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Teaching strategies for clients on antidepressants
Take medication as prescribed, compliance is important; full effectiveness may not be evident until 1 to 2 weeks after start of therapy; encourage to keep appointments; do not consume alcohol or CNS depressants because of their addictive effects; many herbal products interact with antidepressants, esp MAOIs and SSRIs; do not drive or be involved in potentially dangerous mechanical activity until stabilization of the drug dose has been est; do not abruptly dc the drug, should be gradually decreased; consult with prescriber if planning pregnancy; and take with food if upsets GI
Food interaction with MAOIs
- Following foods may cause a hypertensive crisis: cheese, bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, italian green beans, liver, yeast, and soy sauce.
- Increased blood pressure may result from an increased intake of brewer's yeast
Anxiolytics (antianxiety drugs)
Used to treat anxiety, insomnia (short-term), seizures and status epilepticus, alcohol withdrawal, skeletal muscle spasms, and as a preop med.
Common side effects of anxiolytics
Sedation, diziness, headaches, dry mouth, blurred vision, rare urinary incontinence and constipation
Adverse reactions of anxiolytics
- Leukopenia (decreased WBC count) with syptoms of fever, malaise, and sore throat
- Tolerance to the drug dosage with continuous use
- Physical dependency.
To dc use of anxiolytics
Should be gradually decreased over a period of days depending on dose or length of time on the drug. Withdrawal symptoms include: paranoia, delirium, panic, hypertension, and status epilepticus.
Nonpharmacoligic methods for dealing with anxiety
Relaxation technique, psychotherapy, or support groups.
Contraindications for anxiolytic therapy
- Increases CNS depression with consumption of alcohol, CNS depressants, and anticonvulsants;
- Cimetidine increases lorazepam plasma levels, increases phenytoin levels;
- Decreases levodopa effects;smoking decreases antianxiety effects.
- Kava kava my potentiate sedation.
Antidote for benzodiazepine
flumazeni (Romazicon) IV
Therapeutic safety range for lithium therapy
- 0.5 to 1.5 mEq/L
- Serum levels above 1.5 to 2 are toxic.
- (Should be monitored biweekly until therapeutic level has been obtained, and then monthly on a maintenance dose.)
Necessary lab values for clients on lithium therapy
Lithium serum level as well as sodium levels as lithium tends to deplete sodium
Signs of lithium toxicity
- Early symptoms: diarrhea, drowsiness, loss of appetite, muscle weakness, nausea, vomiting, slurred speach, trembling
- Late symptoms: blurred vision, confusion, increased urination, convulsions, severe trembling, and unsteadiness.
Drug interactions with lithium therapy
Diuretics, NSAIDs, tetracyclinldopa, and probenecid decrease renal clearance of lithium, causing drug accumulation.
Dietary guidelines for clients on lithium
- Client should avoid caffeine products because they can aggravate the manic phase of bipolar.
- The client also needs to maintain adequated sodium intake
- Avoid crash diets that affect the physical and mental health.
Teaching for Client on lithium therapy
Take med as prescribed; must be compliant with dosage, lab tests, and follow-up visits; check with health care provider before taking OTC meds; should not drive or operate heavy machinary until stable lithium level is established; advise to maintain adequate fluid intake (2 to 3 L/d initially and then 1 to 2 L/d maintenance and should be increased in hot weather); take med with meals to decrease gastric irritation; effectiveness may not be evident until 1 to 2 weeks after the start of therapy; client planning pregnancy should contact health care provider; should wear or carry ID tag or bracelet to indicate the drug taken.