Mental health medications

Question 1

Review of the nervous system and neurotransmitters

Answer 1

Excitatory: these ‘fire off’ the chemical message and pass it along to the next cell;
Inhibitory: these ‘block’ or prevent the chemical message from being passed along;
Modulatory: these ‘tweak’ or modulate the chemical message and adjust the communication at the synapse

Question 2

What are Monoamine neurotransmitters

Answer 2

They are hormones derived from amino acids. They are called monoamine as they contain one amino group. They include catecholamine and tryptamine hormones.

Question 3

What is Catecholamine hormones

Answer 3

Derived from the amino acid tyrosine;
Include:
Dopamine;
Epinephrine (adrenaline);
Norepinephrine (noradrenaline)

Question 4

What is tryptamine hormones

Answer 4

Derived from the amino acid tryptophan;
Include:
Serotonin;
Melatonin

Question 5

Dopamine

Answer 5

Dopamine, a catecholamine hormone, plays a role in the body’s reward system (arousal, feeling pleasure, and learning) as well as concentration, memory, motivation and sleep. It can be both excitatory and inhibitory.

Question 6

Serotonin

Answer 6

A tryptamine chemical messenger, regulates sleep, mood, anxiety, hunger and pain. It is an inhibitory neurotransmitter.

Question 7

Mood disorders

Answer 7

Depression:

Mood disorder characterised by lowering of mood, loss of interest and enjoyment. Is associated with an imbalance of serotonin.
Bipolar affective disorder

Mood disorder characterised by episodes of mania and depression. Is associated with a dopamine dysfunction.

Question 8

Anxiety

Answer 8

Characterised by constant fears or thoughts that are distressing and affect daily living.

May be associated with an imbalance of serotonin.

Question 9

Personality disorders

Answer 9

Characterised by long-term dysfunctional thinking, feeling and behaving.

Usually results in difficulty relating to people and situations.

Question 10

Psychotic disorders

Answer 10

Characterised by confused thinking, people can experience delusions and hallucinations.

May be associated with a dopamine dysfunction.

Question 11

Trauma related disorders

Answer 11

Conditions that develop as a response to a traumatic event e.g. physical or sexual assault, torture, and natural disasters.

Question 12

Substance use/abuse disorders

Answer 12

Inability to control use of legal or illegal substances despite harmful consequences.

Question 13

What are Antipsychotic medications

Answer 13

Antipsychotic medications are used to treat psychoses (i.e. schizophrenia, delirium, dementia). They act upon dopamine receptors and are often referred to as major tranquilisers. They can be classified as either typical (first generation) or atypical (second generation) antipsychotic medications

Question 14

Typical antipsychotic medications

Answer 14

Examples: Haloperidol, Fluphenazine, Chlorpromazine

Indications/Use

Psychoses
Act on dopamine D2 receptors.
Side effects include: sedation, photosensitivity, decreased libido, rash;
As a result of extrapyramidal disturbances (drug induced Parkinsonism, facial grimacing; akasthasia/fidgeting; tardive dyskinesia/involuntary movements), this class of drugs is used less often that atypical antipsychotics.
Nursing considerations

Assess effectiveness of medication;
Monitor cardiac, liver and renal function;
Observe for hypotension

Question 15

Atypical antipsychotic medications

Answer 15

Examples: Risperidone, Clonazepine, Olanzapine

Indications/Use

Less effect on D2 receptors;
Side effects similar to typical (first generation) antipsychotics, however fewer extrapyramidal effects.
Nursing considerations

Assess effectiveness of medication;
Monitor cardiac, liver and renal function;
Observe for hypotension

Question 16

What are Anxiolytic and hypnotic medications

Answer 16

Anxiolytic medications are used to treat anxiety. They act on GABA receptors and are sometimes termed ‘minor tranquilisers’, as they have a sedative effect and can be addictive. Benzodiazepines (‘benzos’) are the most common anxiolytics

Hypnotics and used to induce sleep. They also act on GABA receptors. Hypnotic drugs should be only used short term and deaths have occurred when used in combination with alcohol

Question 17

Anxiolytic and hypnotic medications

Answer 17

Examples: Diazepam, Temazepam, Oxazepam, Midazolam, Nitrazepam, Lorazepam, Flunitrazepam, Phenobarbitone, Chloralhydrate.

Indications/Use

Act on GABA receptors;
Opens the cells chloride ion channel;
Side effects: sedation, ‘groggy feeling’, memory impairment, mood swings, tolerance/dependence, GIT disturbance, tachycardia, hypotension.
Nursing considerations

Older people are at greater risk of falls;
Long term use is not recommended;
If used longer term, avoid abrupt withdrawal

Question 18

Antidepressants

Answer 18

Antidepressants are medications used to treat depression. They work by increasing serotonin and noradrenaline, which are believed to be low in people with depression. It takes at least 4 weeks for the medication to start working, and treatment usually lasts 4 to 12 months per depressive episode. Two common types of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Question 19

Mood stabilisers

Answer 19

Mood stabilisers are used for manic or cyclic depressive states. These medications enhance the action of the amine reuptake pump, thus inhibiting noradrenaline release and decreasing the neurotransmitter in the synapse

Question 20

Selective serotonin reuptake inhibitors (SSRIs)

Answer 20

Examples: Fluoxetine (Prozac), Paroxetine, Sertraline.

Indications/Use

Used as a first line therapy for depressive disorders, obsessive compulsive disorder (OCD);
Works to block the reuptake of serotonin and noradrenaline;
Side effects: tremor, nausea, headache, anorexia, sweating, fatigue; produces less of a sedative effect.
Nursing considerations

Monitor blood pressure,
Educate person to take drug with food;
Ensure gradual withdrawal of drug

Question 21

Tricyclic antidepressants (TCAs)

Answer 21

Examples: Doxepin, Amitriptyline, Imipramine.

Indications/Use

Second line therapy for depressive disorders;
Block the amine reuptake pump resulting in increased serotonin and noradrenaline;
Side effects: dry mouth, blurred vision, tachycardia, constipation, increased sedation, mental confusion.
Nursing considerations

Closely monitor blood pressure;
Inform the person to avoid operating machinery

Question 22

Mood stabilisers

Answer 22

Examples: Lithium carbonate

Indications/Use

Used to prevent mania and cyclic depressive states (bipolar)
Enhance the action of the amine reuptake pump, inhibiting noradrenaline release and decreasing neurotransmitters in the synapse;
Side effects: GIT disturbance, tremor, muscle weakness, polyuria, toxicity (narrow therapeutic range), cardiac arrhythmia, renal failure.
Nursing considerations

Regular monitoring of serum concentrations of lithium and renal function;
Assess for, and education person about, the early signs of lithium toxicity (thirst, vomiting, polyuria);
Educate person about not taking lithium with NSAID (causes lithium toxicity)