Mark Klimek NCLEX Review: Psych Drugs, Tri, Benzo, MAOI, Lithium, Prozac, Haldol, Clozaril, Zoloft

Mark Klimek NCLEX Review: Psych Drugs, Tri, Benzo, MAOI, Lithium, Prozac, Haldol, Clozaril, Zoloft

Psychiatric Drugs

ALL psychiatric drugs cause low BP and weight changes - usually weight gain

 

Major Classes

 Phenothiazines

- First generation or typical antipsychotics

- All end in “ZINE”

   - Example: Thorazine, Compazine

- They don’t cure … They just reduce symptoms

- We use ZINEs for the ZANY (Cuckoos) … Antipsychotics

- In small doses, they are antiemetics (to treat vomiting)

 

Phenothiazines are major tranquilizers

Major tranquilizers—big guns psych meds—are Antipsychotics

Analogy

Aminoglycosides are to Antibiotics what Phenothiazines are to Antipsychotics

Antipsychotics S/Es = “ABCDEFG”

- Anticholinergic (dry mouth, urinary retention)

- Blurred vision

- Constipation

- Drowsiness

- EPS (tremors, Parkinson)

- Foto sensitivity

- aGranulocytosis (low WBC count, immunosuppressed)

Teach patient how to recognize and report sore throat and symptoms of infection

 

Question

What is the nursing action when someone presents with a S/E?

- Educate

 

Question

What is the nursing action when someone presents with a Toxic effect?

- HOLD the drug à Notify HCP

 

Note

- The #1 nursing diagnosis for “ABCDF” S/Es is to teach patient about SAFETY

- The #1 nursing diagnosis for “G” S/Es is to teach patient to report signs of infections to HCP

 

Decanoate or “Caprate” form of a medication

- The long-acting form of a drug

- Sometimes denoted with the letter “D”

- IM form given for non-compliance

- Often Court-ordered

 

 

Tricyclic Antidepressants

Grandfathered into the NSSRI (Non-selective serotonin reuptake inhibitor) group

Mood elevators (Happy pills)

Elavil (elevates), Tofranil, Aventyl, Desyrel

- Elevates the mood

- Side effects of TCA are:

Anticholinergic (especially, dry mouth)

Blurred Vision

Constipation

Drowsiness

Euphoria (happy)

- Must take meds for 2 to 4 weeks for beneficial effects

- So, after the first week of antidepressant therapy, patient will complain the drug is not working

- Teach patient that the medication takes about 2 to 4 weeks to reach therapeutic effects

 

Benzodiazepines

- Anti-anxiety, minor tranquilizers

- Always have ZEP in the name

- Remember ZZzzs for falling/going to sleep

- Many benzodiazepines end in “Pam” or “Lam”

- Prototype: Valium, induction of anesthetic, muscle relaxant, alcohol

- Can be used as:

   - Seizures medications

   - Preop induction of anesthesia

   - Muscle relaxants

   - EtOH withdrawal medications

   - Ventilation—medication to relax and calm down pts on a ventilator

Benzos work quickly … But do not take them for more than 2 to 4 weeks

 

Administer major and minor tranquilizers at the same time. Why?

- The major antipsychotics take a long time to start working

- The minor antipsychotics start working right away

- Both are administered at the same time

- Example: patient is usually put on Valium and Elavil at the same time

   - Valium is discontinued in 2 to 4 weeks once Elavil kicks in

 

Note

A similar example for giving major and minor tranquilizers together is the concurrent use of Heparin and Coumadin (warfarin)

- Heparin works right away but a patient should not be on it for a long time

- Coumadin takes a few days to start working but a patient can be on it for the rest of his life

 

S/Es of Benzodiazepines are “ABCD”

- Anticholinergic

- Blurred Vision

- Constipation

- Drowsiness

 

Monoamine Oxidase (MAO) Inhibitors

- Antidepressant

- Depression is thought to be caused by norepinephrine, dopamine, and serotonin in brain

- Name of MAOIs starts with

- MARplan, NARdil, PARnate the beginnings—all rhyme

- S/E of MAOIs

   - Anticholinergic

   - Blurred Vision

   - Constipation

   - Drowsiness

 

Teaching Points

- Avoid tyramine-containing food … May cause Hypertensive Crisis

- Food with tyramine

   - Fruits/Veggies—Avoid salad “BAR”: Bananas, Avocados (guacamole), Raisins (dried fruit)

   - Grains—Ok to have, except Yeast

   - Meats—No organs liver, kidney, tripe, heart, no preserved meats (smoked, dried, cured, pickled, hot dogs)

   - Dairy—No cheese except for mozzarella, cottage cheese (no aged cheese)

   - No EtOH, elixirs, tinctures (iodine/betadine) caffeine, chocolate, licorice, soy sauce

 

Lithium

- Used for treating Bipolar disorder - it decreases the mania LI = BI

- S/E: Very Unique—acts more like an electrolyte—think: Potassium/Lithium

- The 3 Ps as S/Es

   - Peeing (Polyuria)

   - Pooping (diarrhea)

   - Paresthesia (earliest sign of electrolyte imbalance)

The earliest sign of electrolyte imbalance is Paresthesia = Numbness and Tingling

 

Toxic effects of lithium

- Tremors

- Metallic taste

- Severe diarrhea

 

Question

What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the time?

- #1 intervention

   - Give patient fluids

- The above S/Sx are S/Es—expected

- Monitor sodium

- Low sodium makes lithium toxic

- High makes lithium ineffective

- Sodium needs to be normal

 

Question

What is the #1 nursing intervention in a patient on lithium presenting with metallic taste and severe diarrhea?

#1 intervention = Give patient fluids

Notify the HCP - this is a toxic effect

 

 

Prozac (fluoxetine)

- SSRI, mood elevator

- Side effects of Prozac are

   - Anticholinergic

   - Blurred Vision

   - Constipation

   - Drowsiness

   - Euphoria (happy)

- Causes insomnia so give before noon. If bid, give at 6 a.m. and noon

- When changing doses, watch for suicidal risk in adolescents

   - Must recently change the dose and be an adolescent or young adult

 

HALDOL (haloperidol)

Tranquilizers (basically same as Thorazine)

S/E of Haldol

- Anticholinergic (dry mouth, urinary retention)

- Blurred vision

- Constipation

- Drowsiness

- EPS (tremors, Parkinson)

- Foto sensitivity

- aGranulocytosis (low WBC count, immunosuppressed)

Teach patient how to recognize and report sore throat and symptoms of infection

-> First generation antipsychotics

Patients may develop NMS (neuroleptic malignant syndrome) from overdose

   - Seen in elderly and young white schizophrenic pts

   - High fever over 105

   - Their doses should be about ½ usual adult dose

 

Question

A patient is being treated with an antipsychotic medication. Patient becomes anxious and presents with tremors. What is the nurse intervention to differentiate NMS (neuroleptic malignant syndrome) from EPS (extrapyramidal syndrome)?

A: Measure the patients’ temperature

- If temperature is WNL, this is EPS

- If temperature is 102 and rising, call the emergency response team and notify HCP …NMS is life threatening

NMS presents with anxiety and tremors, and so does EPS

 

Note: With Haldol, there are safety concerns related to the S/Es

 

Clozaril (clozapine)

- Atypical antipsychotic

- Advantage it does not have A-F side effects

- Don’t confuse it with Klonopin/Clonazepam!

- S/Es of clozapine

   - aGranulocytosis! It is worse than cancer drugs and can trash the patient’s bone marrow

 

Note

- Geodon (ziprasidone) has a black box warning

- Prolong the QT interval, which can cause sudden cardiac arrest

- Do not use in pts with cardiac condition

 

Note: Second generation antipsychotics end in “Zapine”

 

Question

What is the #1 nursing intervention in a patient taking Clozaril (clozapine)

A: Monitor the WBC

 

Zoloft (Sertraline)

Antidepressant

Can cause insomnia

Interact with the followings because they are not metabolized in the liver

- St. John’s Wort and cause serotonin syndrome

- Warfarin and cause bleeding

S/E of serotonin syndrome is “SAD Head”

- Sweating

- Apprehensive (impending sense of doom)

- Dizziness

- Headache

 

Note: The nurse should anticipate lowering the dose of sertraline (Zolof) of a patient on St. John’s Wort and Warfarin.