Mark K Lecture #9 - Pharmacology of Drugs and Nursing Interventions

what do ALL psychiatric drugs cause?

low BP and weight changes (usually weight gain)

what are phenothiazines?

first generation of typical antipsychotic drugs

they don't cure, they just reduce symptoms

what do all phenothiazines end in?

-zine

thorazine, compazine

phenothiazines are _____ _________

major tranquilizers

they are the big gun psych meds!

what are side effects of phenothiazines?

ABCDEFG

anticholinergic (dry mouth, urinary retention)

blurred vision

constipation

drowsiness

EPS (tremors, parkinson)

foto sensitivity

agranulocytosis (low WBCs, immunosuppressed) - teach pt how to recognize symptoms of infection

what is the nursing action when someone presents with a side effect?

educate!

what is the nursing action when someone presents with a toxic effect?

hold the drug! notify HCP

what is the #1 nursing diagnosis for ABCDF side effects (anticholinergic, blurred vision, constipation, drowsiness, photo sensitivity) to teach pt about?

safety

what is the #1 nursing diagnosis for "G" side effects (agranulocytosis) to teach pt to report?

report signs of infections to HCP

what is Decanoate or "Caprate" form of a medication?

the long-acting form of a drug; often court ordered

when is the decanoate form of a medication given IM?

when there is non-compliance

what are tricyclic antidepressants?

mood elevators (happy pills), used to treat depression

in the NSSRI group

what are the four tricyclic antidepressants to know?

elavil, trofranil, aventyl, desyrel

what are the side effects of tricyclic antidepressants?

ABCDE

anticholinergic (dry mouth especially)

blurred vision

constipation

drowsiness

euphoria (happy)

how long do we need to take tricyclic antidepressants for until they work?

must take for 2 to 4 weeks for therapeutic effects

so after the first week, pt will complain the drug is not working

what are benzodiazepines?

anti-anxiety medications and minor tranquilizers

what do most benzodiazepines end in?

pam and lam, also have zep in the name

what are examples of benzodiazepines?

-diazepam (Valium)

-lorazepam (Ativan)

-alprazolam (Xanax)

what else can benzodiazepines be used as?

seizure meds, induction of anesthesia, muscle relaxants, alcohol withdrawal meds, ventilation

how long do benzodiazepines take to work? how long do we take them for?

they work quickly, but do not take for more than 2 to 4 weeks

do we administer major and minor tranquilizers at the same time? why?

yes - major take a long time to start working and minor start working right away; admin both at same time

ex: pt is usually put on valium and elavil at the same time. valium is discontinued in 2 to 4 weeks once elavil kicks in

what are side effects of benzodiazepines?

ABCD

anticholinergic

blurred vision

constipation

drowsiness

what are monamine oxidase (MAO) inhibitors?

antidepressants

what are the 3 MAO inhibitors we need to know?

Marplan, Nardil, Parnate

what are side effects of MAO inhibitors?

ABCD

anticholinergic

blurred vision

constipation

drowsiness

what do we need to teach pts to avoid while taking MAO inhibitors? why?

avoid tyramine-containing food - it can cause a hypertensive crisis

what are examples of food with tyramine that you cannot have?

fruits and veggies - bananas, avocados (guac), raisins (dried fruit)

yeast

meat organs (liver, kidney, tripe, heart)

preserved meats (smoked, dried, cured, pickled, hot dogs)

cheese (except mozzarella)

cottage cheese (aged cheese)

yogurt

alcohol, elixirs, tinctures (iodine/betadine), caffeine, chocolate, licorice, soy sauce

what is lithium?

mood stabilizer used for bipolar disorder (decreases the mania)

what are the side effects of lithium?

polyuria (peeing)

diarrhea (pooping)

paresthesia (numbness and tingling)

what are toxic effects of lithiun?

tremors, metallic taste, severe diarrhea

what is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the time?

give pt fluids!

those side effects are expected

what do we need to monitor while a patient is taking lithium?

sodium!

low sodium makes lithium toxic, high sodium makes lithium ineffective - it needs to be normal

what is the #1 nursing intervention for a pt on lithium presenting with metallic taste and severe diarrhea?

give pt fluids and notify the HCP

toxic effects

what is another name for prozac?

fluoxetine

what is prozac (fluoxetine)?

SSRI, mood elevator

what are the side effects of prozac?

ABCDE

anticholinergic

blurred vision

constipation

drowsiness

euphoria

when do we give prozac? why?

give before noon (if BID, give at 6 am and noon)

causes insomnia!

when changing the dose of prozac, what should we watch for?

watch for suicidal risk in adolescents and young adults only

what is another name for haldol?

haloperidol

what is haldol (haloperidol)?

it is a typical first generation antipsychotic medication - tranquilizer

what are the side effects of haldol?

ABCDEF

anticholinergic (dry mouth, urinary retention)

blurred vision

constipation

drowsiness

EPS (tremors, parkinson)

photo sensitivity

agranulocytosis (low WBC, immunosuppressed)

safety concerns!

what may pts develop from an overdose of haldol? what should their doses be to avoid this?

NMS (neuroleptic malignant syndrome)

elderly and young white pts should only receive 1/2 of usual adult dose

what is a symptom of neuroleptic malignant syndrome?

high fever over 105

a pt is being treated with an antipsychotic medication. pt becomes anxious and presents with tremors. what is the nurse intervention to differentiate NMS from EPS (extrapyramidal syndrome)?

measure the pts temp!

if temp is WNL --> EPS

if temp is 102 and rising --> NMS (call emergency response team and notify HCP)

what do both NMS and EPS present with?

anxiety and tremors

only difference is temp

what is another name for clozaril?

clozapine

what is clozaril (clozapine)?

atypical antipsychotic

what are the side effects of clozaril?

agranulocytosis! - worse than cancer drugs and can trash the pt's bone marrow

what is the #1 nursing intervention in a pt taking clozaril?

monitor the WBC

why is geodon (ziprasidone) dangerous?

it can cause sudden cardiac arrest, do not use in pts with a cardiac condition

what do second generation antipsychotics end in?

-zapine

what is another name for zoloft?

sertraline

what is zoloft?

antidepressant - SSRI

what can zoloft cause?

insomnia

what can zoloft interact with? what does each cause?

st johns wort - causes serotonin syndrome

warfarin - causes bleeding

what are the s/s of serotonin syndrome?

s-weating

a-pprehension (sense of doom)

d-izziness

h-eadache

if a pt is on st. john's wort and warfarin, what do we do?

lower the dose of zoloft