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Psychotherapeutic Drugs Flashcards

1
Q

Alprazolam (Xanax)

Chemical Classification

A

Benzodiazepine (short/intermediate acting)

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2
Q

Alprazolam (Xanax)

Mechanism of Action

A

Depresses subcortical levels of CNS, including limbic system, reticular formation

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3
Q

Alprazolam (Xanax)

Uses

A

Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms

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4
Q

Alprazolam (Xanax)

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis, addiction

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5
Q

Alprazolam (Xanax)

Side Effects

A

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

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6
Q

Alprazolam (Xanax)

Nursing Considerations

A

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
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7
Q

Alprazolam (Xanax)

Overdose Treatment

A

Lavage, VS, supportive care, flumazenil

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8
Q

Amitriptyline

Functional Classification

A

Antidepressant - tricyclic

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9
Q

Amitriptyline

Chemical Classification

A

Tertiary Amine

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10
Q

Amitriptyline

Mechanism of Action

A

Blocks reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine, serotonin in nerve cells

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11
Q

Amitriptyline

Uses

A

Major Depression

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12
Q

Amitriptyline

Contraindications

A

Hypersensitivity to tricyclics, recovery phase of myocardial infarction

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13
Q

Amitriptyline

Side Effects

A

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

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14
Q

Amitriptyline

Nursing Considerations

A

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

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15
Q

Amitriptyline

Overdose Treatment

A

ECG monitoring, lavage; administer anticonvulsant, sodium bicarbonate

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16
Q

Bupropion (Wellbutrin, Zyban)

Functional Classification

A

Antidepressant-miscellaneous

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17
Q

Bupropion (Wellbutrin, Zyban)

Chemical Classification

A

Aminoketone

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18
Q

Bupropion (Wellbutrin, Zyban)

Mechanism of Action

A

Inhibits reuptake of DOPamine

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19
Q

Bupropion (Wellbutrin, Zyban)

Uses

A

Depression (Wellbutrin), smoking cessation (Zyban); seasonal affective disorder

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20
Q

Bupropion (Wellbutrin, Zyban)

Contraindications

A

Hypersensitivity, eating disorders, seizure disorders

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21
Q

Bupropion (Wellbutrin, Zyban)

Side Effects

A

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

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22
Q

Bupropion (Wellbutrin, Zyban)

Nursing Considerations

A

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
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23
Q

Bupropion (Wellbutrin, Zyban)

Overdose Treatment

A

ECG monitoring; lavage, activated charcoal; administer anticonvulsant

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24
Q

Diazepam (Valium)

Functional Classification

A

Antianxiety, anticonvulsant, skeletal muscle relaxant, central acting

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25
Diazepam (Valium) | Chemical Classification
Benzodiazepine, long-acting
26
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
27
Diazepam (Valium) | Uses
Anxiety, acute alcohol withdrawal, adjunct for seizure disorders; preoperatively as a relaxant for skeletal muscle relaxation; rectally for acute repetitive seizures
28
Diazepam (Valium) | Contraindications
Pregnancy (D), hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia gravis, ethanol intoxication, hepatic disease, sleep apnea
29
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
30
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
31
Diazepam (Valium) | Overdose Treatment
Lavage, VS, supportive care, flumazenil
32
Fluoxetine (Prozac) | Functional Classification
Antidepressant, SSRI (Selective Serotonin Reuptake Inhibitor)
33
Fluoxetine (Prozac) | Mechanism of Action
Inhibits CNS neuron uptake of serotonin but not of norepinephrine
34
Fluoxetine (Prozac) | Uses
Major depressive disorder, obsessive-compulsive disorder (OCD), bulimia nervosa; Sarafem: premenstrual dysphoric disorder (PMDD), panic disorder
35
Fluoxetine (Prozac) | Contraindications
Hypersensitivity
36
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
37
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
38
Haloperidol (Haldol) | Functional Classification
Antipsychotic, neuroleptic
39
Haloperidol (Haldol) | Chemical Classification
Butyrophenone
40
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
41
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
42
Haloperidol (Haldol) | Contraindications
Children s disease, angina, epilepsy, urinary retention, closed-angle glaucoma
43
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)
44
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
45
Haloperidol (Haldol) | Overdose Treatment
Activated charcoal, lavage if orally ingested; provide an airway; don not induce vomiting
46
Lithium | Functional Classification
Antimanic, antipsychotic
47
Lithium | Chemical Classification
Alkali metal ion salt
48
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
49
Lithium | Uses
Bipolar disorders (manic phase), prevention of bipolar manic-depressive psychosis
50
Lithium | Contraindications
Pregnancy (D), breastfeeding, children <12yr, hepatic disease, brain trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration
51
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
52
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
53
Lithium | Overdose Treatment
Induce emesis or lavage, maintain airway, respiratory function; dialysis for severe intoxication
54
Lorazepam (Ativan) | Functional Classification
Sedative, hypnotic; antianxiety
55
Lorazepam (Ativan) | Chemical Classification
Benzodiazepine, short acting
56
Lorazepam (Ativan) | Mechanism of Action
Potentiate the actions of GABA, especially in the limbic system and the reticular formation
57
Lorazepam (Ativan) | Uses
Anxiety, irritability with psychiatric or organic disorders, preoperatively; insomnia; adjunct for endoscopic procedures, status epilepticus
58
Lorazepam (Ativan) | Contraindications
Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea
59
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
60
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
61
Lorazepam (Ativan) | Overdose Treatment
Lavage, VS, supportive care, flumazenil
62
Mirtazapine | Functional Classification
Antidepressant
63
Mirtazapine | Chemical Classification
Tetracyclic
64
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
65
Mirtazapine | Uses
Depression; dysthymic disorder; bipolar disorder: depressed, agitated depression
66
Mirtazapine | Contraindications
Hypersensitivity to tricyclics, recovery phase of MI, agranulocytosis, jaundice
67
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
68
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
69
Mirtazapine | Overdose Treatment
ECG monitoring, lavage, activated charcoal; administer anticonvulsant, IV fluids
70
Risperidone (Risperdal) | Functional Classification
Antipsychotic
71
Risperidone (Risperdal) | Chemical Classification
Benzisoxazole derivative
72
Risperidone (Risperdal) | Mechanism of Action
Unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism
73
Risperidone (Risperdal) | Uses
Irritability associated with autism, bipolar disorder, mania, schizophrenia
74
Risperidone (Risperdal) | Contraindications
Hypersensitivity
75
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
76
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
77
Risperidone (Risperdal) | Overdose Treatment
Lavage if orally ingested; provide airway; do not induce vomiting
78
Alprazolam (Xanax) | Functional Classification
Antianxiety

a_nclex (40 decks)

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