Mental Health Exam #3 Medications (1).
Mental Health Exam #3 Medications
Benzodiazepines
T. Class: Anxiolytics aka Antianxiety
Indications: Anxiety Disorder and Symptoms (SHORT-TERM)
● Addictive. Must taper (under supervision; gradually 2-6 weeks)
● Not for Depression!!!
● Contraindication = pt’s with narrow angle glaucoma
● Use with caution in children and older adults.
● Lorazepam (Ativan)
○ Also for: Insomnia from stress
○ AdvFx:
■ Confusion
■ Depression
■ Drowsiness
■ Dry mouth
■ Nausea
■ CV collapse
■ Restlessness
○ NC/PT
■ No alcohol
■ Report vision changes, chest pain, and fainting.
● Alprazolam (Xanax)
○ Also for: Panic Disorders
○ AdvFx:
■ Anger
■ Confusion
■ Constipation
■ CV collapse
■ Disorientation
■ Drowsiness
■ Drug dependency
■ Excitation 1st-two weeks of Tx
■ Restlessness
○ NC/PT
■ No alcohol
■ Interactions:
● Digoxin
● Grapefruit juice
● Diazepam (Valium)
○ AdvFx:
■ Bradycardia
■ Confusion
,Mental Health Exam #3 Medications (1).
■ Constipation
■ CV collapse
■ Depression
■ Diarrhea
■ Libido changes
■ Tachycardia
■ Urine retention
○ NC/PT
■ No alcohol
■ Suggest Med Alert tag
■ Not for pregnancy
● Chlordiazepoxide (Librium)
○ Also for: Alcohol withdrawal
○ AdvFx:
■ Confusion
■ CV collapse
■ Depression
■ Diarrhea
■ Disorientation
■ Drowsiness
■ Drug dependency
■ Urine retention
○ NC/PT
■ No alcohol, contraceptives, or smoking.
■ Not for pregnancy
■ CNS precautions
Non-Benzo
● Buspirone (Buspar) MH Hesi med
○ AdvFx:
■ ABD distress
■ Dizziness
■ Dry mouth
■ Headache
■ Insomnia
■ Light-headedness
○ NC/PT
■ No alcohol, grapefruit juice, MAOIs
■ Use analgesic for headache
■ Avoid OTC sleep meds
■ CNS precautions
, Mental Health Exam #3 Medications (1).
SSRIs
Selective Serotonin Reuptake Inhibitors
How it works: Inhibit serotonin uptake and elicit an antidepressant response.
T. Class: Antidepressants
● First Class of Choice
● Lots of GI disturbances
● Medication of choice for pt’s with Onychophagia (Nail Biting)
● MUST TAPER!
● Inform pt that it may take up to 2-4 weeks after first dose and changes may be
subtle.
Ind: Mood Disorders, Anxiety Disorders, Panic Disorders, OCD
● Escitalopram (Lexapro)
● Citalopram (Celexa)
● Sertraline (Zoloft) MH Hesi med
● Paroxetine (Paxil) - OCD
● Fluoxetine (Proza, Sarafem)*
○ AdvFx
■ Nausea, insomnia, weight gain, nervousness, anxiety, headache
■ Sexual dysfunction
■ Hyponatremia, Risk of GI bleed
■ Serotonin syndrome
○ Contraindications
■ Sensitivity to SSRIs
■ Use of MAOIs
○ NC/PT
■ Increase risk of depression, suicide
■ Do not stop abruptly
■ Not for pregnancy
■ Bleeding problems may occur with NSAIDs
■ May take up to two-weeks for full effect
○ Fluoxetine
■ Tx for Anorexia Nervosa BUT an AdvFx is weight loss!
■ Tx IED
SNRI/Atypical
Serotonin and Norepinephrine Reuptake Inhibitor
- How it differs from SSRI is that it blocks the effects of norepinephrine in addition
to serotonin.
T. Class: Antidepressants
● Venlafaxine (Effexor) - SNRI
○ Ind:
■ Major depression, Panic disorder, Anxiety disorder, and Social anxiety.
Mental Health Exam #3 Medications
Benzodiazepines
T. Class: Anxiolytics aka Antianxiety
Indications: Anxiety Disorder and Symptoms (SHORT-TERM)
● Addictive. Must taper (under supervision; gradually 2-6 weeks)
● Not for Depression!!!
● Contraindication = pt’s with narrow angle glaucoma
● Use with caution in children and older adults.
● Lorazepam (Ativan)
○ Also for: Insomnia from stress
○ AdvFx:
■ Confusion
■ Depression
■ Drowsiness
■ Dry mouth
■ Nausea
■ CV collapse
■ Restlessness
○ NC/PT
■ No alcohol
■ Report vision changes, chest pain, and fainting.
● Alprazolam (Xanax)
○ Also for: Panic Disorders
○ AdvFx:
■ Anger
■ Confusion
■ Constipation
■ CV collapse
■ Disorientation
■ Drowsiness
■ Drug dependency
■ Excitation 1st-two weeks of Tx
■ Restlessness
○ NC/PT
■ No alcohol
■ Interactions:
● Digoxin
● Grapefruit juice
● Diazepam (Valium)
○ AdvFx:
■ Bradycardia
■ Confusion
,Mental Health Exam #3 Medications (1).
■ Constipation
■ CV collapse
■ Depression
■ Diarrhea
■ Libido changes
■ Tachycardia
■ Urine retention
○ NC/PT
■ No alcohol
■ Suggest Med Alert tag
■ Not for pregnancy
● Chlordiazepoxide (Librium)
○ Also for: Alcohol withdrawal
○ AdvFx:
■ Confusion
■ CV collapse
■ Depression
■ Diarrhea
■ Disorientation
■ Drowsiness
■ Drug dependency
■ Urine retention
○ NC/PT
■ No alcohol, contraceptives, or smoking.
■ Not for pregnancy
■ CNS precautions
Non-Benzo
● Buspirone (Buspar) MH Hesi med
○ AdvFx:
■ ABD distress
■ Dizziness
■ Dry mouth
■ Headache
■ Insomnia
■ Light-headedness
○ NC/PT
■ No alcohol, grapefruit juice, MAOIs
■ Use analgesic for headache
■ Avoid OTC sleep meds
■ CNS precautions
, Mental Health Exam #3 Medications (1).
SSRIs
Selective Serotonin Reuptake Inhibitors
How it works: Inhibit serotonin uptake and elicit an antidepressant response.
T. Class: Antidepressants
● First Class of Choice
● Lots of GI disturbances
● Medication of choice for pt’s with Onychophagia (Nail Biting)
● MUST TAPER!
● Inform pt that it may take up to 2-4 weeks after first dose and changes may be
subtle.
Ind: Mood Disorders, Anxiety Disorders, Panic Disorders, OCD
● Escitalopram (Lexapro)
● Citalopram (Celexa)
● Sertraline (Zoloft) MH Hesi med
● Paroxetine (Paxil) - OCD
● Fluoxetine (Proza, Sarafem)*
○ AdvFx
■ Nausea, insomnia, weight gain, nervousness, anxiety, headache
■ Sexual dysfunction
■ Hyponatremia, Risk of GI bleed
■ Serotonin syndrome
○ Contraindications
■ Sensitivity to SSRIs
■ Use of MAOIs
○ NC/PT
■ Increase risk of depression, suicide
■ Do not stop abruptly
■ Not for pregnancy
■ Bleeding problems may occur with NSAIDs
■ May take up to two-weeks for full effect
○ Fluoxetine
■ Tx for Anorexia Nervosa BUT an AdvFx is weight loss!
■ Tx IED
SNRI/Atypical
Serotonin and Norepinephrine Reuptake Inhibitor
- How it differs from SSRI is that it blocks the effects of norepinephrine in addition
to serotonin.
T. Class: Antidepressants
● Venlafaxine (Effexor) - SNRI
○ Ind:
■ Major depression, Panic disorder, Anxiety disorder, and Social anxiety.
