Psychopharmacology (Ch 4) Flashcards
Role of the nurse in psychotropic medication administration: ethical and legal implications
- Nurses must understand the ethical and legal implications associated with the administration of psychotropic medications
- Most states adhere to the clients right to refuse treatment, except in emergency situations
Role of the nurse in psychotropic medication administration: assessment
- A thorough baseline assessment must be conducted before a client is placed on a regimen of psychopharmacological therapy – H&P, EKG, weight and waist circumference
- Cultural considerations are necessary in assessment (some pt.’s respond differently to meds depending on culture & genes, such as being more sensitive. more on next flashcard)
Role of the nurse in psychotropic medication administration: administration and evaluation
The nurse monitors for side effects and adverse reactions and evaluates the therapeutic effectiveness of the medication.
Role of the nurse in psychotropic medication administration: patient education
The nurse translates the complex information related to the medication into terms that can be easily understood by the client.
Education should be provided at about a 5th grade level: give verbal AND written information; Use “every-day language” pt.’s will understand.
Remember it is imperative to assess patient’s understanding of education; consider primary language, developmental stage, and literacy
How do psychotropics work?
Psychotropic medication affects neurotransmission.
Reuptake is the process of neurotransmitter inactivation.
Blocking the reuptake process allows more of the neurotransmitter to be available for neuronal transmission.
5 types of psychotropic medications
1) Antidepressants
2) Mood stabilizers
3) Antipsychotics
4) Benzodiazepines (& other antianxiety agents)
5) Psychostimulants
Antianxiety Agents: indications, action, contraindications/precautions, and interactions
Indications: anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation
Action: depression of the central nervous system (CNS) (exception: buspirone)
Contraindications/precautions: contraindicated in known hypersensitivity, in combination with other CNS depressants, in pregnancy and lactation, narrow-angle glaucoma, shock, and coma. Caution with elderly and debilitated clients, clients with renal or hepatic dysfunction, those with a history of drug abuse or addition, and those who are depressed or suicidal.
Interactions:
- Increased effects when taken with alcohol, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidine, disulfiram, kava kava, or valerian root (& other herbal depressants)
- Decreased effects with cigarette smoking and caffeine consumption
Benzodiazepine Drugs (Anti-Anxiety Agents) (6)
Diazepam (Valium)
Chlordiazepoxide (Librium)
Clorazepate (Tranxene)
Clonazepam (Klonopin)
Lorazepam (Ativan)
Alprazolam (Xanax)
Other anti-anxiety medications (9)
Buspirone (BuSpar) *
Gabapentin (Neurontin)
Hydroxyzine (Atarax, Vistaril)
Propanolol (Inderal)
Atenolol (Tenormin)
Guanfacine (Tenex)
Clonidine (Catapres)
Prazosin (Minipress)
Pregabalin (Lyrica)
Note: Some anti-depressants also used for anxiety
Anti-anxiety medication S/E
Drowsiness, confusion, lethargy, tolerance, physical and psychological dependance, potentiation of other CNS depressants, aggravation of depression, orthostatic hypotension, paradoxical excitement, dry mouth, nausea and vomiting, blood dyscrasias, delayed onset (with buspirone only)
Antidepressants: indications, action, and contraindications/precautions
Indications: Dysthymia (chronic depression), major depressive disorder, depression associated with organic disease, alcoholism, schizophrenia, intellectual disability, depressive phase of bipolar disorder, and depression accompanied by anxiety.
Action: Increase concentration of norepinephrine, serotonin,
and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, heterocyclics, SSRIs, SNRIs) or by inhibiting the release of monoamine oxidase (MAOIs).
Contraindications: Contraindicated in known hypersensitivity (all), acute phase of recovery from myocardial infarction (MI) and in angle-closure glaucoma (tricyclics), and concomitant (naturally accompanying) with MAOIs (all).
Precautions: Caution with elderly or debilitated clients; clients with hepatic, cardiac, or renal insufficiency; psychotic clients; clients with benign prostatic hypertrophy; and those with a history of seizures.
What is the action of the enzyme monoamine oxidase?
The enzyme, monoamine oxidase breaks down excess tyramine in the body; blocking this enzyme helps decrease depression.
Antidepressant classifications (5 types)
1) MAOI (monoamine oxidase inhibitor)
- Many side effects, dietary restrictions (tyramine – see table
4-7 Pg. 71)
2) Tricyclics antidepressants (TCAs)
3) Serotonin Reuptake Inhibitors (SSRIs)
4) Serotonin/norepinephrine reuptake inhibitors (SNRIs)
sometimes called S-SNRI
5) Heterocyclics
Antidepressant - MAOI’s medications (4)
1) Tranylcypromine (Parnate)
2) Phenelzine (Nardil)
3) Isocarboxazid (Marplan)
4) Selegiline (Emsam) - patch
Antidepressant - TCA’s medications (5)
1) Imipramine (Tofranil)
2) Clomipramine (Anafranil)
3) Amitriptyline (Elavil)
4) Nortriptyline (Pamelor)
5) Doxepin
Antidepressant - SSRI’s medications (6)
1) Citalopram (Celexa)
2) Escitalopram (Lexapro)
3) Fluoxetine (Prozac)
4) Paroxetine (Paxil)
5) Sertraline (Zoloft)
6) Vilazodone (Viibyrd)
Antidepressant - SNRI’s medications (3)
1) Desvenlafaxine (Pristiq)
2) Duloxetine (Cymbalta)
3) Venlafaxine (Effexor)
Antidepressant - Heterocyclics medications (3)
1) Bupropion (Wellbutrin)
2) Mirtazapine (Remeron)
3) Trazodone
