Psychopharmacology and Somatic Treatments
Major Psychotropic Classes
- Antidepressants: SSRIs (first-line for depression/anxiety), SNRIs, bupropion, mirtazapine, TCAs (risk of anticholinergic effects, cardiac toxicity in overdose), MAOIs (hypertensive crisis with tyramine).
- Antipsychotics: typical (haloperidol; EPS, tardive dyskinesia) vs. atypical (risperidone, olanzapine, quetiapine, aripiprazole; metabolic syndrome, weight gain).
- Mood stabilizers: lithium (narrow therapeutic index, monitor levels, renal and thyroid effects), valproate (hepatotoxicity, pancreatitis), lamotrigine (Stevens-Johnson syndrome).
- Anxiolytics: benzodiazepines (dependence, respiratory depression with opioids), buspirone.
- Stimulants: methylphenidate, amphetamines (monitor growth, cardiovascular risk).
Somatic Treatments
- ECT: indications (severe depression, catatonia, treatment-resistant), side effects (memory loss, confusion).
- TMS: non-invasive for depression.
- Ketamine/esketamine: rapid antidepressant effect; monitor dissociation and BP.
Nursing Considerations
- Informed consent, education, monitoring for side effects and adherence.
- Lab monitoring: lithium levels (0.6–1.2 mEq/L), CBC for clozapine (agranulocytosis), metabolic panel for atypicals.
- Serotonin syndrome: agitation, hyperthermia, clonus, tachycardia; risk with SSRIs + MAOIs, triptans, etc.
Traps in Questions
- Confusing EPS (acute dystonia, akathisia, parkinsonism) with tardive dyskinesia (late-onset involuntary movements).
- Missing lithium toxicity signs (tremor, confusion, vomiting, ataxia).
- Overlooking drug interactions (e.g., MAOI + tyramine; SSRI + NSAIDs → bleeding).
Worked Example
A patient on lithium reports vomiting and coarse tremor. What is the priority? Answer: Hold lithium and obtain a serum level-signs suggest toxicity. Rule of thumb: any new GI or neurologic symptom on lithium = check level.