psych meds Flashcards
ALL psychiatric drugs cause
low BP and weight changes—usually weight gain
Phenothiazines
First generation or typical antipsychotics (MAJOR tranquilizers)
• They don’t cure … They just reduce symptoms
• We use ZINEs for the ZANY (Cuckoos) … Antipsychotics
First generation or typical antipsychotics end in
ZINE (Thorazine, Compazine)
Phenothiazines in small doses, they are… in large doses…
small- they are antiemetics (to treat vomiting)
large- 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?
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
- 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)
Examples of Tricyclic Antidepressants
• Elavil (elevates), Trofranil, Aventyl, Desyrel
- amitryptiline, nortyptiline, imiparamine
Side effects of Tricyclic Antidepressants
Anticholinergic (especially, dry mouth) Blurred Vision
Constipation
Drowsiness
Euphoria (happy)
Q-T prolongation
How long do you have to wait to see effects of TCA
Must take meds for 2 to 4 weeks for beneficial effects
Benzodiazepines
Anti-anxiety, minor tranquilizers
Benzodiazepines names
• Always have ZEP in the name • Remember ZZzzs for falling/going to sleep • Many benzodiazepines end in “Pam” or “Lam” • Prototype: Valium, induction of anesthetic, muscle relaxant, alcohol
Benzos can be used as…
o 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 until benzos start working
• 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
S/Es of Benzodiazepines
“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
- Anticholinergic
- Blurred Vision
- Constipation
- Drowsiness
Teaching points MAOIs
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 cheese 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
Very Unique—acts more like an electrolyte—think: Potassium/Lithium
• The 3Ps as S/Es
o Peeing (Polyuria)
o Pooping (diarrhea)
o Paresthesia (earliest sign of electrolyte imbalance)
Toxic effects of lithium
- Tremors
- Metallic taste
- Severe diarrhea
What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the time?
• #1 intervention 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
Prozac (fluoxetine)
• SSRI, mood elevator
• Side effects of Prozac (fluoxetine) 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
Prozac (fluoxetine) risks in adolescents
• When changing doses, watch for suicidal risk in adolescents
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)
Haldol may cause..
• Pts 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
How 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 life threatening
• NMS presents with anxiety and tremors, and so does EPS
Clozaril (clozapine)
• Atypical antipsychotic
• S/Es of clozapine (clozaril)
o aGranulocytosis! It is worse than cancer drugs and can trash the pt’s bone marrow
• 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
Second generation antipsychotics
end in “Zapine”
What is the #1 nursing intervention in a pt taking Clozaril (clozapine)
• Monitor the WBC
Zoloft (Sertraline)
• Antidepressant
Zoloft (Sertraline) cant interact with..
• 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
• S/E of serotonin syndrome is
“SAD Head” o Sweating o Apprehensive (impending sense of doom) o Dizzyness o Headache
The nurse should anticipate lowering the dose of sertraline (Zolof) of a pt on..
St. John’s Wort and Warfarin
MAOI meds
phenelizine
isocarboxazid
selegiline
