Psychotherapeutic Meds Workshop
Wednesday, April 24, 2024
10:14 AM
• (Missed the 1st question)
• What symptoms do cholinergic receptors effect?
○ Parasympathetic NS
○ Agonists = stimulate
○ More rest & digest
• What do anticholinergic meds do?
○ Dry up secretions
○ More excitability
○ Sympathetic NS stimulation
• What type of symptoms w/ anticholinergic meds? - block parasympathetic
○ Dried up secretion
○ Cant see, pee, spit, poop
○ Think about systems and how they are affected
 CNS - dilated pupils, anxious, excitability
 CV - increased HR & BP, palpitations, dysrhythmias , flushing/redness d/t
increased blood flow
 GI - dry mouth, constipation, decreased saliva
 GU - decreased urine output,
 Vision - blurred vision, glaucoma (blocks fluid from coming out of eye)
 MS - hyperthermia d/t increased muscle contraction
○ Contraindications:
 Glaucoma
 Renal dysfunction
 Arrhythmias
 HTN
 Hyperthyroidism - Grave's disease
 Dementia - associated w/ ACh in the brain
 BPH - reduced outflow --> potential obstruction
• What are sympathomimetics, and what are S/E?
○ Mimic sympathetic NS
 Work on adrenergic receptors - alpha & beta [Look up for review]
 Alpha 1 - vasoconstriction,
 Beta 1 - inotropic (heart squeeze),
○ S/E:
Antidepressant - SSRI/SNRI/MAOI/TCA
DRUG CLASS: SSRI - Selective Serotonin Reuptake Inhibitors
How does it work?
Blocks the reuptake of serotonin
What are some important S/E of this drug class?
CNS: Headache, drowsiness, dizziness, insomnia, nervousness, anxiety, sedation
GI: N/V/D, dry mouth, anorexia, constipation, weight loss
GU: painful menstruation, cystitis, sexual dysfunction, urgency, impotence
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GU: painful menstruation, cystitis, sexual dysfunction, urgency, impotence
Respiratory: cough, dyspnea, URI, pharyngitis
Serotonin Syndrome: confusion, agitation, disorientation, hallucinations, delirium, seizures, tachycardia,
labile BP, diaphoresis, fever, hyperreflexia, tremors, N/V/D, abdominal pain, coma.
What are some nursing indication for this drug class?
Suicide precautions
Drink adequate fluids
Dry mouth - sugar free candies/beverages
Report sexual difficulties
Sertraline - administer in PM
Paroxetine - administer in PM
Examples:
Fluoxetine, Sertraline, Paroxetine, citalopram, escitalopram
DRUG CLASS: SNRI - Serotonin- NE Reuptake Inhibitors
How does it work?
Decrease reuptake of serotonin & NE and weakly dopamine
What are some important S/E of this drug class?
Nausea, constipation, dizziness, headache, higher HR, hyperhidrosis/diaphoresis, erectile dysfunction,
decreased libido, tachycardia, vomiting, palpitations
Serotonin Syndrome: confusion, agitation, disorientation, hallucinations, delirium, seizures, tachycardia,
labile BP, diaphoresis, fever, hyperreflexia, tremors, N/V/D, abdominal pain, coma.
Boxed warning: increase risk of suicidal thoughts & behaviors
What are some nursing indication for this drug class?
Examples:
Desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine (Effexor)
DRUG CLASS: SNRI - TCA - Tricyclic Antidepressants
How does it work?
Block activity of NE & serotonin or increasing the sensitivity of postsynaptic receptor sites
Relieve symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, SI, daily mood variations
What are some nursing indication for this drug class?
Examples:
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Examples:
Amitriptyline, amoxapine, doxepin, imiparmine, desipramine, nortriptyline,
DRUG CLASS: MAOI - Monoamine Oxidase Inhibitors
How does it work?
Block activity of NE & serotonin or increasing the sensitivity of postsynaptic receptor sites
Relieve symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, SI, daily mood variations
What are some nursing indication for this drug class?
Examples:
Amitriptyline, amoxapine, doxepin, imiparmine, desipramine, nortriptyline,
• Which classes of antidepressants are most safe, and which are considered least safe? Why?
○ Most Safe: SSRI/SNRI
○ Least Safe: MAOI/TCA
 MAOI - hypertensive crisis - tyramine
 TCA - OD can be fatal
• What are important points for all antidepressants?
○ Suicide risk
 Black box warning - adolescents/children
○ Takes a few weeks to see effects
○ Don't stop abruptly
 SI
 Withdrawal symptoms
• What are symptoms of W/D?
○ Headache, N/V, agitation, labile mood, vertigo, malaise, nightmares
• Which of antidepressant drug classes has food restrictions and why?
○ MAOI - Tyramine --> Hypertensive crisis
 MAO is an enzyme that breaks down tyramine
• Your pt is taking an MAOI, Write a list of food that they cannot eat these foods in a language
your pt can understand?
 ANYTHING AGED □ Alcohol
□ Aged Cheese
□ Pepperoni/Sausage (cured meats)
□ Soy sauce / teriyaki /
□ Tofu
□ Fermented foods
□ Nava beans
□ Saurkraut
□ Yogurt
□ Coffee
□ Chocolate
□ Aged fruits - avocado, bananas, citrus fruits
• Which antidepressant drug classes puts pts most at risk for cardiac complications?
○ TCA
• 3 main S/E pts complaining about when taking antidepressants
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• 3 main S/E pts complaining about when taking antidepressants
○ Insomnia
○ Sexual dysfunction
○ Weight gain/Loss
 Sleep / Sex / Slim
• 5HT = Serotonin
○ Found in GI tract, CNS, platelet
○ Metabolized by MAO in liver
 Interacts w/ MAOI
• Which block reuptake of Serotonin?
○ SSRI / SNRI / TCA
• What is serotonin syndrome?
○ Build up of serotonin
○ Usually occurs w/in 24H of use
○ Pt w/ serotonin syndrome - stop meds
DRUG ALERT – SEROTONIN SYNDROME
Serotonin syndrome occurs when there is an inadequate washout period between taking
MAOIs & SSRIs or when MAOIs are combined with meperidine. Symptoms of serotonin
syndrome include:
•  Change in mental status state: confusion & agitation
 Neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors,
myoclonic jerks, collapse, and muscle paralysis
 Autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and
diaphoresis
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• Greatest concern for MAOI (what adverse effect is most concerning)?
○ Build up of tyramine --> hypertensive crisis
• How is fluoxetine (Prozac) different from other SSRIs?
○ Takes longer for symptom relief
○ Longer half life (7 days) - longer for drug to leave body
• What can you recommend if an SSRI is making a PT drowsy?
○ Take medication at night
• What can you recommend if a pt is experiencing dry mouth due to meds?
○ Sugar free candies/beverages
• Memorize drugs that are taken on empty stomach
What classes fall w/in anxiolytic category?
• Benzodiazepines - anxiety, W/D,
○ Work on GABA - acts same as alcohol
• Antidepressants
• Buspirone
• Beta-blockers - decreased symptoms
• Antipsychotics
Benzodiazepines
• Antidote - flumazenil IV
What eye condition is contraindication for benzo administration?
• Glaucoma - benzos block outflow.
Seizure protocol - pt starts convulsing, what medicine do you anticipate giving and which route?
• Lorazepam (Ativan) - IV
• 3rd line - barbituates
Pt stopped taking Ativan 2 days after being on it for 6 weeks rx for anxiety. What is primary
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• Pt stopped taking Ativan 2 days after being on it for 6 weeks rx for anxiety. What is primary
concern?
• Withdrawal
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