NURS126 Chapter 16 (not on exam 4 but on final)

Prototypes of Benzodiazepines

alprazolam

diazepam

lorazepam

Action of Benzodiazepines

binds to gamma-aminobutyric acid (GABA) receptors

a. intensifies effect of GABA

Use of Benzodiazepines

Anxiety

Adverse Effects of Benzodiazepines

CNS depression: dizziness & drowsiness

Contraindications of Benzodiazepines

Patients with narrow-angle glaucoma

Nursing Consideration of Benzodiazepines

Monitor for overdose. Administer flumazenil (Benzodiazepines antagonist)

Patient Education for Benzodiazepines

avoid driving or other activities requiring mental alertness / physical coordination

avoid alcohol & other CNS depressants

do not stop drug abruptly

Action of Buspirone

agonist effects on presynaptic dopamine receptors

high affinity for serotonin receptors

Use of Buspirone

Anxiety (BuSpar)

Adverse Effects of Buspirone

dizziness, drowsiness, & headache

does not cause dependence or withdrawal symptoms

Nursing Considerations for Buspirone

May take several weeks for optimal results

Antidepressants

Uses:

anxiety

depression

obsessive-compulsive behavior

panic attacks

phobias

“Black box warning”

issued to monitor children & adults for warning signs of suicide

a. evident at start of therapy or with dose changes

Prototypes of Tricyclic Antidepressants

amitriptyline

imipramine

Action of Tricyclic Antidepressants

inhibits reuptake of norepinephrine & serotonin into presynaptic nerve terminals

Adverse Effects of Tricyclic Antidepressants

most common: orthostatic hypotension

anticholinergic: blurred vision, constipation, dry mouth, excess perspiration, tachycardia, & urinary retention

overdose: death from dysrhythmias or seizures

Contraindications of Tricyclic Antidepressants

Patients with dysrhythmias or MI

Nursing Considerations for Tricyclic Antidepressants

monitor for suicidal ideation throughout therapy

may take 4 - 6 weeks for therapeutic effect

drug interactions may occur

Patient teaching

do not take OTC, other prescription drugs, or herbal remedies without notifying physician

Prototypes of MAOIs

phenelzine

tranylcypromine

Action of MAOIs

inhibits monoamine oxidase → limit breakdown of dopamine, epinephrine, norepinephrine, & serotonin

Adverse Effects of MAOIs

common: diarrhea, headache, insomnia, & orthostatic hypotension

hypertensive crisis if:

• interaction between MAOIs & foods with tyramine

symptoms: diaphoresis, flushing, nausea, occipital

headache, palpitations, & stiff neck

i. occur within minutes of food ingestion

ii. antidote: calcium channel blockers

Nursing Considerations of MAOIs

patient must refrain from foods with tyramine

a. i.e. bananas, beef/chicken liver, beer, cheese,

chocolate, & yeast

may take 4 - 6 weeks for therapeutic effect

drug interactions may occur

Patient Education of MAOIs

strict observation of dietary restrictions for tyramine

do not take OTC, other prescription drugs, or herbal remedies without notifying physician

Prototypes of SSRIs

citalopram

escitalopram

fluoxetine

paroxetine

sertraline

Action of SSRIs

slows reuptake of serotonin into presynaptic nerve terminals

Adverse Effects of SSRIs

most common: sexual dysfunction in men & women

others: anxiety, headache, insomnia, nausea, & weight gain

serotonin syndrome (SES)

a. occurs when patient receives other drugs affecting

metabolism, synthesis, or reuptake of serotonin

b. symptoms: agitation, ataxia, confusion, hyperpyrexia,

hypertension, sweating, & tremors

c. treatment: discontinue all serotonergic drugs; provide

supportive care that stabilizes VS

Drug Interactions of SSRIs

↑ anticoagulant effects with warfarin

potentially fatal pharmacodynamics with MAOIs

a. prevent with “washout” period of 2 - 5 weeks

Nursing Considerations of SSRIs

assess baseline body weight

obtain history of sexual function disorders

may take 4 - 6 weeks for therapeutic effect

Patient Education of SSRIs

take most SSRIs with food

exercise & restrict caloric intake

Duloxetine (Cymbalta) & venlafaxine (Effexor)

inhibits reabsorption of norepinephrine & serotonin

a. ↑ dopamine, norepinephrine, & serotonin in CNS →

elevate mood

Uses

Generalized anxiety disorder and neuropathic pain

Bupropion (Wellbutrin & Zyban)

inhibits reuptake of serotonin; may affect dopamine & norepinephrine activity

Use

smoking cessation

mirtazapine (Remeron)

blocks presynaptic norepinephrine & serotonin receptors

Prototypes of Mood Stabilizers

lithium

Action of Mood Stabilizers

changes neurotransmitter balance in specific brain regions

Use of Mood Stabilizers

bipolar disorder: moderate extreme shifts in emotion between mania & depression

Adverse Effects of Mood Stabilizers

toxicity from conditions with loss of sodium

a. i.e. ataxia, circulatory collapse, diarrhea, edema,

hypotension, lethargy, muscle weakness,

seizures, & slurred speech

overdose: treat with hemodialysis & supportive care

Contraindications of Mood Stabilizers

pregnancy & lactation

patients with history of cardiovascular & kidney disease

Nursing Consideration of Mood Stabilizers

monitor serum levels: 0.6 - 1.2 mEq/L (therapeutic) & above 1.5 mEq/L (toxic)

Patient Education of Mood Stabilizers

keep all scheduled lab appointments

do not change diet; drink plenty of fluids

practice reliable contraception

Antipsychotic Drugs

Positive

↓ psychotic symptoms

patient maintains normal social relationships

Negative

patient sees behavior as normal; questions need for medication

undesirable adverse effects → nonadherence → return of symptoms

Prototypes of Phenothiazines

chlorpromazine & perphenazine

Action of Phenothiazines

prevent dopamine & serotonin from occupying their receptors in the brain

some symptoms diminish within days; others require as long as 7 - 8 weeks

Use of Phenothiazines

long-term treatment for positive signs of schizophrenia (i.e. delusions & hallucinations)

Adverse Effects of Phenothiazines

anticholinergic: constipation, dry mouth, & urinary retention

extrapyramidal: akathisia, dystonia, parkinsonism, & tardive dyskinesia

a. reversible: early drug withdrawal or dosage reduction

b. permanent: higher doses for prolonged use

neuroleptic malignant syndrome

a. rare but potentially fatal

b. symptoms: confusion, diaphoresis, incontinence, ↑

fever, muscle rigidity, tachycardia, & unstable BP

Nursing Considerations of Phenothiazines

monitor for therapeutic effects

a. improved affect/mood & alleviated/decreased

psychotic symptoms (i.e. delusions, garbled speech,

hallucinations, or paranoia)

assess for extrapyramidal symptoms & neuroleptic malignant syndrome

a. immediately notify physician if present

Prototypes of Butyrophenone

haloperidol

Action of Butyrophenone

blocks postsynaptic D2 dopamine receptors

Use of Butyrophenone

treatment of schizophrenia

Adverse Effects of Butyrophenone

equal or greater incidence of EPS than phenothiazines

Lifespan consideration

older adults: smaller doses; more frequent monitoring with gradual dosage increase

Patient Education of Butyrophenone

immediately report S & S of extrapyramidal symptoms or neuroleptic malignant syndrome

avoid alcohol or illegal drug use

Prototypes of Atypical Antipsychotics

aripiprazole (Abilify), clozapine (Clozaril), olanzapine

(Zyprexa), quetiapine (Seroquel), & risperidone (Risperdal)

Action of Atypical Antipsychotics

blocks dopamine D2, serotonin (5-HT), & alpha-adrenergic receptors

Use of Atypical Antipsychotics

treat positive & negative symptoms of schizophrenia

Adverse Effects of Atypical Antipsychotics

↑ risk of weight gain, hypertriglyceridemia, & diabetes

↑ prolactin levels (risperidone)

a. men: lack of libido, impotence, & gynecomastia

b. women: ↓ libido, menstrual disorders, & osteoporosis

Contraindication of Atypical Antipsychotics

lactation (risperidone)

Nursing Considerations of Atypical Antipsychotics

monitor WBC with differential throughout treatment (clozapine)

a. drug may cause agranulocytosis

monitor BP of patients with cardiovascular problems

a. drug may cause severe hypotension

Patient Education of Atypical Antipsychotics

keep all scheduled lab visits

slowly change positions

take drug as prescribed