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Psych medications

ANTIDEPRESSANTS
- SSRI
o Professors Can Produce Zillions of Little Lessons
Prozac, celexa, paxil, Zoloft, luvox, lexepro
- S(N/D)RI
o WEiRD
Wellbutrin, effexor, remeron, duloxetin
Bupropion
o Wellbutrian Syban
Depression, smoking
o PO, few side effects, do not take with alcohol or MAOs will increase toxicity
o Change in libido, weight change up or down, sleep pattern, heart rhythms
o Diarrhea, NV, anxiety, dry mouth, headache
o The atypical girl was heartbroken and depressed after her boyfriend left her. She couldnt eat, couldnt sleep. She
felt sick to her stomach all the time, causing horrible diarrhea. She was confused why her BF would leave. It was
bc of her low libido. It seemed she always had a HA. She wanted to please her man but got nervous, dizzy and
broke out in a sweat thinking about sex. Her hands would shake, she couldnt hold a glass of waterher mouth
was so dry.
- TCAs
o triptyline, pramine
o Doxepin
Watch for signs of sedation, orthostatic hypotension, dec. sexual ability and desire, dry mouth, urinary
retention, tachycardia
Narrow therapeutic index, only prescribed for a few days or weeks to prevent overdose. Grand mal seizure
and hyperthermia I cooks the brain). Decrease blood cell production, weight gain, muscle twitches
A very traditional man became upset when his dog B.C ran away. He ran through the neighborhood
working up a sweat. His heart raced and he realized this was the first time in years he wasnt thinking
about sex. This realization stopped him dead in his tracks. His heart slowed. As he stood there dry mouth
and muscles twitching he saw B.C trying to urinate on a fat ladys lawn. He picked up his dog dizzy with
happiness. He danced until he stepped in dog poo. B.C I thought u were constipated. He flailed around
trying to fling the poo off his shoe. The fat lady watching was convinced the traditional man was having a
seizure or stroke.
- MAOIs
o Marplan, Nardil, Parnate
Lots of drug and food interactions
NO: Barbiturates, TCAs, antihistamines, CNS depressants, antihypertensive, OTC cold meds
NO: cheese, wine, pickled foods (tyramine/tryptophan)
Sweating, increased BP, dizziness, tremors, pounding/inc HR, constipation
ANXIOLYTICS
- Benzodiazepines
o am, Librium :liberate from alcohol addiction, tranxene
o Xanax most habit forming
Potential for dependence, abrupt stop can lead to anxiety, HA, loss of appetite, extreme case seizures. DO
NOT use with alcohol
Benzo the clown was very tolerant of kids. But in truth they made him tired. One day he got fed up, Im
done with this HA. He decided to stop visiting the kids completely. Once he got home he realized he
missed the kids. He stayed up all night thinking about them. The next day he skipped breakfast. It made
him dizzy but he didnt care. He ran down the street so fast that he fell down and had a seizure.
o Ativan (lorazepam) IV, PO, IM calm then sedated.
o Vistaril can be give IM or PO you feel relaxed then sleepy
Drowsiness, dry mouth, dizzy, ataxia, pain with IM
o Versed (micazolam): moments not remembered ; conscious sedation, use with caution in those with COPD, heart
failure and renal failure, watch for RD, arrhythmia, hypotension, unresponsiveness, agitation and confusion
- NONBENZODIZAPINES
o Anxious on buses. Bring bunnies ( benzo), bc nonbunnies will Restore, the Desire, to Hallucinate on Buses
Halicon, restoril, buspar and desyrel
- ATYPICAL ANXIOLYTICS

o
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Other
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A women takes Ambien falling asleep to frank Sinatra (Sonata) while Lunar (lunestra) moons shines through the
window

All Inquisitive Cats Attack Birds


Atenelol, Inderal, Catapres, Atarax/Vistiril, Benadryl
ANTIPSYCHOTICS
- Atypical
o All Good Zoos Save Rare Cats
Abilify, Geodon, Zyprexa, Seroquel, Risperdal, Clozaril
Weight gain and diabetes
Rare cats get fat, too much sugar, males them huger
- Traditional
o Loxitane, trilafon and thorzine, serentil, merllaril, and stelazine, if youre poor and have psychosis try them all and
moban and haloperidol.
Cheaper than atypicals but S/E more pronounced.
Both share these side effects
Muscle control: tremors, rigidity, contraction, dystonia, loss of facial expression, stooped posture,
shuffling gait pseudoparkinsonism
Tardive dyskinesia (irreversible); NMS hyperthermia cooked brain
Bob was a single guy who could not control his muscle building obsession. He wanted a GF and decided
to try other hobbies. His dream girl was the atypical type. He liked them big and diabetic. Speed dating
made him restless, even when they played shuffle board. He liked poker and had a great poker face, and
limbo. His stooped posture made him a natural. He met a girl at the Tardive, a dive bar near his house.
The sad part is she had NMS and died on their wedding night. Bob went back to contracting his muscles.
MOOD STABILIZERS
- Traditional
o Lithium lith drugs
Weight gain, drowsiness, weakness, nausea, fatigue, hand tremor, inc. thirst and urination, hypothyroidism,
enlarged thyroid
Toxic. Narrow therapeutic window 0.6-1.2 over 1.5 can kill you
N/V drowsiness, slurred speech, blurred vision, confusion, muscle twitching, irregular HR.
seizures, coma
Princess lithium got into fight with queen eskalith. The queen cursed her with an uncontrollable weakness
for ice cream. She gained a ton of weight. As a result she lied around all day feeling constantly tired. When
prince thyroid came home he was shocked to find her in an enlarged state. It made him nauseous to look
at her. His hand tremored as he reached out to take her hand. He didnt want to touch her so he gave her a
glass of water for her thirst instead.
- Atypical
o Depakote, depakene, keppra all the way. Mood unstable? Having fits these drugs will make your day. Tegretol,
lamictal, Neurontin, gabatril, trileptal, Topamax, theyre all atypical.
STIMULANTS
- Ritalin/concerta- methylphenidate
- Adderall- dextroamphetamine
Adverse Effects
- NMS
o Muscle rigidity, fever, autonomic instability, delirium, elevated CPK
o Cramps and tremors, fever, increased BP, agitation, coma, progress rapidly
o Caused by haloperidol or phenothiazines; dompaninergic drugs like levodopa or sudden withdrawal of drugs
o Treat hyperthermia with cooling blanket or ice packs under axillae and groin. Circulatory and ventilator support
- EPS
o Acute and tardive, dystonia (continuous spasm and contractions), akiathisa ( motor restlessness), pseudopark
( rigidity, bradykinesia, and tremors), TD ( irregular jerky movments)
o Maybe caused by antipsychotics
Haloperidol
o Abnormal Involuntary Movement Scale (AIMS)
o Treated with anticholinergics - cogentin
- Pseudoparkinsosims
Signs and symptoms

Bipolar
- Elevated SE, dec. need for sleep, rapid pressured speech, racing thoughts, distractibility, psychomotor agitation, flight of
ideas, may have psychotic features: hallucinations, paranoia.
- Lithium to stabilize mood: toxicity NV diagrrhea, fine hnd tremor, sedation, muscle weakness, weight gain, dry mouth.
Lethargy, ataxia, seizures
- Atypical antipsychotics: all zoos save rare cats
- Atypical mood stabilizers/ anticonvulsants carbamazepine
- Antidepressants: imipramine, amitryptalyine
Depression
Schizophrenia
Personality disorder
- Problem with trust, difficult to develop relationship, need control: give realistic choiceto enhance compliance which group
to do. Open ended statements- tell me what happened. Non judgmental
- Manipulative- identify patient behavior. Set limits(expectations)/establish consequence, non punative way. Do not argue or
bargain
- Aggressive- seek assistance if inc. tension- identify source of anger, ID consequences
- Impulsive- teach stop and think cue. Positive reinforcement, encourage self reward and problem solving
- Paranoid- nonjud/neutral approach, be honest and consistent, clear simple language, explain what youre doing before hand.
Limit actions that can be misinterpreted ie laughing whispering- be non defensive, verbal and physical limits in calm matter
of fact tone. Dont be too nice and friendly
Elder abuse: risk factors female, 80+, history of family violence, cognitive impairment. Signs of abuse: neglect clothing, hygiene,
home; financial- irregular pattern, inappropriate items, bills not paid; physical- burns, bruise, malnourished, unkempt;
- Address underlying cause, do they have aids (visual, hearing), evaluate meds for possible reactions, toxicity : anticholinergics
may cause blurred vision, urinary retention, confusion. Make sure well rested, hydrate, safe, and nourished. Use consistent
staff, assess need for 1:1, communicate to reorient/reassure, fall precautions.
Dementia
- Apraxia: no motor impairment cant remember how to perform movement
- Aphasia: cant find the words
- Agnosia: cant recognize people or objects; no sensory impairement
- Executive fnx impaired: cant plan, organize, sequence or reason
- Supposritve care: security, stimulation, patience, and nutrition
- Cognex: dizzy HA, GI upset, Aricept: insomnia, gi upset, HA, risperdal
Delirium
- Sundown: agitation as sun goes down
- Sunrise: confusion, grogginess in AM from not sleeping or medications
- Relocation: disorientation that follows movement to unfamiliar environment
- Find underlying cause, hypoxia, f & e, diabetic problems. Low stimuli
Agitated patient
- Ensure immediate safety of patient and others
- Assess intervene for possible causes (physical/physiological needs : pain, hunger, missing glasses, medication reaction)
- If behavior persist
o Environment management: move closer to nurses station, check lighting, familiarize patient to environment and
personal belongings
o Behavioral management: frequent reorientation and supportive communication, routine ambulation, toileting,
diversional activities, stagger visits
- If behavior persist, consider use of restraints/ meds
o Least restrictive retraint (lap hugger, wedge cushion)
o Haldol low dose: start low go slow
o sitter
alzheimers
- 1: forgets to pay bills, loses items more often, withdrawn
- 2: doesnt know what to do or who to call in emergency, gets up and drives away at night; calls me after I leave asking when
im coming over
- 3: fearful, paranoid, doesnt remember my name or holidays
- 4: lost all verbal ability, complete help with ADLs/bed bound
Risk for abuse
- Special needs, infants (unwanted unplanned),pregnant women, older adult female (frail)
- Characteristics

Learned helplessness, low self esteem and shame, increased dependence, isolation, guilt and entraptment
Adolescents/ adults
Sexualized or asexual behavior
Cutting/ self abuse
Suicidal ideation
Criminal activity
Substance abuse
Prostitution
Failing/dropping out of school
Leaving home
Pessimisim , hopelessness
Report within 24hs for child ; 48 elders, give information to adults
o Assess safety Shelter, evacuation plan, emergency numbers
Listen, communicating belief, validate decision to disclose (this must be frightening), emphasizing unacceptability ( you
dont deserve to be treated this way)
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o

Signs of escalation
- Signs of anger, clenched fist, clenched teeth, yelling and shouting, intense or avoidance of eye contact, easily offended
o Remain calm, set limits on behavior with clearly defined consequences and follow through. Have client keep diary
of angry thoughts what triggered, how handled. Avoid touching when person becomes angry. Help client determine
true source of anger, ignore initial derogatory remarks, alternate ways to release tension, role model appropriate
ways of expressing anger.
- Signs of aggression: pacing, restlessness, tense face and body language, threats, shouting, use of foul language,
argumentative, threats of homicide or suicide, suspiciousness, panic, anger disproportionate to situation
o Hx of violence, current diagnose and behavior
Schizophrenia, major depression, bipolar disorder, co substance abuse
Ways to de-escalate
- Remain calm. Ensure safety for patient, self, and others. Ask everyone to leave the room. Talking down: You seem very
angry. Lets go to room to talk about it. ( make sure patient isnt between you and the door)
- Physical outlets: maybe it would help to punch a pillow or a bag for a while. Ill sit with you if you want.
- Medication: if agitation continues, offer choice of taking medication voluntairily. If the refuse. Reassess situation to
determine if risk of harm to self or others.
- Call for assistance. Remove self and others from immediate danger.
- Restraints. If not calmed by prior strategies. 4/2 hr checks for removal
- Document check every 15 minutes for circulation
Spiritual needs: faith love hope and forgiveness
Therapeutic relationship: rapport, trust, respect (uncond. Pos. reg.), genuiness, and empathy
Ethics : right to refuse medications, least restrictive treatment, human treatment, confidentiality, access to phone or mail
Therapeutic communication: silence, offering self, accepting, giving recognition, broad openings, general leads, restating, reflecting,
presenting reality
- Sit square, Open posture, Lean forward, Eye contact, Relaxed
Drug intoxication
- Sedative/ hypnotic: CNS depressants: slurred speech, incoordination, unsteady gait, nystagumus, stupor. Withdrawal=
autonomic hyperactivity: sweating high bp, insomnia, nausea, hallucinations
- Stimulants: CNS excitement: tremors, restlessness, anorexia, insomnia, agitation, inc. motor activity. Constipation, high
libido, anxiety, anger, hypervigeilent. Withdrawal: dysphoria, fatigue, increased appetite, psychomotor retardation
- Opiods: sedation, constipation, RD, pinpoint pupils, euphoria followed by apathy, mental clouding, drowsiness and pain
reduction. Withdrawal- dysphoria, nausea and vomiting, muscle aches, lacrimation/rhinorrhea, pupil dilation, piloeraction,
sweating
- Hallucinogens: CNS stimulant, elevated blood sugar, sense of slowing time, paranoia, distorted vision, serenity, fear of losing
control, derealization
Alcohol withdrawal
- S/S begin from 6-12hrs
o Anxiety, N/V, diarrhea, anorexia, wkness, insomnia, increase VS, restless, irritable, sweaty, twitching, tremors
o Hallucinations begin at 12 hrs; signs of withdrawal peak from 24-48hr; alcohol withdrawal syndrome can last 2-10
days (inc. disorientation, confusion, agitation, paranoia, hallucinations) ; grand mal seizures can occur between 7- 48
hrs
- Treatment
o WITHDRAWAL

Long acting CNS depressants with anticonvulsant properties: Valium, Librium, Serax, Ativan,
Phenobarbital
CRAVINGS
Revia (naltrexone)
AVERSION THERAPY
Antabuse
PREVENTION OF WERNICKE AND KORSAKOFF
Vit B1
SEIZURE PREVENTION
magnesium

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Mental status examination


Questions
Nurse patient ratio
What type of patient do you see on the unit
How long is orientation
Is there a mentorship program
Are there any challenges this facility faces?
Has there been any notable successes of failures on the unit in the past year
Do you provide financial support/ grants for continuing education?
How often do you conduct performance reviews?
I know this hospital performs ECT and TMS thats interesting. Is that a common occurance
Magnent designation?
Teaching hospital