Antidepressants
Types:
1. SSRI (Selective Serotonin Reuptake Inhibitors)
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
2. Tricyclic Antidepressants
imipramine (Tofranil)
amitriptyline (Elavil)
amoxapine (Asendin)
3. MAOI (Monoamine Oxidase Inhibitors)
phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)
S/E:
Sedation Nausea Tremors
Drowsiness Blurred vision Muscle twitching
Dry mouth and eyes Insomnia Orthostatic
Urinary retention Headache hypotension
Constipation Nervousness Edema
Weight gain Suicidal ideation Anorexia
Dizziness Vertigo Hypertensive crisis
Nervousness Fatigue
Nursing Interventions:
1. Limit drug access to suicidal patients
2. Monitor vital signs
3. For MOAI, avoid food containing tyramine (ex. Cheese, cream, yogurt, coffee,
chocolate, bananas, raisins, liver, sausages, soy sauce, pickled herring, yeast,
beer, wine)
Mood Stabilizers
Types:
1. Lithium
2. Anti-epileptics (Anticonvulsants)
valproic acid (Depakene, Valprotate)
carbamazepine (Tegretol)
oxcarbazepine (Trileptal)
topiramate (Topamax)
3. Antidepressants
phenelzine (Nardil)
isocarboxazid (Marplan )
tranylcypromine (Parnate )
fluoxetine (Prozac)
paroxetine (Paxil)
citalopram (Celexa, Cipramil)
sertraline (Zoloft)
4. Neuroleptics (Anti-psychotics)
risperidone (Risperdal)
clozapine (Clozaril)
olanzapine (Zyprexa)
Side Effects:
Lithium - Up to 75% of patients treated with lithium experience some side effects.
Most of these are minor and can be reduced or eliminated by lowering the lithium
dose or changing the dosage schedule. These include:
Hypothyroidism Arrhythmias
Kidney damage (long Acne
term use) Hair loss
Anti-epileptics (Anticonvulsants)
Weight gain Sedation Indigestion
Tremor Headache Bruising
Dizziness Nausea Hair loss
Neuroleptics (Anti-psychotics)
Restlessness Sleepiness Increased saliva
Tremors Nausea Abdominal pain
Muscle stiffness Abnormal vision
Importance:
Antipsychotic drugs are first-line therapy for schizophrenia and other psychotic
disorders. They have the ability to decrease dopamine activity, leading to the
alleviation of psychotic symptoms.
Types:
1. Conventional/ Typical- chlorpromazine (Thorazine), haloperidol (Haldol),
thioridazine (Mellaril), fluphenazine (Prolixin)
Advantages: cheaper
Disadvantages: many side effects
2. Newer/ Atypical- risperidone (Risperdal), clozapine (Clozaril), olanzapine
(Zyprexa)
Advantages: effective in treating negative symptoms; not likely to cause EPS or
tardive dyskinesia
Disadvantages: expensive, tendency to cause weight gain
MOA: blocks the action of dopamine and thus can be classified as dopamine
receptor antagonist. All antipsychotics block D2 receptor which in turn promotes the
presence of EPS, resulting in pseudoparkinsonism. The atypical antipsychotics have
a weak affinity for D2 receptor and stronger affinity to D4 receptor. They block the
serotonin receptor. These however cause fewer EPS.
Nursing Interventions:
1. Anti-psychotics react with alcohol, hypnotics, narcotics, and benzodiazepines
to potentiate the sedative effects of antipsychotics. Instruct the client to avoid
use of alcohol and other CNS depressants.
2. In case of photosensitivity, let the client wear sunglasses.
3. Use caution in potentially hazardous activities.
4. Avoid changing positions (lying, sitting, standing) rapidly.
5. Tell the patient to notify the physician if unusual signs and symptoms
develop (sore throat, bruising/bleeding, tics/spasms, trembling.
6. Do not alter the dosage without the prescriber's order.
7. Stop drug immediately if any of the adverse reactions occur.
8. Always assess for the presence of extrapyramidal symptoms.
Definition: Used for the treatment of anxiety and also useful in the induction of
sleep. Anti-anxiety drugs are medicines that calm and relax people with excessive
anxiety, nervousness, or tension, or for short-term control of social phobia disorder
or specific phobia disorder.
Action: Exert a general depressing effect on the CNS, many also exert skeletal
muscle-relaxant and anticonvulsant effects. They preferentially act on the limbic
system of the brain where they potentiate inhibitory neurotransmission in those
systems where γ-aminobutyric acid (GABA) is a neurotransmitter. GABA-A receptor
subtype is selectively affected by benzodiazepines.
Nursing Interventions:
1. Assess the client's medication history, knowledge level and use of current
medications (prescribed, over-the-counter, and illicit drugs), medication
allergies, and pattern of alcohol use.
2. Explore the client's perceptions and feelings about medications; clarify
misinformation, fears, etc.
3. Instruct patient and significant others that alcohol or sedatives potentiate
depressant effects of the drug.
4. Drugs if taken in large doses or to an extended period of time can lead to
physical and emotional dependence.
5. Benzodiazepine use should not be abruptly discontinued to avoid a
withdrawal syndrome.
6. Overdosage of any benzodiazepine is managed by taking its antidote -
flumazenil (Romazicon)
Examples:
A. Benzodiazepines
• Alprazolam (Xanax)
• Diazepam (Valium)
• 3.Flurazepam (Dalmane)
• Lorazepam (Ativan)
• Triazolam (Halcion)
B. Antihistamines
• hydroxizine HCL (Atarax)
C. Propanediol
• meprobamate (Equanil)
D. Azapirones
• buspirone HCL (BuSpar)
E. Benzodiazepine Antagonist
• Flumazenil (Romazicon)
Prepared by:
BSN4A - Group 2
Reference:
Pharmacology: A nursing Process Approach, 4th Edition by Joyce LeFever Kee and
Evelyn Hayes.