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Psychotropic Agents Unit 1. NURS 1950 Nancy Pares, RN, MSN Metro Community College. Obj. 1 Identify major anti-anxiety agents (Chap 14). Four groups (also called anxiolytics/tranquilizers) Antidepressants (Chap 16) Benzodiazepines Barbiturates

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psychotropic agents unit 1

Psychotropic AgentsUnit 1

NURS 1950

Nancy Pares, RN, MSN

Metro Community College

obj 1 identify major anti anxiety agents chap 14
Obj. 1 Identify major anti-anxiety agents (Chap 14)
  • Four groups (also called anxiolytics/tranquilizers)
    • Antidepressants (Chap 16)
    • Benzodiazepines
    • Barbiturates
    • Nonbenzodiazepines/nonbarbiturate CNS depressants
what assessment needed before starting meds
What assessment needed before starting meds?
  • Baseline data
    • Cause of anxiety
    • Vitals
    • Blood dyscrasias, liver disease, pregnancy or breastfeeding
  • WHY?
barbituates
Barbituates
  • Prototype: Phenobarbital (Luminal)
  • Action: enhances the action of the neurotransmitter GABA-which suppresses abnormal neuronal discharges
  • Rarely used today due to significant side effects—high chem dependency & overdose
  • New studies show
    • No effect on anxiety—too much CNS depression
  • Overdoses are common; increase enzyme activity…which causes_resp depression
benzodiazepines
Benzodiazepines
  • Advantages
  • End in ‘pam’
    • Diazapam (Valium),oxazepam (Serax), lorazapam (Ativan)**
benzo
Benzo…
  • Drugs of choice for anxiety and insomnia
  • Action:
    • bind to the GABA receptor (what is this? And what does it do?
  • Uses:
    • Acute anxiety, medical illness, ETOH w/drawal
benzo1
Benzo
  • Adverse effects:
    • Hypotension, confusion, syncope
  • Interactions:
    • ETOH, anesthetics, MAO inhibitors, antihistamines, TCA’s, narcotics, barbiturates
    • Caffeine and smoking interfere with desired effect
    • Overdose:
      • Flumazenil (Romazicon)
benzo2
Benzo
  • Nursing Implications
    • Tolerance develops
    • Can cause physical and psychological dependence
    • No abrupt w/drawal of meds
    • Drug doses vary---check for appropriate dosing
    • Interacts with phenytoin and coumadin
misc drugs for anxiety
Misc Drugs for Anxiety
  • Buspirone (BuSpar)
    • Unrelated to benzo or barbiturates chemically
  • Action: not well known; may be related to dopamine receptors
  • Advantages:
    • Less potential for abuse; lower sedative properties
  • Adverse effects:
    • Dizziness, HA, drowsiness; may take 3-4 wks for optimal effects
nursing implications
Nursing Implications
  • Buspar
    • Schedule regular assessments for slurred speech, dizziness, CNS disturbances; give at regular intervals (not PRN); do not use with MAO Inhibitors or ETOH
misc antihistamine
Misc--Antihistamine
  • Diphenhydramine (Benedryl) and Hydroxyzine (Vistaril)
  • Uses: sedative and antiemetic properties; anticholinergic effects are least with these agents; preop sedation, pruititis
  • Side effects:
    • Blurred vision, constipation, dry mucosa, sedation; drowsiness will decrease with use
stop and review
Stop and Review
  • Before giving an antianxiety, what would you assess?
  • After giving an antianxiety, what would you assess?
  • What are some common nursing diagnosis for clients taking anxiolytics?
obj 2 identify major groups of drugs used to treat depression chp 16
Obj. 2 Identify major groups of drugs used to treat depression ( Chp 16)
  • Classifications
    • Tricyclics
    • MAO inhibitors (monoamine oxidase)
    • SSRI
    • Atypical Antidepressants
general information
General information
  • Action is on serotonin and catecholamines
  • Therapy requires 2-3 wks for mood change
  • Overdoses do occur
  • common side effects:
    • Sedation, anticholinergic activity, tachycardia, orthostatic hypotension, confusion, tremors
obj 3 describe the actions of the cyclic second generation and mao inhibitors
Obj. 3 Describe the actions of the cyclic second generation and MAO inhibitors
  • TCA
    • Action: inhibits reuptake of norepinephrine and seratonin into presynaptic nerve terminals
    • Uses: depression, Manic-depressive (bipolar)disorder, panic disorders
    • Desired effects: mood elevation, increase activity, improve appetite, normalize sleep patterns…..
      • What s/s of depression make these desirable effects?
    • Takes 1-2 months for maximal effect
slide19
TCA
  • Adverse effects:
    • Tremor, numbness, tingling, Parkinsonian symptoms, orthostatic hypotension, anticholinergic effects (which are?)
    • Cardiac arrhythmias, suicidal actions
nursing interventions
Nursing interventions
  • Do not use with MAOI..why?
  • Sympathomimetics increase effects of anticholinergic effects
  • Avoid OTC antihistamines
  • Prototype: imipramine (Tofranil)
slide22
SSRI
  • Sertraline (Zoloft)
    • Action: inhibits reuptake of serotonin
    • Use: depression, anxiety, OCD and panic disorder
    • Adverse effects: agitation, HA , dizziness and fatigue; sexual dysfunction; weight gain;
    • Contraindications: antabuse should be avoided; no MAOI ; use precaution with St. John Wart
nursing interventions1
Nursing interventions
  • May take wks to get effect; effects last 2-3 months after d/c
  • Give in am or pm
  • Note eating disorders hx
  • Exercise and caloric restriction
  • Monitor labs for pro-bound drugs…ex: coumadin
  • May need increase of dilantin due to interactions
slide25
MAOI
  • Phenelzine (Nardil)
  • Action:intensifies effects of norepinephrine in adrenergic synapses
  • Use: depression not responsive to other drugs
  • Common S/E: constipation, dry mouth, orthostatic hypertension; severe hypertension with foods containing tyramine (see pg 189)
  • Contraindications: cardiac disease, renal/hepatic impairment
nursing implications maoi
Nursing Implications- MAOI
  • Refrain from foods that contain tyramine
  • Assess cardiac status
  • Assess lab values (why?)
  • No OTC or herbal meds
  • Avoid caffeine
  • Observe for s/s of stroke or MI
drug interactions maoi
Drug interactions: MAOI
  • General anesthesia, diuretics, antihypertensives: potentiate the hypotensive effects
  • Insulin and oral hypoglycemics: additive effects
  • Meperidine and MAOI= severe reactions
stop and review1
Stop and Review
  • What assessments need to be made before antidepressant medications?
  • What are the nursing diagnosis you would write for clients with antidepressant meds.?
obj 4 specify dietary implications
Obj. 4-Specify dietary implications…
  • Hypertensive Crisis
    • Ingestion of foods with tyramine (this substance promotes release of norepinephrine)
    • Avocados, soybeans, figs, bananas, aged meat, smoked meat, bologna, pepperoni, salami, cheese, caffeine
obj 5 discuss the uses for antimanic agents
Obj. 5 Discuss the uses for antimanic agents.
  • Lithium carbonate (Eskalith)
    • Action: stabalizes the neuronal membrane, reduces release of norepinephrine
    • Uses: reduces euphoria of mania without sedation; may take a week to develop desired effects; begin with low doses and increase q 3-5 days.
    • Common S/E: n/v, anorexia, abd cramps, excessive thirst and urination
lithium
Lithium
  • Adverse effects: persistant vomiting; progressive wt gain, fatigue, nephrotoxicity
  • Serum levels need to be below 1.5mEq/L
  • >1.5: n/v, diarrhea, thirst, polyuria, slurred speech
  • 1.5-2.0: GI upset, confusion
  • 2.0-2.5: ataxia. Blurred vision, coma
  • 2.5 and >: convulsion, oliguria, death
lithium1
Lithium
  • normal blood level:
  • Nutrition needs:
  • Desired effects in 5-7 days; full effect in 21 days
  • Give with food or milk
obj 6 identify antipsychotics
Obj. 6 Identify antipsychotics….
  • Phenothiazines
  • Non phenothiazine
  • Atypical anti psychotics
phenothiazines
Phenothiazines
  • Chlorpromazine (Thorazine)
  • Action:
    • Prevent dopamine and serotonin from occupying their receptor sites and block the excitement symptoms
  • Use:
    • Schizophrenia, bipolar (manic state), depression, antiemetic
pheno
Pheno
  • Adverse effects: (see page 213 table)
    • Extrapyramidal effects
      • Acute dystonia, spasms of tongue, opisthostonos
      • Treat: anticholinergics
    • Parkinsonism (why?)
    • Akathesia
    • Tardive dyskinesia
      • May be irreversible
    • Other common: sedation, sexual dysfunction, breast growth, galactorrhea
pheno1
Pheno
  • Nursing Interventions
    • Increases effect with anticholinergics
    • ETOH and CNS depressants intensify depressant effect
    • NOTE: most phenothiazines end in ‘zine’ ; ex: fluphenzine, prochorperazine, promazine, thiroidazine
    • Careful monitoring of client condition; report EPS symptoms to MD..may need to d/c med
    • Life threatening adverse effect: neuroleptic malignant syndrome (NMS)
tools used to monitor
Tools used to monitor
  • AIMS
    • Abnormal Involuntary Movement Scale
  • DISCUS
    • Dyskinesia Identify System Condensed User Scale
non phenothiazines
Non phenothiazines
  • Haloperidol (Haldol)
  • Action/Use: chemically a butyrphenone; primary use is psychotic disorder—has less sedation than phenothiazine, but greater EPS
  • Nursing Interventions:
    • Same as pheno—monitor carefully, esp. elderly
atypical antipsychotics
Atypical Antipsychotics
  • Clozapine (Clozaril)
  • Action/Use:
    • Largely unknown—block several receptor sites; broader spectrum of action, fewer EPS symptoms
  • Nursing Interventions:
    • Basically same as pheno..give wkly supply to assure lab values get drawn
atypical non pheno
Atypical non pheno
  • New drug aripiprazole (Abilify)
    • Dopamine stabilizer with fewer EPS
    • Adverse effects:
      • HA, N/V, fevers constipation, anxiety
    • Nursing implications
      • As all other categories
atypical non pheno1
Atypical non pheno
  • Risperidone (Risperdal)
  • Action: blocks dopamine D2
  • Use: prevent schizophrenia relapse and bipolar mania s/s
  • Nsing Intervention:
    • Same as phenos
  • Overdose: use activated charcoal
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