Anti-anxiety Medications
Used in anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms convulsive disorders, status epilepticus and pre-operative sedation.
Anti-anxiety Medications
Potentiate the effects of GABA in the brain which produces a calming effect
Anti-anxiety medications
All levels of CNS depression can be affected, from mild sedation to coma.
BuSpar (buspirone)
Does not depress CNS. Takes a long time to reach therapeutic levels. Cannot be prescribed prn.
Anti-anxiety medications
Contraindicated with other CNS depressants, pregnancy, lactation, narrow-angle glaucoma, shock and coma. Use cautiously with elderly, debilitated, and if a history of hepatic or renal failure; also use cautiously if history of drug abuse, addiction, or su
Anti-anxiety medications
Increased effects occur with: alcohol, barbiturates, narcotics, anti-psychotics, anti-depressants, anti-histamines, neuromuscular blocking agents, cimetidine (Tagamet), or disulfiram (antabuse), also with herbs kava and valerian. Decreased effects occur w
Anti-anxiety medications
Side effects: drowsiness, confusion, lethargy, physical and psychological tolerance, ability to potentiate the effects of other CNS depressants, aggravating depression symptoms, orthostatic hypotension, paradoxical excitement, dry mouth, nausea and vomiti
Client teaching for anti-anxiety medications
Do not drive or operate heavy machinery; do not stop taking the drug abruptly; do not consume other CNS depressants; do not take other meds without the approval of physician; move slowly when changing positions; report to the physician any sore throat, fe
Anti-depressant medications
Used in dysthymic disorder, major depression with melancholia, or psychotic symptoms, depression associated with organic disease, alcoholism, schizophrenia, mental retardation, depressive phase of bipolar disorder, depression accompanied by anxiety.
Anti-depressant medications
Increase concentration of norepinephrine, serotonin, and/or dopamine in the body
Anti-depressant medications
Contraindicated in elderly, debilitated, hepatic, cardiac or renal insufficiency and TCA use in the acute phase of recovering from an MI and if angle-closure glaucoma
Anti-depressant medications
Broken down into three distinct classes: tricyclics (TCA), MAO inhibitors (MAOI), and selective serotonin reuptake inhibitors (SSRI)
SSRI
Selective Serotonin Reuptake Inhibitor
SSRI
Increases the concentration of serotonin in the body
SSRI
Interactions: When used with cimetidine (Tagamet) may result in increase concentrations of SSRI; do not use within 14 days of an MAOI or hypertensive crisis can occur; increases impairment of mental and motor skills if used with alcohol; increases concent
SSRI
Side effects: insomnia, agitation, HA, weight loss, sexual dysfunction, serotonin syndrome (changes in mental status, restlessness, myoclonus, hyper-reflexia, tachycardia, labile BP, diaphoresis, shivering, and tremor; d/c med that caused reaction, suppor
Tricyclic Anti-depressants
Increases the concentration of norepinephrine in the body
Tricyclic Anti-depressants
Interactions: When used with MAOI's can produce hyperpyretic crisis, severe seizures, and tachycardia; can prevent therapeutic response with some anti-hypertensives, check with doctor, intensifies the effect of CNS depressants
Tricyclic Anti-depressants
Side effects: blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, bupropon (Wellbutrin) doses should be at least 4 hours apart, no more than 150 mg per dose, and given with extreme caution to anorexic/
MAOI
Monoamine Oxidase Inhibitors
MAOI
Very effective anti-depressant, anti-panic, anti-phobic medication. Two most common are phenelzine (Nardil) and tranylcypromine (Parnate)
MAOI
Potentiates effects of: alcohol, barbiturates, cocaine, anti-histamines; narcotics; steroids
MAOI
Dose may need to be adjusted with: insulin, oral hypoglycemic, oral anti-coagulant, thiazide, diuretic, anti-cholinergic, muscle relaxant
MAOI
Restricted diet for several days before beginning med, during therapy, and for 2 weeks after d/c med; continue diet for 6 weeks after d/c if client was taking fluoxetine (Prozac) Avoid tyramine containing food because of potential risk of hypertensive cri
Mood Stabilizers
Used to control manic episodes. Improves productivity by decreasing psychomotor activity or response to environmental stimuli
Mood Stabilizers
Two most common are lithium carbonate and lithium citrate (concentrate form). Alternatives are anti-convulsants, anti-psychotics and calcium channel blocker verpamil (calan)
Mood Stabilizers (lithium)
Diuretics increase the reabsorption of lithium resulting in possible toxic effects. Sodium bicarb or sodium chloride increases the excretion of lithium (start IV if toxic). If given with haloperidol (haldol) and/or thioridazine (mellaril) can result in en
Mood Stabilizers (lithium)
Begins to be effective in 1-2 weeks, but takes 4 weeks or longer to be fully effective. Levels are drawn weekly until stable, then every 3-6 months routinely
Mood Stabilizers (lithium)
A salt; sodium and fluid balance of the body effects regulation
Lithium toxicity
Toxic level= blood levels greater than 1.5 mEq/L Toxicity symptoms: 1.5-2.0 mEq/L: blurred vision, ataxia, tinnitus, persistent nausea and vomiting, severe diarrhea; 2.0-3.5 mEq/L: excessive output of dilute urine, increasing tremors, muscular irritabilit
Client/Family education for lithium
Do not skimp on dietary sodium intake, avoid junk food, drink 6-8 large glasses of water daily, avoid caffeine
Client/Family education for anti-depressants
Use sunblock lotion and wear protective clothing when outdoors; rise slowly from lying to sitting positions to prevent drop in BP; avoid smoking if on TCA; don't drink alcohol
Anti-psychotic agents
Do not cure psychoses; does reduce the symptoms. Also called major tranquilizers or neuroleptics
Anti-psychotic agents
Major uses include: management of schizophrenia, dementia with psychoses, manic phase of bipolar disorder, occasionally used with severe depression with psychotic features
Anti psychotic agents
Non-psychiatric uses include: vomiting, intractable hiccoughs, control of tics and vocal utterances in Tourette's disorder
Anti-psychotic agents
Exact mechanism of action is not known. Works to block dopamine to decrease psychotic behavior
Anti-psychotic agents
Contraindications/Precautions: contraindicated with a known hypersensitivity; do not use with CNS depressants; blood dyscrasias; Parkinson's liver or cardiac insufficiency; use cautiously with elderly, severely ill or debilitated, diabetic clients; respir
Anti-psychotic agents
Interactions: enhances anti-cholinergic effects of other meds; enhances hypotensive effects of beta-adrenergic agents; antacids and anti-diarrhea meds decrease absorption; enhances effects of drugs that produce respiratory depression
Anti-psychotic agents
Side effects: anti-cholinergic effects; nausea; skin rash; sedation; orthostatic hypotension; photosensitivity; hormonal effects; ECG changes; reduction in seizure threshold; extrapyramidal symptoms; dystonia; tardive dyskinesia; neuroleptic malignant syn
Client/Family Education for anti-psychotic agents
Use caution when driving; do not stop taking drug abruptly after long term treatment; use sunscreen and protective clothing when outdoors; weekly blood work if taking clozapine; no OTC meds without physician approval
Anti-psychotic agents
Have a wide therapeutic range; overdose usually are not fatal. Do not produce euphoria, so low abuse potential. Discontinue temporarily if have epidural or spinal anesthesia.
Clozapine (clozaril)
Atypical anti-psychotic. Does not cause Tardive Dyskinesia or worsen symptoms of pre-existing condition. In some cases symptoms improved after typical anti-psychotic d/c. May cause: orthostatic hypotension; tachycardia; sedation; anti-cholinergic effects;
Olanzapine (zyprexa)
Atypical anti-psychotic. Some clients respond to the drug with in 2-3 days or can take up to 2 weeks. Once stabilized dose is lowered to the lowest effective dose. Bedtime dosing allows client to sleep through side effects when they are at their peak. Wil
Extrapyramidal side effects
Common with the use of typical anti-psychotics drugs (Mellaril and Thorazine). Painful, disabling, and stigmatizing. Can usually be prevented or minimized and effectively treated. Tolerance to most of these side effects usually occurs in the first 3 month
Anti-parkinsonian agents used to treat extrapyramidal side effects
Anticholinergics: Benztropine (Cogentin); Biperidan (Akineton); Procyclidine (Kemadrin); Trihexyphenidyl (Artane). Antihistamines: Diphenhydramine (Benadryl) Dopaminergic agonists: Amantadine (Symmetrel)
Neuroleptic Malignant Syndrome
Occurs within the first few weeks of treatment. Potentially fatal. S/S include: fever up to 107, tachycardia, sweating, muscle rigidity, tachypnea, fluctuations in BP, stupor. More common with high potency drugs and in dehydrated clients. Treatment: sympt
Tardive Dyskinesia
Occurs after long-term treatment with typical anti-psychotics. Stereotypical involuntary movements include: tongue protrusion, lip smacking, chewing, blinking, grimacing, spasmodic movement of limbs and trunk, foot tapping. Consider changing to an atypica
Dietary Restrictions for clients taking MAOI drugs-Must Avoid
Aged cheeses (cheddar, Swiss, Camambert, blue cheese, Parmesan cheese, provolone, brie); Raisins, fava beans, flat Italian beans, Chinese pea pods; Red wines ( Chianti, burgandy, cabernet sauvignon); Smoked and processed meats (salami, bologna, pepperoni,
Diet Restrictions for clients taking MAOI drugs-In moderation
Gouda cheese, processed American cheese, mozzarella; Yogurt and sour cream; Avocados and bananas; Beer, white wine, coffee, colas, tea, hot chocolate; Meat extracts, such as boullion; Chocolate
Dietary restrictions for clients taking MAOI drugs-Limited quantities permissible
Pasteurized cheeses (cream cheese, cottage cheese, ricotta) Figs, Distilled spirits (in moderation)
Central Nervous System Stimulants
Used with ADHD and possibly conduct disorders. Used when primary symptoms manifest in school. Most reliable in 7-13 year olds.
Central Nervous System Stimulants
Action: Increases level of neurotransmitters; produces CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, diminished sense of fatigue, and brighter spirits.
Central Nervous System Stimulants
Interactions: MAOI if used within 14 days of d/c; insulin requirements may need to be adjusted; enhances effects of amphetamines
Medications for ADHD: Stimulants
Desired action: increases attention span; controls hyperactive behaviors, and improves learning ability
Medications for ADHD: Stimulants
Side effects: Overstimulation, restlessness, insomnia, anorexia, weight loss, palpitations, tachycardia, tolerance, physical and psychological dependence, N and V, constipation, potential for seizures, and temporary decrease in growth and development
Medications for ADHD: Anti-depressants (bupropion; Wellbutrin)
Side effects: tachycardia, dizziness, shakiness, insomnia, nausea, anorexia, and weight loss; do not take if a history of seizures or eating disorders
Medications for ADHD: Anti-depressants (imipramine: tofranil)
Side effects: sedation, dry mouth, increased appetite, changes in atrioventricular conduction of the heart, hypertenstion or hypotension, dysrhythmias, and tachycardia, ECG before beginning therapy
Medications for ADHD: Anti-depressants
Need a once a day dose; monitor compliance and toxicity levels; monitor cardiac status and signs of overdose
Disulfiram (Antabuse)
Interrupts metabolism of alcohol. Symptoms of a reaction can occur within 5-10 minutes of consuming alcohol. Be sure client has abstained from alcohol for at least 12 hours before administering. Causes a buildup of toxic substance in the body if the perso
Disulfiram (Antabuse)
Must give excellent instructions about the consequences of drinking alcohol. Things to avoid: Alcohol, cough medications, rubbing compounds, after shave lotions or colognes, some mouth washes, certain desserts, vanilla extract, nail polish removers. No dr
Methadone (Dolophine)
Synthetic opiate. Blocks craving for and the effects of heroine. Withdrawal symptoms begin within 8-12 hours after the last opioid dose and become intense by 36-48 hours; acute phase is over in 10 days; irritability and restlessness may occur for 2-3 mont
ECT medications: glycopyrrolate (Robinul)
classification: quaternary anti-cholinergic. Action: reduces salivation and excessive secretions; use cautiously in patients with GI disturbances, cardiac conditions or respiratory conditions. Side effects: dry mouth, decreased sweating and constipation.
ECT medications: atropine sulfate
classification: belladonna alkaloid. Action: prevents/reduces salivation and respiratory tract secretions in anesthesia, use cautiously with clients with GI disturbances, cardiac conditions, or respiratory conditions. Side effects: dry mouth/nose/throat,
ECT medications: succinylcholine (Anectine)
classification; ultrashort neuromuscular blocker. Action: prevents severe muscle contractions during the seizure, thereby reducing the possibility of fractured or dislocated bones. Side effects: increased intraocular pressure, post-op muscle pain, weaknes
Black Cohosh
May provide relief from menstrual cramps, improves mood, calming effect. Extracts from the roots are thought to have action similar to estrogen. Generally safe in low doses, should not be taken with heart problems, concurrently with antihypertensives, or
Chamomile
As a tea, is effective as a mild sedative in the relief of insomnia. May also aid in digestion, relieve menstrual cramps, and settle upset stomach. Generally recognized safe when consumed in reasonable amounts.
Hops
Used in cases of nervousness, mild anxiety, and insomnia. Also may relieve cramping associated with diarrhea. May taken as a tea, in extracts or capsules.
Kava kava
Used to reduce anxiety while promoting mental acuity. Dosage 150-300 mg BID. Scaly skin rash may occur when taken at high dosage for long periods. Motor reflexes and judgment when driving may be reduced while taking the herb. Concurrent use with CNS depre
Passion flower
Used in tea, capsules, or extract to treat nervousness and insomnia. Depresses CNS to produce mild sedative effect. Generally safe in recommended dosages.
Peppermint
Used as tea to relieve upset stomachs and headaches and a a mild sedative. Pour boiling water over 1T. dried leaves and steep to make tea. Oil of peppermint is also used for inflammation of the mouth, pharynx and bronchus. Considered to be safe when consu
Scullcap
Used as a sedative for mild anxiety and nervousness. Considered safe in reasonable amounts.
St. John's Wort
Used in the treatment of mild to moderate depression. May block reuptake of sertonin/norepinephrine and have a mild MAO inhibiting effect. Effective dose: 900mg/day. Generally recognized as safe when taken at recommended dosages. Side effects include mild
Valerian
Used to treat nervousness and insomnia. Produces restful sleep without morning "hangover" The root may be used to make a tea, or capsules are available in a variety of dosages. Mechanism of action is similar to benzodiazepines, but without addicting prope