Pharmacology - Psychiatric Medications for nursing RN PN (MADE EASY)

hey guys nurse Mike here and welcome to simple nursing calm before we get today's lecture started please remember click here to check out our brand new app based NCLEX product loaded with the highest quality and click style practice questions and complete with detailed video rationales that break down the question for you so finally mastered all those darn select all that apply questions plus all our NCLEX memberships come included with our entire library of over a thousand videos and study guides and cheat sheets come see why over a hundred thousand students have trusted their future to simple nursing calm click here to get started for free now anxiolytics given for anxiety and seizures guys we have benzodiazepines barbiturates and buspirone now the key point here is that benzos and barbs are the dangerous one since they're sedatives making the vitals low and slow and buspirone does not sedate so think you can still drive the bus in buspirone or buspirone now first up is benzodiazepines ending in lamb and Pam like alprazolam and temazepam the good news is that it acts fast within minutes but the bad news here is that it's highly addictive and hard to come off so guys they're not safe for long-term use so the memory trick is just think benzos is like driving a Mercedes Benz with two crazy chicas Pam and lamb guys we're talking living life in the fast lane doing all the things mama told you not to do so guys it's highly addictive and it's a very dangerous lifestyle again these are given for anxiety and seizures but also for alcohol withdrawal and sedation like a medically induced coma for brain swelling now the mechanism of action is pretty simple it increases gaba which decreases activity of neurons so we just think that grandma is gaba or we call gaba or grandma it keeps everyone calm and relaxed kind of like reading you a bedtime story so it's very sedating if you want more gaba we get more sedation so guys the biggest side effect here is the big sedation everything is low and slow so the memory trick is that benzos bring everything low so in the heart we get a low heart rate and blood pressure and the lungs we get low respiratory rate leading to deadly respiratory depression and in the brain we have sedation so guys the big patient teaching is sedation sleepiness and the suppression of ABCs so big key points to write down we take at bedtime and you don't skip doses guys those are two big NCLEX tips coming up in multiple sections now sedation effects and rebound anxiety are the big dangers here so we keep taking even when the patient is feeling okay and we always taper off and never abruptly or suddenly stop and the next topic here is stop drinking alcohol including wine which is always a big topic on exams since it can cause more sedation and the obvious one here is don't operate dangerous machines now the antidote to benzos is write this down flumazenil and the antidote to opioids is naloxone brand name narcan now a few quiz banks including the ATI and the Hesse touched on respiratory arrest using this antidote guys so make sure to write this down and don't get tricked between these two now next up are barbiturates ending in barbra tall like phenobarbital now the good news is it lasts longer in the body usually three to five days and the bad news is it takes longer to get out of the body so we have higher risk for toxicity leading to hypotension and respiratory depression and then ultimately death now a common Hesse question is a scenario of a patient on phenobarbital with low blood pressure and increased sedation guys this is huge priority always assess this patient first so to help you remember this the memory trick is bar for barbiturates or bar like barb at all just think of a bar so you went to the bar and now you're sedated and sleepy and now you're probably locked behind bars like a prison since they last a long time so just think bar is large lasting very toxic sedation and high death rates now buspirone we call buspirone since our memory trick is like riding the bus since it's slow and really easy to quit now guys it's not sedating so you can still drive the bus of boosts perón now it's an atypical and Ziya lytic and the good news is there's no depressant effects but the bad news is that the bus is slow and guys it takes a long time to kick in so the key point to know for the exam is two to four weeks for full effect and the good thing here is no withdrawal symptoms guys that's usually a common mistake on NCLEX exams as well as Hesse so the good news here not addictive no dependence no tolerance and no sedation with again no withdrawal symptoms so it's safe for long-term use again like riding the bus slow and easy to quit now for patient teaching yes driving is okay guys no sedation so you can still drive the bus and again it's not for acute attacks usually taken on a regular basis not as needed now two common test questions for an Zaya lytx question number one patient teaching for diazepam select all that apply guys remember Pam and Lam is like living the fast dangerous life everything's very sedated so number one avoid valerian roots yes guys valerian is like valium have to avoid too much sedation number two avoid ginkgo and ginseng no no no no those are for usually bleeding problems so that's fine number three avoid muscle relaxants yes a sedative got to avoid that number four report history of reaction to midazolam yes guys Pam and Lam any cross reactions usually means an interaction of allergies and number five now lock zone is the antidote for this med now guys that's the opioid an alert and number six decrease alcohol consumption guys no we're not limiting or decreasing we're avoiding it all together when taking a dose of this medication now question number two here a client on phenobarbital which of the following should the nurse do select all that apply so number one monitor for hypertension no guys we're monitoring for hypotension that low and slow number two assess for respiratory depression yes guys low and slow respirations big one right there number three assess for low blood pressure yes for sure number four teach the patient there is no withdrawal symptoms guys no not for phenobarbital that's for buspirone and number five teach sedation is an early side-effect gasps guys barb it's all it's like you went to the bar and now you're very sleepy and sedated now antidepressants the big momma's here we have SSRIs SNRIs TCAs and mao eyes now we'll be covering these one by one but first let's cover the four rules to antidepressants since the NCLEX will not test you directly on the mode of action or basically how the drug works rather it tests safety on how the drug will harm or kill the patient so guys we'll be focusing on the need to know for the NCLEX not just the nice to knows so these four universal principles are NCLEX patient safety number one increased risk of suicide as anti and prescence elevate the mood it gives the patient's more energy energy to go out and carry out the suicide so a big thing to write down is that antidepressants can actually increase suicidal thoughts in the first few weeks of treatment and the big risk is for young adults 18 to 24 years old so we always key term here notify the provider of any suicidal thoughts and always clarify any new prescription guys we're monitoring the clients for key words new thoughts of suicide unusual behavior worsening depression or sudden changes in mood these patients are the most at risk for suicide now number two is the slow onset and the slow taper off never stop abruptly they're taken for a few weeks to reach that therapeutic range so educate patients when saying this met is not working after the first week or they're also saying something about sexual dysfunction patients need to know about this first so they won't stop taking the drug now third is we never mix these keywords here SSRIs with st. John's wort and Mao is with any other antidepressants we're talking TCAs arise even SNRIs guys this could lead to deadly serotonin syndrome so two-week washout period is needed guys key word there two weeks write that down key words never start a new antidepressant while tapering off an MAOI or another so just coming off the day before is a big no-no always a taper off and never mix now point number four is all psychiatric drugs usually decrease the blood pressure so we teach slow position changes for risk for falling and causes weight changes mostly weight gain now first up are the SSRIs sertraline citalopram and East citalopram as those came up the most often on all the quiz banks but we also have paroxetine and fluoxetine now SSRIs are given mainly for depression anxiety and PTSD now the motive action is quite simple typically not tested on the NCLEX but it could come up on pharmacology exams so guys just let the name help you for SSRIs selective serotonin reuptake inhibitors basically inhibits the reuptake of serotonin keeping more around so serotonin levels are increased in the body now the four common side effects which usually improve after three months number one is weight gain number two which is a big one sexual side-effects the key point and always on the NCLEX write this down sexual dysfunction so just remember sertraline causes sexual dysfunction and there's no sedation so don't be tricked SSRIs usually cause insomnia now priority key points we use the acronym SSRI s for the suicide risk that has increased when starting to med or changing the dose again high risk is aged 18 to 24 and a key priority to monitor the key point right here report more energy without change in depression guys huge risk for suicide now the second s is for a slow onset and a slow taper off usually taking about two to four weeks to reach that full effect so we teach patients not to stop the med when starting and during this time and guys always taper off never abruptly stop now the next S is for serotonin syndrome a very deadly complication which happens if we use drugs or vitamins that also increase serotonin levels guys we're talking about a serotonin overdose so the big key point here is we never mix write this down st. John's wort Mao is or tramadol never to be mixed with SSRIs now the signs and symptoms include s RI s for sweaty hot fever never cold or clammy we're talking really hot here our for rigid muscles restlessness and agitation guys big key words write those down we're talking tremors and hyperreflexia not decrease DTRS they'll actually be increased and speaking of increased I is for increased heart rates known as tachycardia over a hundred beats per minute now the famous SNRI duloxetine given for depression and pain like with neuropathy and fibromyalgia so guys just think duloxetine is for a dual purpose both depression and pain or duloxetine helps to dole the pain with fibromyalgia guys the big key point here is to teach that it helps with chronic pain and it also improves sleep in patients with fibromyalgia now don't be tricked common test questions is a client refusing this medication so patients can always refuse medications that's not the problem here but the most appropriate response is to educate the patient on why the medication is given basically the indication so for example if a fibromyalgia patient is prescribed this and they're not depressed they need to be educated on the purpose of why this medication will help with the pain now for our TCAs tricyclic antidepressants we have the two famous ones ami trip Deline and imipramine so memory tricks here ami trip d'Alene just think ami trips on things so guys we have slow position changes and imipramine just basically inhibits my ping now the indication is for depression and anxiety and it also helps with neuropathy or neuropathic pain with diabetes and fibromyalgia but the common side effects to be written down here the big dry the anticholinergic effects guys basically can't CP spit or poop you get the point so can't see we get blurred vision and photophobia can't pee we get urinary retention guys that's a big NCLEX tip priority and most serious we also can't spit so we get a dry mouth and you can't poop so you get conservation now other side effects we get sweating seizures and sedation known as drowsiness or dizziness so it's a priority to teach patience slow position changes now speaking a patient teaching we treat the dry by drinking the fluids and for no seeing or dry eye we teach them to wear sunglasses and eyedrops and no spit for dry mouth chew the gum and for no poop guys we use fiber for constipation now the big key points to write down again orthostatic hypotension we teach slow position changes because amy trip Deline just think amy trips on things guys slow position changes and urinary retention again the memory trick imipramine inhibits my peeing and lastly we never take with an MAOI always a two-week washout period so remember no ma eyes and other antidepressants we're talking tcas SSRIs even snr eyes so remember em Mayo eyes do not mix well with others not even a tapered down dose you must fully come off mo eyes first before transitioning to another antidepressant like a TCA or even SSRI now for the Mao is always an NCLEX favorite here we have phenelzine brand-name nor dil saline and i soak our box aside these are the first and oldest antidepressants known as the big guns very powerful antidepressants used for depression panic disorder as well as social phobia now the mechanism of action is that it increases availability of norepinephrine serotonin and dopamine in the brain and it's used for depression that is resistant to other medications so the key points for Mao Eyes is just the acronym Mao I M for massive hypertension crisis risk usually a key sign is a massive headache so we avoid the tyramine now that's an amino acid that helps regulate the blood pressure and actually triggers hypertension crisis leading to death from a heart attack like an MI or a CVA stroke so guys the big nono list to avoid so no fermented alcohol fermented fruits or veggies and even meats so number one wine and cheese guys know so no wine tasting number two beer and sausage and salami no beer fests and number three is chocolates guys no visiting charlie or his Chocolate Factory we are teaching patients to start the diet at least two weeks before starting Mao is and continued for two weeks after stopping so the memory trick is tyramine ends an i and ii like phenelzine just think tyramine or saline is tyramine so no cheese beer sausage or wine for Tyra mine so big questions on the exams here can the patient eat fruit guys yes can they eat veggies yes can they have fermented fruits or veggies or even pickled veggies no dried processed fruits no what about liver tongue sausage guys these are all meats so no they cannot have it now oh is for OTC or over-the-counter drugs and this can contribute to a hypertension crisis so guys we avoid can see for calcium a for anti-acids a for acetaminophen or basically tylenol and end for NSAIDs like naproxen and ibuprofen now our next oh is for other antidepressants to avoid guys remember Mao lies do not mix with other antidepressants so we're avoiding tcas SSRIs SNRIs this can actually trigger a serotonin syndrome so we have a two-week washout period when changing or swapping out antidepressants guys two full weeks not two days not the day before two weeks from the ending keyword is fully taper off the other so the big key point is no II citalopram which is an SSRI and no imipramine which is a TCA guys the NCLEX will try and trick you so just make sure to know the names of these drugs now I is for increased suicide risk usually within the first few weeks of treatment or when the dose is increased now this especially happens in children adolescents and young adults so the key words to write down here guys patient states this med is not working after two weeks the first thing to do is assessment guys so further expressions of hopelessness despair or suicidal thoughts or harming themselves usually indicates a reason to report to the HCP now for the top three missed questions of psychiatric meds which medication has the most potential risk for injury select all that apply guys we're looking for sedating meds here so number one ami trip Deline remember ami trips on things very sedating so yes option two diphenhydramine or benadryl yes guys very sedating high risk for injury how about option three colace no that's technically a stool softener no sedation there option for alprazolam yes guys that's a benzo Pam and Lam very dangerous life at option five boosts Pirone no remember bus you can drive the bus it's not sedating now question two which combination of drugs should the nurse question select all that apply guys the main focus here is we don't want to mix between SSRIs and Mao lies because remember Mao is don't mix with others so option one searcher with saline guys that's a big no-no that's an SSRI and Mao I never mixed option two alprazolam with citalopram so benzos and SSRIs that's okay now third boost perón with phenelzine that's an anxiolytic with an MAOI technically okay now how about lithium with ketorolac or brand-name toward all that's a tricky one since lithium is a bipolar med and ketorolac is an NSAID so guys that's a big no-no an option five st. John's wort with boosts perón technically that is okay now question number three which has the most potential for injury select all that apply so option one amy trip Deline to treat fibromyalgia pain guys yes Amy trips on things it's very sad ativ high risk for injury now option two a headache while on phenelzine guys yes the very first sign of a hypertension crisis is a headache huge risk for CVA stroke now option 3 taking st. John's wort with sertraline guys yes sertraline is an SSRI and st. John's wort we have to stop guys nothing really comes good from st. John's wort now option for discontinuing a citalopram the day before I so carboxamide guys know that's the most injury guys we can't mix an SSRI and an MAOI within two-week period of each other so not the day before has to be two weeks totally separated now option 5 a peanut butter and jelly sandwich while on saline guy this is okay alcohol cheese and meats are okay no tyramine in it for this maoi now if it was a grilled cheese that's a big no-no or a ham sandwich has meat in it big no-no and even beer and sausage we have no alcohol guys so no alcohol cheese or meats now option number six reporting sore throat fatigue and low-grade fever while on clozapine or Klaus zapping now this technically isn't fair be because this is an anti-psychotic drug but guys yes claws zapping zaps WBC's making a huge risk for infection and technically a risk for injury now we have two atypical antidepressants trazodone and boo pro pre-owned so for trazadone the indication is for a sleep aid and treats depression so memory trick is the Z's and trazodone which makes you sleepy and sedated or think of transit oh and it basically puts you in a trance now the key is to avoid EtOH and other sedatives such as benzos and antihistamines and we teach the patient a take at night since it can cause orthostatic hypotension we also teach slow position changes and a very rare complication is a priapism so teach a patient that if an erection lasts longer than four hours to go to the hospital now next is boo Pro pre-owned SR or XL brand name is wellbutrin the indication is for depression and an aid to stop smoking now the side effects is insomnia headache and weight loss which probably not a bad side effect now teaching guys we never double up on missed doses just like any other medication and nicotine gum may be prescribed in addition to help stop smoking now administration guys the big key point here is XL and s R or basically extended release and sustained release we never crush never chew or cut these kinds of drugs so meds labeled SR or XL should never be altered before admin always swallow whole with or without food guys if you chew or crush it could cause faster absorption and higher levels of the drug can be increased hence the side effects will increase as well now for the bipolar medications first on the list is carbamazepine indication is obviously bipolar but also given for seizures and a big one here is for treatment of trigeminal neuralgia basically neuropathic pain now the side effect number one is leukopenia we have low WBC's which means increased risk or massive infection so the key word here is to report fever and sore throat guys that's the most important now next is accidental pregnancy so key words oral contraceptives are ineffective and we'll need alternative forms of birth control or birth control methods now next is V for valve uric acid so guys just think vowel with a lot of owls so L for liver toxic we monitor for jaundice and liver labs alts and ast s and L for low platelets aka thrombocytopenia we have a big bleed risk now the LP uric acid is also not pregnancy safe and we teach clients not to discontinue abruptly now for the big momma lithium this is the drug to know coming up 22% of the time for all psychiatric meds so for lithium it's given over the long term treatment for both bipolar and schizoaffective disorder so guys the memory trick is a lithium battery since lithium lasts a long time and be for bipolar remember battery now it has a very narrow therapeutic range 0.62 1.2 and the key point here is that toxicity happens over 1.5 so patients at highest risk for toxicity are those with decreased renal function remember kidneys are the washing machines of the body washing the blood out from medications and wastes so any decrease in real function usually sets the stage for toxicity so be cautious with patients in kidney disease and also elderly patients who naturally have decreased kidney function again the key signs for the kidneys are creatinine over 1.3 means bad kidney and urine 30 MLS per hour or less means kidneys are in distress and the signs and symptoms of tinnitus ringing of the ears usually indicates type of kidney malfunction so we use the acronym lifts for all the key points that are highly tested l4 levels over one point five equals huge toxicity so blood levels are drawn regularly to maintain that therapeutic dose and may take up to three weeks so guys a common test question is lithium at a therapeutic level if yes then continue at the current dose now I is for increasing fluid and sodium since lithium lets go of the fluid guys the big key point here and the contraindication is we can't give lithium during dehydration and low sodium that hyponatremia at the low one three five micro equivalents per liter guys always question any prescription the doctor writes if the patient has low sodium or dehydration second thing is never restrict sodium and water key word here do not limit sodium intake since sodium swells the body with water we need to avoid that toxicity here now a typical question is a patient at highest risk for toxicity usually a patient with a stomach flu including diarrhea and vomiting now the big key words here are due to massive dehydration again always reviewing low sodium thanks for watching for our full video & new quiz Bank click right up here to access your free trial and please consider subscribing to our youtube channel last but not least a big thanks to our team of experts helping us make these great videos alright guys see you next time [Music]

Channel: Simple Nursing

Views: 89,564

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Keywords: Registered Nurse RN, Pharmacology, Cathy Parkes, RN, Nursing pharmacology, Pharm, Lithium, bipolar, psych, mental health, SSRI, Mental health pharmacology, SNRI, Antidepressants, Norepinephrine, dopamine, serotonin, pathophysiology psych meds, mental health meds, NCLEX, HESI, ATI, Level up RN, Osmosis, Khan academy

Id: GAdiqTHSzZM

Length: 29min 57sec (1797 seconds)

Published: Mon Aug 03 2020