Pharmacology - Psychiatric

Front 1

Benzodiazepines
(examples/uses)

Back 1

Antianxiety

diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)
Clorazepate (Tranxene)
Oxazepam (Serax)
Clonazepam (Klonopin)

Front 2

Benzodiazepines
(SE and contraindications)

Back 2

Paradoxical response (insomnia, excitation, euphoria, anxiety, rage)
CNS depression, (sedation, light-headedness, ataxia, decreased cognitive function)
Anterograde amnesia
Oral toxicity (drowsiness, lethargy, confusion)
IV toxicity (may lead to respiratory depression, severe hypotension, or cardiac/respiratory arrest)

*Pregnancy category risk D
*Use caution with liver disease
*Diazepam contraindication with respiratory disorders

Front 3

Benzodiazepines
(nursing considerations)

Back 3

● Advise clients to take the medication as prescribed and to avoid abrupt discontinuation of treatment to prevent withdrawal symptoms.
● When discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks.
● Administer the medication with meals or snacks if GI upset occurs.
● Advise clients to swallow sustained-release tablets and to avoid chewing or crushing the tablets.
● Inform clients about the possible development of dependency during and after treatment and to notify the provider if symptoms occur.
*CNS depressants (alcohol, barbiturates, opioids) may result in respiratory depression

Front 4

Atypical Anxiolytic/Nonbarbiturate Anxiolytic
(examples)

Back 4

buspirone (BuSpar)

Front 5

Atypical Anxiolytic/Nonbarbiturate Anxiolytic
(SE and contraindications)

Back 5

Dizziness, nausea, headache, lightheadedness, agitation

● Buspirone is Pregnancy Risk Category B.
● Buspirone is not recommended for use by nursing mothers.
● Use buspirone cautiously in older adult clients and clients with liver and/or renal dysfunction.
● Buspirone is contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued. Hypertensive crisis may result.

Front 6

Atypical Anxiolytic/Nonbarbiturate Anxiolytic
(nursing considerations)

Back 6

• Advise clients to avoid the use of antimicrobial agents.
• Advise clients to avoid drinking grapefruit juice.
● Advise clients to take the medication with meals to prevent gastric irritation.
● Advise clients that effects do not occur immediately. It may take a week to notice the first therapeutic effects and several more weeks for the full benefit. Medication should be taken on a regular basis and not PRN.
● Instruct clients that tolerance, dependence, or withdrawal symptoms are not an issue with this medication.

Front 7

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
(examples/uses)

Back 7

Antidepressant

Paroxetine
Sertraline
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)

Front 8

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
(SE and contraindications)

Back 8

nausea, diaphoresis, tremor, fatigue, drowsiness, sexual dysfunction, weight gain, GI bleeding, hyponatremia, Bruxism: grinding and clenching of teeth, usually during sleep

Serotonin syndrome
• Agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, hyperreflexia, incoordination, tremors, fever, diaphoresis

● Paroxetine is a Pregnancy Risk Category D medication.
● Paroxetine is contraindicated in clients taking MAOIs or a TCA.
● Clients taking paroxetine should avoid alcohol.
● Use paroxetine cautiously in clients with liver and renal dysfunction, seizure disorders, or a history of GI bleeding.

Front 9

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
(nursing considerations)

Back 9

● Advise clients that medications may be taken with food. Sleep disturbances may be minimized by taking medication in the morning.
● Instruct clients to take the medication on a daily basis to establish therapeutic plasma levels.
● Assist with medication regimen adherence by informing clients that therapeutic effects may not be experienced for 1 to 3 weeks.
◯ Obtain baseline sodium levels for older adult clients taking diuretics and monitor periodically.

Front 10

Tricyclic Antidepressants (TCAs)
(examples/uses)

Back 10

Antidepressant

Amitriptyline (Elavil)
Imipramine (Tofranil)
Doxepin (Sinequan)
Nortriptyline (Aventyl)
Amoxapine (Asendin)
Trimipramine (Surmontil)

Front 11

Tricyclic Antidepressants (TCAs)
(SE and contraindications)

Back 11

orthostatic hypotension, anticholinergic effects, sedation, decreased seizure threshold, sweating
Toxicity resulting in cholinergic blockade and cardiac toxicity evidenced by dysrhythmias, mental confusion, and agitation, followed by seizures, coma, and possible death

● TCAs are Pregnancy Risk Category C.
● These medications are contraindicated in clients who have seizure disorders
● Use cautiously in clients who have coronary artery disease; diabetes, liver, kidney and respiratory disorders; urinary retention and obstruction; angle-closure glaucoma; benign prostatic hypertrophy; and hyperthyroidism.

Front 12

Tricyclic Antidepressants (TCAs)
(nursing considerations)

Back 12

*If a significant decrease in blood pressure and/or increase in heart rate is noted, do not administer the medication, and notify the provider.
• Advise clients to avoid hazardous activities such as driving if sedation is excessive.
• Advise clients to take medication at bedtime to minimize daytime sleepiness and to promote sleep.
• Instruct clients on ways to minimize anticholinergic effects.

Front 13

Monoamine Oxidase Inhibitors (MAOI's)
(examples/uses)

Back 13

Antidepressant

phenelzine (Nardil)
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)
Selegiline (Emsam) – transdermal MAOI

Front 14

Monoamine Oxidase Inhibitors (MAOI's)
(SE and contraindications)

Back 14

CNS stimulation, orthostatic hypotension, hypertensive crisis, local rash

● MAOIs are Pregnancy Risk Category C.
● These medications are contraindicated in clients taking SSRIs and in those with pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, and severe renal insufficiency.
● Use cautiously in clients with diabetes and seizure disorders or those taking TCAs.
● Transdermal selegiline is contraindicated for clients taking carbamazepine (Tegretol) or oxcarbazepine (Trileptal), which may increase blood levels of the MAOI.

Front 15

Monoamine Oxidase Inhibitors (MAOI's)
(nursing considerations)

Back 15

• Notify the provider if there is a significant drop in the client’s blood pressure. A reduced dosage of antihypertensive may be indicated.
• Assess the client for ability to follow strict adherence to dietary restrictions (Tyramine)
• Use MAOIs and TCAs cautiously.
• Instruct the client that OTC decongestants and cold remedies frequently contain medications with sympathomimetic action and should be avoided.
• Advise clients to avoid foods that contain these agents (caffeinated beverages, chocolate, fava beans, ginseng).

Front 16

Atypical Antidepressants
(examples)

Back 16

bupropion HCL (Wellbutrin)

Front 17

Atypical Antidepressants
(SE and contraindications)

Back 17

Headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, insomnia, anorexia, seizures

● Bupropion is a Pregnancy Risk Category B.
● This medication is contraindicated in clients taking MAOIs.
● Use cautiously in clients who have seizure disorders.

Front 18

Atypical Antidepressants
(nursing considerations)

Back 18

• MAOIs should be discontinued 2 weeks prior to beginning treatment with bupropion.

Front 19

Antipsychotics – Conventional
(examples)

Back 19

chlorpromazine (Thorazine) – low potency
Haloperidol (Haldol) – high potency
Fluphenazine (Prolixin) – high potency
Thiothixene (Navane) – high potency

Front 20

Antipsychotics – Conventional
(SE and contraindications)

Back 20

Acute dystonia (severe spasms of tongue, neck, face, or back)
Parkinsonism (bradykinesia, rigidity, shuffling gait, drooling and tremors)
Akathisia (unable to stand still or sit)
Late extrapyramidal symptoms &
tardive dyskinesia (TD) (involuntary movements of
the tongue and face)
Neuroleptic malignant syndrome (sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in level of consciousness developing into coma)
Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, tachycardia)
neuroendecrine effects (gynomastia)
orthostatic hypotension, sedation, seizures, sexual dysfunction, photosensitivity, agranulocytosis, severe dysrhythmias

● These medications are contraindicated in clients in a coma, and clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer of the breast, and severe hypotension
● Use of conventional antipsychotic medications is contraindicated in older clients with dementia.
● Use cautiously

Front 21

Antipsychotics – Conventional
(nursing considerations)

Back 21

• Advise clients to avoid over-the-counter medications that contain anticholinergic agents, such as sleep aids.
• Advise clients to avoid alcohol and other medications that cause CNS depression.
• Advise clients to avoid hazardous activities, such as driving.
• Avoid concurrent use of levodopa and other direct dopamine receptor agonists.
● Assess clients to differentiate between EPS and worsening of psychotic disorder.
● Administer anticholinergics, beta-blockers, and benzodiazepines to control early EPS. If symptoms are intolerable, a client can be switched to a low-potency or an atypical antipsychotic agent.
● Advise clients that antipsychotic medications do not cause addiction.
● Advise clients to take medication as prescribed and to take it on a regular schedule.
● Advise clients that some therapeutic effects may be noticeable within a few days, but significant improvement may take 2 to 4 weeks, and possibly several months for full effects.
● Consider depot preparations administered I

Front 22

Antipsychotics – Atypical
(examples)

Back 22

risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Clozapine (Clozaril)

Front 23

Antipsychotics – Atypical
(SE and contraindications)

Back 23

New onset of diabetes mellitus or loss of glucose control in clients who have diabetes
Weight gain, Hypercholesterolemia, orthostatic hypotension, anticholinergic effects