Psychotropic medication use is common among older adults in all settings, including the community, assisted living, and long-term care. The value of this article is that it provides one easily accessible source for critical information about psychotropic medications that all geriatric nurses need to enhance their knowledge and care practices. The use of selective serotonin reuptake inhibitors (ssris) largely replaced tricyclic medications, again due to the perception by clinicians of their greater safety.
Complementary or alternative therapies such as prayer, massage, and aromatherapy can also help reduce depressive symptoms ( antipsychotic medications, typically given for psychotic symptoms (e. Nurses in all practice settings caring for elderly patients should be familiar with this group of medications, their side effects, and the impact of age-related changes on their pharmacodynamics and pharmacokinetics. Preferred anxiolytic and hypnotic medications, along with dosing guidelines and major adverse effects, are provided in incoordination, cognitive impairment, depression, drowsiness, fatigue, irritability, light headedness, sedation, appetite changes, weight loss or gain, constipation, dry mouth, difficulty urinating, dysarthria edema, drowsiness, ataxia, dizziness, memory impairment, headache, paradoxical excitement, incontinence, blood dyscrasia, jaundice, dysarthria, tremor, diplopia, syncope (rare) confusion, dizziness, drowsiness, fatigue, anxiety, headache, lethargy, hangover, euphoria, vertigo, diarrhea, dysarthria, weakness, blurred vision, diaphoresis somnolence, dizziness, ataxia, fatigue, peripheral edema, diarrhea, tremor, weakness, nystagmus, diplopia somnolence, increased appetite with weight gain, increased serum cholesterol, constipation, dry mouth orthostasis, hypertension, myocardial infarction, ataxia, extrapyramidal symptoms, seizures, glucose dysregulation, syndrome of inappropriate antidiuretic hormone, sexual dysfunction, dry mouth, anorexia, constipation, nausea, vomiting, diarrhea, weight gain (or loss), urinary retention, impotence, blood dyscrasia, increased levels in liver function test values, paresthesia, mydriasis orthostasis, ventricular irritability, sedation, dizziness, gait instability, mild cognitive impairment, seizures, weight gain, priapism, headache, dry mouth, edema, nausea, diarrhea chest pain, edema, amnesia, dizziness, hallucinations, light headedness, incoordination, anorexia, dyspepsia, nausea, constipation, dry mouth, tremor, weakness, arthralgia palpitations, headache, dizziness, light headedness, amnesia, nausea, diarrhea, dry mouth, constipation for insomnia, the recommended dosage of gabapentin is up to 300 mg per day for essential tremor, restless leg syndrome, and neuropathic pain, the recommended dosage is up to 3600 mg per day.
On the basis of controlled studies of their use in younger patients, atypical antipsychotic drugs were initially considered a safer alternative in treating older adults with psychotic symptoms or agitation associated with dementia. Although hypnotic drugs, such as zolpidem (ambien all of which are often prescribed off label for insomnia) may improve sleep quality in older adults, they generally are not recommended for long-term use ( ). Older adults can also benefit from supportive counseling and assistance with problem solving for day-to-day stressors.
This article will focus on the three categories of psychotropic medications most commonly prescribed to older adults, and thus those most likely to be encountered by gerontological nurses anxiolytic, antidepressant, and antipsychotic medications. Between 50 and 75 of all patients taking typical antipsychotic drugs experience epses ( ) however, elderly patients are at higher risk for drug-induced parkinsonism and are at increased risk for epses than are younger patients ( nms involves high fever, rigidity, altered consciousness, and autonomic system instability (i. Furthermore, they stated that no medications are more efficacious than atypical antipsychotic drugs for the treatment of psychosis of alzheimers disease, which is one of the behavioral and psychological symptoms of dementia.
The risk for adverse reactions increases dramatically with the number of medications used and with increasing age ( ). In light of cms guidelines (f-tag 329) requiring gradual tapering of psychotropic drugs unless clinically contraindicated, nurses must carefully monitor the length of time a patient has received a medication. Psychotropic medications are typically administered to older adults to manage symptoms of anxiety, depression, psychological distress, andor insomnia.
This lack of training is compounded by the fact that mental health professionals spend limited time in nursing homes to provide consultation or guidance ( ) found that almost half of nurses employed or working in nursing homes were unable to identify the broad psychoactive class for six commonly prescribed drugs. Thus, it is imperative that nurses caring for older adults, regardless of the setting, are knowledgeable about these medications and are able to recognize and appropriately respond to side effects and adverse effects. Are atypical antipsychotics safe in patients with alzheimers disease? Kerber cs, dyck mj, culp kr, buckwalter k. Because of severe adverse side effects and inappropriate prescribing practices, the use of psychotropic medications first came under scrutiny with nursing home residents. However, assumptions about the safety of these psychotropic medications with older adults have increasingly come into question ( ).
Administration of psychotropic medications is potentially hazardous and can result in serious and sometimes fatal consequences for patients of all ages ( ). Furthermore, they stated that no medications are more efficacious than atypical antipsychotic drugs for the treatment of psychosis of alzheimers disease, which is one of the behavioral and psychological symptoms of dementia. Nurses should be aware that depression is often overlooked in older adults and should work collaboratively with physicians to identify elderly clients with depressive symptoms. Nurses in other settings also have varying degrees of knowledge about psychotropic medications and their potential adverse effects. Lindsey, dnsc, rn, undergraduate program director and assistant professor, illinois state university mennonite college of nursing, campus box 5810, normal, il 61790 psychotropic medications are commonly administered to elderly clients to manage behavior and psychiatric symptoms.
Older adults with depression can benefit from psychoeducation, family counseling, visiting nurses, griefloss support groups, and senior center activities ( ). Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. Results revealed a high death rate in patients who received atypical antipsychotic medications versus those treated with placebo. As a result, findings from this national institutes of health-sponsored study suggest that there is no clinical benefit of treatment with atypical antipsychotic drugs in patients with alzheimers disease. However, older adults have increased sensitivity to ssri adverse effects than do younger patients ( ).
It is disturbing to note that 10 of geriatric hospitalizations are related to the use of benzodiazepines ( hypnotic medications are prescribed for insomnia. Nurses in all practice settings caring for elderly patients should be familiar with this group of medications, their side effects, and the impact of age-related changes on their pharmacodynamics and pharmacokinetics. When psychotropic medications are administered, the lowest dosage possible should be used, usually one third to one half the usual dosage of younger individuals, with slow titration upward ( ). The new guidelines stress the importance of appropriate dosing and duration of medications as well as gradual dosage reduction or tapering of specific medication classes, including all psychotropic medications. The preferred kinds of psychotherapies for treatment of depression in older adults include cognitive-behavioral therapy, problem solving psychotherapy, interpersonal therapy, and supportive psychotherapy ( ). Because of severe adverse side effects and inappropriate prescribing practices, the use of psychotropic medications first came under scrutiny with nursing home residents. The use of atypical antipsychotic drugs increased in the 1990s because health professionals believed these drugs were safer than typical antipsychotic medications. Depression is often a comorbid factor with a variety of medical conditions including cancer, coronary heart disease, parkinsons disease, thyroid disease, and cerebrovascular disease. It is well documented that older adults are highly vulnerable to the adverse effects of psychotropic medications. In 2005, the fda completed a meta-analysis of clinical studies examining the use of atypical antipsychotic medications in patients with dementia.Oct 4, 2016 ... buy cheap ..... Wonderfull great site buy oxytrol .... "> buy ramipril 2.5mg Underwood and Paisley sang a version of Dolly ...... 22 ECB announcement that it will purchase $60billion euros per month ...