Psychotropic Drugs: NCLEX Review

Psych drugs are frequently tested on the NCLEX exam, making them a critical area of study.
A key point is that while memorization is necessary, understanding patterns helps simplify the process.

All psychotropic drugs share two common side effects:
- Hypotension: They lower blood pressure.
- Weight gain: They lead to an increase in weight.
These side effects often contribute to patient non-compliance, as hypotension can cause drowsiness and weight gain can be frustrating.

The two primary classes of psychotropic drugs are tranquilizers and antidepressants.

Phenothiazines can be easily identified as their names all end in "-zine."
- Examples: Thorazine, Compazine, Fufenazine, Piperazine, Hydroxyzine, Stelazine, Promethazine.
Phenothiazines are classified as major tranquilizers.
It's crucial to remember that psych drugs, including phenothiazines, do not cure diseases; they only reduce symptoms.

In large doses, phenothiazines act as antipsychotics, alleviating psychotic symptoms like delusions, hallucinations, illusions, flight of ideas, and word salad.
In small doses, they serve as antiemetics, combating nausea.
They are potent tranquilizers, necessitating caution due to their powerful effects.

Nursing care is derived from managing the side effects:
- Dry mouth: Sugarless gum and frequent oral hygiene.
- Blurred vision: Implement safety measures.
- Bladder retention: Instruct patient to void every two hours.
- Constipation: High-fiber, high-fluid diet.
- Drowsiness: Ensure patient safety.
- EPS: Focus on safety.
- Photosensitivity: Advise wearing long sleeves and hats in the sun.
- Agranulocytosis: Educate about reporting infection signs.
The primary nursing diagnosis for patients on phenothiazines is safety, given the tranquilizing effects of the drug.

Decanoate forms are long-acting, administered via intramuscular injection monthly to non-compliant patients.
Non-compliance with medication is a primary reason for hospitalization in psychotic patients.
The term "decanoate" or the abbreviation "D" after a drug name signifies this long-acting form (e.g., Thorazine deconate, Haldol D).

Benzodiazepines are classified as minor tranquilizers, primarily used as anti-anxiety medications.
They alleviate anxiety disorders rather than treating schizophrenia or psychosis.
These drugs typically end in "-pam" or "-lam", with diazepam (Valium) being a classic example.
- Examples: diazepam, lorazepam, aprazolam.

Benzodiazepines have a variety of uses:
- Anxiety relief.
- Muscle relaxation.
- Pre-operative anesthesia induction.
- Treatment of seizures.
It's recommended to avoid long-term use (longer than three months) without medical evaluation.

The side effects are minor compared to major tranquilizers, but still include:
- A: Anticholinergic (dry mouth).
- B: Blurred vision and bladder retention.
- C: Constipation.
- D: Drowsiness.
Benzodiazepines do not cause EPS or agranulocytosis.

Tricyclic antidepressants are mood elevators used to treat depression.
They can be identified by the presence of "-trip" in the drug name, such as amitriptyline and nortriptyline.
Remember, "trip" = vacation (elevates mood) = antidepressant.

A key point for NCLEX is that tricyclic antidepressants take 2-4 weeks to become effective, unlike tranquilizers, which work immediately.
Safety remains an important consideration.

MAOIs are antidepressants that elevate mood and treat depression.
The names of MAOIs are difficult to memorize, lacking common endings.
Instead, remember that if a question involves a depressed patient or any psych illness, and asks about food restrictions, it indicates the drug is an MAOI.

MAOIs share common side effects represented by A, B, C, D:
- A: Anticholinergic (dry mouth).
- B: Blurred vision and bladder retention.
- C: Constipation.
- D: Drowsiness.

MAOIs carry the risk of hypertensive crisis, which can be fatal and therefore, patients must avoid foods containing tyramine.
Tyramine accumulates and causes a hypertensive crisis because MAOIs inhibit tyramine's breakdown.

Fruit and Vegetable Group: Remember "salad bar:"
- Avoid bananas, avocados, and raisins (B.A.R.).
Grain Group: Patients can consume all grains.
Meats: Avoid organ meats (liver, heart, lung, tongue, tripe), preserved meats (smoked, dried, pickled, cured), and hot dogs.
Dairy Group: Avoid aged cheeses (cheddar, Gouda, Swiss, Parmesan) but can have non-aged cheeses (mozzarella, feta, mascarpone, cottage cheese). Also avoid yogurt.
Other: Avoid alcohol, caffeine, soy sauce, and licorice, as they contain tyramine precursors.