Known for its side effects and narrow therapeutic range

Bipolar disorder • Nausea

Helps regulate the “mood swings”
(depression & mania) • Vomiting
• Thirst
• Polyuria
• Tremors

• Confusion • Weight gain

• Blurred vision
Mild: 1.5 - 2 mEq/L
• Diarrhea
Moderate: 2 - 3 mEq/L
• Dehydration
• Tinnitus Severe: > 3 mEq/L causes lithium levels in blood
Ringing in ears • Hyponatremia

• Slurred speech • Old age

kidney function...this means lithium
• Coma builds up in the blood

• Convulsions

• Carry ID that shows you are taking lithium

• Educate on signs & symptoms of toxicity

• Educate and stress importance of taking

medication regularly
• Pregnancy category D:
Contradicted in pregnancy & breastfeeding • Serum lithium levels should be checked
every 1-2 months
• Renal / cardiovascular disease
• Do not operate heavy machinery or drive
• Dehydrated patients
Excessive diarrhea or vomiting • Educate on drinking plenty of water to
avoid dehydration (therefore avoiding tox-
• Receiving diuretics icity)
• Sodium depletion
• Avoid starting a low salt diet
• Hypersensitivity to tartrazine Sudden in salt = in lithium

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 SSRI’s SNRI’s/DNRI’s

Think
ACTION

Inhibits uptake Smiley Affects serotonin,

of serotonin = serotonin Serotonin norepinephrine & dopamine
USES

• Depression • OCD • Depressive episodes • Fibromyalgia

• Anxiety • Eating disorders • Anxiety disorders • Diabetic neuropathy pain
SIDE EFFECTS

• Headache • Nausea • Urinary retention

• Tremors • Dry mouth / thirst • Sexual dysfunc- • Headache • Dry mouth/thirst
• Difficulty sleeping • Constipation tion • Dizziness • Dehydration
3 S’s of SSRI’s SEROTONIN SYNDROME • Vertigo • Constipation
• Too much serotonin • Tightness in muscles • Photosensitivity • Nausea/diarrhea
• Serotonin syndrome
in the brain • Difficulty walking • Agitation/tremors
• Sexual dysfunction • Mental changes • BP & temp • Insomnia
• Stomach issues • Tachycardia
NURSING CONSIDERATIONS

• May take 4 -6 weeks to take effect

Educate on the importance of compliance
• May take 4-6 weeks to take effect
• Take medication in the morning Educate on the importance of compliance
• First line • Do not mix with TCA’s or MAOI’s
• Zyban is used for smoking cessation.
SUICIDE WARNING Do not use it while taking bupropion
A client who had suicidal plans may now have the for depression – it could cause overdose.
energy due to the medication to carry out the plans!

GENERIC TRADE NAME GENERIC TRADE NAME

sertraline Zoloft bupropion Zyban & Wellbutrin
citalopram Celexa duloxetine Cymbalta
DRUG TABLE

escitalopram Lexapro venlafaxine Effexor XR

fluoxetine Prozac milnacipran Savella
vilazodone Viibryd nefazodon —

SUFFIXES SUFFIXES
-talopram, -oxetine, -zodone -faxine, -zodone, -nacipram

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 TCA’s MAOI’s

ACTION
Blocks monoamine oxidase which causes in
Blocks reuptake of serotonin
epinephrine, norepinephrine, dopamine, &
& norepinephrine in the brain serotonin, which causes stimulation of the CNS!

• Depressive episodes

USES
• Neuropathy
• Bipolar disorder Depression
• Enuresis
• OCD

HYPERTENSIVE CRISIS
• Constipation
• Headache

SIDE EFFECTS
• Dry mouth Ca • Orthostatic hypotension
heart p uses • Stiff neck
• Drowsiness patien roblems in • Dizziness
isting c ts with pre-e • Blurred vision • Nausea / vomitting
a x-
• Blurred vision or elde rdiac conditio • Fever
rly clie ns Seek
• Orthostatic hypotension with ca nts...give • Dialated pupils medical h
ution! elp
• Urine retention • Constipation to
blood
pressu
• Cardiotoxic • Dry mouth re
• Nausea/ vomiting

NURSING CONSIDERATIONS
• Can take up to 4 weeks to reach
• May take 2- 3 weeks to take effect
Educate on the importance of compliance therapeutic levels
Educate on the importance of compliance
• WAIT 14 days after being off MAOI’s
• Educate on the signs
to start taking TCA’s
& symptoms of HTN crisis
• Amoxapine is not an antipsychotic drug • Aged cheese
• Avoid foods with Tyramine
but similar to these drugs, it may cause • Fermented meats
• Chocolate
if these symptoms occur) • Caffeinated beverages
• Sour cream & yogurt

GENERIC TRADE NAME GENERIC TRADE NAME

amitriptyline — phenelzine Nardil
amoxapine — tranylcypromine Parnate
DRUG TABLE

clomipramine Anafranil isocarboxazid Marplan

protriptyline Vivactil
nortriptyline Pamelor

SUFFIXES
-triptyline, -pramine

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 Not a
r t li e
drug fo
r treatin
l g
psychia
ter
tric anx
GENERIC TRADE NAME
ie ty
Bipolar disorder conditio
ns alprazolam Xanax
Benzo’s are mainly prescribed for acute anxiety,
lorazepam Ativan
diazepam Valium
clonazepam Klonopin
chlordiazepoxide Librium
Binds to cell receptors enhancing the effects of GABA SUFFIXES
-zolam & -zepam
GABA (inhibitory neurotransmitter)
Antidote: FLUMAZENIL

• Mild drowsiness, sedation

• Lightheadedness, dizziness, ataxia Rise slowly from sitting or lying
• Visual disturbances Do not drive or operate heavy machinery
• Anger, restlessness
• Nausea, constipation, diarrhea Fluids, fiber, & exercise!
Give with food to GI upset
• Lethargy, apathy, fatigue
• Dry mouth Sips of water, suck on hard candy,
chewing sugar-free gum

Withdrawals typically happen when the • Not meant for long term therapy
medication is stopped abruptly or taken because risk for physical & psychological
for >3 months DEPENDENCE
• Anxiety • Agitation • Use of long term therapy leads to
TOLERANCE
• HR • Seizures/tremors Larger doses of the drug are required to
• BP • Insomnia achieve the desired outcome
• Must be TAPERED
• Temp/sweating • Vomiting
the dosage gradually.
• Memory • Muscle aches NEVER stop the medication abruptly!

• Pregnant, laboring & lactating

GENERIC TRADE NAME
women (Preg Category D) Depends on the drug
buspirone Buspar
• Elderly ( chance of dementia) buspirone (Buspar)
acts on serotonin receptors doxepin Silenor
• Impaired liver or kidney function
hydroxyzine (Vistaril) hydroxyzine Vistaril
• Debilitation acts on the hypothalamus & meprobamate —
brainstem reticular formation

63
 Most commonly used for psychosis (schizophrenia)
REVIEW: Why are SGA’s better than FGA’s?
SGA's work on both postive & negative symptoms, and have a lower risk of developing tardive dyskinesia (TD).

Also called typical/conventional Also called atypical

GENERIC TRADE NAME
GENERIC TRADE NAME risperidone Risperdal
chlorpromazine — clozapine Clozaril
haloperidol Haldol quetiapine Seroquel
loxapine Adasuve ziprasidone Geodon
aripiprazole Abilify

• Acts on both serotonin & dopamine in the brain

released in the brain • Helps diminish positive symptoms of schizophrenia
• Helps diminish positive symptoms of schizophrenia & helps negative symptoms as well!

• Anticholernergic effects • Lower risk of TD, EPS & NMS

• Higher risk of TD, EPS, & NMS
• Weight
• Photophobia
• Orthostatic hypotension • Cholesterol
• Photosensitivity • Triglyceride
• Blood sugar

• Involuntary movements of the face, tongue, or limbs that may be irreversible.

• Parkinson’s like symptoms • Akathesia (restlessness) • Dystonia (muscle twitching)

• Combination of symptoms: EPS, high fever, & autonomic disturbance

• One can recover 7-10 days after DC of medication, but it can be fatal
if not treated in time

• Hypersensitivity • Parkinson’s disease

• Educate that it may take • Teach S&S of TD, EPDS, & NMS!
• Comatose pt. • Liver problems 6 - 10 weeks to take • Advise the client to get up slowly
• Depressed • Coronary artery effect
• Tell patient about adverse • Check labs
disease
• Bone marrow reactions and emphasize (blood sugar, LDL, triglycerides)
depression • Hyper or that adherence is very • To decrease the risk of gaining weight,
hypotension important advise the patient about exercise,
• Blood dyscrasias
low-calorie diet, & monitor their
weight.
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