BLUEPRINT MENTAL HEALTH EXAM 2
Lecture 5: Chapter 17- 4questions, Chapter 18 -6 questions, Chapter 19-6 questions=16
Antidepressant medications in Mood Disorder (Tables 17.1-17.4)
Antidepressants TCA
SSRI Tolerated by most patients BUT may cause
Produce few sedating, anticholinergic, and cardiovascular orthostatic hypotension, blurred vision,
side effects, which make them safer for use in older adults.
tachycardia, seizures, constipation, dry
Because of their low side effects and relative safety, mouth, drowsiness, and urinary retention
SEROTININ SYNDROME may occur, and drug must be (emergency).
stopped immediately May accumulate in cardiac tissue and depress
the myocardium and cause life threatening
citalopram (Celexa) dysrhythmias, especially in an O/D.
escitalopram (Lexapro) Elavil – amitriptyline
fluoxetine (Prozac) Anafranil – clomipramine
paroxetine (Paxil) Norpramin - desipramine
sertraline (Zoloft) Sinequan – doxepin
vortioxetine (Trintellix) Tofranil- imipramine
Pamelor – nortriptyline
Atypical Antidepressants. Atypical antidepressants are Vivactil – protriptyline
used when the client has an inadequate response to or side Surmontil – trimipramine
effects from SSRIs. Atypical antidepressants include
nefazodone (Serzone), MAOI- LAST RESORT Medication alert!
mirtazapine (Remeron) -Must be on Tyramine-free diet & remain on
vilazodone (Viibryd) diet for 2 wks. after med is DC'd.
SNRI -Pts. are at risk for hypertensive crisis and
Keep serotonin and norepinephrine in synapse. Treats serotonin syndrome with many meds,
depression by targeting norepinephrine. including OTCs.
GI upset, nervousness, insomnia, sexual SE -Allow 3-4 wks. wash-out between MAOIs
HTN is main side effect and SSRIs (up to 6 wks. with fluoxetine),
TCAs, and other antidepressants.
Effexor – venlafaxine Causes HTN, GI upset. Improves
cognitive symptoms. May cause cardiac prob in O/D) Marplan – isocarboxazid
Nardil – phenelzine
Cymbalta –duloxetine (more balanced for effects on Parnate – tranylcypromine
serotonin and norepi)
Wellbutrin SR – bupropion (energizing, less wt. gain, few
sexual SE, may cause seizures w/eating D/O. Acts as a
booster for antidepressants). May be administered with an
SSRI to prevent the sexual SE of the SSRI
-ALL MUST BE TAPERED- antidepressant withdrawal
syndrome (brain zaps, electric shock in hands/feet)
-Psych meds may take up to 3-6 wks. to activate
-Assess for SI
, BLUEPRINT MENTAL HEALTH EXAM 2
Mood Stabilizers (Table 17.6)
Lithium is effective in about 75% of people with Anticonvulsants that are often used as mood
bipolar illness, both adults and children. The rest do stabilizers include:
not respond or have difficulty taking lithium because valproic acid (Depakote
of side effects, problems with the treatment lamotrigine (Lamictal)
regimen, drug interactions, or medical conditions carbamazepine (Tegretol)
such as renal disease that contraindicate use of Some anticonvulsants that are used off label — not
lithium. officially approved for this condition — as mood
LITHIUM LABS NORMAL 0.5-1.5 stabilizers, include:
Early = ataxia, lack of coordination Mild = (1.5-2.0 oxcarbazepine (Trileptal)
mEq/L) listlessness, nausea, coarse tremor, diarrhea, topiramate (Topamax, )
slurring gabapentin (Neurontin)
Moderate = (2.0 – 2.5 mEq/L) coarse tremor, ataxia,
confusion, delirium, pronounced ataxia Antipsychotics may be prescribed along with mood
Severe = (2.5 – 3.0 mEq/L) altered LOC, stabilizing drugs. In other cases, they seem to assist
hyperextension of extremities, seizures, coma, death mood stabilization on their own. Antipsychotics used
to treat bipolar disorder include:
-DO NOT restrict NaCl when taking Lithium as it may aripiprazole (Abilify)
cause toxicity. olanzapine (Zyprexa)
-NO NSAIDs with Lithium risperidone (Risperdal)
lurasidone (Latuda)
quetiapine (Seroquel)
ziprasidone (Geodon)
asenapine (Saphris)
Characteristics and interventions:
DTO -Danger to others is where a person can intentionally, or actions lead to the harm of other
people. Intervention is to remove person from potential environment where they will hurt someone. In
some cases, including restraining or secluding.
DTS- Danger to self a person refers to when someone is intentionally or unintentionally a threat to
themselves. Intervention In people with SI with a plan a person requires 1:1 direct observation as well
as removing any items that can be used to self-harm
Bipolar disorder involves extreme mood swings from episodes of mania to episodes of depression.
During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor
judgment and rapid thoughts, actions, and speech. During depressed phases, mood, behavior, and
thoughts are the same as in people diagnosed with major depression. Interventions Providing a safe
environment with low stimuli (especially during times of mania), provide simple and direct
explanations, monitor sleep patterns. Provide meds as ordered and monitor.
MDD-Major depressive disorder typically involves 2 weeks or more of a sad mood or lack of interest in
life activities, with at least four other symptoms of depression such as anhedonia and changes in
weight, sleep, energy, concentration, decision-making, self-esteem, and goals. Interventions Assess for
SI or self-harm, monitor nutrition, weight, sleep patterns, administer medications as needed such as
antidepressants. Prep patient if ECT therapy is ordered including NPO at midnight.
Lecture 5: Chapter 17- 4questions, Chapter 18 -6 questions, Chapter 19-6 questions=16
Antidepressant medications in Mood Disorder (Tables 17.1-17.4)
Antidepressants TCA
SSRI Tolerated by most patients BUT may cause
Produce few sedating, anticholinergic, and cardiovascular orthostatic hypotension, blurred vision,
side effects, which make them safer for use in older adults.
tachycardia, seizures, constipation, dry
Because of their low side effects and relative safety, mouth, drowsiness, and urinary retention
SEROTININ SYNDROME may occur, and drug must be (emergency).
stopped immediately May accumulate in cardiac tissue and depress
the myocardium and cause life threatening
citalopram (Celexa) dysrhythmias, especially in an O/D.
escitalopram (Lexapro) Elavil – amitriptyline
fluoxetine (Prozac) Anafranil – clomipramine
paroxetine (Paxil) Norpramin - desipramine
sertraline (Zoloft) Sinequan – doxepin
vortioxetine (Trintellix) Tofranil- imipramine
Pamelor – nortriptyline
Atypical Antidepressants. Atypical antidepressants are Vivactil – protriptyline
used when the client has an inadequate response to or side Surmontil – trimipramine
effects from SSRIs. Atypical antidepressants include
nefazodone (Serzone), MAOI- LAST RESORT Medication alert!
mirtazapine (Remeron) -Must be on Tyramine-free diet & remain on
vilazodone (Viibryd) diet for 2 wks. after med is DC'd.
SNRI -Pts. are at risk for hypertensive crisis and
Keep serotonin and norepinephrine in synapse. Treats serotonin syndrome with many meds,
depression by targeting norepinephrine. including OTCs.
GI upset, nervousness, insomnia, sexual SE -Allow 3-4 wks. wash-out between MAOIs
HTN is main side effect and SSRIs (up to 6 wks. with fluoxetine),
TCAs, and other antidepressants.
Effexor – venlafaxine Causes HTN, GI upset. Improves
cognitive symptoms. May cause cardiac prob in O/D) Marplan – isocarboxazid
Nardil – phenelzine
Cymbalta –duloxetine (more balanced for effects on Parnate – tranylcypromine
serotonin and norepi)
Wellbutrin SR – bupropion (energizing, less wt. gain, few
sexual SE, may cause seizures w/eating D/O. Acts as a
booster for antidepressants). May be administered with an
SSRI to prevent the sexual SE of the SSRI
-ALL MUST BE TAPERED- antidepressant withdrawal
syndrome (brain zaps, electric shock in hands/feet)
-Psych meds may take up to 3-6 wks. to activate
-Assess for SI
, BLUEPRINT MENTAL HEALTH EXAM 2
Mood Stabilizers (Table 17.6)
Lithium is effective in about 75% of people with Anticonvulsants that are often used as mood
bipolar illness, both adults and children. The rest do stabilizers include:
not respond or have difficulty taking lithium because valproic acid (Depakote
of side effects, problems with the treatment lamotrigine (Lamictal)
regimen, drug interactions, or medical conditions carbamazepine (Tegretol)
such as renal disease that contraindicate use of Some anticonvulsants that are used off label — not
lithium. officially approved for this condition — as mood
LITHIUM LABS NORMAL 0.5-1.5 stabilizers, include:
Early = ataxia, lack of coordination Mild = (1.5-2.0 oxcarbazepine (Trileptal)
mEq/L) listlessness, nausea, coarse tremor, diarrhea, topiramate (Topamax, )
slurring gabapentin (Neurontin)
Moderate = (2.0 – 2.5 mEq/L) coarse tremor, ataxia,
confusion, delirium, pronounced ataxia Antipsychotics may be prescribed along with mood
Severe = (2.5 – 3.0 mEq/L) altered LOC, stabilizing drugs. In other cases, they seem to assist
hyperextension of extremities, seizures, coma, death mood stabilization on their own. Antipsychotics used
to treat bipolar disorder include:
-DO NOT restrict NaCl when taking Lithium as it may aripiprazole (Abilify)
cause toxicity. olanzapine (Zyprexa)
-NO NSAIDs with Lithium risperidone (Risperdal)
lurasidone (Latuda)
quetiapine (Seroquel)
ziprasidone (Geodon)
asenapine (Saphris)
Characteristics and interventions:
DTO -Danger to others is where a person can intentionally, or actions lead to the harm of other
people. Intervention is to remove person from potential environment where they will hurt someone. In
some cases, including restraining or secluding.
DTS- Danger to self a person refers to when someone is intentionally or unintentionally a threat to
themselves. Intervention In people with SI with a plan a person requires 1:1 direct observation as well
as removing any items that can be used to self-harm
Bipolar disorder involves extreme mood swings from episodes of mania to episodes of depression.
During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor
judgment and rapid thoughts, actions, and speech. During depressed phases, mood, behavior, and
thoughts are the same as in people diagnosed with major depression. Interventions Providing a safe
environment with low stimuli (especially during times of mania), provide simple and direct
explanations, monitor sleep patterns. Provide meds as ordered and monitor.
MDD-Major depressive disorder typically involves 2 weeks or more of a sad mood or lack of interest in
life activities, with at least four other symptoms of depression such as anhedonia and changes in
weight, sleep, energy, concentration, decision-making, self-esteem, and goals. Interventions Assess for
SI or self-harm, monitor nutrition, weight, sleep patterns, administer medications as needed such as
antidepressants. Prep patient if ECT therapy is ordered including NPO at midnight.
