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Psychotropic Agents Unit 1

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

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  1. Psychotropic AgentsUnit 1 NURS 1950 Nancy Pares, RN, MSN Metro Community College

  2. Obj. 1 Identify major anti-anxiety agents (Chap 14) • Four groups (also called anxiolytics/tranquilizers) • Antidepressants (Chap 16) • Benzodiazepines • Barbiturates • Nonbenzodiazepines/nonbarbiturate CNS depressants

  3. What assessment needed before starting meds? • Baseline data • Cause of anxiety • Vitals • Blood dyscrasias, liver disease, pregnancy or breastfeeding • WHY?

  4. 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

  5. Benzodiazepines • Advantages • End in ‘pam’ • Diazapam (Valium),oxazepam (Serax), lorazapam (Ativan)**

  6. 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

  7. 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)

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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?

  13. Obj. 2 Identify major groups of drugs used to treat depression ( Chp 16) • Classifications • Tricyclics • MAO inhibitors (monoamine oxidase) • SSRI • Atypical Antidepressants

  14. 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

  15. 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

  16. TCA • Adverse effects: • Tremor, numbness, tingling, Parkinsonian symptoms, orthostatic hypotension, anticholinergic effects (which are?) • Cardiac arrhythmias, suicidal actions

  17. Nursing interventions • Do not use with MAOI..why? • Sympathomimetics increase effects of anticholinergic effects • Avoid OTC antihistamines • Prototype: imipramine (Tofranil)

  18. 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

  19. 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

  20. 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

  21. 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

  22. Drug interactions: MAOI • General anesthesia, diuretics, antihypertensives: potentiate the hypotensive effects • Insulin and oral hypoglycemics: additive effects • Meperidine and MAOI= severe reactions

  23. 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.?

  24. 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

  25. 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

  26. 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

  27. Lithium • normal blood level: • Nutrition needs: • Desired effects in 5-7 days; full effect in 21 days • Give with food or milk

  28. Obj. 6 Identify antipsychotics…. • Phenothiazines • Non phenothiazine • Atypical anti psychotics

  29. 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

  30. 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

  31. 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)

  32. Tools used to monitor • AIMS • Abnormal Involuntary Movement Scale • DISCUS • Dyskinesia Identify System Condensed User Scale

  33. 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

  34. 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

  35. 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

  36. 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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