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CHAPTER 76:
PSYCHIATRIC
MEDICATIONS
PYRAMID POINTS
I. Selective Serotonin Reuptake Inhibitors (SSRIs)
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Description
• Inhibit serotonin uptake and elicit an antidepressant response
Side effects
• Gastrointestinal disturbances
• Central nervous system (CNS) stimulation
Interventions
• Initiate safety precautions
• Administer with snack or meal
• Monitor suicidal client
• Instruct client taking fluoxetine (Prozac) and bupropion
(Wellbutrin) to take medication early in day
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II. Tricyclic Antidepressants

Description
• Concurrent use with monoamine oxidase inhibitors can cause
hypertensive crisis
• Cardiac toxicity can occur
• Evaluate electrocardiogram (ECG) prior to treatment,
periodically thereafter

Side effects
• Anticholinergic effects
• Photosensitivity
• Cardiovascular disturbances
• Hypotension
• Ejaculatory or erection disturbances
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continued …
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Interventions
• Instruct client that medication may take several weeks to
•
•
•
•
produce desired effect
Monitor suicidal client
Monitor pattern of daily bowel activity
Administer with food or milk
Administer entire daily oral dose at one time, preferably
at bedtime
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III. Monoamine Oxidase Inhibitors (MAOIs)

Description
• Inhibits the enzyme monoamine oxidase; used to treat
depression
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Side effects
• CNS stimulation
• Anticholinergic effects
• Gastrointestinal (GI) disturbances
• Orthostatic hypotension
Hypertensive crisis
• Occurs as a result of consuming tyramine-containing
foods or medications that interact with MAOIs
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continued …

Interventions
• Instruct client about the importance of avoiding tyraminecontaining foods in the diet
• Monitor blood pressure
• Administer with food if GI distress occurs
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IV. Mood Stabilizers

Description
• Affect cellular transport mechanism and enhance serotonin and
gamma-aminobutyric acid (GABA) functioning, which is
associated with mood
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
Lithium
• Common prescribed mood stabilizer
Side effects
• GI disturbances
• Polyuria, polydipsia
• Weight gain
• Abdominal bloating, diarrhea
• Muscle weakness, fatigue
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IV. Mood Stabilizers (Continued)

Interventions
• Monitor suicidal client, especially during improved mood
•
•
•
•
•
and increased energy levels
Administer with food
Maintain adequate fluid and salt intake
Avoid diuretics, alcohol, over-the-counter (OTC)
medications
Monitor lithium levels and for signs of toxicity
Instruct client about signs requiring reporting
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V. Antianxiety or Anxiolytic Medications
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Description
• Depress CNS, producing relaxation
Side effects
• Sedation
• Dizziness
• Hypotension
Acute toxicity
• Results in confusion, diminished reflexes, coma
Interventions
• Monitor for side effects and signs of toxicity
• Initiate safety precautions
Withdrawal
• Should be tapered gradually over 2 to 6 weeks when
discontinued to prevent withdrawal
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VI. Barbiturates and Sedative-Hypnotics

Description
• Used for short-term treatment of insomnia or for sedation to
relieve anxiety, tension, and apprehension
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
Side effects
• Dizziness
• Drowsiness
• Confusion
Interventions
• Maintain safety
• Instruct client to take medication exactly as prescribed and to
avoid driving or operating hazardous equipment if drowsiness,
dizziness, or unsteadiness occurs
• For insomnia, instruct client to take 30 minutes before bedtime
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VII. Antipsychotic Medications

Description
• Improve thought processes and behaviors of the client
with psychotic symptoms

Side effects
• Anticholinergic effects
• Extrapyramidal effects (parkinsonism, dystonias,
akathisia)

Interventions
• Monitor for side effects
• Teach client about signs and symptoms to report
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VIII. Neuroleptic Malignant Syndrome

Description
• Rare but potentially fatal syndrome that can occur at any
time during therapy with neuroleptic medications

Assessment
• Dyspnea
• Tachycardia
• Tachypnea
• Fever
• Skeletal muscle rigidity
• Altered level of consciousness
• Seizure activity
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continued …
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Interventions
• Notify physician
• Monitor vital signs
• Initiate safety and seizure precautions
• Treat symptoms and prepare to administer medications
as prescribed
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IX. Medications to Treat AttentionDeficit/Hyperactivity Disorder (ADHD)
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Children with ADHD may require medication to
reduce hyperactivity, lengthen attention span
CNS stimulants
• Most effective
• Have calming effect on children with ADHD
• Increase alertness
Side effects
• Tachycardia, anorexia, weight loss, agitation
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continued …

Interventions
• Monitor for side effects
• Avoid OTC medications
• Instruct that last daily dose needs to be taken at least 6
hours before bedtime to prevent insomnia
• Monitor dietary intake and weight
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X. Medications to Treat Alzheimer’s Disease
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Acetylcholinesterase inhibitors improve cognitive
function in early stages
Donepezil (Aricept)
• Can slow heart rate
Galantamine (Razadyne)
• Can cause bronchoconstriction
• Use with caution in clients with asthma, chronic
obstructive pulmonary disease
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X. Medications to Treat Alzheimer’s Disease
(continued)

Memantine (Namenda)
• Sodium bicarbonate, other alkalinizing medications can
decrease renal excretion of medication

Rivastigmine (Exelon)
• Use with caution in clients with peptic ulcer disease,
bradycardia, sick sinus syndrome, urinary obstruction,
lung disease

Tacrine (Cognex)
• Hepatotoxic; monitor liver function test results
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A client has been started on therapy with lithium carbonate
(Eskalith). The nurse instructs the client to do which of the
following?
1.
2.
3.
4.
Maintain a fluid intake of 2 to 3 L/day.
Limit salt intake.
Limit fluid intake.
Stop the medication if gastrointestinal (GI) disturbances occur.
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The client has begun taking phenelzine (Nardil). At the initiation
of therapy, the nurse teaches the client that which of the
following items are allowed in the diet?
1.
2.
3.
4.
Red wine, such as Chianti or sherry
Avocados, figs, and raisins
Lunch meats, such as bologna or salami
Carrots, sweet potatoes, and squash
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