12.pharmacology
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Transcript of 12.pharmacology
MENTAL HEALTH
Pharmacology
Classes of drugs used to treat depression: SSRI’s
MAOI’s
Tricyclic (TCA)
(Atypical antidepressants)
SSRI?
Selective Serotonin Reuptake Inhibitors (SSRI) Currently first choice medication for depression
SSRI?
Selective Serotonin Reuptake Inhibitors (SSRI) Works by blocking re-absorption of serotonin by
nerve cells in the brain Leaves more serotonin available in the brain Increases amount of serotonin enhances the
sending of nerve impulses and increases mood Affect only serotonin not other neurotransmitters
What is Serotonin Syndrome? Rare life-threatening side effect of SSRI’s Characterized by dangerously high levels of
serotonin in the brain Can occur when SSRI interacts with
antidepressants called monoamine oxidase inhibitors (MAOI’s)
Can occur when SSRI’s are taken with other medications
What is Serotonin Syndrome? Can occur when SSRI’s are taken with other
medications such as Pain relief medication such as tramadol Migraine medication such as sumatriptan and
rizatriptan Supplements that affect secrotoin levels, such as
St. John’s Wort
Serotonin Syndrome symptoms: Confusion Anxiety Hallucination Extreme agitation Fluctuations in blood pressure Increased heart rate Nausea and vomiting Fever Seizures Flu like symptom Lethargy coma
Common side effects of SSRI
Nausea Sexual dysfunction, including reduced desire or
orgasm difficulties Dry mouth Headache Diarrhea Nervousness Rash Weight gain Insomnia Agitation, restlessness
Nursing interventions and teaching concerns for clients: Advice – effects may not be experienced for
2-4 weeks and may take 8-12 month for full benefit to be achieved
Continue therapy after notice improvement in symptoms
Sudden discontinuation may result in relapse Do not take with MAOI’s
Commonly used SSRI’s
Prozac
Paxil
Zoloft
Celexa
Lexapro
MAOI
Monoamine oxidase inhibitors
How do MAOI’S work
Help balance certain chemicals in the brain to relieve symptoms of anxiety associated with panic disorders
Not recommended for children, teens, nursing or pregnant women
Inhibit enzyme monoamine oxidase in brain increasing norepinephrine and serotonin
MAOI
Clients taking MAOI’s can develop hypertensive crisis if they consume what foods?
MAOI
Clients taking MAOI’s can develop hypertensive crisis if they consume what foods? Some cheeses Broad beans such as
Fava beans Pickled foods like
Sauerkraut Beer Red wine
MAOI
Marplan Parnate Nardil
MAOI
Common side effects of MAOI’s Difficulty getting to sleep Dizziness, lightheadedness, fainting Dry mouth Blurred vision Appetite changes Severe high blood pressure Changes in heart rate and rhythm Muscle twitching and feeling of restlessness Loss of sexual desire or ability Weight gain
What is action of a Tricyclics?
TCABlock reuptake of
norepinephrine and serotonin in brain
Tricyclics
Tricyclic antidepressants should be avoided in patients who have what disorder(s)? MAOI medications recently Drinking problem Schizophrenics or manic depressive Cardiac conditions Bone marrow function disorders Blood cell disorder
Tricyclics
Common side effects of Tricyclics Tremor Unpleasant taste Nausea Dry mouth Fatigue Weakness Anxiety Sensitivity to sunlight Insomnia Sedation Nervousness Excessive sweating
Nursing interventions and teaching concerns for clients: Monitor mental status and affect Assess for suicidal tendencies Monitor blood pressure and pulse rate before
and during therapy Assess for Leukopenia, liver function tests,
serum glucose periodically May take 2-3 months to be therapeutic
TCA’S
Elavil Sinequan Tofranil Nortriptyline
Atypical antidepressants
Wellbutrin Inhibits dopamine uptake Don’t take with MAOI’s
Effexor, Cymbalta Inhibit serotonin and norepinephrine reuptake
Remeron Increase release if serotonin and norepinephrine
Trazodone Blocks serotonin
What are Anti-anxiety Medications?
Used to treat a variety of anxiety disorders Used in treatment of alcohol and drug
withdrawal Sometime referred minor tranquilizers Some are used short term, benzodiazepines,
while others are used long term, like buspar. Benzodiazepines are used to treat anxiety, can be addictive.
Anti anxiety medications
Ativan (lorazepam) BuSpar (buspirone) Inderal (propanolol) Klonopin (clonazepam) Librium (chlordiazepoxide) Serax (oxazepam) Valium (diazepam) Xanax (alprazolam
Anti-anxiety Medications
Common side effects of anti-anxiety agents Dizziness or lightheaded Trouble sleeping Feeling very tired Stomachache Vomiting Rash Diarrhea Constipation
Nursing interventions and teaching concerns for clients: Can cause drowsiness Can cause tiredness Can cause loss of coordination Do not drink alcohol Caution when operating machinery May have withdrawal symptoms
Antipsychotic Agents
Commonly used to treat:
Positive symptoms Agitation Delusion Hallicinations
Negative symptoms Social withdrawal Lack of emotion Lack of energy
GOAL suppress acute episode Prevent acute recurrence Maintain highest level of functioning
Side effects
Many go away after a few weeks of treatment Drowsiness, tachycardia, dizziness
Decrease in sexual ability or interest Restlessness muscle spasms Shuffling walk Slowed movement and speech Parkinson like symptom
Common side effects defined:
Anticholinergic Dry mouth, visual disturbances, acute urinary retention,
constipation and tachycardia.
Extrapyramydal Acute dystonia, severe spasms of tongue and jaw spreading to
face, neck, and back
Parkinson’s effects rigidity, shuffling gait, drooling, tremors
Dystonia Inability to stand still or sit, pacing
What is Neuroleptic Malignant Syndrome? Uncommon effect that is potentially fatal
when it occurs
Symptoms of Neuroleptic Malignant Syndrome? High grade fever Blood pressure fluctuation Dysrhythmias Muscle rigidity Change in level of consciousness developing
into coma – confusion
Nursing interventions for Neuroleptic malignant syndrome Stop the med Monitor VS Applying cooling blanket Antipyretics Increase fluid intake Benzodiazepines for anxiety
Client teaching topics for clients taking antipyschotics Therapeutic effect may be noticed in a few
days but significant improvement may take 2 to 4 weeks and several months for full effect
Conventional Thorazine Haldol
Atypical Seroquel Abilify Zyprexa (Olanzepine) and Resperidol (Resperdone)
What is Tardive Dyskinesia?
Tardive Dyskinesia:
Muscular side effects of anti-psychotic drugs, especially the older generation like haloperidol.
Does not occur until after many months or years of taking anti-psychotic drugs.
Primarily characterized by random movements in the tongue, lips or jaw as well as of the trunk or hips.
Tardive Dyskinesia:
Prevention is achieved by using the lowest effective dose for the shortest time.
Question:
Benadryl, Cogentin and Artane are three drugs used in mental health to treat what disorder? _______________________
Tardive Dyskinesia
Anti Manic
What is an antimanic medication
Also know as mood stabilizers and anticonsulvants
Used to stabilize mood and behavior with bipolar disorders
List common antimanics
Lithium Dapakene Depakote
Lithium level
Therapeutic 0.6 to 1.2mEq/L Toxicity greater than 1.4mEq/L Life threatening emergency greater than
2mEq/L
What are signs of lithium toxicity Level greater than 1.4 mEq/L Shakiness Thirst Frequent urination Diarrhea Vomiting Drowsiness Muscle weakness Coordination problems Giddiness Blurred vision Tinnitus Seizure Slurred speech Decrease LOC Possible death
Treatment for lithium toxicity
Stopping lithium IV fluids Pumping stomach dialysis
Preventing lithium toxicity
Follow dosing instruction carefully Drink plenty of fluid Do not change or restrict salt intake Check lithium level regularly