Pharmacology & the Responsibilities of the PMHN Flashcards
4 Phases of Drug Treatment
- Initiation phase
- Stabilization phase
- Maintenance phase
- Discontinuation phase
Key Nursing Responsibilities in the 4 Phases of Drug Treatment (3)
- Do a baseline assessment prior to initiating medication
- Proactively monitor and treat side-effects
- Education of patients and families
Major classes of psychiatric medications
- Antipsychotics
- Mood stabilizers
- Antidepressants
- Antianxiety
- Stimulants
Antipsychotics
- First Gen (typical)
Early 50s, discovered for psychosis or schizophrenia, chlorpromazine - Second Gen (atypical)
- Third Gen (atypical)
Mood Stabilizers
- Antimania
- Anticonvulsants
Antidepressants
- TCAs
- SSRIs
- SNRIs + NSSRIs
- MAOIs
Antianxiety
- Benzodiazepines
- Non-benzos
Stimulants
- Methylphenidate (Ritalin)
- Modifinil (provigil)
Knowledge Base Before Administration of Medication
- Classification of the medication you are giving
- Common & serious side effects
- Nursing responsibility specific to medication
Antipsychotic Medication Side Effects (Common) 6
Cardiovascular
Anticholinergic
Weight gain
Endocrine and sexual side effects
Blood disorders
Miscellaneous
Antipsychotic serious side effects
Neuroleptic Malignant Syndrome (NMS)
- a syndrome caused by neuroleptic medications that are dopamine receptor blockers. The classic signs are:
- hyperthermia
- lead-pipe rigidity
- changes in mental status
- autonomic nervous system changes
Acute Medication-related movement disorders: EPS
Extrapyramidal symptoms: involuntary movements that you cannot control
Acute Medication-related movement disorders: Dystonia
Involuntary muscle spasms, abnormal postures, oculogyric crisis, toricollis
Acute Medication-related movement disorders: Parkinsonism
Rigidity, akinesia (slow movement), tremor, mask-like face, loss of spontaneous movements
Acute Medication-related movement disorders: Akineisa
loss or impairment of voluntary muscle movement
Acute Medication-related movement disorders: Akathisia
inability to sit still, restlessness
Chronic medication-related movement disorders: Tardive Dyskinesia
- Irregular, repetitive involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. Abnormal finger movements are common.
Antimania Medications
Lithium Carbonate
Antimania Anticonvulsants
Valproate
Carbamazepine
Gabapentin
Lamotrigine
Topiramate
Lithium Carbonate Side Effects
thirst, metallic taste, urinary frequency, fine tremor, drowsiness, and mild diarrhea
Lithium Carbonate Target Blood levels: Acute phase, and maintenance phase
Acute Phase: 0.8-1.4 mEq/L
Maintenance phase: 0.4-1 mEq/L
Lithium toxicity (MSVDL)
Severe diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination
Anticonvulsant Side Effects: Carbamazepine
- dizziness, drowsiness, tremor, visual disturbances, nausea, and vomiting
- minimized by treating in low doses
- given with food
- weight gain
- Alopecia
- Thyroid function may be altered usually after 6 to 18 months. observe for dry skin, constipation, bradycardia, hair loss, and cold intolerance
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine (Prozac)
- sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (celexa)
- Escitalopram (Lexapro)
SSRI Common Side Effects
- Headache
- Anxiety
- Transient nausea
- Vomiting
- Diarrhea
- weight gain
- sexual dysfunction
- increased suicidality
SSRI Serious Side Effects: Serotonin Syndrome
- Fever
- Muscle rigidity, hyperreflexia, myoclonus
- Tremors, diaphoresis
- Confusion, agitation
Tricyclic Antidepressants (TCAs)
- Amitriptyline
- Clomipramine
- Doxepin
- Imipramine
- Trimipramine
Can overdose and die
TCA Common Side Effects
- sedation
- orthostatic hypotension
- anticholinergic
Other side effects of TCAs
- tremors
- restlessness, insomnia, confusion
- pedal edema, headache, and seizures
- blood dyscrasias
- sexual dysfunction
Adverse: - cardiotoxicity
MAO inhibitors
- considered third line treatments
- used with people who have an atypical presentation of depression
- phenelzine, isocarboxazid
Side Effects of Antianxiety medications
- sedation and CNS depression
- tolerance and dependence (benzos)
- avoid benzodiazepines in the elderly
- used for anxiety
- NOT long term
Stimulants most common side effects
- appetite suppression
- insomnia
- irritability
- weight loss
- nausea
- Headache
- Palpitations
- Blurred vision
- Dry mouth
- constipation
- dizziness
- tachycardia
- Tremors
- Irregular heart rate
Initiation Phase
Full health assessment
Stabilization Phase
- looking for the sweet spot = maximum effectiveness with minimal side effects
- know side effects and target symptoms so we can communicate if we need to increase or decrease and interventions to mitigate side effects
- communicate with the patient
- Start with a test dose
- Internal restlessness
- Monitoring to see how a patient is responding
- medications may be changed to a different medication
- monitoring tests or blood work that is ordered
Maintenance Phase
- looking for exacerbation of the illness
- best time to educate around medication and lifestyle (what are other things you can do and changes you can make because
Discontinuation phase
- weaning/titrating them off the medication
- slowly decreasing medication
- monitoring for return of target symptoms
Medication for Schizophrenia (positive vs negative)
Positive (auditory hallucinations, delusions, paranoia) called positive because they’re obvious and we can see them.
Negative (hygiene, lack of motivation, lack of affect, blunting of affect, lack of ability to engage in a back and forth conversation, a person sitting in a chair and not doing much for hours) the atypical antipsychotics have a better effect on the negative symptoms
- the medication have a greater effect on positive or negative symptoms determines its effectiveness
- typicals treat the obvious, the positive
- atypicals address the negative symptoms better
