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Transcript of NURS 1950 Nancy Pares, RN, MSN Metro Community College.
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NURS 1950Nancy Pares, RN, MSN
Metro Community College
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http://www.cafeoflifepikespeak.com/Videos/Licensed%20To%20Pill.swf
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Four groups (also called anxiolytics/tranquilizers)◦ Antidepressants (Chap 16)◦ Benzodiazepines◦ Barbiturates◦ Nonbenzodiazepines/nonbarbiturate CNS
depressants
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Baseline data◦ Cause of anxiety◦ Vitals◦ Blood dyscrasias, liver disease, pregnancy or
breastfeeding
WHY?
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Prototype: Phenobarbital (Luminal) Action: enhances the action of the
neurotransmitter GABA-which suppresses abnormal neuronal discharges
Rarely used today due to significant side effects—high chem dependency & overdose
New studies show◦ No effect on anxiety—too much CNS depression
Overdoses are common; increase enzyme activity…which causes_resp depression
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Advantages
End in ‘pam’◦ Diazapam (Valium),oxazepam (Serax), lorazapam
(Ativan)**
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Drugs of choice for anxiety and insomnia Action:
◦ bind to the GABA receptor (what is this? And what does it do?
Uses:◦ Acute anxiety, medical illness, ETOH w/drawal
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Adverse effects:◦ Hypotension, confusion, syncope
Interactions:◦ ETOH, anesthetics, MAO inhibitors,
antihistamines, TCA’s, narcotics, barbiturates◦ Caffeine and smoking interfere with desired effect◦ Overdose:
Flumazenil (Romazicon)
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Nursing Implications◦ Tolerance develops◦ Can cause physical and psychological
dependence◦ No abrupt w/drawal of meds◦ Drug doses vary---check for appropriate dosing◦ Interacts with phenytoin and coumadin
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Buspirone (BuSpar)◦ Unrelated to benzo or barbiturates chemically
Action: not well known; may be related to dopamine receptors
Advantages:◦ Less potential for abuse; lower sedative
properties Adverse effects:
◦ Dizziness, HA, drowsiness; may take 3-4 wks for optimal effects
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Buspar◦ Schedule regular assessments for slurred speech,
dizziness, CNS disturbances; give at regular intervals (not PRN); do not use with MAO Inhibitors or ETOH
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Diphenhydramine (Benedryl) and Hydroxyzine (Vistaril)
Uses: sedative and antiemetic properties; anticholinergic effects are least with these agents; preop sedation, pruititis
Side effects:◦ Blurred vision, constipation, dry mucosa,
sedation; drowsiness will decrease with use
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Before giving an antianxiety, what would you assess?
After giving an antianxiety, what would you assess?
What are some common nursing diagnosis for clients taking anxiolytics?
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Classifications◦ Tricyclics◦ MAO inhibitors (monoamine oxidase)◦ SSRI◦ Atypical Antidepressants
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Action is on serotonin and catecholamines Therapy requires 2-3 wks for mood change Overdoses do occur common side effects:
◦ Sedation, anticholinergic activity, tachycardia, orthostatic hypotension, confusion, tremors
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TCA◦ Action: inhibits reuptake of norepinephrine and
seratonin into presynaptic nerve terminals◦ Uses: depression, Manic-depressive
(bipolar)disorder, panic disorders◦ Desired effects: mood elevation, increase activity,
improve appetite, normalize sleep patterns….. What s/s of depression make these desirable effects?
◦ Takes 1-2 months for maximal effect
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Adverse effects:◦ Tremor, numbness, tingling, Parkinsonian
symptoms, orthostatic hypotension, anticholinergic effects (which are?)
◦ Cardiac arrhythmias, suicidal actions
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Do not use with MAOI..why? Sympathomimetics increase effects of
anticholinergic effects Avoid OTC antihistamines Prototype: imipramine (Tofranil)
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Sertraline (Zoloft)◦ Action: inhibits reuptake of serotonin◦ Use: depression, anxiety, OCD and panic disorder◦ Adverse effects: agitation, HA , dizziness and
fatigue; sexual dysfunction; weight gain; ◦ Contraindications: antabuse should be avoided;
no MAOI ; use precaution with St. John Wart
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• May take wks to get effect; effects last 2-3 months after d/c
• Give in am or pm• Note eating disorders hx• Exercise and caloric restriction• Monitor labs for pro-bound drugs…ex:
coumadin• May need increase of dilantin due to
interactions
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• Phenelzine (Nardil)• Action:intensifies effects of norepinephrine
in adrenergic synapses• Use: depression not responsive to other
drugs• Common S/E: constipation, dry mouth,
orthostatic hypertension; severe hypertension with foods containing tyramine (see pg 195)
• Contraindications: cardiac disease, renal/hepatic impairment
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Refrain from foods that contain tyramine Assess cardiac status Assess lab values (why?) No OTC or herbal meds Avoid caffeine Observe for s/s of stroke or MI
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General anesthesia, diuretics, antihypertensives: potentiate the hypotensive effects
Insulin and oral hypoglycemics: additive effects
Meperidine and MAOI= severe reactions
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What assessments need to be made before antidepressant medications?
What are the nursing diagnosis you would write for clients with antidepressant meds.?
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Hypertensive Crisis◦ Ingestion of foods with tyramine (this substance
promotes release of norepinephrine)◦ Avocados, soybeans, figs, bananas, aged meat,
smoked meat, bologna, pepperoni, salami, cheese, caffeine
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Lithium carbonate (Eskalith)◦ Action: stabalizes the neuronal membrane,
reduces release of norepinephrine◦ Uses: reduces euphoria of mania without
sedation; may take a week to develop desired effects; begin with low doses and increase q 3-5 days.
◦ Common S/E: n/v, anorexia, abd cramps, excessive thirst and urination
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Adverse effects: persistant vomiting; progressive wt gain, fatigue, nephrotoxicity
Serum levels need to be below 1.5mEq/L >1.5: n/v, diarrhea, thirst, polyuria, slurred
speech 1.5-2.0: GI upset, confusion 2.0-2.5: ataxia. Blurred vision, coma 2.5 and >: convulsion, oliguria, death
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normal blood level: Nutrition needs: Desired effects in 5-7 days; full effect in 21
days Give with food or milk
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Phenothiazines Non phenothiazine Atypical anti psychotics
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Chlorpromazine (Thorazine) Action:
◦ Prevent dopamine and serotonin from occupying their receptor sites and block the excitement symptoms
Use: ◦ Schizophrenia, bipolar (manic state), depression,
antiemetic
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Adverse effects: (see page 213 table)◦ Extrapyramidal effects
Acute dystonia, spasms of tongue, opisthostonos Treat: anticholinergics
◦ Parkinsonism (why?)◦ Akathesia◦ Tardive dyskinesia
May be irreversible◦ Other common: sedation, sexual dysfunction,
breast growth, galactorrhea
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Nursing Interventions◦ Increases effect with anticholinergics◦ ETOH and CNS depressants intensify depressant
effect◦ NOTE: most phenothiazines end in ‘zine’ ; ex:
fluphenzine, prochorperazine, promazine, thiroidazine
◦ Careful monitoring of client condition; report EPS symptoms to MD..may need to d/c med
◦ Life threatening adverse effect: neuroleptic malignant syndrome (NMS)
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Haloperidol (Haldol) Action/Use: chemically a butyrphenone;
primary use is psychotic disorder—has less sedation than phenothiazine, but greater EPS
Nursing Interventions:◦ Same as pheno—monitor carefully, esp. elderly
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Clozapine (Clozaril) Action/Use:
◦ Largely unknown—block several receptor sites; broader spectrum of action, fewer EPS symptoms
Nursing Interventions:◦ Basically same as pheno..give wkly supply to
assure lab values get drawn
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New drug aripiprazole (Abilify)◦ Dopamine stabilizer with fewer EPS
◦ Adverse effects: HA, N/V, fevers constipation, anxiety
◦ Nursing implications As all other categories