Psychiatric Meds Study Guide PDF

Psychiatric Meds SSRIs fluoxetine | citalopram | escitalopram | paroxetine Therapeutic effects/ findings: intensifies effects of serotonin Increased effects of serotonin can cause:...

Psychiatric Meds SSRIs fluoxetine | citalopram | escitalopram | paroxetine Therapeutic effects/ findings: intensifies effects of serotonin Increased effects of serotonin can cause: neuroleptic malignant syndrome (fever, resp. distress, tachycardia) sexual dysfunction serotonin syndrome (agitation, fever, sweating, tremors) ________________________________________________________________________________________________________ MOAIs phenelzine | selegiline Client education: tyramine = hypertensive crisis. AVOID tyramine foods like aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein supplements, soups, soy sauce, beer, and red wine. Avoid taking OTC meds without doctor’s approval. ______________________________________________________________________________________________________ Mood Stabilizer lithium Therapeutic range: 0.6-1.2 mEq/L Lithium Toxicity: Early indications- 1.5-2.0 mEq/L (confusions, poor coordination, coarse tremors) HOLD med & NOTIFY provider Advanced indications- 2.0-2.5 mEq/L (blurred vision, ataxia, seizures, hypotension) Hold meds & ANTICIPATE order for bowl irrigation. Severe toxicity- > 2.5 mEq/L (oliguria, seizures, coma, death) ANTICIPATE hemodialysis order. ________________________________________________________________________________________________________ Mood-Stabilizing Antiepileptics  carbamazepine | valproic acid | lamotrigine Client education: avoid driving & other alert activities at beginning of treatment, AVOID grapefruit juice, & avoid use in pregnancy. Notify provider of vomiting, yellowing skin, & bruising. Contraindications: Pregnancy: carbamazepine (client benefits > fetal risks), lamotrigine (1st trimester= risk of cleft lip/palate), & valproic acid (should AVOID). carbamazepine: bone marrow suppression or bleeding disorders. valproic acid: liver disorders Use non-hormonal form of birth control ________________________________________________________________________________________________________ Antipsychotics (1st gen) chlorpromazine | haloperidol | fluphenazine | loxapine Complications: Acute Dystonia- < 12 breaths/min (respiratory depression). Tardive Dyskinesia- facial grimacing, eye blinking, tongue thrusting, lip smacking, involuntary hip rocking. 😜 Akathisia: restlessness (early sign of suicidal ideation). Client Education: Change positions slowly. NO driving until sedation is gone. ________________________________________________________________________________________________________ Antipsychotics (2nd & 3rd gen.-Atypical) risperidone | clozapine | aripiprazole Complications: Weight gain, diabetes mellitus, sexual dysfunction, anticholinergic effects, orthostatic hypotension/dizziness 😵‍💫 Contraindicated/Precautions: Pregnancy: clozapine-client benefit > fetal risk | risperidone- safety not est. Lactation: clozapine & risperidone is contraindicated. Contraindicated: dementia AVOID alcohol 🥃  Caution use in 🫀cardiovascular disease, seizures, or diabetes mellitus. Client Education: Exercise & diet, change positions slowly, notify provider of sexual dysfunction. ________________________________________________________________________________________________________ Central Nervous Systems Stimulants methylphenidate | dextroamphetamine | amphetamine Client education: Avoid alcohol 🥃 Avoid caffeine☕️ Tachycardia & palpitations-📞Notify provider Eat nutritious meals🍛(can cause anorexic effect) Don’t take in the evening/night🚫 ________________________________________________________________________________________________________ Alcohol Abuse First line treatments (withdrawal): chlordiazepoxide, diazepam, lorazepam (benzos) Abstinence maintenance: disulfiram _____________________________________________________________________________________________________________________________ Opioid Abuse Intended effects: Methadone: oral opioid replacement, prevents abstinence syndrome, illegal dependence ➡️methadone. Buprenorphine: opioid substitute, prevents withdrawal, SAFER than methadone (⬇️resp. depression risk), FDA approved. ________________________________________________________________________________________________________ Nicotine  Intended effects: Buproprion: ⬇️craving Varenicline: ⬆️dopamine stimulates pleasurable effects of nicotine. Reduces relapse. BOTH meds: ⬇️DECREASE⬇️nicotine CRAVINGS. __________________________________________________________________________________________________ Anti-Parkinson’s Dopamine Synthesis Centrally acting anticholinergics levodopa | carbidopa benztropine | trihexyphenidyl (Most effective) Complications: Beneficial effects diminish by year 5, nausea, vomiting “wearing off” effect, “on-off” phenomena 🏜 DRY mouth, blurred vision, urinary retention antihistamine effects 😴 __________________________________________________________________________________________________ Antiepileptics phenobarbital | phenytoin | carbamazepine | valproic acid | topiramate | gabapentin | oxcarbazepine Complications: barbiturates = drowsiness, sedation, depression, paradoxical excitement, ataxia. Nursing actions: monitor plasma levels; high potential for abuse (barbiturates) Client education: barbiturates (phenobarbital)- ⬇️oral contraceptive effects- use other 🧃 form. AVOID grapefruit juice & alcohol. 🥃 ________________________________________________________________________________ Central Nervous System Muscle Relaxants & Antispasmodics diazepam | cyclobenzaprine | baclofen Purpose: Mimics actions of GABA in spinal cord & brain = ⬇️muscle spasticity. Therapeutic use: muscle spasm f/ muscle injury, anxiety/panic, insomnia. Client education: AVOID hazardous activities (CNS depression) & alcohol/opioids/antihistamines). Take with meals & increase fiber (baclofen).  Interactions: CNS depressants = ⬆️Added CNS depressant effects ( 🚫🥃). ________________________________________________________________________________________________________ Cardiovascular Diuretics LOOP- furosemide Potassium-Sparing- spironolactone Complications: hypokalemia (⬇️K+), Complications: hyperkalemia (⬆️K+) dehydration, hypotension, ototoxicity Client education: AVOID salt substitutes Client education: teach to eat high- (they contain K+). potassium foods, report signs of Electrolyte imbalance: K+ greater than 5 hypokalemia, report urine output less mEq/L than 30ml/hr, monitor weight. Electrolyte imbalance: K+ less than 3.5 mEq/L __________________________________________________________________________________________________ Blood Pressure [VASODILATION: ACE, ARBs, CCB] ACE Inhibitors- ARBs- loSARTAN Calcium Ch Beta Blockers- captoPRIL, lisinoPRIL, Blockers- nifedipine, metoprolol, atenolol, fosinoPRIL verapmil, diltiazem esmolol (beta 1 🫀); propanolol (beta 1 & 2 🫀🫁). Complications: Complications: Complications: HYPOtension, HYPOtension, Contraindications: HYPOtension, cough, HYPOnatremia AV block, sinus dizziness, HYPERkalemia, Client education: bradycardia. angioedema client should peripheral edema Nonselective 🫁🫀- (allergic check BP before bronchospasm, Client reaction-use EPI) taking dose (take asthma, heart education: Client education: dose same time failure. ⬆️fiber & fluids, coughing 1wk or each day). CARDIOselective: notify DR of more NOTIFY DR, Interactions: 🧃 lower extremity asthma. Precautions: captopril 1hr grapefruit juice swelling. before meal Therapeutic Interactions:🧃 myasthenia gravis, HYPOtension, Interactions: effects: grapefruit juice, NSAIDS ⬇️ACE HYPERtension, 🫀 verapamil can ⬆️ peripheral vasc. effects (BP won’t failure digoxin levels= disease, DM, be lowered) ⬆️risk digoxin depression, severe =⬆️BP toxicity allergies. Therapeutic Client Therapeutic effects: effects: angina, education: self- HYPERtension, 🫀 HYPERtension, monitor HR & BP failure a-fib, a-flutter DAILY! HOLD drug: BP & HR low. Interactions: Calcium Ch. Blockers = ⬆️ beta effects (decreased heart functions). Therapeutic effects: HYPERtension, angina, 🫀failure, MI. __________________________________________________________________________________________________ Cardiac Glycosides digoxin Medication administration: vitals, check labs, assess patient. HOLD if pulse is: