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Lecture Aid: Mental Health and Psychiatric Nursing 1

Major tranquilizers/antipsychotics are used to treat schizophrenia and other psychoses. They work by blocking dopamine receptors. Typical antipsychotics like haloperidol treat positive symptoms but cause extrapyramidal side effects. Atypical antipsychotics like risperidol treat both positive and negative symptoms and have fewer side effects. Minor tranquilizers/anxiolytics like alprazolam are used to treat anxiety disorders and promote sleep. They have sedative effects and should be taken with food separately from other drugs to avoid interactions. Antidepressants work to increase appetite and sleep. Tricyclics can cause changes in blood pressure and heart rate so monitoring is needed. MA

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237 views3 pages

Lecture Aid: Mental Health and Psychiatric Nursing 1

Major tranquilizers/antipsychotics are used to treat schizophrenia and other psychoses. They work by blocking dopamine receptors. Typical antipsychotics like haloperidol treat positive symptoms but cause extrapyramidal side effects. Atypical antipsychotics like risperidol treat both positive and negative symptoms and have fewer side effects. Minor tranquilizers/anxiolytics like alprazolam are used to treat anxiety disorders and promote sleep. They have sedative effects and should be taken with food separately from other drugs to avoid interactions. Antidepressants work to increase appetite and sleep. Tricyclics can cause changes in blood pressure and heart rate so monitoring is needed. MA

Uploaded by

Hershey Lerion
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L.

Lintao 1

BASIC CONCEPTS ON PSYCHOPHARMACOLOGY

MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS


• Indication: Schizophrenia and Other Psychosis
• Desired effect: _________of symptoms
• Best taken after meals
• MOA: Block selected dopamine receptors à decrease dopamine à reduce symptoms

Types Typical Atypical

Examples • Haloperidol • Risperdal


• Mellaril • Seroquel
• Thorazine • Clozaril
Disadvantages • EPS • Expensive
• Treats (+) symptoms only • Less available
• More severe agranulocytosis

Advantages • Cheaper • Less or no EPS


• More available • For both (-) & (+) symptoms

  Before 1990’s After 1990’s

Side effects Nursing Action

Blurred vision Avoid _________

Dry mouth Give sugarless gum

Tachycardia, palpitation, constipation, urinary retention Monitor & report

Photosensitivity Don’t expose skin to sunlight

Orthostatic hypotension Monitor BP


Advise gradual change in position

Extra Pyramidal Symptoms Discontinue the next dose


o Pseudoparkinsonism Report at once
o pill-rolling tremors Give antidote:
mask-like face Anticholinergics
o cog-wheel rigidity • Akineton
o propulsive gait • Artane
o Akathisia - restless leg syndrome • Benadryl
o Dystonia - defect in muscle tone • Cogentin
Dopaminergics: L- Dopa
• Espequel, Sporadel

Neuroleptic Malignant Syndrome (NMS) Withhold the next dose


• Muscle rigidity + high grade fever + _________ Notify the physician
Cooling measures

Adverse effect: report promptly


· Tardive dyskinesia - lip smacking
· Agranulocytosis
o Assess for:
▪ Fever
▪ Sore throat
▪ Lab data: WBC count
· Hepatotoxicity
o Assess for ______ & ______

MINOR TRANQUILIZERS/ ANXIOLYTICS


Ä Common indication: Anxiety disorders
Ä Desired Effect: Decreased anxiety, adequate sleep
Ä Have _________effects

Examples: (XL VASET)


Xanax (Alprazolam)
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 2

Librium (Chlordiazepoxide )
Valium (Diazepam)
Ativan (Lorazepam)
Serax (Oxazepam)
Esquanile
Tranxene (Chlorazepate Dipotassium)

Nursing Implications:
· Best taken _________ meals
· Advise to avoid driving
· Administer it separately with any drug

Anxiolytics +
• _________ = severe hypotension / hypersedation
• Another _________ = respiratory depression à death
• Other drugs = CNS depression
• _________ = less effective

ANTIDEPRESSANTS
Desired effects: increased appetite, adequate sleep

Tricyclic Antidepressants
Examples:
· Imipramine · Amitriptyline
(Tofranil) (Elavil)

Nursing Implications:
Ä Best given after meals
Ä Effectivity: after _________ weeks
Ä Check the BP, it causes _________
Ä Check the heart rate, it causes cardiac _________
Ä Monitor I & O
Ä Monitor for signs of increased IOP

MAO INHIBITORS
Indication: refractory depression

Examples:
· Tranylcypromine (Parnate)
· Phenelzine (Nardil)
· Isocarboxazid (Marplan)

Nursing Implications:
Ä Best taken after meals
Ä Report headache; it indicates ______________ crisis
Ä Avoid tyramine containing foods like:
· Avocado
· Banana
· Cheddar and aged cheese
· Soysauce
· Preserved foods
Ä Effectivity: 2-3 weeks
Ä Monitor the BP
Ä There should be at least a _____________ interval when shifting from one anti-depressant to another

Selective Serotonin Reuptake Inhibitors


· Fluoxetine · Paroxetine (Paxil)
(Prozac) · Fluvoxamine
· Celatopram (Luvox)
(Celexa)
· Sertraline (Zoloft)

Nursing Implications:
Ä Avoid the use of:
· Diazepam · Tryptophan
· Alcohol
Ä
Ä Monitor PTT, PT
Ä Never give to pregnant / lactating mothers.
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 3

ANTI-MANIC AGENT
Examples:
· Lithium Citrate · Lithium Carbonate
(Cibalith – S) (Eskalith, Lithane, Lithobid)

Nursing implications:
Ä Never give to _________ mothers
Ä Best taken after meals
Ä Increase intake of:
· fluids (3 L /day)
· sodium (3 gm/day)
Ä Avoid activities that increase perspiration
Ä Effectivity: 10-14 days
Ä Antipsychotic is administered during the first 2 weeks

Level Status S/Sx Nursing Interventions


(mEq/L)

.5 – 1.5 ________ Monitor


Increase _________ & fluid intake

1.6 ________ D/C next dose


Report
*_________

1.7 – 1.9 _________ V_________ D/C next dose


Anorexia Report
Nausea *_________ (antidote)
D_________
Abdominal
cramps

2.0 and _________ _________ D/C next dose


above (Altered LOC) Report
*_________

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