Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
I. FGAs (typical, – MOA: D2 antagonist in basal ganglia – S/E: Photosensitivity, hypotension, – Postural hypotension: raise slowly
traditional) – Therapeutic uses: antipsychotic, anti- EPS, anticholinergic effects, constipation, – Photosensitivity: sunscreen if outdoors
emetic (compazine), sedative weight gain, hyperprolactinemia, ↓ seizure – DON'T stop medications
threshold – Report anticholinergic & EPS S/Es
- haloperidol (Haldol) → high potency = high EPS; low – Noncompliance is a BIG problem d/t S/Es
sedation – A/E: Blood dyscracias, cholestatic – Use other forms that are long-acting to promote
hepatitis, NMS, dystonic reactions, TD, compliance
- chlorpromazine → low potency = low EPS; high seizure
(Thorazine) sedation
II. SGAs (atypical) – MOA: 5HT-D2 antagonist – A/E: NMS, black box warning, ↑ type II – Reduce to lowest possible dose
DM → ↑ in metabolic syndrome – EPS controlled by A.B.D. medications
– Less EPS; little or no TD – Monitor labs: LFTs, CBC w/ ANC, fasting lipid
panel
A. clozapine (Clozaril) – Therapeutic uses: antipsychotic, for – Agranulocytosis, postural hypotension, – Monitor v/s, CBC & ANC
mood disorders (bipolar, depression) anticholinergic effects, tachycardia, – Gold standard but not 1st choice
drooling, weight gain
– ↓ seizure threshold
B. risperidone – EPS in high doses, hyperprolactinemia – Most like FGA (tightly binds to D2 receptors) →
(Risperdal) EPS
C. quentiapine – Weight gain, sedation – Give 1st dose @ HS d/t sedation
(Seroquel)
D. olanzapine (Zyprexa) – Weight gain, sedation, high risk for type – Check BS levels
II DM
E. ziprasidone (Geodon) – Prolongs QT interval – Get baseline ECG before initial therapy
– Little anticholinergic & sedative effects – Give w/ food or lose 50%
III. TGA (atypical) – 5HT-2A antagonist – Orthostatic hypotension – Stronger antidepressant than other atypicals
A. aripiprazole (Abilify) – D2 & 5HT-1A partial agonist – NO anticholinergic, EPS, TD or weight
gain
ANTIDEPRESSANT AGENTS
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
st
1 generation antidepressants
I. MAOIs – ↑ biogenic monoamines (5HT, DA, NE, – 1st sign of OD: HA – Lag time: 2 – 4 weeks (up to 8 wks)
– Marplan, Nardil, E) in nerve tissues, liver, lungs by – CV (tachycardia, circ. Collapse) & – Washout time: 2 weeks
Parnate blocking MAO enzyme CNS (seizure, coma) effects – X: tyramine food/products, sympathomimetics
– HTN crisis (OTC cold remedies)
II. TCAs – ↑ NE by blocking its reuptake – CV (arhythmias) & CNS (seizure) – Lag time: 2 – 4 weeks
– Tofranil – Indication: depression, childhood – Washout time: 2 weeks
enuresis, OCD, adjunctive analgesic, – S/Es: anticholinergic, sedation, – X: elderly d/t anticholinergic & cardiac effects
trigeminal neuralgia, migraine px weight gain, hypotension, sexual – X: SSRIs
dysfunction
III. SSRIs – ↑ 5HT by blocking its reuptake – CNS: HA, dizziness, tremors, – Lag time: 2 – 6 weeks
– Celexa, Lexapro, – Indication: Depression, eating insomnia – Safer (esp. for older adults) but not stronger
Luvox, Paxil, Prozac, Zoloft disorders, OCD, panic attacks, social – GI: nausea, diarrhea, constipation, – X: TCAs (cardiac problems) & MAOIs (serotonin
phobia, PMS sx, menopausal sx dry mouth syndrome)
– Sexual dysfunction
2nd generation antidepressants
I. NDRI – Weakly blocks NE, DA, 5HT reuptake – Fewer S/Es – X: Seizure hx & eating disorders
– buproprion (Wellbutrin) – Can give to pts taking SSRIs to help tx sexual
dysfunction
II. SARI – Blocks 5HT-2 reuptake – No sexual dysfunction – Use at night to help with sleep
– trazodone (Desyrel)
III. SNRI – Blocks 5HT & NE reuptake
– venlafaxine (Effexor) → Indication: depression, GAD, → Give in AM because of energizing effects
panic/social phobias, PMS sx,
menopausal sx
STIMULANTS
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
A. Amphetamines – ↑ NE release & block DA reuptake thus affecting – Sympathomimetic effects: – Withdrawal after prolonged use →
– Ritalin the RAS & DRS agitation, delirium, seizures, HTN, depression
– Dexedrine – Blocks inhibitory neurotransmitters arrhythmias,
– Indication: ADHD, narcolepsy, appetite – Psychological dependency
suppression, Initial tx of depression with withdrawal
and somnolence
B. Non-amphetamines
– Strattera → Indication: ADHD
– Provigil → Indication: sleep apnea, narcolepsy, shift work sleep disorder, “off label” for depression
ANTIANXIETY (SEDATIVE/HYPNOTIC) AGENTS
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
I. Antihistamines – Have sedative & hypnotic properties – – No addiction potential
– Hydroxyzine (Atarax,
Vistaril)
– Benadryl
II. Benzodiazepines (BDZs) – ↑ GABA & other inhibitory – Sedation, ataxia, dizziness, – Monitor LFTs
– lorazepam (Ativan) neurotransmitter anterograde amnesia, – X: hx or current problems of chemical dependency
– diazepam (Valium) – Indication: Anxiolytics, anticonvulsants, idiosyncratic paradoxical – Synergistic effects w/ other CNS depressants → can
anesthesia induction, muscle relaxant, excitement be fatal if mixed with alcohol or opioids
withdrawal from alcohol, hypnotics – Seizure if withdrawn abruptly
– Highly protein bound – Rebound anxiety & insomnia can cause dependency
– Crosses the blood-brain barrier → CNS – Tolerance/withdrawal can occur
effects
– Metabolized in liver
III. Azaspirone – 5HT reuptake inhibitor & DA agonist – – Lag time: 2 weeks
– buspirone (BusPar) – Indication: Anxiolytics, Patients with hx – Non-addictive
of substance abuse/dependency with
depression
IV. Barbiturates – Promote GABA – – Metabolic tolerance (can induce tolerance of
– phenobarbital (Luminal) – Depress the RAS themselves and of other drugs)
– amobarbital sodium – Lipid soluble (crosses the blood-brain – Pharmacodynamic tolerance (nervous system
(Amytal) barrier) adapts to presence of the depressant)
– Indications: Anesthesia induction, – High abuse potential & psychological dependency
anticonvulsant – Acute withdrawal can be fatal
– Potentiates CNS depressants
V. Non-BDZ – Depress the RAS – –
– zolpidem (Ambien) – Indication: Hypnotics
– eszopiclone (Lunesta) – Short half-lives
VI. Melatonin agonist – – – Not a controlled substance
– ramelteon (Rozerem) – Good for older adults
VII. Other – – – No REM rebound
– Chloral hydrate