Topic 7 - PSYCHIATRIC MEDICATION

• SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Side effects

  Weight loss

  • Dizziness
  • Headache
  • Nervousness
  • Insomnia
  • Photosensitivity
  • Central nervous system (CNS) stimulation
  • Dry mouth
  • Nausea and diarrhea
• Selective Serotonin Reuptake Inhibitors (SSRIs)


  Inhibit serotonin uptake and produce an antidepressant response
• SSRI side effects

  • Nausea and diarrhea
  • Dry mouth
  • Central nervous system (CNS) stimulation
  • Photosensitivity
  • Insomnia
  • Nervousness
  • Headache
  • Dizziness
  • Weight loss
• SSRI implementation


  1. Monitor vital signs

  2. Monitor weight

  3. Initiate safety precautions, particularly if dizziness occurs

  4. Instruct the client to take a single dose in the morning to prevent insomnia

  5. Administer with a snack or with meals to reduce the risk of dizziness and lightheadedness

  6. Monitor the suicidal client, especially during improved mood and increased energy levels

  7. Instruct the client on fluoxetine (Prozac) to take the medication early in the day to avoid interference with sleep

  8. For the client on long-term therapy, monitor liver and renal function tests

  9. Monitor white blood cell (WBC) and neutrophil counts and discontinue the medication, as prescribed, if levels fall below normal

  10. If priapism (painful, prolonged penile erection) occurs, discontinue the medication immediately and notify the physician

  11. Instruct the client to change positions slowly to avoid hypotensive effect

  12. Instruct the client to avoid alcohol

  13. Instruct the client to report any visual changes to the physician
• Tricyclic antidepressants


  Block the reuptake of norepinephrine and serotonin at the presynaptic neuron, used to treat depression, may reduce seizure threshold and antihypertensive agent effectiveness, concurrent use with alcohol or antihistamines can cause CNS depression, concurrent use with MAOIs can cause hypertensive crisis
• Tricyclic antidepressant side effects

  • Anticholinergic effects
  • Dry mouth
  • Decreased gastrointestinal (GI) motility and constipation
  • Difficulty voiding
  • Dilated pupils and blurred vision
  • Photosensitivity
  • Cardiovascular disturbances
  • Tachycardia, dysrhythmias
  • Orthostatic hypotension
  • Sedation
  • Weight gain
  • Anxiety, restlessness, and irritability
  • Decreased or increased libido, with ejaculatory and erection disturbances
• Tricyclic antidepressant implementation


  1. Instruct the client that the medication may take several weeks to produce the desired effect (client response may not occur until 2 to 4 weeks after the first dose)

  2. Monitor the suicidal client, especially during improved mood and increased energy levels

  3. Instruct the client to change positions slowly to avoid hypotensive effect

  4. Monitor pattern of daily bowel activity

  5. Assess for urinary retention

  6. For the client on long-term therapy, monitor liver and renal function tests

  7. Administer with food or milk if GI distress occurs

  8. Administer the entire daily oral dose at one time, preferably at bedtime

  9. Instruct the client to avoid alcohol and nonprescription medications, to prevent adverse medication interactions

  10. Instruct the client to avoid driving and other activities requiring alertness

  11. When the medication is discontinued, it should be tapered gradually
• Monoamine Oxidase Inhibitors (MAOIs)


  Inhibit MAO enzyme, which metabolizes amines, norepinephrine, and serotonin, increasing their concentrations, used for depression in clients who have not responded to other antidepressant therapies, concurrent use with certain medications can cause hypertensive crisis
• MAOI side effects


  • Orthostatic hypotension
  • Restlessness
  • Insomnia
  • Dizziness
  • Weakness, lethargy
  • GI upset
  • Dry mouth
  • Weight gain
  • Peripheral edema
  • Anticholinergic effects
  • CNS stimulation, including anxiety agitation and mania
  • Delay in ejaculation
• Hypertensive crisis symptoms


  • Hypertension
  • Occipital headache radiating frontally
  • Neck stiffness and soreness
  • Nausea and vomiting
  • Sweating
  • Fever and chills
  • Clammy skin
  • Dilated pupils
  • Palpitations, tachycardia, or bradycardia
  • Constricting chest pain
• MAOI implementation


  1. Monitor blood pressure frequently for hypertension

  2. Monitor for signs of hypertensive crisis

  3. If palpitations or frequent headaches occur discontinue the medication and notify the physician

  4. Administer with food if GI distress occurs

  5. Instruct the client that the medication effect may be noted during the first week of therapy, but maximum benefit may take up to 3 weeks

  6. Instruct the client to report headache, neck stiffness, or neck soreness immediately

  7. Instruct the client to change positions slowly to prevent orthostatic hypotension

  8. Instruct the client to avoid caffeine or over-the- counter preparations such as weight-reducing pills or medications for hay fever and colds

  9. Monitor for client compliance with medication administration

  10. Instruct the client to carry a Medic-Alert card indicating that an MAOI medication has been prescribed

  11. Avoid administering the medication in the evening because insomnia may result

  12. MAO inhibitors should be tapered and discontinued 7 to 14 days before surgery

  13. When the medication is discontinued, it should be discontinued gradually

  14. Instruct the client to avoid foods that require bacteria or molds for their preparation or preservation or those that contain tyramine
• Antimanic medications


  Affect cellular transport mechanism and alter both the presynaptic and postsynaptic events affecting serotonin, thus enhancing serotonin function, concurrent use with certain medications can increase or decrease lithium levels, therapeutic dose is only slightly less than toxic dose, therapeutic serum level is 0.6 to 1.2 mEq/L
• Antimanic medication side effects

  • Polyuria
  • Polydipsia
  • Anorexia, nausea
  • Dry mouth
  • Mild thirst
  • Weight gain
  • Abdominal bloating
  • Soft stools or diarrhea
  • Fine hand tremors
  • Inability to concentrate
  • Muscle weakness
  • Lethargy
  • Fatigue
  • Headache
  • Hair loss
• Antimanic medication implementation


  1. Monitor the suicidal client, especially during improved mood and increased energy levels

  2. Administer the medication with food to minimize GI irritation

  3. Instruct the client to maintain a fluid intake of 6 to 8 glasses of water a day

  4. Instruct the client to avoid excessive amounts of coffee, tea, or cola, which have a diuretic effect

  5. Instruct the client to maintain an adequate salt intake

  6. Do not administer diuretics while the client is taking lithium

  7. Instruct the client to avoid alcohol

  8. Instruct the client to avoid over-the-counter medications

  9. Instruct the client that he or she may take a missed dose within 2 hours of the
• Blood samples to check serum lithium levels


  Should be drawn in the morning, 12 hours after the last dose was taken
• Side effects of antimanic medications

  • Polyuria
  • Polydipsia
  • Anorexia, nausea
  • Dry mouth
  • Mild thirst
  • Weight gain
  • Abdominal bloating
  • Soft stools or diarrhea
  • Fine hand tremors
  • Inability to concentrate
  • Muscle weakness
  • Lethargy
  • Fatigue
  • Headache
  • Hair loss
• Implementation of antimanic medications

  1. Monitor the suicidal client, especially during improved mood and increased energy levels

  2. Administer the medication with food to minimize GI irritation

  3. Instruct the client to maintain a fluid intake of 6 to 8 glasses of water a day

  4. Instruct the client to avoid excessive amounts of coffee, tea, or cola, which have a diuretic effect

  5. Instruct the client to maintain an adequate salt intake

  6. Do not administer diuretics while the client is taking lithium

  7. Instruct the client to avoid alcohol

  8. Instruct the client to avoid over-the-counter medications

  9. Instruct the client that he or she may take a missed dose within 2 hours of the scheduled time; otherwise the client should skip the missed dose and take the next dose at the scheduled time

  10. Instruct the client not to adjust the dosage without consulting the physician, because lithium should be tapered off and not discontinued abruptly

  11. Instruct the client in the signs and symptoms of lithium toxicity

  12. Instruct the client to notify the physician if polyuria, prolonged vomiting, diarrhea, or fever occurs

  13. Instruct the client that the therapeutic response to the medication will be noted in 1 to 3 weeks

  14. Monitor electrocardiogram (ECG), renal function tests, and thyroid tests
• Lithium toxicity


  Occurs when ingested lithium cannot be detoxified and excreted by the kidneys
• Symptoms of mild lithium toxicity

  • Apathy
  • Lethargy
  • Diminished concentration
  • Mild ataxia
  • Coarse hand tremors
  • Slight muscle weakness
• Symptoms of moderate lithium toxicity

  • Nausea, vomiting
  • Severe diarrhea
  • Mild to moderate ataxia and incoordination
  • Slurred speech
  • Tinnitus
  • Blurred vision
  • Muscle twitching
  • Irregular tremor
• Symptoms of severe lithium toxicity

  • Nystagmus
  • Muscle fasciculations
  • Deep tendon hyperreflexia
  • Visual or tactile hallucinations
  • Oliguria or anuria
  • Impaired level of consciousness (LOC)
  • Grand mal seizure or coma leading to death
• Implementation for lithium toxicity

  1. Hold lithium and notify the physician

  2. Monitor vital signs and LOC

  3. Monitor cardiac status

  4. Prepare to obtain lithium level; electrolyte blood urea nitrogen (BUN), and creatinine counts; and complete blood cell (CBC) count

  5. Monitor for suicidal tendencies and institute suicide precautions
• Lithium


  • Eskalith
  • Lithobid
• Valproic Acid


  • Depakote
• Lamotrigine


  • Lamictal
• Carbamazepine


  • Tegretol
• Olanzapine


  • Zyprexa
• Quetiapine


  • Seroquel
• Risperidone


  • Risperdal
• Antianxiety or anxiolytic medications

  Depress the CNS, thereby increasing the effects of gamma-aminobutyric acid (GABA), which produces relaxation and may depress the limbic system
• Benzodiazepines


  Have anxiety-reducing (anxiolytic), sedative-hypnotic, muscle-relaxing, and anticonvulsant actions
• Side effects of antianxiety or anxiolytic medications

  • Daytime sedation
  • Ataxia
  • Dizziness
  • Headaches
  • Blurred or double vision
  • Hypotension
  • Tremor
  • Amnesia
  • Slurred speech
  • Urinary incontinence
  • Constipation
  • Paradoxical CNS excitement
• Symptoms of acute toxicity of antianxiety or anxiolytic medications

  • Somnolence
  • Confusion
  • Diminished reflexes and coma
• Flumazenil (Romazicon)


  A benzodiazepine antagonist, administered IV, will reverse benzodiazepine intoxication in 5 minutes
• The client being treated for an overdose of a benzodiazepine may experience agitation, restlessness, discomfort, and anxiety
• Implementation of antianxiety or anxiolytic medications

  1. Monitor for motor responses such as agitation, trembling, and tension

  2. Monitor for autonomic responses such as cold, clammy hands and sweating

  3. Monitor for paradoxical CNS excitement during early therapy, particularly in elderly or debilitated individuals

  4. Monitor for visual disturbances, since the medications can worsen glaucoma

  5. Monitor liver and renal function tests and blood counts

  6. Reduce the medication dose, as prescribed, for the older adult client and for the client with impaired liver function

  7. Initiate safety precautions because the older adult client is at risk for falling when taking the medication for sleep or anxiety

  8. Assist with ambulation if drowsiness or lightheadedness occurs

  9. Instruct the client that drowsiness usually disappears during continued therapy

  10. Instruct the client to avoid tasks that require alertness until the response to the medication is established

  11. Instruct the client to avoid alcohol

  12. Instruct the client not to take other medications without consulting the physician

  13. Instruct the client not to withdraw the medication abruptly
• Withdrawal from antianxiety or anxiolytic medications

  1. To lessen withdrawal symptoms, the dosage of a benzodiazepine should be tapered gradually over 2 to 6 weeks

  2. Abrupt or too rapid withdrawal results in: Restlessness, Irritability, Insomnia, Hand tremors, Abdominal or muscle cramps, Sweating, Vomiting, Seizures
• Benzodiazepines


  • Alprazolam (Xanax): Used for the short-term relief of symptoms of anxiety and panic disorders
  • Lorazepam (Ativan): Prescribed for anxiety disorders and for the short-term relief of symptoms of anxiety
• Non-benzodiazepine anxiolytics


  • Buspirone (Buspar): An anxiolytic that is not a benzodiazepine, used for the treatment of generalized anxiety disorder (GAD)
  • Diazepam (Valium): Though primarily used as a muscle relaxant and anticonvulsant, diazepam is sometimes prescribed for anxiety disorders
  • Hydroxyzine (Vistaril, Atarax): An antihistamine that also has anxiolytic properties, used to treat anxiety and tension
  • Gabapentin (Neurontin): Initially developed as an antiepileptic drug, gabapentin is also prescribed off-label for anxiety disorders
  • Pregabalin (Lyrica): Similar to gabapentin, pregabalin is used for various conditions, including generalized anxiety disorder
• Medications for insomnia and anxiety

  • Depress the reticular activating system by promoting the inhibitory synaptic action of the neurotransmitter GABA
  • Used for short-term treatment of insomnia or for sedation to relieve anxiety, tension, and apprehension