Mark k lecture 9

Question 1

ALL psychiatric drugs cause

Answer 1

low BP and weight changes—usually weight gain

Question 1

Phenothiazines

Answer 1

• 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)

Question 2

Phenothiozines are major

Answer 2

tranquilizers

• Major tranquilizers—big guns psych meds—are Antipsychotics

o Aminoglysoside are to Antibiotics what Phenothiazines are to Antipsychotics

Question 3

Antipsychotics S/Es = “ABCDEFG”

Answer 3

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

Question 4

What is the nursing action when someone presents with a S/E?

Answer 4

o Educate

Question 5

What is the nursing action when someone presents with a Toxic effect?

Answer 5

o HOLD the drug ! Notify HCP

Question 6

Decanoate or “Caprate” form of a medication means

Answer 6

• The long-acting form of a drug
• Sometimes denoted with the letter “D”
• IM form given for non-compliance
• Often Court-ordered

Question 7

Tricyclic Antidepressants

Answer 7

• Grandfathered into the NSSRI (Non-selective serotonin reuptake inhibitor) group
• Mood elevators (Happy pills)
• Elavil (elevates), Trofranil, Aventyl, Desyrel
  o Elevates the mood

Question 8

Side effects of Tricyclic Antidepressants are

Answer 8

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

Question 9

Tricyclic Antidepressants names

Answer 9

Elavil (elevates), Trofranil, Aventyl, Desyrel

Question 10

Benzodiazepines

Answer 10

• Anti-anxiety, minor tranquilizers
• Always have ZEP in the name
• Remember ZZzzs for falling/going to
  sleep
• Many benzodiazepines end in “Pam” or
  “Lam”

Question 11

benzo uses

Answer 11

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

Question 12

how long should you use benzos for?

Answer 12

Benzos work quickly … But do not take them for more than 2 to 4 weeks

Question 13

Administer major and minor tranquilizers at the same time. Why?

Answer 13

• 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

Question 14

A similar example for giving major and minor tranquilizers together is the concurrent use of
Heparin and Coumadin (warfarin)

Answer 14

• 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

Question 15

S/Es of Benzodiazepines are “ABCD”

Answer 15

• Anticholinergic
• Blurred Vision
• Constipation
• Drowsiness

Question 16

Monamine Oxidase (MAO) Inhibitors

Answer 16

• 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

Question 17

S/E of MAOIs

Answer 17

o Anticholinergic
o Blurred Vision
o Constipation
o Drowsiness

Question 18

Teaching Points for MOA

Answer 18

• 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

Question 19

Lithium

Answer 19

• Used for treating Bipolar disorder—it decreases the mania LI = BI

Question 20

S/E of lithium Lithium

Answer 20

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

Question 21

Toxic effects of lithium

Answer 21

• Tremors, seizures
• Metallic taste
• Severe diarrhea

Question 22

What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the
time?

Answer 22

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

Question 23

What is the #1 nursing intervention in a pt on lithium presenting with metallic taste and severe
diarrhea?

Answer 23

o Give pt fluids

• Notify the HCP—this is a toxic effect

Question 24

Prozac (fluoxetine)

Answer 24

* SSRI, mood elevator

Question 25

* Side effects of Prozac are

Answer 25

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

Question 26

When changing doses of Prozac in adolescents

Answer 26

When changing doses, watch for suicidal risk in adolescents o Must recently change the dose and be an adolescent of young adult

Question 27

HALDOL (haloperidol)

Answer 27

* Tranquilizers (basically same as Thorazine) * First generation antipsychotics

Question 28

S/E of Haldol

Answer 28

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

Question 29

Pts taking Haldol may develop

Answer 29

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

Question 30

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)?

Answer 30

* 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

Question 31

Clozaril (clozapine)

Answer 31

* 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”

Question 32

S/Es of clozapine

Answer 32

aGranulocytosis! It is worse than cancer drugs and can trash the pt’s bone marrow Monitor white count

Question 33

Geodon (ziprasidone) has a black box warning

Answer 33

* Prolong the QT interval, which can cause sudden cardiac arrest * Do not use in pts with cardiac condition

Question 34

What is the #1 nursing intervention in a pt taking Clozaril (clozapine)

Answer 34

* Monitor the WBC

Question 35

Zoloft (Sertraline)

Answer 35

* Antidepressant

Question 36

S/E of serotonin syndrome is “SAD Head” ( plus Sertraline)

Answer 36

* 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