NURS 3325 Discussion Medications
NURS 3325 Discussion Medications
Another potentially detrimental health effect related to smoking that has implications for care of older adults is the potential for altering the effects of medications. Interactions can occur in people who smoke or use nicotine products (including smokeless tobacco) and in people who have recently quit smoking. Interactions can be due directly to the physiologic effects of nicotine or they may be caused by the hydrocarbons in tobacco smoke, which can affect hepatic metabolism of some medications. Additional information and examples of drug–nicotine interactions are discussed in Chapter 8.
Identify 2 medications affected by nicotine. What changes can it cause? How would you address this with your clients?
A psychotropic describes any drug that affects behavior, mood, thoughts, or perception. It’s an umbrella term for a lot of different drugs, including prescription drugs and commonly misused drugs.
We’ll focus on prescription psychotropics and their uses here.
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health data found that in 2018, 47 million adults over age 18 reported a mental health condition.
This is around 1 in 5 adults in the United States. More than 11 million reported serious mental illness.
Mental health and well-being affect our daily lives. Psychotropic medications can be an important part of the tools available to help keep us well.
- Psychotropics are a broad category of drugs that treat many different conditions.
- They work by adjusting levels of brain chemicals, or neurotransmitters, like dopamine, gamma aminobutyric acid (GABA), norepinephrine, and serotonin.
- There are five major classes of legal psychotropic medications:
- anti-anxiety agents
- antidepressants
- antipsychotics
- mood stabilizers
- stimulants
- Some can cause very serious side effects and have special monitoring requirements by healthcare providers.
Some conditions psychotropics treat include:
- anxiety
- depression
- schizophrenia
- bipolar disorder
- sleep disorders
These medications work by altering neurotransmitters to improve symptoms. Each class works a bit differently, but they have some similarities, too.
The type or class of medication a doctor prescribes depends on the individual and specific symptoms. Some medications require regular use for several weeks to see benefits.
Let’s look closer at psychotropic drugs and their uses.
| Class | Examples |
|---|---|
| Typical antipsychotics | chlorpromazine (Thorazine); fluphenazine (Prolixin); haloperidol (Haldol); perphenazine (Trilafon); thioridazine (Mellaril) |
| Atypical antipsychotics | aripiprazole (Abilify); clozapine (Clozaril); iloperidone (Fanapt); olanzapine (Zyprexa); paliperidone (Invega); quetiapine (Seroquel); risperidone (Risperdal); ziprasidone (Geodon) |
| Anti-anxiety agents | alprazolam (Xanax); clonazepam (Klonopin); diazepam (Valium); lorazepam (Ativan) |
| Stimulants | amphetamine (Adderall, Adderall XR); dexmethylphenidate (Focalin, Focalin XR); dextroamphetamine (Dexedrine); lisdexamfetamine (Vyvanse); methylphenidate (Ritalin, Metadate ER, Methylin, Concerta) |
| Selective serotonin reuptake inhibitor (SSRI) antidepressants | citalopram (Celexa); escitalopram (Lexapro); fluvoxamine (Luvox); paroxetine (Paxil); sertraline (Zoloft) |
| Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants | atomoxetine (Strattera); duloxetine (Cymbalta); venlafaxine (Effexor XR); desvenlafaxine (Pristiq) |
| Monoamine oxidase inhibitor (MAOI) antidepressants | isocarboxazid (Marplan); phenelzine (Nardil); tranylcypromine (Parnate); selegiline (Emsam, Atapryl, Carbex, Eldepryl, Zelapar) |
| Tricyclic antidepressants | amitriptyline; amoxapine; desipramine (Norpramin); imipramine (Tofranil); nortriptyline (Pamelor); protriptyline (Vivactil) |
| Mood stabilizers | carbamazepine (Carbatrol, Tegretol, Tegretol XR); divalproex sodium (Depakote); lamotrigine (Lamictal); lithium (Eskalith, Eskalith CR, Lithobid) |
We’ll briefly cover the classes and some of the symptoms psychotropics treat.
NURS 3325 Discussion Medications
Always talk to your doctor about the specific symptoms you’re experiencing. They’ll find the best treatment options available to help you feel better.
This includes nonmedication options, such as cognitive behavioral therapy.
Some medications, such as antipsychotic medications, may take up to 2 weeksTrusted Source to help with symptom relief. It’s important to give the medicine a chance to work before stopping it.
Anti-anxiety agents
Anti-anxiety agents, or anxiolytics, can treat different types of anxiety disorder, including social phobia related to public speaking. They can also treat:
- sleep disorders
- panic attacks
- stress
How they work
This class is known as benzodiazepines (BZD)Trusted Source. They’re recommended for short-term use. BZDs work by increasing GABA levels in the brain, which causes a relaxing or calming effect. They have serious side effects, including dependence and withdrawal.
Side effects
Side effects of BZDs include:
- dizziness
- drowsiness
- confusion
- loss of balance
- memory problems
- low blood pressure
- slow breathing
Caution
These medications may be habit-forming if used long term. They’re not recommended for more than a few weeks.
SSRI antidepressants
SSRIs are mainly used to treat different types of depression. Among them are major depressive disorder and bipolar disorder.
Depression is more than feeling sad for a few days. It’s persistent symptoms that last for weeks at time. You may also have physical symptoms, like sleep issues, lack of appetite, and body aches.
How they work
SSRIs work by increasing the amount of serotonin available in the brain. SSRIs are the first choice of treatment for many types of depression.
Side effects
Side effects of SSRIs include:
- dry mouth
- nausea
- vomiting
- diarrhea
- poor sleep
- weight gain
- sexual disorders
Caution
Some SSRIs can cause elevated heart rate. Some can increase your risk for bleeding if you’re also using blood thinning medications, such as nonsteroidal anti-inflammatory drugs like aspirin or warfarin (Coumadin, Jantoven).
SNRI antidepressants
How they work
SNRIs help treat depression but work a bit differently than SSRIs. They increase both dopamine and norepinephrine in the brain to improve symptoms. SNRIs might work better in some people if SSRIs haven’t brought improvement.
Side effects
Side effects of SNRIs include:
- headache
- dizziness
- dry mouth
- nausea
- agitation
- sleep problems
- appetite issues
Caution
These drugs can increase blood pressure and heart rate. Your liver function must be monitored while on these medications as well.
MAOI antidepressants
These drugs are older and aren’t used very often today.
How they work
MAOIs improve symptoms of depression by increasing dopamine, norepinephrine, and serotonin levels in the brain.
Side effects
Side effects of MAOIs include:
- nausea
- vomiting
- dizziness
- diarrhea
- dry mouth
- weight gain
Caution
MAOIs taken with certain foods that have the chemical tyramine can increase blood pressure to dangerous levels. Tyramine is found in many kinds of cheese, pickles, and some wines.
Tricyclic antidepressants
These are one of the oldest classes of antidepressants still available on the market. They’re reserved for use when newer medications haven’t been effective.
How they work
Tricyclics increase the amount of serotonin and norepinephrine in the brain to improve mood.
Doctors also use tricyclics off-label to treat other conditions. Off-label use means a drug is used for a condition that doesn’t have Food and Drug Administration (FDA) approval for that condition.
Off-label uses for tricyclics include:
- panic disorder
- migraine
- chronic pain
- obsessive-compulsive disorder
Side effects
Side effects include:
- dry mouth
- dizziness
- drowsiness
- nausea
- weight gain