ANTI PSYCHOTIC DRUGS

Neuroleptics or major tranq

Types:

lesserSx
targets t y

AlmostNoSignsbut I
EarlyDog
Tolerance
see
Fnhances
SIDE EFFECTS:

• Extrapyramidal (EPS)
1). Dystonia - acute muscular rigidity, involuntary muscle movements, di swallowing
Laryngospasm and respi di culties
2 torticollis - arcing of the back
opisthotonos - sti neck
Mostlyseen
oculogyric crisis
in 1stWkof
tx
2). Pseudoaparkinsonism - sx is like Parkinsonism but not Parkinsonism.
- stooped posture, shu ing gait, cogwheel rigidity (ratchet like movement), drooling,
tremors, bradykinesia

3). Akathisia - increased need to move about, restless and anxious, agitated, rigid posture,
lack of spontaneous gestures

Sx appear 2nd
whop tx
• NEUROLEPTIC MALIGNANT SYNDROME (EMS)
- Fatal idiosyncrasy rxn of antipsychotics Appears Last Inks
- high fever, rigidity, increased CPK (crea and Posphotase) Of tx
- delirium, pallor, confusion, increased WBC, diaphoresis

• TARDIVE DYSKENESIA
- irreversible, permanent se Appear late
- tongue protrusion
- blinking, grimacing, lip smacking

0 Pregnant Lactating
Aug Hypersensitivity
Severe Depression
Liver E
lydney Dr
Seizure Disorder
PepticUlcers

Fever SoreThroat Body Malaise

Nursing Management:

• Do not mix with antacid - decreases absorption

• Bp, cbc, vision test, liver fxn test prior therapy
• Mix with juice
• Give IM (not subq to prevent tissue irritation
 ANTI ANXIETY DRUGS
Mechanisms of Action: Nursing Management:

Give Bedtime I IM
Lorazepam
can be given
Q Caffeine subling
t Alcohol
Inhibits Neurotransmission
d
Contraindication:
I Pregnancy
Decrease
Anxiety Lactation
Severe Pvl mo Dee

• BENZODIAZEPINES
works in the limbic system
tramquilizing e ect and numbs emotion
causes ataxia and slurred speech

samples:
Valium (diazepam)
Ativan (lorazepam)
Librium (chlordiazepoxide)
Klonopin (Clonazepam)
Tranxene (chlorazapate)
Xanax (alprazolam)
Serax (Oxazepam)
Restoril (Temazepam)
Dalmane (Flurazepam)
Halvion ( triazolam)

• NON BENZODIAZEPINES
relieves muscle tension
anxiety and insomia
causes lesser sedation
fewer side e ects

samples:
Buspar (Busperone)
Catapres (Clonidine)

• ANTI HISTAMINES
allergy and allergic rxn
motion sickness
prevents EPS
samples:
Benadryl
Atarax / Vistaril (hydroxyzine)
 ANTI MANIC DRUGS
• Mood Stabilizers
• Takes e ect bet 1-3wks or more
• Bipolar Disorders - manic phase

Mechanism of Action:

LITHIUM normalizes serotonin, noreph, acetylcholine, dopamine

Prevents Depression Prevents increase activity causing mani

Side E ects:
2hts I giving initial dose
mild nausea, diarrhea give cradars food
ne hand tremors, give propanolol
decrease appetite
Polydipsia
Polyuria, edema hand feet & face Metallic taste in mouth
fatigue, lethargy weight gain, acne

Sample:
I Na
Lithium - 1st given intake
Carbamazipine - if no e ect in Lithium , or if client is with seizures
i
T SE
Valporic Acid - if with seizure and / or rapid shifting of mood

NormalLI HUMlevel 0.5 2 ME IL

lessthan0.5 HEIL non he c y

MD will either i
peu
T Dose
Morethant.si E4lL C
y FMedsto
carbamazepine
Antidote Mia KITOL

Signs of LITIUM Toxicity: Nursing Management:

V omitting
A norexia
N nystagmus
Initial Wh Monitor Li 2 3X WK
then wkly
D iarrhea / dehydration
A bdominal muscle clamps
thereafter 1stday 2x
must be

J
Contraindications: day
q crash diet Q Exercise in WarmWeather
• pregnancy, impaired kidney fxn Carry Medic Alert Card
• Heart dse, profuse sweating Serum Bracelet
• na restricted diet Sample drawn 12hrs F dose
• Epilepsy, parkinsonism Diuretics Anti Infla
• CNS disorder Na dry T Lithium Effects
• Dehydration
002 Nad Y Lithium Erects
if you missed the dose, ok to give as long as it will not go beyond
2hrs, if more than 2hrs — wait for the nxt dose schedule
 ANTI DEPRESSANT DRUGS
Mood Elevators

Indications:

Major depressive disorders Bipolar Disorders

Anxiety Disorders Psychotic Depression
Eating Disorders

Mechanism of Action:

serotonin & NorEpi are released in the brain in d spaces bet the nerve endings

Carry messages fr one nerve cells to another

A de ciency in these neurotransmitters

Serotonin & NorEpi:

is
DEPRESSION

regulates arousal Vigilance

attention Mood
Sensory processing Appetite and Sleep

Types of Anti Depressants: - targets ataxia

• Tricyclic Anti Depressants (TCA)
S inequan ( Doxepin )
- I 3 Wks
P amelor (Nortriptyline)
E lavil (Amytriptyline)
N orpramine (Desipramine)
T ofranil (Imipramine)

Antidote: PHYSOSTIGMINE (Antilirium) —- only for life threatening sx

 Give If NoResponse I TCA or
canttolerate
SSRI
• Mono Amine Oxidase Inhibitors (MAOI) IS Effects 2 4 wks
TARGETS
Atypical Dep
Pa rnate (Tranylcypromine) Bulimia
Na rdil (Phenelzine)
Ma rplan (Isocarboxazid)

Antidote:
PHENTOLAMINE (regitine) - for excessive pressor response
VALIUM (Diazepam) - for agitation

AVOID: Tyramine Rich Food

Causes Hypertensive meat ternderizers, pickled, processed
(banana, avocado, aged cheese, beans, canned goods, ca eine,Crisis
food, overriped fruits, sour cream, kimchi, etc)

• Selective Serotonin Reuptake Inhibitors ( SSRI)

Zo loft (Sertraline) L uvox (Fluvoxamine)

Pa xil (Flouxetine) C elexa (Citolor)
Pro zac (Flouxetine) L exapro (Escitalopram)

- 1st line of drugs

- Broad spectrum e ects - targets: all types of dep, all eating disorders
- if px cant tolerate SSRI, MD will give MAOI (14days clearance b4 start of MAOI to avoid Serotonin
accumulation syndrome ( seizures, tremors, hyper exia, confusion, tachycardia, hyperthemia, coma)

Signs and Symptoms:

N&V, morning sickness, wt loss, HA, drowsiness

Nursing Management:
- do not abruptly stop to prevent discontinuation syndrome (dizziness, unusual dreams tension,
irritability, agitation diarrhea, nausea, nightmares
- taken in the morning for 4 full wks - morningcoz this causes insomia
- do not mix with TCA or MAOI = FATAL
- monitor BP and PR initially after each dose change to detect hypo or hypertension & irreg ❤ rate
 ELECTRO CONVULSIVE THERAPY
(ECT)
• Intro of electric current directly to the brain causing seizures, confusion, memory loss & HA
• 70 - 150 volts , in 0.2 - 8 seconds
• Seizures must last bet 30-60 secs ONLY

Indications:
• Severe Depression - desire to commit suicide, detachment from reality (psychosis)
• Tx Resistant Depression - doesnt improve with medications
• Severe Mania - intense euphoria, agitation or hyperactivity in bipolars, sx of mania - impared dec making,
impulsive or risky behavior, substance abuse
• Catatonia - associated with schizo
• Agitation & Agression in people with dementia
• Pregnancy - when meds are nor possible Mild I 2x per month
Nursing Consideration:
Zo
improvement
• Before procedure:
◦informed consent
I IF 12sessions 1 i

◦Baseline VS / Xray
Improvement
◦Obtain baseline memory ability (ask a set of questions)
◦Routine benzodiazepines must be omitted the night before ECT
◦NPO by midnight prior ECT
ZHSTOPECD
◦Prepare oxygen

• During Procedure:
◦orient & prepare, remove dentures & jewelries
◦Lay on bed, provide bite block - avoid tongue bite
◦Prepare Meds
Atropine Sulfate - prevents salivary secretion
Methohexital (Brevital) - pain reliever, short acting ; decrease anxiety level
Succinylcholine - prevents grandmal seizure, muscle relaxant
◦hit the jolt; give O2 if necessary
◦Expect seizures - dont i pin px down during seizures

• After Procedure:
◦Side lying or turn head one side Prevents Aspiration
◦Expect px to fall asleep
◦Px may be awake after few mins
◦Dont give H2O without checking gag re ex
Prevents Aspiration
◦Reorient patient ( ask same set of questions)
◦Benzodiazepines may be given —- after ECT & if the px awakes agitated

Immediate Side E ects:

• fear, anxiety, confusion

• HA, feeling strange - lightheadedness
• Jaw ache, disorientation, groggy
• Intense sleepiness, hallucinations, inability to eat

Contraindications:
asthma, severe pulmonary dse, COPD Metal implants, brain tumors, dislocation/fractures
glaucoma / retinal detachment unstable dentition, active bleeding
Recent Mi or stroke for d past month INCREASED ICP
pregnancy but not absolute (should not be high risk mother)
 PSYCHOTHERAPIES
• Behavioral Therapy - behavioral modi cation
- to identify & help change potentially self destructive or unhealthy behaviors
- telling px - speci c unwanted behavior

• Cognitive Therapy - change negative thoughts to positive one

• Cognitive - Behavioral Therapy - combination of cognitive & behavioral therapy

- combination of the way you think vs the way you behave

• Rational Emotive Therapy (RET) - the way you think a ects the way you feel
- Replace irrational thoughts with rational ones

• Systhemic Desensitization - usual used for phobias

- gradual exposure to the feared object

• Implosive Therapy or ooding - sudden exposure to feared object

• Gestalt Therapy - putting past to rest, focuses on Here & Now

• Reminisce Therapy - recollecting the past experiences & events of life

• Aversion Therapy - introducing Noxious stimuli

• Positive Reframing / Relabelling - nd meaning for every situation, be it good or bad

- everything happens for a reason

• Family Therapy - develop & maintain healthy boundaries

- promote problem solving by better understanding of family dynamics

• Group Therapy - to initiate sense of belonging/relatability thru understanding w/c is achieved by

sharing common experiences
- to tx emotional trauma, depression, anxiety, PTSD, ADHD
- usually, 1-2hrs per wk

• Music Therapy - calming e ect, lowering BP, manage pain, reduces stress

• Recreational Therapy - form of diversion; help reduce stress, dep & anxiety. Build con dence, socialize

• Vocational Therapy - learning new skills & earn from it. (Baking, cooking, massage…)

• Art Therapy - helps px interpret emotions thru art

• Play Therapy. - to observe & gain insights into a child’s prob

• Sex Therapy - type of talk therapy to help individuals experiencing issues

- increase pleasure, intimacy, connection with partner
- resolving con icts & disappointments in rel that may contribute to sexual problems