STU1 Melissa S (BiPolar, Mania); Heather Trail (Paranoid Schizophrenia); Lisa H (Disorganized Schizophrenia)

Drug Action

Side Effects

Contraindications

RN Implications

Antidepressants
SSRI
Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Escitalopram
(Lexapro)
Sertaline (Zoloft)

Celexa

major depression, bipolar, panic,

OCD, premenstrual dysphoric
disorder, bulimia
takes 2-4 weeks to work
blocks reuptake of serotonin &
strengthens transmission of
serotonin

Trazadone

Block reuptake & degradation

of 5-HT
Prozac is 5-HT antagonist
reducing anorexic & bulimic
effects (muscarinic antagonist)
Decreased ability to block
muscarinic & H1 receptors =
more selective action; greater
efficacy without heavy anticholinergic effects

treats major depressive disorder

do not take w/MAOIs

fewer S/E than TCAs

weight loss, sweating, HA
insomnia- give AM
GI: N/V/D-(short lived)
sexual dysfunction (dec med to
fix issue)
increased anxiety & restlessness

Anti-Cholinergic
Inhibit spinal reflexes of
organism & DA leading to
apathy & libido
stimulation of 5-HT receptor
activity in brain cause N/V

Suicidal thoughts when you are

first taking it
Do not give to children under 18
Do not use with MAOIs
Take after meal or snack
Avoid EtOH

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Drug/Use

Drug Action

Side Effects

Contraindications

RN Implications

Antianxiety (Sedatives)
Benzodiazepines

Lorazepam (Ativan)
Diazepam (Valium)
Alprazolam (Xanax)

Quick onset of action

CNS depressant
Enhances GABA in limbic
system (expression & emotions)

CNS depressant, HR &

tachypnea
High abuse potential
Sedation
Ataxia
Cognitive function
Dizziness, ataxia, vertigo
Feeling of detachment

Patients with known substance

abuse problems
Pregnancy or breast feeding
EtOH
Use with other CNS depressants
- paradoxal excitement
Depressants cause potentiation

risk of dependency &

addiction (psychological &
physical) with use >2 weeks
Short term use only
Monitor elderly
Avoid abrupt withdrawal
(seizures)

chlordiazepoxide
hydrochloride
(Librium)

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Drug Action

Side Effects

blocks norepinephrine,
acetylcholine, dopamine, &
histamine receptors
for schizophrenia, acute mania of
bipolar, N/V, intractable hiccups
*Haldol & Prolixin come in long
acting IM or depot (lasts 14-30
days)- used for pt. having
difficulty complying w/daily med
regimens

All Acute S/E can be controlled

by antiparkinsonian meds Cogent
or Benadryl
AIMS test- used to assess EPS
effects
have potential to cause serious
life threatening adverse effects
Neuroleptic malignant syndrome
(NMS) can be lethal, its a
complication of antipsychoticsS/E are high fver, LOC, VS
instability

Contraindications

RN Implications

Antipsychotic/Schizophrenia
Traditional/Typical
(old)
Haloperidol (Haldol)
Chlorpromazine
(Thorazine)
Fluphenazine
(Prolixin)
Thioridazine
(Seroquel)

S/E are all related to dopamine

anticholinergic effects, erectile
dysfunction, cardiac
dysrhythmias
Reversible/ACUTE:
EPS- extrapyramidal side effects
are common: dystonia- acute
muscle spasms, torticollis,
oculogyris crisis (feel like they
cant breathe) requires
IMMEDIATE attention,
Parkinsonian syndrome- muscle
rigidity, akathisia- motor
restlessness, agitated, anxiety
Permanent:
tardive dyskinesia- no effective
treatment.1st sign of it is wormlike movements under tongue if
you see these symptoms- call
MD & hold Haldol

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Drug Action

Side Effects

DA receptors antagonists block

action of DA, DA
transmission
ACh muscarinic, NE- , & H
receptor antagonist

Musc. receptor block:

tachycardia, anticholinergic, &
impaired memory
H block: Sedation, weight gain,
orthostasis
5-HT: Antipsychotic effects,
weight gain, hypotension,
ejaculatory dysfunction
GABA: Lowers seizure threshold
block: Sexual dysfunction,
priapism (prolonged erection)
block (NE SNS smooth
muscle): VASODILATION =
Orthostatic hypotension,
dizziness, antipsychotic effect,
reflux tachycardia, failure to
ejaculate
D block: Antipsychotic effect,
EPS, amenorrhea, increased
prolactin (gynecomastia [man],
galactorrhea [women])

Contraindications

RN Implications

Antipsychotic/Schizophrenia
Haldol

other Atypicals (new)

Risperidone
(Risperdal)

D antagonist = risk of EPS

prolactin
reseptor blocker
H receptor blocker

Olanzapine
(Zyprexa)
Quetiapine (Seroquel)
geodon (zipasidone)

treat schizophrenia and the

manic symptoms of bipolar
disorder

Motor difficulties at doses

Sexual dysfunction
Orthostatic hypotension=falls
Sedation
Weight gain ( appetite)
risk of CVA in older adults
with dementia being treated for
aggravation

sedation, postural hypotension,

weight gain, allergic skin rash,
photosensitivity
anticholinergic- dry mouth, nasal
stuffiness, constipation, urinary
hesitancy/retention, blurred
vision

Monitor for involuntary

movements (AIMS)
Non-adherence is a significant
issue

if meds are cheeked (not

swallowed) give liquid to ensure
ingestion
pts are first given tablet form
(least restrictive form)
monitor pts response
help pts manage common S/E
monitor BP w/ IM route-due to
hypotensive properties

only use in children over 10

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Drug Action

Side Effects

Contraindications

RN Implications

Anticonvulsants/Antiseizure/Antiepileptic (AED)
Divalproex
(Depakote)

Na channel activity, firing

rate of overexcited neurons

hypernatremia
Anticholinergic
orthostasis
sedation
ataxia
Rash (first 20 weeks, report
immediately, can progress to lifethreatening exfoliative dermatitis
or Stevens-Johnson syndrome)

Drug Action

Side Effects

seizures, maina in
bipolar, & migraines
Carbamazepine
(Tegretol)
Gabapentin
(Neurotin)

Baseline LFT, CBC, ECG,

sedation & skin rashes
&electrolyte levels; monitor blood
carbamazepine (Tegretol)=
levels to avoid toxicity
sedation. in liver enzymes,
cardiac conduction issues,
rashes, leukopenia
valproic acid (Depakene)=
sedation & GI distress- most
common, tremors, ataxia, weight
gain, alopecia,
thrombocytopenia, platelet
dysfunction

Contraindications

RN Implications

Antiparkinsons
Benztropine
(Cogentin)
Diphenhydramine
(Benedryl)

classified by mode of action:

Cogentin- anticholinergic
Benadryl- antihistamine
used in psychiatric areas: EPS of
antipsychotic meds inc.
Parkinsonian syndrome,
akathisia, dystonia, tardive
dyskinesia
the imbalance of
neurotransmitters that cause
Parkinsons disease & drug
induced EPS is the same

Cogentin- contraindicated w/
narrow angle glaucoma,
obstructive disorders of GI tract,
prostatic hypertrophy
Benadryl-

Cogentin: blurred vision, dry

mouth, constipation, N,
drowsiness, nervousness, urinary
retention/hesitancy
Benadryl: similar to Cogentinbut milder, mostly drowsiness &
sedation

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Cogentin
Increase in ACh
Plays a role in
learning & memory
Regulates mood:
mania, sexual
aggression
Affects sexual &
aggressive behavior
Stimulates
Parasympathetic
Nervous System

Drug Action

Side Effects

Contraindications

complete medical history &

physical exam needed before
meds are started- inc. thyroid fxn
test (T3 & T4), urinalysis, kidney
fxn test, ECG, & serum sodium
levels
do not give if pregnant
do not give to its w/renal,
cardiovascular, hypertensive, or
thyroid disorders
need to monitor F/E- fluid
balance
because of small therapeutic
range, never take the lab values
alone- also need to compare
them to: S/E, blood draws, & the
patient
diuretics, NSAIDS, ACE increase
risk of toxicity

fine hand tremors- most

common S/E
hypernatremia
weight gain
toxicity= N/V/D, ataxia
(incoordination), dizziness,
confusion, seizures, hypotension,
cardiac arrest
dont skip dose
if active, stay active
maintain norms- inc. salt intake
if sick call MD, don't take OTC
meds (F/E balance)

RN Implications

Antimanics/Psychotherapeutic/Bipolar Drugs
Lithium
mood stabilizer

treats manic excitement & averts

manic & depressive cycles in
bipolar patients
changes sodium ion transport
which alters catecholamine
metabolism, promotes the growth
of neurons
sodium in the body & lithium
compete
therapeutic range 0.5-1.5 mEq/L
stop at first sign of toxicity

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Lithium

Uncertain, but possibly:

Affects electrical conductivity in
neurons as positively charges
ion similar to Na+ & K
Interacts with Na & K at cell
membrane to stabilize electrical
activity
Reduces glutamate (excitatory)
for antimanic effect
Inhibits 5-HT autoreceptors

Toxicity & adverse effects r/t

influence on electrical
conductivity, threatening all body
functions regulated by electrical
currents
CV: sinus bradycardia
CNS: toxicity = extreme cerebral
conductivity leading to
convulsions
Musc.: tremors or extreme motor
dysfunction ( doses)
Disrupts F&E balance causing
polyuria & edema
Hypothyroidism (affects iodine
T3 conversion)

Hyponatremia can risk of

toxicity d/t renal absorption of
Na = reabsorption of lithium
Musc./Nerve: Tremor, ataxia,
confusion, convulsions
GI: N/V/D
CV: Arrhythmias
F&E: Polyuria, polydipsia, edema
Endo.: Goiter & hypothyroidism

Low therapeutic index (0.5-1.5)

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