Psychotherapeutic Drugs Flashcards
Lithium
Describe
- Drug Class
- Mechanism of Action
- Side Effects
- Indication
- Interaction
- Dosage
- S/s of Severe Toxicity
- Side Effects
- Treatment for OD
Nursing Process
- Assessment
- Implementation
- Teaching
Mood Stabilizing Drug
(MOA): Increases receptors sensitivity to serotonin
(Indication): Treats manic episode of Bi-polar
(Dosage): 0.5 -1.5mEq/ml
(Tx for OD): IV fluids & Hemodialysis
(Severe Toxicity S/s): Seizures, Heightened reflexes, Delirium, Coma, Death, Low BP, Confusion
(Side Effects): Headache, Muscle weakness, Edema, Slurred speech, Blood Dyscrasias, Dry mouth, Restlessness, Hypotension, Dizziness, Drowsiness, Tremors, Increases urination, nephrotoxicity, GI Distress, Dysrhythmias
(Interactions): Diuretics, NSAIDS, ACE inhibitors, ARBS, Antidepressants
(Assessment): Vs & Na (Na depletion), Sodium & lithium lvls
(Implementation): Monitor for (VS, Na lvls, & Suicidal tendencies, Urine output, renal function)
(Teaching): Take drug as prescribed & keep medical appointments (Lithium lvls monitored monthly), Effective (3-4 week), Keep adequate Na diet (more Na) & Adequate fluid intake (2-3L), Take with food
Amitriptyline & Nortriptyline
Describe
- Drug Class
- Mechanism of Action
- Indications
- Interactions
- Side effects
Nursing Process
- Implementation
- Teaching
Tricyclic Antidepressants
(MOA): Blocks uptake of neurotransmitters (norepinephrine & serotonin) in brain
(Indications): Depression, Anxiety, Insomnia, Chronic Pain Syndrome
(Interactions): MAOIs (Cardiovascular instability), Alcohol, CNS Depressants, Anticholinergics
(Side Effects): Suicidal thoughts, Anticholinergic effects (Weight gain, orthostatic hypotension, blood dyscrasias, GI Distress
(Implementation): Administer med @ night, Taper down (Avoid withdraw)
(Teaching): Takes several weeks for therapeutic effects, Greater risk for suicide
Tranylcypromine sulfate & Phenelzine Sulfate
Describe
- Drug Class
- More likely to cause what?
Monoamine Oxidase Inhibitor: Non-Selective MAOI-A
- More likely to cause food interaction & hypertensive crisis
Monoamine Oxidase Inhibitor Non-selective MAO-A & Selective MAO-B
Describe
- Mechanism of Action
- Interactions
- Indications
- Side Effects
(MOA): Increases lvls of (Norepinephrine, Dopamine, Epinephrine, & Serotonin)
(Interactions): Decongestants, Antidepressants (Phenylephrine & Pseudoephedrine) = Hypertensive Crisis, (TCA, SSRI, SNRI), Food w/ tyramine, OTC w/ Tyramine
(Indications): Depression (not controlled by TCA & 2nd generation anti-depressants)
(Side Effects): Agitation, Restlessness, Insomnia, Anticholinergic effects, Orthostatic hypotension, Hypertensive Crisis
Fluvoxamine, Fluoxetine, Escitaloprim, Paroxetine, Citalopram, Sertraline
Describe
- Drug Class
- Mechanism of Action
- Indications
- Interactions
- Therapeutic Effect Range
- Side Effects
- Drug for Chronic pain
Nursing Process
- Implementation
- Teaching
Selective Serotonin Reuptake Inhibitors
MOA: Increases Serotonin
Indication: Depression, OCD, Anxiety, Panic Phobias, Prevents Migraine headaches, Chronic pain
Interactions: MAOIs, Saint John warts, SSRI
TR: 3-4 weeks
Side Effects: Insomnia, Headache, Tremors, Seizures, Suicidal Ideation, GI Distress, Sexual dysfunction
Implementation: Slow taper for discontinuation of SSRI
Teaching: Be off of SSRI 14 days before starting MAOI & Be off of MAOI 5 weeks before SSRI
Venlafaxine, Duloxetine, Desvenlafaxine
Describe
- Drug Class
- Mechanism of Action
- Indication
- Interaction
- Side effects
Nursing Process
- Teaching
Serotonin Norepinephrine Reuptake inhibitors
MOA: Inhibit reuptake of serotonin & norepinephrine, increases these substance in nerve fibers
Indication: Major depression, Anxiety disorders, Adjuvant, chronic pain
Interactions: Saint John’s Wart & MAOI
Side effects: Stevens Johnsons Syndrome, Anticholinergic Effects, Hypertension, Euphoria, Seizures, Blood dyscrasias, GI distress, Insomnia, Sexual Dysfunction
Teaching: Be off of SNRI 14 days before starting MAOI
Nursing Process for Antidepressants
Describe
- Assessment
- Implementation
- Teaching
- Evaluation
Assessment: Base line VS & Weight, Hepatic & renal function, Past medical history, Current meds
Implementation: Monitor for suicidal tendencies & Seizures
Teaching: Avoid food containing Tyramine, take drugs as prescribed, Avoid (Alcohol, CNS depressants, & Cold medicines), Take w/ food, Don’t stop abruptly, Take TCA at bedtime, TR (2-4 weeks), Avoid Herbal supplements
Evaluation: Engages with others & more positive, Less suicidal
Fluphenazine & Fluphenazine Deconate
Describe
- Drug Class
- Mechanism of Action
- Indication
- Interaction
- Side Effects
Typical Anti-Psychotics (Phenothiazines)
MOA: Blocks dopamine (Strong affinity to D2)
Indiction: Treats Schizophrenia
Interaction: Alcohol/CNS depressants, Kava-kava, Tramadol
Side Effects: EPS, Peripheral edema, Weight gain, Anticholinergic effects, Neuroleptic malignant syndrome, Hypo/Hypertension, Tachycardia, Sedation, Seizures
Haloperidol & Haloperidol Deconate
Describe
- Drug Class
- Mechanism of Action
- Indication
- Contraindication
- Interaction
- Side Effects
- How long is this drug taken
Nursing Process
- Implementation
Typical Anti-Psychotics (Butyrophenone)
MOA: Blocks Dopamine (Strong affinity to D2)
Indication: Acute & Chronic Psychoses (Dementia), Schizophrenia, Tourette’s Syndrome
Contraindication: Narrow-angle glaucoma, Sedation, Severe liver, kidney, cardiovascular disease, blood dyscrasias
Interaction: Alcohol/CNS depressants, Kava-kava, Tramadol, Phenobarbital, Carbamazepine, Caffeine
Side Effects: Sedation, Anticholinergic Effects, EPS, Neuroleptic Malignant Syndrome, Insomnia, Agitation, Orthostatic hypotension, Tachycardia, Dysrhythmias
Notes: Taken for years
Implementation: Given only thru IM (z-track method), Identify S/s: EPS
Clozapine
Describe
- Drug Class
- Mechanism of Action
- Indication
- Side Effects
Nursing Process:
- Implementation
Atypical Antipsychotics
MOA: Blocks Dopamine (Affinity D4)
Indication: Severely ill schizophrenic pts (Intolerant to Typical Antipsychotics)
Side Effects: Blood Dyscrasias
Implementation: Monitor CBC, Stop if WBC is (<3000)
Ziprasidone
Describe
- Drug Class
- Side Effects
Nursing Process
- Implementation
Atypical Antipsychotics
Side Effects: Prolonged Q-T Interval
Implementation: Caution with Cardiac pts, Monitor EKG
Aripiprazole
Describe
- Drug Class
- Mechanism of Action
- Side effects
Nursing Process
- Implementation
Atypical Antipsychotics
MOA: Blocks Serotonin & Dopaminergic D4 receptors
Side Effects: Weight Gain, Hyperglycemia, Memory impairment, Metabolic syndrome (Diabetes), Impacts cardiovascular health, EPS, Agranulocytosis
Implementation: Monitor weight
Olanzapine & Risperidone
Describe
- Drug Class
- Side effects
Nursing Process
- Implementation
Atypical Antipsychotics
Side Effects: EPS, Insomnia, Gynecomastia
Implementation: Monitor Blood glucose (Metabolic Syndrome)
Nursing Process for Antipsychotics
Describe
- Assessment
- Implementation
- Teaching
Assessment: VS, Mental status, Medical History, Weight
Implementation: Monitor for “Cheeking”, Give oral drugs w/ ( milk or water), Give only thru (IM: Z-track), Disregard drug that remains in a plastic syringe for more than (15mins)
Teaching: TR (3-6 weeks), Avoid alcohol/CNS depressants & Kava Kava, don’t stop abruptly, Avoid dangerous activities
Buspirone
Describe
- Drug Class
- Mechanism of Action
- Indication
- Side Effects
- Interactions
Nursing process
- Teaching
Anti-Anxiety
MOA: Binds to serotonin & dopamine receptors
Indication: Anxiety
Side effects: Tachycardia, Palpations, Chest pain, Drowsiness/Dizziness, Headache, N, Nervousness, Excitement
Interaction: Grapefruit, Kava kava, Valerian, Chamomile
Teaching: TR (1-2 weeks), Take drug on scheduled basis
