Pharm 3 Unit 4 CNS Depressants/ Psychotherapeutic Drugs
How is EPS treated?
By prescribing antiparkinsonian drugs such as benztropine, diphendyramine, or binperiden.
Side effects of benzodiazepines
CNS depression (Sedation, light-headedness, ataxia, decreased cognitive function) Anterograde amnesia (difficulty recalling events after dosing) Acute toxicity Paradoxical response (insomnia, excitation, anxiety, euphoria, rage) Withdrawal symptoms
Psychological conflict turns into physical symptoms
Conversion
Parkisons is the imbalance of what?
Decreased dopamine, and increased acetylcholine
Side effects of psychosis?
Disorganized thoughts, distortion of reality, delusions/hallucinations, incoherence, catatonia, aggressive/violence
Levadopa/Carbidopa
Dopamine replacement for PD, Has a "wearing off" effect
Who is at higher risk for decreased kidney/liver function
Elderly
How often do you draw lithium levels?
Every week until therapeutic
Typical Antipsychotic side effects?
Extrapyramidal AE: parkinsonian syndrome, acute dystonias, akathisia, Neuroleptic malignant syndrome: rigidity, dystonia, agitation, high fever, sweating, tachycardia, HTN, Tardive Dyskinesia
What safety measure should be made aware of while taking a benzo of any kind?
Fall risk, risk for dependence or overdose
What is the depression side of bipolar disorder?
Fatigue, sad or hopeless, appetite changes, thinking/attempting suicide
What is the Benzodiazepine antidote?
Flumazenil
A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks? 1- Lithium 2- Diazepam 3- Fluvoxamine 4- Fluphenazine
Fluphenazine
Tricylics
For depression and OCD
When given a large dosage of a CNS depressant, what is this helping?
General anesthetic
What is the prototype of Haloperidol?
Haldol
Side effects of serotonin syndrome?
Hallucinations, diaphoresis, agitation
What is the manic side of bipolar depression?
Happy for long periods of time, talking fast/racing thoughts, easily distracted, overconfidence in abilities
Hypertensive crisis symptoms
Headache (insufficient blood/oxygen to brain), Visual problems (insufficient blood supply to optic nerve), Alteration of consciousness, Seizure, Angina pectoris, SOB (fluid overload), Edema/swelling
What is important to teach a client about when they are taking MAOI's?
Hypertensive crisis
What is the mode of action for a medication to treat parkisons?
Increase dopamine at receptor sites
What is an example of an Antimania drug?
Lithium
Which antidepressant doesn't play well with any other meds?
MAOI's
While taking lithium patients should:
Maintain sodium intake
A level of anxiety where a person is alert, and this may enhance their learning
Mild anxiety
A level of anxiety where a person only focuses on immediate concern only
Moderate anxiety
When is amitriptyline given?
Mostly given at nighttime due to sedative effect
What does lithium interact with?
NSAIDS, Diuretics
Side effects of SRNI's?
Nightmares, irritability, N/V
SSRIs can also be used to treat
OCD & PTSD
What is Fluphenazine?
Prolixin, a Typical antipsychotic, a type of phenothiazine
Uses of Benzodiazepines
Reduced anxiety postoperative; promotes amnesia; produces mild sedation with moderate to very little respiratory depression when titrated, substance abuse withdrawl
Anti psychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism. Select all that Apply 1. Rigidity 2. Tremors 3. Mydriasis 4. Photophobia 5. Bradykinesia
Rigidity, Tremors, Bradykinesia
Side effects of TCAs
SE: sedation, anticholinergic effects, impotence, orthostatic hypotension (safety), sedation, diaphoresis, sexual dysfunction, cardio toxicity
A level of anxiety where reduction in focus and cognitive ability are impaired
Severe anxiety
A level of anxiety where someone has difficulty functioning & thinking
Severe anxiety
Side effects of SSRIs
Sexual dysfunction, CNS stimulation, Weight loss in early therapy, weight gain with long-term, Serotonin Syndrome, Withdrawal Syndrome, Hyponatremia Rash, Sleepiness, faintness, lightheadedness, GI Bleeding, Dry mouth, headache
What is a prototype of Levadopa/Carbidopa?
Sinemet
How do we prevent EPS?
Start with a low dose of med, AIMS test, patient education, early monitoring
Symptoms related to anxiety
Tachycardia, tachypnea, increased BP, dilated pupils
A client with chronic undifferentiated schizophrenia is receiving an antipyschotic medication. For which potentially irreversible extrapyramidal side effect should a nurse monitor the client? 1. Torticollis 2. Oculogyric crisis 3. Tardive dyskinesia 4. Pseuodoparkinsonism
Tardive Dyskinesia
What demographic population is at higher risk for taking sedative-hypnotics and why?
The elderly because they are CNS depressants and are at risk for falls, etc
What are some Patient education points for antidepressants?
They may take 2-4 weeks and up to 6 weeks to reach their therapeutic levels, do not stop abruptly, monitor for suicide risk, avoid other CNS depressants including ETOH, they have supplement & herbal reactions, may cause weight gain
What do antipsychotics treat?
They reduce the symptoms of hallucinations, delusions, and thought disorders. Used primarily in the treatment of schizophrenia and severe cases of bipolar disorder.
Amitriptyline TCA
Tx for major depression, decreases insomnia
Do atypical or typical anti psychotics have more side effects?
Typical anti psychotics
Patient teaching for levadopa/carbidopa
Urine discoloration is normal, position change slowly (orthostatic hypotension), eat a low protein meal (meds bind better)
SNRI meds
Venlafaxine (Effexor) Duloxetine (Cymbalta)
Bupropion uses?
Weight loss, smoking cessation, seizures
What is a prototype of Bupropion?
Wellbutrin
Phenothiazines
a group of antihistamine drugs that became the first group of effective antipsychotic medications
Schizophrenia
a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions
Neuroleptic Malignant Syndrome
a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp, hyperrigidity
negative symptoms of schizophrenia
absence of appropriate behaviors, flat affect, withdrawal, difficulty thinking
When given a low dosage of a CNS depressant, what is this helping?
anti anxiety effects
How do antipsychotics work?
block dopamine receptors (dopaminergic antagonist)
Serotonin Syndrome
caused by serotonin medications, and has HYPERreflexive muscle activity
sedative-hypnotics
drugs that cause calmness, sleepiness, and slow down bodily functions
Antidepressants
drugs that combat depression by affecting the levels or activity of neurotransmitters in the brain. They increase the availability of serotonin.
Benzodiazepines
drugs that lower anxiety and reduce stress
rationialization
finding 'good reason' for things that we really know are wrong
haloperidol decanoate
given to pt noncompliant of antipsychotics; slow release form given IM monthly
extrapyramidal system
groups of neurons within the central nervous system that are responsible for the refinement of movement patterns
positive symptoms of schizophrenia
hallucinations, delusions, racing thoughts, bizzare thinking, agitation
Lithium side effects?
headache, memory impairment, blurred vision, dental caries, lethargy, drowsiness, dizziness, tremors, anorexia, hypotension, etc
Which organ excretes most drugs?
kidneys
What organ metabolizes drugs?
liver
psychosis
loss of contact with reality
What is bipolar disorder treated with?
mood stabilizers
SSRIs
most commonly used drug treatment for depression
Side effects of levodopa/carbidopa
ortho hypotension, rebound symptoms if stop abruptly, discolored urine
When given a high dosage of a CNS depressant, what is this helping?
produce sleep
Denial
psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful realities.
Regression
return to an earlier or less advanced condition
Tolerance
the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect
Non-phenothiazines
thiothixene (Navane), haloperidol (Haldol), loxapine (Loxitane), molindone (Moban)
Normal level for lithium
0.6-1.2 mEq/L
A primary nurse observes that a client has become jaundiced after 2 weeks of antipsychotic drug therapy. The primary nurse continues to administer the anti psychotic until the health care provider can be consulted. What does the nurse manager conclude concerning this situation? 1. Jaundice is sufficient reason to discontinue the antipsychotic 2. The blood level of antipsychotics must be maintained once established 3. Jaundice is a benign side effect of antipsychotics that has little significance 4. The prescribed dose for the antipsychotic should have been reduced by the nurse.
1- Jaundice is sufficient reason to discontinue the antipsychotic
A nurse teaching clients about dietary restrictions when taking a monoamine oxidase inhibitor (MAOI). What response does the nurse tell them to anticipate if they do not follow these restrictions? 1. Occipital headaches 2. Generalized urticaria 3. Severe muscle spasms 4. Sudden drop in blood pressure
1- Occipital headaches (hypertensive crisis)
Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode, manic episode. What cautionary advice should the nurse give the client? 1- Sit up slowly 2- Report double vision 3- Expect increased salivation 4- Take the medication on an empty stomach
1- Sit up slowly
A client has been receiving fluphenazine for several months. For which side effects should the nurse assess the client? Select all that apply 1- Tremors 2- excess salivation 3- Rambling speech 4- reluctance to converse 5- minimal use of nonverbal expression 6- uncoordinated movement of extremities
1- Tremors 6- Uncoordinated movement of extremities
A monoamine oxidase inhibitor (MAOI) is prescribed. What should the nurse include in the teaching plan about what to avoid when taking this drug? 1. Ingesting aged cheese 2. Prolonged exposure to the sun 3. Engaging in active physical exercise 4. Over the counter antihistamine drugs
1. Ingesting aged cheese
hypertensive crisis
180/110
Lithium toxicity
2 or greater, tremors, metallic taste, severe diarrhea, excessive sweating, vomiting
A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client it will take before noticing a significant change in the depression? 1. 4 to 6 days 2. 2 to 4 weeks 3. 5 to 6 weeks 4, 12 to 16 hours
2- 2 to 4 weeks
Neuroleptic malignant syndrome is a potentially fatal reaction to an antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? Select all that Apply 1. Jaundice 2. Diaphoresis 3. Hyperrigidity 4. Hyperthermia 5. Photosensitivity
2- Diaphoresis 3- Hyperrigidity 4- Hyperthermia
A health care provider prescribes haloperidol (haldol) for a client. What should the nurse teach the client to avoid while taking this medication? 1- Driving at night 2- Staying in the sun 3- Ingesting aged cheeses 4- Taking medications containing aspirin
2- Staying in the sun
A client with depression is to receive fluoxetine (Prozac). What precaution should the nurse consider when initiating with this drug? 1. It must be given with milk and crackers to avoid hyperacidity and discomfort 2. Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis 3. Blood levels may not be sufficient to cause noticeable improvement for 2-4 weeks 4. Blood levels should be obtained weekly for 3 months to monitor for appropriate levels
3- Blood levels may not be sufficient to cause noticeable improvement for 2-4 weeks
A client is receiving lithium. What is an important nursing intervention while this medication is being administered? 1. Restrict the clients daily sodium 2. Test the clients urine specific gravity weekly 3. Monitor the clients drug blood level regularly 4. Withhold the clients other medications for several days
3- Monitor the clients drug blood level regularly
A client in the the hyperactive phase of a mood disorder, bipolar type, is receiving lithium carbonate. The nurse identifies that the client's lithium blood level is 1.8 mEq/L. It is most important for the nurse to: 1. Continue the usual dose of lithium and note any adverse reaction 2. Discontinue the drug until the lithium serum level drops to 0.5 mEq/L 3. Ask the physician to increase the dose of lithium because the blood lithium level is too low 4. Hold the drug and notify the physician immediately because the blood lithium level may be toxic
4- Hold the drug and notify the PCP immediately because the blood lithium level may be toxic
A nurse administers an anti psychotic to a client. For which common manageable side effect should the nurse asses the client? 1. Jaundice 2. Melanocytosis 3. Drooping eyelids 4. Unintentional tremors
4- unintentional tremors
Typical Antipsychotics (conventional)
A class of older drugs to treat schizophrenia and related psychotic disorders primarily by reducing excess levels of dopamine in the brain.
Parkinson's disease
A disorder of the central nervous system that affects movement, often including tremors.
bipolar disorder
A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
Isocarboxazid
A type of MAOI drug
Serotonin
Affects mood, hunger, sleep, and arousal
What foods must you AVOID while taking MAOI's?
Aged cheese, wine and beer, processed meats, pickled foods, cream, yogurt, coffee, chocolate, bananas, raisins, liver, yeast, soy sauce A.K.A super bowl foods
What is the cause of psychosis?
An imbalance of dopamine in the brain (too much)
Trazadone
Antidepressant for insomnia by inhibiting serotonin reuptake. This can be taken more long term
atypical antipsychotics
Antipsychotics that do not have significant side effects common to older antipsychotics
What are some types of atypical drugs?
Aripiprazole, risperidone
These anti psychotics treat both negative and positive symptoms
Atypical anti psychotics
What lab levels should you monitor while a patient is taking lithium?
BUN/Creatine, AST/ALT, TSH, TS3,TS4, Sodium, lithium levels
Pharmacological interventions for anxiety
Benzodiazepines (anxiolytic), antidepressants