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ch2 psyc

psychopharmocology treatment for psyc pts
cerebrum all lobes found in cerebrumm except pineal gland
pineal body endocrine gland, influences pituitary, islets of langerhans, parathyroid, adrenals, & gonads
Left Hemisphere of brain controls RIGHT side of body, logical reasoning, analytic functions ie: reading, writing, math
Right Hemisphere of brain controls LEFT side of body, creative thinking, intuition, artistic ability
Frontal lobe controls organizational thoughts, body movement, emotions, moral behavior, regulates arousal, focuses attention, prob solving, dcision making
abnormalities of frontal lobe associated with: schizophrenia, ADHD, dementia
Parietal lobe interpret sensations ie: taste & touch, spatial orientation
temporal lobe: sense of smell, hearing, memory, emotional expression
Occipital lobe coordinates language generation, visual interpretation, depth perception
cerebellum info form body(CNS,muscles,joints,organs) ie: coordinattion of movement & postural adjustment
abnormalities of cerebellum dec. dopamine (parkinson/dementia)
Brainstem (midbrain, pons, medulla, CNIII, XII) medulla-the gap b/t is motor pathway. midbrain connects pons & cerebellum & includes most of the reticular formation & extrapyramidal system
Locus ceruleus norepi producing neurons in brainstem R/T stress, anxiety, & impulsive behavior
Limbic system (^brainstem) thalamus- regulates activity, sensation & emotion. hypothalamus- temp reg. appetite control, endocrine function, sex drive,impulse,anger,rage,excitement. hippocampus/amygdala-emotional arousal/memory
abnormalities of Limbic system momeory loss w/dementia, poorly controlled emotions & impulses w/psychotic & manic behavior
neurotransmitter chemical substance made in neuron that aid in transmission of info in body
reuptake transported back from synapse to axon to be stored later
neuro, relay message metabolized & inactivated by enzymes MAO
Dopamine in brainstem, EXCITATORY & synthesized by tyrosin(dietary amino acid)
function of dopamine controls complex movements ie:motivation, cognition, reg of emotional responses
disfunction of dopamine schizo & psychosis(^dop), parkinsons
Norepinephrine (noradrenaline) in brainstem; changes in attention, learning, memory, sleep/wakefulness, mood reg
excess of norepi anxiety disor. memory loss, social withdrawal, depresison
Tx excess norepi antidepressants that block reuptake of norepi ie:MAOIs block metabolizing norepi
epinephrine(adrenaline) limited distrobution in body but controls fight/flight in PNS
Serotonin found ONLY in brain; from tryptophan(dietary amino acid)
function serotonin INHIBITORY; controls food intake, sleep/wake, temp reg, pain control, sex behavior, reg of emotions
disfuntion of serotonin anxiety/mood dix, schizo, delusions, hallucinations, withdraw behavior
Tx serotonin dix antidepressants that block serotonin reuptake leaves it available longer in synapse which ^ mood
Histamine psyc drugs block histamine C/o weight gain, sedation, hypotension
Acetylcholine in brain, spinal cord, PNS(neuromuscular junction in skeletal muscles)
ACTH function EXCITATORY & INHIBITORY, tells muscles to "wake up", synthesized from dietary choline(red meat & veggies)
dix ACTH dec. ACTH=alzheimers or myesthenia gravis
glumtamate EXCITATORY amino acid, ^ can have neurotoxic effects ie: stroke, hypoglycemia, sustained hypoxia/ischemia, huntingtons/alzheimers
gamma-aminobutyric acid (GABA) inhibitory modulates other neurotransmitter, induces sleep ie:benzos
antipsychotics (NEUROLEPTIC) agents Tx: s/s of psychosis ie:delusions, hallucintaions seen in schizo/schizo affective dix & mania seen in Bipolar dix
Off-label use of neuroleptic agents anxiety/insomnia, aggressiveness, delusions/hallucinations
mec. of action neuroleptics blocks dopamine
most common indications neuroleptics schizo, mania, drug psychosis
Side effects neuropleptics******** *******EPS: acute dystonia, pseudoparkinsonism, akathisia
****EPS***** ***Extrapyramidal Side Effects. C/o blockade of D2 receptors in midbrain region of brainstem
Tx for EPS*** ***Lower dose of antipsychotic, change to different antipsychotic, or admin of anticholinergic meds (cogentin or Benadryl)
Dystonia acute muscular rigidity & cramping, stiff or thick tongue w/diff swallowing & laryngospasm(severe)& respritory diff.
when is dystonia likely to occur in 1st week of tx, clients >40, males, & in those recieving high potency drugs(haloperidol & thyroxine)
Toricollis twisted head & neck from spasms & stiffness in muscles groups
opisthotonus tightness in entire body with the head back & an arched neck
oculogryic crisis eyes rolled back in a locked position
Tx for dystonia immediate anticholinergic drugs ie: IM cogentin or IM/IV benadryl
akathisia intense need to move about. pt appears restless or anxious & agitated w/rigid posture or gait & no spontaneous gestures. leads to med noncompliance
tx of akathisia change in antipsychotic med or addition of oral agent ie: beta-blocker, anticholinergic, or benzo
Neuroleptic Malignant Syndrome NMS potentially fatal idiosyncratic reaction to antipsychotic drug.
S/S of NMS rigidity, ^ fever, autonomic instability ie: unstable Bp, diaphoresis,& pallor. dellerium, ^enzymes esp:Creatine & phosphokinase. Pts often confused or mute, fluctuates agitation->stupor
Risk factors for NMS dehydration, poor nutrition, & concurrant illness.
Tx NMS ASAP discontinue ALL neuroleptics & institue supportive med care to tx dehydration & hyperthermia until pts condition stabilizes.
Tardive Dyskinesia TD permanant involuntary movements caused by long-term use of conventional neuroleptic agents. 20%-30% of pts will develop TD. No effective Tx available. meds can mask beginning s/s until "break through" s/s appear
S/S TD tonuge thrusting & protruding, lip smaking, blinking, grimacing & other unnecessary facial movements, upper & lower extremeties, & truncal musculatrue.
how to lower riskfor TD keeping maintenance dosages as low as possible, changing meds, & monitering pt for s/s w/the Abnormal Involuntary Movement Scale, or given atypical antipsyc meds
anticholinergic side effects ortho-hypo, dry mouth, constipation, urinary hesitancy/retention, blurred vision, dry eyes, photophobia, nasal congestion, dec memory
Tx for side effects of anticholinergics calorie-free beverage, hard candy to alleviate dry mouth; stool softners, adequate fluid intake, & inclusion of grains/fruits in diet to prevent constipation
other side effects of neuroleptics ^blood prolactin levels(may c/o gynacomastia & tenderness in men & women), dec libido, erectile & orgasmic dysfunction, menstral irregularities, ^risk breast cancer, weight gain(^risk DM/hyperglycemia)
agranulocytosis potentially fatal side effects of neuroleptics ie:Clozapine s/s:fever, malaise, ulcerative sore thraot, &leukopenia.
monitoring for agranulocytosis weekly WBC count ^3500/mm ot obtain the next weeks dose of clozapine for 1st 6 months of therapy. if WBC is 3500 & absolute neutrophil ocunt is 2000, frequency of WBC counts may dec(every 2 weeks, then every 4)
antidepressants Tx major depressive dix, anxiety dix, depressed phase of Bipolar dix, psychotic depression
off-label use of antidepressants Tx of chronic pain, migraines headaches, peripheral & DM neuropathies, sleep apnea, dermatologic dix, panic dix, eating dix
mec of action antidep interacts w/ norepi & serotonin so they regulate mood, arousal, attention, sensory processing, & appetite
4 groups of antidep 1-tricyclic & reltated cyclic antidep. 2-SSRIs. 3-MAOIs. 4-others: pristiq, effexor, wellbutrin, cymbalta, desyrel, serzone
cyclic antidep former 1st-line therapy but not now cuz they c/o sedation, ortho-hypo, anticholinergic side effects & are lethal if overdosed
MAOIs low incidence of sedation or anticholinergic effects but use w/extreme caution for 3 resons
3 reasons for precaution with MAOIs HTN crisis (Nardil) if pt ingests tyramine. bad combo w/other MAOIs, tricyclic antidep, demerol, CNS depressants, antiHTN, general anethetics. Lethal if overdosed
SSRIs 1st line drug for depression. Prozac Weekly id good for pt stabilized on fluoxetine. good for suicidal pts c/o no risk for overdose only for mild-mod depression
side effects of SSRIs anxiety, agitation, akathisia, nasea, insomnia, sexual dys, weight gain, sedation(paxil), sweating, diarrhea(sympotmatic Tx), hand tremor, headache.
side effects of cyclic antidepressants anticholinergic effects, ortho-hypo, sedation, weight gain, tachycardia & sexual dys(common resons for noncompliance)
side effects of MAOIs daytime sedation, insomnia, weight gain, dry mouth, ortho-hypo, sex dys. HTN crsis
MAOI foods to avoid(tyramine) ALL cheese except(ricotta, cottage, cream, processed slices) aged meats, fava beans, bean curd (tofu), banana peel, overripe fruit, avocado, beer, sauerkraut, soy sauce, soybean, yogurt, sour cream, peanuts, brewers yeast, MSG
side effects of other antidep sedation, headaches, dry mouth, nausea, agitation, insomnia, dizziness sweating, priapism wich can cause impotence
Serotonin Syndrome (serotonergic syndrome) taking MAOI & SSRI at the same time. 12hrs must epapse b4 other med is given. s/s: agitation, sweating, fever, tachycardia, hypoTN, rigidity, hyperflexia, (coma, death extreme reaction)
dosing for SSRI take 1st thing in the morning unless sedation problem. if dose forgot & its been >8hrs, take missed dose.
dosing for cyclic antidep take at night in a single dose. if forgot & >3hrs elapsed, take dose. if >3hrs, omit dose for that day
dosing for MAOI PT must know of life-threatening hyperadrenergic crisis can happen if tyramin-free diet is not adhered to. do not take with any other OTC drug b4 talking to MD
mood-stabilizing drugs Tx for bipolar dix, acute episodes of mania. Lithium, some anticonvulsant drugs(tegretol & depakote). neurontin, topamax, trileptal, lamictal. klonopin used for acute mania.
mec of action mood-stabilizers lithium normalizes reuptake of serotonin, norepi, acetylcholine, dopamine. acts directly on G-protien.
kindling process valporic acid & carbamazepine inhibit it by raising threshold to prevent minor seizures. snowball effect when minor seizure activity seems to build up into more frequent & severe seizures.
dosage lithium (900-3600ng) no pareneral forms available. monitor serum lithium levels & assess pts response to drug.serum level should be 1.0. >0.5 is not therapeutic & <1.5=toxic. monitor every 2-3 days then weekly
dosage carbamazepine & valporic acid 800-1200mg daily, extreme is 200-2000mg/day. 1000-1500mg/day, extreme dosage 750-3000mg/day. serum drug levels taken after 12hrs of last dose monitor therapeutitic levels
side effects lithium mild nausea/diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste, fatigue/lethargy. Weight gain & acne. porpanolol inmproves tremor
toxic lithium s/s severe diahrrea, vomiting, drowsiness, muscle weakness, lack of coordination. if untx can lead to renal failure, coma, & death. Discon. drug ASAP if lith level >3.0, dialysis needed
side effects of carbamazepine & valporic acid drowsiness, sedation, dry mouth, blurred vision. Car(rashes/ortho-hypo) valporic(weight gain, alopecia, hand tremor)
anxiolytic agents txs anxiety dix, insomnia, OCD, dperession, PTSD, alcohol withdrawal.
mec of action anxiolytics benzos mediate actions of GABA
side effects of anxiolytics physical dependance except buspar, CNS depression, clouded sensorium, hangover effect. busporine(dizziness, sedation, nausea, headache)
pt teaching anxiolytics antianxiety agents relieve s/s such as anxiety or insomnia but not the underlying problems that c/o anxiety. Do no drink while on meds
stimulant drugs ADHD in childrens & adolescents & narcolepsy
mec of action stimulants indirectly acting amines release norepi, dop, & serotonin from presynaptic nerve terminlas as opposed to direct agonist effects on postsynaptic receptor.
dosage stimulants 20-200mg/day
side effects of stimulants anorexia, weight loss, nausea, & irritablity. Avoid caffine, sugar, & chocolate.
drug holidays not taking meds on weekends, holidays & summer breaks so growth & weight can increase.
pt teaching stimulants keep out of reach of children. a 10-day Rx can be fatal
Disulfram(antabuse) used as alcohol deterrent b/c causes adverse reaction when taken with alcohol.
side effects of antabuse fatigue, drowsiness, halitosis, tremor, impotence
Created by: 1225581002