Mental Health Meds

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1

SSRI's

selective serotonin reuptake inhibitors

generalized anxiety, panic, ocd, depressive, trauma and stressor,

Sertraline (zoloft) - (panic disorder, ocd, social anxiety, ptsd)

Escitalopram (lexapro) - (GAD, OCD)

Fluoxetine (prozac) - (Panic, GAD) (No st. johns wart, causes warfarin increase, higher lithium, birth defects, NSAIDS and anticoags increases bleed risk)

Paroxetine (paxil) - (generalized anxiety, panic, ocd, depressive, trauma and stressor)

Fluvoxamine (luvox)- (OCD, social anxiety )

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SSRI's

Does not block uptake of dopamine or norepinephrine

Paroxetine- CNS stimulation > Insomnia

long half life> 4 weeks for therapeutic effect

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SSRI's adverse effects

Early effects- nausea, diaphoresis, tremor, fatigue, drowsiness. (effects should go away in 5-6 weeks)

Later effects (5-6 weeks in)- sexual dysfunction, anorgasmia, decreased libido, weight gain, H/A

gastrointestinal bleeding

hyponatremia

serotonin syndrome (2-72 hours after start of treatment)- confusion, hallucinations, hyperreflexia, sweating, tremors, anxiety

Bruxism- (can be treated with buspirone (buspar))

withdrawal syndrome - (avoid abrupt discontinuation; taper)

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SSRI contraindications

contraindicated in MAOI's> serotonin syndrome

contraindicated in pregnancy (paroxetine category D)

avoid alcohol

paroxetine caution liver and renal dysfunction, seizure disorder, or hx of gastrointes bleeding.

caustiously in clients who have bipolar disorder, mania!

TAKE WITH FOOD, IN THE MORNING, 4 WEEKS FOR THERAPEUTIC EFFECTS

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Benzodiazepine sedative-hypnotic anxiolytics

enhances inhibitory effects of GABA in CNS. relief occurs rapidly.

diazepam (valium)- tx of seizures, insomnia, muscle spasm, alcohol withdrawal, surgery, anesthesia

lorazepam (ativan)

chlordiazepoxide (librium) **

clorazepate (tranxene) **

oxazepam (serax)

Clonazepam (klonopin)

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benzos adverse effects

CNS depression>avoid operating equipment

Anterograde amnesia> can't remember events after dosing.

toxicity- oral> drowsiness, lethargy> gastric lavage (activated charcoal, saline cathartics). IV> hypotension, respiratory depression, cardiac arrest (Diazepam, Lorazepam)>Flumazenil (romazicon).

Paradoxical response- (insomnia, excitation, euphoria, anxiety, rage)

Withdrawal effects- TAPER off over several weeks

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Benzos contraindications

pregnancy category D

schedule 4 drug

Diazepam contraindicated in sleep apnea, respiratory depression, glaucoma.

diazepam cautiously liver disease, hx or addiction

USED SHORT TERM TO AVOID DEPENDENCE

TAPER OFF > AVOID WITHDRAWAL SYNDROME

ADMINISTER WITH FOOD

AVOID CHEWING OR CRUSHING TABLETS

POTENTIAL DEPENDANCY

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Atypical anxiolytic/ nonbarbiturate anxiolytics

Buspirone (Buspar)

mechanism unknown- does bind to serotonin and dopamine receptors.

Buspar- (panic disorder, OCD, social anxiety, trauma stressor (PTSD))

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Buspirone (Buspar) adverse effects/contraindications

adverse:

CNS effects - dizziness, nausea, H/A, agitation > DOES NOT cause SEDATION

Contraindications:

breastfeeding

cautiously in liver and renal dysfunction

concurrent MAOIs > 14 days after MAOIs is fine > HYPERTENSIVE CRISIS

Medication interactions: (increases effects of buspar)

  • Erythromycin
  • ketoconazole
  • St. Johns wort
  • Grapefruit juice

TAKE WITH MEALS

3-6 WEEKS FOR THERAPEUTIC EFFECTS

TAKE ON A REGULAR BASIS

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Tricyclic Antidepressants

block reuptake of noreponephrine and serotonin in synaptic space, increasing effects

  • Amitriptyline (Elavil)
  • Imipramine (tofranil)
  • Doxepin (Sinequan)
  • Nortriptyline (Aventyl, pamelor)
  • Amoxapine (asendin)
  • Trimipramine (Surmontil)
  • (Am, Im, Dox, Nor, Am Trim. ("ine")
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Tricyclic adverse effects

Orthostatic hypotension

Anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia). interventions: chew gum, sip water, sunglasses outdoors, high fiber, exercise to promote peristalsis, increase fluid 2L/day, void before taking medicine.

Sedation - diminishes over time, dont drive, TAKE AT BEDTIME

toxicity- seizure, coma, death. ECG, 1 week supply to acutely ill patients, vitals

decreased seizure threshold

excessive sweating - frequent linen changes

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Tricyclic contraindications

contraindicated in seizure disorder

cautiously in CAD, DM, liver, kidney and respiratory disorders, urinary retention, BPH, glaucoma, hyperthyroidism.

MAOI's > severe hypertension

antihistamines > increased cholinergic effects

alcohol, benzos, opioids, antihistamines > increased CNS depression

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MAOIs monoamine oxidase inhibitors

blocks MAO in the brain, increases norepinephrine and dopamine and serotonin

- DEPRESSION AND BULIMIA

  • isocarboxazid (marplan)
  • tranylcypromine (parnate)
  • selegiline (emsam) - transdermal patch
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MAOIs adverse effects

  • CNS stimulation
  • orthostatic hypotension
  • hypertensive crisis > tyramine > administer phentolamine IV or nifedipine (procarida)
  • local rash from transdermal patch
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MAOIs contraindications

SSRIs

renal insufficiency, HF, CVD, pheochromocytoma

caution in seizure disorder, renal insufficiency, DM

transdermal selegiline contraindicated in clients taking carbamazepine (tegretol), oxcarbazepne (trileptal) > increases MAOI levels

Medication/food interactions

  • TCAs > hypertensive crisis
  • SSRI's > serotonin syndrome
  • antihypertensives > hypotensive effects
  • over the counter cold remedies (sympathomimetic) > hypertensive crisis
  • meperidine (demerol)> hyperpyrexia (>106.7)
  • hypertensive crisis> TYRAMINE
  • vasopressors - caffeine, phenylethylamine, chocolate, ginseng, fava beans > HTN
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atypical antidepressants

inhibits dopamine uptake

bupropion (wellbutrin)

  1. depression
  2. alternative for SSRIs, sexual dysfunction S/E
  3. aids to quit smoking
  4. prevents seasonal depression

venlafaxine (effexor) (hypoNa+, increases diastolic, avoid abrupt cessation, sexual functioning)

duloxetime (cymbalta) (hypoNa+, increases diastolic, avoid abrupt cessation, sexual functioning)

desvenlafaxine (pristiq) (hypoNa+, increases diastolic, avoid abrupt cessation, sexual functioning)

mirtazapine (remeron) (sleepiness, elevated cholesterol) (replacement of SSRIs)

reboxetine (edronax) (replacement of SSRIs) (dry mouth, hypotension, sexual dysfunction, urinary hesitancy or retention, AVOID MAOI)

trazodone (desyrel) (priapism, taken concurrently with other meds)

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atypical antidepressants adverse effects

H/A, dry mouth, GI distress, constipation, tachy, nausea, restlessness, insomnia > increase fiber, sip water, take mild analgesic

suppression of appetite > weight loss

Seizures

contraindicated:

seizure disorders

MAOIs > discontinue 2 weeks prior> toxicity

anorexia nervosa, bulimia

THERAPEUTIC EFFECTS 1-3 WEEKS, FULL EFFECTS 2-3 MONTHS

CONTINUE THERAPY AFTER RESOLUTION 6MONTHS TO A YEAR

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Mood Stabilizers antiepileptic drugs

  • carbamazepine (tegretol, equtro)
  • valporic acid (depakote)
  • lamotrigine (lamictal)
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antieleptic mood stabilizers adverse effects

Carbimazepine (tegretol,equetro)

  • CNS effects - nystagmus, double vision, vertigo, H/A, staggering gait - admnister at BEDTIME
  • blood dyscrasias (leukopenia, anemia, thrombocytopenia)
  • teratogenesis - no PREGNANCY
  • hypo-osmolarity - promotes secreton of ADH >monitor sodium, htn, urine output
  • skin disorders - dermatitis (steven johnson syndrome)> wear suncreen> use antihistamine in mild reactions
  • CONTRAINDICATED IN PEOPLE WHO HAVE BONE MARROW SUPPRESSION
  • MEDS- oral contraceptives and warfarin- causes decrease in medication
  • grapefruit juice- increases blood levels
  • phenytoin phenobarbital- decreases effect

Lamotrigine (lamictal)

  • double or blurred vision, H/A, dizziness, N/V
  • serious rashes, steven johnsons syndrome
  • carbimazepine, phenytoin, phenobarbital
  • valproic acid
  • oral contraceptives

Valproic acid (depakote)

  • GI effects
  • hepatotoxicity- watch liver function q 2 months for first 6 months, dont give under 2 years old
  • pancreatitis
  • thrombocytopenia
  • teratogenesis
  • BIRTH DEFECTS
  • NO LIVER DISORDERS
  • phenytoin, phenobarbital
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Lithium Carbonate

adverse effects

  • gastrointestinal distress > give with meals or milk
  • fine hand tremors> administer beta blockers > check lithium toxicity
  • polyuria, mild thirst- drink 2-3L/day, spironolactone
  • weight gain
  • renal toxicity
  • Goiter and hypothyroidism (cold, dry skin, bradycardia, weight gain) > give levothyroxine
  • electrolyte imbalance
  • Brady dysrhythmias
  • hypotension

toxicity levels

NORMAL 0.4-0,8

CONTRAINDICATED PREGNANCY (TERATOGENIC, FIRST TRIMESTER ESPECIALLY)

NO BREASTFEEDING

  • diuretics
  • NSAIDS - toxicity
  • anticholinergics - urinary retention, polyuria

Monitor levels Q2-3 days until stable, than Q 1-3 mnths, monitor in morning 12 hours after administered.

0.8-1.4 initially ok

THERAPEUTIC EFFECTS 1-2 WEEKS

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antipsychotics first generation

blocks dopamine, acetylcholine, histamine, norepi.

Treats: psychotic disorders, schizo, bipolar disorder, tourettes disorder, prevention n/v

  • haloperidol (haldol)
  • fluphenazine
  • loxapine
  • thioridazine
  • thiothixene
  • perphenazine
  • trufluoperazine
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antipsychotics adverse effects

  • agronulocytosis > watch for infection, WBC baseline
  • anticholinergic effects
  • extrapyramidal symptoms> acute dystonia (tongue, neck, face, and back spasms, 5 h- 5d after start, CRISIS, treat with anticolinergics. Parkinsonism- treat with anticolinergics. akathisia- inability to sit or stand still, watch for first 2 months, manage with beta blockers, anticholinergic, benzos). Tardive dyskinesia- involuntary movements of tongue and face, such as lip smacking and tongue fasciculations. involuntary arm lefs and trunk movements. evaluate after 12 months and then every 3 months.
  • neuroendocrine effects- gynecomastia, galactorrhea, menstrual irregularities
  • neuroleptic malignant syndrome-
  • orthostatic hypotension
  • sedation
  • seizures
  • severe dysrythmias
  • sexual dysfunction
  • skin effects
  • med/food interactions: anticholinergic agents
  • cns depressants
  • levodopa