physical manifestations such as tachycardia, palpitations, and hypertension Drug class: Mood stabilizer Drug: o Lithium (Lithobid) MOA: Unknown – alters ion transport Indication: Bipolar disorder Off label use: Depression Requires serum concentration monitoring o Therapeutic response at serum concentration of 0.4-1.2mEq/L o Toxic above 1.5 mEq/L (Some say toxic as low as 1.2 mEq/L) Bullet Point Nursing © 2024  Bullet Point Nursing SE/AE: Adverse cardiac, renal, and CNS effects, nephrogenic DI, polyuria Black box warning: Monitor lithium levels for toxicity due to narrow therapeutic index Patient education: o Requires regular lab monitoring o Due to interfering with ADH, the patient must drink sufficient fluids Drug class: Valproate Drug: o Valproic acid (Depakote) MOA: Prolong sodium channel inactivation and is also a GABA agonist Indications: Seizure disorder, migraines, bipolar disorder SE/AE: Nausea, bleeding risk Black box warning: o Hepatoxicity o Highly teratogenic – least preferred for females of childbearing age o Pancreatitis Cannot be given to children under two years old Drug name: Lamotrigine (Lamictal) MOA: Prolong sodium channel inactivation, blocks specific calcium channels, and blocks glutamate Indications: Seizure disorder and bipolar disorder SE/AE: CNS effects One of the best options for use in pregnancy Black box warning: SJS/TEN Patient education: o Can decrease effectiveness of oral contraceptives Another option for bipolar disorder are the newer antipsychotics, carbamazepine, Drug class: CNS stimulants Drugs: o Methylphenidate (Ritalin) o Amphetamine (Adderall) o Dextroamphetamine (Dexedrine) MOA: CNS stimulants. These drugs cause release of norepinephrine and dopamine Indications: ADHD and narcolepsy Black Box warning: Linked to abuse and dependency Controlled substance (Schedule II) SE/AE: Weight loss and insomnia First line treatment for ADHD Drug name: Atomoxetine (Strattera) Bullet Point Nursing © 2024  Bullet Point Nursing MOA: Blocks reuptake of norepinephrine, increasing its effects Indication: ADHD Less effective than CNS stimulants and therefore second line treatment Not a controlled substance Drug name: Modafinil (Provigil) MOA: Not fully understood, increases dopamine in the brain Indications: Daytime fatigue related to narcolepsy, ADHD, OSA, and shift work sleep disorder Off-label use: Depression and fatigue from varies sources Controlled substance (Schedule IV) Always educate on the non-pharm interventions for insomnia All insomnia medications can cause drowsiness. Drug class: Dual orexin receptor antagonist (DORA) Drugs: o Daridorexant (Quviviq) o Suvorexant (Belsomra) MOA: Blocks Orexin A and B which suppresses the wake drive Indication: Insomnia Not for long term use Controlled substance (Schedule IV) Drug class: Histamine one receptor antagonist (Antihistamine) Drug: o Doxylamine (Unisom) o Hydroxyzine (Vistaril) MOA: Histamine one receptor antagonist, decreases histamine which results in sedation Indications: Insomnia, nausea in pregnancy, anxiety, allergies Doxylamine is available over the counter Drug class: Benzodiazepine receptor agonist (BZRA) Drugs: o Zolpidem (Ambien) o Eszopiclone (Lunesta) MOA: Same as benzodiazepines Indication: Insomnia Should not be used for long-term management Controlled substance (Schedule IV) Black Box warning: Risk of abuse and dependency Drug class: Melatonin receptor agonist Drug: Bullet Point Nursing © 2024  Bullet Point Nursing o Ramelteon (Rozeram) MOA: Activates melatonin receptors which control circadian rhythm and sleep-wakefulness Indication: Insomnia Not a controlled substance Relatively safe for long term use Drug class: Tricyclic antidepressants (TCA) Drugs: o Doxepin MOA: Histamine antagonist for insomnia, has other actions for depression Indications: Depression, insomnia A complementary and alternative medication (CAM) used for insomnia is melatonin Drug class: First generation antipsychotics (phenothiazine and non-phenothiazine) Drugs: o Chlorpromazine o Fluphenazine o Haloperidol MOA: Block dopamine 2 receptors Indication: Schizophrenia Off label use: Bipolar and nausea Haloperidol is also used for acute psychosis SE/AE: Drowsiness, anticholinergic effects, sexual dysfunction, and orthostatic hypotension Associated with extrapyramidal symptoms (EPS). o These include acute dystonia, parkinsonism, akathisia, and tardive dyskinesia ▪ Some can be treated with benztropine Associated with Neuroleptic Malignant Syndrome (NMS) o Rare but potentially fatal reaction, presents with rigidity, high fever, dysrhythmias, AMS ▪ Can be treated with dantrolene Effects more likely with high potency antipsychotics versus low potency antipsychotics Black Box warning: Not to be used for dementia related psychosis Antipsychotics have a high incidence of medication noncompliance Drug class: Second generation antipsychotics (Atypical antipsychotics) Drugs: o Aripiprazole (Abilify) o Lurasidone (Latuda) o Olanzapine (Zyprexa) o Quetiapine (Seroquel) o Risperidone (Risperdal) o Ziprasidone (Geodon) MOA: Blocking dopamine 2 and serotonin receptors Bullet Point Nursing © 2024  Bullet Point Nursing Indications: Bipolar disorder, depression and schizophrenia Off label use: Delusional disorder and OCD SE/AE: Metabolic effects (weight gain, DM, dyslipidemia) EPS and orthostatic hypotension Less likely versus first generation to have EPS Ziprasidone is also used for acute psychosis Black Box warning: Not to be used for dementia related psychosis Antipsychotics have a high incidence of medication noncompliance Full onset can be up to 8 weeks Bullet Point Nursing © 2024  Bullet Point Nursing References Adams, M., Holland, N. & Chang, S. (2023). Pharmacology for nurses; a pathophysiologic approach. Pearson Burchum, J., & Rosenthal, L. (2022). Lehne's pharmacology for nursing care. Elsevier Mccuistion, L., Vuljoin-DiMaggio, K., Winton, M., & Yeager, J. (2023) Pharmacology: A patient centered nursing process approach. Elsevier Post, R. (2022). Bipolar disorder in adults: Choosing maintenance treatment. www.uptodate.com Rush, A. J. (2020) Unipolar major depression in adults: Choosing initial treatment. www.uptodate.com Winkelman, J. (2022). Overview of the treatment of insomnia in adults. www.uptodate.com Bullet Point Nursing © 2024