Pyschotherapeutic Drugs
-Confusion, tremors, GI discomfort, somnolence, seizures, death, cardiac dysrhythmias -long-term treatment could cause hypothyroidism
Adverse effects of lithium
-Most commonly used as an anxiolytic
Alprazolam (Xanax)
-Used for alcohol withdrawal, status epilepticus, anxiety relief -interacts with alcohol, oral contraceptives
Diazepam (Valium)
-SSRI -1st line antidepressant used to treat depression, bulimia, OCD, panic disorder, premenstrual dysphoric disorder -do not administer with MAOIs -give in morning due to side effect of insomnia
Fluoxetine (Prozac)
B Buspirone (BuSpar) is a third-generation anxiolytic that has the advantage of being both nonsedating and non-habit-forming. All the other options are sedatives as well as anxiolytics.
A patient diagnosed with an anxiety disorder has been using lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient? A. Alprazolam (Xanax) B. Buspirone (BuSpar) C. Chlordiazepoxide (Librium) D. Hydroxyzine hydrochloride salt (Vistaril)
D Oxazepam (Serax) is a benzodiazepine drug. Flumazenil (Romazicon) is an antidote for benzodiazepine overdoses. Naloxone (Narcan), naltrexone (ReVia), and nalmefene (Revex) are not antidotes for benzodiazepine overdoses.
A patient is admitted to the emergency department after an overdose of oxazepam (Serax). Which antagonist may be used to treat this patient? A. Naloxone (Narcan) B. Naltrexone (ReVia) C. Nalmefene (Revex) D. Flumazenil (Romazicon)
A The nurse avoids administering tramadol (Ultram) to a patient who takes a selective serotonin reuptake inhibitor because it increases the risk for serotonin syndrome. This is because tramadol (Ultram) exerts its analgesic effect by blocking the reuptake of norepinephrine and serotonin. Ibuprofen (Motrin) is unlikely to provide relief to a patient with chronic pain unless the pain has developed an inflammatory aspect. Fentanyl (Duragesic) and oxycodone (OxyContin) are reasonable choices of analgesics for this patient, but both agents require careful monitoring.
A patient takes sertraline (Zoloft) for depression related to chronic pain. The nurse avoids administering which analgesic agent to help prevent serotonin syndrome? A. Tramadol (Ultram) B. Ibuprofen (Motrin) C. Fentanyl (Duragesic) D. Oxycodone (OxyContin)
B Because the potential for abuse is low, buspirone (BuSpar) is a suitable antianxiety agent for this patient. Diazepam (Valium) is contraindicated because benzodiazepines are highly addictive. Venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor, and escitalopram (Lexapro) is a selective serotonin reuptake inhibitor; both medications have a low potential for abuse and are first-line antidepressant therapies. The nurse does not know whether the patient has depression along with the anxiety, so these drugs are not indicated.
A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? A. Diazepam (Valium) B. Buspirone (BuSpar) C. Venlafaxine (Effexor) D. Escitalopram (Lexapro)
-prototypical TCA -considered second line to SSRIs and SNRIs -treats insomnia and neuropathic pain
Amitriptyline (Elavil)
-Can be used as adjunct therapy for sexual dysfunction related to antidepressants -used as a smoking cessation aid
Bupropion indications
-Non-sedating and non-habit forming -May have drug interactions with SSRIs and can cause serotonin syndrome -Do not administer with MAOIs
Buspirone (BuSpar)
-used for uncontrollable hiccups
Chlorpromazine
-atypical antipsychotic ***blood dyscrasias
Clozapine (Clozaril)
B Clozapine (Clozaril) has a potentially life-threatening adverse effect of agranulocytosis. Agranulocytosis is usually evidenced by flu-like symptoms such as fever and weakness. Breast enlargement and nipple discharge or changes in menstruation are not adverse effects of atypical antipsychotic medications. Teaching the patient about the components of a white blood cell count is not required.
Clozapine (Clozaril), an atypical antipsychotic medication, is prescribed for a patient with a schizophreniform disorder. Which information would be most important to include in the teaching plan for this client? A. Strategies to manage breast enlargement and nipple discharge B. The importance of promptly reporting flu-like symptoms C. Contraceptive measures and expected changes in menstruation D. The meaning of various components of a white blood cell count
-long-term psychotherapeutic -oral, IM, IV useful in treating patients with schizophrenia who were nonadherent in their drug regimen
Haloperidol (Haldol)
-used for treatment of alcohol withdrawal -can be given IV push or continuous infusion for agitated patients going through drug withdrawals to prevent seizures
Lorazepam (Ativan)
-block dopamine receptors in the brain
Mechanism of action for antipsychotics
-used to treat opioid withdrawal
Methadone
-SSRNI -antidepressant that can be used in males that have had sexual dysfunction as an adverse effect to other antidepressants
Mirtazapine (Remeron)
-isocarboxazid (Marplan) -phenelzine (Nardil) -tranylcypromine (Parnate)
Nonselective MAOIs
Peak: 1-3 days Duration: 5-7 days
Opioid Withdrawal Peak and Duration
-Also known as narcotics -Intended drug effects: relieve pain, reduce cough, relieve diarrhea, and induce anesthesia -Abuse and psychological dependency: opioids promote relaxation and euphoria
Opioids
-wear sunscreen due to photosensitivity -avoid alcohol -take antacids 2 hours before or 1 hour after administration -oral forms may be taken with food -change positions slowly
Phenothiazines
-atypical antipyschotic -therapeutic dose 1-6 mg/day -Risperdal Consta: injectable that lasts 2 weeks -Risperdal Sustenna: injectable that lasts up to 4 weeks
Risperidone (Risperdal)
-sedation -impotence -orthostatic hypotension
TCA Side Effects
-Depression -Childhood enuresis -OCD -adjuncts for chronic pain conditions such as neuralgia
TCA indications
D The patient who is treated with TCAs may develop TCA poisoning due to alcohol intake, which can cause severe central nervous system depression. Therefore, the nurse should administer multiple doses of activated charcoal to the patient in order to reduce the drug absorption. Interventions such as hemodialysis, administration of hypotensive drugs, and urine acidification to pH 5 do not help in preventing TCA poisoning. These nursing interventions are more appropriate for treating monoamine oxidase inhibitor (MAOI) poisoning.
The nurse finds that a patient who has been prescribed tricyclic antidepressant (TCA) therapy consumes alcohol regularly. What intervention will the nurse expect to perform to promote drug safety? A. Refer the patient for regular hemodialysis. B. Administer hypotensive drugs as prescribed. C. Perform urine acidification until the pH is 5. D. Administer multiple doses of activated charcoal.
C Anticholinergics reduce the efficacy of phenothiazine. Beta blockers cause additive effects with the drug. Thiazide diuretics reduce the clearance of the drug and cause drug accumulation. Opioids cause additive effects similar to that of beta blockers.
The nurse is caring for a patient who is treated with phenothiazines. Which class of drugs reduces the efficacy of phenothiazine and should be avoided? A. Beta blockers B. Thiazide diuretics C. Anticholinergics D. Opioids
B There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.5 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.
The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate (Lithobid). The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? A. The patient will have persistent manic symptoms. B. The patient should have effective relief from the manic symptoms. C. The patient may have impaired liver and renal functioning. D. The patient may have cardiac dysrhythmia and tremors.
1.5-2.4 mEq/L
Therapeutic range of lithium
-Naltrexone -Vivitrol -Subutrex, Suboxone
What are drugs used to treat opioid withdrawal?
-Citalopram (Celexa) -Duloxetine (Cymbalta) -Trazodone (Desyrel)
What are the 2nd generation antidepressants?
-Anxiolytic drugs -Mood-stabilizing drugs -Antidepressant drugs -Antipsychotic drugs
What are the types of psychotherapeutic drugs?
Benzodiazepines
What class of drugs are used to treat anxiety disorders?
Benzodiazepam
What drug class is used for alcohol withdrawal?
Flumazenil (Romazicon)
What drug is administered for benzodiazepine overdose?
Reduce anxiety by reducing overactivity of the CNS
What is the mechanism of anxiolytic drugs?
A Buspirone (BuSpar) is an anxiolytic drug, which has agonist activity at both the serotonin and dopamine receptors to exert its antianxiety effect. Alprazolam (Xanax) is a benzodiazepine that is commonly used as an anxiolytic. The drug elicits its effects by increasing the activity of gamma-aminobutyric acid (GABA) receptors that block nerve transmission in the central nervous system. Lorazepam (Ativan) is an intermediate-acting benzodiazepine that increases the activity of the GABA receptors. Amitriptyline (Elavil) is the most commonly used tricyclic antidepressant.
Which anxiolytic drug promotes antagonistic activity at both the serotonin and dopamine receptors? A. Buspirone (BuSpar) B. Alprazolam (Xanax) C. Lorazepam (Ativan) D. Amitriptyline (Elavil)
D The patient who is taking monoamine oxidase inhibitors must avoid food containing tyramine, as it can cause a hypertensive crisis. Since cottage cheese contains less tyramine, it can be included in the patient's diet. Corned beef, red wine, and fava beans contain high amounts of tyramine. Therefore, these should not be included in the patient's diet.
Which food can be included in the diet of a patient who is taking monoamine oxidase inhibitors? A. Corned beef B. Red wine C. Fava beans D. Cottage cheese
D Sodium bicarbonate alkalizes the urine and enhances the elimination of medication; therefore, sodium bicarbonate is used to speed up the elimination of high doses of tricyclic antidepressants (TCAs). Diazepam is used to reduce central nervous system damage associated with high doses of TCAs. Antidysrhythmics are drugs used to treat cardiovascular events that occur as a result of an overdose of TCAs. The administration of activated charcoal reduces the absorption of TCAs.
Which medication increases the rate of urinary elimination of tricyclic antidepressants in the event of an overdose? A. Diazepam B. Antidysrhythmic C. Activated charcoal D. Sodium bicarbonate
first nicotine-free medication used as a smoking cessation aid
Zyban
-nicotine withdrawal treatment -stimulates nicotine receptors
varenicline (Chantix)