NUR 312: Pharmacology in Nursing II



NUR 312: Pharmacology in Nursing II

Unit II: Drugs That Affect Physical Regulation

Psychoactive Drugs

Purposes and Advantages of Psychoactive Agents

Neurohormones:

Dopamine .

Serotonin

Norepinepherine

Categories of Psychoactive Drugs:

1. Antipsychotic Drugs:

Uses

Psychotic symptoms: positive symptoms of schizophrenia Delusions

Hallucinations

Illusions

Phenothiazines: (1st. Generation)

Thorazine (Chlorpromazine)

Mellaril (Thioridazine)

Prolixin Decanoate (Fluphenazine) Intramuscular (I.M.)

Non Phenothiazines: (1st. Generation)

Navane (Thiothixene)

Haldol Decanoate (Haloperidol) Intramuscular (I.M.)

Non Traditional Antipsychotics: (2nd. Generation)

Less side effects

Best to treat the negative symptoms of schizophrenia:

Flat Affect, alogia (restricted thought and speech),

Avolition/apathy

Anhedonia/asociality,

Attentional impairment

Clozaril (Clozapine) (weekly or Bi weekly WBC)

Risperdol (Risperidone)

Zyprexia (Olanzapine)

Abilify (Aripiprazole)

Geodon (Ziprasidone)

Side Effects of Antipsychotics:

Sedation: drowsiness

Weight Gain

Risk for Diabetes

Photosensitivity

Dizziness

Orthostatic Hypotension

Sexual Dysfunction

Elevation of Prolactin levels

Anticholinergic Side Effects: blurred vision. dry mouth (cotton mouth),

constipation, urinary retention

Blood Dyscrasias: Agranulocytosis. low WBC

Extrapyramidal SideEffects (E.P.S.)

dystonia, akathesia, psuedoparkinsonism, cogwheel rigidity, masked facies, .

oculogyric crisis, difficulty swallowing, stiffness of muscles, shuffling gait

Nursinq Intervention: For EPS: Notify M.D. and obtain order for: (one of the drugs

below)

Cogentin or Artane (Anticholinergics)

Symmetrel (Dopamine Agonist)

Benedryl (Antihistamine)

Tardive Dyskensia (irreversible) wormlike tongue movements, ataxia,

Neuroleptic Malignant Syndrome (rare} 14-30% mortality

Use Cautiously: diabetes, children under 6 Yr. , glaucoma, ulcers

Interactions: CNS Depressants

Nursing Implications:

Antianxiety Drugs: Benzodiazapines & Miscellaneous,

Action: Increase action of GABA that inhibits nerve transmission in the CNS

Depresses activity in brainstem

Sedative, hypnotic, anticonvulsant

Therapeutic Uses:

Commonly Prescribed Antianxiety Drugs:

Valium (Diazepam) anticonvulsant in IV dose

Xanax

Versed

Tranxene (Clorazapate), Librium, Ativan: used frequently for Detoxification

from Alcohol

Interactions:

CNS Depressants or alcohol + Benzodlazepines = additive effect and

Increased depression

Tagamet, antabuse (disulfiram), MAOI, tobacco + Benzodizapines =

decreased metabolism and increased depression

Common Side effects:

Overdose

Flumazenil (Romazicon)

Benzo. Receptor blocker (Antagonist) reverse effects

Teaching:

Buspar (Buspirone)

Potent antianxiety drug but no muscle relaxant, anticonvulsant, sedative, or alcohol

potentiating action

Takes several weeks for antianxiety effects

Use: Not effective with Panic Disorder or alcohol withdrawal

Side effects:

Inderal (Propranolol) Beta Blocker used for decreasing symptoms that lead to anxiety like tachycardia

Antidepressants:

Uses: Major Depression

Anxiety Disorders

Target symptoms:

Amine Hypothesis

Permissive Hypothesis

Dysregulation Hypothesis

Tricyclic Antidepressants:

Elavil

Tofranil

Uses:

***2-4 weeks to have antidepressant effect

Trazadone

2nd Generation Antidepressants: SSRI's (Selective Serotonin /Reuptake

Inhibitors)

Prozac

Zoloft

Paxil

Other Newer Antidepressants

Lexapro

Wellbutrin /Zyban

Effexor

Vestra

Remeron

Side effects of Antidepressant Therapy and Interventions

Overdose can be fatal due to "cardiac arrythemias with Tricyclics"

Anticholinergic side effects: Dry mouth, Constipation, Urinary retention, nausea,

diarrhea

Psychomotor activationIinsomnia: take drug in morning, eliminate caffeine "

Sedation, Drowsiness especially 1st week

Ejaculatory Disturbances & decreased Libido, priapism

Tremors, headache, nervousness

Monoamine Oxidase Inhibitors (MAOI’s): Used for non responders to other

antidepressant therapy

Monoamine Oxidase: Role of tyramine and dietary restrictions:

Life Threatening Side Effects of MAIO used with other drugs or foods:

Hypertensive crisis: sudden elevation of BP, palpitations, chest pain,

sweating, fever n&v

Hold MAOI's, do not lie down (increases BP in head)

Thorazine 100 mg. 1M repeat if necessary (blocks norepinepherine)

Phentolamine IV in 5 mg dose (binds with. norepinepherine)

Cooling blanket.

Ser Seratonin Syndrome: Occurs when SSRI’s are administered too close to

D/C of MAOl's Confusion, disorientation, mania, restlessness, diaphoresis,

shivering.

Diarrhea, nausea.

DIC all serotonergic drugs, anticonvulsants, Klonapin or Ativan

**Do not reintroduce serotonin drugs

Only 3 drugs

Nardil

Pamate

Marplan

Side Effects:

Extreme hypotension

Nursing Interventions:

Careful health teaching on diet and drug reactions

Dietary restrictions:

Drugs that may produce hypertensive crisis:

Mood Stabilizing Drugs:

Lithium Carbonate usual dose is 900 mg/day

Side effects & Nursing Implications:

serum lithium levels .5 - 1.5 meq./L

Lithium (continued)

dose adjusted by serum level, not symptoms

weight gain, fine hand tremors, mental dullness, polyuria, kidney impairment

narrow therapeutic index:; toxicity a risk

Symptoms of Lithium toxicity:

Nursing responsibilities

Anticonvulsant Mood Stabilizers

Tegretal (Carbamazapine)

Depakote (Valproic Acid)

Neurontin

Tegretal and valproic acid (depakote) serum levels

Used in pt. who cannot tolerate Lithium and for bipolar disorder, schizoaffective disorder, borderline personality disorder, schizophrenia. Often used in combination with other medications "

Response in 1-2 weeks

Nursing Implications

LMC/Aug. 2004

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