Mental Health Antidepressants and Mood Stabilizers

• Benign Prostatic Hyperplasia (BPH)

  Glandular units in the prostate gland undergo tissue hyperplasia, resulting in an enlarged prostate
• Treatments for BPH


  • Alpha-adrenergic antagonists
  • 5-Alpha-reductase inhibitors
  • Anticholinergics
  • Phosphodiesterase-5 inhibitors
• The client with BPH should avoid drugs that can cause urinary retention such as anticholinergics, antihistamines, and decongestants
• Alpha-adrenergic antagonists


  • Side effects: CNS - dizziness, headache; CV - orthostatic hypotension; Other - decreased libido, URI, priapism
• Patient teaching for alpha-adrenergic antagonists

  They are also used to control BP, advise using at bedtime, take with food
• 1. Alpha-reductase inhibitors


  Drug names: Finasteride & Dutasteride
• 1. Alpha-reductase inhibitors


  • Side effects: Endo - decreased libido, erectile dysfunction, gynecomastia; CV - orthostatic hypotension
• Patient teaching for 5-Alpha-reductase inhibitors

  Safety: women of childbearing age must not handle crushed or broken tablets, wear gloves when handling tablets
• Anticholinergics


  Side effects: SLUDGE
• Phosphodiesterase-5 inhibitors


  • Most commonly used medical treatment for ED, facilitate erection by enhancing blood flow to the penis
• Phosphodiesterase-5 inhibitors side effects

  • Headache (most common), dyspepsia, nasal congestion & nasopharyngitis; Rare side effects: blurred vision, photosensitivity, sensitivity to light and blue-green color tint, hearing loss, tinnitus, seizures, priapism, and urinary tract symptoms such as dysuria and cloudy or bloody urine
• Patient teaching for Phosphodiesterase-5 inhibitors

  Do not drink grapefruit juice, nitroglycerin/other nitrate medications used to treat heart disease can cause a significant decrease in blood pressure when taken with PDE-5 inhibitors, obtain list of drugs taken by patient, wear sunscreen/protection
• First Generation Antipsychotics (Conventional)

  • Strong blockade of dopamine in the CNS causing serious movement disorders (EPS), has 2 action unlike the 2nd gen
• Second Generation Antipsychotics (Atypical)


  • Moderate blockage of dopamine in the CNS, much stronger blockage of receptors for serotonin, the risk of EPS is lower than with the first-generation antipsychotics, carry a significant risk of metabolic effects such as weight gain, diabetes, and dyslipidemia
• Fluphenazine (Phenothiazine subgroup)


  Blocks dopamine receptors in brain and controls psychotic symptoms
• Fluphenazine side effects


  • CNS: sedation, dizziness, headache, blurred vision, seizures, cerebral edema, EPS;
  • Cardiac: orthostatic hypotension, dysrhythmias;
  • Other: sexual dysfunction, urinary retention, dry mouth
• Haloperidol (Butyrophenone class)


  Alters the effect of dopamine on the CNS, the mechanism for antipsychotic effects is unknown
• Haloperidol uses and contraindications

  • Treats psychoses, schizophrenia, attention-deficit/hyperactivity disorder, Tourette's syndrome;
• Haloperidol side effects


  • CNS: EPS (acute dystonia, akathisia, tardive dyskinesia), parkinsonism, sedation;
  • CV: prolonged QT interval, orthostatic hypotension;
  • Weight gain, sexual dysfunction
• Clozapine (Second-Generation Antipsychotics)


  First atypical agent used to treat schizophrenia and other psychoses
• Clozapine side effects


  • CNS: sedation, tremors, blurred vision; GI: dry mouth, constipation; CV: tachycardia, orthostatic hypotension; Low possibility of EPS
• Clozapine adverse effects


  • Seizures, agranulocytosis - Need to monitor WBC count for leukopenia
• Anxiolytics - Benzodiazepines withdrawal


  Gradually decrease dose over several days, symptoms develop slowly in 2 to 10 days and may last several weeks
• Benzodiazepine withdrawal symptoms


  • Short term use: CNS - tremor, agitation, nervousness, sweating, insomnia; GI - anorexia; Long term use: paranoia, delirium, panic, hypertension, status epilepticus
• Tricyclic Antidepressants (TCA's)


  Side effects: CV - orthostatic hypotension; CNS - sedation, seizures; Other - sexual dysfunction, suicidal ideation; Anticholinergic effects - tachycardia, urinary retention, constipation, dry mouth, blurred vision

  
• TCA's adverse reactions


  Cardiotoxicity - serious effects are rare in the absence of overdose or pre-existing cardiac impairment; Overdose is life threatening - related to anticholinergic and cholinergic blockade
• TCA's patient teaching


  Administration - start low and increase; Onset of therapeutic response is delayed regardless of dosage; Once daily dosing at bedtime; Caution in elderly; Gradually decreased to avoid withdrawal symptoms
• Selective Serotonin Reuptake Inhibitors (SSRIs)


  More commonly used to treat depression than TCAs due to fewer side effects; Do not cause hypotension, sedation, anticholinergic effects, or cardiotoxicity as do many of the TCAs
• SSRI side effects


  • CNS - headache, blurred vision, insomnia, nervousness; GI - dry mouth, nausea, vomiting, diarrhea, anorexia; Other - sexual dysfunction
• SSRI withdrawal syndrome


  Dizziness, headache, nausea, sensory disturbances, tremor, anxiety and dysphoria
• SSRI patient teaching


  Taper the dose slowly, grapefruit juice with SSRIs can lead to toxicity, side effects often decrease over 1 to 4 weeks
• Monoamine Oxidase Inhibitors (MAOIs)


  Used if Depression is not controlled by TCAs and second-generation antidepressants; Effective as TCAs but due to serious adverse reactions very few patients take MAOIs as an antidepressant
• MAOI side effects


  • CNS side effects,
  • CV - orthostatic hypotension
  • Anticholinergic effects,
  • Hypertensive crisis from tyramine interactionliver toxicity
• MAOI patient teaching


  Frequent blood pressure monitoring, some drug interactions can be fatal, avoid CNS stimulants and certain foods that can cause a hypertensive crisis
• Lithium


  Therapeutic range: 0.8 to 1.2 mEq/L; Alteration of ion transport in muscle and nerve cells, increased receptor sensitivity to serotonin
• Lithium uses


  • Bipolar disorder (1st drug used), manic episodes
• Lithium side effects


  • CNS SE
  • GI - metallic taste, thirst, dry mouth
  • Renal - polyuria, dehydration
  • CV - hypotension, peripheral edema
  • Other - weight gain/loss
• Lithium adverse effects


  • Urinary and fecal incontinence, hyperglycemia, proteinuria, leukocytosis, nephrotoxicity;
• Lithium patient education


  Cannot be taken during pregnancy,

  increased sodium intake

  increases renal excretion,

  increased urine output can result in body fluid loss and dehydration,

  adequate fluid intake of 1 to 2 liters
• Lithium nursing interventions


  Observe client for depression, mood changes, insomnia, apathy, or lack of interest in activities; Monitor vital signs, lithium levels, cardiac status; Advise client to avoid caffeine products, monitor sodium intake and fluid intake; Monitor for toxicity; Mouth checks to see if patient swallowed it