Mark k lecture 9 Flashcards
ALL psychiatric drugs cause
low BP and weight changes—usually weight gain
Phenothiazines
- First generation or typical antipsychotics
- All end in “ZINE”
o Example: Thorazine, Compazine - They don’t cure … They just reduce symptoms
- We use ZINEs for the ZANY (Cuckoos) … Antipsychotics
- In small doses, they are antiemetics (to treat vomiting)
Phenothiozines are major
tranquilizers
- Major tranquilizers—big guns psych meds—are Antipsychotics
o Aminoglysoside are to Antibiotics what Phenothiazines are to Antipsychotics
Antipsychotics S/Es = “ABCDEFG”
o Anticholinergic (dry mouth, urinary retention)
o Blurred vision
o Constipation
o Drowsiness
o EPS (tremors, Parkinson)
o Foto sensitivity
o aGranulocytosis (low WBC count, immunosuppressed)
Teach patient how to recognize and report sore throat and symptoms of infection
What is the nursing action when someone presents with a S/E?
o Educate
What is the nursing action when someone presents with a Toxic effect?
o HOLD the drug ! Notify HCP
Decanoate or “Caprate” form of a medication means
- The long-acting form of a drug
- Sometimes denoted with the letter “D”
- IM form given for non-compliance
- Often Court-ordered
Tricyclic Antidepressants
- Grandfathered into the NSSRI (Non-selective serotonin reuptake inhibitor) group
- Mood elevators (Happy pills)
- Elavil (elevates), Trofranil, Aventyl, Desyrel
o Elevates the mood
Side effects of Tricyclic Antidepressants are
Anticholinergic (especially, dry mouth)
Blurred Vision
Constipation
Drowsiness
Euphoria (happy)
* Must take meds for 2 to 4 weeks for beneficial effects
* So, after the first week of antidepressant therapy, pt will complain the drug is not working
* Teach pt that the medication takes about 2 to 4 weeks to reach therapeutic effects
Tricyclic Antidepressants names
Elavil (elevates), Trofranil, Aventyl, Desyrel
Benzodiazepines
- Anti-anxiety, minor tranquilizers
- Always have ZEP in the name
- Remember ZZzzs for falling/going to
sleep - Many benzodiazepines end in “Pam” or
“Lam”
benzo uses
minor tranquilizers
Seizures medications
o Preop induction of anesthesia
o Muscle relaxants
o EtOH withdrawal medications
o Ventilation—medication to relax and calm down pts on a ventilator
how long should you use benzos for?
Benzos work quickly … But do not take them for more than 2 to 4 weeks
Administer major and minor tranquilizers at the same time. Why?
- The major antipsychotics take a long time to start working
- The minor antipsychotics start working right away
- Both are administered at the same time
- Example: pt is usually put on Valium and Elavil at the same time
o Valium is discontinued in 2 to 4 weeks once Elavil kicks in
A similar example for giving major and minor tranquilizers together is the concurrent use of
Heparin and Coumadin (warfarin)
- Heparin works right away but a pt should not be on it for a long time
- Coumadin takes a few days to start working but a pt can be on it for the rest of his life
S/Es of Benzodiazepines are “ABCD”
- Anticholinergic
- Blurred Vision
- Constipation
- Drowsiness
Monamine Oxidase (MAO) Inhibitors
- Antidepressant
- Depression is thought to be caused by norepinephrine, dopamine, and serotonin in brain
- Name of MAOIs starts with
- MARplan, NARdil, PARnate the beginnings—all rhyme
S/E of MAOIs
o Anticholinergic
o Blurred Vision
o Constipation
o Drowsiness
Teaching Points for MOA
- Avoid tyramine-containing food … May cause Hypertensive Crisis
- Food with tyramine
o Fruits/Veggies—Avoid salad “BAR”: Bananas, Avocados (guacamole), Raisins (dried
fruit)
o Grains—Ok to have, except Yeast
o Meats—No organs liver, kidney, tripe, heart, no preserved meats (smoked, dried, cured,
pickled, hot dogs)
o Dairy—No chees except for mozzarella, cottage cheese (no aged cheese)
o No EtOH, elixirs, tinctures (iodine/betadine) caffeine, chocolate, licorice, soy sauce
Lithium
- Used for treating Bipolar disorder—it decreases the mania LI = BI
S/E of lithium Lithium
acts more like an electrolyte—think: Potassium/Lithium
* The 3 Ps as S/Es
o Peeing (Polyuria)
o Pooping (diarrhea)
o Paresthesia (earliest sign of electrolyte imbalance)
The earliest sign of electrolyte imbalance is Paresthesias = Numbness and Tingling
Toxic effects of lithium
- Tremors, seizures
- Metallic taste
- Severe diarrhea
What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the
time?
o Give pt fluids
* The above S/Sx are S/Es—expected
* Monitor sodium
* Low sodium makes lithium toxic
* High makes lithium ineffective
* Sodium needs to be normal
What is the #1 nursing intervention in a pt on lithium presenting with metallic taste and severe
diarrhea?
o Give pt fluids
- Notify the HCP—this is a toxic effect
Prozac (fluoxetine)
- SSRI, mood elevator
- Side effects of Prozac are
o Anticholinergic
o Blurred Vision
o Constipation
o Drowsiness
o Euphoria (happy)
Causes insomnia so give before noon. If bid, give at 6 a.m. and noon
When changing doses of Prozac in adolescents
When changing doses, watch for suicidal risk in adolescents
o Must recently change the dose and be an adolescent of young adult
HALDOL (haloperidol)
- Tranquilizers (basically same as Thorazine)
- First generation antipsychotics
S/E of Haldol
o Anticholinergic (dry mouth, urinary retention)
o Blurred vision
o Constipation
o Drowsiness
o EPS (tremors, Parkinson)
o Foto sensitivity
o aGranulocytosis (low WBC count, immunosuppressed)
Teach patient how to recognize and report sore throat and symptoms of infection
Pts taking Haldol may develop
NMS (neuroleptic malignant syndrome) from overdose
o Seen in elderly and young white schizophrenic pts
o High fever over 105
o Their doses should be about 1⁄2 usual adult dose
A pt is being treated with an antipsychotic medication. Pt becomes anxious and presents with
tremors. What is the nurse intervention to differentiate NMS (neuroleptic malignant syndrome)
from EPS (extrapyramidal syndrome)?
- Measure the pts’ temperature
o If temperature is WNL, this is EPS
o If temperature is 102 and rising, call the emergency response team and notify HCP …
NMS is lifethreatening - NMS presents with anxiety and tremors, and so does EPS
Clozaril (clozapine)
- Atypical antipsychotic 2nd gen
- Advantage it does not have A-F side effects
- Don’t confuse it with Klonopin/Clonazepam!
used to treat schizophrenia
Second generation antipsychotics end in “Zapine”
S/Es of clozapine
aGranulocytosis! It is worse than cancer drugs and can trash the pt’s bone marrow
Monitor white count
Geodon (ziprasidone) has a black box warning
- Prolong the QT interval, which can cause sudden cardiac arrest
- Do not use in pts with cardiac condition
What is the #1 nursing intervention in a pt taking Clozaril (clozapine)
- Monitor the WBC
Zoloft (Sertraline)
- Antidepressant
S/E of serotonin syndrome is “SAD Head” ( plus Sertraline)
- Can cause insomnia
o Sweating
o Apprehensive (impending sense of doom)
o Dizzyness
o Headache - Interact with the followings because they are not metabolized in the liver
o St. John’s Wort and cause serotonin syndrome
o Warfarin and cause bleeding
