Download NUR 312: Pharmacology in Nursing II

NUR 312: Pharmacology in Nursing II
Unit II: Drugs That Affect Physical Regulation
Psychoactive Drugs
Purposes and Advantages of Psychoactive Agents
Neurohormones:
Dopamine .
Serotonin
Norepinepherine
Categories of Psychoactive Drugs:
1. Antipsychotic Drugs:
Uses
Psychotic symptoms: positive symptoms of schizophrenia Delusions
Hallucinations
Illusions
Phenothiazines: (1st. Generation)
Thorazine (Chlorpromazine)
Mellaril (Thioridazine)
Prolixin Decanoate (Fluphenazine) Intramuscular (I.M.)
Non Phenothiazines: (1st. Generation)
Navane (Thiothixene)
Haldol Decanoate (Haloperidol) Intramuscular (I.M.)
Non Traditional Antipsychotics: (2nd. Generation)
Less side effects
Best to treat the negative symptoms of schizophrenia:
Flat Affect, alogia (restricted thought and speech),
Avolition/apathy
Anhedonia/asociality,
Attentional impairment
Clozaril (Clozapine) (weekly or Bi weekly WBC)
Risperdol (Risperidone)
Zyprexia (Olanzapine)
Abilify (Aripiprazole)
Geodon (Ziprasidone)
Side Effects of Antipsychotics:
Sedation: drowsiness
Weight Gain
Risk for Diabetes
Photosensitivity
Dizziness
Orthostatic Hypotension
Sexual Dysfunction
Elevation of Prolactin levels
Anticholinergic Side Effects: blurred vision. dry mouth (cotton mouth),
constipation, urinary retention
Blood Dyscrasias: Agranulocytosis. low WBC
Extrapyramidal SideEffects (E.P.S.)
dystonia, akathesia, psuedoparkinsonism, cogwheel rigidity, masked facies, .
oculogyric crisis, difficulty swallowing, stiffness of muscles, shuffling gait
Nursinq Intervention: For EPS: Notify M.D. and obtain order for: (one of the drugs
below)
Cogentin or Artane (Anticholinergics)
Symmetrel (Dopamine Agonist)
Benedryl (Antihistamine)
Tardive Dyskensia (irreversible) wormlike tongue movements, ataxia,
Neuroleptic Malignant Syndrome (rare} 14-30% mortality
Use Cautiously: diabetes, children under 6 Yr. , glaucoma, ulcers
Interactions: CNS Depressants
Nursing Implications:
Antianxiety Drugs: Benzodiazapines & Miscellaneous,
Action: Increase action of GABA that inhibits nerve transmission in the CNS
Depresses activity in brainstem
Sedative, hypnotic, anticonvulsant
Therapeutic Uses:
Commonly Prescribed Antianxiety Drugs:
Valium (Diazepam) anticonvulsant in IV dose
Xanax
Versed
Tranxene (Clorazapate), Librium, Ativan: used frequently for Detoxification
from Alcohol
Interactions:
CNS Depressants or alcohol + Benzodlazepines = additive effect and
Increased depression
Tagamet, antabuse (disulfiram), MAOI, tobacco + Benzodizapines =
decreased metabolism and increased depression
Common Side effects:
Overdose
Flumazenil (Romazicon)
Benzo. Receptor blocker (Antagonist) reverse effects
Teaching:
Buspar (Buspirone)
Potent antianxiety drug but no muscle relaxant, anticonvulsant, sedative, or
alcohol
potentiating action
Takes several weeks for antianxiety effects
Use: Not effective with Panic Disorder or alcohol withdrawal
Side effects:
Inderal (Propranolol) Beta Blocker used for decreasing symptoms that lead to
anxiety like tachycardia
Antidepressants:
Uses: Major Depression
Anxiety Disorders
Target symptoms:
Amine Hypothesis
Permissive Hypothesis
Dysregulation Hypothesis
Tricyclic Antidepressants:
Elavil
Tofranil
Uses:
***2-4 weeks to have antidepressant effect
Trazadone
2nd Generation Antidepressants: SSRI's (Selective Serotonin /Reuptake
Inhibitors)
Prozac
Zoloft
Paxil
Other Newer Antidepressants
Lexapro
Wellbutrin /Zyban
Effexor
Vestra
Remeron
Side effects of Antidepressant Therapy and Interventions
Overdose can be fatal due to "cardiac arrythemias with Tricyclics"
Anticholinergic side effects: Dry mouth, Constipation, Urinary retention, nausea,
diarrhea
Psychomotor activationIinsomnia: take drug in morning, eliminate caffeine "
Sedation, Drowsiness especially 1st week
Ejaculatory Disturbances & decreased Libido, priapism
Tremors, headache, nervousness
Monoamine Oxidase Inhibitors (MAOI’s): Used for non responders to other
antidepressant therapy
Monoamine Oxidase: Role of tyramine and dietary restrictions:
Life Threatening Side Effects of MAIO used with other drugs or foods:
Hypertensive crisis: sudden elevation of BP, palpitations, chest pain,
sweating, fever n&v
Hold MAOI's, do not lie down (increases BP in head)
Thorazine 100 mg. 1M repeat if necessary (blocks norepinepherine)
Phentolamine IV in 5 mg dose (binds with. norepinepherine)
Cooling blanket.
Seratonin Syndrome: Occurs when SSRI’s are administered too close to
D/C of MAOl's Confusion, disorientation, mania, restlessness, diaphoresis,
shivering.
Diarrhea, nausea.
DIC all serotonergic drugs, anticonvulsants, Klonapin or Ativan
**Do not reintroduce serotonin drugs
Only 3 drugs
Nardil
Pamate
Marplan
Side Effects:
Extreme hypotension
Nursing Interventions:
Careful health teaching on diet and drug reactions
Dietary restrictions:
Drugs that may produce hypertensive crisis:
Mood Stabilizing Drugs:
Lithium Carbonate usual dose is 900 mg/day
Side effects & Nursing Implications:
serum lithium levels .5 - 1.5 meq./L
Lithium (continued)
dose adjusted by serum level, not symptoms
weight gain, fine hand tremors, mental dullness, polyuria, kidney impairment
narrow therapeutic index:; toxicity a risk
Symptoms of Lithium toxicity:
Nursing responsibilities
Anticonvulsant Mood Stabilizers
Tegretal (Carbamazapine)
Depakote (Valproic Acid)
Neurontin
Tegretal and valproic acid (depakote) serum levels
Used in pt. who cannot tolerate Lithium and for bipolar disorder, schizoaffective
disorder, borderline personality disorder, schizophrenia. Often used in
combination with other medications
Response in 1-2 weeks
"
Nursing Implications
LMC/Aug. 2004