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Lecture 9 Psych Medications

- All psych medications cause 2 things regardless of classification:

• Lower’s blood pressure
• Weight changes (usually increase weight)

Phenothiazine’s

• Phenothiazine’s are an old class of psych medication that have a couple different

names:

• First generation antipsychotic medications
• Typical antipsychotics
• All Phenothiazine medications end in “zine”.
• Prochlorperazine
• Cholorpromazine
• Thioridazine
• Fluphenazine

- Action:

• All Phenothiazine medication do not cure the psychotic disorder, they just

reduce the symptoms.

• In large doses they are antipsychotics
• “We use zine’s for the zainy (insane)”
• In small doses they are antiemetic’s
• Phenothiazine’s are major tranquilizers.
• “Aminoglycosides are to antibiotics” as “Phenothiazine’s are to

tranquilizers”

- Meaning: when no other tranquilizers are working the Phenothiazine’s are

used to get the job done. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:09:07 GMT -05:00

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- Side effects of Phenothiazine’s:

- Phenothiazine’s have a long list of major side effects:

• Anticholinergic effects (primarily dry mouth)
• Blurred vision
• Constipation
• Drowsiness

- EPS (Extrapyramidal syndrome): drug induced Parkinson’s

• Photosensitivity

- Agranulocytosis (low WBC count): immunosuppressed

- Nursing Care:

• The nursing care is focused on treating the side effects of Phenothiazine’s
• Since patients on these medications have blurred vision, drowsiness, and

EPS, the number one concern is risk for injury.

• Cogentin and Artane are given to reduce EPS effects

- Decanoate:

• Typically abbreviated with the letter “D”
• Thioridazine “D”
• If the “D” comes after the name of the medication it means it is a long-acting

medication. Meaning it is given once IM and its actions last for weeks or months at a time.

• This is for noncompliant patients.

Tricyclic Antidepressants NSSRI

• Tricyclic Antidepressants are and old class of antidepressant medications that fall

under the category of NSSRI (Non-Selective Serotonin Reuptake Inhibitors) medications.

• These medications are mood elevators that are used to treat depression.
• Elavil (amitriptyline)
• Tofranil (imipramine)
• Avitil
• Deceril

- Side effects of Tricyclic Antidepressants:

• Anticholinergic (primarily dry mouth)
• Blurred vision
• Constipation
• Drowsiness
• Euphoria
• The patient must take these medications for at least 2 - 4 weeks before the effects

kick in. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:09:07 GMT -05:00

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Benzodiazepines

• Benzodiazepines are antianxiety medications
• Benzodiazepines are considered to be minor tranquilizers
• “Zine’s” major tranquilizers
• “Zep’s” minor Tranquilizers

- Benzodiazepines always have “zep” in their names:

• Clonazepam
• Chlordiazepoxide (Librium)
• Diazepam (valium)
• Lorazepam (Ativan)

- These medications are more the just minor tranquilizers:

• Used in pre-op to induce anesthesia
• Used as a muscle relaxant
• Used in alcohol withdrawal to prevent seizures
• Help people when they are fighting the ventilator
• These medications work quickly to produce the desired effect but should not be

taken for more than two weeks. They can be taken PRN, but have a risk of addiction.

• For patients that come to the emergency department with anxious-depression they

will be given a benzodiazepine and an anti depressant. The benzodiazepine is given for 2 weeks with the antidepressant because it works quickly to reduce symptoms.After 2 weeks the antidepressant effects kick in and there is no longer a need for the benzodiazepine.

- Side effects:

• Anticholinergic (primarily dry mouth)
• Blurred vision
• Constipation
• Drowsiness

- Nursing care:

• Nursing care is focused on treating the side effects.
• Blurred vision, and drowsiness leaves the patient at risk for injury.

Monoamine Oxidase Inhibitors (MAOI)

• MAOI’s are antidepressants.
• Not given as a first line antidepressant, rarely seen. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:09:07 GMT -05:00

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• These medications are still around (usually in elderly patients with long history of

depression) because once you are on an MAOI antidepressant you can’t get off them without having withdrawal.

• MAOI antidepressant’s drugs start with “Mar”, “Nar”, and “Par”.
• Marplan (Isocarboxazid)
• Nardil (Phenelzine)
• Parnate (Tranylcypromine)

- Side effects:

• Anticholinergic (primarily dry mouth)
• Constipation
• Drowsiness

- Patient teaching:

• The patient must avoid all foods containing Tyramine to prevent severe

hypertensive crisis.

• Bananas, avocados, and dried fruits
• No organ meats (heart, liver, kidney, tongue, hotdogs)
• No preserved meats (smoked, dried, cured, or pickled)
• No cheeses or yogurt (except for cottage and mozzarella)
• No alcohol
• No chocolate or caffeine
• No over the counter medications.

Lithium

• Lithium is an electrolyte.
• Used for treating mania in bipolar disorder.
• Unlike all other psych medications.
• All psych medications (other than lithium) alter neurotransmitters to get

the desired effect.

• Lithium stabilizes nerve cell membranes.

- Side effects of lithium:

• Polyuria
• Diarrhea
• Paresthesia (tingling sensation) (first sign of electrolyte imbalance)

- Toxic effects of lithium:

• Tremors
• Metallic taste
• Severe diarrhea This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:09:08 GMT -05:00

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