1. CHAPTER 76: PSYCHIATRIC MEDICATIONS
PYRAMID POINTS
CHAPTER 76:
PSYCHIATRIC MEDICATIONS

2. PYRAMID POINTS I. Selective Serotonin Reuptake Inhibitors (SSRIs)
Description
Inhibit serotonin uptake and elicit an antidepressant response
Side effects
Gastrointestinal disturbances
Central nervous system (CNS) stimulation
Interventions
Initiate safety precautions
Administer with snack or meal
Monitor suicidal client
Instruct client taking fluoxetine (Prozac) and bupropion (Wellbutrin) to take medication early in day
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3. PYRAMID POINTS II. Tricyclic Antidepressants Description Side effects
Concurrent use with monoamine oxidase inhibitors can cause hypertensive crisis
Cardiac toxicity can occur
Evaluate electrocardiogram (ECG) prior to treatment, periodically thereafter
Side effects
Anticholinergic effects
Photosensitivity
Cardiovascular disturbances
Hypotension
Ejaculatory or erection disturbances
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4. PYRAMID POINTS continued … Interventions
Instruct client that medication may take several weeks to produce desired effect
Monitor suicidal client
Monitor pattern of daily bowel activity
Administer with food or milk
Administer entire daily oral dose at one time, preferably at bedtime
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5. PYRAMID POINTS III. Monoamine Oxidase Inhibitors (MAOIs) Description
Inhibits the enzyme monoamine oxidase; used to treat depression
Side effects
CNS stimulation
Anticholinergic effects
Gastrointestinal (GI) disturbances
Orthostatic hypotension
Hypertensive crisis
Occurs as a result of consuming tyramine-containing foods or medications that interact with MAOIs
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6. PYRAMID POINTS continued … Interventions
Instruct client about the importance of avoiding tyramine-containing foods in the diet
Monitor blood pressure
Administer with food if GI distress occurs
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7. PYRAMID POINTS IV. Mood Stabilizers Description Lithium Side effects
Affect cellular transport mechanism and enhance serotonin and gamma-aminobutyric acid (GABA) functioning, which is associated with mood
Lithium
Common prescribed mood stabilizer
Side effects
GI disturbances
Polyuria, polydipsia
Weight gain
Abdominal bloating, diarrhea
Muscle weakness, fatigue
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8. PYRAMID POINTS IV. Mood Stabilizers (Continued) Interventions
Monitor suicidal client, especially during improved mood and increased energy levels
Administer with food
Maintain adequate fluid and salt intake
Avoid diuretics, alcohol, over-the-counter (OTC) medications
Monitor lithium levels and for signs of toxicity
Instruct client about signs requiring reporting
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9. PYRAMID POINTS V. Antianxiety or Anxiolytic Medications Description
Depress CNS, producing relaxation
Side effects
Sedation
Dizziness
Hypotension
Acute toxicity
Results in confusion, diminished reflexes, coma
Interventions
Monitor for side effects and signs of toxicity
Initiate safety precautions
Withdrawal
Should be tapered gradually over 2 to 6 weeks when discontinued to prevent withdrawal
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10. PYRAMID POINTS VI. Barbiturates and Sedative-Hypnotics Description
Used for short-term treatment of insomnia or for sedation to relieve anxiety, tension, and apprehension
Side effects
Dizziness
Drowsiness
Confusion
Interventions
Maintain safety
Instruct client to take medication exactly as prescribed and to avoid driving or operating hazardous equipment if drowsiness, dizziness, or unsteadiness occurs
For insomnia, instruct client to take 30 minutes before bedtime
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11. PYRAMID POINTS VII. Antipsychotic Medications Description Side effects
Improve thought processes and behaviors of the client with psychotic symptoms
Side effects
Anticholinergic effects
Extrapyramidal effects (parkinsonism, dystonias, akathisia)
Interventions
Monitor for side effects
Teach client about signs and symptoms to report
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12. PYRAMID POINTS VIII. Neuroleptic Malignant Syndrome Description
Rare but potentially fatal syndrome that can occur at any time during therapy with neuroleptic medications
Assessment
Dyspnea
Tachycardia
Tachypnea
Fever
Skeletal muscle rigidity
Altered level of consciousness
Seizure activity
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13. PYRAMID POINTS continued … Interventions Notify physician
Monitor vital signs
Initiate safety and seizure precautions
Treat symptoms and prepare to administer medications as prescribed
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14. PYRAMID POINTS
IX. Medications to Treat Attention-Deficit/Hyperactivity Disorder (ADHD)
Children with ADHD may require medication to reduce hyperactivity, lengthen attention span
CNS stimulants
Most effective
Have calming effect on children with ADHD
Increase alertness
Side effects
Tachycardia, anorexia, weight loss, agitation
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15. PYRAMID POINTS continued … Interventions Monitor for side effects
Avoid OTC medications
Instruct that last daily dose needs to be taken at least 6 hours before bedtime to prevent insomnia
Monitor dietary intake and weight
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16. PYRAMID POINTS X. Medications to Treat Alzheimer’s Disease
Acetylcholinesterase inhibitors improve cognitive function in early stages
Donepezil (Aricept)
Can slow heart rate
Galantamine (Razadyne)
Can cause bronchoconstriction
Use with caution in clients with asthma, chronic obstructive pulmonary disease
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17. PYRAMID POINTS X. Medications to Treat Alzheimer’s Disease (continued)
Memantine (Namenda)
Sodium bicarbonate, other alkalinizing medications can decrease renal excretion of medication
Rivastigmine (Exelon)
Use with caution in clients with peptic ulcer disease, bradycardia, sick sinus syndrome, urinary obstruction, lung disease
Tacrine (Cognex)
Hepatotoxic; monitor liver function test results
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18. 1. Maintain a fluid intake of 2 to 3 L/day. 2. Limit salt intake.
A client has been started on therapy with lithium carbonate (Eskalith). The nurse instructs the client to do which of the following?
1. Maintain a fluid intake of 2 to 3 L/day.
2. Limit salt intake.
3. Limit fluid intake.
4. Stop the medication if gastrointestinal (GI) disturbances occur.
Answer: 1
Rationale: The client who begins taking lithium carbonate must maintain a fluid intake between 2 and 3 L/day. The client should also maintain normal salt intake. Both of these are necessary to avoid dehydration. GI disturbances generally disappear during continued therapy.
Test-Taking Strategy: Focus on the medication in the question and recall the client teaching points related to the administration of lithium. Remember that the client taking lithium carbonate must maintain a fluid intake between 2 and 3 L/day. If you had difficulty with this question, review this medication.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2007). Saunders nursing drug handbook 2007 (p. 699). Philadelphia: W.B. Saunders.
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19. 1. Red wine, such as Chianti or sherry 2. Avocados, figs, and raisins
The client has begun taking phenelzine (Nardil). At the initiation of therapy, the nurse teaches the client that which of the following items are allowed in the diet?
1. Red wine, such as Chianti or sherry
2. Avocados, figs, and raisins
3. Lunch meats, such as bologna or salami
4. Carrots, sweet potatoes, and squash
Answer: 4
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid foods that are high in tyramine because they could trigger a potentially fatal hypertensive crisis. Foods to avoid include aged cheeses, smoked or processed meats, red wine, and avocados, raisins, and figs. Vegetables are generally acceptable, with the exception of broad beans, including fava beans.
Test-Taking Strategy: To answer this question accurately, you must be familiar with this medication and the foods that must be avoided while it is being administered. Recalling that this medication is an MAOI will direct you to the correct option. Review the client teaching points related to the administration of MAOIs if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology
Reference: Lehne. R. (2007). Pharmacology for nursing care (6th ed., pp ). Philadelphia: W.B. Saunders.
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