lOMoARcPSD|44586770 Mark klimek psych drugs Clinical Pharmacology (Louisiana State University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Southern Peach Co. (swpeachcreations@gmail.com) lOMoARcPSD|44586770 ALL PSYCH DRUGS CAUSE LOW BLOOD PRESSURE AND WEIGHT GAIN PHENOTHIAZINE – 1 generation antipsychotics – TYPICAL ANTIPSYCHOTICS st - All end in “zine” Action: they do not cure psych diseases, just reduce the symptoms - In large doses they are antipsychotics o We use “zines” for the “zaneys” - In small doses they are antiemetics Letter C – considered MAJOR tranquilizers o These are the big guns Side Effects: Major major tranquilizer has a major major side effects o A – anticholinergic effect (dry mouth primarily) o B – blurred vision o C – constipation o D – drowsiness o E – EPS (extrapyramidal syndrome – like Parkinson’s) o F – photosensitivity o G – agranulocytosis (low white count – immunosuppressed) - These are side effects not toxic effects - What do you do when a pt displays a side effect? Do you hold the drug? NO o You teach the patient, inform the doctor and keep giving the pill - When someone experiences a toxic effect to a drug what do you do? o Hold the drug, call the doctor immediately For EPS would you call the Dr and immediately hold the drug? No – they have Parkinson’s drugs to treat the EPS. The nurse is treating the SE, so what is the number 1 nursing diagnosis when a client is on a major tranquilizer? Risk for Injury/Safety Deaconate – can come after the name of a drug or appear as D, it’s a long-acting drug. Can work for 2 weeks or a month. A longacting IM form given to noncompliant clients. Usually is given court ordered by the judge - A warrant can be put out for a patient who does not come in for their monthly court ordered injection TCAs – old class of antidepressants They are mood elevators used to treat depression “happy pill” - Elavil “elevates” your mood – so if you link the other 3 with Elavil, then you will remember the others are also mood elevators. (They all rhyme) – say them on repeat - Amitriptyline (Elavil) - Imipramine (Tofranil) - Nortriptyline (Aventyl) - Desyrel Doxepin (Sinequan) Amoxapine (Asendin) Trimipramine (Surmontil) Desipramine (Norpramin) Clomipramine (Anafranil) Side Effects: - A – anticholinergic (dry mouth) - B – blurred vision - C – constipation - D – drowsiness - E – euphoria (happy happy joy joy) You must take these for about 2-4 weeks until you see the beneficial effect. They do not work right away. After 1 week, the pt will say “these aren’t working.” We teach the pt that these take a little while to work. Downloaded by Southern Peach Co. (swpeachcreations@gmail.com) lOMoARcPSD|44586770 BENZODIAZEPINES – antianxiety medications – MINOR tranquilizers They always have “zep” in the name Zeps and Zines are tranquilizers – if you want to put someone to sleep give them the “…zzz” What do you find at a “zep”lin concert? A bunch of minors on tranquilizers Alprazolam (Xanax) Lorazepam (Ativan) Chlordiazepoxide (Librium) Clorazepate (Tranxene) Oxazepam (Serax) Clonazepam (Klonopin) Diazepam (Valium) Indications – they are more than just minor tranquilizers, they can also be used as - Preop anesthesia - Muscle relaxer - Good for alcohol withdrawal - Good for seizures - Help people when they are fighting the ventilator They work quickly, but you should not take them for more than 2-4 weeks. Relationship between an antidepressant and a minor tranquilizer? One takes 2-4 weeks to work and you can be on it for the rest of your life, the other works right away but can’t be on it for more than 2-4 weeks. When someone comes in anxiously depressed, they give them both right away. Then in the next 2-4 weeks when antidepressant kicks in, they get taken off of the minor tranquilizer. Heparin is to Coumadin, as a Tranquilizer is to an Antidepressant Side Effects - A – anticholinergic effects (dry mouth) - B – blurred vision - C – constipation - D – drowsiness Number 1 nursing diagnosis is – safety/injury MAOIs – antidepressants They are dirt cheap compared to other antidepressants We spot these from the beginning of the names – they all rhyme - MARplan - NARdil - PARnate Side Effects Patient Teaching - Prevent severe acute, sometimes fatal, hypertensive crisis - The patient must avoid all foods containing tyramine o Think “Salad BAR” – no bananas, apples, raisins (dried fruits) o No avocado – this includes guacamole o Grains are fine – cookies, pies, cakes, bread o No organ meats, preserved meats, processed lunch meats/hot dogs o No cheese except for COTTAGE & MOZARELLA o Not allowed to have yogurt o No alcohol, chocolate, caffeine Teach pt not to take over the counter meds when they are on an MAOI Downloaded by Southern Peach Co. (swpeachcreations@gmail.com) lOMoARcPSD|44586770 LITHIUM – it’s an electrolyte – used for treating bipolar disorder because it decreases mania. It DOES NOT treat Depression - The most unique psych drug because side effects are not ABCD Side Effects – 3 P’s - Peein - Poopin - Paresthesia o Why paresthesia? Because the earliest sign of all electrolyte imbalances in numbness and tingling If you give someone large does of Lithium and make their level high, first sign is paresthesia If someone has 3 P’s are you giving the med or holding the med and calling the doctor? We are giving the med and just telling the doctor later. For TOXIC side effects – we hold and call immediately - Tremors - Metallic taste - Severe diarrhea Number 1 intervention for someone on lithium is INCREASE FLUIDS – make sure they get ample fluids because they are peein and poopin all the times, which means they are losing fluid, putting them at risk for dehydration We are watching SODIUM level If they are sweating while outside working, a little manic working outside – do not give them free water, given them Gatorade or an electrolyte solution. Lithium is closely linked to sodium, low sodium makes lithium more toxic, high sodium will make lithium ineffective. Low sodium = toxic High sodium = doesn’t work The only way lithium works is if sodium is normal PROZAC – a SSRI – similar to Elavil Side Effects - A – anticholinergic effect - B – blurred vision - C – constipation - D – drowsiness - E – euphoria Prozac causes INSOMNIA – you have to give this before noon. Do not give Prozac at bedtime. When changing the dose of Prozac for an adolescent or young adult – watch for increased suicide risk What if an adolescent is on Prozac, does that make them an increased risk for SI? NO – only when you change the dose. You have to have both (recently changed dose and adolescent/young adult). HALDOL – has a deaconate form – it’s basically the same as Thorazine – Typical 1 generation antipsychotic st Side Effects: - A – anticholinergic effect - B – blurred vision - C – constipation - D - drowsiness - E – EPS (extrapyramidal syndrome - like Parkinson’s) - F – photosensitivity - G – agranulocytosis (low WBCs – immunocompromised) Downloaded by Southern Peach Co. (swpeachcreations@gmail.com) lOMoARcPSD|44586770 *NMS – elderly patients and young white schizophrenics can develop NMS from an overdose of Haldol – a potentially fatal hyperpyrexia with temps of 106-108. It can start at 102 and go way up – therefore dose for elderly patients should be half of the adult dose. NMS can have some anxiety and tremors – this is a huge deal and you can die EPS can have some anxiety and tremors – but it’s a side effect, no big deal - Boards wants to know that you know the difference between these – how can you tell the difference? TAKE A TEMPERATURE If they say you have a pt on a major tranquilizer who has anxiety and tremors, what do you do? Take their temperature. If elevated, immediately call for response team CLOZARIL (CLOZAPINE) – “zap” – prototype (original first) 2 generation Atypical Antipsychotic (new class for nd the “zaney” - Used to treat severe schizophrenia – MAJOR Tranquilizer o Developed to replace the “zines” and Haldol – looked promising because it had an advantage (did not have side effects ABCDEF), but what it did have was agranulocytosis. White count can fall horribly low and develop really bad infections from being on this drug Geodon has a BBW – prolongs the QT interval and can cause sudden cardiac arrest. - Shouldn’t use in people with heart problems - Geodon is a variation of Clozaril ZOLOFT (SERTRALINE) – SSRI, like Prozac - - Also causes insomnia, but you can give it at bedtime Watch for interactions with St. John’s Wort + Sertraline = Serotonin Syndrome o Symptom SAD HEAD Sweat Apprehension (impending sense of doom) Dizziness Headache Watch for interaction with Coumadin + Sertraline = bleeding out o Watch for increased bleeding (Coumadin dose needs to be lowered) Zines – 1st MAJOR Tranquilizers Zapines – 2nd MAJOR Tranquilizers Zeps – MINOR Tranquilizers Downloaded by Southern Peach Co. (swpeachcreations@gmail.com)
