Psych Drugs
- Note: All psych drugs cause hypotension and weight gain.
Phenothiazines: 1st Generation / Typical Antipsychotics
- Naming Rule: All phenothiazines end in “-zine.”
- Function: These drugs do not cure psychotic disorders but help manage symptoms.
- “Zines for the zaney” – They are used to treat severe psychiatric conditions.
- “ZzZ… zines” – They also act as sedatives.
- Other Uses: In small doses, phenothiazines can be used as anti-emetics.
- Classification: These are major tranquilizers.
- Do not confuse “zeps” (benzodiazepines) with “zines” (phenothiazines).
Side Effects (Non-toxic)
- Anticholinergic – Dry mouth.
- Blurred Vision.
- Constipation.
- Drowsiness.
- EPS (Extrapyramidal Symptoms) – Symptoms include pill-rolling, cogwheel rigidity, and shuffling gait.
- Photosensitivity – Sensitivity to light.
- Agranulocytosis – Low white blood cell count, leading to immunosuppression.
If the Patient Exhibits Side Effects:
- Educate the patient to continue taking the medication.
- Notify the doctor about the side effects.
- Continue the medication as prescribed.
- Manage and treat the side effects as necessary.
If the Patient Exhibits Toxic Effects:
- Hold the medication and notify the doctor immediately.
- Nursing diagnosis should prioritize risk for injury or safety concerns.
Tricyclic Antidepressants (TCA)
Now classified under NSSRIs (Non-Selective Serotonin Reuptake Inhibitors).
- Time to Effect: It takes 2-4 weeks before you start noticing the effects.
- Examples: Elavil, Tofranil, Aventyl, Desyrel.
- “Elavil elevates your mood” – These medications help improve mood.
- Common Side Effects:
- Anticholinergic – Dry mouth.
- Blurred Vision.
- Constipation.
- Drowsiness.
- Euphoria – Excessively happy mood.
Benzodiazepines
Minor tranquilizers that always contain “zep” in their name.
- “ZzZ… Zep” – Used as sedatives.
- Uses (Remember ABCDE):
- A: Pre-op for anesthesia.
- B: Muscle relaxant.
- C: Alcohol withdrawal.
- D: Seizure management.
- E: Calming patients fighting mechanical ventilation.
- Duration: Benzos work quickly but should not be taken for longer than 2-4 weeks.
- Antidepressants (ADs) take longer to work but can be taken long-term.
- Benzos work immediately but are for short-term use only.
- “Heparin is to Coumadin as a tranquilizer is to an antidepressant” – Short-term use (benzos) versus long-term (antidepressants).
- Do Not Confuse: “Zeps” (benzodiazepines) with “zines” (phenothiazines).
- Common Side Effects:
- Anticholinergic – Dry mouth.
- Blurred Vision.
- Constipation.
- Drowsiness.
- Primary Nursing Diagnosis: Risk for injury due to sedation effects.
MAOIs (Monoamine Oxidase Inhibitors)
- Naming Mnemonic: Names rhyme – Partite, Nardil, Marplan (Think “PaNaMa”).
- Patient Teaching:
- To avoid hypertensive crisis, steer clear of foods high in tyramine.
- Tyramine-rich foods to avoid:
- Salad BAR: Bananas, Avocados, Raisins (any dried fruit).
- Organ meats and preserved meats (hot dogs, lunch meats, smoked, cured, pickled, etc.).
- No dairy except for mozzarella and cottage cheese.
- No yogurt, alcohol, or chocolate.
- No OTC meds should be taken while on MAOIs without consulting a doctor.
Lithium: Used for Bipolar Disorder
- Action: Primarily decreases mania but does not affect depression.
- Unique Property: The only psych drug that doesn’t interfere with neurotransmitters.
- Side Effects (Non-toxic) – Remember the 3 P’s:
- Peeing (increased urination).
- Pooping (diarrhea).
- Paresthesia (tingling).
- Action: Continue giving the medication and no need to call the doctor.
- Toxic Effects:
- Tremors.
- Metallic taste.
- Severe diarrhea.
- Action: Hold the medication and call the doctor.
- #1 Nursing Intervention:
- Increase fluid intake.
- If the patient is sweating, give Gatorade/Powerade (electrolytes), not plain water.
- Monitor for dehydration and sodium levels.
- Low sodium = Increased risk of lithium toxicity.
- High sodium = Lithium becomes less effective.
Prozac (Fluoxetine): SSRI, Similar to Elavil
- Side Effects:
- Anticholinergic (dry mouth).
- Blurred vision.
- Constipation.
- Drowsiness.
- Euphoria (excessively happy mood).
- Insomnia – Administer in the morning, not at bedtime.
- Increased suicide risk – Particularly in young adults during dosage changes.
Haldol (Haloperidol): Typical 1st Generation Antipsychotic
Used for schizophrenia, similar to Thorazine.
- Side Effects:
- Anticholinergic (dry mouth).
- Blurred vision.
- Constipation.
- Drowsiness.
- EPS (Extrapyramidal Symptoms) – Parkinson-like symptoms (e.g., tremors, rigidity), usually not serious.
- Photosensitivity.
- Agranulocytosis – Immune suppression due to bone marrow suppression.
- Neuroleptic Malignant Syndrome (NMS):
- Caused by Haldol overdose, especially in young white men and elderly patients.
- Symptoms: Extremely high fever (105-108°F), anxiety, tremors.
- Fatal if untreated.
- Intervention: Reduce dosage for elderly patients (give half the normal adult dose).
- Tip: Measure temperature to distinguish NMS from EPS.
Clozaril (Clozapine): 2nd Generation Atypical Antipsychotic
Used for severe schizophrenia, designed to replace phenothiazines and Haldol.
- Side Effects: Does not have typical A-F side effects of other antipsychotics.
- Major Concern: Severe agranulocytosis (extremely low WBC count, leading to immunosuppression).
- Monitor: Regular WBC checks are crucial due to the risk of infection.
Geodon (Ziprasidone)
- Black Box Warning: Prolongs the QT interval, increasing the risk of sudden cardiac arrest.
- Do NOT administer to patients with heart conditions.
Zoloft (Sertraline): SSRI
- Can cause insomnia, but it’s safe to give at bedtime.
- Drug Interactions: Zoloft affects drug metabolism, increasing the risk of toxicity in other medications.
- Warfarin/Coumadin doses should be reduced due to increased bleeding risk.
- St. John’s Wort + Zoloft: Risk of Serotonin Syndrome (dangerous drug interaction).
- Symptoms: Sweating, apprehension (impending sense of doom), dizziness, headaches.
Apperture Labs 