Antidepressants, antipsychotics, and mood stabilizers with their black box warnings and key nursing monitoring points.
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- What is the black box warning for SSRIs regarding suicidality?
- Increased risk of suicidal thinking and behavior in children, adolescents, and young adults up to age 24.
- How long does it typically take for SSRIs to reach full therapeutic effect?
- 4 to 6 weeks
- What combination commonly triggers serotonin syndrome?
- An SSRI taken with an MAOI (or another serotonergic drug)
- Serotonin syndrome presents with hyperthermia, agitation, tremor, and ____.
- hyperreflexia
- What dietary restriction is required for patients taking MAOIs?
- Avoid tyramine-rich foods (aged cheese, cured meats, red wine)
- What happens if a patient on an MAOI eats tyramine-rich food?
- Hypertensive crisis
- How long should a patient wait after stopping fluoxetine before starting an MAOI?
- About 5 weeks, due to fluoxetine's long half-life
- Why are tricyclic antidepressant (TCA) overdoses especially dangerous?
- They are cardiotoxic and can cause fatal arrhythmias
- Do TCAs carry the same suicidality black box warning as SSRIs?
- Yes, increased suicidality risk in children, adolescents, and young adults
- What two conditions are contraindications for bupropion?
- Seizure disorder and eating disorder
- What vital sign should be monitored closely with venlafaxine, an SNRI?
- Blood pressure, for risk of hypertension
- What is the therapeutic serum range for lithium?
- 0.6 to 1.2 mEq/L
- What are early signs of lithium toxicity?
- Nausea, vomiting, diarrhea, and fine tremor
- What are signs of severe, late-stage lithium toxicity?
- Ataxia, confusion, seizures, and cardiac arrhythmias
- How does low sodium intake affect lithium levels?
- It increases the risk of lithium toxicity