How to heal pt with insomnia: Sleep and rest

Diagnose insomnia:

Difficulty falling asleep

Waking often and trouble going back to sleep
Waking too early
Tired upon waking

Hypnotic: Induces drowsiness or sleep. Given at bedtime

Sedative: Relaxing and calm effect. Given in daytime
Barbiturates: Used less often due to harsh effects. It's a Schedule 4 drug
Nonbarbiturates: More effective
Benzodiazepines: Restoril and Halcion
Nonbenzodiazepines: Lunesta and Ambien
Barbiturates action

Help sleep (hypnosis)

Produce CNS depression
Mood alterations
Deep coma
Respiratory depression
Nonbarbiturates action

Produce CNS depression

Less effect on respiratory
Effects diminish over 1st 2 weeks so dose may need to be increased
Uses of sedatives/hypnotic: Insomnia, Convulsions, With anesthesia
Adv rxn: Dizziness, Drowsiness, H/A, NAUSEA (MOST COMMON)
Melantonin: Hormone produced in pineal gland in brain, Available in herbal form. Works
in 30 min
Valerian: Comes in herb tea, capsule, tablet, tincture. Improves overall sleep. Take 1 hr
before bedtime. Takes 2-4 weeks to work
Older adults are at greater risk for: Over sedation, Dizziness, CONFUSION, Ataxia
How long apart should sedation/hypnotic be given with opioid: 2 hours
When taking sedatives do not take: OTC cough and cold meds bc they cause drowsiness

Depression: Down in the dumps

Unipoloar depression: Extreme or exaggerated sadness anxiety interferes with daily
functioning
Major depression disorder: S/s occur on a daily basis for 2 or more weeks
4 classes of antidepressants:

SSRI
SNRIs/DNRIs
TCAs
MAOIs

SSRI: inhibit CNS uptake of serotonin. Increased levels act as a stimulant to reverse
depression.
should not be taken with St. John's Wort: Selective Serotonin Reuptake Inhibitors
uses of Selective Serotonin Reuptake Inhibitors: depressive episodes, OCD, and Bulimia
Action of Selective Serotonin Reuptake Inhibitors: inhibit CNS uptake of serotonin, acts
as a stimulant to reverse depression.
Examples of SSRIs: Celexa, lexapro, Prozac, paxil, Zoloft
SNRIs/DNRIs: Affects neurotransmission of serotonin, norepinephrine and dopamine
TCA: Inhibit reuptake of norepinephrine or serotonin in the brain
TCA can cause: Cardiac related adv rxn like tachycardia and heartblock
TCA should be given cautiously with: Older adults and pre existing cardiac dx
MAOIS: blocks monoamine oxidase that increases epinephrine, norepinephrine,
dopamine and serotonin that stimulate CNS
Foods containing thyamine: Aged cheese, Beef/chix livers, Fermented meats, fava beans,
Yeast extract, sauerkraut.
Tx for depression: antidepressant drugs and psychotherapy
action of Tricyclic antidepressants: Inhibit reuptake of norepinphrine or serotonin in the
brain. Mood elevation.
Uses of Tricyclic antidepressants: depressive episodes, bipolar disorder, enuresis, and
neuropathic pain.
Adverse Reactions of Tricyclic: sedation, dry mouth, urinary retention, and visual
disturbances, Constipation and photosensitivity

tardive dyskinesia: Abnormal involuntary movements such as tongue protrusion or

chewing motion.
What drug is used for smoking cessation: Zyban - is a form of An Antidepressant drug
bupropion. Why should smokers avoid zyban if taking bupropion: It can cause brupion
overdose
With depression, what should be monitored: Suicide tendency. Inspect oral cavity to
ensure that drug is swallowed
How should antidepressant drugs be given if they are given IM: In a large muscle mass
and keep patient lying down for 30 minutes to an hour.
Who is at an increased risk for suicide: Adolescents
Goal of antidepressants: to bring about the greatest felief of symptoms while minimizing
unpleasant adverse effects
Ex of Typical antipsychotic: Haldol and thorazine
Atypical antipsychotic: Used more often b/c they produce less sx acts on serotonin as
well as dopamine. Ex. abilify and seroquel
agranulocytosis: decreased or lack of granulocytes (type of WBC)
akathisia: extreme restlessness & increased motor activity
anhedonia: finding no pleasure in activities
delusions: false belief that cannot be changed with reason
dystonia: prolonged muscle contractions cause twisting and repetitive movements or
abnormal postures
flattened affect: absence of emotion
hallucinations: false sensation of perception of reality
neuroleptic malignant syndrome: rare reaction to antipsychotic drug; includes
extrapyramidal syndrome, hypothermia, & autonomic disturbances
Action of Antipsychotic drugs: inhibiting or blocking the release of neurotransmitter
dopamine in the brain & possibly increasing the firing if the nerve cells in certain areas if
the brain.
Uses of Antipsychotic drugs:

Schizophrenia
Manic phase of Bipolar Disorder
Agitated behavior associated w/ dementia

Lithium carbonate is rapidly absorbed after oral admin. The most common adverse
reaction: tremors, nausea, vomiting, thirst, & polyuria.
Adverse reactions of Antipsychotic drugs:
Generalized Systemic Reactions

Sedation, headache, hypotension

Dry mouth, nasal congestion
Urticia, photophobia, photosensitivity (Can cause sever sunburn, when exposed to
sun or uv light)
Behavioral Changes

Possible increase in the intensity of the psychotic symptoms

Lethargy, hyperactivity, paranoid reactions, agitation, & confusion

Extrapyramidal Syndrome (EPS): Parkinsons like symptoms, akathisia, & dystonia

Neuroleptic Malignant Syndrom (NMS): Extrapyramidal effects, hyperthermia, &
autonomic disturbance. Occurs w/in 1 month, potentially fatal. The pt develops muscle
rigidity and a sudden, high fever.
Contraindications of Antipsychotic drugs: severely depressed, have bone marrow
depression, blood dyscrasias, Parkinson's disease, liver impairment, coronary artery
disease, or severe hypo/hypertension.
Lithium: contraindicated in pt w/ hypersensitivity to tartrazine, renal or cardio disease,
sodium depletion & dehydration, in pt receiving diuretics.
Precautions of Antipsychotic drugs: pt w/ respiratory disorders, glaucoma, prostatic
hypertrophy, epilepsy, decreased renal function, & peptic ulcer disease
Lithium is monitored carefully in patients who: sweat profusely, experience diarrhea or
vomiting, or who have an infection or fever causing fluid loss
Nursing Alert for Antipsychotic drugs: In combative pts or those who have serious
manifestations of acute psychosis (hallucinations or loss of contact w/reality), parental
administration may be repeated q1-4hrs until desired effects are obtained. The nurse
monitors the pt closely for cardiac arrhythmias or rhythm changes, or HTN.
Manic Drugs: lithium (Eskaalith, Lthobid)
During psychotic episode, clients do not perceive reality in the same way as others. A
touch may seem violent
Prochlorperazine can make you very sensitive to light. So wear sunscreen.
Do not drink any alcohol 2 hours before taking Ambien for insomnia.

Fluoxetine: you may have to take this drug for a few more days before you feel its
effects.
Prescribe Lunesta for a client that cant sleep
Client on eszopiclone: avoid Alcohol
St john wart has potential adverse effects when taken with antidepressants
SRNI/DRNI are prescribed for: neuropathic pain, aggressive behaviors and Fibromyalgia
Sertraline: start to work in as soon as 10 days, but may take 4 weeks.
A pt prescribed phenelzine sulfate (Nardil) should avoid eating: cheddar cheese and
bratwurst.
MAO inhibitors are rarely used in clinical practice today bc: they may interact with some
foods and drugs to produce severe hypertension and possible heart attack.
Pt complains of dry mouth: provide sugarless gum or hard candy
Mood disorder meds should not be taken with grapefruit juice.
Prozac and sarafem: these two drugs are the same class and should not be taken together.
Haloperidol is a typicall anti-psychotic, it can cause: Extrapyramidal effects.
A pt receiving Clozapine, monitor WBC weekly.
Behavior with psychosis exhibit: disorganized and often bizarre thinking.
A pt w dementia has been very agitated lately,, prescribe: Antipsychotic
Dopamine is a neurotransmitter that deals with pleasure and reward in the brain