Antipsychotic Drugs S/E - ATENOH Anticholinergic effects ntukin granulocytosis (dec.

WBC) - hold next dose, notify physician

WOF: fever, soar throat Clozapine (clozaril)

Tardive Diskinesia (permanent) Late appearing, abnormal involuntary motor movement Typical drugs WOF: lip smacking, tongue protrusion, muscle rigidity

Extrapyramidal S/E (EPSE) Typical, temporary 1. Acute dystonia oculogyric crisis, fixed stare, torticollis, opisthonus 2. Akathisia sits, stands, walks around 3. Pseudo-parkinsonism-

uroleptic Malignant Syndrome (NMS) fatal WOF: increased: temp, BP, rigidity stop next dose, notify physician supportive tx, seizure precautions

Orthostatic Hypotension Move slowly to prevent falls Photosensitivity- wide brimmed hats

Hepatotoxicity - hold next dose, notify physician altered liver enzymes Yellow sclera

WOF: HEPATOXICITY AGRANULOCYTOSIS NMS WITHOLD NEXT DOSE, NOTIFY PHYSICIAN

Anticholinergic Effects 1. Pupillary dilation mydriasis a. Blurred vision 2. Dry mouth 3. Constipation 4. Urinary retention 5. Increased heart rate Palpitation (Subjective), Tachycardia (Objective) Mood Affecting Disorders Dysthymia - emo/alone at least 2 years Cyclothymia up/down ADLs intact labile at least 2 years Bipolar D/O major labile X ADL history of mania 1 year then depression Mania at least 1 week Major Depression at least 2 weeks Hypomania 4 days (myosis pupillary constriction)

Major Depression no ADLs at least 2 weeks, introjections Etiology: o o o o S/SX o o o Decreased self-esteem may lead to suicide Decreased energy Decreased amount of sleep leads to insomnia irritable Genetics Decreased NOREPINEPHRINE and SEROTONIN Decreased energy Increased superego frustration decreased self esteem Sense of loss anger (hostility to self) self blame, suicide because of low self-esteem

NI o Safety suicide observe suicidal cues: Giving away prized possessions Sudden change in behaviour Verbalization of thoughts of suicide

Directly ask (counsel) Initiate suicide precautions WOF: Early AM shift and end of PM shift when supervision is minimal; peak time of anti-depressants (2-4 wks)

o o

Medication Basic needs Rest and sleep no daytime naps Activity simple, with initial RN- directive

o -

Nutrition small frequent feedings

MOA: inc. NE + dec. SERO = inc. Energy 2 weeks Anafranil Elavil Vivactyl Tofranil Sinequan Ascendin Parnate Nardil Marplan MAOI TCA

 S/E: o

Prozac Praxil Zoloft Luvox SSRI

SSRI (Selective Serotonin Reuptake Inhibitor) DrowsinesS Sexual dysfunction (temporary) Rash photosensitivity Insomnia give activity gI disturbance- diarrhea

TCA (Tricyclic Antidepressants) Tofranil: oldest TCA Cardiac problems Hypertension BP Arrhythmia ECG

Antukin and increased Appetite

MAOI (Monoamine Oxidase Inhibitor) Keeps MAO away, keeping storage of thyramine at liver, so thyramine circulates converts to NE. Causes Hypertensive crisis avoid thyramine/ thryramine rich foods 1. Fermented- aged, cottage cheese; wine and beer 2. Processed (esp. Canned) 3. Preserved (pickles) 4. Overripe fruits avocado and banana

Do not take different antidepressants at the same time. Wait for wash out period of 1-2 weeks.

Electroconvulsive Therapy (ECT) o o o o o o For major depression Artificially inducing grand-mal (tonic-clonic) seizures MOA: unknown but it increases NE Frequency: 2-3x/week # of effective treatments: 6-15 Drugs: Anesthesia (General) Muscle relaxant Anaectine to reduce fracture Atropine Sulfate- Anticholinergic drugs decrease salivary secretion and prevent aspiration, increase heart rate, prevents bradycardia

S/E: Confusion Aching Head Temporary memory loss

Post ECT NI: Gag reflex Reorient Assess VS and backache check for fracture Side lying Suction

Mania Etiology: o Genetics

o o o o S/SX: o o o

Increase NE and SERO Increased energy Reaction to depression (denial and reaction formation) Loss Anger/hostility to others violence

Mapang-api Mayabang Magulo Doesnt eat and sleep cardiac collapse

Madaldal Flight of ideas Clang association rhymes Pressured speech

o NI: o o

Malibog SPO

Safety limit settings least environmental stimuli Medications Pro-mood stabilizer Drug of choice: Lithium Anticonvulsants: Depakene Depakote (Valproic Acid) Tegretol (Carbamazepine)

Basic needs: Rest and sleep day naps Activity gross motor movement

Solitary deliver linens

Nutrition finger foods or portable foods

Lithium (Lithobid, Lithane) Level of therapeutic value: 0.6-1.2 mEq/L ag period: 1 week waiting for therapeutic effect

Increased urine polyuria- DHN (diarrhea, vomiting, diaphoresis) toxicity <Na & Lithium = inversely proportional> Toxicity S/SX: o o o o o Mgt: o o o o urea manitol Aminophylline (Theophylline) Severe: Hemodialysis Diarrhea Vomiting Diaphoresis Muscle weakness Coarse hand tremors

Hydrate - increase OFI to 3L/day Salt intake maintain normal/usual/adequate salt intake of 2-3g/day