Chapter 15 - Nsg. 118
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| The treatment of emotional and mental disorders. | Psychotherapeutics
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| What are the three main emotional & mental disorders. | Psychosis, Affective Disorders, Anxiety
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| 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
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| 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
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| 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
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| 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
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| Benzodiazepine Anxiolytics | diazepam (Valium)
lorazepam (Ativan)
alprazolam (Xanax)
clonazepam (Klonopin)
chlordiazepoxide (Librium)
mdazolam (Versed)
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| Benzodiazepine: Adverse Effects | 1. decreased CNS activity
2. Hypotension
3. Drowsiness
4. N/V or consitpation
5. Loss of coordination
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| Benzodiazepines: Contraindications | 1. other sedatives
2. alcohol
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| Drug used to reverse benzodiazepine effects: | flumazenil
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| Antimanic Drugs | Lithium
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| Drug of choice for mania that has potentiate serotonergic neurotransmission and a narrow therapeutic range (0.6-1.2 mEq/L) | Lithium
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| 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)
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| Three categories of Antidepressants | 1. Newer-Generation (SSRIs & 2nd / 3rd Generation)
2. Tricyclic
3. MAOIs
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| Newer-Generation Antidepressants - 2nd Generation | trazodone (Desyrel)
burpropion (Wellbutrin)
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| Newer-Generation Antidepressants - SSRIs | fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
fluvoxamine (Luvox)
citalopram (Celexa)
escitalopram (Lexapro)
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| 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
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| Adverse Effects of Newer Generation Antidepressants | HA, Dizziness, Tremors, nervousness, insomnia, FATIGUE, nausea, diarrhea, constipation, dry mouth, sexual dysfunction, WEIGHT GAIN, weight loss, sweating
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| Interactions for Newer-Generation Antidepressants | highly bound to plasma proteins, inhibition of cytochrome P-450, MAOIs
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| Tricyclics | amitriptyline (Elavil, Endep); doxepin (Sinequan); imipramine (Tofranil); desipramine (Norpramin); nortriptyline (Aventyl, Pamelor)
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| Method of Action : Tricyclics | Blocks norepinephrine uptake (tremors, tachycardia); & Blocks serotonin reuptake (Nausea, HA, anxiety, sexual dysfunction
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| Indications : Tricyclics | Drepression; Childhood enuresis Tx: imipramine (Tofranil); Obsessive-compulsive disorders Tx: clomipramine ; Adjunctive for chronic pain (neuralgia)
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| Adverse Effects : Tricyclics | Sedation; Impotence; Orthostatic Hypotension; edema,muscle tremors,delayed micturation in elder
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| Tricyclics : Overdose | usually LETHAL (affects CNS (sz) & Cardio(dysrhythmias) - NO ANTIDOTE (use charcoal, BLS, Manage Sz & Dysrhythmias
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| MAOIs | phenelzine (Nardil) & tranycypromine (Parnate)
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| Method of Action : MAOIs | Inhibits MAO enzyme in CNS; Does not breakdown Amines (dopamine, serotonin, norepinephrine) = alleviation of depression symptoms
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| Indictions : MAOIs | Depression (increased sleep & appetite) and for depression not responding to tricyclics
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| Adverse Effects : MAOIs | Fewer - Orthostatic Hypotension most common
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| 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)
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| 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)
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| Concurrent use of MAOIs and SSRIs may lead to | Serotonin Syndrom "wash-out" between switch
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| Drugs used to treat seroius mental illness, behavioral problems or psychotic disorders | Antipsychotics
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| Antipsychotics | Thioxanthenes: thiothixene (Navane)
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| Antipsychotics | Butyrophennes: haloperidol (Haldol)
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| Antipsychotics | Dihydroindolones: molindone (Moban)
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| Antipsychotics | Dibenzoxazepine: loxapine (Loxitane)
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| Antipsychotics | Phenothiazines: three structural groups
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| Antipsychotics | Atypical antipsychotics: New Class
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| Method of Action : Antipsychotics | Blocks dopamine receptors giving a tranquilizing effect
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| Atypical Antipsychotics | clozapine (Clozaril); risperidone (Risperdal); olanzapine (Zyprexa); quetiapine (Seroquel); ziprasidone (Geodon); aripiprazole (Abilify)
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| Atypical Antipsychotics : Method of Action | Blocks dopamine receptors (D2) and blocks specific serotonin receptors (5HT2)
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| Atypical Antipsychotics : Interactions | Bipolar, Depressive/Drug Induced psychosis, Schizophrenia, Autism, Tourette's, Nausea, Intractable hiccups
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| 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)
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| Other Adverse Effects of Antipsychotics | Neuroleptic malignant syndrom (NMS), Extrapyramidal symptoms (EPS) - Tx with benztropine (cogentin) & trihexyphenidyl (Artane); Tardive dyskinesia (TD)
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| 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
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| Nurisng Implications Continued - Psychotherapeutics | Coping skills, No alcohol or other CNS depressants
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| Antianxiety - Nurisng Implications | elderly monitor for oversedation
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| 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
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| 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)
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| Therapeutic Effects - Psychotherapeutics | Mental alertness, cognition, affect, mood, ability of ADLs, appetite, sleep patterns, potential for injury
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| 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
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| 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
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| Therapeutic Effects for antipsychotics are | improved mood & affect, alleviation of psychotic symptoms and episodes, decrease in hallucintaions, paranoia, delusions, garbled speech, ability to cope
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| Theraputic Effecst for Lithium | Less mania and levels of 0.6-1.2 mEq/L
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