Chapter 16: Psychotherapeutic Drugs Flashcards
Psychotherapeutic Drugs
- Used in the treatment of emotional and mental disorders
- Ability to cope with emotions can range from occasional depression or
anxiety to constant emotional distress - When emotions significantly affect an individual’s ability to carry out
normal daily functions, treatment with a psychotherapeutic drug is a
possible option.
cause of mental disorders
Thought to arise from abnormal levels or imbalance of neurotransmitters
- Dopamine and epinephrine
- Serotonin and histamine
- Gamma-aminobutyric acid and acetylcholine
Types of psychotherapeutic
drugs
- Anxiolytic drugs
- Mood-stabilizing drugs
- Antidepressant drugs
- Antipsychotic drugs
Axiolytic Drugs
- Reduce anxiety by reducing overactivity in central nervous system
(CNS). - Benzodiazepines : Depress activity in the brainstem and limbic system.
- Miscellaneous drug: buspirone (Buspar)
- Nonsedating and nonhabit forming
- May have drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)
-Do not administer with MAOIs
Benzodiazepines
- Largest and most commonly prescribed anxiolytic
- used to treat alcohol withdrawal, insomnia, and muscle spasms and depression
ex: Alprazolam ( Xanax)
Diazepam (Valium)
Lorazepam ( Ativan)
Benzodiazepine Adverse effects
- Decreased CNS activity, sedation
- Hypotension
- Drowsiness, loss of coordination, dizziness, HA
- N/V, Dry mouth, constipation
Benzodiazepine Overdose
- dangerous when taken with other sedatives or alcohol
- FLUMAZENIL (romazicon) is used to reverse benzo effects.
Benzodiazepine Interactions
- Alcohol and CNS depressants can result in additive CNS depression, even death
- more likely to occur in patients with renal or hepatic compromise
Alprazolam
(Xanax)
- Most commonly used as an anxiolytic
- Indicated for GAD, short term relief of anxiety symptoms, panic disorder and anxiety associated with depression.
Adverse Effects: confusion, ataxia, HA
Interactions: Alcohol, oral contraceptives
Diazepam
(Valium)
- Long acting benzo
- for use of: anxiety relief, management of alcohol withdrawal, preop sedation, skeletal muscle spasms and reversal of status epilepticus.
- Adverse effects: HA, confusion, slurred speech
- Interactions: alcohol, oral contraceptives
Lorazepam
(Ativan)
Treats: anxiety, seizures, alcohol withdrawal.
- Intermediate - acting Benzo
- can be given IV push for agitation
- continuous infusion
Misc. Anxiolytic
( Buspirone/ Buspar)
Treats: anxiety
- administered on a scheduled basis
- lacks sedative properties
Adverse effects: Paradoxical anxiety, blurred vision, HA, nausea
Mood Stabilizing Drugs
( Lithium carbonate and Lithium citrate)
- used to treat bipolar illness
- other drugs maybe used w/ lithium:
- benzos
-antipsychotic drugs - antiepileptic drugs
- dopamine receptor agonists
- benzos
Lithium
- Drug choice for the treatment of mania.
- it is thought to potentiate serotonergic neurotransmission
- Narrow therapeutic range: acute mania—lithium serum level of 1 to 1.5 mEq/L; maintenance serum levels should range between 0.6 and 1.2 mEq/L.
- Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity, including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death.
- Keeping the sodium level in the normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels.
Lithium Adverse effects
- Most serious adverse effect is cardiac dysrhythmia.
- Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension
- Long-term treatment may cause hypothyroidism.
Before administering lithium to a patient, it is most important for
the nurse to assess which laboratory
value?
Answer: Sodium
Lithium may become toxic if the
patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity
Antidepressant drugs
- Increases the levels of neurotransmitter concentration in CNS
- requires at least 6 weeks of therapy
- higher risk of suicide
-may require upward titration of dosages - used for major depressive disorders
- other uses: dysthymia, schizo, eating disorders, personality disorders
When patients are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks of therapy?
answer: suicidal thoughts
Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy.
Tricyclic Antidepressant
(TCA)
- Have been replaced by SSRIs as first line for antidepressants
ex: Amitriptyline (elavil)
mechanism of action: blocks reuptake of neurotransmitters, causing accumulation at the nerve endings.
indications:
- depression
- childhood enuresis
- OCDs, chronic pain
- increased appetite is an effect
Adverse Effects:
- sedation
- impotence
- orthostatic hypotension
- (in older patients: dizzines, postural hypotension, edema, constipation, muscle tremors).
5 classes of Antidepressants drugs
- Tricyclic Antidepressants (TCAs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Atypical Antidepressants
Serotonin Syndrome
Happens when combine with antidepressants that increase serotonin (esp MAOIs)
Symptoms:
- skin flushing
- hyperthermia
- agitation
- muscle rigidity
- seizures
- altered mental status
Sertraline is..
An SSRI commonly used for treatment for depression.
Works by inhibiting the re-uptake of serotonin.
Monitor for:
- suicidal ideation
- lithium toxicity
Lithium is…
A mood stabilizer medication used for treatment of bipolar disorder.
Works by altering ion transport across cell membranes.
Monitor for:
- suicidal ideation
- lithium toxicity
Which anxiolytic drug promotes agonistic activity at both the serotonin and dopamine receptors?
Buspirone
