Psychotherapeutic Agents Flashcards
What do psychotherapeutics do and do not do for perceptual and behavioral disorders?
- Help patients function in a more acceptable manner
- Carry on ADLs
- DO NOT CURE the disorder
What is schizophrenia?
Hallucinations, paranoia, delusions, speech abnormalities, absence of typical social behaviors
- Tends to run in families
- May reflect a fundamental biochemical abnormality
What is bipolar disorder?
Extremes of depression followed by hyperactivity and excitement
* Strong genetic component
* May reflect a biochemical imbalance then overcompensation by neurons and the inability to reestablish stability
Considerations for Pyschotherapeutic Agents
In children
- Often used in combo with other CNS drugs
- Long term effects not known
- Monitor carefully for adverse effects and developmental progress
- Lithium is not typically used
- Treatment should be part of an interdisciplinary approach
Considerations for Pyschotherapeutic Agents
In Adults
- Regular followup
- Some meds require prior ECG to look for prolonged QT interval
- Cautiously used during pregnancy/lactation
- Lithium can cause SERIOUS congenital abnormalities - contraception for women of child bearing age
Considerations for Pyschotherapeutic Agents
In Older Adults
- More susceptible to adverse effects
- Need a reduced dose
- Monitor closely for toxicity
- Should not be used with dementia pts (Increased risk of death)
- Renal impairment + Lithium = monitor closely; decreased dose; maintain hydration and salt intake
- Some need ECGs due to prolonged QT interval
Typical Antipsychotic
Drug Names
“-azine”
* Prochlorperazine
* Thioridazine
* Chlorpromazine
Haloperidol
Atypical Antipyschotics
Drug Names
“-piprazole”
* Aripiprazole
* brexpiprazole
“-apine”
* Quetiapine
* Olanzapine
* Clozapine
“-idone”
* risperidone
* Ziprasidone
* iloperidone
Antipsychotic/Neuroleptic Drugs
Mechanism of Action
- Typical: block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
- Depress the RAS, limiting the stimuli coming into the brain
- Atypical: block both dopamine and serotonin receptors
Antipsychotics
Indications
- schizophrenia
- hyperactivity
- combative and agitated behavior
- severe behavioral problems in children
- Adjunct thereapy to major depressive disorder
What to remember with antipsychotics and IM route?
IM route provides 4 to 5 times the active dose as oral doses
give a much smaller dose by IM
Antipsychotics/ Neuroleptics
Contraindications
Absolute:
Allergy
Relative:
* CNS depression
* Blood dyscrasias
* Parkinson’s Disease
* Prolonged QT interval
* Black Box warning: serious CV events, including death in pts with dementia
Cautions:
* conditions worsened by anticholinergeic effects (glaucoma, urinary retention, BPH)
* Seizure disorder (decrease seizure threshold)
* Liver, renal, cardiac disease
Antipsychotics/ Neuroleptics
Adverse Effects
- CNS: drowsiness, sedation, weakness, tremors, extrapyramidal effects, neuroleptic malignant syndrome
- Anticholinergic: constipation, dry mouth, nasal congestion, urinary retention, blurred vision
- Gynecomastia
- CV: prolonged QT interval, hypotension, orthostatic hypotension
- Bone marrow suppression
- Atypical antipyschotics: diabetes and weight gain
What are extrapyramidal effects?
- Pseudoparkinsonism (drooling, shuffling gait)
- Dystonia (spasm of tongue, neck, back)
- Akathisia (restlessness)
- Tardive Dyskinesia (lip smacking, abnormal movements)
What is Neuroleptic Malignant Syndrome?
- high fever
- muscle stiffness
- potentially irreversible
Antipsychotics/ Neuroleptics
Drug Interactions
- CNS depressants, including alcohol
- anticholinergics
Antipsychotics/ Neuroleptics
Assessment
History:
* Contraindications/cautions
Physical:
* Vital Signs
* CNS: orientation, affect
* Cardiac
* Abdominal
Labs:
* EKG
* Renal and hepatic function
* CBC
* Glucose
Antipsychotics/ Neuroleptics
Nursing Conclusions
- Impaired Physical Mobility (r/t extrapyramidal effects)
- Altered Cardiac Output
- Fall risk
- Injury Risk
- Urinary Retention
- Constipation
- Knowledge Deficit
Antipsychotics/ Neuroleptics
Implementation/Patient Teaching
- Parenteral Forms: Recumbent for 30 minutes
- Monitor CBC and glucose
- Arrange for gradual withdrawal after long term use
- Safety & Comfort measures: positioning of arms/legs; sugarless candy/lozenges for dry mouth; viod before taking
- Vision examinations
- Throrough patient teaching: May cause a pink/brown color of urine (Normal); May take weeks to take effect
Drugs used for bipolar disorder
-
Lithium
Antipsychotics: - Aripiprazole
- Olanzapine
- Quetiapine
- Ziprasidone
Lithium
Mechanism of Action
- Unknown how it affects mania
- Alters sodium transport in nerve and muscle cells
- Influences reuptake of neurotransmitters NE and dopamine
Lithium
Pharmacokinetics
- Kidney reabsorbs more lithium during dehydrated and hyponatremic states => leads to toxicity
Lithium
Contraindications
Absolute:
* Allergy
Relative:
* Significant renal or cardiac disease
* Deyhdration/risk for dehydration/hyponatremia
Lithium
Adverse Effects
Leukocytosis
Insipidus (diabetes insipidus: increased thirst and urination)
Tremors/teratogenic/thyroid issues
Hypothyroidism
Lithium
Toxicity
Directly related to levels in blood:
1.3-1.4: lethargy, slurred speech, muscle weakness, n&v
1.5-2: above signs plus ECG changes
2-2.5: ataxia, clonic movements, hyperreflexia, seizures
>2.5: complex multi-organ toxicity, significant risk of death
Lithium
Drug Interactions
Drugs
* Haloperidol (antipyschotic): increased risk of encephalopathy
* Carbamazepine (other antiseizure): increased CNS toxicity
* Diuretics: Increased lithium toxicity
Herbal
* Psyllium: decreased absorption of lithium
Antimanic Drugs
Assessment
History:
* Contraindications/Cautions
Physical:
* Vital Signs
* Skin/mucus membranes
* CNS
* Abdominal
* Urinary Output
Labs/Tests:
* Renal function
* CBC
* Thyroid Function
* Lithium levels
* Sodium levels
* EKG
Antimanic Drugs
Nursing Conclusions
- Impaired comfort/acute pain
- Injury Risk
- Impaired urinary elmination
- Altered thought processes
- Knowledge deficit
Antimanic Drugs
Implementation/Patient Teaching
- Monitor serum levels closely (every 2-3 days in beginning, every 3-6 months once stable)
- May take with food or milk
- Decrease dose after manic episodes
- Pt. maintains adequate intake of salt and fluids
- Safety and comfort measures for GI and CNS effects
- Pt teaching: Avoiding pregnancy, avoiding dehydration
