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.

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

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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:
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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.

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

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