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Psycotherapeutics
Chapter 15 - Nsg. 118
| Question | Answer |
|---|---|
| The treatment of emotional and mental disorders. | Psychotherapeutics |
| What are the three main emotional & mental disorders. | Psychosis, Affective Disorders, Anxiety |
| A severe emotional disorder that impairs the mental function of the affected individual to the point that individual can't particpate in activities of daily living. | Psychosis EX: Schizophrenia Depression & Drug-Induced Psychosis |
| What are the six major anxiety disorders. | 1. Obsessivecompulsive disorder (OCD) 2. Posttraumatic stress disorder (PTSD) 3. Generalized anxiety disorder (GAD) 4. Panic Disorder 5. Social Phobia 6. Simple Phobia |
| Neurotransmitters that play an important role in maintaining mental health are: | Catecholamines (Dopamine & norepinephrine) & Indolamines (Serotonin & Histamine) also biochemicals such as GABA, ACh, Sodium, Potassium, and Magnessium play apart as well |
| Antianxiety Drugs | 1. Benzodiazepines (drepress activity in the brainstem) 2. Antihistamines (depress CNS by sedation and primarily used in allergic conditions) 3. Misc. Drugs: buspirone(BuSpar) - which is non-sedating & non-habit forming |
| Benzodiazepine Anxiolytics | diazepam (Valium) lorazepam (Ativan) alprazolam (Xanax) clonazepam (Klonopin) chlordiazepoxide (Librium) mdazolam (Versed) |
| Benzodiazepine: Adverse Effects | 1. decreased CNS activity 2. Hypotension 3. Drowsiness 4. N/V or consitpation 5. Loss of coordination |
| Benzodiazepines: Contraindications | 1. other sedatives 2. alcohol |
| Drug used to reverse benzodiazepine effects: | flumazenil |
| Antimanic Drugs | Lithium |
| Drug of choice for mania that has potentiate serotonergic neurotransmission and a narrow therapeutic range (0.6-1.2 mEq/L) | Lithium |
| Etiology of Depression: | 1. Biogenic amine hypothesis(alteration of neuronal & synaptic catecholamine concentration) 2. Permissive hypothesis (decreased concentrations of serotonin) 3. Dysregulation hypothesis (failure in regulation of catecholamine activity) |
| Three categories of Antidepressants | 1. Newer-Generation (SSRIs & 2nd / 3rd Generation) 2. Tricyclic 3. MAOIs |
| Newer-Generation Antidepressants - 2nd Generation | trazodone (Desyrel) burpropion (Wellbutrin) |
| Newer-Generation Antidepressants - SSRIs | fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) fluvoxamine (Luvox) citalopram (Celexa) escitalopram (Lexapro) |
| Indications for Newer-Generation Antidepressants: | depression Bipolar disorder Obesity & Eating Disorders Obsessive-Compulsive Disorder Panic Attacks or Disorders Social Anxiety Disorders Posttraumatic Stress Disorders (PTSD) Myoclonus Tx of various substance abuse problems |
| Adverse Effects of Newer Generation Antidepressants | HA, Dizziness, Tremors, nervousness, insomnia, FATIGUE, nausea, diarrhea, constipation, dry mouth, sexual dysfunction, WEIGHT GAIN, weight loss, sweating |
| Interactions for Newer-Generation Antidepressants | highly bound to plasma proteins, inhibition of cytochrome P-450, MAOIs |
| Tricyclics | amitriptyline (Elavil, Endep); doxepin (Sinequan); imipramine (Tofranil); desipramine (Norpramin); nortriptyline (Aventyl, Pamelor) |
| Method of Action : Tricyclics | Blocks norepinephrine uptake (tremors, tachycardia); & Blocks serotonin reuptake (Nausea, HA, anxiety, sexual dysfunction |
| Indications : Tricyclics | Drepression; Childhood enuresis Tx: imipramine (Tofranil); Obsessive-compulsive disorders Tx: clomipramine ; Adjunctive for chronic pain (neuralgia) |
| Adverse Effects : Tricyclics | Sedation; Impotence; Orthostatic Hypotension; edema,muscle tremors,delayed micturation in elder |
| Tricyclics : Overdose | usually LETHAL (affects CNS (sz) & Cardio(dysrhythmias) - NO ANTIDOTE (use charcoal, BLS, Manage Sz & Dysrhythmias |
| MAOIs | phenelzine (Nardil) & tranycypromine (Parnate) |
| Method of Action : MAOIs | Inhibits MAO enzyme in CNS; Does not breakdown Amines (dopamine, serotonin, norepinephrine) = alleviation of depression symptoms |
| Indictions : MAOIs | Depression (increased sleep & appetite) and for depression not responding to tricyclics |
| Adverse Effects : MAOIs | Fewer - Orthostatic Hypotension most common |
| Overdose : MAOIs | symptoms appear 12 hours after ingestion and then include (tacycardia, circulatory collapse, sz, coma) Tx: to protect brain & heart and eliminate toxin (gastric lavage, urine acidificaiton, hemodialysis) |
| Interactions : MAOIs | Foods/Drinks with amino acid tyramine leads to hypertensive crisis which can lead to cerebral hemorrhage, stroke, coma, or death ~This includes: aged cheese, smoked/pickled meats, fish, poultry, yeast extracts, red wines, italian broad beans(fava beans) |
| Concurrent use of MAOIs and SSRIs may lead to | Serotonin Syndrom "wash-out" between switch |
| Drugs used to treat seroius mental illness, behavioral problems or psychotic disorders | Antipsychotics |
| Antipsychotics | Thioxanthenes: thiothixene (Navane) |
| Antipsychotics | Butyrophennes: haloperidol (Haldol) |
| Antipsychotics | Dihydroindolones: molindone (Moban) |
| Antipsychotics | Dibenzoxazepine: loxapine (Loxitane) |
| Antipsychotics | Phenothiazines: three structural groups |
| Antipsychotics | Atypical antipsychotics: New Class |
| Method of Action : Antipsychotics | Blocks dopamine receptors giving a tranquilizing effect |
| Atypical Antipsychotics | clozapine (Clozaril); risperidone (Risperdal); olanzapine (Zyprexa); quetiapine (Seroquel); ziprasidone (Geodon); aripiprazole (Abilify) |
| Atypical Antipsychotics : Method of Action | Blocks dopamine receptors (D2) and blocks specific serotonin receptors (5HT2) |
| Atypical Antipsychotics : Interactions | Bipolar, Depressive/Drug Induced psychosis, Schizophrenia, Autism, Tourette's, Nausea, Intractable hiccups |
| Adverse Effects : Antipsychotics | CNS Sedation, delirium, Orhtostatic hyptension, syncope, dermatologic, photosensitivity, rash, dry mouth, urinary hesitancy, impaired erection, leukopenia, Galactorrhea (milk from nipples), irregular menses, polydipsia (thirst) |
| Other Adverse Effects of Antipsychotics | Neuroleptic malignant syndrom (NMS), Extrapyramidal symptoms (EPS) - Tx with benztropine (cogentin) & trihexyphenidyl (Artane); Tardive dyskinesia (TD) |
| Nursing Implications for Psychotherapeutics | Assess Physical & Emotional status, baseline VS, LFT, Renal Test, Contraindications & Interactions, LOC, Mental Alertness, Potentional for injury to self/others, check mouth to be sure they can swallow, simple explanations, DONT abrupt withdrawal |
| Nurisng Implications Continued - Psychotherapeutics | Coping skills, No alcohol or other CNS depressants |
| Antianxiety - Nurisng Implications | elderly monitor for oversedation |
| Antidepressants - Nursing Implicaitons | May take several weeks to see therapeutic effects, monitor for suicide & provide support, assist elderly with ambulation, Tricyclics need weened before surgery, monitor for effects, encourage pt to wear ID, avoid caffeine & cigarettes & tyramine foods |
| Phenothiazines - Nursing Implications | wear sunscreen, avoid antacids within 1 hour, no alcohol, long-term haloperidol may result in tremors,N/V, take orals with meds to prevent GI upset, fall precautions (orthstatics) |
| Therapeutic Effects - Psychotherapeutics | Mental alertness, cognition, affect, mood, ability of ADLs, appetite, sleep patterns, potential for injury |
| Therapeutic Effects for Anxiolytics are | improved mental alertness, cognition, and mood; fewer anxiety & panic attacks; improved sleep patterns & appetite, less tension and irritability; fewer feelings of fear & doom, more interest in others |
| Therapeutic Effects for Antidepressants are | improved sleep patterns & nutrition, increased feelings of self-esteem, decreased feeling of hopelessness, increased interest in self and appearance, increased interest in ADLs, fewer depressive manifestations or suicidal thoughts |
| Therapeutic Effects for antipsychotics are | improved mood & affect, alleviation of psychotic symptoms and episodes, decrease in hallucintaions, paranoia, delusions, garbled speech, ability to cope |
| Theraputic Effecst for Lithium | Less mania and levels of 0.6-1.2 mEq/L |
Created by:
LILES
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