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EDITHA C. SABALBORO
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Social anxiety disorder
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ANTIANXIETY Used for the treatment of anxiety and also
useful in the induction of sleep.
Exert a general depressing effect on the CNS,many also exert skeletal muscle- relaxant and
anticonvulsant effects.
These drugs were formerly called minor
tranquilizers.
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Used when the individual has difficulty incoping with environmental stresses and
accomplishing daily activities.
Although the use of sedative-hypnotics has
declines in the last decade, they are still widely
used to reduce anxiety.
Anxiolytics are available in oral and parental
(IM, IV) preparations.
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TypesA. Benzodiazepines - good to help calm the
patient before OR, anti convulsant, muscle
relaxant
Alprazolam (Xanax)
Chlordiazepxide (Librium)
Clorazepate (Tranxene) Diazepam (Valium)
Estazolam (ProSom)
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Halazepam (Paxipam) Lorazepam (Ativan)
Oxazepam (Serax)
Prazepam (Centrax) Temazepam (Restoril)
Triazolam (Halcion)
Flurazepam (Dalmane)
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Nonbenzodiazepine
Azaspirodecanedione buspirone (BuSpar)
Anticonvulsant benzodiazepine
Clonazepam (Klonopin)
Propanediols
Meprobamate (Equanil or Miltown)
Tybamate (Solacen)
Quinazolines
Methaqualone (Quaalude)
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Precautions Drug interaction: drugs potentiate depressant
effects of alcohol or sedatives.
Tolerance to the sedatives and hypnotic effects
develops eventually with all these drugs,although it develops more slowly with thebenzodiazepines than with the others.
All of these drugs, if taken in large enoughdoses or for extended time periods, can lead tophysical and emotional dependence.
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Adverse side effects and related to diminishedmental alertness; caution about driving or
operating hazardous machinery until tolerance
develops.
A drop of BP OF 20 MMHg. (systolic) on
standing warrants withholding the drug and
notifying the physician.
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Signs and symptoms of toxicityAtaxia
Drowsiness
DizzinessDepressed RR,BP
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Benzodiapine use should not be abruptlydiscontinued to avoid a withdrawal syndrome.
Severe withdrawal symptoms can occur if
agents are taken for long time (over 8 months)
and high doses
Tolerances can contribute to self-medication
and dosage escalation.
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Nursing Care of Clients ReceivingAntianxiety orAnxiolytic Medication
Assess the clients medication history, knowledgelevel and use of current medications (prescribed,
over- the-counter, and illicit drugs), medicationallergies, pattern of alcohol use.
Explore the clients perceptions and feelings aboutmedications; certify misinformation, fears, etc.
Review psychotropic drug references for currentinformation.
Plan for client learning about medication
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Administer medications as prescribed. Teach the client about the medication, desired
effect, side effects, food or activity restrictions,
and lag period between onset of treatment and
symptom remission.
Supplement verbal teaching with appropriate
written or audio- visual materials.
Administer clients response to medication and
understanding of teaching.
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schizophrenia
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ANTIPSYCHOTIC
Used to treat a psychotic symptom; that issymptoms of being out of touch with reality;
Act by blocking dopamine receptors in the CNS
and sympathetic nervous system activity; some also exert antiemetic, anticholinergic,
and antihistamines effects.
Antipsychotics control behavior when theclients uncontrolled actions are destructive toself, others, or the environment.
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May be prescribed in conduction withbenzodiazepines (the diazepam\valium
category), which is thought to minimize the use
of neuroleptics and to diminish the potential for
tardive dyskinesia.
The antipsychotics agents or neuroleptics were
formerly called major tranquilizers.
Available in oral and parental (IM, IV)preparations.
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Types
A. Phenothiazines
Aliphatics
Chlorpromazine (Thorazine)
Promazine (Sparine)
Triflupromazine (Vesprin)
Piperidines Mesoridazine (Serentil)
Thioridazine (Trilafon)
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Piperazines Fluphenazine (Prolixin, Permitil)
Perphenazine (Trilafon)
Triflouperazine (Stelazine)
B. Benzisoxazole
Risperidone (Risperdal)
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C. Butyrophenons Dreperidol (Inaspine)
Haloperidol (Haldol)
D. Thioxanthenes
Chlorprothixene (Taractan)
Thiothixene (Navane)
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E.Dibenzoxazepine Loxapine (Loxatane)
F. DihydroindoloneMolindone (Moban)
G. Dibenzodiazepine Clozapine (Clozaril)
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Precautions Drug interactions: potentiate the action of
alcohol, barbiturates, antihypertensives, and
anticholinergics; concomitant use should be
avoided when possible;
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Adverse effects:
Agranulocytosis
jaundice (caused by hepatotoxicity)
signs of extrapyramidal tract irritation,
orthostatic hypotension ?
constipation and urinary retention
anorexia
hypersensitivity reactions (tissue fluid accumulation,
photoallergic reaction,
impotence, cessation of menses or ovulation
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Extrapyramidal side effects (EPSEs Dystonia: occurs early in treatment, possibly
after initial dosage; involves grimacing,
torticollis, intermittent muscles spasms.
Pseudoparkinsonism: resembles true
Parkinsonism (tremor, masklike facies,
drooling, restlessness, festinating gait, rigidity).
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Akathisia: motor agitation (restless legs,jitters, nervous energy); most common of all
EPESs.
Akinesia: fatigue, weakness (hypotonia), painful
muscles, anergy (lack of energy).
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Tardive dyskinesia: late appearing afterprolonged use of antipsychotic drugs; not most
severe effect characterized by involuntary
movements of cae, jaw, and tongue,
lipsmacking, grinding of teeth, rooling or
protrusion of tongue, tics diaphragmatic
movements that may impair breathing;
condition disappears during sleep; usuallyirreversible; all antipsychotics stopped to see if
symptoms subside.
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Akathisia
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Tardive dyskinesia
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pseudoparkinsonism
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Antiparkinson drugs: block the extrapyramidalsymptoms.
Anticholinergics (Cogentin)
Benztropine (Cogentin)
Trihexyphenidyl(Artane) Procyclidine (Kemadrin)
Biperiden (Akineton)
Antihistaminediphanhydramine (Benadryl)
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Nursing Care of Clients ReceivingAntipsychotic
Agents Monitor for sign of hepatic toxicity (e.g., jaundice).
Monitor for signs of infection (e.g., sore throat)
Monitor blood pressure in standing and supinepositions.
Assist client to get out of bed slowly
Assess for hypotension and tachycardia
If hypotension occurs, monitor by measuring BPbefore each dose is given.
Consult physician as to safe BP systolic/diastolicmargins for each client.
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Offers sugar-free chewing gum of hard candy toincrease salivation and relieve dry mouth.
Assist with ambulation as necessary; keep side
rails up when non-ambulatory.
Assess for extrapyramidal symptoms
(antiparkinsonism agent may be prescribed to
decrease symptoms).
Monitor blood work during long- term therapy.
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Instruct client to:
-Avoid administration with other CNSdepressants, including concurrent use of alcohol.
-Avoid engaging in potentially hazardous
activities.-Avoid exposure to direct sunlight; wear
protective clothing and sunglasses outdoors.
-Recognize extrapyramidal symptoms and
report their occurrence to the physicianimmediately.
-Avoid changing positions rapidly.
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-Notify physician if sore throat, fever, or weakness
occurs, avoid crowded, potentially infectious places.
-Increase water intake and eat high-fiber diet toavoid constipation.
-Expect weight gain (diet pills should not be taken);
control weight with appropriate diet.
-Avoid mixing neuroleptics with certain juices orliquids (coffee, tea, or cola beverages may decrease
effectiveness of drug).
-Avoid antacids or take 1 to 2 hours afterantipsychotic drug is taken (antacids decreaseabsorption of antipsychotics).
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Use precautions when preparing medication toavoid contact with the skin.
Evaluate clients response to medication and
understanding of teaching.
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Antidepressants Used to improve the general behavior and
mood of clients experiencing melancholia;
depressed mood, loss of interests, inability to
respond to pleasurable events,
-a depression that is worst in the morning and
lifts slightly as the day progresses, early
morning awakening (and inability to fall asleepagain), marked psychomotor retardation or
agitation, anorexia, weight loss, and guilt.
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Antidepressant drugs increase the level ofnorepinephrine at subcortical neuroeffector
sites.
Available in oral and parenteral (IM)
preparations.
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Norepinephrine blockers provide elevatedlevels of the neurohormone by preventing
reuptake and storage at the axon (tricyclic
compounds).
Monoamine oxidase inhibitors (MAOIs) elevate
norepinephrine levels in brain tissues by
interfering with the enzyme MAO; act as psychic
energizers. Selective serotonin reuptake inhibitors (SSRIs)
are thought to alleviate depression by
preventing reuptake of serotonin in the CNS.
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Types
Norepinephrine blockers or tricyclic
antidepressants (TCAs)
Amitriptyline (Elavil)
Amoxapine (Asendin)
Clomipramine (Anafranil)
Desipramine (Norpramin) Doxepin (Sinequan)
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Imipramine (
Tofranil
)
Maprotiline (Ludiomil)
Nortriptyline (Pamelor)
Protriptyline (Vivactil) Trimipramine (Surmontil)
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Selective serotonin reuptake inhibitors (SSRIs)
Bupropion (Wellbutrin)
Flouxetine (Prozac)
Sertraline (Zoloft) Paroxetine (Paxil)
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Precautions Norepinephrine blockers or tricyclic
antidepressants (TCAs)
Drug interactions: potentiate effects of
anticholinergic drugs and CNS depressants
(e.g., alcohol and sedatives).
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Adverse effects: orthostatic hypotensions, skin
rash, drowsiness, dry mouth, blurred vision,
constipation, urine retention, tachycardia, CNS
stimulation is elderly clients (excitement,
restlessness, incoordination, fine tremor,nightmares, delusions, disorientation,
insomnia).
TCAs should not be given to clients with narrow-angle glaucoma.
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Monoamine oxidase inhibitors (MAOIs)
Drug interactions: MAOIs potentiate the effects
of alcohol, barbiturates, anesthetic agents
(cocaine), antihistamines, narcotics, corticoids,
anticholinergics, and sympathomimetics drugs.
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Drug-food interactions: hypertensive crisis with
vascular rupture, occipital headache,
palpitations, and stiffness of neck muscles,
emesis, sweating, photophobia, and cardiac
dysrhythmias may occur when neurohormonallevels are elevated by ingestion of foods with
high tyramine content (pickled herring, beer,
wine, chicken livers, aged or natural cheese,chocolate).
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Adverse effects: orthostatic hypotension (CNS
effect); skin rash (hypersensitivity); drowsiness
(CNS depression); dry mouth, blurred vision,
urinary retention, tachycardia (anticholinergic
effect); sexual dysfunction (autonomic effect);nightmares, delusions, disorientation, insomnia
(CNS stimulation).
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Selective serotonin reuptake inhibitors (SSRIs)
Usually these drugs are administered before
noon to avoid insomnia or sleep disturbances.
Drug interactions: may interact with tryptophan;
question concominant use of diazepam,
warfarin, and digoxin; should be discontinued 4
to 6 weeks before switching to MAOIs.
Adverse effects: insomnia, headache, dry
mouth, sexual dysfunction, anxiety, diarrhea
and other gastrointestinal-tract complaints.
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Nursing Care of Clients Receiving
Antidepressants
Assess for effectiveness of drug action.
Maintain suicide precautions, especially as
depression begins to lift; carefully monitor
serum glucose in diabetics.
Instruct client to:
Change positions slowly.
Avoid engaging in hazardous activities.
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Utilize sugar-free chewing gum or hard candy to
stimulate salivation.
Check with physician before taking all OTC
preparations or before consuming alcohol.
Expect therapeutic effect to be delayed; may
take 3 to 4 weeks for the TCAs and shorter for
the MAOIs.
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MAOIs
Maintain dietary restrictions; avoid foods
containing tyramine (aged cheeses, beer,
chianti wine, yogurt, soy sauce, chocolate).
Monitor client for occurrence of hypertensive
crisis (occipital headache, palpitations, and
stiff neck).
Avoid concurrent administration of adrenergic
drugs.
Avaluate clients response to medication and
understanding of teaching.
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Description
Used to control the manic episode of mood
disorders and for maintenance in clients with a
history of mania.
Act by reducing adrenergic neurotransmitter
levels in cerebral tissue through alteration of
sodium transport.
Antimanic agents are available in oral capsules
and tablets, both regular and sustained-release
forms, and in concentrates.
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Types
Antimanic agents and mood stabilizers
Lithium carbonates (Eskalith, Lithane,
Lithonate, Lithizine, Lithobid).
Lithium citrate (concentrate form).
Alternative antimanic agents and mood
stabilizers
Carbamazepine (Tegretol)
Clonazepam (Klonopin)
Valproic acid (Depaneke, Valproate sodium)
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Drug-food interaction: restriction of sodium intake
increases drug substitution for sodium ions,
which causes signs of hyponatremia (nausea,
vomiting, diarrhea, muscle fasciculations,
stupor, and seizures); therefore salt intakemust be maintained.
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Adverse effects: excess voiding and extreme
thirst caused by drug suppression of
antidiuretic hormone (ADH) function, which
causes dehydration; slurred speech,
disorientation, confusion, cogwheel rigidity,ataxia, renal failure, respiratory depression,
and coma are toxic side effects; toxic effects
can easily occur because the differencebetween the therapeutic level and toxic level is
slight.
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Nursing Care of Clients ReceivingAntimanic and
Mood-stabilizingAgents
Recognize that therapeutic effects will be
delayed for several weeks.
Recognize that dehydration and hyponatremia
predispose the client to lithium toxicity.
Assess therapeutic blood levels (0.6 to 1.2
mEq/L) during course therapy.
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Supervise ambulation if necessary.
Administer with meals to reduce GI irritation.
Teach the client that the nausea, polyuria, and
thirst that occur initially will subside after
several days.
Teach client and family to observe for signs of
toxicity (diarrhea, vomiting, drowsiness,
muscular wekness, ataxia, confusion, andtonic-clonic seizures).
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Evaluate clients response to medication and
understanding of teaching.
Draw CBC every 2 to 4 weeks to monitor for
WBC suppression and anemia noted with
carbamazepine.
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