OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway Marulas, Valenzuela City

COLLEGE OF NURSING

NCM 105A: CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR

WEEK 4: ASSIGNMENT

Submitted by:

BALUNAN, MIKAELLA C.

BSN 3Y2-1

Submitted to:

MS. A. I. BAUTISTA RN, MAN

DECEMBER 04, 2019

 PSYCHOPHARMACOLOGY
MECHANISM OF CONTRAINDI-
DRUG CLASSIFICATION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
ACTION CATIONS

ANTI-PSYCHOTIC DRUGS Antipsychotic The indications  CNS depression A. EXTRAPYRAMIDAL TX FOR EXTRAPYRAMIDAL
TYPICAL: also known as for antipsychotic  Bone marrow SIDE EFFECTS: EFFECTS:
 PHENOTHIAZINE neuroleptics or drugs are the depression 1. AKINESIA/ 1. AKINESIA
o THORAZINE major tranquilizer management of  Parkinsonism PSUEDOPARKINSONISM  Amantadine (Symmetryl)
(Chlorpromazine) are a class of schizophrenia both  Hypotension - Motor 100mg BID (Anticholinergic or
o TRILAFON medication in the acute phase  Hepatic retardation, decreased Dopamine agonist)
(Perphenazine) primarily used to and as dysfunction arm swing, mask-like 2. AKATHISIA
o PROLIXIN manage psychosis maintenance  Glaucoma face, salivation, tremors,  Anti-cholinergic
(Fluphenazine) (including therapy, mania bradycardia. C – Cogentin (Benztropin)
o MELLARIL delusions, delusional 2. AKATHISIA A – Akeniton (Biperiden)
(Thioridazine) hallucinations, depression and - Motor K – Kemadrin (Procyclidine)
o SERENTIL paranoia or behavioral restlessness, pacing, A - Artane (Trihexaphenidyl)
(Mesoridazine) disordered disturbance in inability to sit still, rigid  Beta-blockers – Inedral
o STELAZINE thoughts) pricipally dementia. The posture and gait, hand (Propanolol)
(Trifluphenazine) in schizophrenia distinction tremors.  Benzodiazepine – Ativan
 THIOXANTHENE and bipolar between 3. DYSTONIA (Lorazepam)
o NAVANE disorder. schizophrenia and - Acute muscular  Change anti-psychotic drug
(Thiotixine) Use to improve affective illness can rigidity and cramping, 3. DYSTONIA
 BUTYROPHENONES the thought make be difficult stiff or thick tongue,  Cogentin (Benztropin) 1-
o HALDOL process and and is probably torticollis, opisthotonus, 2mg IM
(Haloperidol) behavior of the unnecessary in the oculogyric crisis  Benadryl (Dipenhydramine)
INAPSINE (Droperidol) client with drug treatment of 4.TARDIVE DYSKINESIA 4. TARDIVE DYSKINESIA
 DIABENZAZEPINE psychotic the acute episode - Eye blinking, lip  Maintain dosage as low as
o LOXITANE symptoms. smacking, teeth grinding, possible
(Loxapine) It blocks the tics and spasm, tongue  Changing meds as
 DIHYDROINDOLONE dopamine protruding, cheek necessary
o MOBAN receptors in the puffing, body rocking
 Monitor client periodically
(Molindone) post synaptic B. OTHER SIDE EFFECTS:
for initial signs of TD using
ATYPICAL: membrane. 1. ANTICHOLINERGIC
Abnormal Involuntary Movement
o CLOZARIL SIDE EFFECTS – dry
Scale (AIMS)
(Clozapine) mouth, urinary
TX FOR OTHER SIDE EFFECTS:
o RISPERDAL retention, constipation,
1. ANTICHOLINERGIC SIDE EFFECTS
(Risperidone) blurred vision
o SEROQUEL 2. ENDOCRINE –  Sugarless candies or ice
(Quentiapine) Gynecomastia, chips
o ZYPREXA amenorrhea, sexual  Measure I/O, assess for
(Olanzapine) dysfunction, increased bladder distention of bladder
o GEODON risk for breast cancer fullness
(Ziprasidone) 3. CARDIOVASCULAR –  Increase fluid, fiber foods
Tachycardia, and exercise
arrythmias,  Provide well lighted
dysrhythmias environment
4. CNS EFFECTS – 2. ENDOCRINE
headaches,  Breast exam
dizziness/sedation,  Encourage client to discuss
decreased mental effect on body image
alertness  Report any sexual desire or
5. DERMATOLOGIC – functioning
Photosensitivity, 3. CARDIOVASCULAR
dermatitis  Assess radial pulse and
C. SERIOUS SIDE EFFECTS apical pulse
1. AGRANULOCYTOSIS  Report feeling of
2. HEPATOXICITY lightheadedness and dizziness
3. NEUROLEPTIC 4. CNS EFFECTS
MALIGNANT SYNDROME
 Headache may be
D – Diaphoresis
temporary until client will be
C - Change in mental
accustomed to medictaions
alertness
 May take meds at bedtime
H – Hyperthermia,
as advised
Hypertension
 Caution client on activities
A- Agitation,
that needs mental alertness
Tachycardia,
5. DERMATOLOGIC
Tachypnea
 Avoid exposure to sunlight
M- Muscle rigidity,
to prevent skin burning
Pallor
 Offer sunscreen before
exposure to sunlight
 Supervise personal hygiene.
TX FOR SERIOUS SIDE EFFECTS
1. AGRANULOCYTOSIS
  Monitor results of WBC
 Withhold further meds
 Notify physician
 Reverse isolation
2. HEPATOXICITY
 Monitor results of liver fx
test
 Withhold further meds
 Notify physician
 Ensure adequate rest, fluids
and nutrition
3. NEUROLEPTIC MALIGNANT
SYNDROME
 Pharmacology: Dopamine
receptor agonist, Betablockers and
Benzodiazepam
 Withhold further meds
 Admit client to ICU
 Administer IV fluids and anti
arrythmia, maintain stable body
temp
OTHERS:
 Check the vital signs before
and after medication.
 Client is instructed to take
sips water frequently for avoiding
of dry mouth.
 Increased intake of fluid
and high fiber diet is recommended
to avoid constipation.
 Educate the client not to
drive after taking medication
 ANTI-DEPRESSANT The main Indicated to  Cardiovascular A. COMMON SIDE TX FOR TCA OVERDOSE:
DRUGS hypothesis clients with major disease EFFECTS:  Monitor vital signs and ECG
TRICYCLIC DEPRESSANTS regarding the depressive  Glaucoma 1. ANTICHOLINERGIC tracing
or (TCA’s) mechanism of disorder,  Benign prostatic SIDE EFFECTS – dry  Maintain patent airway
o SINEQUAN action of anxiety/panic hypertrophy mouth, urinary retention,  C arthartics or gastric lavage
(Doxepin) antidepressant disorders, eating  Liver and renal constipation, blurred  Medications that has
o ANAFRANIL drugs is disorders, chronic diseases vision cholinergic stimulants such as Anti-
(Clomiframin) monoaminergic stress, post trauma,  Hypersensitivity 2. GIT – Anorexia and lirium (Physostigmine)
o VIVACTIL and mainly involves bipolar type 2,  Myocardial nausea, constipation or TX FOR SEROTONIN SYNDORME:
(Protriptylline) two depression to infarction and diarrhea  Pharmacology (Serotonin
o ELAVIL neurotransmitters, secondary to other angle-closure 3. CARDIOVASCULAR – receptor antagonist) – Sansert
(Amitriptylline) serotonin and mental disorders, glaucoma Tachycardia, arrythmias, (Methysergide), Periactin
o TOFRANIL noradrenaline. NK1 such as those seen  Allergy to TCAs. dysrhythmias (Cypropheptadine)
(Imipramine) receptor in OCD, panic Prevent severe 4. CNS EFFECTS –  Stop medication and notify
o ASCENDIN antagonists may attacks and phobias hypersensitivity Sedation and fatigue, physician
(Amoxaphine) display etc. reactions. headache, insomnia,  Admit client to ICU
o NORPRAMIN anxiolytic/antidepr Primarily  Myocardial anxiety and agitation, NURSING INTERVENTION FOR
(Desipramine) essant-like indicated for the infarction. Can abnormal thinking MAOI’s:
MONOAMINE OXIDASE properties relief of symptoms reoccur because 5. DERMATOLOGIC –  Avoid food rich in tyramine
INHIBITOR or (MAOI’s) It blocks the of depression, of the cardiac Photosensitivity, rash, content to avoid hypertensive crisis
o MARPLAN reuptake of particularly anxiety effects of the sweating such as aged cheese (cheddar
(Isocarboxazid) serotonin an and sleep drug 6. ENDOCRINE – cheese, swiss cheese, bleu cheese),
o NARDIL norepinephrine disturbances.  Myelography Hypoglycemia, low aged or fermented meats, fish or
(Phenelzine) into the pre Some TCAs are within previous sodium, sexual poultry, smoked or pickled meat or
o PARNATE synaptic indicated for 24 hours or in dysfunction poultry (salmon), chicken and beef
(Tranylcypromine) membrane. enuresis in children the next 48 B. SERIOUS SIDE EFFECTS liver paste, brewer’s yeast, red
SELECTIVE SEROTONIN older than 6 years. hours. Prevent 1. AGRANULOCYTOSIS wines (chianti/ burgundy) and
REUPTAKE INHIBITOR or Researches on its possible drug- 2. SEROTONIN SYNROME herring (sausage, beef, salami and
(SSRI’s) possible indications drug interaction D- Diaphoresis pepperoni).
o PROZAC for treatment of with dyes C - Change in mental OTHERS:
(Fluoxetine) chronic and  Concurrent use status (such as  Administer IV fluid and anti-
o PAXIL (Paroxetine) intractable pain are of MAOIs. confusion, arrythmic drug, hyperthermic
o ZOLOFT currently Potential for restlessness, agitation) measures.
(Sertraline) conducted. serious adverse H – Hypertension,
 Limit drug access if patient
o LUVOX TCAs also act effects or toxic Rigor
is suicidal to decrease the risk of
(Fluoxamine) as anticholinergic. reactions
overdose to cause harm. Administer
OTHER COMPOUNDS: Clomipramine  Pregnancy, A – Acidosis, resp. a major portion of dose at bedtime
o DYSEREL is approved for use lactation. failure as ordered if drowsiness and
(Trazadone) in treatment of Potential M - Myoclonus anticholinergic effect are severe to
o EFFEXOR obsessive- adverse effects 3. TCA OVERDOSE decrease the risk of patient injury.
(Venlafaxine) compulsive to the fetus and S - Sedation, stupor  Assess for the mentioned
o WELLBUTRIN disorders the baby C – Convulsion, coma cautions and contraindications (e.g.
(Buprioprion)  Preexisting A -Agitation, ataxia drug allergies, hepatorenal
o SERZONE cardiovascular R - Respiratory diseases, psychosis, glaucoma, etc.)
(Nefazodone) disorders. Drug depression to prevent any untoward
has cardiac complications.
stimulatory  Assess for history of seizure
effect disorders, psychiatric problems,
 Angle-closure suicidal thoughts and myelography
glaucoma, within the past 24 hours or in the
urinary next 48 hours to avoid potentially
retention, serious adverse reactions.
prostate  Perform a thorough
hypertrophy, GI physical assessment to establish
or GU surgery. baseline data before drug therapy
Exacerbated by begins, to determine the
the effectiveness of therapy, and to
anticholinergic evaluate for the occurrence of any
effects of the adverse effects associated with
drug drug therapy.
 History of  Monitor results of
seizures. Seizure electrocardiogram and laboratory
threshold is tests (e.g. renal and liver function
decreased tests) to monitor the effectiveness
because of of the therapy and provide prompt
stimulation of treatment to developing
receptor sites complications.
 Hepatorenal
diseases.
Interfere with
drug
metabolism and
excretion which
 increase the risk
of drug toxicity

ANTI-MANIC DRUGS or Normalizes the Indicated for  Hypersensitivity A. COMMON SIDE TX FOR LITHIUM TOXICITY:
MOOD STABILIZERS reuptake of patients with manic response to EFFECTS:  Withhold any further doses
o ESKALITH serotonin, cyle of bipolar lithium 1. GIT – Anorexia and  Obtain immediate serum
(Lithium) norepinephrine, disorder,  Renal disease nausea, constipation or lithium level
o TEGRETOL dopamine and hypomania,  Thyroid disease diarrhea  Monitor vital signs,
(Carbamazepine) acethylcholine. unipolar  Severe 2. CNS EFFECTS – Fatigue electrolyte levels, BUN and
o DEPAKINE The specific depression, debilitation, and lethargy creatinine
(Valporate) biochemical schizophrenia, dehydration, 3. Polyuria, tremors,  Hemodialysis is indicated
o LAMICTAL mechanism of catatonia sodium metallic taste and weight for severe toxicity
(Lamotrigine) lithium action in (periodic), depletion gain PREVENTION OF LITHIUM
o Second- stabilizing mood is alcoholism,  Concomitant B. SERIOUS SIDE EFFECTS TOXICITY:
generation or unknown. Upon prevention of therapy with 1. THYROID  Maintain adequate H2o
atypical ingestion, lithium recurrent episodes diuretics; very IMPAIRMENT – thyroid intake
antipsychotic becomes widely of mania and high risk of functions are monitored  Maintain adequate sodium
drugs (Senapine, distributed in the depression, lithium toxicity every 3-6 months for intake 2g/ day
Olanzapine, central nervous aggressive-conduct under such clients on long-term  Cautious use in clients with
Quetiapine, system and disorder, self- conditions lithium diarrhea, polyuria, vomiting,
Risperidone, interacts with a abusive behavior,  History of 2. RENAL IMPAIRMENT profuse sweating, low salt diet as it
Aripiprazole) number of borderline leukemia C. TOXIC EFFECTS (MaN s increase incident of lithium toxicity.
neurotransmitters personality SaVeD)  Drink fluids with necessary
and receptors, disorder, schizo- M – Muscle weakness electrolytes when exercising
decreasing affective disorder N - Nausea  Report symptoms
norepinephrine and episodes of S - Slurred speech indicating toxicity should they occur
release and acute A - Agitation, Aatxia
 Maintain appointments to
increasing hypersensitivity V - Vomiting
monitor blood levels as prescribed
serotonin associated with D – Diarrhea,
 Restrict caffeine intake.
synthesis. other mental Drowsiness
OTHERS:
disorders. D. SEVERE TOXICITY
 Assess for the mentioned
(CASHieR)
cautions and contraindications (e.g.
C - Coma
drug allergies, CNS depression, CV
 A - Altered level of disorders, glaucoma, respiratory
consciousness, depression, etc.) to prevent any
Arrythmias untoward complications.
S - Seizure, stupor,  Perform a thorough
spasticity of physical assessment (other
muscle medications taken, CNS, skin,
H - Hypotension respirations, and laboratory tests
R – Renal Failure like thyroid, liver, and renal
functions tests and complete blood
count or CBC) to establish baseline
data before drug therapy begins, to
determine effectiveness of therapy,
and to evaluate for occurrence of
any adverse effects associated with
drug therapy.

ANTI-ANXIETY DRUGS NON- Main Indications  Sedation COMMON SIDE EFFECTS:  Check for drug or herbal
NON-BENZODIAZEPINE BENZODIAZEPINE: are anti anxiety  Confusion D - Drowsiness interactions
o BUSPAR - Acts a disorders with or  Diarrhea I – Impaired memory  Check for allergies
(Buspirone) partial agonist at without depressive  Dependence P – Poor motor  Assess baseline mental status
BENZODIAZEPINES serotonin symptoms mainly and withdrawal coordination  Assess for suicidal tendencies
o DALMANE receptors which because of their symptoms S - Sedation  5 D’s
(Flurazepam) decreases ability to generate  Stomach upset OTHERS: D - Dependence
o LIBRIUM serotonin turnover addiction. o Nausea D – Driving and other hazardous
(Chlordiazepoxide) o Nervousness activities should be avoided
o ATIVAN o Dizziness D – Drowsiness and sedation
(Lorazepam) BENZODIAZEPINE: o Reduced sexual decreases with time
o SERAX - Mediates desire D - Don’t stop benzodiazepines
(Oxazepam) the action of GABA o Insomnia abruptly
o TRANXENE (gamma amino o Weight gain or loss D - Don’t drink alcohol beverages
(Chlorazepate) butyric acid). o Headache with anti-anxiety drugs
o VALIUM Reduce symptoms
(Diazepam) of anxiety by
o INDERAL increasing the
(Propranolol) action of a brain
o VISTARIL chemical called
(Hyroxyzine) gamma -
o EQUANIL aminobutyric acid
(Propanolol) GABA. GABA is a
o KLONOPIN chemical that
(Clonazepam) nerve cells use to
o HALCION communicate with
(Triazolam) each other and it
o RESTRORIL reduce brain
(Temazepam) activity
o XANAX
(Akprazolam)

ANTI-CHOLINERGIC A substance Indicated to Contraindications o Dry mouth.  Assess for contraindications

DRUGS that blocks the patients with are usually due to o Blurred vision. or cautions (e.g., history of allergy to
o ATROPEN action of the COPD, overactive the drug’s o Dry eyes. drug, GI obstruction, hepatorenal
(Atropine) neurotransmitter bladder and pharmacologic and o Constipation. dysfunction, etc.) to avoid adverse
o COGENTIN acetylcholine at incontinence, adverse effect o Urinary retention. effects.
(Benztropin synapses in the gastrointestinal includes: o Dizziness due to drop  Establish baseline physical
Mesylate) central and the disorders such as  Glaucoma in blood pressure on assessment to monitor for any
o AKENITON peripheral nervous diarrhea, poisoning  Prostatic standing up (postural potential adverse effects.
(Biperiden) system. These due to some hypertrophy hypotension)  Assess neurological status
o KEMADRIN agents inhibit insecticides and  Intestinal or o Cognitive problems (e.g., orientation, affect, reflexes) to
(Procyclidine) parasympathetic poisonous urinary (confusion) evaluate any CNS effects.
o ARTANE nerve impulses by mushrooms, obstruction or o Heart rhythm  Assess abdomen (e.g.,
(Trihexaphenidyl) selectively blocking symptoms of retention disturbance bowel sounds, bowel and bladder
o ATROVENT the binding of the Parkinson's disease  Cardiovascular patterns, urinary output) to
(Ipratropium) neurotransmitter such as abnormal disease evaluate for GI and GU adverse
acetylcholine to its involuntary muscle effects.
receptor in nerve movement, Asthma  Monitor laboratory test
cells. and dizziness. results to determine need for
possible dose adjustments and to
identify potential toxicity.