Psychotherapeutic Drugs Flashcards
Alprazolam (Xanax)
Functional Classification
Antianxiety
Alprazolam (Xanax)
Mechanism of Action
Depresses subcortical levels of CNS, including limbic system, reticular formation
Alprazolam (Xanax)
Uses
Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms
Alprazolam (Xanax)
Contraindications
Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis, addiction
Alprazolam (Xanax)
Side Effects
CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, memory impairment, poor coordination
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension
EENT: Blurred Vision, tinnitus, mydriasis
GI: constipation, dry mouth, nausea, vomiting, anorexia, diarrhea, weight gain/loss, increased appetite
GU: decreased libido
INTEG: rash, dermatitis, itching, angioedema
Alprazolam (Xanax)
Nursing Considerations
ASSESS:
- Mental status: anxiety, mood, sensorium, orientation, affect, sleeping pattern, drowsiness, dizziness, especially in geriatric patients both before and during treatment
- BP lying, standing; pulse; if systolic BP drops 20mmHg, hold product, notify prescriber
- Hepatic, blood studies: AST, ALT, bilirubin, creatinine, LDH, alk phos, CBC; may cause neutropenia, decreased Hct, increased LFTs
- PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: anxiety, panic attacks, agitation, seizures, headache, nausea, vomiting, muscle pain, weakness; withdrawal seizures may occur after rapid decrease in dose or abrupt discontinuation; because duration of action is short, considered to be the product of choice for geriatric patients
Alprazolam (Xanax)
Overdose Treatment
Lavage, VS, supportive care, flumazenil
Amitriptyline
Functional Classification
Antidepressant - tricyclic
Amitriptyline
Chemical Classification
Tertiary Amine
Amitriptyline
Mechanism of Action
Blocks reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine, serotonin in nerve cells
Amitriptyline
Uses
Major Depression
Amitriptyline
Contraindications
Hypersensitivity to tricyclics, recovery phase of myocardial infarction
Amitriptyline
Side Effects
CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, EPS (geriatric patients), increased psychiatric symptoms, SEIZURES, SUICIDAL THOUGHTS
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, HYPERTENSION, palpitations, DYSRHYTHMIAS
EENT: Blurred Vision, tinnitus, mydriasis, ophthalmoplegia
GI: Constipation, Dry Mouth, weight gain, nausea, vomiting, PARALYTIC ILEUS, increased appetite, cramps, epigastric distress, jaundice, HEPATITIS, stomatitis
GU: Urinary Retention
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, EOSINOPHILIA, LEUKOPENIA, APLASTIC ANEMIA
INTEG: rash, urticaria, sweating, pruritus, photosensitivity
Amitriptyline
Nursing Considerations
ASSESS:
-BP lying, standing; pulse q4hr; if systolic BP drops 20mmHg, hold product, notify prescriber; take vital signs q4hr with CV disease; ECG for flattening of T wave, prolongation of QTc interval, bundle branch block, AV block, dysrhythmias in cardiac patients
-Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy
-Hepatic studies: AST, ALT, bilirubin
-Weight q wk; appetite may increase with product
-EPS primarily in geriatric patients: rigidity, dystonia, akathisia
-Mental status: mood, sensorium, affect, suicidal tendencies; increase in psychiatric symptoms: depression, panic; suicidal tendencies are higher in those </=24yr, restrict amount of product available
-Urinary retention, constipation; constipation is most likely to occur in children and geriatric patients
-WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness; do not usually occur unless product was discontinued abruptly
-Alcohol consumption; if alcohol is consumed, hold dose until morning
PAIN SYNDROMES (UNLABELED): intensity, location, severity; use pain scale; product may be taken for 1-2 months before effective
-SEXUAL DYSFUNCTION: erectile dysfunction, decreased libido
PERFORM/PROVIDE:
-Gum, hard sugarless candy, frequent sips of water for dry mouth
Amitriptyline
Overdose Treatment
ECG monitoring, lavage; administer anticonvulsant, sodium bicarbonate
Bupropion (Wellbutrin, Zyban)
Functional Classification
Antidepressant-miscellaneous
Bupropion (Wellbutrin, Zyban)
Chemical Classification
Aminoketone
Bupropion (Wellbutrin, Zyban)
Mechanism of Action
Inhibits reuptake of DOPamine
Bupropion (Wellbutrin, Zyban)
Uses
Depression (Wellbutrin), smoking cessation (Zyban); seasonal affective disorder
Bupropion (Wellbutrin, Zyban)
Contraindications
Hypersensitivity, eating disorders, seizure disorders
Bupropion (Wellbutrin, Zyban)
Side Effects
CNS: Headache, Agitation, Dizziness, Akinesia, Bradykinesia, Confusion, SEIZURES, delusions, Insomnia, Sedation, Tremors, SUICIDAL IDEATION
CV: Dysrhythmias, Hypertension, palpitations, Tachycardia, hypotension, COMPLETE AV BLOCK; QRS PROLONGATION (OVERDOSE)
EENT: Blurred Vision, Auditory Disturbances
GI: Nausea, Vomiting, anorexia, diarrhea, Dry Mouth, increased appetite, Constipation, altered taste
GU: impotence, urinary frequency, retention, Menstrual Irregularities
INTEG: Rash, pruritus, Sweating, STEVENS-JOHNSON SYNDROME
MISC: Weight Loss or Gain
Bupropion (Wellbutrin, Zyban)
Nursing Considerations
ASSESS:
- Hepatic/renal function in patients with hepatic, kidney impairment
- For increased risk of seizures; if patient has excessively used CNS depressants and OTC stimulants, dosage of buPROPion should not be exceeded
- For smoking cessation after 7-12wk; if progress has not been made, product should be discontinued
- Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms
PERFORM/PROVIDE:
- Assistance with ambulation during beginning therapy because sedation occurs
- Safety measures, primarily for geriatric patients
Bupropion (Wellbutrin, Zyban)
Overdose Treatment
ECG monitoring; lavage, activated charcoal; administer anticonvulsant
Diazepam (Valium)
Functional Classification
Antianxiety, anticonvulsant, skeletal muscle relaxant, central acting
Diazepam (Valium)
Chemical Classification
Benzodiazepine, long-acting
Diazepam (Valium)
Mechanism of Action
Potentiates the actions of GABA, especially in the limbic system, reticular formation; enhances presympathetic inhibition, inhibits spinal polysynaptic afferent paths
Diazepam (Valium)
Uses
Anxiety, acute alcohol withdrawal, adjunct for seizure disorders; preoperatively as a relaxant for skeletal muscle relaxation; rectally for acute repetitive seizures
Diazepam (Valium)
Contraindications
Pregnancy (D), hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia gravis, ethanol intoxication, hepatic disease, sleep apnea
Diazepam (Valium)
Side Effects
CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, ataxia
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension
EENT: Blurred Vision, tinnitus, mydriasis, nystagmus
GI: constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
HEMA: NEUTROPENIA
INTEG: rash, dermatitis, itching
RESP: RESPIRATORY DEPRESSION
Diazepam (Valium)
Nursing Considerations
ASSESS:
- BP (lying, standing), pulse; respiratory rate, if systolic BP drops 20mmHg, hold product, notify prescriber, respirations q5-15min if given IV
- Blood studies: CBC during long-term therapy; blood dyscrasias (rare); hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alk phos
- DEGREE OF ANXIETY; what precipitates anxiety and whether product controls symptoms
- ALCOHOL WITHDRAWAL SYMPTOMS, including hallucinations (visual, auditory), delirium, irritability, agitation, fine to coarse tremors
- Seizure control and type, duration, intensity of seizures
- For muscle spasms; pain relief
- IV site for thrombosis or phlebitis, which may occur rapidly
- Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies
- PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness after long-term use
PERFORM/PROVIDE:
- Assistance with ambulation during beginning therapy, for drowsiness, dizziness, safety measures
- Check to confirm PO medication swallowed
Diazepam (Valium)
Overdose Treatment
Lavage, VS, supportive care, flumazenil
Fluoxetine (Prozac)
Functional Classification
Antidepressant, SSRI (Selective Serotonin Reuptake Inhibitor)
Fluoxetine (Prozac)
Mechanism of Action
Inhibits CNS neuron uptake of serotonin but not of norepinephrine
Fluoxetine (Prozac)
Uses
Major depressive disorder, obsessive-compulsive disorder (OCD), bulimia nervosa; Sarafem: premenstrual dysphoric disorder (PMDD), panic disorder
Fluoxetine (Prozac)
Contraindications
Hypersensitivity
Fluoxetine (Prozac)
Side Effects
CNS: Headache, Nervousness, Insomnia, Drowsiness, Anxiety, Tremor, Dizziness, Fatigue, Sedation, Poor Concentration, Abnormal Dreams, Agitation, SEIZURES, apathy, euphoria, hallucinations, delusions, psychosis, SUICIDAL IDEATION, NEUROLEPTIC MALIGNANT SYNDROME-LIKE REACTIONS, serotonin syndrome
CV: Hot Flashes, Palpitations, angina pectoris, hypertension, TACHYCARDIA, 1ST-DEGREE AV BLOCK, BRADYCARDIA, MI, THROMBOPHLEBITIS
EENT: visual changes, ear/eye pain, photophobia, tinnitus
GI: Nausea, Diarrhea, Dry Mouth, Anorexia, Dyspepsia, Constipation, Cramps, Vomiting, Taste Changes, Flatulence, Decreased Appetite
GU: Dysmenorrhea, Decreased Libido, Urinary Frequency, UTI, amenorrhea, cystitis, impotence, urine retention
HEMA: HEMORRHAGE
INTEG: Sweating, Rash, Pruritus, acne, alopecia, urticaria, ANGIOEDEMA, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
META: hyponatremia
MS: Pain, arthritis, twitching
RESP: Infection, Pharyngitis, Nasal Congestion, Sinus Headache, Sinusitis, Cough, Dyspnea, Bronchitis, asthma, hyperventilation, pneumonia
SYST: Asthenia, Viral Infection, Fever, Allergy, Chills
Fluoxetine (Prozac)
Nursing Considerations
ASSESS:
- Mental Status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic; monitor for seizures, seizures potential increased
- BULIMIA NERVOSA: appetite, weight daily, increase nutritious foods in diet, watch for bingeing and vomiting
- ALLERGIC REACTIONS/SERIOUS SKIN REACTIONS: angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, rash, urticaria; product should be discontinued, may need to give antihistamine
- BP (lying/standing), pulse q4hr, if systolic BP drops 20mmHg, hold product, notify prescriber; ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
- Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy; check platelets; bleeding can occur, thyroid function, growth rate, weight
- Hepatic studies: AST, ALT, bilirubin, creatinine, weight weekly; appetite may decrease with product
- Alcohol consumption; if alcohol is consumed, hold dose until AM
PERFORM/PROVIDE
-Safety measures, primarily for geriatric patients
Haloperidol (Haldol)
Functional Classification
Antipsychotic, neuroleptic
Haloperidol (Haldol)
Chemical Classification
Butyrophenone
Haloperidol (Haldol)
Mechanism of Action
Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by DOPamine at synapse; exhibits strong alpha-adrenergic, anticholinergic blocking action; mechanism for antipsychotic effects unclear
Haloperidol (Haldol)
Uses
Psychotic disorders, control of tics, vocal utterances in Gilles de la Tourette’s syndrome, short-term treatment of hyperactive children showing excessive motor activity, prolonged parenteral therapy in chronic schizophrenia, organic mental syndrome with psychotic features, hiccups (short-term), emergency sedation of severely agitated or delirious patients, ADHD
Haloperidol (Haldol)
Contraindications
Children s disease, angina, epilepsy, urinary retention, closed-angle glaucoma
Haloperidol (Haldol)
Side Effects
CNS: EPS: Pseudoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Drowsiness, Headache, SEIZURES, NEUROLEPTIC MALIGNANT SYNDROME, confusion
CV: Orthostatic Hypotension, hypertension, CARDIAC ARREST, ECG changes, TACHYCARDIA, QT PROLONGATION, SUDDEN DEATH, TORSADES DE POINTES
EENT: blurred vision, glaucoma, dry eyes
GI: Dry Mouth, Nausea, Vomiting, Anorexia, Constipation, diarrhea, jaundice, weight gain, ILEUS, HEPATITIS
GU: urinary retention, dysuria, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia
INTEG: Rash, photosensitivity, dermatitis
RESP: LARYNGOSPASM, dyspnea, RESPIRATORY DEPRESSION
SYST: RISK FOR DEATH (DEMENTIA)
Haloperidol (Haldol)
Nursing Considerations
ASSESS:
- Swallowing of PO medication; check for hoarding or giving of medication to other patients
- Prolactin, CBC, urinalysis, opthalmic exam before and during prolonged therapy
- Dementia, affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
- BP standing, lying; take pulse, respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30mmHg
- Dizziness, faintness, palpitations, tachycardia on rising
- EPS including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
- NEUROLEPTIC MALIGNANT SYNDROME/SEROTONIN SYNDROME: hyperthermia, muscle rigidity, altered mental status, increased CPK, seizures, hypo/hypertension, tachycardia; notify prescriber immediately
- Constipation, urinary retention daily; if these occur, increase bulk, water in diet
PERFORM/PROVIDE
- Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program, fainting is possible; patient should not stand still for long periods
- Sips of water, sugarless candy, gum for dry mouth
- Storage in tight, light-resistant container
Haloperidol (Haldol)
Overdose Treatment
Activated charcoal, lavage if orally ingested; provide an airway; don not induce vomiting
Lithium
Functional Classification
Antimanic, antipsychotic
Lithium
Chemical Classification
Alkali metal ion salt
Lithium
Mechanism of Action
May alter sodium, potassium ion transport across cell membrane in nerve, muscle cells; may balance biogenic amines of norepinephrine, serotonin in CNS areas involved in emotional responses
Lithium
Uses
Bipolar disorders (manic phase), prevention of bipolar manic-depressive psychosis
Lithium
Contraindications
Pregnancy (D), breastfeeding, children <12yr, hepatic disease, brain trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration
Lithium
Side Effects
CNS: Headache, Drowsiness, Dizziness, tremors, twitching, ataxia, SEIZURE, slurred speech, restlessness, confusion, stupor, memory loss, clonic movements, fatigue
CV: Hypotension, ECG changes, DYSRHYTHMIAS, CIRCULATORY COLLAPSE, edema
EENT: tinnitus, blurred vision
ENDO: hyponatremia, goiter, hyperglycemia, hypo/hyperthyroidism
GI: Dry Mouth, Anorexia, Nausea, Vomiting, Diarrhea, incontinence, abdominal pain, metallic taste
GU: POLYURIA, GLYCOSURIA, PROTEINURIA, ALBUMINURIA, urinary incontinence, polydipsia
HEMA: LEUKOCYTOSIS
INTEG: drying of hair, alopecia, rash, pruritus, hyperkeratosis, acneiform lesions, folliculitis
MS: muscle weakness
Lithium
Nursing Considerations
ASSESS:
- MENTAL STATUS: manic symptoms, mood, behavior before, during treatment
- LITHIUM TOXICITY: diarrhea, vomiting, tremor, twitching
- weight daily; check for, report edema in legs, ankles, wrists
- sodium intake; decreased sodium intake with decreased fluid intake may lead to lithium retention; increased sodium, fluids may decrease lithium retention
- skin turgor at least daily
- urine for albuminuria, glycosuria, uric acid during beginning treatment, q2mo thereafter
- neurologic status: LOC, gait, motor reflexes, hand tremors
- Serum Lithium levels 2x/wk initially then q2mo (therapeutic level: 0.5-1.5mEq/L); toxic level >1.5mcg/L
- ECG in those >50yr with CV disease
Lithium
Overdose Treatment
Induce emesis or lavage, maintain airway, respiratory function; dialysis for severe intoxication
Lorazepam (Ativan)
Functional Classification
Sedative, hypnotic; antianxiety
Lorazepam (Ativan)
Chemical Classification
Benzodiazepine, short acting
Lorazepam (Ativan)
Mechanism of Action
Potentiate the actions of GABA, especially in the limbic system and the reticular formation
Lorazepam (Ativan)
Uses
Anxiety, irritability with psychiatric or organic disorders, preoperatively; insomnia; adjunct for endoscopic procedures, status epilepticus
Lorazepam (Ativan)
Contraindications
Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea
Lorazepam (Ativan)
Side Effects
CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, weakness, unsteadiness
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension; APNEA, CARDIAC ARREST (IV, RAPID)
EENT: Blurred Vision, tinnitus, mydriasis
GI: Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
INTEG: rash, dermatitis, itching
MISC: acidosis
Lorazepam (Ativan)
Nursing Considerations
ASSESS:
- ANXIETY: decrease in anxiety; mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies
- renal/hepatic/blood status if receiving high-dose therapy
- PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness, tremors, seizures, after long-term, excessive use
PERFORM/PROVIDE:
- Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
- Check to confirm that PO medication has been swallowed
Lorazepam (Ativan)
Overdose Treatment
Lavage, VS, supportive care, flumazenil
Mirtazapine
Functional Classification
Antidepressant
Mirtazapine
Chemical Classification
Tetracyclic
Mirtazapine
Mechanism of Action
Blocks reuptake of norepinephrine and serotonin into nerve endings, thereby increasing action of norepinephrine and serotonin in nerve cells; antagonist of central alpha2-receptors; blocks histamine receptors
Mirtazapine
Uses
Depression; dysthymic disorder; bipolar disorder: depressed, agitated depression
Mirtazapine
Contraindications
Hypersensitivity to tricyclics, recovery phase of MI, agranulocytosis, jaundice
Mirtazapine
Side Effects
CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, weakness, nightmares, EPS (geriatric patients), increased psychiatric symptoms, SEIZURES
CV: Orthostatic Hypotension, ECG Changes, Tachycardia, HYPERTENSION, palpitations
EENT: Blurred Vision, tinnitus, mydriasis
GI: Diarrhea, Dry Mouth, nausea, vomiting, PARALYTIC ILEUS, increased appetite, cramps, epigastric distress, constipation , JAUNDICE, HEPATITIS, stomatitis, weight gain
GU: Urinary Retention, ACUTE RENAL FAILURE
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, EOSINOPHILIA, LEUKOPENIA
INTEG: rash, urticaria, sweating, pruritus, photosensitivity
SYST: flulike symptoms, increased cholesterol levels
Mirtazapine
Nursing Considerations
ASSESS:
- BP (lying, standing), pulse q4hr; if systolic BP drops 20mmHg, hold product, notify prescriber; vital signs q4hr in patient with CV disease
- Blood studies: CBC, leukocytes, differential, cardiac enzymes, lipid profile, blood glucose if patient is receiving long-term therapy
- Hepatic studies: AST, ALT, bilirubin, creatinine
- Weight weekly; appetite may increase with product
- ECG for flattening of T wave, bundle branch block, AV block, dysrhythmias in cardiac patients
- Mental status: mood, sensorium, affect, suicidal tendencies (especially among adolescents, young adults), increase in psychiatric symptoms: depression, panic; EPS primarily in geriatric patients: rigidity, dystonia, akathisia
- SEROTONIN SYNDROME: hyperthermia, hypertension, myoclonus, rigidity, delirium, coma; if using other serotonergic products
- Alcohol consumption; if alcohol consumed, hold dose until morning
PERFORM/PROVIDE
- Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
- Safety measures, including side rails, primarily for geriatric patients
Mirtazapine
Overdose Treatment
ECG monitoring, lavage, activated charcoal; administer anticonvulsant, IV fluids
Risperidone (Risperdal)
Functional Classification
Antipsychotic
Risperidone (Risperdal)
Chemical Classification
Benzisoxazole derivative
Risperidone (Risperdal)
Mechanism of Action
Unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism
Risperidone (Risperdal)
Uses
Irritability associated with autism, bipolar disorder, mania, schizophrenia
Risperidone (Risperdal)
Contraindications
Hypersensitivity
Risperidone (Risperdal)
Side Effects
CNS: EPS, Pseudoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia; Drowsiness, Insomnia, Agitation, Anxiety, Headache, SEIZURES, NEUROLEPTIC MALIGNANT SYNDROME, dizziness, SUICIDAL IDEATION, head titubation (shaking)
CV: orthostatic hypotension, TACHYCARDIA; HEART FAILURE, SUDDEN DEATH (GERIATRIC PATIENTS), AV block
EENT: blurred vision, tinnitus
GI: Nausea, vomiting, Anorexia, Constipation, jaundice, weight gain
GU: hyperprolactinemia, gynecomastia, dysuria
HEMA: NEUTROPENIA, GRANULOCYTOPENIA
MISC: RENAL ARTERY OCCLUSION; weight gain, hyperprolactinemia (child)
MS: RHABDOMYOLYSIS
RESP: rhinitis, sinusitis, upper respiratory infection, cough
Risperidone (Risperdal)
Nursing Considerations
ASSESS:
- SUICIDAL THOUGHTS/BEHAVIORS: often when depression is lessened; mental status before initial administration
- Swallowing of PO medication; check for hoarding or giving of medication to other patients
- I&O ratio; palpate bladder if urinary output is low
- Bilirubin, CBC, hepatic studies monthly
- Urinalysis before, during prolonged therapy
- Affect, orientation, LOC, reflexes gait, coordination, sleep pattern disturbances
- QT PROLONGATION: BP standing, lying; pulse, respirations; take these q4hr during initial treatment; establish baseline before starting treatment; report drops of 30mmHg; watch for ECG changes
- Dizziness, faintness, palpitations, tachycardia on rising
- EPS: akathisia, tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
- SERIOUS REACTIONS IN GERIATRIC PATIENT: fatal pneumonia, heart failure, sudden death, dementia
- NEUROLEPTIC MALIGNANT SYNDROME: hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, change in BP, fatigue, tachycardia
- Constipation, urinary retention daily; if these occur, increase bulk, water in diet
- Weight gain, hyperglycemia, metabolic changes in diabetes
PERFORM/PROVIDE:
- Decreased stimuli by dimming lights, avoiding loud noises
- Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
- Increased fluids to prevent constipation
- Sips of water, candy, gum for dry mouth
- Storage in tight, light-resistant container (PO); unopened vials in refrigerator, protect from light; do not freeze
Risperidone (Risperdal)
Overdose Treatment
Lavage if orally ingested; provide airway; do not induce vomiting
Alprazolam (Xanax)
Chemical Classification
Benzodiazepine (short/intermediate acting)
