NURS 1950Nancy Pares, RN, MSN
Metro Community College
http://www.cafeoflifepikespeak.com/Videos/Licensed%20To%20Pill.swf
Four groups (also called anxiolytics/tranquilizers)◦ Antidepressants (Chap 16)◦ Benzodiazepines◦ Barbiturates◦ Nonbenzodiazepines/nonbarbiturate CNS
depressants
Baseline data◦ Cause of anxiety◦ Vitals◦ Blood dyscrasias, liver disease, pregnancy or
breastfeeding
WHY?
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
Advantages
End in ‘pam’◦ Diazapam (Valium),oxazepam (Serax), lorazapam
(Ativan)**
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
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)
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
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
Buspar◦ Schedule regular assessments for slurred speech,
dizziness, CNS disturbances; give at regular intervals (not PRN); do not use with MAO Inhibitors or ETOH
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
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?
Classifications◦ Tricyclics◦ MAO inhibitors (monoamine oxidase)◦ SSRI◦ Atypical Antidepressants
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
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
Adverse effects:◦ Tremor, numbness, tingling, Parkinsonian
symptoms, orthostatic hypotension, anticholinergic effects (which are?)
◦ Cardiac arrhythmias, suicidal actions
Do not use with MAOI..why? Sympathomimetics increase effects of
anticholinergic effects Avoid OTC antihistamines Prototype: imipramine (Tofranil)
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
• 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
• 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
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
General anesthesia, diuretics, antihypertensives: potentiate the hypotensive effects
Insulin and oral hypoglycemics: additive effects
Meperidine and MAOI= severe reactions
What assessments need to be made before antidepressant medications?
What are the nursing diagnosis you would write for clients with antidepressant meds.?
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
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
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
normal blood level: Nutrition needs: Desired effects in 5-7 days; full effect in 21
days Give with food or milk
Phenothiazines Non phenothiazine Atypical anti psychotics
Chlorpromazine (Thorazine) Action:
◦ Prevent dopamine and serotonin from occupying their receptor sites and block the excitement symptoms
Use: ◦ Schizophrenia, bipolar (manic state), depression,
antiemetic
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
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)
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
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
New drug aripiprazole (Abilify)◦ Dopamine stabilizer with fewer EPS
◦ Adverse effects: HA, N/V, fevers constipation, anxiety
◦ Nursing implications As all other categories