Psychpharm drugs Flashcards
Extrapyramidal SEs
- acute dystonic reaction: occur as muscle spams involving tongue, neck, and back - oculogyric crisis - frightening for patient.
- pseudoparkinsonism: resembles true PD, will see tremors, mask-like facial expression, shuffling gait, drooling, rigidity, cogwheeling, pill rolling.
- akathisia: extreme restlessness; can do undetected, patient very uncomfy; can be difficult to distinguish from agitation.
- *tardive dyskinesia: usually occurs after LT treatment; motor tics involving tongue, mouth or face or may occur as purposeless involuntary movements of trunk and extremities; irreversible syndrome; TO AVOID - GIVE SMALLEST DOSE FOR SHORTEST AMT OF TIME.
Neuroleptic malignant syndrome
characterized by hyperpyrexia (fever), severe EPS, muscle rigidity, diaphoresis, autonomic instability, increased CPK, increased confusion or worsening of psych symptomology.
usually develops in 3-9 days. mortality rate 14-30% secondary to resp failure resulting from pulmonary emboli, cardiovascular collapse or acute renal failure.
BROMOCRIPTINE (PARLODEL) or DANTROLENE (DANTRIUM) may be ordered for NMS.
Cogentin (Benztropine)
Artane (Trihexyphenidyl)
Benadryl (Diphenhydramine)
Symmetrel (Amantadine HCl)
- anticholinergic and antihistaminic
- indicated for trreatment of EPS (not tardive d.)
- should NOT be given prophylatically or in the presence of paralytic ileus or prostatci hypertrophy
Atypical antipsychotics
Clozaril (clozapine) Risperdal (risperidone) Zypreza (olanzapine) Seroquel (quetiapine) Geodon (zipresidone) Zydis (olanzapine) - some in long-acting form given IM Symbyax (olanzapine, fluoxetine, prozac) Saphris (asenapine) - sublingual 5-10mg Invega (paliperidone)
*now considered the most effective drugs for schizophrenia – less SEs – more compliance
Novel antipsychotic
Abilify (aripiprazole)
TCAs antidepressants
- Elavil (Amitriptyline)
- Norpramine (Desipramine)
- Sinequan, Adapin (Doxepin)
- Tofranil (Imipramine)
- Asendin (Amoxapine)
- Aventyl (Nortriptyline)
- Vivactil (Protriptyline)
- Surmontil (Trimipramine)
- Anafranil (Clomipramine)
- Maprotiline (Ludiomil)
TCAs
- do not produce euphoria
- not addictive
- MAJOR concers = arrhythmias
TCAs - SEs
- anticholinergic SEs - tolerance should occur
- sedation, drowsiness (CNS effects)
- skin rashes, agranulocytosis
- orthostatic hypotentsion
- arrhythmias
- tremors or mild psudoparkinsonism
- weight loss/gain
- confusion or restlessness in elderly
TCAs - Nursing Implications
- Gaining energy = suicide watch
- Pts should know that it takes 1-4 wks to work
- Pts should know that they’ll develop tolerance to anticholingeric SEs
- these drugs with potentiate the effect of alcohol and other CNS depressants.
- can cause dental caries - hyposalivation - dry mouth
- – perform good oral hygiene and only use sugarless gum/candy
MAOIs
Nardil
Marplan
Parnate
- usually last resort antidepressant
- 3-4 weeks to work
- must abide to tyramine diet
- contraindicated for use in patients with HD, phenochromocytoma, pregnancy, kidney dz, epilepsy.
MAOIs - SEs
- caution must be taken to avoid a precipitating hypertensive crisis
MAOIs - Nursing Implications
- Pts should know to avoid tyramine containing foods and beverages.
- Pt should be monitored for symptoms of headache, hypertension, stiff neck
- Pt should know that it may not work for 2-4 weeks.
- Be aware of suicidal ideation and/or intent.
SSRIs
A. 1. Prozac (Fluoxetine) & Prozac Weekly 90 mg
- Zoloft (Sertraline)
- Paxil ( Paroxetine)
- Luvox (Fluvoxamine)
- Celexa (Citalopram)
- Sarafem (Fluoxetine)
Serotonin syndrome
Can occur in pts who are taking drugs that enhance the action of serotonin to the point of inducing a hyperserotonergic state.
Highest risk is when SSRIs and MAOIs are combined.
Symptoms: (hard to distinguish from NMS) mental changes, hyperreflexia, autonomic instability, rigidity, diaphoresis, tachycardia, hyperthermia, and seizures.
SS occurs within hours of taking drugs.
Treatment begins with stopping the meds, controlling elevated temp, seizures, myoclonus and hypertension.
SSRIs - Nursing Implications
- Risk of suicide
- There must be a 14 day wait between stopping a MAOI and starting an SSRI
- Take in morning (they interrupt sleep)
- Can be given in one dose - long half-life
Novel Antidepressants
Wellbutrin (Bupropion) - block reuptake of activating antidepressant. Can cause weight loss and seizures. Also assists in smoking cessation.
Desyrel (Trazodone) - has serotonergic activity but little anticholingeric activity or SEs. It causes postural hypotension and sedation (often given for insomnia). Rare SE of PRIAPISM.
Effexcor (Venlafaxine): Blocks the reuptake of serotonin and norepi. Does not have anticholinergic SEs. Can cause N, anorexia, insomnia and sweating (in high doses), but does not interfere with sexual performance.
Serzone (Nefazodone): Works by blocking the reuptake of serotonin and norepi (less so). Has few SEs (nausea most common) and doesn’t affect sexual function or BP. May be useful in depressed elderly.
Remeron (Mirtazapine): Enhances the release of serotonin and norepi. SEs include sedation, drowsiness, weight gain but no sexual dysfunction. Strongly interactive with alcohol.
Antianxiety meds
- Librium (Chlordiazepoxide)
- Valium (Diazepam)
- Tranxene (Chorazepate)
- Ativan (Lorazapam) -benzo
- Xanax (Alprazolam) - benzo
- Serax (Oxazepam) - benzo
- Buspar (Busprione HCI, not a benzo)(mechanism of action unknown; doesn’t depress CNS)
- Klonopin (Clonazepam) - benzo
- Clonidine (Catapres) (anti-hypertensive)
- Propranolol – beta blocker (Inderal)
- *** Vistaril (antihistamine) - give cautiously to pt that has taken an
anti-parkinsonian med
Antianxiety
- Act by sedating the cerebral cortex as well as lower brain centers. – effect is lowered anxiety, muscle relaxation and release of inhibitions.
- Drugs are habit forming and should be limited to 14 days of use.
- Contraindicated with pregnancy and addictive personalities.
Antianxiety - SEs
- drowsiness, ataxia, dizziness, and headache
- confusion in elderly
- rash, n/v, dry mouth and blood dyscrasias
- withdrawal syndrome can occur from abrupt cessation – SEs include increased anxiety, restlessness, tachycardia, tremors, diaphoresis, hallucinations, convulsions.
- paradoxical reactions have been reported such as increased anxiety, insomnia and agitation.
Antianxiety - Nursing Implications
- When treatment is started, pt may be somewhat drowsy - inform that this should subside.
- Always get a thorough drug history. Be aware of withdrawal symptoms.
- Educate pt and family about addictive effects. Take only as prescribed.
Lithium
- Indicated in treatment of BD.
- Acts as an antimanic, specific biochemical mechanism of action is unknown.
- Therapeutic effects take 7-10 days. (0.5-1.5 mEq). – Therapeutic range is very close to toxic range.
- Contraindicated in patients with cardiovascular/renal disease and in patients with brain damage and pregnancy.
Lithium - SEs
- Lithium toxicity
- tremors
- weakness
- n/v
- diarrhea
- polyuria
- thirst
- edema
- hypothyroidism
Early signs of toxicity:
- severe GI disturbances
- muscle weakness
- ataxia
- gross tremors of the extremities
Increased toxicity:
- blurred vision
- slurred speech
- nystagmus
- muscle hyperirritability
Severe toxicity:
- hypertension of limbs
- toxic psychosis
- EEG changes
- circulatory failure
- coma
- death
Lithium - Nursing Implication
- Teach about toxic symptoms
- anytime a pt loses significant amounts of body fluid (vomiting, diarrhea, diaphoresis), the serum lithium concentration will rise.
- Do not use diuretics.
- Lithium is very similar structurally to sodium so it competes at many sites. – Pts must maintain a regular intake of salt because a decrease in sodium will cause lithium levels to rise.
- Take as prescribed.
Other antimanic agents
Klonopin (clonazepam)
Tegretrol (carbamazepine)
Depakote (valproic acid)
Calan (verapamil) Ca channel blocker
Antabuse (Disulfiram)
- Prescribed as a deterrent for alcoholics to avoid alcohol.
- Inhibits alcohol metabolism at its most toxic step – causes intense reaction.
- Symptoms: flushing, warm skin, and HA.
- Later, pt may experience N/V, anxiety, thirst, confusion and hypotension.
- It can be fatal.
- Pts must be taught to avoid alcohol.
- It will stage in system for 1-2 weeks after being discontinued.
- Pts not given med until they are highly motivated to quit drinking and commit themselves to sobriety.
Naltrexone (Revia)
- Used for alcohol dependence
- It’s an opioid receptor antagonist and blocks the effects of alcohol on beta endorphin activity in the brain.
- It is effective in supporting abstinence, preventing relapse, and decreasing both craving and alcohol consumption.
Buprenorphine (Subutex)
- Acts as an opiod agonist, enabling opiod-depending individuals to discontinue opioids without experiencing withdrawal.
- When combined with naloxone (Suboxone), there is a less risk of abuse by patient.
Darvon (Darvocet)
- An opioid used in detox protocol to taper patients off of opioids (heroine and other narcotics)
Methadone
- Used in treatment of narcotic withdrawal and dependence
- Take PO once a day
- Suppresses narcotic withdrawal for 24-36 hours
- Since it is effective in eliminating withdrawal symptoms, it’s used in detoxifying opiate addicts
- ONLY effective in cases of addiction to heroine, morphine, and other opioid drugs.
- Reduces cravings associated with heroin use and blocks the high from heroin, but does not provide the euphoric rush.
- Pt remains physically dependent on the opioid but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts.
