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Psychiatric Medications

Schizophrenia Medications:
First generations medications cause limbic and motor affects; not
use very often
Extrapyramidal side effects (EPS): dystonia, akathsia and
psudeoparkinsons
Anticholinergic drugs for side effects: trihexyphenidyl (Artane) and
benztropine mesylate (Cogentin)
Tardive Dyskenia is persistent EPS is 10% of patient long after
medication is stopped
Other Side effects include: weight gain, sexual dysfunction,
gynecomastia, drooling, and tardive dyskinesia, (Halter 219)
Suffix Chlorpromaize (thorazine) and Haperdoil (Haldol)
Second generations are the primary treatment and cause less EPS
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel),
and ziprasidone
clozapine (Clozaril) is the most effective but due to angroulocytosis
WBC is needed every six months
common side effects is usually metabolic syndromewhich includes
weight gain, dyslipidemia, and altered glucose metabolism thought to
be due to increased insulin resistance
The only third generation Arirprizole (Amblify) and causes little
side effects
Bipolar Medications:

Individuals with bipolar disorder often require multiple medications.


For severe manic episodes, lithium or valproate (Depakote) AND a
second-generation antipsychotic such as olanzapine (Zyprexa) or
risperidone (Risperdal) are recommended.
Lithium has a low therapeutic level and needs to be monitored
carefully for toxicity
Therapeutic level 0.4-1.0 mEq/L |Severe <2.0 mEq/L

Common Side Effects


o Fine tremors, polyuria and mild thirds
Early toxicity
o N/V, diarrhea, slurred speech, muscle weakness

Advanced toxicity
o Confusion, muscle hyperirritability, coarse hand tremors, EKG changes
and sedation
Severe toxicity
o Ataxia, seizures, stupor, severe hypotension, blurred vision,
convulsions DEATH

Anticonvulsants
valproate (Depakote), carbamazepine (Tegretol), and lamotrigine
(Lamictal)
monitor liver and platelet count for valproate (Depakote) AND
carbamazepine (Tegretol)
a rare but very serious demagogical rash may appear with lamotrigine
Sedatives (anxiolytic)
Clonazepam (Klonopin) and lorazepam (Ativan) are antianxiety
(anxiolytic)
Used with acute mania, should not be used in patient with substance
abuse history
Serotonin Selective Reuptake Inhibitors
First line of treatment for major depression
Some SSRIs activate and others sedate; choice depends on patient
symptoms
Risk of lethal overdose minimized with SSRIs

Common Side effects


Agitation, insomnia, headache, nausea and vomiting, sexual
dysfunction, and hyponatremia
SERATONIN SYNDROME
One rare and life-threatening event associated with SSRIs is serotonin
syndrome. This syndrome is thought to be related to over-activation of
the central serotonin receptors caused by either too high a dose or
interaction with other drugs.
Symptoms
o Hyperactivity or restlessness
o Tachycardia cardiovascular shock
o Fever hyperpyrexia

o
o
o
o
o
o
o

Elevated blood pressure


Altered mental states (delirium)
Irrationality, mood swings, hostility
Seizures status epilepticus
Myoclonus, incoordination, tonic rigidity
Abdominal pain, diarrhea, bloating
Apnea death

Tricyclic Antidepressants

desipramine (Norpramin) or protriptyline (Vivactil), may be best for a


patient who is lethargic and fatigued.
If a more sedating effect is needed for agitation or restlessness, drugs
such as amitriptyline (Elavil) and doxepin (Sinequan)
closely resembles that of antipsychotic medications, and the
anticholinergic actions are similar (e.g., dry mouth, blurred vision,
tachycardia, constipation, urinary retention, and esophageal reflux)
urinary retention and severe constipation warrant immediate medical
attention (
The most serious effects of the TCAs are cardiovascular:
dysrhythmias, tachycardia, myocardial infarction, and heart
block.

Monoamine Oxidase Inhibitors

MAOIs are particularly effective for people with unconventional


depression (characterized by mood reactivity, oversleeping, and
overeating) (Halter 268)
Hypertensive crisis usually occurs within a few hours of ingestion of
tyramine.
The crisis may begin with
o headaches, stiff or sore neck,
o palpitations
o increase or decrease in heart rate (often associated with chest
pain),
o N/V, pyrexia
When a hypertensive crisis is suspected, immediate
medical attention is crucial. (Halter 269)

Antianxiety Medications:
Selective Serotonin Reuptake Inhibitors (Antidepressants)

Selective serotonin reuptake inhibitors (SSRIs) are considered the first


line of defense in most anxiety and obsessive-compulsive related
disorders.
Common SSRI
o paroxetine (Paxil)
o fluoxetine (Prozac)
o escitalopram (Lexapro)
o fluvoxamine (Luvox)
o sertraline (Zoloft)

Some of these antidepressants exert more of an activating effect


than others and may actually increase anxiety.
Sertraline (Zoloft) and paroxetine (Paxil) seem to have a more calming
effect than the other SSRIs. (Halter 296)

Benzodiazepines - Antianxiety (anxiolytic)

Benzodiazepines are mainly used in acute situations and for a short


duration until long-term regime can be implemented
An important nursing intervention is to monitor for side effects of the
benzodiazepines, including sedation, ataxia, and decreased
cognitive function.
Benzodiazepines are not recommended for patients with a known
substance abuse problem and should not be given to women during
pregnancy or breast-feeding

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