Lecture 9 Psychotropic Drugs

LECTURE 9 PSYCHOTROPIC DRUGS • even though there are several classes, info tends to overlap • ALL psych drugs cause low BP & weight changes! -> usually weight gain (but a few cause weight loss) • for most of these meds, you need to take take them for 2-4 weeks before you get beneficial effect! - many PT’s say that they don’t work after only taking ! them for 1 week (nurse teaching) PHENOTHIAZINEs: • old class of drugs -> 1st gen/typical anti-psychotics • ALL end in “-zine” • actions:! - do not cure psych diseases -> reduce the symptoms! - in large doses they are anti-psychotics ! -> “-zines for the zany”! - in small doses they are anti-emetics! - considered major tranquilizers! -> Aminoglycosides are to antibiotics as ! Phenothiazines are to tranquilizers = THE BIG ! GUNS (when nothing else is going to work) • major side effects (not toxic effects):! A = anti-cholinergic (primarily dry mouth)! B = blurred vision! C = constipation! D = drowsiness! E = EPS -> extrapyramidal syndrome (looks like ! Parkinson’s)! F = photosensitivity! aG = agranulocytosis (low WBC count, ! immunosuppressed)! ** side effect vs. toxic effect nursing actions:! - side effect = teach PT, inform MD, keep giving ! med (& give drugs that can help alleviate)! - toxic effect = hold drug, call MD immediately • the nursing care is treating the side effects! - #1 nursing diagnosis for a client on a tranquilizer is ! risk for injury (safety issues) • decanoate = long-acting IM form given to noncompliant clients! - is something that may be court ordered TRICYCLIC ANTI-DEPRESSANTS: • old class of anti-depressants & most have been grandfathered into a newer class:! - NSSRI = non-selective serotonin re-uptake inhibitor • are mood elevators used to treat depression! = “happy pills” ! - include Elavil, Tofranil, Aventyl, Desyrel • side effects:! A = anti-cholinergic (primarily dry mouth)! B = blurred vision! C = constipation! D = drowsiness! E = euphoria BENZODIAZEPINEs: • anti-anxiety meds • considered to be minor tranquilizers (primary use) • they always have “-zep” in the name! -> both major & minor tranquilizers have “Z’s” • ex. Diazepam (Valium), Xanax, Clonazepam, Lorazepam • indications: are more than just minor tranquilizers! a) pre-op to induce anesthesia! b) muscle relaxant! c) good for alcohol withdrawal! d) seizures! e) help people when they are fighting the ventilator ! (relax & calm down) • work quickly but technically, you shouldn’t take them for more than 2-4 weeks • relationship between an anti-depressant & a minor tranquilizer?! - one takes 2-4 weeks and you can be on it for the ! rest of your life (anti-depressant)! - the other works quickly but you should only be on it ! for 2-4 weeks (minor tranquilizer)! —> a lot of PT’s get put on both when first admitted as the ! minor tranq. will work right away & then when the anti-! depressant kicks in, they are taken off the minor tranq.! * heparin is to warfarin as a tranquilizer is to ! an anti-depressant • side effects:! A = anti-cholinergic (primarily dry mouth)! B = blurred vision! C = constipation! D = drowsiness • # 1 nursing diagnosis is risk for injury (safety issues) MAOIs - MONOMINE OXIDASE INHIBITORS: • anti-depressants (one of the first types developed)! - don’t really use them much anymore because of the ! restrictions & side effects! - dirt cheap compared to other anti-depressants • you need to spot an MAOI when you see it on the test from the beginning of the name! —> the beginnings of the name rhyme: Marplan, ! Nardil, Parnate (all brand names) • side effects:! A = anti-cholinergic (primarily dry mouth)! B = blurred vision! C = constipation! D = drowsiness • the important thing is patient teaching:! a) to prevent severe, acute, sometimes life-! threatening hypertensive crisis (high BP)! - PT must avoid all foods containing tyramine (an ! amino acid that regulates BP)! -> NO aged cheese (can have mozzarella & cottage ! cheese), yogurt, cured/preserved/organ meats, ! alcohol, caffeine, chocolate, fermented foods, ! bananas, avocado’s (guacamole!), any dried fruit! b) do not take OTC meds when on an MAOI LITHIUM: • used to treat bi-polar disorder! -> it decreases mania (does not treat the depression) • of all psych drugs, it’s the most unique (diff. side effects) because all the other ones mess w/ neuro-transmitters! -> Lithium does not = stabilizes nerve cell membranes • unique side effects that act more like an electrolyte:! P = peeing P = pooping ! P = paresthesia -> earliest sign of all electrolyte imbalances • TOXIC effects:! —> hold & call the MD! - tremors - metallic taste - severe diarrhea • Interventions for PT’s on Lithium:! a) #1 = increase fluids! -> because they are peeing & pooping a lot so at ! higher risk for dehydration! b) watch Na levels! c) if they are sweating like crazy don’t give free water, ! give Gatorade or some other electrolyte solution! -> PT has to have a normal Na for Lithium to work! d) NOTE: Lithium is closely linked to sodium.! - low Na = makes Lithium more toxic! - high Na = makes Lithium ineffective! *** need normal Sodium levels! PROZAC -> SSRI - SELECTIVE SEROTONIN REUPTAKE INHIBITOR: • similar to Elavil (NSSRI) • side effects:! A = anti-cholinergic (primarily dry mouth)! B = blurred vision! C = constipation! D = drowsiness! E = euphoria • Prozac causes insomnia! -> give it before noon (bad idea to give at bed time) • When changing the dosage for a young adult/ adolescent, watch for increased suicidal risk! -> only this age group & only when there is recent ! dosage change HALDOL: • has a decanoate form (long acting IM) • basically the same as Thorazine so side effects are:! - A B C D E F aG • is also an old 1st gen/typical anti-psychotic like the ! “-zine’s” (major tranquilizer) • the big thing they test for Haldol is NMS!! - elderly PT’s & young, white schizophrenics may ! develop NMS w/ Haldol overdose • NMS = neuroleptic malignant syndrome! - potentially fatal hyper-pyrexia! - could reach 106-108 degrees (definitely over 105)! - dosage for elderly PT’s should be half the adult dose • has anxiety & tremors (like EPS) & get both w/ it:! ** boards will want to know if you know the ! difference between them! —> EPS = side effect (no big deal)! —> NMS = medical emergency!!! (PT can die!) • How do you tell the difference between EPS & NMS?? take a temperature! -> no excuse for the nurse to miss NMS! -> first action when faced w/ a PT that has anxiety & ! tremors = take their temp.! ** if over 102 call emergency response team coz it’ll ! be a bad situation (even if it’s not 105 degrees yet) • safety concerns related to the side effects:! - as soon as they get hit by Haldol, they go down CLOZAPINE (CLOZARIL): • prototype 2nd gen/atypical anti-psychotic! - new class for the “zany” • used to treat severe schizophrenia • was meant to replace the “-zines” & Haldol! - advantage is that it does not have the side effects ! A B C D E or F! - has slight effects but minor compared to “-zines” ! - BUT does have side effect aG (agranulocytosis)! -> horrendous in trashing bone marrow! -> causes unbelievably low WBC counts causing ! you to get horrible infections • other variations created that have less aG effects but still have to monitor them • not everyone gets the low WBC so some people can take it but some people can’t • nursing priority = monitor WBC counts • Note: Geodon (Ziprasidone)! - has a black box warning -> prolongs the QT interval ! & can cause sudden cardiac arrest! —> shouldn’t really use in PT’s w/ heart problems • in general, these drugs end w/ “-zapine”! - another tranquilizer class that has a “z” SERTRALINE (ZOLOFT): • another SSRI like Prozac • also causes insomnia BUT you can give it at bedtime • the big thing these days is testing the interactions:! a) cytochrome P450 system in the liver = major pathway ! in which drugs are metabolized & deactivated in the liver ! -> Zoloft is notorious for interfering w/ this system ! (causes toxicities of other drugs because they ! are not getting metabolized) ! -> whenever you add Sertraline to a PT’s drug ! regimen, you will probably have to lower the ! dosages of the other drugs! b) watch for interactions w/ St. John’s Wort! - you will get serotonin syndrome ! -> potentially life-threatening! -> looks like the MAO PT’s that eat the tyramine! ** SAD Head = sweaty, apprehensive, dizzy, headache! c) interactions w/ Warfarin (Coumadin) ! - if PT on both, they might bleed out (MUST reduce ! Coumadin) -> watch for increased bleeding if on ! both because Zoloft makes Coumadin go toxic