Medication appropriate for a person in acute and extreme psychomotor agitation is:
Typical - Haldol, Thorazine
Atypical - Geodon, Ativan
The patient has been taking lithium for months. Her most recent blood level was 2.2 mEq/L. What reactions might the nurse expect to see?
This is above maintenance level.
From 2 - 3.5 - increased tremors, muscular irritability, psychomotor retardation, mental confusion, giddiness, excessive output of dilute urine
From 3.5 - above - potentially life threatening, arrhythmia, MI, cardiovascular collapse, impaired consciousness, nystagmus, seizures, oliguria, aneuria
The patient has been taking Prozac, a SSRI, for 3 weeks. In your teaching for the patient would include telling him about common side effects involved with this drug. What are the common side effects?
Headache, insomnnia, sexual dysfunction, GI upset, weight changes, anxiety
When you are teaching the patient about his SSRI, Zoloft, he askes you, "What makes this such a good drug?" What are some of the positive attributes of the SSRIs? What is one of the most serious, although rare, side effects of the SSRI?
Positive: lower incidence of anticholinergic SE, less cardio-toxicity, faster onset of action than TCAs, effective antidepression with anxious features, clients with psychomotor agitation, less dangerous when OD.
Rare: Serotonin Syndrome - overreaction of Central Serotonin receptor
increase levels of neurotransmitters in the CNS. The produce CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, diminshed sense of fatigue and brighter spirits
What are the side effects and nursing implications of CNS stimulants?
Overstimulation, restlessness, insomnia - assess mental status for changes in mood, level of activity, degree of stimulation and aggressiveness. Ensure pt is protected from injury, keep stimuli low and environment as quiet as possible to discourage overstimulation; to prevent insomnia, administer last dose 6-8 hours before bedtime.
Palpitations, tachycardia - monitor and record VS at regular intervals throughout therapy. Report significant changes to dr.
Anorexia, weight loss - to reduce anorexia, the medication can be administered immediately after meals. Weigh pt regularly because of anorexia and temporary interruption of growth and development
Tolerance - develops rapidly. Take drug holidays under dr. direction.
Drug should not be DCd abruptly. To do so could initiate: N/V, abdominal cramping, HA, fatigue, weakness, mental depression, suicidal ideation and increase in dreaming and psychotic behavior.
Stopping a CNS stimulant abruptly could cause:
N/V, abdominal cramping, HA, fatigue, weakness, mental depression, suicidal ideation and increase in dreaming and psychotic behavior.
What are the side effects of Antipsychotic medications?
Anticholinergic effects, nausea, GI upset, skin rash, ortostatic hypotension, photosensitivity, hormonal effects, weight gain, reduction of seizure threshold, salivation, EPS
Anticholinergic effects are a side effect of antipsychotic and antidressant medications. What are they and what are the nursing implications?
Dry mouth - give sugarless hard candy, ice, water, good oral hygiene
Blurred vision - should subside, do not drive until vision clears
Constipation - high fiber diet, increase fluid intake and physical activity
Urinary retention - report any difficulty urinating, Monitor I&O
One of the extrapyramidal symptoms of antipsychotic medications is pseudoparkinsonism. What are the signs and symptoms?
One of the extrapyramidal symptoms of antipsychotic medications is Akathisia. What are the signs and symptoms?
Akathisia - continuous restlessness. Motor inner driven restlessness, agitation; shifting of weight from foot to foot, inability to sit still.
One of the extrapyramidal symptoms of antipsychotic medications is Dystonia. What are the signs and symptoms?
Dystonia - involuntary muscular movements of face, arms, legs. Spasms of major muscle groups of the neck, back, eyes. Oculogyric crisis - uncontrolled rolling back of eyes - may be mistaken for seizure activity; should be treated as emergency situation - contact dr and IV benzos (Cogentin) given. Stay with pt and reassure
One of the extrapyramidal symptoms of antipsychotic medications is Tardive dyskinesia. What are the signs and symptoms?
This is a late onset symptom. Bizarre facial and tongue movements, stiff neck, lip smacking, tongue protrusion and thrusting, blinking, grimacing and other excessive unnecessary facial movements. All patients receiving long-term antipsychotic therapy are at risk; symptoms are potentially irreversible; assess pt frequently by doing rating scale for EPS such as AIMS.
There are two life threatening effects of antipsychotic medications. What are they and what are their symptoms and nursing indications?
Agranulocytosis - rare - usually occurs within three months; S&S: sore throat, fever, malaise. A CBC should be done. With Clozaril patients should have weekly blood counts for 6 mths.
Neuroleptic Malignant Syndrome - rare, but potentially fatal. S&S: severe parkinsonian muscle rigidity, lead pipe rigidity, hyperpyrexia, tachycardia, increase in CPK, tachpnea, fluctuations in BP, diaphoresis, rapid deterioration of mental status to stupor and coma. Routine assessments of temp and observe for parkinsonian symptoms. Stop drug immediately, monitor VS, degree of muscle rigidity, I&O, LOC
Antiparkinsonian agents include three subcategories. What are they?
Cogentin, Akineton, Parsidol, Kemadrin, Artane
What is the action of antiparkinsonian agents?
To restore the natural balance of two major neurotransmitters in CNS - acetylcholine and dopamine
What are the side effects and nursing interventions of Antiparkinsonian agents?
Paralytic ileus - rare - monitor for abdominal distention, absent bowel sounds, N/V, epigastric pain, report to dr.
urinary retention - tell pt to report difficulty, monitor I&O
tachycardia, decreased sweating, increased temperature - assess VS each shift; report any changes
Nausea, GI upset - give with food
Sedation, drowsiness, dizziness - give at bedtime, tell pt. not to drive
Exacerbation of psychoses - assess for signs of loss of contact with reality; intervene during hallucinations; talk about real events; orient to reality; stay with patient during agitation and delirium; remain calm
What are the categories and names of antianxiety medications?
Antihistamines - hydroxyzine
What is the action of BuSpar?
It does not depress CNS. It is beleied to produce desired effects through interactions with serotonin, dopamine and other neurotransmitter receptors.
What are the side effects and nursing indications for antianxiety medications?
drowsiness, confusion, lethargy (most common)
Tolerance - instruct patient not to dc abruptly.
Ability to potentiate effects of other CNS depressants - instruct not to drink alcohol or take other medications that depress CNS
Possibility of aggravating other depressive symptoms - assess patients mood daily; take necessary precations
paradoxical excitement - symptoms opposite of desired effect - stop taking drug, notify dr.
What are the different side effects of BuSpar that do not apply to other antianxiety meds?
lag time of 10 days to 2 weeks between onset of therapy and subsiding of anxiety.
No evidence that BuSpar creates tolerance or dependence
What are the life threatening effects of antianxiety meds?
What are the nursing implications and teaching of Parnate?
do not give in evening - insomnia; monitor BP, assess for psychosis, hypomania, seizures, CBC, liver function test; assess mental status, mood changes, monitor pulse rate, I&Os, avoid tyramine rich foods - hypertensive crisis; do ot DC abruptly, avoid alcohol, change position slowly, avoid caffeine
What are the nursing implications and teaching of Marplan?
do not give in pm - insomnia; assess mental status, mood changes; monitor BP and pulse rate; I&O, liver function; avoid tyramine, tryptophan, tyrosine; avoid alcohol, caffeine, CNS depressants; don't DC abruptly; change position slowly
What are the nursing implications and teaching for Wellbutrin and Zyban?
CP in history of bulimia, increased risk of bleeding with warfarin, nicotine may cause hypertension
may be used with sedatives for first week, avoid bedtime doses, give with food, for SAD give in fall, taper in early spring, assess mood change and mental status, restrict amount available to patient, may require 4 weeks, may impair judgment, watch for suicidality, avoid alcohol, unused shell may appear in stool, use sunscreen, cease smoking during 2nd week
What are the nursing implications and teaching with Desyrel?
May increase digoxin, increase CNS depression with other CNS depressants, may increase PT with warfarin; administer with meals monitor BP, P; assess mental status, suicidal tendencies; assess CBC, renal and hepatic function
Change position slowly, avoid alcohol and CNS depressants
What are the side effects of Remeron?
no sexual disturbances, drowsiness, constipation, dry mouth, increased appetite, agranulocytosis, weight gain
What are the nursing implications and teaching of Remeron?
may give at bedtime to decrease drowsiness, assmental status and suicidal tendencies, take BP and P, weight, seizure activity, CBC, hepatic function
Change position slowly, avoid alcohol and CNS depressants; notify dr. if dry mouth urinary retention or constipation; monitor dietary intake
Enhance the reuptake of serotonin, norepinephrine; decrease levels in body
What are the side effects of Lithium Carbonate?
Fatigue, seizures, impaired memory, anorexia, abdominal pain, bloating, hypothyroid, drowsiness, dizziness, headache, dry mouth, thirst, GI upset, N/V, fine hand tremors, hypotension, arrhythmias, pulse irregularities, polyuria, dehydration, weight gain
What are the signs of Lithium toxicity?
blurred vision, ataxia, tinnitus, severe N/V, severe diarrhea, severe tremor - stop drug notify dr.
What are the nursing implications and teaching of Lithium?
Give with food or milk; monitor VS 2-3 times/day; monitor I&O, turgur; doctor may give propranolol for tremors; assess mental status; monitor lithium levels; draw blood samples in a.m.
Drink 2000-3000 ml/day; consistent and moderate sodium intake, avoid excessive amount of caffeine; avoid activities cause increased sodium loss; notify doctor of diarrhea, vomiting; ECG evaluated if histor of CVD or older than 40; notify dr of irregular pulse, SOB
What are the nursing implications and teaching of Klonopin?
Interaction with alcohol, antidepressants, antihistamines, benzodiazepines; seizure precautions; give with food; taper off; assess degree and manifestation of anxiety and mental status; assess for drowsiness, unsteadiness, clumsiness; monitor CBC and liver function.
Avoid alcohol, CNS depressants; notify dr. of unusual tiredness, bleeding, sore throat, fever, clay color stools, yellow skin, behavior changes, suicidality, aggression, violence or other behavior changes
What are the nursing implications and teaching of Tegretol?
CP in bone marrow suppression; seizure precautions, give with food, give at bedtime, do not give suspension with other liquid meds - becomes orange rubbery mass, monitor for behavior changes, monitor for changes in skin condition, monitor CBC, platelet, reticulocyte, serum, iron; perform genetic testing in patient of Asian ancestory; DC if bone marrow depression
Notify dr if behavior changes; skin rash, fever, sore throat, mouth ulcers, bruising, abdominal pain, chills, pale stool, dark urine, jaundice, avoid alcohol and grapefruit juice; use sunscreen and nonhormonal contraception
What are the nursing implications and teaching of Depakene?
Give with food; give at bedtime; assess for seizures; assess for suicidality, hepatic function; may interfere with accuracy of thyroid funciton test; false positive urine ketone tests;
do not drive until dr clears; avoid alcohol and CNS depressants; watch for behavior changes, suicidality, and panic attacks; carry ID describing regimen; notify dr if anorexia, abdominal pain, severe N/V, facial edema, lethargy, bleeding, bruising; pregnant pts enroll in NAAED pregnancy registry
What are the nursing implications and teaching of Depakote?
increased bleeding with warfarin; toxicity increased by aspirin and carbamazepine; give with meals; do not give with milk or carbonation; assess seizures, suicidality, mood; monitor CBC, plateletes, bleed time, hepatic function; may interfere with accuracy of thyroid function; false positive urine ketone tests;
do not DC abruptly; no driving til cleared by dr; avoid alcohol and CNS depressants; monitor mood, behavior changes, suicidality; pregnant pts - register with NAAED pregnancy registry; carry ID, drug regimen; call dr if anorexia, abdominal pain, jaundice, severe N/V, easy bleeding, bruising
What are the nursing implications and teaching of Trileptal?
may alter effects of drugs, may decrease effectiveness of hormonal BC; implement seizure precautions; monitor ECG and electrolytes; may cause hyponatremia; may require fluid restrictions and DC of med; gradually DC, avoid alcohol and CNS depressants; no driving until okayed by dr; use alternate forms of BC; notify dr of behavior changes, suicidality; carry ID and med regimen
What are the teaching and nursing implications of Topamax?
monitor for behavior changes and suicidality; monitor CBC and platelets; may cause anemia and metabolic acidosis;
if more than one dose missed, gradually DC; may cause decreased sweating and increased body temp; hydrate well in heat; 2000-3000 ml/day to prevent stones; avoid driving until response known; avoid alcohol and CNS depressants; use nonhormonal BC; use sunscreen; carry ID, notify dr if behavior changes, eye problems or before surgery
What is a combination antipsychotic and antidepressant for Bipolar treatment?
What are the nursing implications and teaching of verapamil?
give with food or milk; patient should remain recumbent for 1 hour after IV, administer over 2 minutes; monitor BP, PR, ECG, I&O, daily weight, signs of CHF, renal and hepatic function
Avoid large amounts of grapefruit juice and caffeine; teach to take pulse; contact dr if HR<50; change position slowly; good dental hygiene; avoid alcohol, cold meds; notify dr of irregular HB or severe headache, wear sunscreen
What are the Central Nervous System stimulants - amphetamines?
What is the action of CNS stimulants - amphetamines?
Increase levels of neurotransmitters in CNS; produce CNS and respiratory stimulation; dilated pupils, increased motor activity and mental alertness; decreased sense of fatigue and brighter spirits
What are the teaching and nursing implications of Ritalin?
Give with water, milk, or juice; monitor BP, P, R; assess for heart disease; monitor for behavior chang; monitor height and weight
Avoid caffeine; shell may appear in stool; may need medication holidays
What are the side effects of Cylert?
seizures, insomnia, hepatic failure, anorexia, additive CNS stimulants with other CNS stimulants
What are the teaching and nursing implications of Cylert?
give in the morning; medication holidays; assess attention span; motor or vocal tics; impulse control; behavior changes; monitor height and weight; serum ALT every 2 weeks; may cause elevated LDH; alkaline phosphate, AST and ALT levels; taper off; may cause dizziness; avoid caffeine; may cause liver failure
What are the teaching and nursing implications of Concerta?
give on empty stomach, take with water milk or juice; monitor BP, P, R; monitor height and weight; may produce false sense of euphoria and well being; monitor CBC, differential and platelet count; take last dose 6 hours before bedtime; do not abruptly DC; avoid caffeine
What are the teaching and nursing implications of Adderall?
Fruit juices can increase effect of amphetamine; medication free days; monitor BP, P, R; obtain family history; may produce false sense of euphoria; high dependence and abuse potential; assess height and weight; take last dose 6H before bed; avoid caffeine; may impair judgment; may cause dry mouth
What are the side effects of Vyvanse?
behavioral disturbances, sudden death, anorexia
What are the teaching and nursing implications of Vyvanse?
administer in morning; assess attention span and impulse control; monitor BP, P, R; history of family sudden death; evaluate unexplained syncope; monitor height and weight; monitor for behvior change
notify HCP of signs and symptoms of heart problems; check weight 2-3 times/weekly
What is the CNS nonstimulant drug for ADHD?
What are the traditiona/typical antipsychotics?
What are the side effects of Prolixin?
NMS; extrapyramidal reactions, photosensitivity, agranulocytosis; may increase risk of lithium toxicity; may cause Q & T wave changes
What are the teaching and nursing implications of Prolixin?
Do not mix with caffeine, tannins or pectinates; assess mental status, BP, P, R, ECG; watch that patient swallows pills; assess fluid take and bowel function; observe for akathisia, parkinsonia, dystonia; give benzos or benadryl for symptoms
Change position slowly; may cause drowsiness; use sunscreen; good oral hygiene; notify HCP of bleed, rash, hepatic or renal function
What are the teaching and nursing implications of Haldol?
administer with food, do not dilute with coffee or tea; assess mental status, BP, P, ECG; may cause QT interval changes; monitor I&O, weight; assess fluid intake and bowel function; monitor for akathisia, parkinsonian, dystonic - give benzos; monitor for NMS, leukocytosis; increased liver function tests; increase CPK; monitor CBC and liver function tests; do not increase or DC without dr permission; may cause drowsiness; avoid alcohol; use sunscreen; good oral hygiene
What are the teaching and nursing implications of Stelazine?
Give with food; assess mental status, weight, BMI, BP, ECG, sedation, I&O, weight; make sure pill is swallowed; monitor for akathisia, parkinsonian, dystonic - give benzos or benadryl; monitor for NMS, CBC, liver function, ocular exams; may cause false +/- pregnancy tests.
Do not abruptly DC, change position slowly; may cause drowsiness; avoid extremes in temps; avoid alcohol; may turn urine pink to reddish brown