psycho pharmacology 2010

8/6/2019 Psycho Pharmacology 2010

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Objectives

Discuss historical perspectives related to

psychopharmacology

Describe indications, actions,

contraindications, precautions, side

effects, and nursing implications for

psychotropic medications


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Historical Perspective

Before 1950, sedatives & amphetamines were

the only psychotropics available.

Since the 1950s, psychopharmacology has

expanded to include antipsychotic,

antidepressant and antianxiety drugs.

Psychotropic drugs are intended to be used as

an adjunct to individual or group psychotherapy.


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PSYCHOPHARMACOLOGY

The 101st Congress of the US designatedthe 1990s as the Decade of the Brainwith the challenge for studying the

biological basis of behavior.

In keeping with the neuroscientific

revolution, greater emphasis is placed onthe study of the organic basis forpsychiatric illness.


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Principles of Psychopharmacology

Principles that guide the use of Rx include:Effect on target symptom

Adequate dosage for sufficient time

Lowest dose needed for maintenanceLower doses for elderly

Tapering rather than abrupt cessation to avoid

rebound or withdrawal

Follow-up care

Simplify the regimen for increased compliance


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Implications for NursingImplications for Nursing

Emphasis in psychiatric

nursing is on a smooth

transition from a

psychosocial approach toa biopsychosocial focus.

New science and

technology must be

incorporated into nursing

practice, education, andresearch.


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Neurotransmitters play an important rolein human emotions and behavior and arethe target for the mechanism of action inmany psychotropic medications.

Major categories of neurotransmitters Cholinergics

Monoamines

Amino acids Neuropeptides


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Neurotransmitters

Chemicals that are stored in the axon

terminals of the presynaptic neuron

An electrical impulse through the neuron

stimulates its release into the synaptic

cleft, which in turn determines whether

another electrical impulse is generated.


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Important Neurotransmitters

Acetylcholine- important in pathology and treatmentof Alzheimers and parkinsonism

Dopamine- important in pathology and treatment ofschizophrenia & parkinsonism

GABA- important in pathology & treatment of anxiety

Glutamate-important in pathology & treatment ofAlzheimers

Serotonin- important in pathology & treatment ofmania and depression

Norepinephrine- important in pathology & treatmentof mania & depression


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ReceptorsMolecules situated on the cell membrane that

are binding sites for neurotransmitters.


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Psychotropics

Antianxiety agents

Antidepressants

Mood Stabilizing agentsAntipsychotics

Antiparkinsonism agents

Sedative-hypnoticsADHD agents


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How do psychotropics work?

Antidepressants- block reuptake of

neurotransmitters

Antipsychotics- block dopamine & otherreceptors

Benzodiazepines- facilitate transmission

of GABA

Psychostimulants increase release of

neurotransmitters


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Key Terms

Agranulocytosis

Akathisia

Amenorrhea

Dystonia

Extrapyramidal

symptoms

Gynecomastia

Hypertensive crisis

Neuroleptic Malignant

Syndrome (NMS)

Oculogyric crisis

Priapism

Retrograde ejaculation

Serotonin syndrome

Tardive dyskinesia


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Antianxiety Agents

Benzodiazepines- used for anxiety

Xanax, Librium, Klonopin, Valium, Ativan,

Serax, Tranxene

Non-benzodiazepines used for anxiety

Buspar, Atarax, Vistaril, Inderal


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Sleep Medication

Benzodiazepines used for sleep

Dalmane, Restoril, Halcion, ProSom

Non-benzodiazepines used for sleep

Ambien, Sonota, Lunesta, Rozerem


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Antidepressants Agents

Tricyclics- Elavil, Pamelor, Norpramin,

Ascendin, Sinequan, Tofranil, Vivactil, Surmontil

MAOIs- Nardil, Parnate, Marplan, Emsan

SSRIs -Prozac, Paxil, Zoloft, Luvox, Celexa,

Lexapro

SNRIs- Effexor, Cymbalta, Pristiq


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Common Side Effects

ALL Classes- dry mouth,sedation, nausea

Tricyclics-blurred vision, constipation, urinary

retention, orthostatic hypotension, reduced seizurethreshold, tachycardia, arrhythmias, weight gain

MAOIs- hypertensive crisis

SSRIs Insomnia, agitation, headache, GI upset,sexual dysfunction, serotonin syndrome, weightloss


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Mood Stabilizing Agents

Lithium Carbonate

Valproic Acid (Depakote)

Lamotrigine (Lamictal)

Carbamazepine (Tegretol)

Topiramate (Topomax)

Atypical Antipsychotics (Abilfy,Geodon, Zyprexa

Risperdal & Seroquel)


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Mood Stabilizing Agents

Indications: prevention & treatment of manicepisodes associated with bipolar disorder

Action: Lithium enhances the reuptake ofnorepinephrine and serotonin in the brain,

lowering levels in the body and resulting indecreased hyperactivity.

The role of anticonvulsants and antipsychotics inthe treatment of bipolar mania is not fullyunderstood.


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Lithium Side Effects

Drowsiness, dizziness, headache

Dry mouth, thirst, GI upset, N/V

Fine hand tremors

Hypotension, arrhythmias Polyuria, dehydration

Weight gain

Potential for toxicity Therapeutic range 0.6 1.2mEq/L

Toxic levels equal to or greater than 1.5mEq/L


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Depakote

LFTs and CBC with Diff to prevent liver, kidney orblood cell complications.

Blood levels must be monitored regularly.

Therapeutic range is 50 110

Depakote can cause liver dysfunction, hepaticfailure and blood dyscrasias.


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Anticonvulsant Side Effects

Nausea and vomiting

Drowsiness; dizziness

Blood dyscrasiasProlonged bleeding time (Depakote)

Risk of severe rash (Lamictal)

Decreased efficacy of oral contraceptives(Topomax)


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Antipsychotics

Indications:Treatment of acute and chronic

psychosis.

Action: Unknown; thought to block postsynaptic

dopamine receptors in the basal ganglia,

hypothalamus, limbic system, brainstem, and

medulla. Newer agents may block action onreceptors specific to serotonin and other

neurotransmitters.


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Antipsychotic Agents

Typical (older)

First Generation

Thorazine

Haldol

Prolixin

Stelazine

Navane

Loxitane

Atypical (newer)

Second Generation

Clozaril

Risperdal

Zyprexa

Seroquel

Geodon

Abilify


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Side orAdverse EffectsAgranulocytosis- white bone marrow suppression

associated with Clozaril

Akathesia restlessness, an urgent need for

movement.

Amenorrhea cessation of menses.Dystonia-involuntary muscular movements

(spasms) of the face, arms, legs & neck

Extrapyramidal symptoms-responses that

originate outside the pyramidal tracts

Tardive dyskinesia-Syndrome of symptoms

characterized by bizzare facial and tongue

movements


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Gynecomastia-enlargement of breast tissue in the

male

Hypertensive crisis- life threatening syndrome resultswhen patient on MAOIs eats a product high in

tyramine

Neuroleptic Malignant Syndrome NMS- life

threatening condition with muscle rigidity, extremeEPS, fever, HTN and tachycardia

Oculogyric crisis-involuntary deviation and fixation of

the eyeballs

Priapism- prolonged, painful erectionSerotonin Syndrome- occurs when two drugs that

potentiate serotonergic neurotransmission are used


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Long Acting Injections

There are 3 Antipsychotics available in Depot

formulations for patients who experience

problems with compliance: Prolixin (decanoate) Duration 7 28 days

Haldol (Decanoate) Duration of 4 weeks

Risperdal Consta Duration of2 weeks


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ADHDAgents

Indications: ADHD in children and adults

Action:The CNS stimulants increaselevels of norepinephrine, dopamine, and

serotonin in the CNS.

Straterra inhibits the reuptake ofnorepinephrine


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ADHDAgents

Dexadrine

Adderall (XR)

Focalin (XR)

Ritalin (LA,SR)

Concerta

Metadate(CD,ER)

Methylin(ER)

Straterra (non-stimulant)


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Special Populations: OlderAdults

o Higher risk for toxicity due to:

- Increased proportion of adipose tissue

- Decreased rate of excretion of medications

in the liver- Decreased renal filtration

o Greater risk of antipsychotic side effects:sedation, orthostatic hypotension, EPS, and

tardive dyskinesia


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Special Populations: Pregnant Women

Goal of medication therapy: effect a balancebetween the risk to the fetus and the risk ofmental illness to the mother.

Practices:

avoid during gestational weeks 6 to 10

monotherapy at lowest dose for shortest time

lower the dose before delivery

increase dose after delivery

Resume medication when finished

breastfeeding


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Nursing responsibilities for

psychotropic drug administration..

Demonstrate knowledge necessary to developmedication education and treatment plans.

Differentiate psychiatric symptoms from medication

side effects. Identify appropriate use of psychopharmacologic

agents in special populations.

Involve clients & their families.

Identify factors that might prevent the activeinvolvement of clients in their care.

Describe appropriate nonpharmacologic interventions.

Discuss the use of standardized rating scales.


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psycho pharmacology 2010

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