Pyschopharmcology

Question 1

What are the legal issues that a nurse must consider when administering psychotropic medications? (think about administration under the MHA92)

Answer 1

Legal:

Right to refuse treatment: A health consumer under the MHA92 has the right to refuse medication. Administering medication without consent can result in initiated assault.

Informed consent: As a nurse you must ensure that the health consumer receiving medication has given informed consent, unless authorised under the MHA92. This includes the understanding of the effects, benefits, purpose and potential side-effect of medication that they are taking.

Question 2

What are the ethical issues that a nurse must consider when administering psychotropic medications? (think about administration under the MHA92)

Answer 2

Ethical:

Autonomy: respecting the individual’s right to make decision that impact their treatment, including a choice to refuse medication, unless legally overridden under the MHA92.

Beneficence: Acting in the best interest of the health consumer, ensuring that the medication will benefit their mental health and wellbeing.

Non – Maleficence: Avoiding harm as a nurse you must monitor for and report adverse reactions of side effects promptly.

Question 3

What are some of the factors that contribute to non-adherence with psychotropic medication?

Answer 3

1.Lack of insight not understanding or the belief that the medication is a necessity.

2.Negative attitudes towards medication, the effectiveness or the potential side effects can discourage a person from taking their medication

3.Forgetfulness or difficulty with medication schedules, can make it challenging for people to adhere to the prescribed schedule

4.Side effects of the medication can lead to people wanting to discontinue or reduce the dosage of their medication

Question 4

What are some strategies that nurses can use to address these factors?

Answer 4

Provide psychoeducation on information about the purpose of the medication and how it works, potential side effects and why it is important to adhere to the medication. Recommend to the person a pill organiser or an alarm to help them remember to take their medication. Also involve the person in the process regarding their treatment plan and encourage them to develop strategies that will improve adherence.

Question 5

What is prn medication? When might this be used?

Answer 5

When required, usually used when the patient deems that they are in need of it

Question 6

What are depot antipsychotic drugs? When might these be used?

Answer 6

Depot antipsychotic are a long-acting injectable form of an antipsychotic medication. It is designed to slowly release the medication over weeks. Depot are used to help people with schizophrenia or other psychotic disorders to maintain their treatment and prevent relapse, also can be used to people who experience difficulty adhering to their schedule for oral medication.

Question 7

What considerations need to be made related to psychotropic drug use with:

Pregnant and lactating women

Answer 7

Teratogenic effects of psychotropic medication can expose the foetus to an increased risk of congenital malformation, antidepressants and lithium are excreted in breast milk.

-Antipsychotics and depot injections should be avoided in the first trimester of pregnancy
-Women that are pregnant and breastfeeding should be prescribed the lowest dose possible
-Women who are breastfeeding should avoid depot injections
-When diagnosed as pregnant women that use atypical antipsychotics should change to typical antipsychotics

Question 8

What considerations need to be made related to psychotropic drug use with:
Children and adolescents

Answer 8

Antidepressants should only be prescribed to children and adolescents with caution as they are vulnerable to the cardiotoxic and seizure-inducing effects of high doses of tricyclic compounds.

Question 9

What considerations need to be made related to psychotropic drug use with:

Older people

Answer 9

Older people experience more adverse effects from psychotropic medication use, more common in people over the age of 70 due to a slower medication metabolism and excretion. For instance, benzodiazepines are more likely to cause dizziness which can increase the risk of a fall or serious injury. Antidepressants in older people can cause dizziness, hypotension, constipation, oedema, tremor and delayed micronutrition.

Question 10

Pharmacodynamics

Answer 10

Focuses on what the drug does to the body

Question 11

Pharmacokinetics

Answer 11

Focuses on what the body does to the drug

Question 12

Akathisia

Answer 12

Restlessness where the person cannot stay still

Question 13

Ataxia

Answer 13

Lack of voluntary coordination of muscle movement

Question 14

Dysarthria

Answer 14

Slow and slurred speech that can be difficult to understand

Question 15

Tinnitus

Answer 15

Ringing in the ears

Question 16

Anticholinergic

Answer 16

Drug that inhibits acetylcholine (neurotransmitter) and the parasympathetic nerve impulses to manage side effects from antipsychotic medication

Question 17

Extrapyramidal side effects

Answer 17

Drug -induced movement disorders

Question 18

Metabolic syndrome

Answer 18

Cluster if conditions that increase risk for diabetes, stroke and heart disease. This includes increased waist circumference, high BSL, high triglycerides and increased blood pressure

Question 19

Neuroleptic malignant syndrome

Answer 19

Rare, life threatening condition as a result of some antipsychotic medications (or combination of medications) including fever, muscle rigidity, altered MSE and autonomic dysfunction

Question 20

Hypertensive crisis

Answer 20

Rapidly rising blood pressure which can cause a stroke

Question 21

Prolonged QT interval

Answer 21

Delays repolarization in the heart which can lead to dangerous, life threatening arrhythmias

Question 22

Serotonin Syndrome

Answer 22

A potentially life-threatening syndrome caused by excessive brain cell activity as a result of high levels of serotonin

Question 23

Anti-anxiety: Benzodiazepines

Answer 23

Examples:
Lorazepam
Diazepam
Clonazepam
Alprazolam

Common side-effects:
Drowsiness
Dependence
Muscle weakness
Paradoxical increase in aggression

Consumer education:
This medicine can cause sleepiness, dizziness, and impair concentration. Do not drive or perform skilled tasks (e.g. use tools or machinery) if you feel sleepy or until you know how this medicine impairs you, especially when you first start treatment.

This medicine can increase the effects of alcohol. Limit alcohol intake

Question 24

Anti-anxiety: Azapirones

Answer 24

Examples: Buspirone

Common side-effects:
Chest pain
Confusion
Blurred vision
Tinnitus

Consumer education:
Do not take if you suffer from liver or kidney disease
Do not take if you suffer from epilepsy
You are pregnant or plan to become pregnant

Question 25

Anti-anxiety: Beta-adrenergic blockers

Answer 25

Example: Propranolol Common side effects: Depression and low mood Dizziness Headache Consumer education: Do not stop taking this medicine unless your doctor tell you to stop Swallow this medicine whole, do not crush or chew

Question 26

Anti-depressant: Tricyclic and related drugs

Answer 26

Example: Amitriptyline Lofepramine Trazodone Side effects: Sedation Dry mouth Constipation Blurred vision Urinary retention Seizures Consumer education: It may take 2-6 weeks before the client sees any improvement

Question 27

Anti-depressant: Selective serotonin reuptake inhibitors and related drugs (SSRIs)

Answer 27

Example: Fluoxetine Paroxetine Side effects: Constipation Weight gain Dry mouth Sexual dysfunction Change in appetite Anxiety Consumer education: This medicine may cause dizziness or drowsiness; be careful driving or operating machinery until you know how this medicine affects you. It may take a few weeks for your antidepressant to start working and you may initially feel worse at the start of treatment; this may be due to your illness or due to side effects from the medicine. If you experience worsening of your mood, agitation, aggression, other unusual changes in behaviour and mood, or thoughts of self-harm or suicide, report this to your health care professional immediately Stopping this medicine suddenly may make you feel unwell. The dose of this medicine should be reduced slowly before stopping it completely

Question 28

Anti-depressant: Serotonin and noradrenaline reuptake inhibitors (SNRIs)

Answer 28

Example: Venlafaxine Mirtazapine Side effects: Constipation Nausea Weight changes Dry mouth Tremor Insomnia Consumer education: It may make you sleepy, if it happens do not drive or use machines and tools. Inform person that stopping this medication can make you feel suddenly unwell, the does should be slowly reduced before it is stopped completely.

Question 29

Anti-depressant: Monoamine oxidase inhibitors (MAOIs)

Answer 29

Example: Isocarboxazid Phenelzine Tranylcypromine Side effects: Dry mouth. Upset stomach. Diarrhea or constipation. Headache. Sleepiness during the day. Trouble sleeping at night. Dizziness or lightheadedness. Consumer education: Inform person that it may take 4-6 weeks before they notice a marked effect from the medication and of the importance to continue to take the medication. Inform about possible interactions with foods and other drugs. These are foods that contain tyramine such as strong cheese, home brew, yeast products and smoked fish.

Question 30

Mood stabliser: Lithium

Answer 30

Examples: Lithium carbonate Common side-effects: GI disturbances Weight changes Anorexia Oedema Consumer education: Lithium toxicity: routine and regular monitoring of serum drug concentration is required to to avoid dose-related toxicity. Many factors can influence lithium concentrations including drug interactions, changes to diet and fluid intake, illness, and adherence to treatment. Take each dose with food. The tablets should not be crushed, chewed or swallowed with hot liquids. Drink plenty of water and avoid dietary changes which reduce or increase sodium (salt) intake. Stop taking this medicine and contact your doctor if you experience loss of appetite, diarrhoea, vomiting, muscle weakness, lack of co-ordination, drowsiness, tinnitus (ringing in the ears), blurred vision, slurred speech, tremor, and muscle twitching. These symptoms may mean that your lithium levels need to be checked. Your family members should also be aware of these symptoms.

Question 31

Mood stabiliser: Anticonvulsants

Answer 31

Example: Valproate Topiramate Lamotrigine Carbamazepine Side effects: Diarrhoea Weight gain Thinning hair Irregular or delayed periods Consumer education: Do stop taking suddenly Take with meals if GI upset is experienced Report unusual symptoms such as spontaneous bruising, sore throat, unusual bleeding, fever, malaise, yellow skin or eyes, to the doctor.

Question 32

Antipsychotic: typical antipsychotics

Answer 32

Examples: Chlorpromazine Haloperidol Common side-effects: Constipation Dry mouth Blurred eyesight Dizziness Consumer education: This medicine may make you sleepy. If this happens, do not drive or use tools or machines.

Question 33

Antipsychotic: Atypical antipsychotics

Answer 33

Example: Olanzapine Common side-effects: Weight gain Dry mouth Increased appetite Constipation Consumer education: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol. Protect your skin from sunlight— even on a bright but cloudy day. Do not use sunbeds.

Question 34

Antipsychotic: Clozapine

Answer 34

Side effects: Nausea Dry mouth Weight gain Urinary incontinence Consumer education: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol. Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds. Life threatening side effects: agranulocytosis, constipation, myocarditis find out more and describe how you would explain this to your client. Tell your doctor immediately if you have symptoms of an infection such as fever, sore throat or flu-like illness. This medicine often causes constipation which can be serious. If you have fewer bowel motions than normal, or if you experience tummy discomfort, bloating, hard or dry stools, difficulty passing gas, nausea, vomiting, reduced appetite, constipation or diarrhoea whilst taking clozapine tell your doctor immediately Tell your doctor immediately if you develop a fast or irregular heartbeat, unexplained tiredness, rapid breathing, shortness of breath, swelling of the feet or legs, light headedness or chest pain whilst taking clozapine.

Question 35

Antipsychotic: Depot preparations

Answer 35

Examples: Flupenthixol Zuclopenthixol Paliperidone Relprev Side effects: Dystonia Dyskinesia Hyperglycaemia Diabetes Weight gain Consumer education: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol. This medicine may cause constipation which can be serious. If you have fewer bowel motions than normal, or if you experience tummy discomfort, bloating, hard or dry stools, difficulty passing gas, nausea, vomiting, reduced appetite, or diarrhoea whilst taking this medicine tell your doctor immediately; do not wait to see if symptoms settle.