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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 depression (

  • 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


Psychotropic agents unit 1
TCA and MAO inhibitors

  • Adverse effects:

    • Tremor, numbness, tingling, Parkinsonian symptoms, orthostatic hypotension, anticholinergic effects (which are?)

    • Cardiac arrhythmias, suicidal actions


Nursing interventions
Nursing interventions and MAO inhibitors

  • Do not use with MAOI..why?

  • Sympathomimetics increase effects of anticholinergic effects

  • Avoid OTC antihistamines

  • Prototype: imipramine (Tofranil)


Psychotropic agents unit 1
SSRI and MAO inhibitors

  • 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 and MAO inhibitors

  • 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


Psychotropic agents unit 1
MAOI and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • 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… and MAO inhibitors

  • 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 and MAO inhibitorsantimanic 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • 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…. and MAO inhibitors

  • Phenothiazines

  • Non phenothiazine

  • Atypical anti psychotics


Phenothiazines
Phenothiazines and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • AIMS

    • Abnormal Involuntary Movement Scale

  • DISCUS

    • Dyskinesia Identify System Condensed User Scale


Non phenothiazines
Non phenothiazines and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitors

  • 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 and MAO inhibitorspheno

  • Risperidone (Risperdal)

  • Action: blocks dopamine D2

  • Use: prevent schizophrenia relapse and bipolar mania s/s

  • Nsing Intervention:

    • Same as phenos

  • Overdose: use activated charcoal