Patho/Pharm 2 (CH 4) - Neurological Drugs PT 2 CONTINUED

atypical antidepressant

Bupropion

Bupropion MOA

atypical antidepressant inhibtits dopamine reuptake

primary use for Bupropion

- depression

- seasonal affective disorder

- adjunct therapy for smoking cessation

seasonal affective disorder

a person experiences depression during winter months and improved mood during spring.

pt education taking Bupropion

- N/V/GI distres (take w/ food)

- weight loss

- high-risk seizures

CNS EFFECTS:

- insomnia

- agitation

- tremors

- psychosis effects (higher in children)

nursing care for pts taking Bupropion

- weight monitoring

- monitor CNS effects (report is symptoms occur)

- monitor psychosis effects

- montior seizure risk/seizure precautions

- do not crush med

cautionary pts on Bupropion

- hx liver/kidney dysfunction

- cardiac disesases

- szhizophrenia

- bipolar disorder

- diabetes

- hx alc abuse

- cimetidine (lowers effectiveness)

contraindications for taking Bupropion

- allergy

- suicidal thoughts

- hand tremors

- CNS tumors

medications contraindicated w/ Bupropion

- MOAI <14days last dose

antiseizure medications:

- phenytonin

- phenybarbital

- carbamepazine

mood stabilizer

Lithium

Lithium MOA

mood stabilizer

- #1 preferred bipolar medication

primary use for Lithium

- acute manic episodes

- bipolar disorder

- preventative for manic/depressive episodes

pt education taking Lithium

- GI upsest

- fatigue

- headache

- confusion

- memory impairment

- polyuria

- high risk hyperthyroidism/thyroid storm/goiter

- Lithium toxicity s/s

- s/s of low lithium levels

- hyponatremia worsens lithium toxicity --> increase fluids 2-3L/day

lithium toxicity levels vs lithium withdrawel levels

> 1.2 = severe lithium toxicity

< 0.6 = withdrawel/ manic episodes

nursing priorities for pts taking Lithium

- monitor lithium levels agressively

- I/O

- electrolyte levels

- hyperthyroidism s/s

- monitor tumor growths

- kidney function tests

- take w/ milk + food

- do not crush

Hyperthyroidism

overactivity of the thyroid gland causing:

- lethargic

- bradycardia

- low body temp

cautionary pts taking Lithium

- hx thyroid issues

- hx seizures

- diabetes

- urinary retention issues

- suicidal thoughts

- older adults

contraindications for taking Lithium

- pregnancy (teratogenic fetal heart defects during 1st trimester)

- lactating

- renal insufficiency

- cardiac disorder

- dehydration/hyponatremia

- hx angioedema

medications contraindicated w/ Lithium

- NSAIDS (besides aspirin)

TOXICITY LEVELS:

- tetracyclines

- diuretics

- meldopa

- probenacid

- antihypertensives

INCREASES URINARY RETENTION

- phenothiazine

- haloperidol

traditional antipsychotics

chlorpromazine

haloperidol

chlorpromazine/ haloperidol MOA

- 1st generation traditional antipsychotic

- blocks CNS receptors

primary use for chlorpromazine/ haloperidol

- schizophrenia

- manic episodes bipolar disorder

pt education taking chlorpromazine/ haloperidol

- AKATHISIA

- PARKINGSONSISMS

- ACUTE DYSTONIA

- TARDIVE DYSKINESIA

- sexual dysfunction

- severe dysrhythmias

- dermatitis

- neurolytic malignant syndrome

- anticholinergic effects

akathisia education for pts on chlorpromazine/ haloperidol

- within 2 months med therapy

- med can still be continued even if symptoms progress

causes =

- uncontrolled constant movements

- restlessness

parkingsonsisms education for pts on chlorpromazine/ haloperidol

- within 1st month med therapy

- parkinsons meds can reduce manifestations

- contraindicated w/ levidopa/carbidopa (neurtilizes antipsychotic effects)

causes =

- rigidity

- tremors

- sluggishness

acute dystonia education for pts on chlorpromazine/ haloperidol

- within first few hrs --> days med therapy

- anticholingerics help this effect

- requries IMMEDIATE ATTENTION

causes =

- severe painful muscle spasms

- neck/body spasms

tardive dyskinesia education for pts on chlorpromazine/ haloperidol

- within months to years med therapy

- decrease dose to lower effects

- IN SOME CASES tardive dyskinesia CAN BE PERMANENT

causes =

- withering movements of tongue and neck

neurolytic malignant syndrome

life threatening RARE manifestation of traditional antipsychotic med therapy (specifcally haloperidol/chloropomazine) causes =

- high fever

- muscle rigidity

- usstable vitals

- loss of consciousness

nursing care for pts taking chlorpromazine/ haloperidol

- monitor muscle disorder s/s

- Beta-blockers/ benzos help muscle manifestations

- Monitor anticholinergic effects

- monitor sexual dysfunction

- frequent vital signs/ EKG checks

- Wear gloves

- Keep pt in recumbent 30 min after IM/IV therapy

- CHECK COMPATIBILITY W/ OTHER MEDS

neurolytic malignant syndrome nursing care

fever > 105 =

- cold compresses

- aspirin/acetaminophen

- IV dantrolene/bromocriptine

contraindications for chlorpromazine/ haloperidol

- allergy

- alc withdrawels

- bx bone marrow supression

- CNS depressants

- pregnancy

- lactation

cautionary pts taking chlorpromazine/ haloperidol

- hx COPD

- hx glaucoma

- diabetes

- liver dysfunction

- thyroid disorders

- protate hypertrophy

- HTN

MEDS 2hrs before:

- CNS depressants

antacids

antidiarrhea

2nd generation antipsychotic

risperidone

risperidone MOA

2nd generation antipsychotic

- blocks dopamine receptors + serotonin

primary use for risperidone

- schizophrenia

- bipolar episodes

- autism

pt education taking risperidone

CNS effects:

- drowsiness

- insomnia

- dizziness

EXTRAPYMIDAL effects:

- weight gain

- dyskinesdia

- akathesia

- parkinsonsims

nursing care for pts taking risperidone

- monitor CNS effects

- monitor extrapymidal effects/report immediatly

- weight check

- avoid w/ soft drinks/tea/caffine

contraindications for taking risperidone

- allergy

- lactation

- severe CNS disorders

- dementia psychotic episdes

- stroke risk

- children <13y/o

- parkinsons disease

- hx live/kidney disorders

- antihypertensives (antipsychotic increase toxicity)

cautionary medications w/ risperidone

LOWERS EFFECTIVENESS:

- phenytoin

- carbamepazine

- clozapine

- phenobarbital

- rifampin