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Social anxiety disorder
w w 
á sed for the treatment of anxiety and also
useful in the induction of sleep.
á xert a general depressing effect on the C S,
many also exert skeletal muscle- relaxant and
anticonvulsant effects.
á hese drugs were formerly called minor
tranquilizers.
á sed when the individual has difficulty in
coping with environmental stresses and
accomplishing daily activities.
á wlthough the use of sedative-hypnotics has
declines in the last decade, they are still widely
used to reduce anxiety.
á wnxiolytics are available in oral and parental
(,  preparations.
ypes
w. Benzodiazepines - good to help calm the
patient before OR, anti convulsant, muscle
relaxant
á wlprazolam (anax

á Chlordiazepxide (Librium

á Clorazepate (ranxene

á
iazepam (alium

á stazolam (ProSom
á ëalazepam (Paxipam
á Lorazepam (wtivan

á Oxazepam (Serax

á Prazepam (Centrax

á emazepam (Restoril

á riazolam (ëalcion

á lurazepam (
almane
onbenzodiazepine
á wzaspirodecanedione buspirone (BuSpar

wnticonvulsant benzodiazepine
á Clonazepam (Klonopin

Propanediols
á eprobamate (quanil or iltown
á ybamate (Solacen

uinazolines
á ethaqualone ( uaalude
Precautions
á
rug interaction: drugs potentiate depressant
effects of alcohol or sedatives.
á olerance to the sedatives and hypnotic effects
develops eventually with all these drugs,
although it develops more slowly with the
benzodiazepines than with the others.
á wll of these drugs, if taken in large enough
doses or for extended time periods, can lead to
physical and emotional dependence.
á wdverse side effects and related to diminished
mental alertness; caution about driving or
operating hazardous machinery until tolerance
develops.
á w drop of BP O 20  ëg. (systolic on
standing warrants withholding the drug and
notifying the physician.
Signs and symptoms of toxicity
wtaxia

rowsiness

izziness

epressed RR,BP
á Benzodiapine use should not be abruptly
discontinued to avoid a withdrawal syndrome.
á Severe withdrawal symptoms can occur if
agents are taken for long time (over 8 months
and high doses
á olerances can contribute to self-medication
and dosage escalation.
ursing Care of Clients Receiving wntianxiety or
wnxiolytic edication
á wssess the client·s medication history, knowledge
level and use of current medications (prescribed,
over- the-counter, and illicit drugs , medication
allergies, pattern of alcohol use.
á xplore the client·s perceptions and feelings about
medications; certify misinformation, fears, etc.
á Review psychotropic drug references for current
information.
á Plan for client learning about medication
á wdminister medications as prescribed.
á each the client about the medication, desired
effect, side effects, food or activity restrictions,
and lag period between onset of treatment and
symptom remission.
á Supplement verbal teaching with appropriate
written or audio- visual materials.
á wdminister client·s response to medication and
understanding of teaching.
schizophrenia
w PSCëOC
á sed to treat a psychotic symptom; that is
symptoms of being out of touch with reality;
á wct by blocking dopamine receptors in the C S
and sympathetic nervous system activity;
á some also exert antiemetic, anticholinergic,
and antihistamines effects.
á wntipsychotics control behavior when the
client·s uncontrolled actions are destructive to
self, others, or the environment.
á ay be prescribed in conduction with
benzodiazepines (the diazepam\valium
category , which is thought to minimize the use
of neuroleptics and to diminish the potential for
tardive dyskinesia.
á he antipsychotics agents or neuroleptics were
formerly called major tranquilizers.
á wvailable in oral and parental (, 
preparations.
ypes
w. Phenothiazines
á wliphatics
á Chlorpromazine (horazine
á Promazine (Sparine
á riflupromazine (esprin

á Piperidines
á esoridazine (Serentil
á hioridazine (rilafon
á Piperazines
á luphenazine (Prolixin, Permitil

á Perphenazine (rilafon

á riflouperazine (Stelazine

B. Benzisoxazole
á Risperidone (Risperdal
C. Butyrophenons
á
reperidol (naspine

á ëaloperidol (ëaldol

. hioxanthenes
á Chlorprothixene (aractan

á hiothixene ( avane
.
ibenzoxazepine
á Loxapine (Loxatane

.
ihydroindolone
á olindone (oban

.
ibenzodiazepine
á Clozapine (Clozaril
Precautions
á
rug interactions: potentiate the action of
alcohol, barbiturates, antihypertensives, and
anticholinergics; concomitant use should be
avoided when possible;
wdverse effects:
á wgranulocytosis
á jaundice (caused by hepatotoxicity
á signs of extrapyramidal tract irritation,
á orthostatic hypotension ?
á constipation and urinary retention
á anorexia
á hypersensitivity reactions (tissue fluid accumulation,
á photoallergic reaction,
á impotence, cessation of menses or ovulation
xtrapyramidal side effects (PSs
á
ystonia: occurs early in treatment, possibly
after initial dosage; involves grimacing,
torticollis, intermittent muscles spasms.
á Pseudoparkinsonism: resembles true
Parkinsonism (tremor, masklike facies,
drooling, restlessness, festinating gait, rigidity .
á wkathisia: motor agitation (restless legs,
´jittersµ, nervous energy ; most common of all
PSs.
á wkinesia: fatigue, weakness (hypotonia , painful
muscles, anergy (lack of energy .
ardive dyskinesia: late appearing after
prolonged 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; usually
irreversible; all antipsychotics stopped to see if
symptoms subside.
wkathisia
ardive dyskinesia
pseudoparkinsonism
wntiparkinson drugs: block the extrapyramidal
symptoms.
á wnticholinergics (Cogentin
á Benztropine (Cogentin
á rihexyphenidyl(wrtane
á Procyclidine (Kemadrin
á Biperiden (wkineton

wntihistamine
diphanhydramine (Benadryl
ursing Care of Clients Receiving wntipsychotic
wgents
á onitor for sign of hepatic toxicity (e.g., jaundice .
á onitor for signs of infection (e.g., sore throat
á onitor blood pressure in standing and supine
positions.
á wssist client to get out of bed slowly
á wssess for hypotension and tachycardia
á f hypotension occurs, monitor by measuring BP
before each dose is given.
á Consult physician as to safe BP systolic/diastolic
margins for each client.
á Offers sugar-free chewing gum of hard candy to
increase salivation and relieve dry mouth.
á wssist with ambulation as necessary; keep side
rails up when non-ambulatory.
á wssess for extrapyramidal symptoms
(antiparkinsonism agent may be prescribed to
decrease symptoms .
á onitor blood work during long- term therapy.
á nstruct client to:
-wvoid administration with other C S
depressants, including concurrent use of alcohol.
-wvoid engaging in potentially hazardous
activities.
-wvoid exposure to direct sunlight; wear
protective clothing and sunglasses outdoors.
-Recognize extrapyramidal symptoms and
report their occurrence to the physician
immediately.
-wvoid changing positions rapidly.
- otify physician if sore throat, fever, or weakness
occurs, avoid crowded, potentially infectious places.
-ncrease water intake and eat high-fiber diet to
avoid constipation.
-xpect weight gain (diet pills should not be taken ;
control weight with appropriate diet.
-wvoid mixing neuroleptics with certain juices or
liquids (coffee, tea, or cola beverages may decrease
effectiveness of drug .
-wvoid antacids or take 1 to 2 hours after
antipsychotic drug is taken (antacids decrease
absorption of antipsychotics .
á se precautions when preparing medication to
avoid contact with the skin.
á valuate client·s response to medication and
understanding of teaching.
wntidepressants
á sed 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 asleep
again , marked psychomotor retardation or
agitation, anorexia, weight loss, and guilt.
á wntidepressant drugs increase the level of
norepinephrine at subcortical neuroeffector
sites.
á wvailable in oral and parenteral (
preparations.
á orepinephrine blockers provide elevated
levels of the neurohormone by preventing
reuptake and storage at the axon (tricyclic
compounds .
á onoamine oxidase inhibitors (wOs elevate
norepinephrine levels in brain tissues by
interfering with the enzyme wO; act as psychic
energizers.
á Selective serotonin reuptake inhibitors (SSRs
are thought to alleviate depression by
preventing reuptake of serotonin in the C S.
á ypes
á orepinephrine blockers or tricyclic
antidepressants (Cws
á wmitriptyline (lavil

á wmoxapine (wsendin

á Clomipramine (wnafranil

á
esipramine ( orpramin

á
oxepin (Sinequan
á mipramine (ofranil
á aprotiline (Ludiomil

á ortriptyline (Pamelor

á Protriptyline (ivactil

á rimipramine (Surmontil
Selective serotonin reuptake inhibitors (SSRs
á Bupropion (Wellbutrin

á louxetine (Prozac

á Sertraline (Zoloft

á Paroxetine (Paxil
Precautions
á orepinephrine blockers or tricyclic
antidepressants (Cws
á
rug interactions: potentiate effects of
anticholinergic drugs and C S depressants
(e.g., alcohol and sedatives .
á wdverse effects: orthostatic hypotensions, skin
rash, drowsiness, dry mouth, blurred vision,
constipation, urine retention, tachycardia, C S
stimulation is elderly clients (excitement,
restlessness, incoordination, fine tremor,
nightmares, delusions, disorientation,
insomnia .
á Cws should not be given to clients with narrow-
angle glaucoma.
á Cws are contraindicated during the recovery
phase of myocardial infarction or when client·s
history indicates cardiac dysrhythmias and
cardiac conduction defects.
á here should be a minimum of 14 days
between switching the Cw-resistant client to
wOs to avoid hypertensive crisis.
á wbrupt discontinuation of Cws can cause
nausea, headache, and malaise.
onoamine oxidase inhibitors (wOs
á
rug interactions: wOs potentiate the effects
of alcohol, barbiturates, anesthetic agents
(cocaine , antihistamines, narcotics, corticoids,
anticholinergics, and sympathomimetics drugs.

rug-food interactions: hypertensive crisis with
vascular rupture, occipital headache,
palpitations, and stiffness of neck muscles,
emesis, sweating, photophobia, and cardiac
dysrhythmias may occur when neurohormonal
levels are elevated by ingestion of foods with
high tyramine content (pickled herring, beer,
wine, chicken livers, aged or natural cheese,
chocolate .
wdverse effects: orthostatic hypotension (C S
effect ; skin rash (hypersensitivity ; drowsiness
(C S depression ; dry mouth, blurred vision,
urinary retention, tachycardia (anticholinergic
effect ; sexual dysfunction (autonomic effect ;
nightmares, delusions, disorientation, insomnia
(C S stimulation .
Selective serotonin reuptake inhibitors (SSRs
á sually these drugs are administered before
noon to avoid insomnia or sleep disturbances.
á
rug interactions: may interact with tryptophan;
question concominant use of diazepam,
warfarin, and digoxin; should be discontinued 4
to 6 weeks before switching to wOs.
á wdverse effects: insomnia, headache, dry
mouth, sexual dysfunction, anxiety, diarrhea
and other gastrointestinal-tract complaints.
á ursing Care of Clients Receiving
wntidepressants
á wssess for effectiveness of drug action.

á aintain suicide precautions, especially as


depression begins to lift; carefully monitor
serum glucose in diabetics.
á nstruct client to:

á Change positions slowly.

á wvoid engaging in hazardous activities.


á tilize sugar-free chewing gum or hard candy to
stimulate salivation.
á Check with physician before taking all OC
preparations or before consuming alcohol.
á xpect therapeutic effect to be delayed; may
take 3 to 4 weeks for the Cw·s and shorter for
the wOs.
wO·s
á aintain dietary restrictions; avoid foods
containing tyramine (aged cheeses, beer,
chianti wine, yogurt, soy sauce, chocolate .
á onitor client for occurrence of hypertensive
crisis (occipital headache, palpitations, and
stiff neck .
á wvoid concurrent administration of adrenergic
drugs.
á wvaluate client·s response to medication and
understanding of teaching.
á
escription
á sed to control the manic episode of mood
disorders and for maintenance in clients with a
history of mania.
á wct by reducing adrenergic neurotransmitter
levels in cerebral tissue through alteration of
sodium transport.
á wntimanic agents are available in oral capsules
and tablets, both regular and sustained-release
forms, and in concentrates.
á mproves productivity by decreasing
psychomotor activity or response to
environmental stimuli.
á Lithium, a norepinephrine uptake accelerator
alters sodium transport in nerve and muscle
cells and affects a shift in intraneural
metabolism of norepinephrine.
ypes
á wntimanic agents and mood stabilizers

á Lithium carbonates (skalith, Lithane,


Lithonate, Lithizine, Lithobid .
á Lithium citrate (concentrate form .

wlternative antimanic agents and mood


stabilizers
á Carbamazepine (egretol

á Clonazepam (Klonopin

á alproic acid (
epaneke, alproate sodium
Precautions
á
rug interactions: diuretics increase the
reabsorption of lithium resulting in possible
toxic effects; haloperidol and thiodazine when
given with these drugs can result in
encephalopathic syndrome; sodium
bicarbonate or sodium chloride increase the
excretion of lithium.

rug-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 intake
must be maintained.
wdverse effects: excess voiding and extreme
thirst caused by drug suppression of
antidiuretic hormone (w
ë 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 difference
between the therapeutic level and toxic level is
slight.
ursing Care of Clients Receiving wntimanic and
ood-stabilizing wgents
á Recognize that therapeutic effects will be
delayed for several weeks.
á Recognize that dehydration and hyponatremia
predispose the client to lithium toxicity.
á wssess therapeutic blood levels (0.6 to 1.2
mq/L during course therapy.
á Supervise ambulation if necessary.
á wdminister with meals to reduce  irritation.

á each the client that the nausea, polyuria, and


thirst that occur initially will subside after
several days.
á each client and family to observe for signs of
toxicity (diarrhea, vomiting, drowsiness,
muscular wekness, ataxia, confusion, and
tonic-clonic seizures .
á valuate client·s response to medication and
understanding of teaching.
á
raw CBC every 2 to 4 weeks to monitor for
WBC suppression and anemia noted with
carbamazepine.
á

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