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ATI Mental Health Medications Psychology (PSY) Alverno College PN Mental Health Nursing Edition 10. 0 - Assessment Technologies Institute 20 pages 2023/2024
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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
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
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
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
Therapeutic use: depressive disorder
Complications:
headache, lightheadedness, agitation,
nervousness, sedation, excitement)
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:
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
Complications:
o Urinary retention – report immediately
Contraindications/Precautions:
disorders, urinary retention, angle closure glaucoma, benign
prostatic hypertrophy and hyperthyroidism
Interactions:
A norepinephrine and serotonin specific
antidepressant
Mirtazapine
Less sexual dysfunction than with SSRIs
Generally well tolerated
Decreases elevated vital signs and manifestations of anxiety, panic, hypervigilance, and insomnia
Propranolol
Can decrease manifestations of hypervigilance and insomnia
Prazosin
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:
CNS depressants, increased appetite and
weight gain, elevated cholesterol
to quit
with an
Monitor for hyponatremia
neurol
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:
restlessness, insomnia, dizziness
Contraindications/Precautions:
Interactions:
Complications:
o Administer with meals or milk
o Administer beta-blocker (propranolol)
o Use potassium sparing diuretic (spironolactone)
o Monitor BUN and creatinine
o Obtain baseline T3 T4 and TSH levels
o Administer levothyroxine
imbalances
Contraindications/Precautions:
Interactions:
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
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:
Carbamazepine:
Lurasidone
Olanzapine
Quetiapine
Aripiprazole
Risperidone
Asenapine
Cariprazine
Ziprasidone
Ziprasidone
Olanzapine
Aripiprazole
Lamotrigine:
headache, n/v
syndrome)
phenobarbital, oral contraceptives
Valproate:
ingestion
o therapeutic
Range: 50-
anticonvulsants
Are useful during acute mania with or
without valproate or lithium
Can be used long-term as prophylaxis
against mood episodes.
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
Advantages:
o Dosing schedule for 2-3 times daily
o Sustained-release is taken 1-2 daily
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)
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
use disorder
drowsiness subsides
Naltrexone
maintenance of opioid use disorder
from opioids
Think: All Dads Need..
alcohol
(Acamprosate,
Disulfiram, Naltrexone)
Lozenges
Inhaler
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
o Administer benztropine to reverse extrapyramidal effects of thioridazine
o Treats moderate to severe Alzheimer’s disease