Nursing 3010 Psych Meds – Flashcards
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Alzheimer's Meds (Acetylcholineterase Inhibitors) Drugs
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Tacrine HCl (Cognex) Donepezil HCl (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)
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Alzheimer's Meds (Acetylcholineterase Inhibitors)
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Indications: Alzheimer's Disease Adverse Reactions: nausea & diarrhea Nursing Implications: Teach clients they should take no anticholinergic meds. -Meds should not be used in cases of severe liver impairments -Take w/ meals to avoid GI upset -DO NOT DISCONTINUE ABRUPTLY!!!
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Alzheimer's Meds (N-Methyl D-Aspartate (NMDA) Antagonist) Drugs
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Memantine (Namenda)
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Alzherimers Meds (N-Methy D-Aspartate (NMDA)
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Indications: Alzheimer's Disease Adverse Reactions: headaches, dizziness, constipation Nursing Implications: Add to acetylcholineterase inhibitors in moderate to severe Alzheimer's disease
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Anti-psychotic Meds (Phenothiazines) Drugs
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Chlorpromazine HCl (Thorazine) Trifluoperazine HCl (Stelazine) Thioridazine HCl (Mellaril) Perphenazine (Trilafon) Triflupromazine (Vesprin) Loxapine (Loxitane)
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Anti-psychotic Meds (Phenothiazines)
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Indication: to control psychotic behavior ex: hallucinations, delusions, and bizarre behavior Adverse Reactions: drowsiness, orthostatic hypotension, weight gain, anticholinergic effects Extrapyramidal effects: Pseudo-parkinsonism, akathisia, dystonia, tardive dyskinesia photosensitivty, blood dyscrasias: granulocytosis, leukopenia neuroleptic malignant syndrome (NMS)
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Anti-psychotic Meds (Phenothiazines) Nursing Implication
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Nursing Implications: Extrapyrimidal effects are major concern -Monitor older clients closely -takes 2-3 weeks to achieve therapeutic effect -keep client supine for 1 hr after administration and advise to change positions slowly because of effects of orthstatic hypotension -tech client to avoid: alcohol, sedatives (potentiate effect of CNS depressants), antacids (reduce absorption of drug)
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Anti-psychotic Med (Phenothiazines) Drug
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Fluphenazine HCl (Prolixin)
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Anti-psychotic Med (Phenothiazines)
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Indications: to control psychotic behavior; useful in treatment of psychotmotor agitation associated with thought disorders Adverse Reactions: Same as other Nursing Implications: absorbed slowly - used w/ noncompliant clients b/c it can be administered IM once every 14 days
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Anti-psychotic Med (Nonphenothiazines) Drugs
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Haloperidol (Haldol) Thiothixene HCl (Navane) Pimozide (Orap)- used only for Tourette's syndrome
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Anti-psychotic Med (Nonpehnothiazines)
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Indications: to control psychotic behavior; less sedative than phenothiazines Adverse Reactions: severe extrapyrimidal reactions, leukocytosis, blurred vision, dry mouth, urinary retention Nursing Implications: teach client to avoid alcohol - Orap is used only for Tourette's syndrome
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Anti-psychotic Meds (Long Acting Drugs) Drugs
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Fluphenazine decanoate (Prolixin Decanoate) Haloperidol decanoate (Haldol Decanoate)
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Anti-psychotic Meds (Long Acting)
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Indications: client who require supervision w/ med regimen Adverse Reactions: similar to Prolixin and Haldol Nursing Implications: Similar to Haldol and Prolixin - Prolixin can be given every 7-28 days -Haldol can be given every 4 weeks -Require several months to reach steady-state drug levels
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Anti-psychotic Meds (Atypical) Drugs
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Risperidone (Risperdal) Oxanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Abilify) Ziprasidone (Geodon) Clozapine (Clozaril)
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Anti-psychotic Meds (Atypical)
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Indications: treats positive and negative symptoms w/o significant EPS; - clients who have not responded well to typical antipsychotics; fewer side effects - Clozapine has superior efficacy in clients who have been treatment-resistant
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Anti-psychotic Meds (Atypical) Adverse Reactions
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Risperdal: NMS, EPS, dizziness, nausea, constipation, anxiety Zyprexa: drowsiness, dizziness, EPS, agitation Seroquel: drowsiness, dizziness, headache, EPS, weight gain, anticholinergic effects Clozaril: agranulocytosis, drowsiness, dizziness, nausea, constipation, NMS
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Anti-psychotic Meds (Atypical) Implications
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-Monitor WBC weekly for first 6 months the biweekly - Baseline VS & EKG: Report abnormal VS - Monitor for NMS & EPS - Teach to change positions slowly - Seroquel: monitor lipids, especially for obese, diabetic, or HTN clients
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Anticholinergic Meds (EPS) Drugs
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Trihexyphenidyl HCl (Artane) Benztropine mesylate (Cogentin) Amatadine (Symmetrel) Bendaryl Ativan Klonopin Inderal for Akathisia Vitamin E for Tardive Dyskinesia
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Anticholinergic Meds (EPS)
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Indications: acts on extrapyramidal system to reduce disturbing symptoms Adverse Reactions: anticholinergic effects, drowsiness, headaches, urinary hesitancy, memory impairment Nursing Implications: usually given in conjunction w/ antipsychotics
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Antidepressant Meds (Tricyclics) Drugs
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Amitriptyline HCl (Elavil) Depramine HCl (Norpramin) Impramine HCl (Tofanil) Nortriptyline HCl (Aventyl) Protriptyline HCl (Vivactil) Maprotiline (Ludomil)
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Antidepressant Meds (Tricyclics)
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Indications: depression, clients w/ morbid fantasies do not respond well to these drugs Adverse Reactions: anticholinergic effects, CNS effects, cardiovascular effects, GI effects, narrow therapeutic index Nursing Implications: administer at bedtime - takes 2-6 weeks to achieve therapeutic effects -should discontinue 1-3 weeks before starting MAOIs - Avoid concurrent use of antihypertensive drugs - carefully evaluate suicide risk, lethal in overdose
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Antidepressant Meds (MAO-Inhibitor) Drugs
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Isocarboxazid (Marplan) Phenezline sulfate (Nardil) Tranycypromine (Parnate) Selegiline (Eldepryl)
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Antidepressant Meds (MAO-Inhibitor) Monoamine Oxidase Inhibitors
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Indications: depression, phobias, anxiety Adverse Reactions: tachycardia, urinary hesitancy, constipation, impotence, dizziness, insomnia, muscle twitching, drowsiness, dry mouth, fluid retention, confusion Hypertensive Crisis: severe HTN, severe HA, chest pain, fever , sweating, nausea, and vomiting
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Antidepressant Meds (MAO-Inhibitor) Implication
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- DO NOT USE W/ TCAs (HTN Crisis) - Dietary restrictions - Do not use w/ SSRIs - Do not take OTC drugs w/ physician approval - use w/ caution around machinery -Teach warning signs of HTN crisis: HA, palpitations, increased BP
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Antidepressant Meds (SSRIs) Drugs
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Fluoxetine HCl (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro) Vilaodone (Viibryd)
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Antidepressant Meds (SSRIs) Selective Serotonin Reuptake Inhibitors
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Indications: depression, anxiety, panic disorder, aggression, anorexia nervosa, OCD Adverse Reactions: Serotonin Syndrome- at least three symptoms: rapid onset of AMS, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, diarrhea sexual dysfunction, allergic reaction or rash; withhold drug, if occurs and weight gain
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Antidepressant Meds (SSRIs) Nursing Implications
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- Discontinue Prozac at least 5 weeks before starting a MAOI - Give in evening if sedation occurs - Monitor for serotonin syndrome - Do not use w/ St. John's wort - Must be tapered slowly if continuing or changing from one SSRI to another.
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Antidepressant Meds (Atypical) Drugs
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Trazodone (Desyrel)
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Antidepressant Meds (Atypical)
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Indications: depression, insomnia, dementia w/ agitation Adverse Reactions: safer than TCAs or MAOIs in terms of side effects. Nursing Implications: effective 2-4 weeks after treatment is initiated.
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Antidepressant Meds (S/NRIs) Drugs
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Duloxetine (Cymbalta) Venlafazine (Effexor) Desvenlafaxine (Pristiq)
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Antidepressant Meds (S/NRIs) Serotonin/Norepinephrine Reuptake Inhibitors
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Indications: depression, anxiety, panic disorder, aggression, anorexia nervosa, OCD, management of diabetic neuropathic pain Adverse Reactions: nausea, dry mouth, insomnia, headache, fatigue, depressed appetite, increased sweating, sexual dysfunction Withdrawal symptoms: w/ abrupt cessation- agitation, tremors, headache, nightmares
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Antidepressant Meds (S/NRIs) Nursing Implications
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Nursing Implications: do not use w/ MAOIs- HTN crisis result in violent reaction - Wait at least 14 days between MAOI and S/NRIs - Baseline B/P and monitor periodically - may cause a drop in BP - Same nursing implications as SSRIs
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Antidepressant Meds (NDRIs) Drugs
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Bupropion (Wellbutrin, Zyban) Mirtazapine (Remeron)
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Antidepressant Meds (NDRIs) Norepinephrine Dopamine Reuptake Inhibitors
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Indications: second line of antidepressant when SSRI and SNRI are not affective, smoking cessation, anxiety, sleep disturbances Adverse Reactions: insomnia, tremor, anorexia and wight loss, dry mouth, sleep disturbances, poor appetite, pain, sexual dysfunction, sedation Nursing Implications: lowers seizure threshold, should not be used for patients w/ seizure disorders or eating disorders because of increased seizure incidence in this group. -Ephedra: HTN crisis - Take in evening - Exaggerated w/ alcohol use of other CNS depressants.
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Mood Stabilizing Drugs
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Lithium carbonate (Carbolith) Any level above 1.5 is toxic
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Mood Stabilizing Drugs cont.
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Indications: bipolar disorders, especially in manic phase Adverse Reactions: nausea, fatigue, thirst, polyuria and find hand tremors, weight gain, hypothyroidsm, early signs of toxicity- diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination, possible renal impairment
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Mood Stabilizing Drugs Nursing Implications
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- Lithium is excreted by the kidney. Maintain adequate serum levels - Assess electrolytes, especially sodium - Baseline studies of renal, cardiac, and thyroid status must be obtained before therapy is begun - teach client early symptoms of lithium toxicity. If drug is continued, coma, convulsions, and death may occur - instruct client to keep salt usage consistent. - use w/ diuretics is contraindicated. Diuretic-induced sodium depletion can increase lithium levels, causing toxicity.
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Anticonvulsant Mood Stabilizers Drugs
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Valproic Acid (Depakene)
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Anticonvulsant Mood Stabilizers
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Indications: used in bipolar disorder alone or w/ lithium Adverse Reactions: GI distress, nausea, anorexia, vomiting, hepatotoxicity, Neurologic symptoms- tremor, sedation, headache, dizziness. Nursing Implications: administer w/ food, monitor blood levels, maintain serum levels 50-125 ug/ml
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Anticonvulasant Mood Stabilizers Drugs cont.
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Carbamazepine (Tegretol)
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Anticonvulsant Mood Stabilizers cont.
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Indications: used in bipolar disorders, used as an alternative to lithium Adverse Reactions: dizziness, ataxia, blood dysrasias Nursing Implications: main serum levels at 8-12 g/ml - Stop drug is WBC drops below 3000/MM3 - Monitor hepatic and renal function
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Anticonvulsant Mood Stabilizers Drugs cont. part 2
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Lamotrigine (Lamictal)
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Anticonvulsant Mood Stabilizers cont. part 2
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Indications: used in bipolar disorders alone or w/ other mood stabilizers Adverse Reactions: headache, dizziness, double vision, rash (Stevens-Johnson Syndrome)
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Antianxiety Meds (Benzodiazepines) Drugs
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Chlordiazepoxide HCl (Librium) Diazepam (Valium) Alprazolam (Xanax) Clorazepae dipotassium (Tranxene) Lorazepam (Ativan)
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Antianxiety Meds (Benzodiazepines)
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Indications: reduce anxiety, induce sedation, relax muscles, inhibits convulsions, treat alcohol and drug withdrawal symptoms, safer than sedative-hypnotics Adverse Reactions: sedation, drowsiness, ataxia, dizziness, irritability, blood dyscrasias, habituation increased tolerance Nursing Implications: administer at HS - Do not combine w/ ETOH or other CNS depressants - Avoid driving and avoid working around equipment - Gradually taper drug therapy, short term drug supplement to other medications
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Antianxiety Meds (Nonbenzodiazepines) Drugs
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Buspirone (BuSpar)
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Antianxiety Meds (Nonbenzodiazepines)
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Indications: reduce anxiety, help to control symptoms such as insomnia, sweating, and palpitations associated w/ anxiety Adverse Reactions: dizziness Nursing Implications: takes several weeks for antianxiety effects to become apparent - intended for short term use
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Antianxiety Meds (Nonbenzodiazepines) Drugs cont.
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Zolpidem (Ambien)
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Antianxiety Meds (Nonbenzodiazepines) cont.
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Indications: used for short term treatment of insomnia Adverse Reactions: daytime drowsiness Nursing implications: give w/ food 1-11 1/2 hours before bedtime
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Antianxiety Meds (Nonbenzodiazepines) Drugs cont. 2
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Famelteon (Rozerem)
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Antianxiety Meds (Nonbenzodiazepines) cont. 2
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Indications: approved for long treatment of insomnia, selectively binds to melatonin receptors Adverse Reactions: dizziness Nursing Implications: appropriate for clients w/ delayed sleep onset
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Tricyclics Used of OCD Drugs
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Amitriptyline HCl (Elavil) Depramine HCl (Norpramin) Impramine HCl (Tofanil) Nortriptyline HCl (Aventyl) Protriptyline HCl (Vivactil) Maprotiline (Ludomil)
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Tricyclics Used of OCD
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Indications: depression, clients w/ morbid fantasies do not respond well to these drugs Adverse Reactions: anticholinergic effects, CNS effects, cardiovascular effects, GI effects, narrow therapeutic index Nursing Implications: administer at bedtime - takes 2-6 weeks to achieve therapeutic effects -should discontinue 1-3 weeks before starting MAOIs - Avoid concurrent use of antihypertensive drugs - carefully evaluate suicide risk, lethal in overdose
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SSRIs used for OCD Drugs
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Fluoxetine HCl (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro) Vilaodone (Viibryd)
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SSRIs used for OCD
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Indications: depression, anxiety, panic disorder, aggression, anorexia nervosa, OCD Adverse Reactions: Serotonin Syndrome- at least three symptoms: rapid onset of AMS, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, diarrhea sexual dysfunction, allergic reaction or rash; withhold drug, if occurs and weight gain
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SSRIs used for OCD Nursing Implications
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- Discontinue Prozac at least 5 weeks before starting a MAOI - Give in evening if sedation occurs - Monitor for serotonin syndrome - Do not use w/ St. John's wort - Must be tapered slowly if continuing or changing from one SSRI to another.
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Alcohol Deterrents Drugs
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Disulfiram (Antabuse)
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Alcohol Deterrents
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Indications: Treatment of alcoholism; adversion therapy. Interferes w/ breakdown of alcohol causing an accumulation of acetaldehyde (A byproduct of alcohol in the body Adverse Reactions: severe SE occur if alcohol is consumed N/V. Hypotension, headache, rapid pulse and respirations, flushed face and bloodshot eyes, confusion, chest pain, weakness, dizziness Nursing Implications: teach client what to do expect if ETOH consumed - People w/ serious heart disease, epilepsy, liver impairment, or mental illness should not take - Be aware some clients use the SE as a means of "punishment" and if a client repeatedly consumed alcohol while taking the drug, the health care provider should be notified. - Use to motivate clients who have shown the ability to stay sober.
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Alcohol Deterrent Drugs cont.
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Acamprosate (Campral)
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Alcohol Deterrent cont.
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Indications: treament of alcohol dependence by reducing anxiety and unpleasant effects that trigger resuming drinking, balances GABA and glutamate neurotransmitters Adverse Reactions: headache, nausea, diarrhea Nursing Implications: helps reduce cravings - does not reduce or eliminate withdrawal symptoms
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Alcohol Withdrawal (Benzodiazepines) Drugs
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Chlordiazepoxide (Librium) Lorazepam (Ativan)
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Alcohol Withdrawal (Benzodiazepines)
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Indications: reduce anxiety, induce sedation, relax muscles, inhibits convulsions, treat alcohol and drug withdrawal symptoms, safer than sedative-hypnotics Adverse Reactions: sedation, drowsiness, ataxia, dizziness, irritability, blood dyscrasias, habituation increased tolerance Nursing Implications: administer at HS - Do not combine w/ ETOH or other CNS depressants - Avoid driving and avoid working around equipment - Gradually taper drug therapy, short term drug supplement to other medications
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Stimulants Drugs
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Dextroamphetamine sulfate (Dexedrine) Methylphenidate HCl (Ritalin, Concerta) Pemoline (Cylert) Lisdexamfetamine (Vyvanse) Amphetamine/dextroamphetamine (Adderall) Dexmethylphenidate (Focalin)
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Stimulants
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Indications: treat ADD/ADHD, methylphenidate is also used to treat narcolepsy Adverse Reactions: may interact w/ MAOIs producing fever and hypertensive crisis, nervousness and insomnia; dizziness, Tourette's syndrome, tachycardia, palpitations, angina, dysrhythmias, anorexia, weight loss, nausea and abdominal pai Nursing Implications: short acting 2-4 hours - Teach to take last dose at least 6 hrs before bedtime if insomnia occurs - Administer 1-3 doses daily - Administer w/ or after meals to avoid appetite suppression, - Monitor heart rate, rhythm, and blood pressure - Monitor height and weight to detect growth suppression
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Antidotes
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Naloxone HCl (Narcan) Opoid overdoes Flumazenil (Romazicon) Benzodiazepine antidote Acetylcysteine (Mucomyst) Acetaminophen overdose Calcium Channel Blockers MAOI overdose
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ECT Meds
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Atropine sulfate (Atropen) Succinylcholine Thiopental sodium (pentothal)
