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ATI Mental Health Medications, Study notes of Nursing

ATI Mental Health Medications Psychology (PSY) Alverno College PN Mental Health Nursing Edition 10. 0 - Assessment Technologies Institute 20 pages 2023/2024

Typology: Study notes

2023/2024

Available from 03/28/2024

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ATI Mental Health Medications
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SSRIs
MOA: inhibit serotonin reuptake
Therapeutic use: first line treatment for depression, panic disorders, trauma, and stressor related
disorders
Paroxetine (anxiety/trauma/stress disorders/PTSD)
Sertraline (anxiety/trauma/stress disorders)
Fluoxetine (depressive disorders)
Citalopram
Escitalopram
Fluvoxamine
May be taken with food
Take medication AM
Discontinue slowly over 1-2 months
SNRIs
Complications:
-Early AE: nausea, diaphoresis, tremor, fatigue, drowsiness
-Later (after 5-6 weeks): sexual dysfunction, weight gain, headache
-Weight changes (weight loss short term, gain long term)
-GI bleeding
-Hyponatremia (more likely in older adults)
- Serotonin Syndrome: confusion, agitation, disorientation, seizures, tachycardia, diaphoresis, fever
leading to hyperpyrexia, incoordination, hyperreflexia
-Bruxism: grinding and clenching of teeth, usually during sleep:
-Withdrawal: nausea, sensory disturbances, anxiety, tremor, malaise, unease
Contraindications/Precautions
-Paroxetine is a Pregnancy Risk Category D
-Fluoxetine is Pregnancy Risk Category C
-Contraindicated in clients taking MAOIs or TCAs
-Liver and renal dysfunction, seizure disorders, history of GI bleeding
-Caution with those who have bipolar disorder (d/t risk of mania)
Interactions:
- Concurrent use of TCAs, MOAIs, or St Johns wort can cause serotonin syndrome
-Warfarin (monitor PT and INR levels)
-Avoid lithium
-Concurrent use of NSAIDS and anticoagulants
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SSRIs

MOA: inhibit serotonin reuptake

Therapeutic use: first line treatment for depression, panic disorders, trauma, and stressor related

disorders

 Paroxetine (anxiety/trauma/stress disorders/PTSD)

 Sertraline (anxiety/trauma/stress disorders)

 Fluoxetine (depressive disorders)

 Citalopram

 Escitalopram

 Fluvoxamine

May be taken with food

Take medication AM

Discontinue slowly over 1-2 months

SNRIs

Complications:

- Early AE: nausea, diaphoresis, tremor, fatigue, drowsiness - Later (after 5-6 weeks): sexual dysfunction, weight gain, headache - Weight changes (weight loss short term, gain long term) - GI bleeding - Hyponatremia (more likely in older adults) - Serotonin Syndrome: confusion, agitation, disorientation, seizures, tachycardia, diaphoresis, fever

leading to hyperpyrexia, incoordination, hyperreflexia

- Bruxism: grinding and clenching of teeth, usually during sleep: - Withdrawal: nausea, sensory disturbances, anxiety, tremor, malaise, unease

Contraindications/Precautions

- Paroxetine is a Pregnancy Risk Category D - Fluoxetine is Pregnancy Risk Category C - Contraindicated in clients taking MAOIs or TCAs - Liver and renal dysfunction, seizure disorders, history of GI bleeding - Caution with those who have bipolar disorder (d/t risk of mania)

Interactions:

- Concurrent use of TCAs, MOAIs, or St Johns wort can cause serotonin syndrome - Warfarin (monitor PT and INR levels) - Avoid lithium - Concurrent use of NSAIDS and anticoagulants

MOA: inhibit uptake of serotonin and norepinephrine

Therapeutic use: used for major depression, panic disorders, and generalized anxiety disorders.

 Venlafaxine

 Duloxetine

 Desvenlafaxine

 Levomilnacipran

Benzodiazepine Sedative Hypnotic Anxiolytics

Complications:

- Headache, nausea, agitation, anxiety, dry mouth, sleep disturbances - Hyponatremia (especially in older adults) - Anorexia - Hypertension - Sexual dysfunction

Contraindications/Precautions:

- Pregnancy category C - No MAOIs - Duloxetine should not be used in clients with hepatic disease or in

those who consume large amounts of alcohol

Interactions:

- Concurrent use of MAOIS and St. Johns wort can cause serotonin

syndrome

- CNS depression with alcohol, opioids, antihistamines - Concurrent use with NSAIDS and anticoagulants can further suppress

platelet aggregation, thereby, increasing the risk of bleeding

Atypical Anxiolytic

Therapeutic use: generalized anxiety disorder, long term

 Buspirone

Not for PRN , scheduled only

Does NOT cause sedation, tolerance, dependence, or

withdrawal manifestations

Take with meals

Full effect: 2-4 weeks

TCAs

Therapeutic use: depressive disorder

Complications:

  • CNS effects (dizziness, drowsiness, nausea,

headache, lightheadedness, agitation,

nervousness, sedation, excitement)

  • Adverse Effects: xerostomia or dry mouth,

headache, nausea, insomnia

Contraindications/Precautions:

- Pregnancy Risk Category B - No breastfeeding - Liver or kidney dysfunction - Contraindicated for concurrent use with MAOI

antidepressant (or for 14 days after MAOIs are

discontinued. Hypertensive crisis can result)

Interactions:

  • Erythromycin, ketoconazole, St. John’s wart, and

grapefruit juice can increase the effects of

buspirone

Other uses: neuropathic pain, fibromyalgia, anxiety, insomnia, bipolar disorder, OCD, ADHD

 Amitriptyline

 Imipramine

 Clomipramine

o Adverse effects:

sedation, orthostatic

hypotension,

anticholinergic effects,

tachycardia, constipation

 Doxepin

o Adverse Effects:

constipation,

tachycardia, drowsiness,

weight gain

 Nortriptyline

 Amoxapine

 Trimipramine

 Desipramine

o Adverse effect: sedation

NOTE: pseudoephedrine interacts with

TCAs and is contraindicated

MAOIs

Complications:

  • Orthostatic hypotension
  • Anticholinergic effects

o Urinary retention – report immediately

  • Sedation
  • Toxicity
  • Decreased seizure threshold
  • Excessive sweating
  • Increased appetite

Contraindications/Precautions:

  • Pregnancy Risk Category C
  • Contraindicated for seizure disorders
  • Caution: CAD, diabetes, liver, kidney, and respiratory

disorders, urinary retention, angle closure glaucoma, benign

prostatic hypertrophy and hyperthyroidism

Interactions:

  • Concurrent use with MAOIS can cause severe hypertension

NaSSA

A norepinephrine and serotonin specific

antidepressant

 Mirtazapine

Less sexual dysfunction than with SSRIs

Generally well tolerated

Beta Blockers

Decreases elevated vital signs and manifestations of anxiety, panic, hypervigilance, and insomnia

 Propranolol

Centrally Acting Alpha Blockers

Can decrease manifestations of hypervigilance and insomnia

 Prazosin

Centrally Acting Alpha 2 Agonist

 Clonidine

o Expect a child to be drowsy while taking this medication

 Other adverse effects: somnolence, fatigue, hypotension

o Can be administered with or without food

o Administer twice daily: morning and evening

o Swallow whole – no crushing, chewing, cutting

o May also treat heroin withdrawal

Adverse Effects:

  • Sleepiness that can be exacerbated by other

CNS depressants, increased appetite and

weight gain, elevated cholesterol

to quit

with an

Monitor for hyponatremia

neurol

Mood Stabilizer

Therapeutic use: bipolar disorders,

schizophrenic disorders (Long term

treatment)

 Lithium Carbonate

 Therapeutic level: 0.6 - 1.

May reduce regression and decrease

impulsivity

Valproic acid can be administered safely with lithium

Hold the dose if patient reports nausea with frequent episodes of emesis

Complications:

  • Headache, dry mouth, GI distress, increased HR, nausea,

restlessness, insomnia, dizziness

  • Appetite suppression – weight loss
  • Seizures at high doses
  • Priapism can be a serious adverse effect of trazadone

Contraindications/Precautions:

  • Bupropion is Pregnancy Risk Category B medication
  • Contraindicated in seizure disorder
  • Those taking MAOIs
  • Bupropion is contraindicated for anorexia and bulimia
  • Trazadone: caution in clients who have cardiac disease

Interactions:

  • MAOIs
  • Increased risk of seizures with concurrent use of SSRIs

Complications:

  • GI distress: nausea, diarrhea, abdominal pain

o Administer with meals or milk

  • Fine hand tremors

o Administer beta-blocker (propranolol)

  • Polyuria, mild thirst

o Use potassium sparing diuretic (spironolactone)

  • Weight gain
  • Renal toxicity

o Monitor BUN and creatinine

  • Goiter and hypothyroidism, with long term treatment

o Obtain baseline T3 T4 and TSH levels

o Administer levothyroxine

  • Bradydysrhythmias, hypotension, and electrolyte

imbalances

Contraindications/Precautions:

  • Pregnancy Risk Category D
  • Teratogenic especially in the first trimester of pregnancy
  • Discourage breastfeeding
  • Renal or cardiac disease, hypovolemia, schizophrenia

Interactions:

  • Diuretics

NSAIDS

2.0-2.5 (advanced

indication)

Extreme polyuria and dilute urine,

tinnitus, giddiness, jerking

movements, blurred vision, ataxia,

seizures, severe hypotension and

stupor leading to coma, possible

death from respiratory

complications

Administer an emetic to alter clients, or

administer gastric lavage

Urea, mannitol, or aminophylline may be

prescribed to increase the rate of

excretion

Greater than 2.

(severe toxicity)

Rapid progression of

manifestations leading to coma

and death

Hemodialysis can be warranted

Mood Stabilizing Antiepileptic Meds

Therapeutic use: prevent relapse of manic and depressive episodes,

particularly useful for clients who have mixed mania and rapid-cycling

bipolar disorders

 Carbamazepine

 Valproate

 Lamotrigine

 Valproic Acid

o Monitor liver function regularly

 Topiramate

 Oxcarbazepine

Contraindications:

  • Pregnancy Risk Category D, they can result in birth defects

Carbamazepine:

  • Minimal effect on cognitive function
  • CNS effects: nystagmus, double vision, vertigo, staggering gait,

Antipsychotics (Overview)

 Lurasidone

 Olanzapine

 Quetiapine

 Aripiprazole

 Risperidone

 Asenapine

 Cariprazine

 Ziprasidone

 Ziprasidone

 Olanzapine

 Aripiprazole

Lamotrigine:

  • Double or blurred vision, dizziness,

headache, n/v

  • Serious skin rashes (stevens-Johnson

syndrome)

  • Slowly titrate
  • Interactions: carbamazepine, phenytoin,

phenobarbital, oral contraceptives

Valproate:

  • GI effects: n/v,

ingestion

  • Hepatotoxicity
  • Pancreatitis
  • Thrombocytopenia
  • Tetra genesis
  • Weight gain
  • Monitor plasma levels

o therapeutic

Range: 50-

  • Interactions:

anticonvulsants

Are useful during acute mania with or

without valproate or lithium

Can be used long-term as prophylaxis

against mood episodes.

2nd

Generation Antipsychotics

Control positive and negative symptoms

First line treatment for schizophrenia

ALL second gen meds can cause diabetes, weight gain, and dyslipidemia

 Risperidone

o Potential adverse effect: elevated blood glucose, dyslipidemia

 Asenapine

o Sublingual tablets (DO NOT SWALLOW). Do not eat and drink for 10 minutes after

dosing.

o Adverse effects: drowsiness, prolonged QT interval, EPS for higher doses, temporary

numbing of mouth

 Iloperidone

o Significant risk for weight gain, prolonged QT interval, and orthostatic hypotension

o Common adverse effects: dry mouth, sedation, fatigue, nasal congestion

 Lurasidone

o approved for bipolar depression

o Low risk for weight gain, diabetes, and dyslipidemia

o No anticholinergic effects

o Administer with food (at least 350 calories)

o Common adverse effects: sedation, akathisia, parkinsonism, agitation and anxiety,

nausea

 Paliperidone

 Quetiapine

o Periodic glucose tests should be performed

 Clozapine

o Adverse effects: agranulocytosis, constipation, high risk for weight gain, diabetes, and

dyslipidemia, sedation, orthostatic hypotension, hypersalivation, anticholinergic effects

o You should have your WBC checked once per week for six months (notify provider if

evidence of infection)

 Olanzapine

o Adverse effect: Leukopenia and neutropenia, sedation, orthostatic hypotension,

anticholinergic effects

o low risk for EPS

o high risk of diabetes, weight gain, dyslipidemia

 Ziprasidone

o Adverse effect: Leukopenia and neutropenia

2nd Generation Antipsychotics – Continued

Advantages:

  • Decrease in affective findings (depression, anxiety) and suicidal behaviors
  • Improvement of neurocognitive defects, such as poor memory
  • Few or no EPS
  • Fewer anticholinergic effects (with the exception of clozapine)
  • Less relapse

o Dosing schedule for 2-3 times daily

o Sustained-release is taken 1-2 daily

Alcohol Withdrawal

 Benzodiazepines (used first)

o Chlordiazepoxide

o Diazepam

 minimize manifestations of withdrawal

 Feelings of sedation should resolve in about 1 week (7-10 days)

o Lorazepam

 For acute withdrawal

o Oxazepam

 Adjunct Medications

o Carbamazepine (decrease in seizures)

o Clonidine

o Propranolol (decrease in craving)

o Atenolol (decrease in craving)

Alcohol Maintenance (following withdrawal)

 Disulfiram

o Type of aversion (behavioral) therapy

o If used with alcohol/ any alcohol containing products–

acetaldehyde syndrome will occur

 n/v, weakness, sweating, palpitations, hypotension.

Can progress to respiratory depression, seizures, and

death

 this can occur two weeks even after stopping medication

 ensure no alcohol intake for at least 12 hours prior to administration

o wear a medical alert bracelet

o administered as a deterrent to prevent future alcohol use

o NO pure vanilla extract

 Naltrexone

o Suppresses the craving and pleasurable effects of alcohol

(also used for opioid withdrawal)

o Take with meals

o Can be given monthly via IM injections

 Acamprosate

o Orally three times a day

o Diarrhea can result

o Avoid if pregnant

Opioids

 Methadone

o Used for withdrawal and long-term maintenance for opioid

use disorder

o Prescribed as a substitute for opioids prior to detoxification

 Clonidine

o Does not reduce the craving for opioids

o Avoid activities that require mental alertness until

drowsiness subsides

o Chew gum, etc. to prevent dry mouth

o Obtain baseline vitals

 Buprenorphine

o Used for both withdrawal and maintenance

o Decreases feelings of craving

o Administer sublingually

 Naltrexone

o Opioid antagonist that is used for the long-term

maintenance of opioid use disorder

o The usual medication of choice following detoxification

from opioids

Think: All Dads Need..

alcohol

(Acamprosate,

Disulfiram, Naltrexone)

o One spray in each nostril = amt in one cigarette

o NOT for client’s who have upper respiratory system disorders

o Contains menthol

 Lozenges

o Avoid oral intake 15 minutes prior and during usage

o Allow to dissolve in the mouth (20-30 minutes)

o Limit use to 5 in a 6 hour period, MAX of 20/day

o Available in 2mg and 4mg strengths

 Inhaler

Random

  • Donepezil can improve cognitive function in the early stages of Alzheimer’s disease

o Administer the medication at bedtime to reduce the risk of injury due to bradycardia

and syncope

o Taking with NSAID increases the risk of GI bleeding

  • Thioridazine hydrochloride

o Administer benztropine to reverse extrapyramidal effects of thioridazine

  • Memantine

o Treats moderate to severe Alzheimer’s disease