psychiatric nursing notes.pdf

8/19/2019 PSYCHIATRIC NURSING NOTES.pdf

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PSYHCHOPHARMACOLOGIC AGENTS

I. ANTI-PSYCHOTICS

SUB-CLASSIFICATIONS

PHENOTHIAZINES NON-PHENOTHIAZINES

MOA

- antagonizes dopamine in the CNS and also blocks Cholinergic, Histaminic,Serotogenic, Adrenergic neurotransmitters

-- (( aannttiicchhoolliinneer r ggiicc,, aannttiihhiissttaammiinniicc,, aannttii--eemmeettiicc )) bblloocckkss aaccttiivviittyy oof f tthhee CCNNSS

r r eecceeppttoor r ss aanndd ssyymmppaatthheettiicc nneer r vvoouuss ssyysstteemm

INDICATION

-- f f oor r mmeer r llyy ccaalllleedd mmaa j joor r ttr r aannqquuiilliizzeer r ss // nneeuur r oolleeppttiiccss.. uusseedd ttoo r r eelliieevvee ppssyycchhoottiicc ssyymmppttoommss(( ddeelluussiioonnss ,, hhaalllluucciinnaattiioonnss aanndd lloooosseenneessss oof f aassssoocciiaattiioonn))oof f sscchh j jiizzoopphhr r eenniiaa,, mmaanniiaa aanndd ppssyycchhoottiicc ddeeppr r eessssiioonn aanndd oor r ggaanniicc mmeennttaall ddiissoor r ddeer r ss

- acute management of agitation and hyperactivity

SIDE/ ADVERSE EFFECTS:

ANTICHOLINERGIC EFFECTS ((EEPPSS))EEXXTTRR A APPYYRR A AMMIIDD A ALL SSYYMMPPTTOOMMSS

– – PPSSEEUUDDOOPP A ARRKKIINNSSOONNIISSMM--ttr r eemmoor r ,, mmaasskk lliikkee f f aacciieess ddr r oooolliinngg ,, r r eessttlleessssssnneessss – – A AKK A ATTHHIISSII A A-- r r eessttlleessssnneessss,,aanndd aannxxiieettyy – – DDYYSSTTOONNII A A--ggr r iimmaacciinngg ,, ttoor r ttiiccoolllliiss ,,ooccuullooggyyr r iicc ccr r iissiiss,, iinntteer r mmiitttteenntt mmuussccllee ssppaassmmss - TARDIVE DYSKINESIA-lip smaking and tongue and mouth

(NMS) NEUROLEPTIC MALIGNANT SYNDROME*- hyperthermia, and severe EPS -muscular rigidity, tremors, trismus, choreiform

movements,autonomic instability /hyperactivity

and alterations in LOC

SEIZURESHEPATOTOXICITY*

ORTHOSTATIC HYPOTENSION

PHOTOSENSITIVITY and HYPERSENSITIVITYENDOCRINE DISORDERS

DYSCRASIAS *

AGRANULOCYTOSIS – sorethroat,chills,fever,malaise

LEUKOPENIA

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS:

CC//II :: hhyyppeer r sseennssiittiivviittyy ,, ggllaauuccoommaa ,, ccoonnvvuullssiivvee dd//oo ,, ppr r eeggnnaannccyy aanndd llaaccttaattiioonn,, eellddeer r llyy cclliieennttss

NURSING CARE GUIDELINES:

C- antipsychotics, neuroleptics, major tranquilizersH- decreased overt or positive manifestations of psychosisE- p.c.C- rise slowly

avoid sunlightReport –sorethroat,fever,muscular rigidity

Reduced psychomotor agitation and insomnia – 1 week

Reduction of hallucinations, delusions and thought disorder takes 6-8 weeks for full

Chlorpromazine (Thorazine)Fluphenazine (Prolixin)

Perphenazine ( Trilafon)Prochlorperazine (Compazine)

Thioridazine ( Mellaril)

Triflouperazine (Stelazine)

Clozapine ( Clozaril)Haloperidol ( Haldol)

Olanzapine ( Zyprexa )Risperidone ( Risperdal)

THIOXANTHENES

Thiothixene ( Navane)


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therapeutic effect

BP and temperatureK – monitor blood levels

Seizures, NMS and EPSL.F.T.’s

CBC with differential

medical management :

NMS – Bromocriptine or Amantadine( dopamine agonist) and

Dantrolene (Dantrium) muscular relaxant

Dystonia – Diphenhydramine,Benztropine , Diazepam, Lorazepam

Pseudoparkinsonism – Antiparkinsonian, AnticholinergicAkathisia – Anticholinergic, Benzodiazepines, Beta-blockers,Clonidine

Tardive dyskinesia – early referral-dose reduction , no anticholinergics

II. ANTI-PARKINSONIAN AGENTS

CLASSIFICATIONS

2 TYPES :

1.) DOPAMINERGIC DRUGS MOA: enhance dopaminergic activity

slows deterioration of dopaminergic nerve cells

Increasing dopamine

2.) ANTI-CHOLINERGIC AGENTS

MOA:inhibit relative excess in cholinergic activity, symptomatic reliefDecrease signs and symptoms ( tremors,rigidity, drooling promote optimal levels

of motor function (gait, posture and speech )

INDICATIONS: For management of anti psychotic induced EPS- pseudoparkinsonism

SIDE AND ADVERSE EFFECTS

Anticholinergic Effects Blurring of vision, constipation, 3D’s and orthostatic hypotension,sorethroat*

Headache, photosensitivity, drowsiness, CHF and halluciantions

CONTRAINDICATIONS AND SPECIAL PRECAUTION

Glaucoma, tachycardia, HPN, Cardiac D/O, asthma, duodenal ulcer

Carbidopa – Levodopa ( Sinemet)Amantadine ( Symmetrel)

Bromocriptine Mesylate ( Parlodel)

Levodopa ( Larodopa)Pergolide Mesylate ( Permax)

Ropinirole(Requip)

Tolcapone ( Tasmar)

Trihexypheiedil ( Artane)Biperiden Hydrochloride ( Akineton)

Benztropine Mesylate ( Cogentin)

Diphenhydramine Hydrochloride(Benadryl)

Misc. agent

Selegiline ( Eldepryl)


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NURSING CARE GUIDELINES

C- dopaminergic or anti-cholinergic H- decrease tremors and rigidity in 2-3 days

E- p.c.

C- avoid sudden position change

Avoid Vit. B6 and CHON rich foods- dec. absorption of medication

Avoid alcohol-increases sedative effects K - check BP- orthostatic hypotension

drugs not withdrawn abruptly

III . ANTI DEPRESSANTS

COMMON TYPES

TRICYCLICS MONO AMINE OXIDASE SELECTIVE SEROTONIN

INHIBITORS REUPTAKE INHIBITORS

Mechanism of

Action

CNS STIMULANTS

INDICATIONS

effective in management and treatment of depression and related mood and depressive disorders

such as:

Obsessive compulsive ,Eating d/o,Obesity,Bipolar disorder,Panic d/o

Imipramine(Tofranil)Amitriptryline ( Elavil)

Clomipramine (Anafril)Doxepin ( Sinequan)

Nortryptyline ( Aventyl)

Tranylcypromine (Parnate)Isocarboxazid ( Marplan)

Phenelzine (Nardil)

Citalopram ( Celexa)Flouxetine (Prozac)

Paroxetine ( Paxil)Sertraline ( Zoloft)

Fluvoxamine (Luvox)

Inhibits reuptake anddestruction of

serotonin to prolong its

action

Blocks the

metabolicdestruction of

neurotransmitters by

the enzyme mono-

amine oxidase

Prolongs the action

of norepinephrineDopamine

Serotonin by

blocking thereuptake of this

neurotransmitters

Ritalin ( Methylphenidate)Amphetamine ( Benzedrine)

Increases levels of neurotransmitters

in the brain thereby increasing CNS

activity and decreasing

hyperactivity.


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SIDE EFFECTS AND ADVERSE REACTIONS:

TCA’S MAOI SSRI CNS Stimulants

Cardiac arrhythmias,

palpitations,orthostatic

hypotension

Constipation,Sedation,anticholinergic effects

Confusion

Bone marrow depression

Hypertensive crisis

Liver and cardiovascular

disease

Weight gainSexual dysfunction

photosensitivity

Tremors, decreased

libido, NAVDA

Nervousness, insomnia,

drowsinessanxiety

Growth suppression,

insomnia

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS


Hypersensitivity, liver

disease , glaucoma

Hypertension

Cardiovascular disease

and Liver disease

same


C- anti-depressants

H- decreased signs and symptoms of depression(increased appetite and sleepE – p.c.


C-

2-3 wks initial effect

3-6 wks full therapeuticeffect

Emphasize compliance

Avoid citrus juice –decrease absorption

K-

Monitor BP, HR andECG

2-3 initial

3-4 full ther. EffectAvoid foods rich in

tyramine –leads to

hypertensive crisis

( processed,preserved andfermented )

Monitor BP and food

items

2-3 initial

3-4 full ther. effect

Give in AM , not

beyond 2 pm6 hours before bedtime

IV. ANTI – MANIC

EXAMPLES

MOA

Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters

INDICATIONS

•• TTr r eeaattmmeenntt oof f aaccuuttee mmaanniiaa aanndd f f oor r ppr r oopphhyyllaaxxiiss oof f r r eeccuur r r r eenntt mmaanniicc aanndd ddeeppr r eessssiivvee eeppiissooddeess iinn bbiippoollaar r ddiissoor r ddeer r


NAVDA

Fine tremors leading to coarse tremors

Thirst

Nystagmus

Nephrotoxicity*

Cardiac toxicity*

Hyperthyroidism – Thyroid Crisis*

Lithium Carbonate ( Eskalith,

Lithane, Quilinium –R,Lithionate)

Carbamaze ine Te retol


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Cardiovascular disease , renal disease, clients on low sodium diet and on diuretic therapy, brain damage,

pregnancy and lactation


C- mood stabilizer – anti manic

H - decrease hyperactivity/manic episodesInitial effect – 10-14 days

Full therapeutic effect 3-4 weeks

E- after meals with milk or food C- antipsychotics given with lithium for immediate management of

manic episodes.Diet – Na 6-10 grams a day; fluids- 3 liters per day

Avoid caffeine , diuretics and activities that increase perspiration

K - monitor for untoward signs and symptoms

Monitor serum level at least once a month(A.M. 12 hours after

the last dose

maintenance dose - .5 – 1.2 mEq / L

acute level – 1.5 mEq / Llevel for the elderly .4 – 1.0 mEq / L

Antidote for toxicity – Mannitol (Osmitrol) or Acetazolamide (Diamox)

V. ANTI ANXIETY

CLASSIFICATION:

BENZODIAZEPINES AZASPIRONES NON-BENZODIAZEPINE

Miscellaneous agents

MOA: depresses Reticular Activating system and reduces anxiety by stimulating the action of an inhibitory

neurotransmitter called GABA

INDICATIONS; treatment of anxiety disorders and for short term relief of symptoms ofAnxiety; selective medications effective for skeletal muscle relaxation, pre

and post-op sedation, seizure control.


Sedation and Dizzinees,drowsiness and dry mouth

Paradoxical reactions*(hallucination and delusions),CNS depression*

Addison’s disease , Dependency*, hepatotoxicity*


Glaucoma, hypersensitivity, liver and kidney dysfunction, psychoses,

elderly , pregnancy and lactation


C - anxiolytics, minor tranquilizers

H- decrease anxiety

E- a.c. – food delays absorption

C - rise slowly

Avoid caffeine and alcohol

K - monitor CBC, LFT’s,

report sorethroat, jaundice, weakness and fever

Alprazolam ( Xanqax)

Chlordiazepoxide ( Librium)

Clorazepate ( Tranxene)Diazepam ( Valium)

Lorazepam ( Ativan)Oxazepam ( Serax)

Buspirone

(Buspar)

Hydroxyzine ( Vistaril)Meprobamate ( Equanil)

psychiatric nursing notes.pdf

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