NURS MISC Meds NCLEX graded A+ document

Psychiatric Meds: 1. Selective Serotonin Reuptake Inhibitors (SSRIs). Examples: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone hydrochloride. a. Used for depression, bipolar dis ...

Psychiatric Meds: 1. Selective Serotonin Reuptake Inhibitors (SSRIs). Examples: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone hydrochloride. a. Used for depression, bipolar disorder, OCD, panic attacks, eating disorders. b. Adverse effects: GI issues (nausea, vomiting, diarrhea); dry mouth; photosensitivity- note client should avoid exposure to sunlight, dizziness (BP decreases)- administer with a snack or meal to reduce the risk of dizziness and light-headedness; decreased libido; insomnia; c. Monitor: suicidal client, especially during improved mood and increased energy levels; monitor for WBCs and neutrophil counts, because it can decrease over time, which can be susceptible to infections, and the med is stopped if levels decrease below the normal; monitor for liver and kidney functions, altered values needs adjustment of dosage. d. Serotonin syndrome- some clients can develop, s/s- elevated temp., muscle rigidity and elevated creatine phosphokinase levels; can increase if given with MAOIs (needs to avoided). e. Do Not Give with MAOIs, wait 14 days prior administering MAOIs. Buspirone is not given with MAOIs because it can cause hypertensive reaction. Paroxetine causes dry mouth and client needs to take sucking on ice chips or sugarless gum/candy; water will not help. 2. Monoamine Oxidase Inhibitors (MAOIs). Examples: Phenelzine, Tranylcypromine, Isocarboxazid, Selegiline. a. Used for severe depression, psychosis and panic disorders. It is given who have not responded to other antidepressant therapies, including electroconvulsive therapy. b. Adverse effects: orthostatic hypotension; dizziness; weight gain; sexual dysfunction; c. Teach to avoid Tyramine containing foods (avocados, bananas, beef or chicken liver, caffeine-coffee, tea or chocolate, aged cheese, except cottage cheese, raisins, red wine, beer, soy sauce, yogurt, etc.). Hypertensive crisis can be triggered by foods rich in Tyramine. Hypertensive crisis- HTN, neck stiffness and soreness, clammy skin, dilated pupils, palpations, tachy/brady. Antidote for HC is Phentolamine by IV injection. If palpations or frquesnt headaches happen withhold medication and notify HCP. 3. Tricyclic Antidepressants. Examples: Amitriptyline, Nortriptyline, Imipramine, Amoxapine, Clomipramine,Desipramine, Doxepin. a. Used for depression, depression related to alcohol and cocaine withdrawal, chronic pain, anxiety, panic disorders, OCD. b. Adverse effects: orthostatic hypotension; dry mouth(encourage oral hygiene and the use of hard candies and mouth rinces to relive dry mouth); constipation; urinary retention or difficulty voiding; photosensitivity (prevent to sunlight exposure); decreased libido; seizure can occur with bupropion; dysrhythmias; c. Monitor for suicidal clients, especially during improved mood and increased energy levels. Administer with food or milk if GI distress occur and at bedtime because of the sedative effect. Instruct to avoid alcohol and over counter meds/herbs. Meds should not be stopped abruptly, rather should be tapered (gradually decrease). d. Inform the client that antidepressant meds may take several weeks to produce desired effect; client response may not occur until 2-4 weeks after the first dose. Contraindicated with history of seizures or chronic cardiac disease. Priority Nursing Actions- to take for tricyclic antidepressants overdose: 1. Check airway and maintain a patent airway 2. Administer oxygen 3. Check VS 4. Obtain ECG 5. Prepare for gastric lavage with activated charcoal (client should be positioned in lateral side to prevent aspiration) 6. Prepare to administer physostigmine and antidysrhytmic meds. 7. Document the vent, actions taken and the client’s response. 4. Mood Stabilizers. Examples: Lithium (main). Other mood stabilizers are Aripiprazole, Carbamazepine, Gabapentin, Lamotrigine, Olanzipine, Respiridone, Quetiapine, Valproate sodium. a. Used for mania, bipolar disorder. b. Therapeutic drug serum level is 0.6-1.2 mEq/L. More than 1.5 is toxic, includes such as tremor, confusion, seizures, possible death. To check Lithium levels every 1-2 months or whenever behavioural changes suggests an altered serum level. c. Adverse effects: polyuria, polydipsia, dry mouth, weight gain, muscle weakness, headache, hair loss, inability to concentrate, Hypothyroidism. d. Monitor for serum Na+ levels (normal levels maintains therapeutic levels of Lithium). Blood samples to check serum lithium levels should be drawn in the morning, 12 hours after the last dose was taken. Instruct client to take at least 6-8 glasses of water a day and adequate salt intake to prevent lithium toxicity. e. Administer the med with food to minimize GI irritation, instruct to avoid excessive amounts of coffee, tea or cola, which has diuretic effect. No alcohol and no OTC meds. The client can take the med within 2 hours, otherwise should skip it the missed dose and take the next dose at the scheduled time. No stopping abruptly rather tapered. f. Instruct client the therapeutic level is noted in 1-3 weeks. Instruct client if polyuria, prolonged vomiting, diarrhea or fever occurs then notify HCP. Interventions for lithium toxicity: 1. Withhold Lithium and notify the HCP 2. Monitor VS and LOC 3. Monitor cardiac status 4. Prepare to obtain samples to monitor lithium, electrolyte, BUN, and creatinine levels and CBC. 5. Monitor for suicidal tendencies and initiate suicide precautions. 5……... Antianxiety or Anxiolytic Medications. Benzodiazepines – (ZEPAM). Examples: Diazepam, Alprazolam, Clonazepam, Lorazepam, Temazepam, etc. a. Used for anxiety disorders, seizures, pre-op sedation, and alcohol withdrawal. b. Contraindicated in clients with narrow angle glaucoma c. Adverse effects: drowsiness, sedation, dizziness, hypotension, GI issues, blurred or double vision, slurred speech, amnesia, d. Antidote for Benzodiazepine is Flumazenil, administered via IV and reverses in 5 minutes. After may experience agitation, restlessness, discomfort and anxiety. e. Initiate safety precautions for elder people are at risk for falling after taken anxiety meds. Instruct client not to stop medication abruptly because is going to cause seizures, rather should be tapered gradually over 2-6 weeks. Withdrawal can cause: restlessness, irritability, insomnia, hand tremors, sweating, vomiting and seizures. 6. Barbiturates examples: Phentobarbital sodium, Phenytoin, Amobarbital sodium, Pentobarbital sodium, Secobarbital sodium. Sedative Hypnotics examples: Eszopiclone, Zaleplon, Zolpidem, Ramelteon. Chloral Hydrate used for alcohol withdrawal and insomnia. Client should take the med with food and a full of glass of water, fruit juice, or ginger ale to prevent gastric irritation. a. Used for anti-seizure, for partial seizures; short term treatment for insomnia or for sedation to relive anxiety, tension and apprehension. b. Adverse effects: dizziness and drowsiness, irritability. c. Phenytoin causes aplastic anemia, pancytopenia, gingival hyperplasia, Stevens Johnson and hepatitis. Box warning: administration IV should not exceed 50mg/min in adults.