Topic 5: Drugs that Affect the neurological system Flashcards
Barbiturates (No Antidotes)
a class of drugs used to induce sedation; chemical derivatives of barbituric acid
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium)
considered prototypical barbiturate; classified as a long-acting drug
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Mechanism of action
CNS depressants acts primarily on brainstem (‘reticular formation’)
- sedative and hypnotic effects are dose related
- act by reducing nerve impulses traveling to area of the brain (cerebral cortex)
- ability to inhibit nerve impulse transmission due in part to ability to potentiate the action of inhibitory neurotransmitter GABA, found in high concentration in CNS
- Barbiturates raise seizure threshold; can be used to treat seizures
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Indications
- prevention of generalized tonic-clonic seizures and fever-induced convulsion
- useful in Tx of hyperbilirubinemia in neonates
- rarely used today as a sedative and is no longer recommended to be used as a hypnotic drug
Indications for Barbiturates
All barbiturates have same sedative hypnotic effects but differ in their potency, time to onset of action, and duration of action. The various categories of barbiturates can be used to the following therapeutic purposes: ultrashort, short, intermediate, and long acting
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Contraindication
known drug allergy, pregnancy, significant respiratory difficulties, and severe kidney or liver disease. These drugs (barbs) must be used with caution in older adults due to their sedative properties and increased fall risk
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Adverse effects
low therapeutic index; long acting, adverse effects relate to the CNS and include drowsiness, lethargy, dizziness, hangover, and paradoxical restlessness or excitement. -Barbs deprive people of their REM sleep which can result in agitation. With most sedative drugs the risk of fall occurs so for older adults it can be suggested to take half of dose
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Assessment
- insomnia, any concerns voiced about sleep patterns or disorders, the time it takes to fall asleep, vitals, physical assessment, renal and liver, mental status, miscellaneous info about medical history, use of drugs etc.,
- evaluate cautions, contraindications, and drug interactions
- NOT to be used pregnant or lactating women- these drugs cross the placenta and breast-blood barriers posing a risk for respiratory depression in the fetus and neonate. If women take while pregnant baby will have withdrawal symptoms
Barbiturates (No Antidotes) Phenobarbital (Luminol Sodium) Patient teaching
advice about hangover effects to older patients, encourage to keep journal of sleep, avoid caffeine when trying to go to bed (avoid at least 6 hours before bedtime), keep drugs out of the reach of children, emphasize to take as required, educate about driving or operation of heavy machine while taking those drugs
Difference between sedatives and hypnotics
-Sedatives reduce nervousness, excitability, and irritability
without causing sleep, but a sedative can become a hypnotic if it is given in large enough doses.
-Hypnotics cause sleep and have a much more potent effect on the CNS than do sedatives
Phenobarbital is also used to treat?
status epilepticus (prolonged uncontrolled seizures). In extreme cases, patients may be intentionally overdosed to the extent of causing therapeutic phenobarbital or pentobarbital coma
Benzodiazpenes
a chemical category of drugs most frequently prescribed as anxiolytic (drugs used to reduce intensity of anxiety) drugs and less frequently as sedative-hypnotic agents
Benzodiazpenes Diazepam (Valium) - long acting Mechanism of action
Diazepam (Valium) - long acting
Mechanism of action: sedative and hypnotic action is related to ability to depress activity in CNS. Specifically the hypothalamic, thalamic, and limbic systems of the brain. Because research suggest they are GABA receptors or other adjacent receptors. GABA- primary inhibitory neurotransmitter of the brain and it serves to modulate CNS activity by inhibiting overstimulation
Benzodiazpenes Diazepam (Valium) Indications
treatment of anxiety, procedural sedation, and anesthesia adjunct, anticonvulsant therapy, and skeletal relaxation following orthopedic injury or surgery
Benzodiazpenes Diazepam (Valium) contraindication
drug allergy, narrow-angle glaucoma, and pregnancy
Benzodiazpenes Diazepam (Valium) Adverse effects
can be harmful if dose is mixed with alcohol, headache, drowsiness, paradoxical excitement or nervousness, dizziness, vertigo, cognitive impairment and lethargy. Fall hazard for older population, have comparatively less intense effects on the normal sleep cycle, ‘hangover’ effect is sometimes reported (daytime sleepiness), withdrawal symptoms like rebound insomnia. Amnesia, anorexia, sedation, lethargy, fatigue, confusion, drowsiness, dizziness, ataxia, headache, visual changes, hypotension, weight gain or loss, nausea, weakness
Benzodiazpenes Diazepam (Valium) Toxicity/management
when taken with alcohol, barbiturates, overdose causes somnolence, confusion, diminished reflexes, and coma. Treatment is the antidote Flumazenil
Benzodiazpenes Diazepam (Valium) Interactions
alcohol, opioids, muscle relaxants will cause intense CNS depressant, kava and valerian are herbal supplements that interact and can lead to CNS depression, grapefruit results in prolonged effect, increased effect and toxicity
Benzodiazpenes Diazepam (Valium) Assessment
vitals, identification of disorders or conditions that pose threat for caution or contraindications, monitor suicide, anemic, have history of substance/alcohol abuse, caution pregnant or lactating patients, renal functions or hepatic function studies to help prevent toxicity or complications, pay attention to drug interactions
Benzodiazpenes Diazepam (Valium) Patient teaching
advice about hangover effects to older patients, encourage to keep journal of sleep, avoid caffeine when trying to go to bed (avoid at least 6 hours before bedtime), keep drugs out of the reach of children, emphasize to take as required, educate about driving or operation of heavy machine while taking those drugs
Benzodiazpenes Midazolam (Versed) – short acting Mechanism of action
sedative and hypnotic action related to ability to depress activity in the CNS. Specifically the hypothalamic, thalamic, and limbic systems of the brain. Because research suggest they are GABA receptors or other adjacent receptors. GABA- primary inhibitory neurotransmitter of the brain and it serves to modulate CNS activity by inhibiting overstimulation
Benzodiazpenes Midazolam (Versed) Indication
commonly used preoperatively and for moderate sedation. It has the ability to cause amnesia and anxiolysis (reduced anxiety), as well as sedation
Benzodiazpenes Midazolam (Versed) contraindications
drug allergy, narrow-angle glaucoma, and pregnancy
Benzodiazpenes Midazolam (Versed) adverse effects
harmful if dose mixed with alcohol, headache, drowsiness, paradoxical excitement or nervousness, dizziness, vertigo, cognitive impairment and lethargy. Fall hazard for older population, have comparatively less intense effects on the normal sleep cycle, ‘hangover’ effect is sometimes reported (daytime sleepiness), withdrawal symptoms like rebound insomnia. Amnesia, anorexia, sedation, lethargy, fatigue, confusion, drowsiness, dizziness, ataxia, headache, visual changes, hypotension, weight gain or loss, nausea, weakness
Benzodiazpenes Midazolam (Versed) toxicity/management
same for all benzos
Benzodiazpenes Midazolam (Versed) interactions
same for all benzo
Benzodiazpenes Midazolam (Versed) assessment
Same for all benzos
Lorazepam (Ativan) -ANXIOLYTIC DRUGS
Mechanism of action
decrease anxiety by reducing over activity in CNS, benzos increase action of GABA (blocks nerve transmission on CNS), benzos depress activity in brainstem and limbic system
Benzodiazepenes: Lorazepam (Ativan) Indications
uses for anxiety, alcohol withdrawal, and agitation
Benzodiazepenes: Lorazepam (Ativan) Contraindications
known drug allergy, narrow-angle glaucoma, and pregnancy due to their sedative properties and risk for teratogenic effects
Benzodiazepenes: Lorazepam (Ativan) Adverse effects
CNS depression and rebound disinhibition (sedation for 1-2 hours followed by agitation and confusion), increase risk for falls in older adults. Amnesia, anorexia, sedation, lethargy, fatigue, confusion, drowsiness, dizziness, ataxia, headache, visual changes, hypotension, weight gain or loss, nausea, weakness
Benzodiazepenes: Lorazepam (Ativan) Interactions
- alcohol and CNS depressants can result in additive CNS depression and even death
- Serious consequence more likely to occur in patients with renal or hepatic compromise, oral contraceptives, azole antifungals, SSRIs
Benzodiazepenes: Lorazepam (Ativan) Assessment
assess for cautions, contraindications, and drug interactions
- prescriber may order lab studies; CBC, serum electrolyte levels, and hepatic/renal function
- assess blood pressure, alertness, orientations, sensory/motor functioning, thorough medication profile, give med cautiously under very close supervision if patient is suicidal; may be associated with suicidal attempts
Benzodiazepenes: Lorazepam (Ativan) Implementation
frequent monitoring of vitals with special attention to BP and postural BP readings, encourage use of elastic compression stocks and change positions to minimize dizziness, check for possibilities of patient holding drugs in mouth, create a therapeutic environment for discussing any disturbing thoughts such as suicidal thoughts
Benzodiazepenes: Lorazepam (Ativan) Patient teaching
encourage patients to avoid operating machinery and driving, educate development of tolerance, instruct patient not to take OTC or herbal supplements w/o taking to prescriber, advise to not use drugs that contradict, advise patients to wear medical alert or other ID with their diagnosis and list of their drugs/allergies updated every 3 months, meds need to be taken as order avoiding withdrawal
Central Nervous System Depressants and Muscle Relaxant: Kava Mechanism of action:
central nervous system depressant
Central Nervous System Depressants and Muscle Relaxant: Kava indications
common use for relief of anxiety, stress, restlessness, and promotion of sleep
Central Nervous System Depressants and Muscle Relaxant: Kava contraindications
in patients with Parkinson’s disease, liver disease, depression, or alcoholism, in those operating heavy machinery, and in pregnant and breastfeeding women
Central Nervous System Depressants and Muscle Relaxant: Kava Adverse effects
skin discoloration, possible accommodative disturbances and pupillary enlargement, scaly skin (with long term use)
Central Nervous System Depressants and Muscle Relaxant: Kava interactions
alcohol, barbiturates, psychotic drugs. May increase the effect of barbiturates and alcohol
Central Nervous System Depressants and Muscle Relaxant: Kava Patient teaching
extended continuous intake can cause a temporary yellow discoloring of the skin, hair, and nails
Herbal therapy and dietary supplement: Valerian Mechanism of action
central nervous system depressant
Herbal therapy and dietary supplement: Valerian Indication
common use for relief of anxiety, restlessness, and sleep disorder
Herbal therapy and dietary supplement: Valerian contraindications
patients with cardiac disease, liver disease, or those operating heavy machinery including treatment of insomnia, moderate sedation, muscle relaxation, anticonvulsant therapy, and anxiety relief.
Herbal therapy and dietary supplement: Valerian Adverse effects
central nervous system depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, insomnia
Herbal therapy and dietary supplement: Valerian interactions
increases CNS depression if used with sedatives, monamine oxidase inhibitors, phenytoin, may have enhanced relative and adverse effects when taken with other drugs (including other herbal products) that have known sedative properties (including alcohol)
Herbal therapy and dietary supplement: St. Johns wort Indication
depression, anxiety, sleep disorders, nervousness
Herbal therapy and dietary supplement: St. Johns wort contraindications
patients with bipolar depression, schizophrenia, Alzheimer’s disease, and dementia
Herbal therapy and dietary supplement: St. Johns wort adverse effects
GI upset, allergic reactions, fatigue, dizziness, confusion, dry mouth, possible, photosensitivity (especially fair skinned)
Herbal therapy and dietary supplement: St. Johns wort interactions
may lead to serotonin syndrome if used with other serotonergic drugs (selective serotonin reuptake inhibitors). May interact with many drugs, including antidepressants, antihistamines, digoxin, immunosuppressants, theophylline, and warfarin, benzodiazepines & other hypnotic drugs. Cyclosporin and other immunosuppressants, tyramine-containing foods, opioids, digoxin, HIV drugs, oral contraceptives
Benzodiazepene (antagonist):
Flumazenil (Romazicon)
Mechanism of action: short half-life and duration effects of 1-4 hours, therefore if used to reverse the effects of a long-acting benzo, the dose of the reversal drug may wear off and the patient may become sedated again-requiring more Flumazenil.
Indications: used to acutely reverse the sedative effects of benzodiazepines. It antagonizes the action of benzo on the CNS but directly competing with the benzos for binding at the receptors. Used in cases of overdose or excessive IV sedation.
Sedative Hypnotic: Zolpidem (Ambien)
Drug Class: Non-Benzodiazepines, CNS Depressant
Mechanism of action: Depresses activity in the CNS. Specifically the hypothalamic, thalmic, and limbic system
Indications: Induces sleep & reduces agitation & anxiety related to depression and acute seizure disorders
-Women maximum dose 5mg (This is strict)
-Men maximum dose 5mg-10mg (Strict)
Contraindications: If pt allergic to aspirin, they will be allergic to this
Contraindications for ALL sedative hypnotics
Known drug allergy, narrow angle glaucoma, and pregnancy
Adverse effects for ALL sedative hypnotics
Headache, drowsiness, paradoxical excitement or nervousness, dizziness & vertigo, cognitive impairment and lethargy. May feel a “hangover” effect.
Interactions for ALL sedative hypnotics
- CNS depressants (alcohol, opioids, muscle relaxants)
- Herbal supplements: Kava & Valerian
- Nograpefruit juice or grapefruit. (alters drug metabolism-inhibition of cytochrome)
Toxicity treatment for sedative hypnotics: Zolpidem (Ambien), Restoril (temazepam)
Flumazenil
Nursing assessment for sedative hypnotics: Zolpidem (Ambien), Restoril (temazepam)
Perform assessment focusing on patient’s insomnia, with attention to onset, duration, frequency, and pharmacologic/non-pharmacologic measures. Concerns voiced by the family. Allergies, use of alcohol, smoking history & over the counter herbal supplements. Closely monitor those who are anemic, suicidal, or have history of abusing drugs, alcohol, or other substances.
Implementation for sedative hypnotics: Zolpidem (Ambien), Restoril (temazepam)
If taking medication in hospital then patient must use safety precautions, such as side rails or bed alarm. Ambulation after medication is taken (bathroom) must have assistance from nurse.
Patient teaching for sedative hypnotics: Zolpidem (Ambien), Restoril (temazepam)
Keep journal of sleep patterns. Caffeine should only be consumed in the morning, follow drug regimen, time restraints related to driving, drug interactions, hangover effects may occur, effect that grapefruit has on benzodiazepines
Muscle relaxants: Cyclobenzaprine (Flexeril) mechanism of action
Works with in the CNS. Most are known as Centrally acting skeletal muscle because of their site of action. Effects of the drug come from the sedative effects and not the direct muscle relaxation. There is no direct effect on the muscle, itself.
Muscle relaxants: Cyclobenzaprine (Flexeril) Indications
Relief of muscle spasms often following injuries such as low back pain. Most effective when used with physical therapy.
Muscle relaxants: Cyclobenzaprine (Flexeril) contraindications
Known drug allergies. Contraindications for some drugs may include severe renal impairment when used with muscle relaxants.
Muscle relaxants: Cyclobenzaprine (Flexeril) Adverse effects
Euphoria, lightheadedness, dizziness, drowsiness, fatigue, confusion, and muscle weakness. Pt will grow tolerant to the drug.
-Less Common: Diarrhea, GI upset, headache, slurred speech
Muscle relaxants: Cyclobenzaprine (Flexeril) Interactions
Do not take with other depressant drugs (alcohol or benzodiazepines). Caution for overdosage must be taken. Will cause anxiety, tremors and mental confusion when overdose is happening.
Assessment for Muscle relaxants: Cyclobenzaprine (Flexeril)
Perform a complete head to toe assessment with a focus on the neurologic system. In the older adult, there is an increased risk for CNS toxicity with possible hallucinations, confusion, and excessive sedation.
Muscle relaxants: Cyclobenzaprine (Flexeril) Implementation
Frequently monitor airway, breathing, and circulation. Closely monitor all vital parameters, level of consciousness, and presence of sedation. Encourage cautious ambulation. The greatest risk for hypotension is within 1 hour after dosing.
Muscle relaxants: Cyclobenzaprine (Flexeril) patient teaching
Patient must take drug as prescribed, keep out of reach from children, encourage assistance with ambulating, Do not abruptly discontinue using, and do not use with other CNS depressants.
Sedative Hypnotic: Restoril (Temazepam) Drug class and mechanism of action
Drug class: Benzodiazepines, CNS Depressant
-Mechanism of action: Depresses activity in the CNS. Specifically the hypothalamic, thalmic, and limbic system. Specific receptors in the brain (GABA) are thought to be for benzodiazepine
Sedative Hypnotic: Restoril (Temazepam) indications
Induces sleep & reduces agitation & anxiety related to depression and acute seizure disorders.
Antiepileptic: Phenytoin (Dilantin)
*Highly protein bound, do not quit quickly
Antiepileptic meachanism of action for Entire class
Alters movement of sodium, potassium, calcium, and magnesium ions resulting in more stabilized and less excitable cell membranes.
Indications for antiepileptic: Phenytoin (Dilantin)
-Tonic-colonic and partial seizures
antiepileptic: Phenytoin (Dilantin) contraindications
Heart conditions that involve bradycardia
antiepileptic: Phenytoin (Dilantin) adverse effects
Lethargy, abnormal movements, mental confusion, and cognitive changes. Gingival hyperplasia (long term use), hirsutism
antiepileptic: Phenytoin (Dilantin) interactions
Azole Antifungals, benzodiazepines, proton pump inhibitors, sulfonamides, carbamazepine, cyclosporine, rifampin, warfarin
Patient teaching for antiepileptic
Educate the patient on the sedating effects of drug therapy so patient safety is put first. The patient is not allowed to drive, or operate heavy machinery. Report any suicidal thoughts. Avoid alcohol and caffeine.
Antiepileptic (Anticonvulsants): Gabapentin: (Neurontin) indications
Partial seizures and for prophylaxis of partial seizures
Antiepileptic (Anticonvulsants): Gabapentin: (Neurontin) adverse effects
Dizziness, drowsiness, nausea, visual and speech changes, edema
Antiepileptic (Anticonvulsants): Gabapentin: (Neurontin) Interactions
Alcohol
Antiepileptic (Anticonvulsants): Topiramate (Topamax) indications
Partial and secondarily generalized seizures, for generalized tonic-colonic seizures, and for drop attacks in Lennox Gastaut syndrome
Antiepileptic (Anticonvulsants): Topiramate (Topamax) contraindications
Do not take during pregnancy, may lead to cleft palate in children
Antiepileptic (Anticonvulsants): Topiramate (Topamax) adverse effects
Dizziness, drowsiness, GI upset, ataxia
Antiepileptic (Anticonvulsants): Topiramate (Topamax) interactions
other Antiepileptic drugs (Carbamazepine, hydantoins, valproic acid) and oral contraceptives.
Antiepileptic (Anticonvulsants): Carbamazepine (Tegretol) indication
Partial seizures and generalized tonic-clonic seizures, was used for trigeminal neuralgia
Antiepileptic (Anticonvulsants): Carbamazepine (Tegretol) contraindication
Individuals with myoclonic and absence seizures, and bone marrow depression
Antiepileptic (Anticonvulsants): Carbamazepine (Tegretol) adverse effects
Nausea, headache, dizziness, unusual eye movements, visual change, behavior changes, rash, abdominal pain, abnormal gait, GI upset
Antiepileptic (Anticonvulsants): Carbamazepine (Tegretol) interactions
Azole, antifungals, isoniazid, macrolides, SSRIs, barbituates, acetaminophen, rifampin, valporic acid, theophylline
Antiepileptic (Anticonvulsants): Valproic Acid (Depakote) indication
Generalized seizures (absence, myoclonic, and tonic-clonic) Also used for bipolar disorder, and shown to be affective with partial seizure treatment.
Antiepileptic (Anticonvulsants): Valproic Acid (Depakote) contraindication
Liver impairment, and urea cycle disorders
Antiepileptic (Anticonvulsants): Valproic Acid (Depakote)
Dizziness, drowsiness, GI upset, weight gain, hepatotoxicity, pancreatitis
Antiepileptic (Anticonvulsants): Valproic Acid (Depakote)
Aspirin
CNS Stimulant: Amphetamines mechanism of action
Stimulate areas of the brain associated with mental alertness. Cerebral cortex and thalamus. Increase the release of norepinephrine and dopamine.
CNS Stimulant indication for ENTIRE drug class
ADHD and narcolepsy
CNS Stimulant contraindication for ENTIRE drug class
Known drug allergies or cardiac structural abnormalities. Anxiety or agitation can be exacerbated. Hypertension, glaucoma or Tourette’s syndrome.
CNS Stimulant adverse effect for ENTIRE drug class
Drug will speed up body systems. Increased HR & BP, anxiety, insomnia, angina, headache, tremor, decreased appetite.
CNS Stimulant interactions for ENTIRE drug class
Avoid MAOIs, caffeine, and CNS stimulants. Can cause dysrhythmias.
CNS Stimulant assessment
A continuous and very cautious patient assessment is needed. For each child gather a baseline, weight, BP, height, growth and development, and vital signs. Atypical behavior, such as loss of attention span, history of social behaviors in school are very important. Adult patients also need an excessive assessment of weight, height, and blood pressure.
CNS Stimulant implementation
Dosage should be individualized depending on patient, and well planned scheduling of meds is important. Do not take 6 hours prior to bed time.
CNS Stimulant patient teaching
Advice to take as ordered, advise client to be cautious when driving, and limit caffeine.
CNS Stimulant: Methylphenidate (Ritalin)
Stimulates areas of the brain associated with mental alertness
Antidepressant-Tricyclic: Amtitriptyline (Elavil) mechanism of action
Correcting imbalance in the neurotransmitter concentrations of serotonin and norepinephrine at the nerve endings in the CNS. Blocks presynaptic reuptake of neurotransmitters.
Antidepressant-Tricyclic: Amtitriptyline (Elavil) indication
Depression (more commonly used for insomnia and neuropathic pain)
Antidepressant-Tricyclic: Amtitriptyline (Elavil) contraindication
Known drug allergy, pregnancy, and recent myocardial infraction
Antidepressant-Tricyclic: Amtitriptyline (Elavil) adverse effects
Anorexia, dry mouth, blurred vision, constipation, sexual dysfunction, altered blood glucose levels, urinary retention, anxiety, sedation, HA, insomnia, rash, photosensitivity, dysrhythmias.
Antidepressant-Tricyclic: Amtitriptyline (Elavil) interactions
Alcohol, CYP inhibitors (increase intoxicity)
Antidepressants-Selective Serotonin Reuptake Inhibitor(SSRI): Fluoxetine (Prozac), Escitalopram oxalate (Lexapro), Sertraline (Zoloft) mechanism of action
inhibition of serotonin reuptake is the primary mechanism of action. SSRIs may have a weak effect on norepinephrine and dopamine reuptake
Antidepressants-Selective Serotonin Reuptake Inhibitor(SSRI): Fluoxetine (Prozac), Escitalopram oxalate (Lexapro), Sertraline (Zoloft) indications
Depression, OCD, bulimia nervosa, panic disorder, premenstrual dysphoric disorder
Antidepressants-Selective Serotonin Reuptake Inhibitor(SSRI): Fluoxetine (Prozac), Escitalopram oxalate (Lexapro), Sertraline (Zoloft) contraindications
Known drug allergy, concurrent MAOI therapy
Antidepressants-Selective Serotonin Reuptake Inhibitor(SSRI): Fluoxetine (Prozac), Escitalopram oxalate (Lexapro), Sertraline (Zoloft) adverse effects
Anxiety, dizziness, drowsiness, insomnia, HA, mild GI disturbances, sexual dysfunction, tumor
Antidepressants-Selective Serotonin Reuptake Inhibitor(SSRI): Fluoxetine (Prozac), Escitalopram oxalate (Lexapro), Sertraline (Zoloft) interactions
MAOIs, linezolid, lithium, buspirone, benzodiazepines, warfarin, phenytoin, propafenone
Atypical Antidepressant: Bupropion (Wellbutrin),
Enzyme Monoamine Oxidase Inhibitor (MAOI)
mechanism of action
Weak effects on the brain serotonin activity, primarily dopaminergic and noradrenergic
Atypical Antidepressant: Bupropion (Wellbutrin),
Enzyme Monoamine Oxidase Inhibitor (MAOI) indication
Depression, smoking cessation, substance abuse, glaucoma, heart failure
Atypical Antidepressant: Bupropion (Wellbutrin),
Enzyme Monoamine Oxidase Inhibitor (MAOI) contraindications
Known drug allergy, seizure disorders, and those currently on an MAOI stroke
Atypical Antidepressant: Bupropion (Wellbutrin),
Enzyme Monoamine Oxidase Inhibitor (MAOI) adverse effects
Dizziness, HA, sedation, nausea, blurred vision, tachycardia, dry mouth, tremor, agitation
Atypical Antidepressant: Bupropion (Wellbutrin),
Enzyme Monoamine Oxidase Inhibitor (MAOI) interactions
Azole antifungals, phenothiazine, protease inhibitors, carbamazepine, alcohol, CNS depressants
Nursing assessment with antidepressants
Complete head to toe assessment, and mental status examination Thoroughly assess the patients neurologic functioning, including level of consciousness, mental alertness, and motor/cognitive functioning. Constantly assess the patient for suicidal ideation or tendencies. This must always be a potential risk with any depressed patient.
Implementation with antidepressants
Nurse demonstrates a firm, calm, and empathic attitude with the use of therapeutic communication. Provide patient with short simple instructions and information about the drug, its action, and the length of time before effects are expected.
-Administered exactly how medication is ordered.
Evaluation for antidepressants
Medication may take 4-6 weeks to reach full potential. Observe patient for improved mood, and affect and alleviation decrease in psychotic symptoms.
Patient education for antidepressants
Consumption of fiber supplements must occur at least 2 hours before or after the dosing of medication to avoid interference with drug absorption. . Encourage patient to openly talk about their feelings.
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) mechanism of action
Inhibit the MAO enzyme system in the CNS, therefore, dopamine, serotonin, & norepinephrine are not broken down and therefore higher levels of these substances occur
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) indication
Used to treat parkinson’s disease
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) contraindication
Meperidine
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) adverse effects
Can cause hypertensive crisis, dizziness, dsykinesias, nausea, syncope, and hypertension
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) interactions
Food: Aged cheese, smoked meats, yeast extracts, red wine, Italian broad beans
Drugs: Meperidine, other opioids, other MAOIs, SSRIs, oral contraceptives, and buspirone
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) assessment
Complete assessment head to toe and a mental status evaluation. If patient has history of suicidal thoughts they must be monitored closely. Look for deterioration in health status.
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) implementation
Monitor periodic liver function tests and ongoing vital signs. Assess needed emotional support. Discontinue immediately with hypertensive crisis. Regitine should be on hand to control severe hypertension reaction
Enzyme Monoamine Oxidase Inhibitor (MAOI)
Drug Name: Phenelzine (Nardil) patient teaching
After stopping MAOI, instruct client to wait 2-3 weeks prior to taking another antidepressant. Advise patient while taking MAOI, not to take over the counter cold and flu products. Foods and beverages high in tyramine are to be avoided. Contact immediately if any blurred vision, agitation, urinary retention, or ataxia occur. Encourage wearing a medical alert necklace.
Antipsychotics Drug Class:
Typical: Conventional
Chloropromazine HCL (Thorazine) (PO, PR, IM ,IV) Mechanism of action
Depresses cerebral cortex, hypothalamus, limbic system, which control activity, aggression; blocks neurotransmission produced by dopamine at synapse
Antipsychotics Drug Class:
Typical: Conventional
Chloropromazine HCL (Thorazine) (PO, PR, IM ,IV) indication
Psychotic illnesses, schizophrenia, depression. Anxiolytic and antianxiety effects, ADHD, Tourette’s, & behavioral problems
Antipsychotics Drug Class:
Typical: Conventional
Chloropromazine HCL (Thorazine) (PO, PR, IM ,IV) contraindication
Known drug allergies, significant CNS depression, brain damage, liver or kidney disease, blood dycrasias, uncontrolled epilepsy, seizures
Antipsychotics Drug Class:
Typical: Conventional
Chloropromazine HCL (Thorazine) (PO, PR, IM ,IV) adverse effects
Parkinson’s, hypotension, HA, confusion, edema, rash, weight gain, urinary retention, dry mouth, neuroleptic malignant syndrome, photosensitivity, gynecomastia
Antipsychotics Drug Class:
Typical: Conventional
Chloropromazine HCL (Thorazine) (PO, PR, IM ,IV) interactions
Alcohol, other CNS depressants, anticholinergic, antihypertensive, beta blockers, opioids, levodopa/carbidopa, thiazine diuretics
Antipsychotics Drug Class:
Typical: Conventional
Haloperidol: Brand Name= Haldol (Oral, IM, IV) mechanism of action
Blocks dopamine receptors to the brain, which decreases dopamine concentration in the CNS. Blocks serotonin.
Antipsychotics Drug Class:
Typical: Conventional
Haloperidol: Brand Name= Haldol (Oral, IM, IV) indications
Used in patients with Schizophrenia who are non-adherent with their drug regimen, long term treatment, low doses for nausea, ADHD, & Tourette’s
Antipsychotics Drug Class:
Typical: Conventional
Haloperidol: Brand Name= Haldol (Oral, IM, IV) contraindications
Known hypersensitivity, Parkinson’s disease, and patients taking large amounts of CNS depressants, children less than 3, coma
Antipsychotics Drug Class:
Typical: Conventional
Haloperidol: Brand Name= Haldol (Oral, IM, IV) adverse effects
Parkinson’s, hypotension, HA, confusion, edema, rash, weight gain, urinary retention, dry mouth, neuroleptic malignant syndrome, photosensitivity, gynecomastia
Antipsychotics Drug Class:
Typical: Conventional
Haloperidol: Brand Name= Haldol (Oral, IM, IV) interactions
Alcohol, other CNS depressants, anticholinergic, antihypertensive, beta blockers, opioids, levodopa/carbidopa, thiazine diuretics
Antipsychotics: Atypical: Quetiapine fumarate (Seroquel) mechanism of action
Functions as an antagonist at multiple neurotransmitter receptors in the brain.
Antipsychotics: Atypical: Quetiapine fumarate (Seroquel) indications
Bipolar disorder, bipolar 1 disorder, depression, mania, schizophrenia, recurrent suicidal behavior
Antipsychotics: Atypical: Quetiapine fumarate (Seroquel) contraindications
Hypersensitivity, breastfeeding mothers, children, dementia patients, suicidal patients
Antipsychotics: Atypical: Quetiapine fumarate (Seroquel) adverse effects
Anorexia, nausea, constipation, orthostatic hypotension, back pain, fever, Parkinson’s, leukopenia, dizziness, HA, seizures, anxiety
Antipsychotics: Atypical: Quetiapine fumarate (Seroquel) interactions
Alcohol, CNS drugs, erythromycin, fluconazole, levodopa, lithium
Antipsychotics: Atypical: Risperidone (Risperdal) (IM Deep muscle) mechanism of action
Blocks dopamine receptors to the brain, which decreases dopamine concentration in the CNS
Antipsychotics: Atypical: Risperidone (Risperdal) (IM Deep muscle) indication
Psychotic illness, schizophrenia, depression. Anxiolytic and antianxiety effects
Antipsychotics: Atypical: Risperidone (Risperdal) (IM Deep muscle) contraindication
Known drug allergies, significant CNS depression, brain damage, liver or kidney disease, blood dycrasias, uncontrolled epilepsy, seizures
Antipsychotics: Atypical: Risperidone (Risperdal) (IM Deep muscle) adverse effects
Parkinson’s, sedation, tachycardia, agitation, seizures, dyskinesia, dizziness, drowsiness, and headache
Antipsychotics: Atypical: Risperidone (Risperdal) (IM Deep muscle) interactions
Alcohol, other CNS drugs, antihypertensive, anticholinergic, ketoconazole, and carbamazepine
Antipsychotics assessment
Head to toe assessment of all body systems and a careful psych evaluation. Assess for suicidal thoughts and mental alertness. Assessment of baseline motor, sensory, and neurologic functioning is very important.
Antipsychotics implementation
Must be taken exactly how the medication is described. Patient avoids hot showers. If serum levels of Haloperidol are less than 4ng/mL, the patient may show symptoms of the mental disorder, and high levels of 22ng/mL will result in toxicity. Risperidone is to be given as ordered and administered by injection into deep muscle mass. Drug therapy must be monitored closely (serum levels and med compliance)
Antipsychotics evaluation
Improvement of mood, and affect, and alleviation or decrease in psychotic symptoms (hallucinations, paranoia, delusions, garbled speech). Look for tic like trembling movements of hands, face, neck, and head
Antipsychotics patient teaching for typical
Urine may turn pink or reddish brown. Medication could take 6 weeks or longer to show effects. Daily dose 1-2 hours before bedtime. Avoid sun exposure, and advise client to wear medication ID bracelet.
Antipsychotics patient teaching for atypical
Advise client about orthostatic hypotension and how to handle rising from sitting or lying. Recommend avoiding hot tubs, hot showers, and tubs due to hypotension. Avoid abruptly withdrawing the drug. EPS mat result. Avoid hazardous activities if drowsy or dizzy. Report impaired vision, tremors, muscle twitching.
