Psychotropic Agents Unit 1

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Psychotropic AgentsUnit 1

• NURS 1950
• Nancy Pares, RN, MSN
• Metro Community College

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Obj. 1 Identify major anti-anxiety agents (Chap
14)

• Four groups (also called anxiolytics/tranquilizers
  )
• Antidepressants (Chap 16)
• Benzodiazepines
• Barbiturates
• Nonbenzodiazepines/nonbarbiturate CNS depressants

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What assessment needed before starting meds?

• Baseline data
• Cause of anxiety
• Vitals
• Blood dyscrasias, liver disease, pregnancy or
  breastfeeding
• WHY?

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Barbituates

• Prototype Phenobarbital (Luminal)
• Action enhances the action of the
  neurotransmitter GABA-which suppresses abnormal
  neuronal discharges
• Rarely used today due to significant side
  effectshigh chem dependency overdose
• New studies show
• No effect on anxietytoo much CNS depression
• Overdoses are common increase enzyme
  activitywhich causes_resp depression

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Benzodiazepines

• Advantages
• End in pam
• Diazapam (Valium),oxazepam (Serax), lorazapam
  (Ativan)

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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

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Benzo

• Adverse effects
• Hypotension, confusion, syncope
• Interactions
• ETOH, anesthetics, MAO inhibitors,
  antihistamines, TCAs, narcotics, barbiturates
• Caffeine and smoking interfere with desired
  effect
• Overdose
• Flumazenil (Romazicon)

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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

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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

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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

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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

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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?

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Obj. 2 Identify major groups of drugs used to
treat depression ( Chp 16)

• Classifications
• Tricyclics
• MAO inhibitors (monoamine oxidase)
• SSRI
• Atypical Antidepressants

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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

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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

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TCA

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

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Nursing interventions

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

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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

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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 drugsex coumadin
• May need increase of dilantin due to interactions

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MAOI

• Phenelzine (Nardil)
• Actionintensifies 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 195)
• Contraindications cardiac disease, renal/hepatic
  impairment

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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

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Drug interactions MAOI

• General anesthesia, diuretics, antihypertensives
  potentiate the hypotensive effects
• Insulin and oral hypoglycemics additive effects
• Meperidine and MAOI severe reactions

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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.?

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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

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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

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Lithium

• Adverse effects persistant vomiting progressive
  wt gain, fatigue, nephrotoxicity
• Serum levels need to be below 1.5mEq/L
• gt1.5 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 gt convulsion, oliguria, death

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Lithium

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

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Obj. 6 Identify antipsychotics.

• Phenothiazines
• Non phenothiazine
• Atypical anti psychotics

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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

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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

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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)

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Non phenothiazines

• Haloperidol (Haldol)
• Action/Use chemically a butyrphenone primary
  use is psychotic disorderhas less sedation than
  phenothiazine, but greater EPS
• Nursing Interventions
• Same as phenomonitor carefully, esp. elderly

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Atypical Antipsychotics

• Clozapine (Clozaril)
• Action/Use
• Largely unknownblock 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

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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