1
ALL psychiatric drugs cause
low BP and weight changes—usually weight gain
The #1 nursing diagnosis for “ABCDF” S/Es
•
The #1 nursing diagnosis for “G” S/Es is to teach pt to
is to teach pt about SAFETY
report signs of infections to HCP
If you want to put someone asleep, give
him the
ZZzzs
• Zines for the Zany (major antipsychotics)
• Zeps for the minor antipsychotics
S/Es of Benzodiazepines are “ABCD”
• Anticholinergic
• Blurred Vision
• Constipation
• Drowsiness
What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the
time?
• #1 intervention
• The above S/Sx are S/Es—expected
• Monitor
o Give pt fluids
sodium
• Low sodium makes lithium toxic
• High makes lithium ineffective
• Sodium needs to be normal
Phenothiazines
• First generation or
• All end in
• They don’t cure ... They just
• We use ZINEs for Antipsychotics
• In small doses, they are
• typical antipsychotics
• “ZINE”o Example: Thorazine, Compazine
• reduce symptoms
• the ZANY (Cuckoos) ...
• antiemetics (to treat vomiting)
Decanoate or “Caprate” form of a medication
• The long-acting
• Sometimes denoted with
• IM form given for
• Often
form of a drug
• the letter “D”
• non-compliance
• Often Court-ordered
Benzodiazepines
>Anti anxiety, major tranquilizers that always have
>Remember ZZzzs for
>Many end in
Protype: Valium, induction of
>ZEP in the name
>falling/going to sleep
>Pam or Lam
>anesthetic, muscle relaxant, ETOH
Monamine Oxidase (MAO) Inhibitors
• Antidepressant
• Depression is thought to be caused by
• Name of MAOIs starts with
norepinephrine, dopamine, and serotonin in brain
MARplan, NARdil, PARnate the beginnings—all rhyme
What is the #1 nursing intervention in a pt on lithium presenting with metallic taste and severediarrhea?•
#1 interventiono Give pt fluids
Notify the HCP—this is a toxic effect
Phenothiozines
are major tranquilizers• Major tranquilizers—big guns psych meds—are Antipsychotics
Tricyclic Antidepressants
• Grandfathered into the
• Mood
• Elavil (elevates),
o Elevates
Tricyclic Antidepressants
• NSSRI (Non-selective serotonin reuptake inhibitor) group
• elevators (Happy pills)
• Trofranil, Aventyl, Desyrel
o Elevates the mood
Benzodiazepines can be uses as
Seizure meds, preop induction of anesthesia, muscle relaxants, ETOH withdrawl meds, ventialtion med to relax & calm down pt on ventilator
• S/E of MAOIs
o Anticholinergic
o Blurred Vision
o Constipation
o Drowsiness
Prozac (fluoxetine)
• SSRI, mood elevator
• Side effects of Prozac are
• Causes insomnia so give
• When changing doses, watch for
o Anticholinergic
o Blurred Vision
o Constipation
o Drowsiness
o Euphoria (happy)
before noon. If bid, give at 6 a.m. and noon
suicidal risk in adolescents
o Must recently change the dose and be an adolescent of young adult
Antipsychotics S/Es = “ABCDEFG”
Anticholinergic (dry mouth, urinary retention)
oBlurred vision
o Constipation
o Drowsiness
o EPS (tremors, Parkinson)
o Foto sensitivity
o aGranulocytosis (low WBC count, immunosuppressed)
Teach patient how to recognize and report sore throat and symptoms of infection
o 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
Benzos work quickly but do not
take than for more than 2-4 weeks
Teaching Points
• Avoid tyramine-containing food ... May
• Food with tyramine
o No
cause Hypertensive Crisis
o Fruits/Veggies—Avoid salad “BAR”: Bananas, Avocados (guacamole), Raisins (dried
fruit)
o Grains—Ok to have, except Yeast
o Meats—No organs liver, kidney, tripe, heart, no preserved meats (smoked, dried, cured,
pickled, hot dogs)
o Dairy—No chees except for mozzarella, cottage cheese (no aged cheese)
EtOH, elixirs, tinctures (iodine/betadine) caffeine, chocolate, licorice, soy sauce
HALDOL (haloperidol)
• Tranquilizers (basically same as )
• S/E of Haldol
Teach patient how to recognize and report
• First generation antipsychotics
• Pts may develop
Thorazine
o Anticholinergic (dry mouth, urinary retention)
o Blurred vision
o Constipation
o Drowsiness
o EPS (tremors, Parkinson)
o Foto sensitivity
o aGranulocytosis (low WBC count, immunosuppressed)
sore throat and symptoms of infection
NMS (neuroleptic malignant syndrome) from overdose
o Seen in elderly and young white schizophrenic pts
o High fever over 105
o Their doses should be about ½ usual adult dose
What is the nursing action when someone presents with a Toxic effect?
o HOLD the drug ! Notify HCP
So, after the first week of antidepressant therapy, pt will complain the drug is not working
Teach pt that the medication takes about 2 to 4 weeks to reach therapeutic effects
Administer major and minor tranquilizers at the same time. Why?
• The major antipsychotics take a
• The minor antipsychotics start working
• Both are administered at the
• Example: pt is usually put on
o Valium is discontinued in
• long time to start working
• right away
• the same time
• Valium and Elavil at the same time
o 2 to 4 weeks once Elavil kicks in
Lithium
• Used for treating
• S/E: Very Unique—acts more like an
• The 3 Ps as S/Es
The earliest sign of electrolyte imbalance is
Toxic effects of lithium
Bipolar disorder—it decreases the mania LI = BI
electrolyte—think: Potassium/Lithium
o Peeing (Polyuria)
o Pooping (diarrhea)
o Paresthesia (earliest sign of electrolyte imbalance)
Paresthesias = Numbness and Tingling
• Tremors
• Metallic taste
• Severe diarrhea
A pt is being treated with an antipsychotic medication. Pt becomes anxious and presents with
tremors. What is the nurse intervention to differentiate NMS (neuroleptic malignant syndrome) from EPS (extrapyramidal syndrome)?
• Measure the pts’ temperature
o If temperature is WNL, this is EPS
o If temperature is 102 and rising, call the emergency response team and notify HCP ...
NMS is lifethreatening
• NMS presents with anxiety and tremors, and so does EPS
Note: With Haltol, there are safety concerns related to the S/Es