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(Zoloft) Serotonin-NE-RI’s Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvanlafaxine (Pristiq) Atypical Antidepressants Amoxapine Bupropion (wellbutrin) Mirtazapine (Remeron) Nefazodone Trazodone (Desyrel)
Selective Serotonin Reuptake Inhibitors (SSRI's)
15. Educate the pt about the potential for discontinuation syndrome if the medication is stopped abruptly rather than tapered; the syndrome is characterized by GI distress, hehavioral or perceptual oddities, movement problems, & sleep disturbances 16. be aware of the potential for Serotonin syndrome, characterized by elevated temperature,musclerigidity, & elevated creatinephokinase levels; this risk is greatly Increased when SSRIs are given with MAOIs. AVOID this medication combination 17. Instruct the pt that OTC cold meds can ↑ the likelyhood of serotonin syndrome 18. In pregnancy, consultation with obstetricianis recommended regarding taking these meds 19. monitor the medication response in children, adolescents & older adults bc the response may be different than in adult pts 20. Encourage psychotherapy
Amitriptyline Clomipramine (Anafranil) Desipramine (Norpramine)
A. Description: Doxepin (Sinequan) 1. Inhibit serotonin uptake & elicit an antidepressant response 2. The potentional for medication interactions is high & complete Imipramine (Tofranil) medication assessments must be obtained and evaluated; inquire Nortriptyline (Aventyl HCL, Pamelor) about the use of herbal therapies,especially St. John's Wort B. Side Effects: Protriptyline (Vivactil) 1. N/V/D &cramping Trimipramine (Surmontil) 2. dry mouth 3. CNS $ including akathisia (restlessness, agitation) Tricyclic Antidepressants 4. BP changes 5. photosensitivity A. Description: 6. Insomnia, somnolence (sleepy, drowsy), apathy 1. Block the reuptake of NE (& serotonin) at the presynaptic 7. Nervousness neuron; used to Tx depression 8. Seizure activity 2. May reduce seizure threshold 9. Wt loss or Gain 3. may reduce effectiveness of antihypertensive agents 10. ↓ libido 4. Concurrent use with alcohol or antihistamines can cause CNS 11. Apathy depression 12. Tremors 5. *Concurrent use with MAOIs can cause hypertensive crisis 13. ↑ sweating 6. *Cardiac toxicity can occur & all the clients should receive ECG C. Interventions: before TX & periodically thereafter 1. SSRIs interact with numerous medications 7. OD is life-threatening, necessitating immediate Tx 2. Monitor VS bc SSRIs can potentially lower or elevate BP 8. The tricyclic antidepressant clomipramine (Anafranil) may be 3. Monitor Wt used to tx OCD 4. Initiate safety precautions, particularly if dizziness occurs ***PRIORITY NSG ACTIONS*** 5. Instruct pt to avoid alcohol 6. Administer w/ a snack or meal to reduce the risk of dizziness or Actions to take for a Tricyclica Antidepressant OD lightheadedness 1.Check airway & maintain a patent airway 7. Monito the suicidal pt, especially during improved mood & ↑ energy levels 2. Administer O2 8. Instruct the pt taking Fluoxetine (Prozac) or Bupropion 3. Check VS (Wellbutrin) to take the med early in the AM to prevent 4. Obtain ECG interference with sleep 9. for pt on long-term therapy, monitor liver & renal function test 5. Prepare for gastric lavage with activated charcoal results; altered values may occur requiring dosage adjustments 6. Prepare to administer physostigmine ( a cholinesterase inhibitor) 10. monitor WBC & neutrophil counts; the med may be discontinued & antidysrhythmic medications if levels ↓ below normal 11. If priapism (painful, prolonged penile erection) occurs, the med is 7. Document the event, actions taken, & the pts response withheld & the physician is notified 12. Inform the pt about the possibility of ↓ libido 13. Instruct the pt to change positions slowly to avoid hypotensive event 14. Instruct the pt report any visual changes to Dr
dialated 1. guanethidine. Instruct the pt to avoid caffeine or OTC preparations such as wt reducing pills or medications for hay fever & colds MONOAMINE OXIDASE INHIBITORS (MAOIs) 9. Administer with food if GI distress occurs to relieve dry mouth 5. Encourage psychotherapy week of therapy. Interventions: 11. withhold the medication & exposure to sunlight notify Dr. Sedation 6. Othostatic 4. delay in ejaculation increased energy levels * 2. Monoamine oxidase metabolizes amines. Instruct the pt to avoid foods that contain tyramine Teach the pt about foods that contain tyramine. HTN 4. tyramine-containing foods. especially during improved mood and 12. CV disturbances (Tachycardia or Dysrhythmias. dry mouth 6. but maximum benefit may take 3 weeks 6. preferably @ 6. Concurrent use with opiod analgesics may cause HTN or Papaya hypoTN. are given MAOIs 4. NE. Anxiety. shrry Sausage. Instruct pt to avoid alcohol & nonpresciption meds to prevent 8. Instruct pt that the medication effect may be noted during the first 14. bolgona. decreased GI motility. insomnia 3. Occipital HA radiating frontally 5.it should be d/c gradually Selegiline (Emsam) 13.B. Side Effects: B. instruct the pt to report HA. Monitor for pt compliance with medication administration Isocarboxazid (Marplan) 10. which is present in the brain. Administer the entire daily PO dose at one time. Consuming tryeamineA. Monitor pattern of daily bowel activity * 1. or neck soreness immediately Inform the pt that antidepressant medication may take several weeks to 7. weakness. & Kidneys Avocadoa 2. or seizures Pickled herring Raisins Red wine. Anticholinergic effects: dry mouth. N/V 6. pepperoni. monitor liver and renal function 3. it should be tapered gradually D. Sweating 7. salami Sour cream Soy sauce Yogurt . restlessness. tachycardia. constipation 2.or bradycardia 9. irritability 9.agitation. Concurrent use with amphetamines. NE. Description: containing foods when taking MAOI can cause hypertensive crisis 1. antidepressants. lethargy 4. Inhibit the enzyme monoamine oxidase. spleen. Fever & chills bedtime 7. Encourage PO hygiene & the use of hard candies & mouth rinses 4. Instruct pt to change positions slowly to avoid hypotensive effect C. levodopa. restlessness 2. Caffeine (coffee. Constricting chest pain alertness until the response is known. coma. & Serotonin. chocolate) *Cheese especially aged . or Meat extracts & tenderizers vasoconstrictors may cause hypertentive crisis Overripe fruit 5. Seizures (w/ Bupropion) 7. including ECT. When the med is d/c by the Dr. Clammy skin 8.. Avoid administering the med in the evening bc insomnia may Tranycypromine (Parnate) results 12. neck stiffness. wt gain 8. dopamine. Instruct pt to change positions slowly to prevent orthostatic produce the desired effect (pts response may not occur until 2-4 weeks after hypotention the first dose) 8. pts who havedepression & have not responded to other Broad beans antidepressant therapies. Photosensitivity 3. Orthostatic hypotention pupils & blurred vision. Administer with food or milk ifGI distress occurs* 5. beer. Instruct the pt to carry a Medic-Alert card indicating that an MAOI med is being taken Pheneizine ( Nardil) 11. CNS $ (anxiety. Neck stiffness & soreness test results 4. Side Effects: 1. The potential for medication interactions w/OTC cold meds 1. Instruct the pt to avoid driving & other activities requiring 10.except cottage cheese epinephrine. Assess for urinary retention 2. dizziness hypotention) 5. mania) 1. Monitor BP frequently for HTN * exists 2. ↓ or ↑ libido with ejaculatory & erection disturbances 10. bld plateletsm liver. nasal Figs decongestants. Interventions: 11. Dilated pupils adverse medication interactions 9. sedation is expected in 11. When the med is d/c by the Dr. For the pt on long-term therapy.resperpine. peripheral edema 8. Caution the pt for photosensitivity & to take measures to prevent 3. If palpitations or frequent HA occur. Palpitations. difficulty voiding. methyldopa. so the Bananas concentration of these amines ↑s with MAOIs Beef or chicken liver Brewer's yeast 3. wt gain 7. 13. Monitor the suicidal pt. **Hypertensive Crisis* 3. tea. anticholinergic effects C. Monitor for signs of hypertensive crisis 12. GI upset 5. Antidote for hypertentive crisis: phentolamine by IV injection early therapy & may subside with time 10.
Interventions: 1. fine hand tremors i. muscle fasciculations (twitching) 14. serum lithium level 1. Instruct the pt that he or she may take a missed dose within 2 Olanzapine/fluoxetine ( Symbyax) Oxcarbazepine (Trileptal) hours of the scheduled time. fluid 2.* b. the cause of an ↑ in the lithium level include ↓ Na+ intake. Serum lithium levels should be checked Q1-2mo.MOOD STABILIZERS D.2 mEq/L. blood samples to check serum lithium levels should be drawn in e.5 mEq/L 12. Severe diarrhea 4. Instruct pt to avoid alcohol Lamotrigine (Lamictal) 6. Monitor wt lithium excretion. divalproex sodium the Dr.Deep tendon hyperflexia 15. Apathy 6. Concurrent use with diuretics. which are associated with noted in 1-3 weeks mood 12. aminophylline. & creatinine levels& CBC count e. N/V 3. Lithium 13. Symptoms of toxicity begin to appear when the serum lithium levels at which toxicity is highly variable among individual pts level is 1/5-2 mEq/L 5. a. Mild Toxicity: & electrolyte loss associated with excessive sweating.mild to moderate ataxia & incoordination 5. decrease GI upset or NSAIDs ↑ lithiums reabsorption by the kidneys orinhibits 14. HA d. excreted by the kidneys the actural dose at which the therapeutic effect is achieved & the b. Nystagmus (involuntary eye movement “Dancing eyes”) 13. Instruct the pt that the therapeutic response to the medication is ɣ-aminobutyric acid (GABA) function. phenothiazines. mild ataxia the AM. hypothyroidism f. or fever occurs A. fatigue c. if polyuria. Monitor for suicidal tendencies & institute suicide precautions Lithium Preparations Lithium carbonate (Lithobid) Lithium citrate . Serum lithium levelis 1/5 mEq/L dehydration. Monitor the ECG. Side Effects: 3. Instruct the pt to notify the Dr. diarrhea. or cola. leading to death 5. abd. tea. inability to concentrate 4. Tonic-clonic seizures or coma. Moderate Toxicity: 1. reducing its effectiveness E. electrolyte. Do NOT administer diuretics while the pt is taking lithium Gabapentin ( Neurontin) 5. instruct the pt to avoid OTC meds Olanzapine (Zyprexa) 7. Prepare to obtain samples monitoring lithium. slurred speech 6. impaired LOC h. Interventions for lithium toxicity: a. soft stools or diarrhea h. valproic acid (Depakene). fluoxetine (Prozac). withhold lithium & notify Dr. Acetazolamide (Diamox). Monitor the suicidal pt. Instruct the pt about the s/s of lithium toxicity Ziprasidone (Geodon) 10. and illness or OD b. especially during improved mood and increased energy levels ** 2.blurred vision 8. Serumlithium level >2. otherwise the pt shouldskip the Quetiapine (Seroquel) missed dose and take the next dose at the scheduled time Risperidone (Risperdal) 8. Administer the med w/ food to minimize GI irritation Other Mood stabilizers: 3. hair loss e. muscle twitching 9. lethargy b. Lethargy any behavioral change suggests an altered serum level d. coarse hand tremors g. polydipsia b. ** Lithium Toxicity** 3. Irregular tremor 10. wt gain f. diminished concentration 7. slight muscle weakness C. anorexia. Polyuria a. renal function tests. BUN. muscle weakness a. Instruct the pt toavoid excessive amounts of coffee. Instruct the pt not to adjust the dosage without consulting with Valproate sodium (Depacon). methyldopa. nausea c. Description: producing toxicity a. Visual or tactile hallucinations 16. Or whenever c. sodium bicarbonate may ↑ renal excretion of lithium.5 mEq/L 2. either of which ↑s therisk of lithium toxicity Instruct the pt taking lithium (Lithobid) to maintain fluid intake of 6-8 2. the therapeutic drug serum level of lithium is 0. 12 hours after the last dose was taken f. Monitor cardiac status d. prolonged vomitting. mild thirst e.5-2. Occurs when ingested lithium cannot be detoxified & 4.bloating g. Monitor VS & LOC c. Description: Affect cellular transport mechanism & enhance serotonin or 11. bc lithium should betapered & not be d/c abruptly (Depakote) 9. Severe Toxicity: 11. or glasses of H2O a day and an adequate salt intake to prevent lithium toxicity. Instruct the pt to take the medication with food or milk to 1. Aripiprazole (Abilify) which have a diuretic effect Carbamazepine ( Tegretol) 4. dry mouth d.6 to 1. Tinnitus 7. and thyroid tests (ensure that these tests are performed before the start of therapy) B. the therapeutic dose is only slightly less than the amount 1. or bother.
trembling & C. Initiate safety precautions bc the older adult is at risk for falling A. slurred speech 10. Butabarbital sodium ( Butisol sodium) Pentobarbital sodium ( Nembutal sodium) & withdrawal should occur only under medical supervision Phenobarbital sodium ( Luminal Sodium) B. coma & death may result from respiratory & CV collapse . assisst with ambulation if drowsiness or lightheadedness occurs of GABA. Instruct the pt that drowsiness usually disappears during system continual therapy 10. Benzos interact with other CNS medications. 5. Instruct the pt not to take other medications without consulting Clonazepam (Klonopin) the Dr. HA Eszopiclone (Lunesta) 5. seizures 3. Abrupt or too rapid withdrawal results in the following: Temazepam (Restoril) a. absent reflexes 6. a pt being treated for an OD of benzo's may experience agitation. & apprehension C. Side Effects: 2. Monitor for paradoxical CNS excitement during early therapy. restlessness Triazolam (Halcion) b. Flumazenil(Romazicon). usedfor short-term treatment of insomnia or for sedation to relieve anxietym tension. 3. signs of shock glaucoma 7.producing and Amobarbital sodium (Amytal Sodium) additive effect 5. Abrupt withdrawalof benzos can be potentially life-threatening. sweating 2. confusion 4. Letharygy inhibitory synaptic action of the neurotransmitter GABA 14. Dizziness & drowsiness 3. Megaloblastic anemia 1. Ataxia Sedative-hypnotics: 3. the dosage of a benzo should be Oxazepam ( Serex) tapered gradually over 2-6 weeks Quazepam (Doral) 2. a benzo antagonist administered IV. Tachycardia 2. Withdrawal: Lorazepam (Ativan) Midazolam ( Versed) 1. Side Effects: Secobarbital sodium (Seconal Sodium) 1. Antianxiety medications depress the CNS. blurred or double vision Meprobamate (Miltown) 6. hypotention Ramelteon (Rozerem) 7. Interventions: 7. Overdose: tension 1. Monitor for motor responses such as agititation. to lessen withdrawal symptoms. Clorazepate (Tranxene) 13. confusion 1. somnolence B.for the pt with impaired liver function ANTIANXIETY OR ANXIOLYTIC MEDICATIONS 7. hand tremors Buspirone(BuSpar) e. depressed respiration 5. tremor Zaleplon (Sonate) 8. Monitor liver & renal function test results & CBC counts 8. agranulocytosis restlessness. Instruct pt to avoid tasks that require alertness until the response BENZODIAZEPINES: to the medicationis established Alprazolam (Xanax. reduce the medication dose as prescribed for the older adult pt & 9. Monitor for visual disturbances bc the medications worsen 6. Acute Toxicity 1. Instruct the pt not to stop the medication abruptly (can result in Diazepam (Valium) seizure activity Flurazepam (Dalmane) E. 4. Thrombocytopenic purpura D. urinary incontinence 11. paradoxical CNS excitement 1. amnesia Zolpidem (Ambien) 9. Benzo's have anxiety reducing (anxiolytic). allergic reactions 5. cold & clammy skin 3. Avoid alcohol Chlordiazepoxide (Librium) 12. Dizziness Chloral hydrate (Aquachoral Supprettes. Description: when taking the medication for sleep or anxiety 1. weak & rapid pulse 4. which produces relaxation & may depress the limbic 9. diminished reflexes & coma 2. constipation A. Depress thereticular activating systems by promoting the 13. irritability reverses benzo's intoxication in 5 minutes 4. Monitor for autonomic responses such as cold clammy hands & 2. insomnia NONBENZO Anxiolytic d. Behavioral change 2. Niravam) 11. hypotension sweating 3. Somnote) 4. Or muscle cramps f. sedative-hypnotic. increasing the effects 8. Description: 12. h. dilate pupils particularly in older adults & debilitated pts 5. Daytime sedation 2. Benzodiazepines are contraindicated in pts with acute narrowangle glaucoma & should be used cautiously in children & older BARBITURATES & SEDATIVE-HYPNOTICS adults Barbiturates: 4. irritability c. abd. discomfort & anxiety 6. vomiting muscle relaxing & anticonvolsant actions g.
For insomnia. Severe withdrawal symptoms begin within 24 hours after the medication is d/c in an individual with severe medication dependence 2. Typical antipsychotics are more effective for positive symptoms of schizophrenia. Instruct the pt to avoid driving or opperating heavy hazardous equipment if drowsiness.and alogia. Atypical: are more effective for the negative symptoms of schizophrenia. delirium 9. or ginger ale to prevent gastric irritation. such as avolition. The effects of antipsychotic medications are potentiated when give with other medications acting on the CNS. Affect dopamine receptors in the brain. Maintain safety by supervising ambulation & using side rails at night 4. 5. instruct the pt to take the medication30 minutes before bedtime. including oculogyric crisis • facial grmicing • Twisting of the torso or other muscle groups Akathisia • Restlessness • constant moving about Tardive Dyskinesia • Protrusion of the tongue • chewing motion • Involuntary movements of the body & extremities Other S/Es • drowsiness • Blood dyscrasias • Pruritus • Phototsensitivity • Elevated BG levels • Increased wt • Impaired body temperature • gynecomastia • Lactation ANTIPSYCHOTIC MEDICATIONS Typical: Chlorpromazine (Thorazine) Fluphenazine deconate (Prolixin Decanoate) Haloperidol Loxapine (Loxitane) Moloddone (Moban) Pimozide (Orap) Thiothixene (Navane) Trifluperazine Atypical: Aripiprazole (Abilify) Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) A. C. Anxiety 4. fruit juice. Instruct the pt taking chloral hydrate to take the medication with food & a full glass of H2O. apathy. Instruct the pt not to d/c the medication abruptly 10. and delusions. Instruct the pt to take the medication as directed 5. Withdrawal 1. especially pts with schizophrenia 2. medications should be used withcaution in the pt who has suicidal tendencies or hasa hx or drug addiction 3. Side Effects of Antipsychotic Medications Anticholinergic Effects: Dry mouth Increased HR Urinary retention Constipation Hypotention Extrapyramidal S/Es Parkinsonism • Tremors • Mask-like facies • Rigidity • Shuffling gait • Dysphagia • Drooling Dystonias • Abnormal or involuntary eye movements. tremors 8. such as hallucinations. Insomnia 5. typical antipsychotic medications also block the chemoreceptor trigger zone and vomiting center in the brain. Description: 1. Administer lowerdoses as prescribed for the older pt 2. avoid taking with a large amount of food to help absorption 8. producing anantiemetic effect 4. Gradual withdrawal is used to detoxify a dependent pt 3. Improve the though process and the behavior of the pt with psychotic symptoms. Avoid alcohol 7. Instruct the pt that a hangover effect may occur in the morning 9. behavioral changes E. dizzinessm or unsteadiness occurs 6. aggression. reducing the psychotic symptoms 3. seizures 10. Interventions: . Nightmares 6. daytime agitation 7. Interventions: 1.D.
Elevated WBC count. the liquid formmight be preferred bc some pts hide 2. Excessive salivation when outdoors 15. & malaise C. Administer the med with food or milk to decrease gastric upset 1. Monitor serum glucose level after a dosage increase. Dyskinesia 16. Interventions 18. Oculogyric Crisis 15. High or low BP 9.Monitor VS 1. 5. Change positions slowly to avoid orthostatic hypotention 17. Although rare. Initiate safety &seizure precautions reduced gradually to avoid sudden occurrence of psychotic 4. A potentially fatal syndrome that may occur at any time during Monitor for symptoms of neuroleptic malignant sysndrome (can therapy with neuroleptic (antipsychotic meds) occur w/ other antipsychotic medications) 2. the medication dosage should be 3. after the pt has changed from one medication to another. Avoid skin contact with liquid concentrate to prevent contact 5. 4. Notify the Dr. Monistor VS 19. the absorption rate is faster with the liquid form 4. Instruct the pt to report signs of liver dysfunction. Use a cooling blanket to lower the body temperature 8. Increased sweating dermatitis 6. Tachycardia or irregular pulse rate tablets in there mouths to avoid taking them 3. When d/c anti-psychotics. Inform the pt that some medications may cause a harmless 12. NMS more commonly occurs in the initiation of 3. pale skin 12. or when a combination of medications is 5. fever. wear hats & protective clothing 14. Prepare to d/c the medication symptoms. Inform the pt that a full therapeutic affect maynot be evident for 9. Instruct the the pt to Avoid alcohol or other CNS depressants 16. however an observable 10. malaise. Administer antipyretics as prescribed Monitor for EPSE in the pt taking anti-psychotics meds! 7. For PO use. jaundice. fever & RUQ (abd) pain 2. instruct the pt to use sunscreen. Fever 8. 2. protect the liquid concentrate from light 7. loss of bladder control 10. Difficulty swallowing 14. excessive weakness or fatigue 3-6 weeks after initiation of therapy. AssessmentL 6. NEUROLEPTIC MALIGNANT SYNDROME A. Dyspnea or tachypnea 7. Seizures 13. including sore phosphokinase level throat. Monitor electrolytelevels & administer fluids IV as prescribed 1. liver function results. including 1. altered LOC therapeutic response may be apparent I n 7-10 days 11. Instruct the pt to report s/s of agranulocytosis. Th pt taking an antipsychotic medication may require long-term used medication for parkinoian symptoms B. Monitor LOC 6. skeletal muscle rigidity 11. Monitor urine output therapy. Severe EPSE change in urine color pinkish-to red brown 13. & creatinine 17. dilute the liquid concentrate with fruit juice 8. Description: .