Chap 16 Psychotherapeutic Drugs Flashcards
Biochemical Imbalance Theory
imbalance of neurotransmitters
Dopamine and epinephrine
Serotonin and histamine
Gamma-aminobutyric acid and acetylcholine
Anxiety
Unpleasant state of fear
Affective Disorders (Mood Disorders)
Changes in mood from mania to depression
Bipolar disorder is an example
Psychosis
Severe emotional disorder that impairs mental fxn to the point they cannot participate in activities of daily living
Hallmark:Loss of contact with reality
Depressive and drug-induced psychosis
Anxiolytic Drugs
Benzodiazepines
Depress activity in the brainstem and limbic system.
Benzodiazepines/Adverse Effects/Overdose/Interactions
Largest and most commonly prescribed anxiolytic
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Adverse Effects
Decreased CNS activity, sedation
Hypotension
Drowsiness, loss of coordination, dizziness, headaches
Nausea, vomiting, dry mouth, constipation
Overdose
dangerous with alcohol
Flumazenil (Romazicon) may be used to reverse benzodiazepines’ effects.
Interactions
Alcohol and CNS depressants can result in additive CNS depression and even death.
More likely to occur in patients with renal or hepatic compromise
Alprazolam (Xanax)
Most used as an anxiolytic
Adverse effects: confusion, ataxia, headache, and others
Diazepam (Valium)
Indications: relief of anxiety
Avoid in patients with hepatic dysfunction
Adverse effects: headache, confusion, slurred speech, and others
Lorazepam (Ativan)
Used to treat or prevent alcohol withdrawal
Buspirone (Buspar)
Lacks sedative properties and dependency potential as other benzodiazepines
Mood-Stabilizing Drugs
Lithium carbonate
Drugs used in combination with lithium
Benzodiazepines
Antipsychotic drugs
Antiepileptic drugs
Dopamine receptor agonists
New agent: cariprazine (Vraylar)
Lithium Level Range/Adverse Effects
treatment of mania
Narrow therapeutic range: 1-1.5 mEq/L; maintenance serum lvls should range between 0.6 and 1.2 mEq/L.
exceeding 1.5-2.5 mEq/L produce toxicity, GI discomfort, tremor, confusion, somnolence, seizures, and possibly death.
Keeping the sodium level normal range (135-145 mEq/L) helps therapeutic lithium levels.
Adverse effects
Most serious adverse effect is cardiac dysrhythmia.
Long-term treatment may cause hypothyroidism
Antidepressants
Requires at least 6 weeks of therapy
Higher risk of suicide
Tricyclic Antidepressants (TCA)
largely been replaced by SSRIs as first-line antidepressant drugs
Amitriptyline (Elavil)
Tricyclic Antidepressants: Indications/Overdose
Depression
Childhood enuresis (imipramine)
Adjunctive analgesics for chronic pain conditions
Overdose
CNS and cardiovascular systems are
mainly affected.
dysrhythmias
Amitriptyline (Elavil)
Commonly used to treat insomnia and neuropathic pain
Monoamine Oxidase Inhibitors (MAOIs)
Disadvantage: potential to cause hypertensive crisis when taken with tyramine
MAOIs and Tyramine
Ingestion of foods or drinks with tyramine leads to hypertensive crisis
Avoid foods that contain tyramine!
Aged, mature cheeses (cheddar, bleu, Swiss)
Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)
THE CHACOOTURIE BOARD
SSRIs
fluoxetine,
sertraline,
mirtazapine
Bupropion
also indicated as an aid in smoking cessation
Zyban: approved for smoking cessation treatment
Second-Generation Antidepressants Adverse Effects
insomnia (partly caused by reduced rapid eye movement sleep),
weight gain, and
sexual dysfunction
Serotonin Syndrome
More severe symptoms
Hyperthermia
Seizures
Rhabdomyolysis
Cardiac dysrhythmias
Fluoxetine (Prozac)
Prototypical SSRI
Indications: depression, bulimia, OCD, panic disorder
Contraindications: known drug allergy and concurrent MAOI therapy
Interactions: warfarin
Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others
Duloxetine (Cymbalta)
Indications:
depression,
GAD, and
pain resulting from diabetic peripheral neuropathy or fibromyalgia
Mirtazapine (Remeron)
Sedation often occurs
Dose at bedtime
appetite stimulant
Antipsychotics Used to Treat/Adverse Effects
Drug-induced psychoses,
schizophrenia
Adverse Effects
Agranulocytosis and
hemolytic anemia
Extrapyramidal symptoms (EPS)
Involuntary muscle symptoms similar to Parkinson’s disease
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
Tardive dyskinesia
Involuntary contractions of oral and facial muscles
+/- Symptoms of Schizophrenia
Positive symptoms: hallucinations, delusions, and conceptual disorganization
Negative symptoms: apathy, social withdrawal, blunted affect, poverty of speech, and catatonia
Haloperidol (Haldol) Indications
Indications: long-term treatment of psychosis
Quetiapine (Seroquel)
Atypical Antipsychotic
Clozapine (Clozaril) Adverse effects
Adverse effects: blood dyscrasias
Monitor WBC counts frequently
Risperidone (Risperdal)
Indication: schizophrenia, including negative symptoms
Adverse effects: minimal EPS at therapeutic dosages of 1 to 6 mg/day
Risperdal Consta: long-acting injectable form; lasts approx 2 weeks
Invega Sustenna: long-acting injection; lasts 1month
Psychotherapeutic Drugs: Nursing Implications
Obtain liver and renal function tests.
Complete Suicide Assessment Scale
Assess level of consciousness, mental alertness, and potential for injury to self and others.
Advise patients to avoid abrupt withdrawal.
Advise change positions slowly avoid postural hypotension and possible injury.
small amounts of meds should dispensed a time to minimize risk of suicide attempts.
Simultaneous use these drugs w/ alcohol or other CNS depressants can be fatal.
Antidepressants
inform patients that it may take several weeks to see therapeutic effects.
assess for suicidal tendencies
Assist older adult with ambulation, falls may occur because of drowsiness or postural hypotension.
With MAOIs, instruct patients and family regarding tyramine-containing foods and signs and symptoms of hypertensive crisis.
Antipsychotics—phenothiazines
Instruct patients to wear sunscreen because of photosensitivity.
avoid taking antacids or antidiarrheal preparations within 1 hour of a dose.
Inform patients to avoid alcohol and other CNS depressants with these medications.
-drugs may cause drowsiness, dizziness, or fainting;
change positions slowly.
therapeutic effects
Monitor mental alertness,
cognition,
affect,
mood,
ability to carry out activities of daily living,
appetite, and
sleep patterns.
Monitor potential for self-injury
therapeutic effects For anxiolytics
Improved mental alertness, cognition, and mood
Fewer anxiety and panic attacks
Improved sleep patterns and appetite
Less tension and irritability; fewer feelings of fear, impending doom, and stress
More interest in self and others
therapeutic effects For antidepressants
Improved sleep patterns and nutrition
Increased feelings of self-esteem
Decreased feelings of hopelessness
Increased interest in self and appearance
Increased interest in daily activities
Fewer depressive manifestations or suicidal thoughts or ideations
therapeutic effects For antipsychotics
Improved mood and affect
Alleviation of psychotic symptoms and episodes
Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope
For lithium
Less mania
Therapeutic lithium levels of 0.6 to 1.2 mEq/L
