MENTAL HEALTH

Pharmacology

Classes of drugs used to treat depression: SSRI’s

MAOI’s

Tricyclic (TCA)

(Atypical antidepressants)

SSRI?

Selective Serotonin Reuptake Inhibitors (SSRI) Currently first choice medication for depression

SSRI?

Selective Serotonin Reuptake Inhibitors (SSRI) Works by blocking re-absorption of serotonin by

nerve cells in the brain Leaves more serotonin available in the brain Increases amount of serotonin enhances the

sending of nerve impulses and increases mood Affect only serotonin not other neurotransmitters

What is Serotonin Syndrome? Rare life-threatening side effect of SSRI’s Characterized by dangerously high levels of

serotonin in the brain Can occur when SSRI interacts with

antidepressants called monoamine oxidase inhibitors (MAOI’s)

Can occur when SSRI’s are taken with other medications

What is Serotonin Syndrome? Can occur when SSRI’s are taken with other

medications such as Pain relief medication such as tramadol Migraine medication such as sumatriptan and

rizatriptan Supplements that affect secrotoin levels, such as

St. John’s Wort

Serotonin Syndrome symptoms: Confusion Anxiety Hallucination Extreme agitation Fluctuations in blood pressure Increased heart rate Nausea and vomiting Fever Seizures Flu like symptom Lethargy coma

Common side effects of SSRI

Nausea Sexual dysfunction, including reduced desire or

orgasm difficulties Dry mouth Headache Diarrhea Nervousness Rash Weight gain Insomnia Agitation, restlessness

Nursing interventions and teaching concerns for clients: Advice – effects may not be experienced for

2-4 weeks and may take 8-12 month for full benefit to be achieved

Continue therapy after notice improvement in symptoms

Sudden discontinuation may result in relapse Do not take with MAOI’s

Commonly used SSRI’s

Prozac

Paxil

Zoloft

Celexa

Lexapro

MAOI

Monoamine oxidase inhibitors

How do MAOI’S work

Help balance certain chemicals in the brain to relieve symptoms of anxiety associated with panic disorders

Not recommended for children, teens, nursing or pregnant women

Inhibit enzyme monoamine oxidase in brain increasing norepinephrine and serotonin

MAOI

Clients taking MAOI’s can develop hypertensive crisis if they consume what foods?

MAOI

Clients taking MAOI’s can develop hypertensive crisis if they consume what foods? Some cheeses Broad beans such as

Fava beans Pickled foods like

Sauerkraut Beer Red wine

MAOI

Marplan Parnate Nardil

MAOI

Common side effects of MAOI’s Difficulty getting to sleep Dizziness, lightheadedness, fainting Dry mouth Blurred vision Appetite changes Severe high blood pressure Changes in heart rate and rhythm Muscle twitching and feeling of restlessness Loss of sexual desire or ability Weight gain

What is action of a Tricyclics?

TCABlock reuptake of

norepinephrine and serotonin in brain

Tricyclics

Tricyclic antidepressants should be avoided in patients who have what disorder(s)? MAOI medications recently Drinking problem Schizophrenics or manic depressive Cardiac conditions Bone marrow function disorders Blood cell disorder

Tricyclics

Common side effects of Tricyclics Tremor Unpleasant taste Nausea Dry mouth Fatigue Weakness Anxiety Sensitivity to sunlight Insomnia Sedation Nervousness Excessive sweating

Nursing interventions and teaching concerns for clients: Monitor mental status and affect Assess for suicidal tendencies Monitor blood pressure and pulse rate before

and during therapy Assess for Leukopenia, liver function tests,

serum glucose periodically May take 2-3 months to be therapeutic

TCA’S

Elavil Sinequan Tofranil Nortriptyline

Atypical antidepressants

Wellbutrin Inhibits dopamine uptake Don’t take with MAOI’s

Effexor, Cymbalta Inhibit serotonin and norepinephrine reuptake

Remeron Increase release if serotonin and norepinephrine

Trazodone Blocks serotonin

What are Anti-anxiety Medications?

Used to treat a variety of anxiety disorders Used in treatment of alcohol and drug

withdrawal Sometime referred minor tranquilizers Some are used short term, benzodiazepines,

while others are used long term, like buspar. Benzodiazepines are used to treat anxiety, can be addictive.

Anti anxiety medications

Ativan (lorazepam) BuSpar (buspirone) Inderal (propanolol) Klonopin (clonazepam) Librium (chlordiazepoxide) Serax (oxazepam) Valium (diazepam) Xanax (alprazolam

Anti-anxiety Medications

Common side effects of anti-anxiety agents Dizziness or lightheaded Trouble sleeping Feeling very tired Stomachache Vomiting Rash Diarrhea Constipation

Nursing interventions and teaching concerns for clients: Can cause drowsiness Can cause tiredness Can cause loss of coordination Do not drink alcohol Caution when operating machinery May have withdrawal symptoms

Antipsychotic Agents

Commonly used to treat:

Positive symptoms Agitation Delusion Hallicinations

Negative symptoms Social withdrawal Lack of emotion Lack of energy

GOAL suppress acute episode Prevent acute recurrence Maintain highest level of functioning

Side effects

Many go away after a few weeks of treatment Drowsiness, tachycardia, dizziness

Decrease in sexual ability or interest Restlessness muscle spasms Shuffling walk Slowed movement and speech Parkinson like symptom

Common side effects defined:

Anticholinergic Dry mouth, visual disturbances, acute urinary retention,

constipation and tachycardia.

Extrapyramydal Acute dystonia, severe spasms of tongue and jaw spreading to

face, neck, and back

Parkinson’s effects rigidity, shuffling gait, drooling, tremors

Dystonia Inability to stand still or sit, pacing

What is Neuroleptic Malignant Syndrome? Uncommon effect that is potentially fatal

when it occurs

Symptoms of Neuroleptic Malignant Syndrome? High grade fever Blood pressure fluctuation Dysrhythmias Muscle rigidity Change in level of consciousness developing

into coma – confusion

Nursing interventions for Neuroleptic malignant syndrome Stop the med Monitor VS Applying cooling blanket Antipyretics Increase fluid intake Benzodiazepines for anxiety

Client teaching topics for clients taking antipyschotics Therapeutic effect may be noticed in a few

days but significant improvement may take 2 to 4 weeks and several months for full effect

Conventional Thorazine Haldol

Atypical Seroquel Abilify Zyprexa (Olanzepine) and Resperidol (Resperdone)

What is Tardive Dyskinesia?

Tardive Dyskinesia:

Muscular side effects of anti-psychotic drugs, especially the older generation like haloperidol.

Does not occur until after many months or years of taking anti-psychotic drugs.

Primarily characterized by random movements in the tongue, lips or jaw as well as of the trunk or hips.

Tardive Dyskinesia:

Prevention is achieved by using the lowest effective dose for the shortest time.

Question:

Benadryl, Cogentin and Artane are three drugs used in mental health to treat what disorder? _______________________

Tardive Dyskinesia

Anti Manic

What is an antimanic medication

Also know as mood stabilizers and anticonsulvants

Used to stabilize mood and behavior with bipolar disorders

List common antimanics

Lithium Dapakene Depakote

Lithium level

Therapeutic 0.6 to 1.2mEq/L Toxicity greater than 1.4mEq/L Life threatening emergency greater than

2mEq/L

What are signs of lithium toxicity Level greater than 1.4 mEq/L Shakiness Thirst Frequent urination Diarrhea Vomiting Drowsiness Muscle weakness Coordination problems Giddiness Blurred vision Tinnitus Seizure Slurred speech Decrease LOC Possible death

Treatment for lithium toxicity

Stopping lithium IV fluids Pumping stomach dialysis

Preventing lithium toxicity

Follow dosing instruction carefully Drink plenty of fluid Do not change or restrict salt intake Check lithium level regularly