Psychotropic Medications for NCLEX: SSRIs, Antipsychotics & Mood Stabilizers

Psychotropic Medications for NCLEX Review

Mental health pharmacology is a frequently tested topic on the NCLEX. Understanding medication classifications, mechanisms, side effects, and nursing considerations is crucial for exam success.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are first-line treatment for depression and anxiety disorders. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro). They work by blocking serotonin reuptake in the synaptic cleft. Therapeutic effects take 2-4 weeks. Side effects include nausea, headache, sexual dysfunction, and insomnia. Teach patients about serotonin syndrome risk when combined with MAOIs or other serotonergic drugs. Symptoms of serotonin syndrome include hyperthermia, agitation, myoclonus, and altered mental status.

Antipsychotic Medications

First-generation (typical) antipsychotics like haloperidol (Haldol) and chlorpromazine block dopamine D2 receptors. They are effective for positive symptoms of schizophrenia but cause significant extrapyramidal symptoms (EPS) including dystonia, akathisia, tardive dyskinesia, and pseudoparkinsonism. Monitor for neuroleptic malignant syndrome (NMS): fever, muscle rigidity, altered consciousness, and autonomic instability. Second-generation (atypical) antipsychotics like risperidone, olanzapine, and clozapine treat both positive and negative symptoms with fewer EPS. Clozapine requires regular CBC monitoring due to risk of agranulocytosis.

Mood Stabilizers

Lithium is the gold standard for bipolar disorder. Therapeutic blood level is 0.6-1.2 mEq/L. Monitor for toxicity symptoms: coarse tremor, GI distress, confusion, and seizures. Maintain adequate sodium and fluid intake as dehydration increases lithium levels. Other mood stabilizers include valproic acid (Depakote) and carbamazepine (Tegretol), which require hepatic function monitoring.

Nursing Priorities

Assess for suicidal ideation especially during the first 2-4 weeks of antidepressant therapy when energy returns before mood improves. Never abruptly discontinue psychotropic medications. Educate patients about the importance of adherence even when feeling better. Review with our pharmacology mini-exams and study psychotropic medication cheat sheets.