Mood altering drugs

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Butterbug10
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161442
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Mood altering drugs
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2012-07-08 09:17:26
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mood altering drugs
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  1. Key facts about barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    • Believed to cause generalized CNS depression by mimicking or enhancing the effects of GABA in the brain
    • Metabolized by the liver
    • Excreted in the feces
  2. When to use barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    • Anesthesia
    • Insomnia
    • Seizures
  3. When NOT to use barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    • pregnancy
    • Uncontrolled pain
    • History of acute intermittent porphyria or CNS depression
  4. Adverse reactions to barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    Hangover feeling, slurred speech, paradoxical excitement, drowsiness, lethargy, hypoventilation, nausea, vomiting
  5. Key nursing actions for barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    • Administer I.V. slowly
    • Assess pt's sleep patterns
    • Know that many sedative-hynotics are controlled substances
    • Limit amount of medication available to pt
    • Know that long-term use of these drugs may cause physical and psychological dependence
    • Monitor pt's respiratory status
  6. Topics for patient discussion about barbituates [Ex: thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal sodium), phenobarbital (Luminal)]
    • Therapy regimen
    • Signs and symptoms of possible adverse reaction
    • Activity restriction
    • Safety measures
    • Avoidance of alcohol and OTC antihistamines and other CNS depressants
    • Notification of practitioner before using other prescription drugs
    • Need for compliance with therapy and medical follow-up
  7. Key facts about benzodiazepines [Ex: alprazolam (Xanax), chloridiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril)]
    • Cause generalized CNS depression by mimicking or enhancing the effects of GABA
    • Metabolized by the liver
    • Excreted in the urine
  8. When to use benzodiazepine [Ex: alprazolam (Xanax), chloridiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Damane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril)]
    • Anxiety
    • Alcohol withdrawal
    • Preoperative sedation
    • Insomnia
    • Seizures Skeletal muscle relaxation
  9. When NOT to use benzodiazepines [Ex:alrazolam (Xanax), chloridiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril)]
    • Pregnancy
    • Uncontrolled pain
    • Preexisting CNS depression
    • Acute angle-closure glaucoma
  10. Adverse reactions to benzodiazepines [Ex: alprazolam (Xanax), chloridiazepoxide (librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril)]
    • Commonly drowsiness; ataxia; temporary memory impairments; reactions fo rage, excitedment, or hostility
    • Possible confusion, dry mouth, nausea
  11. Key nursing actions for benzodiazepines [Ex: alprazolam (Xanax), chloridiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril)]
    • Administer I.V. doses slowly
    • Instruct patient to notify practitioner if dose becomes ineffective after a few weeks
    • Advise patient not to increase dosage unless instructed by practitioner
    • Don't discontinue abruptly
  12. Key facts about nonbarbituates sedative-hypnotics and anxiolytics [Ex: buspirone (BuSpar), chloral hydrate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan), zaleplon (Sonata), zolpidem (Ambien)]
    • Cause generalized CNS depression
    • Metabolized by the liver
    • Excreted in the feces
  13. When to use nonbarbituate sedative-hypnotics and anxiolytics [Ex:buspirone (BuSpar), chloral hydrate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan), zaleplon (Sonata), zolpidem (Ambien)]
    • Insomnia
    • Preoperative sedation
    • General anesthesia
  14. When NOT to use nonbarbituate sedative-hypnotics and anxiolytics [Ex: buspirone (BuSpar), chloral hydrate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan), zaleplon (Sonata), zolpidem (Ambien)]
    • Pregnancy
    • Uncontrolled pain
    • Preexisting CNS depression
  15. Adverse effects of nonbarbitaute sedative hypnotics and anxiolytics [Ex: buspirone (BuSpar), chloral hydrate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan), zaleplon (Sonata), zolpidem (Ambien)]
    • Drowsiness
    • respiratory depression
    • nausea
    • vomiting
  16. Key nursing actions for nonbarbituate sedative-hypnotics and anxiolytics [Ex: buspirone (BuSpar), chloral hydrate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), promethazine (Phenergan), zaleplon (Sonata), zolpidem (Ambien)]
    • Use Z-track method of injection (hydroxyzine)
    • Administer after meals (chloral hydrate)
    • Know that long-term use may cause dependence
  17. Key facts about phenothiazines [Ex: chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thiethylperazine (Torecan), thioridazine (Mellaril), thiothixene (Navane)]
    • Block the neurotransmitter depamine inthe limbic system inhibiting the impulse of nwural impulses
    • Inhibit chemoreceptor trigger zone in the medulla of the brain
    • Metabolized by the liver
    • Excrerteed mostly in the urine
  18. When to use phenothiazines [Ex: chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thiethylperazine (Torecan), thioridazine (Mellaril), thiothixene (Navane)]
    • Psychosis, schizophrenia, chizoaffective disorder, depression with psychotic features, psychotic symptoms associated with organic brain syndrome
    • Nausea and vomiting
  19. When NOT to use phenothiazines [Ex: chlorpromazine (Thorazine), fluphenazine Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thiethylperazine (Torcan), thioridazine (Mellaril), thiothixene (Navane)]
    • Angle-closure gluacoma
    • CNS depression
    • Pregnancy (first trimester)
    • Coma
    • Risk of suicide
  20. Adverse reactions to phenothiazines [Ex: chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thiethylperazine (Torcan), thioridazine (Mellaril), thiothixene (Navane)]
    Extrapyridamidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, sedation, blurred vision, dry mouth, constipation, blood dyscrasias, photosensitivity reaction, sunburn, heat intolerance
  21. Key nursing actions for phenothiazines [Ex: chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thiethylperazine (Torcan), thioridazine (Mellaril), thiothixene (Navane)]
    • Tell pt that urine may discolor to pink or red-brown
    • Instruct pt to call preactitioner before taking over-the-counter or herbal preparations
    • Monitor QT interval in patient taking thioridazine
  22. Key facts about butyrophenones [Ex:(droperidol (Inapsine), haloperidol (Haldol)]
    • Block the neurotransmitter dopamine in the limbic system, inhibiting the transmission of impulses
    • Inhibit the chemoreceptor trigger-zone in the medulla of the brain
    • Metabolized by the liver
    • Excreted mostly in the urine
  23. When to use butyrophenones [Ex: droperidol (Inapsine), haloperidol (Haldol)]
    • Nausea and vomiting durgin surgery and diagnostic procedures
    • As adjunct to anesthesia
    • Psychosis, Tourette syndrome, behavioral problems in children with explosive hyperexcitability, hyperactivity in hyperactive children
  24. When NOT to us butyrophenones [Ex: droperidol (Inapsine), haloperidol (Haldol)]
    • Angle-closure glaucoma
    • CNS depression
  25. Adverse reactions to butyrophenones [Ex: droperidol (Inapsine), haloperidol (Haldol)]
    Extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, sedation, blurred vision, dry mouth, constipation, blood dyscrasia, photosensitivity reaction, sunburn, heat intolerance
  26. Key nursing actions for butyrophenones [Ex: droperidol (Inapsine), halperidol (Haldol)]
    • Tell pt to avoid driving or other hazardous activities until CNS effects are known
    • Advise pt to avoid alcohol and other CNS depressants during therapy
  27. Key facts about atypical antipsychotics [Ex: clomipramine (Anafranil), clozapine (Clozaril), loxapine (Loxitine), molindone (Moban), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperidol), ziprasidone (Geodon)]
    • Block the neurotrasmitter dopamine in the limbic system, inhibiting the transmission of neural impulses
    • Inhibit the chemoreceptor trigger zone in the medulla of the brain
    • Excreted mostly in urine
  28. When to use atypical antipsychotics [Ex: clomipramine (Anafranil), clozapine (Clozaril), loxapine (Loxitine), molindone (Moban), olanzapine (Zyprexa), quetiapine (Serolquel), risperidone (Risperidol), ziprasidone (Geodon)]
    • Psychotic disorders, such as schizophrenia and schizoaffective disorders
    • Obsessive-complusive disorder
    • Bipolar disorder
    • Risk of recurrent suicidal behavior
  29. When NOT to use atypical antipsychotics [Ex: clomipramine (Anafranil), clozapine (Clozaril), loxapine (Loxitine), molidone (Moban), olanzapine (Zyprexa), quetiapine (Serolquel), risperidone (Risperidol), ziprasidone (Geodon)]
    • Angle-closure glaucoma
    • CNS depression
  30. Adverse reactions to atypical antipsychotics [Ex: clomipramine (Anafranil), loxapine (Loxitine), molidone (Moban), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperidol), ziprasidone (Geodon)]
    Extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, sedation, blurred vision, blood dyscrasias, photosensitivity reaction, sunburn, heat intolerance
  31. Key nursing actions for atypical antipsychotics [Ex: clomipramine (Anafranil), loxapine (Loxitine), molidone (Moban), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperidol), ziprasidone (Geodon)]
    • Assess pt's mental status
    • Monitor pt for extrapyramidal symptoms and other adverse reactions
    • If pt is recovering from anesthesia with droperidol or fentanyl, decrease opioid analgesic dosages to one-quarter to one-third of normal
    • After parenteral doses, monitor pt for orthostatic hypotension
    • Know that pt receiving long-term antipsychotic therapy should undergo revular evaluation of red and white blood cell counts
    • Don't give antacids within 1 hr of administering these drugs
    • Know that drug should be discontinued gradually
    • Teach pt to:
    • -comply with therapy
    • -avoid alcohol and other CNS depressants
    • -avoid driving and hazardous activities until CNS effects of drug are known
    • -use sunscreen and wear protective clothing
  32. Topics for pt discussion concerning atypical antipsychotics [Ex: clomipramine (Anafranil), loxapine (Loxitine), molidone (Moban), olanzapine (Zyrexa), quetiapine (Seroquel), risperidone (Risperidol), ziprasidone (Geodon)]
    • Therapy regimen
    • Signs and symptoms of possible adverse reaction
    • time required for drug to reach maximum effectiveness
    • Safety measures
    • Avoidance of alcohol and other CNS depressants
    • Need for compliance with therapy and medical follow-up
  33. drug examples for tricyclic and quadracyclic antidepressants
    Amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), doxepine (Sinequan), imipramine (Tofranil), nortriptyline (Palemor), protryptiline (Vivactil)
  34. Drug examples of second-generation  and misc antidepressants
    bupropion (Wellbutrin), duloxetine (Cymbalta), fluoxetine (Prozac), venlafaxine (Effexor)
  35. Drug examples of SSRIs
    citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac)

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