NURS 1950
Nancy Pares, RN, MSN
Metro Community College
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Four groups (also called
anxiolytics/tranquilizers)
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Antidepressants (Chap 16)
Benzodiazepines
Barbiturates
Nonbenzodiazepines/nonbarbiturate CNS
depressants
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Baseline data
◦ Cause of anxiety
◦ Vitals
◦ Blood dyscrasias, liver disease, pregnancy or
breastfeeding
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WHY?
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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
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Overdoses are common; increase enzyme
activity…which causes_resp depression
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Advantages
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End in ‘pam’
◦ Diazapam (Valium),oxazepam (Serax), lorazapam
(Ativan)**
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Drugs of choice for anxiety and insomnia
Action:
◦ bind to the GABA receptor (what is this? And what
does it do?
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Uses:
◦ Acute anxiety, medical illness, ETOH w/drawal
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Adverse effects:
◦ Hypotension, confusion, syncope
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Interactions:
◦ ETOH, anesthetics, MAO inhibitors, antihistamines,
TCA’s, narcotics, barbiturates
◦ Caffeine and smoking interfere with desired effect
◦ Overdose:
 Flumazenil (Romazicon)
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Nursing Implications
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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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Buspirone (BuSpar)
◦ Unrelated to benzo or barbiturates chemically
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Action: not well known; may be related to
dopamine receptors
Advantages:
◦ Less potential for abuse; lower sedative properties
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Adverse effects:
◦ Dizziness, HA, drowsiness; may take 3-4 wks for
optimal effects
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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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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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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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Classifications
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Tricyclics
MAO inhibitors (monoamine oxidase)
SSRI
Atypical Antidepressants
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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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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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Adverse effects:
◦ Tremor, numbness, tingling, Parkinsonian
symptoms, orthostatic hypotension, anticholinergic
effects (which are?)
◦ Cardiac arrhythmias, suicidal actions
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Do not use with MAOI..why?
Sympathomimetics increase effects of
anticholinergic effects
Avoid OTC antihistamines
Prototype: imipramine (Tofranil)
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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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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
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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
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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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General anesthesia, diuretics,
antihypertensives: potentiate the hypotensive
effects
Insulin and oral hypoglycemics: additive
effects
Meperidine and MAOI= severe reactions
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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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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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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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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
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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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Phenothiazines
Non phenothiazine
Atypical anti psychotics
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Chlorpromazine (Thorazine)
Action:
◦ Prevent dopamine and serotonin from occupying
their receptor sites and block the excitement
symptoms
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Use:
◦ Schizophrenia, bipolar (manic state), depression,
antiemetic
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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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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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AIMS
◦ Abnormal Involuntary Movement Scale
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DISCUS
◦ Dyskinesia Identify System Condensed User Scale
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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
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Clozapine (Clozaril)
Action/Use:
◦ Largely unknown—block several receptor sites;
broader spectrum of action, fewer EPS symptoms
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Nursing Interventions:
◦ Basically same as pheno..give wkly supply to
assure lab values get drawn
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New drug aripiprazole (Abilify)
◦ Dopamine stabilizer with fewer EPS
◦ Adverse effects:
 HA, N/V, fevers constipation, anxiety
◦ Nursing implications
 As all other categories
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Risperidone (Risperdal)
Action: blocks dopamine D2
Use: prevent schizophrenia relapse and
bipolar mania s/s
Nsing Intervention:
◦ Same as phenos
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Overdose: use activated charcoal