Antidepressants and Nursing Interventions

Antidepressants

Amitriptyline: Used for angle-closure glaucoma, recent MI, heart failure; may increase suicide risk.
Nursing Interventions (NI): Monitor weight, BMI, fasting glucose; assess for suicidal tendencies, especially early in therapy. Limit drug access.
Adverse Reactions (AR): Cardio: Arrhythmias, Torsade de pointes, hypotension; Neuro: suicidal thoughts, lethargy, sedation; Other: ECG changes, drowsiness, orthostatic hypotension.
Escitalopram: Used for concurrent pimozide, MAO inhibitors, citalopram, angle-closure glaucoma, bipolar disorder history.
Nursing Interventions (NI): Monitor mood, suicidal tendencies, and sexual function.
Adverse Reactions (AR): CV: Torsades de Pointes, chest pain; Derm: increased sweating; EENT: mydriasis; F&E: hyponatremia; GI: diarrhea; GU: decreased libido; Neuro: neuroleptic malignant syndrome; Resp: cough; Misc: serotonin syndrome, fever, flu-like symptoms, hot flashes.

Other Medications

Fluoxetine: Concurrent use of pimozide, MAO inhibitors, thioridazine, screen patient for bipolar.
Adverse Reactions (AR): Derm: sweating; Endo: SIADH; GI: diarrhea, nausea; Neuro: Neuroleptic malignant syndrome, suicidal thoughts.
Aripiprazole: Hypersensitivity, concurrent CYP2D6 or CYP3A4/CYP2D6 inhibitors/inducers, cardiovascular or cerebrovascular disease, hypotension, diabetes, seizures.
Nursing Interventions (NI): Assess mental status, weight, BMI, and blood pressure

Anti-anxiety Agents

Buspirone: Severe hepatic or renal impairment, concurrent MAO inhibitors, large grapefruit ingestion.
Adverse Reactions (AR): EENT; blurred vision, nasal congestion, sore throat; Resp: chest congestion; CV: chest pain, palpitations; GI: nausea, abdominal pain; GU: changes in libido; Derm: rashes; MS: myalgia; Neuro: incoordination, numbness, paresthesia, tremor; Misc: dizziness, drowsiness, excitement, fatigue, headache, insomnia, nervousness, weakness.

Anticonvulsants/Mood Stabilizers

Carbamazepine: Bone marrow suppression, increased risk of suicidal thoughts and behaviors.
Nursing Interventions (NI): Monitor skin, monitor for changes in behavior.
Adverse Reactions (AR): CV: heart failure, edema, hypertension; Derm: DRESS; EENT: blurred vision, corneal opacities, nystagmus; F&E: SIADH, hyponatremia; GI: hepatotoxicity; Hemat: agranulocytosis, aplastic anemia, thrombocytopenia; Neuro: suicidal thoughts, ataxia, drowsiness.

Antipsychotics

Chlorpromazine: Angle-closure glaucoma, bone depression, severe liver/cardiovascular disease, concurrent pimozide, lactation.
Adverse Reactions (AR): CNS: neuroleptic malignant syndrome; CV: hypotension, tachycardia; Derm: photosensitivity, pigment changes; EENT: blurred vision, dry eyes; Endo: galactorrhea; GI: constipation; GU: urinary retention; Hemat: agranulocytosis; Metabolic: hyperthermia.
Diazepam: Hypersensitivity, cross-sensitivity to other benzodiazepines, coma, sever pulmonary, hepatic impairment.
Adverse Reactions (AR): EENT: blurred vision; GI: constipation; Neuro: dizziness, drowsiness; Resp: respiratory depression.

Anti-Alzheimer's Agents

Donepezil: Hypersensitivity to donepezil or piperidine derivatives.
Adverse Reactions (AR): CV: afib, hyper/hypo tension; Derm: ecchymoses; GI: diarrhea; GU: frequent urination; Misc: hot flashes, weight loss, MS: arthritis, muscle cramps, Neuro: headache.

Mood Stabilizers

Lithium Carbonate: Hypersensitivity, Brugada syndrome, alcohol or tartrazine content.
Nursing Interventions (NI): Assess mental status; monitor output ratios, fluid intake (2-3 liters/day); monitor serum lithium levels.
Adverse Reactions (AR): CV: ECG changes; Derm: acneiform eruption, folliculitis, alopecia, diminished sensation, pruritus; EENT: aphasia, blurred vision; Endo: hypothyroidism, goiter, hyperglycemia, hyperparathyroidism, hyperthyroidism; F&E: hypercalcemia, hyponatremia; GI: abdominal pain, anorexia, bloating, diarrhea; neuro: tremors, seizures, confusion.

Anti-Psychotics/Others

Clozapine: Schizophrenia, unresponsive to or intolerant to other antipsychotics.
Nursing Interventions (NI): Monitor mental status, blood pressure, assess BMI, monitor for myocarditis, and tardive dyskinesia.
Adverse Reactions (AR): CV: cardiac arrest, deep vein thrombosis, HF, mitral valve incompetence, myocarditis, torsades de pointes, ventricular arrhythmias, hypotension, tachycardia, bradycardia, ECG changes, hypertension, syncope; Derm: rash, sweating; Neuro: extrapyramidal reactions, neuroleptic malignant syndrome, seizures, dizziness, sedation; GI: gastrointestinal obstruction, hepatotoxicity.
Methadone: Significant respiratory depression, acute or severe bronchial asthma, paralytic ileus.
Nursing Interventions (NI): Assess pain, blood pressure, pulse, respirations, bowel function, before and during administration.
Adverse Reactions (AR): CV: torsades de pointes, hypotension, bradycardia, QT interval prolongation; Derm: flushing, sweating; EENT: blurred vision, diplopia, miosis; Endo: adrenal insufficiency; GI: constipation, nausea, vomiting; GU: urinary retention; Neuro: confusion, sedation, dizziness, dysphoria, euphoria, hallucinations; Resp: respiratory depression; Misc: physical dependence, psychological dependence, tolerance.
Buprenorphine: Hypersensitivity, significant respiratory depression, acute or severe bronchial asthma.
Nursing Interventions (NI): Monitor for signs and symptoms of adrenal insufficiency, LOC, blood pressure, and pulse.
Adverse Reactions (AR): CV: hypertension, hypotension, palpitations, QT interval prolongation; Derm: sweating; Hemat: agranulocytosis, leukopenia; Neuro: confusion, dyphoria, hallucinations, sedation; Resp: respiratory depression; Misc: hypersensitivity reactions.
Naloxone: Hypersensitivity.
Nursing Interventions (NI): Monitor respiratory rate, rhythm, depth; pulse; ECG; and blood pressure.
Adverse Reactions (AR): CV: ventricular arrhythmias, hypertension, hypotension; GI: nausea; vomiting.