Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L.

Lintao 1

BASIC CONCEPTS ON PSYCHOPHARMACOLOGY

MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS

• Indication: Schizophrenia and Other Psychosis
• Desired effect: _________of symptoms
• Best taken after meals
• MOA: Block selected dopamine receptors à decrease dopamine à reduce symptoms

Types Typical Atypical

Examples • Haloperidol • Risperdal

• Mellaril • Seroquel
• Thorazine • Clozaril
Disadvantages • EPS • Expensive
• Treats (+) symptoms only • Less available
• More severe agranulocytosis

Advantages • Cheaper • Less or no EPS

• More available • For both (-) & (+) symptoms

  Before 1990’s After 1990’s

Side effects Nursing Action

Blurred vision Avoid _________

Dry mouth Give sugarless gum

Tachycardia, palpitation, constipation, urinary retention Monitor & report

Photosensitivity Don’t expose skin to sunlight

Orthostatic hypotension Monitor BP

Advise gradual change in position

Extra Pyramidal Symptoms Discontinue the next dose

o Pseudoparkinsonism Report at once
o pill-rolling tremors Give antidote:
mask-like face Anticholinergics
o cog-wheel rigidity • Akineton
o propulsive gait • Artane
o Akathisia - restless leg syndrome • Benadryl
o Dystonia - defect in muscle tone • Cogentin
Dopaminergics: L- Dopa
• Espequel, Sporadel

Neuroleptic Malignant Syndrome (NMS) Withhold the next dose

• Muscle rigidity + high grade fever + _________ Notify the physician
Cooling measures

Adverse effect: report promptly

· Tardive dyskinesia - lip smacking
· Agranulocytosis
o Assess for:
▪ Fever
▪ Sore throat
▪ Lab data: WBC count
· Hepatotoxicity
o Assess for ______ & ______

MINOR TRANQUILIZERS/ ANXIOLYTICS

Ä Common indication: Anxiety disorders
Ä Desired Effect: Decreased anxiety, adequate sleep
Ä Have _________effects

Examples: (XL VASET)

Xanax (Alprazolam)
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 2

Librium (Chlordiazepoxide )
Valium (Diazepam)
Ativan (Lorazepam)
Serax (Oxazepam)
Esquanile
Tranxene (Chlorazepate Dipotassium)

Nursing Implications:
· Best taken _________ meals
· Advise to avoid driving
· Administer it separately with any drug

Anxiolytics +
• _________ = severe hypotension / hypersedation
• Another _________ = respiratory depression à death
• Other drugs = CNS depression
• _________ = less effective

ANTIDEPRESSANTS
Desired effects: increased appetite, adequate sleep

Tricyclic Antidepressants
Examples:
· Imipramine · Amitriptyline
(Tofranil) (Elavil)

Nursing Implications:
Ä Best given after meals
Ä Effectivity: after _________ weeks
Ä Check the BP, it causes _________
Ä Check the heart rate, it causes cardiac _________
Ä Monitor I & O
Ä Monitor for signs of increased IOP

MAO INHIBITORS
Indication: refractory depression

Examples:
· Tranylcypromine (Parnate)
· Phenelzine (Nardil)
· Isocarboxazid (Marplan)

Nursing Implications:
Ä Best taken after meals
Ä Report headache; it indicates ______________ crisis
Ä Avoid tyramine containing foods like:
· Avocado
· Banana
· Cheddar and aged cheese
· Soysauce
· Preserved foods
Ä Effectivity: 2-3 weeks
Ä Monitor the BP
Ä There should be at least a _____________ interval when shifting from one anti-depressant to another

Selective Serotonin Reuptake Inhibitors

· Fluoxetine
(Prozac)
· Celatopram
(Celexa)
· Sertraline (Zoloft)
· Paroxetine (Paxil)
· Fluvoxamine
(Luvox)

Nursing Implications:
Ä Avoid the use of:
· Diazepam · Tryptophan
· Alcohol
Ä
Ä Monitor PTT, PT
Ä Never give to pregnant / lactating mothers.
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 3

ANTI-MANIC AGENT
Examples:
· Lithium Citrate · Lithium Carbonate
(Cibalith – S) (Eskalith, Lithane, Lithobid)

Nursing implications:
Ä Never give to _________ mothers
Ä Best taken after meals
Ä Increase intake of:
· fluids (3 L /day)
· sodium (3 gm/day)
Ä Avoid activities that increase perspiration
Ä Effectivity: 10-14 days
Ä Antipsychotic is administered during the first 2 weeks

Level Status S/Sx Nursing Interventions

(mEq/L)

.5 – 1.5 ________ Monitor

Increase _________ & fluid intake

1.6 ________ D/C next dose

Report
*_________

1.7 – 1.9 _________ V_________ D/C next dose

Anorexia Report
Nausea *_________ (antidote)
D_________
Abdominal
cramps

2.0 and _________ _________ D/C next dose

above (Altered LOC) Report
*_________