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[h]

Psychiatric Drugs

[q] Benzodiazepine sedative hypnotic anxiolytics

[a] Diazepam, Alprazolam, Chlordiazepoxide, Clorazepate, Oxazepam, Clonazepam

[q] Other uses for benzodiazepines

[a] Seizure disorders, Insomnia, Muscle spasm, Alcohol withdrawal, Induction of anesthesia

[q] Benzodiazepine Side Effect

[a] CNS depression (avoid hazardous activities), Anterograde amnesia (difficulty recalling events that occur after dosing), Acute toxicity, paradoxical respnse, risk for dependence/withdrawal

[q] Benzodiazepine Oral tab toxicity (drowsiness, lethargy, confusion) Actions

[a] Gastric lavage, administration of activated charcoal or saline

[q] Benzodiazepine IV toxicity (respiratory depression, severe hypotension, or cardiac arrest) Actions

[a] Administer flumazenil, Monitor the client’s vital signs, maintain patent airway, Fluids, resuscitation equipment

[q] Diazepam contraindication

[a] clients who have sleep apnea, respiratory depression and/or glaucoma. Careful with client who have liver disease and/or a history of mental illness or a substance use disorder.

[q] Buspirone

[a] Nonbarbiturate Anxiolytic, Dependency is much less likely. No sedation, Might take upto 3 to 6 weeks for the full benefit, not recommended for women who are breastfeeding

[q] Buspirone contraindication

[a] contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued – Hypertensive crisis may result

[q] Buspirone and food/med

[a] Avoid the use of antimicrobial agents Erythromycin, ketoconazole, Herbal St. John’s wort and grapefruit juice – increases the effect on Buspirone

[q] Selective Serotonin Reuptake Inhibitors

[a] Sertraline , Paroxetine, Escitalopram, Citalopram, Fluoxetine, Fluvoxamine (SPEC FF)

[q] SNRI- selective serotonin and norepinephrine reuptake inhibitors

[a] Venlafaxine

[q] SSRI – Early adverse effects (first few days/weeks)

[a] Nausea, diaphoresis, tremor, fatigue, drowsiness : Instruct clients to take the medication as prescribed, Advise clients that these effects should soon subside.

[q] SSRI Later adverse effects (after 5 to 6 weeks of therapy)

[a] sexual dysfunction, weight gain, GI bleeding, Hyponatremia, Bruxism (grinding and clenching of teeth, usually during sleep)

[q] Serotonin Syndrome

[a] Group of symptoms which can appear from 2 to 72 hours after starting SSRI treatment – serious/Lethal. MAOIs, TCAs, and St. John’s wort increase risk of serotonin syndrome

[q] Serotonin Syndrome Symptoms

[a] HATRED FACT: Hallucinations, Agitation, Tremors, Reflex – hyper, Easily distracted, Diaphoresis, Fever, Anxiety, Confusion, Tachycardia

[q] SSRI and pregnancy

[a] Fluoxetine and paroxetine increase the risk of birth defects. SSRI not recommended in later trimester of pregnancy (pulmonary HTN in newborn)

[q] Tricyclic Antidepressants

[a] Amitriptyline, Imipramine, Doxepin, Nortriptyline, Amoxapine, Trimipramine

[q] Tricyclic Antidepressants Side Effects

[a] Orthostatic hypotension, Anticholinergic effects (Dry mouth, Blurred vision, Photophobia, Urinary hesitancy or retention, Constipation, Tachycardia) ; Sedation, Excessive sweating

[q] Tricyclic Antidepressants – Client Teaching to minimize anticholinergic effects

[a] Chewing sugarless gum, Sipping on water, Wearing sunglasses when outdoors, Eating foods high in fiber, Participating in regular exercise, Increasing fluid intake to at least 2 to 3 L a day from beverages, Voiding just before taking medication

[q] Monoamine Oxidase Inhibitors (MAOIs) – Antidepressent

[a] Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline

[q] MAOIs Side effect

[a] CNS stimulation (anxiety, agitation, mania), Orthostatic hypotension, Hypertensive crisis (with tyramine rich food),

[q] MAOI precautions

[a] Hypertensive crisis (tyramine food), Dont give to clients on SSRI, Use cautiously in clients who have diabetes and seizure disorders or those taking TCAs, Transdermal selegiline is contraindicated for clients taking carbamazepine (increases blood level of MAOI)

[q] Tyramine-rich foods to Avoid With MAOIs

[a] aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, beers, wine

[q] MAOI Nurse Notes

[a] Full therapeutic effects may take 2 to 3 months, Suicide watch – Antidepressant medications can increase the client’s risk for suicide, Avoid Tyramine rich food

[q] Lithium Carbonate

[a] Mood Stabilizer, Also used for Alcohol use disorder, Bulimia nervosa, Psychotic disorders

[q] Lithium Less than 1.5 mEq/L

[a] Diarrhea, nausea, vomiting,thirst, polyuria, muscle weakness, fine hand tremor,slurred speech : Advise clients to withhold medication and notify

[q] Lithium Level : 1.5 to 2.0 mEq/L

[a] Ongoing gastrointestinal distress, including nausea, vomiting, and diarrhea; mental confusion; poor coordination;coarse tremors : withhold medication and notify

[q] Lithium Severe toxicity : 2.0 to 2.5 mEq/L

[a] Extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma and possibly death from respiratory complications

[q] Lithium Level Greater than 2.5 mEq/L

[a] coma and death

[q] Lithium Nurse Notes

[a] Monitor plasma lithium levels – Maintenance level range is between 0.4 to 1.0 mEq/L. Maintain adequate fluid and sodium intake – Hyponatremia and dehydration increases toxic levels

[q] Carbamazepine, Valproic acid, Lamotrigine (mood stabilizing antiepileptic drugs)

[a] Treatment of bipolar disorder

[q] Carbamazepine Side effect 1

[a] CNS effects (nystagmus, double vision, vertigo staggering gait, headache) – Start with low dose, Administer dose at bedtime.

[q] Carbamazepine Side effect 2

[a] Blood dyscrasias (leukopenia, anemia, thrombocytopenia) – Have client’s baseline CBC and platelets, ongoing monitoring, bruising and bleeding gum?, sore throat, fatigue, or other indications of infection?

[q] Carbamazepine Side effect 3

[a] Teratogenesis (dont use in pregnancy), Increases ADH – leading to fluid overload (watch for signs of hypervolumea, monitor sodium), Skin disorders (dermatitis, rash,Stevens-Johnson syndrome) – wear sunscreen

[q] Valporic Acid Side Effect

[a] Hepatotoxicity, Pancreatitis, Thrombocytopenia

[q] Conventional/ First Generation – Antipsychotic medications

[a] Control mainly the positive symptoms (hallucinations, delusions, and bizarre behavior of psychotic disorders)

[q] Second-generation (atypical) antipsychotic agents

[a] Relief of both the positive and negative symptoms of the disease, Decreasee depression, anxiety and suicidal behaviors. Improve memory, Less extrapyramidal and anticholinergic side effects

[q] Conventional/ First Generation – Antipsychotic example

[a] Chlorpromazine, Haloperidol, Fluphenazine, Thiothixene, Perphenazine

[q] Conventional/ First Generation – Antipsychotic Adverse Effects

[a] Extrapyramidal side effects (Acute dystonia, Parkinsonism, Akathisia, Tardive dyskinesia) , Neuroleptic malignant syndrome, Anticholinergic effects, Neuroendocrine effects (gynecomastia, galactorrhea, menustral abnormalities), Seizures, Skin (photosensitivity, dermatitis), orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis, Severe dysrhythmias

[q] Extrapyramidal side effects

[a] Acute dystonia (severe spasms of tongue,neck, face, or back) Parkinsonism (bradykinesia, rigidity, shuffling gait, drooling,tremor) , Akathisia (unable to stand or sit still) , Tardive dyskinesia (involuntary movements of the arms, legs, trunk or tongue and face like lip-smacking)

[q] Neuroleptic malignant syndrome S/S

[a] high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in level of consciousness developing into coma.

[q] Neuroleptic malignant syndrome Management

[a] Stop antipsychotic medication, vitals, cooling blanket, antipyretics, increase fluids, diazepam to control anxiety, dantrolene to induce muscle relaxation

[q] Second-generation (atypical) antipsychotic agents

[a] Risperidone, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone, Clozapine, Lurasidone,Paliperidone,Iloperidone

[q] Second-generation (atypical) antipsychotic agents Adverse Effect

[a] New onset of diabetes mellitus, Weight gain, CV disorder (HTN, high cholestrol, orthostatic), Anticholinergic effects, CNS (agitation, dizziness, sedation, sleep problem), Mild EPS (tremor)

[q] Quetiapine specific side effect

[a] cataracts – baseline and regular eye exam

[q] Ziprasidone specifc side effect

[a] ECG changes and QT prolongation may lead to torsades de pointes

[q] Clozapine specific side effect

[a] Agranulocytosis – Obtain baseline WBC and monitor weekly, Monitor for indications of infection (fever, sore throat, lesions in mouth), and notify

[q] Disulfiram – Alcohol withdrawal – Abstinence Maintenance

[a] Disulfiram used concurrently with alcohol will cause acetaldehyde syndrome to occur (nausea, vomiting, weakness, sweating, palpitations, and hypotension). Acetaldehyde syndrome can progress to respiratory depression, cardiovascular suppression, seizures, and death.

[q] Disulfiram Nurse Notes

[a] Advise clients to avoid any products that contain alcohol (cough syrups, mouthwash,aftershave lotion), monitor LFT, wear a medical alert bracelet, participate in a 12-step self-help program

[q] Nicotine patch

[a] apply a nicotine patch to an area of clean, dry skin each day, Remove the patch prior to MRI scan, and replace when the scan is completed

[q] Varenicline

[a] Reduces cravings for nicotine

[q] Varenicline Nurse Notes

[a] Take medication after a meal, Monitor BP and blood sugar, notify the provider if nausea, vomiting, insomnia, new-onset depression or suicidal thoughts occur

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