Module 072

PYRAMID POINTS
MODULE 72:
PSYCHIATRIC MEDICATIONS
COPYRIGHT © 2017, ELSEVIER INC. ALL RIGHTS RESERVED.
Slide 1

MENTAL HEALTH:
Psychiatric Medications
PYRAMID POINTS
I. Selective Serotonin Reuptake Inhibitors (SSRIs)
◦ Description
◦ Inhibit serotonin uptake and elicit an antidepressant response
◦ Side/adverse effects
◦ Gastrointestinal disturbances
◦ Central nervous system (CNS) stimulation
◦ Interventions
◦ Initiate safety precautions.
◦ Administer with snack or meal.
◦ Monitor suicidal client; monitor blood pressure.
◦ Instruct client taking fluoxetine and bupropion to take medication early in
day.
◦ Potential for serotonin syndrome
Slide 2

MENTAL HEALTH:
PYRAMID POINTS
II. Tricyclic Antidepressants
◦ Description
◦ Concurrent use with MAOIs can cause hypertensive crisis.
◦ Cardiac toxicity can occur.
◦ Evaluate electrocardiogram (ECG) prior to treatment, periodically thereafter.
◦ Overdose is life threatening, necessitating immediate treatment.
◦ Side effects
◦ Anticholinergic effects
◦ Photosensitivity
◦ Cardiovascular disturbances
◦ Orthostatic hypotension
◦ Ejaculatory or erection disturbances
Slide 3

MENTAL HEALTH:
PYRAMID POINTS
II. Tricyclic Antidepressants (continued)
◦ Interventions
◦ Instruct client that medication may take several weeks to produce desired effect.
◦ Monitor suicidal client.
◦ Monitor pattern of daily bowel activity.
◦ Administer with food or milk.
◦ Administer entire daily oral dose at one time, preferably at bedtime.
◦ Encourage psychotherapy.
Slide 4

MENTAL HEALTH:
PYRAMID POINTSIII. Monoamine Oxidase Inhibitors (MAOIs)
◦ Description
◦ Inhibits the enzyme monoamine oxidase; used to treat depression
◦ CNS stimulation
◦ Anticholinergic effects
◦ Gastrointestinal disturbances
◦ Orthostatic hypotension
Slide 5

MENTAL HEALTH:
PYRAMID POINTSIII. Monoamine Oxidase Inhibitors (MAOIs) (continued)
◦ Hypertensive crisis
◦ Occurs as a result of consuming tyramine-containing foods or medications that
interact with MAOIs
◦ Antidote is phentolamine by intravenous injection.
◦ Interventions
◦ Instruct client about the importance of avoiding tyramine-containing foods in
the diet (can cause hypertensive crisis).
◦ Monitor blood pressure.
◦ Administer with food if GI distress occurs.
◦ When medication discontinued by HCP, should be discontinued gradually.
Slide 6

MENTAL HEALTH:
PYRAMID POINTS
IV. Mood Stabilizers
◦ Description
◦ Affect cellular transport mechanism and enhance serotonin and gamma-
aminobutyric acid (GABA) functioning, which is associated with mood
◦ Lithium
◦ Commonly prescribed mood stabilizer
◦ Therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L; actual dose at
which the therapeutic effect is achieved and the levels at which toxicity
occurs is highly variable among individual clients.
Slide 7

MENTAL HEALTH:
PYRAMID POINTS
IV. Mood Stabilizers (continued)
◦ GI disturbances
◦ Polyuria, polydipsia
◦ Weight gain
◦ Abdominal bloating, diarrhea
◦ Muscle weakness, fatigue
Slide 8

MENTAL HEALTH:
PYRAMID POINTS
◦ Interventions
◦ Monitor suicidal client, especially during improved mood and increased
energy levels.
◦ Administer with food.
◦ Maintain adequate fluid and salt intake.
◦ Avoid diuretics, alcohol, over-the-counter (OTC) medications.
◦ Instruct client to maintain fluid intake of 6-8 glasses of water a day and
adequate salt intake to prevent lithium toxicity.
◦ Monitor lithium levels and for signs of toxicity.
◦ Monitor weight.
Slide 9

MENTAL HEALTH:
PYRAMID POINTS
◦ Lithium toxicity
◦ Occurs when ingested lithium cannot be detoxified and excreted by the
kidneys
◦ Symptoms of toxicity begin to appear when the serum lithium level is 1.5
to 2 mEq/L.
◦ Can be mild, moderate, or severe toxicity
◦ Interventions
◦ Withhold lithium and notify HCP.
◦ Monitor vital signs and LOC.
◦ Monitor cardiac status.
◦ Monitor for suicidal tendencies, and institute suicide precautions.
Slide 10

MENTAL HEALTH:
PYRAMID POINTS
V. Antianxiety or Anxiolytic Medications
◦ Description
◦ Depress CNS, producing relaxation, may depress limbic system
◦ Daytime sedation
◦ Dizziness
◦ Hypotension
◦ Acute toxicity
◦ Results in confusion, diminished reflexes, coma
◦ Flumazenil reverses benzodiazepine intoxication in 5 minutes.
◦ Interventions
◦ Monitor for side effects and signs of toxicity.
◦ Initiate safety precautions.
◦ Withdrawal
◦ Should be tapered gradually over 2 to 6 weeks when discontinued to prevent
withdrawal
Slide 11

MENTAL HEALTH:
PYRAMID POINTS
VI. Barbiturates and Sedative-Hypnotics
◦ Description
◦ Used for short-term treatment of insomnia or for sedation to relieve
anxiety, tension, and apprehension
◦ Dizziness
◦ Drowsiness
◦ Confusion
◦ Irritability
Slide 12

MENTAL HEALTH:
PYRAMID POINTS
VI. Barbiturates and Sedative-Hypnotics (continued)
◦ Overdose
◦ Tachycardia, weak and rapid pulse, signs of shock
◦ Hypotension
◦ Cold and clammy skin
◦ Withdrawal
◦ Severe withdrawal symptoms begin within 24 hours after the medication is
discontinued in an individual with severe medication dependence.
◦ Anxiety
◦ Insomnia
◦ Nightmares
◦ Daytime agitation
Slide 13

MENTAL HEALTH:
PYRAMID POINTS
VI. Barbiturates and Sedative-Hypnotics (continued)
◦ Interventions
◦ Maintain safety.
◦ Instruct client to take medication exactly as prescribed and to avoid driving
or operating hazardous equipment if drowsiness, dizziness, or
unsteadiness occurs.
◦ For insomnia, instruct client to take 30 minutes before bedtime.
Slide 14

MENTAL HEALTH:
PYRAMID POINTS
VII. Antipsychotic Medications
◦ Description
◦ Improve thought processes and behaviors of the client with psychotic
symptoms, especially schizophrenia
◦ Extrapyramidal syndrome (parkinsonism, dystonias, akathisia, tardive
dyskinesia)
◦ Interventions
◦ Monitor for side effects.
◦ Teach client about signs and symptoms to report.
◦ Monitor urine output and serum glucose levels.
Slide 15

MENTAL HEALTH:
PYRAMID POINTS
VIII. Neuroleptic Malignant Syndrome
◦ Description
◦ Rare but potentially fatal syndrome that can occur at any time during therapy with
neuroleptic (antipsychotic) medications
◦ Assessment
◦ Dyspnea
◦ Tachycardia
◦ Tachypnea
◦ Fever
◦ Skeletal muscle rigidity
◦ Altered level of consciousness
◦ Seizure activity
Slide 16

MENTAL HEALTH:
PYRAMID POINTS
VIII. Neuroleptic Malignant Syndrome (continued)
◦ Interventions
◦ Notify HCP.
◦ Monitor vital signs.
◦ Initiate safety and seizure precautions.
◦ Prepare to discontinue medication.
◦ Monitor LOC.
Slide 17

MENTAL HEALTH:
PYRAMID POINTS
IX. Medications to Treat Attention-Deficit/ Hyperactivity Disorder
◦ Children with ADHD may require medication to reduce hyperactivity behavior and
lengthen attention span.
◦ CNS stimulants
◦ Most effective
◦ Have calming effect on children with ADHD
◦ Increase alertness
◦ Tachycardia
◦ Anorexia and weight loss
◦ Elevated BP
◦ Agitation
Slide 18

MENTAL HEALTH:
PYRAMID POINTS
IX. Medications to Treat Attention-Deficit/ Hyperactivity Disorder (continued)
◦ Interventions
◦ Monitor for CNS side/adverse effects.
◦ Avoid OTC medications.
◦ Instruct that last daily dose needs to be taken at least 6 hours before bedtime to
prevent insomnia.
◦ Monitor dietary intake and weight.
◦ Monitor blood pressure.
Slide 19

MENTAL HEALTH:
PYRAMID POINTS
X. Medications to Treat Alzheimer’s Disease
◦ Acetylcholinesterase inhibitors improve cognitive function in early stages.
◦ Donepezil
◦ Can slow heart rate
◦ Galantamine
◦ Can cause bronchoconstriction
◦ Use with caution in clients with asthma, chronic obstructive pulmonary disease.
Slide 20

MENTAL HEALTH:
PYRAMID POINTS
X. Medications to Treat Alzheimer’s Disease (continued)
◦ Memantine
◦ Sodium bicarbonate, other alkalinizing medications can decrease renal excretion
of medication.
◦ Rivastigmine
◦ Use with caution in clients with peptic ulcer disease, bradycardia, sick sinus
syndrome, urinary obstruction, lung disease.
Slide 21

MENTAL HEALTH:
Audience Response System Question
(for use with iClicker)
A client with Alzheimer’s disease was started on
medication therapy with donepezil 1 month ago. On
return to the clinic for a follow-up visit, the nurse should
assess which vital sign most closely for an adverse effect
from this medication?
1.Heart rate
2.Level of pain
3.Respiratory rate
4.Blood pressure reading
Slide 22

MENTAL HEALTH:
Audience Response System Question
(for use with iClicker)
A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred
vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L. Based on this
information, the nurse should take which action?
1.Administer an antiemetic.
2.Contact the health care provider.
3.Encourage the client to wear sunglasses when outdoors.
4.Implement anxiety reduction techniques to alleviate the tremors.
Slide 23

Module 072

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Module 072