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WCC Nur 175

Antianxiety & Hypnotic- Benzodiazepines

*lorazepam (Ativan)
*diazepam (Valium)
*clonazepam (Klonopin)
* Alprazolam (Xanax)

COMMON SIDE EFFECTS: antianxiety agents

1) drowsiness, confusion and lethargy
2) dry mouth, nausea, vomiting
3) tolerance (physical and psychological dependence)
4) potentiates effects of other CNS depressants
5) orthostatic hypotension
6) blood dyscrasias: anemia, leukopenia, thrombocytopenia

SPECIFIC DRUG: Buspirone (BuSpar)

*Long term anxiety control
*delayed onset- 10-14 days to become effective
* less likely to cause sedation
* less likely to cause tolerance


*Nonbenzodiazepines--- Short acting sedative & hypnotic sleep agents
- Zolpidem (Ambien)
- Lunesta

Types of antidepressents

1. Tricyclics
2. SSRI's
3. SNRI's
4. SNDI's
5. MOI's

Tricyclic antidepressants

*Increases Norepinephrine
*Most dangerous in overdose
*Anticholergenic effects
- amitriptyline (Elavil)
- imipramine (Tofranil)
-avoid smoking increases metabolism of drug

SSRI antidepressants

*Selective Serotonin Reuptake Inhibitors
*Usually first line used
- fluoxetine (Prozac)
- sertraline (Zoloft)
-paroxetine (Paxil)

SNRI antidepressents

*Serotonin and Noradrenaline Reuptake Inhibitors
*Less side effects than tricyclics
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
*Also for aches and pains

SNDI antidepressents

*Serotonin and Noradrenaline DisInhibitors
*Used with elderly
*Can cause sleepiness, weight gain
-mirtazapine (Remeron)
-bupropion (Wellbutrin) (Zyban)
*Can be used to quit smoking
-trazodone (Desyrel)

Antidepressants: common side effects

1) dry mouth, nausea
2) sedation
* gone within 2-3 weeks
* more prominent during peak
-usually take 2-4 weeks before there is a therapeutic effect.
- be alert for sudden lifts in mood
- do not stop abruptly can cause withdrawal
- do not drink alcohol
- be aware of teratogenic effects during pregnancy

MAO inhibitors

- phenelzine (Nardil)
- tranylcypromine (parnate)
-EMSAM (selegiline transdermal system)
*special diet- avoid foods high in tyramine- avocados, figs, fermented & smoked foods (meat, cheese)
*diet must be maintained for 2 weeks after stopping MAOI's

SIGNS AND SYMPTOMS: Hypertensive crisis

*Occurs when the client consumes food containing tyramine and take certain medication while on MAOI meds
1) markedly increased BP
2) severe occipital headache
3) palpitations
4) nausea, vomiting
5) nuchal rigidity
6) fever, sweating
7) chest pain
8) coma

TREATMENT: Hypertensive crisis

1) stop the MAOI meds; condition can be fatal
2) supportive medical and nursing measures related to signs and symptoms; antihypertensive meds
3) condition usually resovles on its own once the medication is is out of the body
4) client and family education


lithium (Lithobid)
-narrow therapeutic range
**0.4-1.3 mEq/L**
- lithium is a salt if sodium levels are decreased or depleted it increases risk of toxicity consume enough salt and water (2500 ml- 3000 ml)
-may take 2-3 weeks to work; may also be given an antipsychotic meanwhile
- DO NOT change brands
- lithium levels should be checked 1-3x a wk
- after levels are stable check monthly during maintenance
- blood lvls drawn 12 hours after last dose


Weight Gain

Toxicity- can lead to:
*Blurred vision
*Ataxia- uncoordinated muscle movements

SIGNS AND SYMPTOMS: lithium toxicity

1) serum levels
*1.5-2.0 mEq/l: blurred vision, ataxia, tinnitus, persistent nausea and vomiting, severe diarrhea
*2.0-3.5 mEq/l : excessive output of dilute urine , increasing tremors, muscular irritability, psychomotor retardation, mental confusion, and giddiness.
*above 3.5 mEq/L: impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, and cardiovascular collapse.


*Off label mood stabilizers
- valproate (Depakote)
*used for depression in kids
-carbamazepine (Tegretol)
-lamotrigine (Lamictal)
*maintenance of bipolar disorder
*Watch for rash- Stevens-Johnson syndrome


*addresses the positive symptoms of schizophrenia
(symptoms not seen in healthy people- should not be present)
*lower cost but more side effects- EPS
-chlorpromazine (Thorazine)
-fluphenazine (Prolixin)
-haloperidol (Haldol)
*used in ED for agitated patients

Side effects of Conventional antipsychotic drugs

1) Dystonia:
muscle stiffness
2) Akathisia:
continuous restlessness and fidgeting
3) Tardive dyskinesia (TD):
lip smacking- not reversible
4) Pseudoparkinsonism:
shuffling gait, tremor, drooling, rigidity
*Neuroleptic Malignant Syndrome (NMS):
rare but life-threatening
*Orthostatic hypotension

TREATMENT: Extrapyramidal symptoms (EPS)

1) stop the antipsychotic medication; symptoms are potentially irreversible
2) Administer anti-parkinsonian drugs: benztropine (cogentin) usually given IM
3) client and family education

SIGNS AND SYMPTOMS: Tardive dyskinesia

1) involuntary muscle movements
2) bizarre facial and tongue movements
3) stiff neck
4) difficulty swallowing

SIGNS AND SYMPTOMS: Neuroleptic malignant syndrome (NMS)

1) Parkinsonian muscle rigidity
2) hyperpyrexia; up to 107 degrees
3) tachycardia
4) tachypnea
5) fluctuations in BP
6) diaphoresis
7) rapid deterioration of mental status to stupor or coma

TREATMENT: Neuroleptic malignant syndrome (NMS)

1) Stop the antipsychotic medication; condition can be fatal
2) bromocriptine (Parlodel) or dantrolent (Dantrium) given to counter effects of NMS
3) supportive nursing measures related to signs and symptoms ( cooling blankets, sponge baths)
4) client and family education!


*Target positive & negative symptoms of schizophrenia
(Negative- what is not present- flat affect, lack of pleasure)
*Fewer EPS
*Risk of metabolic syndrome
-clozapine (Clozaril)
-risperadone (Risperdal)
-quetiapine (Seroquel)
-olanzapine (Zyprexa)
-iloperidone (Fanapt)
-lurasidone HCl (Latuda)
-ziprasidone HCl (Geodon)
-aripeprazole (Abilify)
-paliperidone (Invega)

Neurotransmitter affected: ANTIDEPRESSENT DRUGS


Neurotransmitter affected: ANTIANXIETY DRUGS


Neurotransmitter affected: SEDATIVE HYPNOTIC


Neurotransmitter affected: MOOD STABILIZER


Neurotransmitter affected: ANTIPSYCHOTIC


Neurotransmitter affected: ANTICHOLINESTERASE


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