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.