unit 3 mental health medications

Antidepressant black box warning

All antidepressants carry an FDA black-box warning for increased risk of suicidality in children and adolescents.

What is the nursing intervention for the following safety issue of anxiolytics? Blood dyscrasias, although rare, can be serious or life threatening

Assess for sore throat, fever, bruising, or unusual bleeding. Hold medication and report these symptoms immediately to the doctor.

What is the nursing intervention for the following safety issue of anxiolytics? Antianxiety agents may aggravate symptomsof depression.

Assess the client's mood and assess for suicide risk.

Anxiolytic medication example

Benzodiazepines

Long term anxiolytics

Buspirone, Fluoxetine, and sertraline

Drug interactions with SSRIs

Buspirone, TCAs (especially clomipramine), selegiline, St. John's Wort: Serotonin syndrome MAOIs: Hypertensive crisis Warfarin, NSAIDs: Increased risk of bleeding Alcohol, benzodiazepines: Increased sedation Antiepileptics: Lowered seizure threshold

Which of the following medications would be an appropriate prn medication for an individual with anxiety symptoms? a) Buspirone b) Alprazolam c) Fluoxetine d) Sertraline

Correct answer: B Alprazolam is a benzodiazepine that works as a CNS depressant to produce quick-acting effects of relaxation in an individual with anxiety symptoms. Buspirone has a delayed effect and should not be used on a prn basis. Fluoxetine and sertraline may be used on a long- term basis with individuals who have anxiety disorders but are not effective on a prn basis for anxiety symptoms.

Anxiolytics action

Depression of the central nervous system (CNS) by mediating the effects of GABA (inhibitory neurotransmitter) with an exception to Buspirone which is a partial agonist at serotonin receptors

What is the nursing intervention for the following safety issue of anxiolytics? Paradoxical excitement (opposite from the desired effect) may occur. Especially the elderly may be at higher risk for agitation and increased anxiety

Hold the medication and notify the doctor

Antidepressant actions

Increase concentration of norepinephrine, serotonin, or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, SSRIs, SNRIs MAOIs: Inhibiting the release of monoamine oxidase inhibitors (MAOIs)

Contraindications (drug interactions) to anxiolytics

Increased effects of anxiolytic agents can occur when taken concomitantly with alcohol, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidine, or disulfiram. Increased effects can also occur with herbal depressants. Decreased effects can be noted with cigarette smoking and caffeine consumption.

What is the nursing intervention for the following safety issue of anxiolytics? Drowsiness, confusion, and lethargy are the most common side effects

Instruct client not to drive or operate dangerous machinery while taking this medication

What is the nursing intervention for the following safety issue of anxiolytics? Tolerance and physical dependence may develop. Abrupt withdrawal can be life threatening (except with buspirone); signs include sweating, agitation, tremors, nausea, and vomiting, delirium, seizures

Instruct client not to stop taking the drug abruptly. Assess the client for signs of developing tolerance (requiring higher doses of medication to achieve effects). Educate the client about symptoms of withdrawal. Contact the doctor immediately if symptoms of withdrawal are assessed.

What is the nursing intervention for the following safety issue of anxiolytics? Effects of other CNS depressants are increased

Instruct the client not to drink alcohol or take other CNS depressants, antihistamines, cimetidine, antidepressants, neuromuscular blocking agents, or disulfiram while taking these drugs

What is the nursing intervention for the following safety issue of anxiolytics? Orthostatic hypotension may occur.

Instruct the client to rise slowly from a sitting to standing position to minimize risk for falls. Monitor lying and standing blood pressures to assess for orthostatic hypotension.

What is the nursing intervention for the following safety issue of anxiolytics? Congenital malformations have been associated with use of these drugs during the first trimester of pregnancy

Instruct the female client who is pregnant or anticipating pregnancy while on these drugs to explore alternative treatment options with her prescriber

Antidepressant indications

Major depressive and dysthymic disorders (longstanding mood disorder) • Some atypical drugs have received FDA approval • Most anxiety disorders, bulimia nervosa, premenstrual dysphoric disorder, borderline personality disorder, obesity, smoking cessation, and alcoholism

First line antidepressant medication categories

SSRI SNRI

Serotonin Function

Serotonin in your brain regulates your mood. It's often called your body's natural "feel good" chemical. When serotonin is at normal levels, you feel more focused, emotionally stable, happier and calmer. Low levels of serotonin are associated with depression. Many medications used to treat anxiety, depression and other mood disorders often target ways to increase the level of serotonin in your brain.

Short term anxiolytics

benzodiazepine (ex. diazepam, alprazolam, clonazepam (klonopin), diazepam (valium), chlordiazepoxide (librium), lorazepam (ativan), flurazepam (dalmane))

Benzodiazepine drugs

clonazepam (klonopin) diazepam (valium) chlordiazepoxide (librium) lorazepam (ativan) flurazepam (dalmane)

Anxiolytic indications

nxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation

What does SSRI stand for?

selective serotonin reuptake inhibitor

What does SNRI stand for?

serotonin norepinephrine reuptake inhibitor

serotonin syndrome

serotonin overstimulation, potentially fatal (high fever, convulsions, severe HTN, psychosis) can occur if pt overdoses or if pt takes it too close to taking an MAOI (pt will need a watch out period to wean off MAOI before taking serotonin increaser)

Define reuptake

the process of neurotransmitter inactivation