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PSYCHOTROPIC MEDICATIONS Connie K. Cupples, MS, MSN, RN Union University

PSYCHOTROPIC MEDICATIONS Connie K. Cupples, MS, MSN, RN Union University. Classifications. Antipsychotics (neuroleptics) Anxiolytics (antianxiety meds) Side Effect Meds (anticholinergic/antiparkinsonism drugs) Antidepressants Mood Stabilizers. Psychosis.

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PSYCHOTROPIC MEDICATIONS Connie K. Cupples, MS, MSN, RN Union University

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  1. PSYCHOTROPIC MEDICATIONSConnie K. Cupples, MS, MSN, RNUnion University

  2. Classifications • Antipsychotics (neuroleptics) • Anxiolytics (antianxiety meds) • Side Effect Meds (anticholinergic/antiparkinsonism drugs) • Antidepressants • Mood Stabilizers

  3. Psychosis • Symptoms – delusions, hallucinations, difficulty processing information, incoherence • Schizophrenia – chronic psychotic disorder which has both positive and negative symptoms

  4. Positive Symptoms • Characterized by exaggeration of normal function • Examples – delusions, hallucinations, paranoia, agitation

  5. Negative Symptoms • Characterized by decrease or lessening of function and motivation • Examples – Poverty of speech content, poor self care, social withdrawal, flat affect, avolition,

  6. Categories of Antipsychotic Meds • Traditional (phenothiazines & nonphenothiazines) • Atypical

  7. Mechanism of Action • Block actions of dopamine • Five subtypes of dopamine receptors – D1 to D5 • All block D2 (dopaminergic) receptor – promotes ERS resulting in pseudoparkinsonism • Atypicals have weak affinity to D2 receptors – cause fewer EPS

  8. Adverse Reactions to Antipsychotics • Extrapyramidal Side Effects (EPS) • Anticholinergic Effects • Cardiovascular Effects • Rare & Toxic Effects (Neuroleptic Malignant Syndrome – NMS)

  9. Extrapyramidal Side EffectsEPS • Pseudoparkinsonism • Acute Dystonic Reactions • Akathisia • Tardive Dyskinesia

  10. Pseudoparkinsonism • Rigidity, masklike facies, stooped posture, drooling, shuffling gait, “pill-rolling”, tremor • Treat with trihexyphenidyl (Artane) or benztropine (Cogentin)

  11. Acute Dystonic Reactions • Opisthotonos • Oculogyric Crisis • Torticollis • Treat with diphenhydramine hydrochloride (Benedryl) 25-50 mg IM/IV (Cogentin 1-2 mg IM/IV may be second choice)

  12. Akathisia • Motor innerdriven restlessness • May be treated with propanolol (Inderal) or benzodiazapenes

  13. Tardive Dyskinesia • Facial – protruding tongue, smacking, licking, spastic facial distortion, smacking movements • Limbs – choreic, athetoid • Trunk – pelvic thrusts, neck & shoulder movements

  14. Anticholinergic Side Effects • Dry Mouth • Urinary Retention • Constipation • Blurred vision • Photosensitivity • Dry Eyes • Impotence

  15. Cardiovascular Effects • Hypotension and postural hypotension • Tachycardia

  16. Rare and Toxic Effects • Agranulocytosis • Jaundice • Neuroleptic Malignant Syndrome – hyperpyrexia, severe muscle rigidity, elevated BP, tachycardia, diaphoresis, incontinence

  17. Prototypes • Fluphenazine (Prolixin) p. 379 • Haloperidol (Haldol) p. 380 • Haloperidol Decanoate

  18. Phenothiazines & Nonphenothiazines • Refer to p. 382 - 383 • Low to High Potency

  19. Nursing Process with Antipsychotic Medications • Assessment • Planning • Nursing Interventions – Discuss with different routes for meds • Patient Teaching • Evaluation

  20. Anxioloytics • Benzodiazepines • Buspirone (Buspar) • Used to treat primary anxiety and secondary anxiety • Nonpharmacologic measures to treat anxiety

  21. Mechanism of Action • Enhance action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter within the CNS

  22. Side Effects of Anxiolytics • Sedation • Dizziness • Headache • Dry Mouth • Blurred Vision • Constipation

  23. Adverse Reactions • Leukopenia (decreased WBCs) • Fever, Malaise, Sore throat • Tolerance • Physical dependence (SHOULD NOT BE ABRUPTLY DISCONTINUED) – MAY SHOW WITHDRAWAL SYMPTOMS

  24. List of Anxiolytics • See page 387 • Prototype – Lorazepam – Ativan – pg. 388.

  25. Nursing Process with Anxiolytics • Assessment • Planning • Interventions – Discuss difference in nursing interventions and teaching with Buspar • Teaching • Evaluation

  26. Antidepressants • Used to treat three types of depression – reactive, major, bipolar affective disorder • Depressive episodes are accompanied by anhedonia, depressed mood, hopelessness, helplessness, along with other signs and symptoms

  27. Four Groups of Antidepressants • Tricyclics (TCAs) • Selective Serotonin Reuptake Inhibitors (SSRIs) • Atypicals • Monoamine Oxidase Inhibitors (MAOIs)

  28. Prototype • See page 392 – Amitriptyline (Elavil) • Action – Block the uptake of norepinephrine and serotonin in the brain • Clinical response occurs 2-4 weeks

  29. Side Effects of TCAs • Orthostatic hypotension • Sedation • Anticholinergic side effects • Cardiotoxity • Seizures • Blood dyscrasias • Sexual dysfunction

  30. Selective Serotonin Reuptake Inhibitors • Action – block reuptake of serotonin into the nerve terminal of CNS enhancing its transmission at the serotonergic synapse • Prototype – page 394 – fluoxetine (Prozac) • List of meds – page 393

  31. Side Effects of SSRIs • Fewer than with TCAs • Dry mouth, blurred vision, insomnia, headache, nervousness, anorexia, nausea, diarrhea, suicidal ideation

  32. Atypical Antidepressants • Second generation • Action – affect either serotonin, norepinephrine and dopamine • See page 394 for examples • See page 395 for side effects

  33. Monoamine Oxidase Inhititors (MAOIs) • Action – Inhibits monoamine oxidase so that the levels of norepinephrine, dopamine, epinephrine, & serotonin rise thus relieving symptoms of depression • Tranylcypromine sulfate (Parnate), isocarboxazid (Marplan), phenelzine sulfate (Nardil)

  34. Drug & Food Interactions • Can be fatal • Avoid foods containing tyramine – cheese, cream, coffee, chocolate, cured meats, bananas, raisins, red wines, beer, yeast (see page 395 for complete list). • Avoid meds containing phenylephrine and pseudoephedrine

  35. Nursing Process with Antidepressants • Assessment • Nursing Diagnoses • Planning • Nursing Interventions (include teaching) • Evaluation

  36. Mood Stabilizer: Lithium • Action – alters sodium, potassium ion transport across cell membrane in nerve cells: may balance biogenic amines of norepinephrine • Alternate meds – carbamazepine (Tegratol), valproic acid (Depakote), lamotrigine (Lamictal)

  37. Side Effects of Lithium • Dry mouth • Thirst • Nausea • Polyuria • Weight gain • Fine hand tremor

  38. Early Signs of Toxicity • Nausea • Vomiting • Diarrhea • Thirst • Polyuria • Slurred speech • Muscle weakness Varcarolis, E.M. (2006) p. 372

  39. Advanced Signs of Toxicity • Coarse hand tremor • Persistant GI disturbances • Mental confusion • Muscle hyperirritability • ECG changes • Incoordination Varcarolis, p. 372

  40. Severe Toxicity • Ataxia • Clonic movements • Large amounts of dilute urine • Severe hypotension • Coma • Cardiac dysrhymias • Death

  41. Nursing Process with Lithium • Assessment • Nursing Diagnoses • Planning • Nursing Interventions – watch lithium level – PATIENT TEACHING – Dietary considerations • Evaluation

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