Psychotropic Agents Unit 1
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Transcript Psychotropic Agents Unit 1
NURS 1950
Nancy Pares, RN, MSN
Metro Community College
http://www.cafeoflifepikespeak.com/Videos/Licensed%20To%20Pill.swf
Four groups (also called
anxiolytics/tranquilizers)
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Antidepressants (Chap 16)
Benzodiazepines
Barbiturates
Nonbenzodiazepines/nonbarbiturate CNS
depressants
Baseline data
◦ Cause of anxiety
◦ Vitals
◦ Blood dyscrasias, liver disease, pregnancy or
breastfeeding
WHY?
Prototype: Phenobarbital (Luminal)
Action: enhances the action of the
neurotransmitter GABA-which suppresses
abnormal neuronal discharges
Rarely used today due to significant side
effects—high chem dependency & overdose
New studies show
◦ No effect on anxiety—too much CNS depression
Overdoses are common; increase enzyme
activity…which causes_resp depression
Advantages
End in ‘pam’
◦ Diazapam (Valium),oxazepam (Serax), lorazapam
(Ativan)**
Drugs of choice for anxiety and insomnia
Action:
◦ bind to the GABA receptor (what is this? And what
does it do?
Uses:
◦ Acute anxiety, medical illness, ETOH w/drawal
Adverse effects:
◦ Hypotension, confusion, syncope
Interactions:
◦ ETOH, anesthetics, MAO inhibitors, antihistamines,
TCA’s, narcotics, barbiturates
◦ Caffeine and smoking interfere with desired effect
◦ Overdose:
Flumazenil (Romazicon)
Nursing Implications
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Tolerance develops
Can cause physical and psychological dependence
No abrupt w/drawal of meds
Drug doses vary---check for appropriate dosing
Interacts with phenytoin and coumadin
Buspirone (BuSpar)
◦ Unrelated to benzo or barbiturates chemically
Action: not well known; may be related to
dopamine receptors
Advantages:
◦ Less potential for abuse; lower sedative properties
Adverse effects:
◦ Dizziness, HA, drowsiness; may take 3-4 wks for
optimal effects
Buspar
◦ Schedule regular assessments for slurred speech,
dizziness, CNS disturbances; give at regular
intervals (not PRN); do not use with MAO Inhibitors
or ETOH
Diphenhydramine (Benedryl) and Hydroxyzine
(Vistaril)
Uses: sedative and antiemetic properties;
anticholinergic effects are least with these
agents; preop sedation, pruititis
Side effects:
◦ Blurred vision, constipation, dry mucosa, sedation;
drowsiness will decrease with use
Before giving an antianxiety, what would you
assess?
After giving an antianxiety, what would you
assess?
What are some common nursing diagnosis for
clients taking anxiolytics?
Classifications
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Tricyclics
MAO inhibitors (monoamine oxidase)
SSRI
Atypical Antidepressants
Action is on serotonin and catecholamines
Therapy requires 2-3 wks for mood change
Overdoses do occur
common side effects:
◦ Sedation, anticholinergic activity, tachycardia,
orthostatic hypotension, confusion, tremors
TCA
◦ Action: inhibits reuptake of norepinephrine and
seratonin into presynaptic nerve terminals
◦ Uses: depression, Manic-depressive
(bipolar)disorder, panic disorders
◦ Desired effects: mood elevation, increase activity,
improve appetite, normalize sleep patterns…..
What s/s of depression make these desirable effects?
◦ Takes 1-2 months for maximal effect
Adverse effects:
◦ Tremor, numbness, tingling, Parkinsonian
symptoms, orthostatic hypotension, anticholinergic
effects (which are?)
◦ Cardiac arrhythmias, suicidal actions
Do not use with MAOI..why?
Sympathomimetics increase effects of
anticholinergic effects
Avoid OTC antihistamines
Prototype: imipramine (Tofranil)
Sertraline (Zoloft)
◦ Action: inhibits reuptake of serotonin
◦ Use: depression, anxiety, OCD and panic disorder
◦ Adverse effects: agitation, HA , dizziness and
fatigue; sexual dysfunction; weight gain;
◦ Contraindications: antabuse should be avoided; no
MAOI ; use precaution with St. John Wart
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May take wks to get effect; effects last 2-3
months after d/c
Give in am or pm
Note eating disorders hx
Exercise and caloric restriction
Monitor labs for pro-bound drugs…ex:
coumadin
May need increase of dilantin due to
interactions
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Phenelzine (Nardil)
Action:intensifies effects of norepinephrine in
adrenergic synapses
Use: depression not responsive to other
drugs
Common S/E: constipation, dry mouth,
orthostatic hypertension; severe hypertension
with foods containing tyramine (see pg 195)
Contraindications: cardiac disease,
renal/hepatic impairment
Refrain from foods that contain tyramine
Assess cardiac status
Assess lab values (why?)
No OTC or herbal meds
Avoid caffeine
Observe for s/s of stroke or MI
General anesthesia, diuretics,
antihypertensives: potentiate the hypotensive
effects
Insulin and oral hypoglycemics: additive
effects
Meperidine and MAOI= severe reactions
What assessments need to be made before
antidepressant medications?
What are the nursing diagnosis you would
write for clients with antidepressant meds.?
Hypertensive Crisis
◦ Ingestion of foods with tyramine (this substance
promotes release of norepinephrine)
◦ Avocados, soybeans, figs, bananas, aged meat,
smoked meat, bologna, pepperoni, salami, cheese,
caffeine
Lithium carbonate (Eskalith)
◦ Action: stabalizes the neuronal membrane, reduces
release of norepinephrine
◦ Uses: reduces euphoria of mania without sedation;
may take a week to develop desired effects; begin
with low doses and increase q 3-5 days.
◦ Common S/E: n/v, anorexia, abd cramps, excessive
thirst and urination
Adverse effects: persistant vomiting;
progressive wt gain, fatigue, nephrotoxicity
Serum levels need to be below 1.5mEq/L
>1.5: n/v, diarrhea, thirst, polyuria, slurred
speech
1.5-2.0: GI upset, confusion
2.0-2.5: ataxia. Blurred vision, coma
2.5 and >: convulsion, oliguria, death
normal blood level:
Nutrition needs:
Desired effects in 5-7 days; full effect in 21
days
Give with food or milk
Phenothiazines
Non phenothiazine
Atypical anti psychotics
Chlorpromazine (Thorazine)
Action:
◦ Prevent dopamine and serotonin from occupying
their receptor sites and block the excitement
symptoms
Use:
◦ Schizophrenia, bipolar (manic state), depression,
antiemetic
Adverse effects: (see page 213 table)
◦ Extrapyramidal effects
Acute dystonia, spasms of tongue, opisthostonos
Treat: anticholinergics
◦ Parkinsonism (why?)
◦ Akathesia
◦ Tardive dyskinesia
May be irreversible
◦ Other common: sedation, sexual dysfunction,
breast growth, galactorrhea
Nursing Interventions
◦ Increases effect with anticholinergics
◦ ETOH and CNS depressants intensify depressant
effect
◦ NOTE: most phenothiazines end in ‘zine’ ; ex:
fluphenzine, prochorperazine, promazine,
thiroidazine
◦ Careful monitoring of client condition; report EPS
symptoms to MD..may need to d/c med
◦ Life threatening adverse effect: neuroleptic
malignant syndrome (NMS)
Haloperidol (Haldol)
Action/Use: chemically a butyrphenone;
primary use is psychotic disorder—has less
sedation than phenothiazine, but greater EPS
Nursing Interventions:
◦ Same as pheno—monitor carefully, esp. elderly
Clozapine (Clozaril)
Action/Use:
◦ Largely unknown—block several receptor sites;
broader spectrum of action, fewer EPS symptoms
Nursing Interventions:
◦ Basically same as pheno..give wkly supply to
assure lab values get drawn
New drug aripiprazole (Abilify)
◦ Dopamine stabilizer with fewer EPS
◦ Adverse effects:
HA, N/V, fevers constipation, anxiety
◦ Nursing implications
As all other categories