Psalm 23:18

There is surely a future hope for you, and your hope will not be cut off..

NURSING FACTS IN BRIEF

Psychotherapeutic, Somatic and Psychopharmacologic Management

ANTIPSYCHOTIC DRUGS Neuroleptics or major tranquillizers Takes effect in 1-4 weeks Indications: psychosis, delusions, hallucinations, schizophrenia, mania, insomnia Blocks dopamine in the brain lessens psychotic thinking and bizarre behaviors Typical Antipsychotics blocks dopamine receptors in the brain, produces many EPS Examples of typical Antipsychotics:Thorazine, Prolexin, Mellaril, Serentil, Stelazine, Haldol, Moban Atypical Antipsychotics: weaker dopamine receptors, lesser incidences of EPS Dopamine System Stabilizer: stabilizes dopamine input. Example: Abilify Side effects: EPS ( dystonia, pseudoparkinsonism, akathisia), Neuroleptic malignant syndrome ( most fatal reaction) fever, unstable BP, diaphoresis, pallor delirium, confusion Tardive dyskinesia (irreversible) lipsmacking, blinking, grimacing, unnecessary facial expressions Anticholinergic SE: dry mouth, urinary retention, blurred vision, constipation, tachycardia, dry nasal passages Agranulocytosis: fever, malaise sore throat. Photosensitivity. Orthostatic hypotension- drop of BP due sudden change in position and prolonged standing Contraindications: pregnancy, lactation, DM, liver impairment, CV diseases, glaucoma Nursing Management: 1. Avoid skin contact. 2. Mix with juice. 3. Do not mix with antacids. 4. Avoid direct sunlight. 5. Teach client about orthostatic hypotension. Slowly withdraw drug to prevent seizures. 6. Report signs of agraulocytosis. ANTI-ANXIETY DRUGS Anxiolytics/ sedatives/ hypnotics Reduces involuntary awakenings and increases sleep time Indications: anxiety and anxiety D/O, alcohol withdrawal, borderline personality D/O Benzodiazepines mediate actions of GABAdecreases anxiety Benzodiazepines ( more side effectss): Valium, Ativan, Librium, Xanax, Serax, Restoril, Dalmane Non-Benzodiazepines (lesser side effects): Buspar, Catapres Antihistamines (prevents EPS, allergy, motion sickness): Benadryl, Atarax, Vistaril Side effects: drowsiness and sedation, poor coordination, dizziness, nausea, headache Contraindications: pregnancy, lactation, pulmonary disorders Nursing Management: 1. Give at bedtime. 2. Avoid alcohol and caffeine-rich foods. 3. Give before meals. 4. Do not give solutions that are cloudy. 5. Observe for therapeutic and adverse side effects. 6. Abrupt cessation causes agitation, rebound insomnia, nightmares and sudden death. 7. Teach client to report signs of agranulocytosis 8. Give drugs separately to prevent drug to drug interactions. 8. Never mix with antitacids.

ANTI-MANIC DRUGS Mood stabilizers. Takes effect in 1-3 weeks or more Indicated for manic episode in bipolar disorders Normalizes serotonin, norepinephrine, acethycholine and dopamine to prevent depression and mania Side effects: mild nausea and vomiting, fine hand tremors, loss of appetite, polydipsia, polyuria, metallic taste in the mouth, edema, acne Examples: Lithium (Eskalith, Lithium Carbonate), Carbamazepine, Valproic Acid Normal serum level: 0.6-1.2 mEq/L Toxic level: more than 1.5 mEq/L Nursing Management:1. Monitor serum lithium level regularly. 2. 3 grams of daily salt. 3. 2-3 liters of fluids per day. 4. Mannitol and dialysis for lithium toxicity. 5. Do not give morning dose until serum sample is taken. ANTI-PARKINSONS Usually appear after initial dose of antipsychotics. Treats EPS Attempts to correct imbalance between dopamine and acetylcholine Side effects: sedation, atropine psychosis, photosensitivity, anti-cholinergic side-effects,, agranulocytosis, orthostatic hypotension, hormonal changes.
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DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

Examples: Cogentin, Artane, Parlodel, Larodopa, Benadryl Nursing Management: 1. Give meds with food. 2. Observe for therapeutic side effects and improvement in gait and posture. 3. Teach about orthostatic hypotension. 4. Limit strenuous activities. 5. Avoid taking antidepressants. 6. Weekly CBC monitoring. 7. Weigh client regularly. 8. Calorie-controlled diet and light exercise.

ANTI-DEPRESSANTS Mood elevators; second line agent Indications: major depressive disorders, anxiety disorders, bipolar disorders, eating disorders Balances serotonin and norepinephrine Tricyclic Anti-depressants (1-3 weeks): Sinequan, Pamelor, Elavil, Norpramine, Tofranil. Antidote: Physostagmine (Antilirium) only with life threatening symptoms MAOI (2-4 weeks): Parnate, Nardil, Marplan; third line agent Used for clients who does not respond to TCA or cannot tolerate SSRI Contraindications: pregnancy, lactation, CHF, HPN, liver and kidney problems, alcoholism, schizophrenia, over 60 and under 16 years of age, DM Avoid tyramine-rich food---causes hypertensive crisis Antidote: Phentolamine ( Regitine) for increased BP SSRI (2-3 weeks): first line agent; Zoloft, Paxil, Prozac Broad spectrum action, most popular Indications: depression, anxiety, bulimia, alcoholism, schizophrenia, OCD Nursing Management: 1. Should be taken in morning for 4 weeks for full effects. 2. Avoid TCA or MAOI= FATAL!!! 3. Monitor BP before dosage change to detect hypo pr hypertension. 4. Avoid altering dosage. 5. Do not operate machineries and driving. Report unusual symptoms like tremors, nausea and vomiting, anorexia, nervousness and sexual dysfunctions. 6. Notify doctor of depression worsens. ELECTROCONVULSIVE THERAPY Introduction of 70-150 volts for 0.2-8.0 seconds producing 30-60 seconds seizures, confusion and memory loss. Contraindications: recent MI, asthma, pulmonary disorders, increase ICP, fractures and dislocations Nursing Management: 1. Informed consent. 2. NPO by midnight baseline VS and memory abilities and premeds like Atropine sulfate (decreases secretions); Brevital ( short-acting barbiturate); succinylcholine (muscle relaxant). Post- treatment: side lying, oxygenate, orient, quiet environment.

ALTERNATIVE TREATMENT MODALITIES Behavior therapy modifying observable behavior Cognitive therapy replacing appropriate thoughts Thought Stopping decreases depression and anxiety of irrational provoking behaviors Reframing/Relabelling- relabels dysfunctional behaviors or thoughts to a more reasonable one. Rational-Emotive therapy- individuals values and beliefs control behavior. Deep- breathing exercises- mild to moderate anxiety Benzons relaxations response- relaxes mild to moderate anxiety Assertiveness training- right to choose ones response at a given situation Desensitization gradual exposure to the feared object Flooding/Implosive therapy- sudden exposure to the feared object Gestalt therapy here and now theory Family therapy- establishes communication and family interactions Group therapy 8-10 members; homogenous or heterogenous Aversion therapy- introduction of a noxious stimuli Milieu therapy- using environment for therapeutic purposes Play therapy- ideal for children Art therapy expression of feelings through drawings, etc Recreational therapy involving into activities Vocational therapy learning new skills Music therapy soft music relaxes the body and the mind Sex therapy- maintain healthy sexual functioning Reminisce therapy- used for older people Notes: ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________
The vision that you glorify in your mind, the ideal that you enthrone in your heart - this you will build your life by, and this you will become. - 2 -

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250