Overview
This lecture covers key mental health medications commonly encountered in nursing, including their uses, therapeutic ranges, side effects, toxicities, and important nursing considerations.
Mood Stabilizers: Lithium & Others
- Lithium is a mood stabilizer with a narrow therapeutic range of 0.6–1.2 mEq/L; toxicity occurs at ≥1.4 mEq/L.
- Signs of lithium toxicity include excessive thirst, frequent urination, blurred vision, and must be reported immediately.
- Sodium levels affect lithium; low sodium (<135) increases risk of toxicity.
- Valproic acid and carbamazepine are both used as mood stabilizers and anticonvulsants.
- Carbamazepine can cause hepatotoxicity, agranulocytosis, aplastic anemia, and Stevens-Johnson syndrome; monitor liver function and WBCs.
Antidepressants: SSRIs, MAOIs, TCAs, Atypicals
- SSRIs (e.g., fluoxetine, sertraline, paroxetine) commonly cause sexual dysfunction and can lead to serotonin syndrome (tremors, agitation, confusion).
- MAOIs (e.g., phenelzine) require a tyramine-restricted diet to avoid hypertensive crisis; caution foods like aged cheeses, cured meats, chocolate, and red wine.
- TCAs (e.g., amitriptyline) are used for depression and chronic pain.
- Bupropion is an atypical antidepressant; not associated with tyramine interactions.
Antipsychotics: Typical & Atypical
- Haloperidol (typical antipsychotic) can cause extrapyramidal symptoms (involuntary muscle movements); assess and report immediately.
- Risperidone (atypical antipsychotic) and other atypicals can cause neuroleptic malignant syndrome (NMS): high fever, muscle rigidity, confusion; medical emergency.
- Clozapine (atypical) can cause agranulocytosis; monitor WBC count closely.
Anxiolytics: Benzodiazepines
- Lorazepam is a benzodiazepine that causes sedation and risk of dependence; used short-term only.
- Monitor for hypotension, not hypertension; can also prevent seizures.
Key Terms & Definitions
- Therapeutic Range — the optimal concentration for medication effectiveness and safety.
- Lithium Toxicity — dangerous accumulation of lithium causing neurological and renal symptoms.
- Agranulocytosis — dangerously low white blood cell count, increasing infection risk.
- Extrapyramidal Symptoms (EPS) — drug-induced muscle control disorders (e.g., tremors, rigidity).
- Neuroleptic Malignant Syndrome (NMS) — life-threatening reaction to antipsychotics: fever, rigidity, mental status changes.
- Serotonin Syndrome — excessive serotonin levels causing agitation, tremor, confusion.
- Tyramine — amino acid in certain foods; can cause hypertensive crisis with MAOIs.
Action Items / Next Steps
- Review foods high in tyramine and symptoms of lithium toxicity, serotonin syndrome, and NMS.
- Study drug classes, their side effects, and nursing considerations for major mental health medications.
- Monitor required labs (WBC, liver enzymes, drug levels) for patients on antipsychotics and mood stabilizers.