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MCC Nursing MH Pharm

MH Pharm & Treatment

QuestionAnswer
Potency the amount of the drug needed to achieve that maximum effect Low Potency requires Higher Dosage to achieve efficacy
Efficacy the maximal therapeutic effect that a drug can achieve
Half life the time that it takes for half the drug to be removed from the blood stream.
Off Label Use use of a drug that for a condition that differs from the one involved in the original FDA testing
Black box warning serious life threatening side effects that are located on a insert highlighted, boxed and located separate from the other text.
Principals of Psychotropic Drugs 1.Identify Target Symptoms 2.Allow for Sufficient time on medication before evaluation 3.Use the lowest effective dose 4.Use the lowest dose for older adults 5.Always taper off medication 6.Follow up care 7. Simple regimen to increase compliance
What are Anti psychotic drugs?(dopamine blockers) aka neuroleptics used to treat psychosis( dillusions, hallutionations, schizophrenia (mostly) bipolar disorders manic phase)
Should a patient mix anti psychotic drugs? NO!
What are typical, conventional, anti psychotics? use the dopamine neurotransmitter are very potent and have a great deal of side effects
Two categories of typical anti psychotics Phenothiazines ~chlorpromazine (Thorazine) ~prochlorperazine (Compazine) ~fluphenazine hydrochloride (Prolixin) Non phenothiazines ~ haloperidol (Haldol) ~loxapine (Loxitane) ~droperidol (Inapsine)
What warning should be taken with elderly patients and atypical anti psychotics? Elderly patients with dementia related psychosis are at an increased risk of death
What are the side effects of typical anti psychotics called? Extrapyramidal Syndrome EPS
What are the 4 conditions of EPS? pseudoparkinsonism, Acute Dystonia, Akanthisia, and Tardive dyskinesia
What are the signs and symptomes of Pseudoparkinsonism? Tremors, Masklike face, Rigidity, Shuffling gait Treated by changing antipsychotic medication therapy, change the antipsychotic drug, adding an anticholinergic , or amantadine
Signs and Symptoms of Acute Dystonia S/S happens in the first 7 days of medication use facial grimacing abnormal/involuntary eye movement Torticollis, Opisthotonus, Oculogyric crisis
Signs and symptoms of Akathisia Restlessness Constant moving treated by a change in anti psychotic medication or by adding a beta-blocker, anticholinergic or benzodiazepine
Signs and symptoms of Tardive dyskinesia Protrusion of the tongue (FROG) Chewing motion (COW) Involuntary movement of the body and extremities (Blowfish)
What is the treatment for EPS? Cogentin (benztropine) most common Symmetrel (amantadine)
What are Atypical Antipsychotics? Are more commonly used have fewer side effects and use dopamine and serotonin transmitters EX. clozapine (Clozaril) risperidone (Risperadal) olanzapine (Zyprexa) ziprasidone (Geodon)
Common side effects of all antipsychotic medications? Anticholinergic effects (dry out) Hypotension/hypertension, blood dyscrasis (Clozaril), photosensitivity, weight gain*, tachycardia, high cholesterol HDL 40 for women and 50 for men 150mg/dL triglycerides. Increase blood sugar levels dizziness drowsiness
What side effect is special to Clozaril Causes low white blood cell counts especially the neutrophils
What is the Nursing Actions and Client Teaching for Antipsychotics? 1. Monitoring- constantly check patients Vitals. Look for hypotension and tachycardia. 2. Look for EPS and NMS signs and symptoms. 3. Check Labs. Check glucose and WBC along with baseline lab work. BUN and Live enzymes 5. Make sure the patient protects themselves from sun exposure 6. Teach patient to avoid alcohol consumption 7. Do not stop taking medications 8. Take missed dose with in 3-4 hrs and medication can take 3-6 weeks to work
What is NMS? Neuroleptic Malignant Syndrome. Fatal but treatable side effect. (RARE) Appears w/in 2 weeks of medication therapy.
Signs and Symptoms of NMS? *FEVER OVER 104 F* Difficulty Breathing Tachycardia, irregular pulse, unstable bp, diaphoresis, altered LOC, elevated WBC.
Nursing Actions for NMS * Notify Physician* Discontinue medications Monitor Vitals, LOC, and Electrolytes Take seizure precautions Administer Antipyretics Utilize Cooling blanket
Client teaching for Anticholinergic effects exercising and drinking plenty of water and bulk forming food in the diet. Also use stool softeners and avoid laxatives.
What are antidepressants? use to treat depressive illness, anxiety disorders, and depressed phase of bipolar disorder
What are the four groups of antidepressants? 1.Tricyclic and cyclic depressants 2.SSRI 3.MAOI 4. Others
SSRI Selective Serotonin Reuptake Inhibitors Most Common antidepressant Works on Serotonin hormone Newest in the drug category Has the least side effects Ex. Fluoxetine Hydrochloride (Prozac) Sertraline Hydrochloride (Zoloft) Paroxetine (Paxil) Citaloprim (Cylexa)
What are the side effects of SSRI? N/V and diarrhea CNS stimulation -agitation, pacing Akathisia, Dry mouth photosensitivity Insomnia, Dizziness, weight gain, sexual dsyfunction
What two side effects are special to SSRI's? Insomnia CNS stimualtion
Can you take a SSRI and a MAOI together? Why or why not? No, because it can cause serotonin syndrome. Must be off of MAOI or SSRI 14 days before taking the other medication.
Nursing Actions, Care, and Techniques for SSRI Monitor: Vitals, Weight, Labs and Suicidal patients Must have a base line set of vitals Zoloft no grape fruit Teach about driving and safety at home due to dizziness AM dosing ~~> insomnia Do not drink alcohol
When can I take a missed dose of SSRI medication? With in 8 hours of missed dose
How long does it take for SSRI to take on full therapeutic effect 2-3 weeks
Which anti psychotic is best to prescribe to a suicidal patient? SSRI because of the length of time to take therapeutic effect
What are the side effects of Serotonin Syndrome? Aggitation, diaphoresis, fever, tachycardia,hyper reflexia
What are TCA? Tricyclic Antidepressants oldest category of antidepressants more extreme side effects can be deadly and cardiotoxic
What are the major concerns regarding TCA's? Seizure threshold Anti hypertensive therapy interactions Interaction with alcohol Interaction with MAOI
Examples of TCA? Clomipramine hydrochloride (Anafranil) Amitriptyline Hydrochloride (Elavil) Mirtazapine (Remeron)
Side Effects of TCA? Anticholinergic Effects Photosensitivity Cardio Disturbances Orthostatic disturbances Sedation Anxiety Weight gain Decreased/ Increased Libidi
Which side effects are special to TCA's Thrombocytopenia Cardiac Disturbances, (Arrythmia MI and Strokes) Anticholinergic effects Seizures
Nursing Actions for TCA Monitor: Suicide Risk Compliance, Bowel and bladder habits,Vitals. Must be Tapered Change positions slowly, Take medication at night Avoid Alcohol
How long before TCA reaches therapeutic effectiveness? 4 to 6 weeks
When can a patient take a missed dose of a TCA? with in 3 hrs of missed dose.
What is a MAOI? Monoamine Oxidase Inhibitors Oldest Category , Most potent Last effort
Examples of MAOI Phenelxine sulfate (Nardil) Tranylcypromine (Parnate)
What type of patients should not use MAOI? Cardiac, BP, and Asthma patients
What is the diet exception for patients on MAOI's? Do not eat food with tyramine because it can cause the patient to go into a life threatening hypertensive crisis
Which foods should the nurse include in patient teaching to a patient on MAOI's Mature aged cheeses and dishes made with cheese, except cottage cheese, cream cheese, and cheese slices Aged meats MSG Over Ripe Fruit Tap beers Yogurt, sour cream, peanuts , brewers yeast
Side effects of a MAOI Daytime sedation and lethargy GI Upset Weight gain Insomnia Sexual dysfunction dizziness orthostatic hypotension Hypertensive/ Hypertensive Crisis Anticholinergic side effects Hepatocelluar jaundice Arrhythmia/ anorexia
Which side effect is special to MAOI Hypertensive Crisis
Nursing Actions for MAOI Monitor Vitals Compliance- Are they taking their medications? Dosing Considerations - side effects are specific to patient Change positions slowly Take with food for GI upset Watch other meds for possible hypertension crisis Know when to call physician
What are Mood Stabilizers? Medications used to help decrease manic swings associated with bipolar disorders. Helps minimize the kindling process.
What is the example of a mood stabilizer? Lithium
What chemical is Lithium dependent upon? Sodium: A decrease in Sodium increases Lithium and vice versa
What is the therapeutic range of Lithium? 0.5 to 1.3
Side effects of Mood Stabilizers Polyuria polydypsia Anorexia Nausea Dry mouth Weight gain Abdominal bloating diarrhea Headache
What are the side effects that are special to Mood Stabilizers? Alopecia, Fine hand tremors (increase with toxicity), and lethargy
How often does Lithium levels need checking? Every 1-2 weeks once stable 1 a month
Nursing Actions for Lithium... Monitor Lithium levels Watch for suicide risk- lethal OD Advise patient to take with food and to drink 6-8 glasses of water Lithium must be tapered Watch diuretics and different OTC meds.
How long does it take Lithium to reach level of therapeutic response? 1-3 weeks
When do you call the doctor while on Lithium? Prolonged polyuria, polydypsia, and vomiting
When are Lithium levels toxic? when serum levels are above 1.5 mEq/L
What happens during Mild Lithium Toxicity? Serum levels are 1.5 - 2.0 mEq/L Patient experiences: Apathy, Lethargy, Diminished concentration, mild ataxia/muscle weakness (difficulty walking), and coarse hand tremors
What happens during Moderate Lithium Toxicity? Serum levels 2.0-2.5 mEq/L Patient experiences N/V, severe diarrhea, mild to moderate ataxia and incoordination (not walking), slurred speech, tinnitus, blurred vision, and irregular tremors
What happens during Severe Lithium Toxicity? Serum levels above 2.5 mEq/L Patient experiences Nystagmus (twitching of the eyes), muscle fasciculation(muscles move on their own), hyperreflexia, visual and tactile hallucinations, oliguria and anuria, impaired LOC, and grand mal seizures, coma, &death
Nursing actions for Lithium Toxicity 1.Hold Lithium dose 2.Call DR 3. Monitor Vitals,& LOC 4. Cardiac Status - Telemetry EKG 5.LABS- BUN, Kreatin, Liver enzyme, and Metabolic Panel 6.Seizure precautions 7. Suicide precautions until OD can be ruled out.
What is the intended use for Anti anxiety medications/ anxiolytics ? Use to treat anxiety and anxiety disorders, insomnia, OCD, depression, PTSD, and alcohol withdrawl.
Name three examples of anti anxiety medications? Benzodiazepines: Alprazolam(Xanax) Chlordiazepoxide) Librium Clonazepam (Klonopins) Diazepam (Valium) Lorazepam (Ativan) Temazepam (Restoril) Nonbenzodiazepine Buspirone (BuSpar)
What are the side effects of anti anxiety medications? CNS depression, Ataxia, Dizziness, Hangover effect, Tolerance and Dependence, Hypotension, Tremors, Slurred Speech
What are the S/S of over dose/ toxicity of anti anxiety medications? Somnolence, Confusion,Diminished reflexes & Coma
Which medication is used as an antidote for anti anxiety over dose? Flumazenil (Romazicon)
Nursing Actions for anti anxiety drug? Monitor - motor responses, autonomic responses, paradoxical responses, and visual disturbances, and Labs
Client teaching for anti anxiety drugs ~inform patient that anti anxiety medication are aimed to relieve symptoms of anxiety and insomnia but do not treat the underlying cause. ~Benzodiazepines enhances the effects of alcohol ~Slows reaction time and should not drive until become use to med ~with drawl can be fatal do not stop medications abruptly
What is the intended use of Stimulants? ~mostly used to ADHD children and adolescents, residual ADD in adults, and narcolepsy.
What are the side effects of Stimulants? Anorexia Weight loss Nausea Growth and weight suppression Dry mouth irritability
What are 3 examples of Stimulants? Methylphenidate (Ritalin) Amphetamine (Adderall) Atomoxetine (Strattera)
Dosage consideration for Stimulants Dosage for children with ADHD are based on age, weight, and behavior of the child the child , along with the family tolerance for the child's behavior.
What is the client teaching for sitmulants? Inform patient about the potential for abuse. Take medication after meals 10 day supply can be fatal keep out of reach of children Avoid Caffeine
What is the intended use for Disulfiram/ Antabuse Is used with alcoholics who are motivated to refrain from drinking.
What is the Mechanism of Action of Disulfiram? Sensitizing agent that causes adverse reactions with when mixed with alcohol in the body. 5-10 mins after taking disulfiram if the patient ingest alcohol symptoms begin to appear
Signs and symptoms of Disulfiram Vasodilation, Headache, sweating, dry mouth, nausea, vomitting, dizziness, and weakness. holitosis, impotence, tachycardia Severe reactions: chest pain, dyspnea, severe hypotension, confusion, and death
Nursing actions and teachings for Disulfiram Never give Disulfiram to patients under the influence of alcohol without informing patient and or family of the side effects. Teach patients to look out for every day products that contain alcohol
What classification of Carbamazepine (Tegretol)? Anticonvulsant used as mood stabilizer
What classification of Methylphenidate (Ritalin)? Stimulant
What classification of Benztropine (Cogentin) ? Anticholinergic
What classification of Amitriptyline (Elavil) ? Tricyclic antidepressant
What classification of Fuoxetine (Prozac)? SSRI antipsychotic
What classification of Clozapine ( Clozaril)? Atypical antipsychotic
What classification of Clonazepam (Klonopin)? Benzodiazepine
What classification of Quetiapine (Seroquel)? Atypical antipsychotic
What are the sign/ symptoms of Serotonin syndrome Hypothermia Autonomic instability/ delirium Rigidity Myoclomus
What are the characteristic of anticholinergic side effects. Anorexia Blurry vision Constipation/confusion Dry mouth Stasis of urine
More side effects of antipsychotic drugs Impotence Sedation/ seizures Hypotension Akanthisia Dermatological side effects EPS
What are some examples of Psychotropic Drugs? Anti psychotics, antidepressants, mood stabilizers, anxiolytics, and stimulants
Created by: MCCGroup5