The use of medications to treat mental illness
- effect what?
psychopharmacology
-cns
-CNS is composed of:
-The nerves control what kind acts?
The CNS is composed of the brain, the spinal cord, and associated nerves that control voluntary acts.
brain consists of:
brain consists of the cerebrum, cerebellum, brain stem, and limbic system.
creative thinking,
intuition
, and artistic abilities is what part of brain?
Right
The cerebral hemispheres are divided into which lobes?
The cerebral hemispheres are divided into four lobes: frontal, parietal, temporal, and occipital.
The frontal lobes control:
Abnormalities in the frontal lobes are associated with:
The frontal lobes control the organization of thought, body movement, memories, emotions, and moral behavior.
Abnormalities in the frontal lobes are associated with
schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia.
cerebellum is located below the cerebrum and is the center for:
Research has shown that inhibited transmission of _____, a neurotransmitter, in this area is associated with the lack of smooth coordinated movements in diseases such as
Parkinson's disease a
Cerebellum
The cerebellum is located below the cerebrum and is the center for coordination of
movements and postural adjustments.
It receives and integrates information from all areas of the body, such as the muscles, joints, organs, and other components
brain stem includes:
extrapyramidal system relays information about?
The brain stem includes the midbrain, pons, and medulla oblongata and the nuclei for cranial nerves III through XII.
extrapyramidal system relays information about movement and coordination from the brain to the spinal nerves.
limbic system is an area of the brain located above the brain stem that includes:
limbic system is an area of the brain located above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala (although some sources differ regarding the structures this system includes). The thalamus regulates activity, sensation
neurotransmission:
Neurotransmitters are the chemical substances manufactured in the neuron that aid in the transmission of information throughout the body. They either:
These neurons communicate information with one another by sending electrochemical messages from neuron to neuron, a process called neurotransmission. These electrochemical messages pass from the dendrites (projections from the cell body), through the soma
Dopamine:
Location, e or I, controls, implicated?
Excitatory
-primarily in the
brain stem
-Controls complex movements, motivation, cognition; regulates emotional response
-Dopamine is implicated in
schizophrenia and other psychoses as well as in movement disorders such as Parkinson's disease.
-levodopa
What is the most prevalent neurotransmitter?
Norepinephrine
Norepinephrine:
Ex
Norepinephrine, the most prevalent neurotransmitter in the nervous system, is located primarily in the brain stem and plays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation
Norepinephrine and its derivativ
Serotonin
Serotonin, a neurotransmitter found only in the brain, is derived from tryptophan, a dietary amino acid
function of serotonin is mostly inhibitory, and it is involved in the control of food intake, sleep and wakefulness, temperature regulation, pain contr
Acetylcholine
People with what has decreased?
Acetylcholine is a neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of skeletal muscle. It can be excitatory or inhibitory
Studies have shown that people with
Alzheimer's
disease h
Gamma-Aminobutyric Acid
Meds: GABA penten, nerotin
Mood stabilizer, nerve pain,
anticonvulsant
neurotransmitter in the brain and has been found to
modulate
other neurotransmitter systems rather than to provide a direct stimulus (Healy, 2009). Drugs that increase GABA function, s
major inhibitory neurotransmitter in the brain?
Gamma-Aminobutyric Acid
Psychoimmunology
Researchers are following many avenues to discover possible causes of mental illness. Psychoimmunology, a relatively new field of study, examines the effect of psychosocial stressors on the body's immune system.
The following sections discuss several categories of drugs used to treat mental disorders (psychotropic drugs):
The following sections discuss several categories of drugs used to treat mental disorders (psychotropic drugs): antipsychotics, antidepressants, mood stabilizers, anxiolytics, and stimulants.
Half-life
Half-life is the time it takes for half of the drug to be removed from the bloodstream. Drugs with a shorter half-life may need to be given three or four times a day, but drugs with a longer half-life may be given once a day
off-label use
At times, a drug will prove effective for a disease that differs from the one involved in original testing and FDA approval. This is called off-label use. An example is some anticonvulsant drugs (approved to prevent seizures) that are prescribed for their
Epinephrine
Ex
Epinephrine has limited distribution in the brain but controls the
fight or flight response
in the peripheral nervous system.
Efficacy
Potency
Efficacy refers to the maximal therapeutic effect that a drug can achieve. Potency describes the amount of the drug needed to achieve that maximum effect; low-potency drugs require higher dosages to achieve efficacy, whereas high-potency drugs achieve eff
black box warning
When a drug is found to have serious or life-threatening side effects, even if such side effects are rare, the FDA may issue a black box warning.
Principles That guide Pharmacologic Treatment
-how to figure out what med?
-tapering
Page 26
- trial and error based on
symptoms
!!!!
-Psychotropic medications often are decreased gradually (tapering) rather than abruptly. This is because of potential problems with rebound (temporary return of symptoms), recurrence of the original symptom
Haloperidol (Haldol) shot last how long?
Up to 4 weeks.
Antipsychotic drugs:
Antipsychotic drugs work by blocking ____
-Antipsychotic drugs, formerly known as neuroleptics, are used to treat the symptoms of psychosis, such as the delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder
Off-label uses of antipsyc
Con. Antipsy
-The major action of all antipsychotics in the nervous system is?
-which may account for the lower incidence of extrapyramidal side effects. Name examp
The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopa-mine; however, the therapeutic mechanism of action is only partially understood.
Effective in treating target symptoms but also produces many
Ziprasidone (Geodon)
Used for Dementia
Quetiapine (Seroquel)
Mood stabilizing drug
Aripiprazole (Abilify)
Bipolar and antipsy
Which come in depo?
Haldol (4Weeks)
Extrapyramidal symptoms (EPSs):
-serious neurologic symptoms, are the major side effects of antipsychotic drugs.
-They include acute
dystonia, pseudoparkinsonism, and akathisia.
Which causes least eps?
ziprasidone (Geodon) rarely causing EPS (
Therapies for acute dystonia, pseudoparkinsonism, and akathisia are similar and include:
-
lowering the dosage of the antipsychotic
, changing to a different antipsychotic, or administering
anticholinergic medication
(discussion to follow).
Ex:
-Benztropine (Cogentin)
-Diphenhydramine (Benadryl)
-Diazepam (Valium)
Acute dystonia:
-includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
Spasms or stiffness in muscle groups can produce -torticollis: -opisthotonus: -oculogyric crisis:
(needs to be treated immediate!) with?
-(twisted head and neck)
-(tightness in the entire body with the head back and an arched neck)
-(eyes rolled back in a locked position)
-anticholinergic drugs. (Cogentin) or (Benadryl)--antihistamine-- for oculogyric crisis
Immediate treatment with anticholinergic drugs such as:
-such as intramuscular benztropine mesylate (Cogentin) or intramuscular or intravenous diphenhydramine (Benadryl), usually brings rapid relief.
Drug-induced parkinsonism, or pseudoparkinsonism
-, is often referred to by the generic label of EPS.
-Symptoms resemble those of Parkinson's disease and include a
stiff, stooped posture; mask-like facies; decreased arm swing; a shuffling, festinating gait (with small steps); cogwheel rigidity (ratchet-
Akathisia:
-is reported by the client as an intense need to move about.
- The client appears restless or anxious and agitated, often with a rigid posture or gait and a lack of spontaneous gestures.
- Akathisia can be treated by a change in antipsychotic medication o
-Neuroleptic malignant syndrome (NMS)
-What increases risk?
-Treatment?
-
is a potentially fatal
idiosyncratic reaction to an antipsychotic (or neuroleptic) drug.
-The major symptoms of NMS are rigidity;
high fever; autonomic instability such as unstable blood pressure, diaphoresis, and pallor; delirium; and elevated levels o
-Tardive dyskinesia
-Tardive dyskinesia (TD), a syndrome of permanent involuntary movements, is most commonly
caused by the long-term use of conventional antipsychotic
drugs.
-The pathophysiology is still unclear, and
no effective treatment has been approved for general use.
Tardive dyskinesia whats important to know?
Its permanent!!!
--Anticholinergic side effects:
-Anticholinergic side effects often occur with the use of antipsychotics and include:
-
orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory.
E
Which antipsy is particularly fatal? Has a side effect of agranulocytosis?
-
Clozapine
produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis.
-This develops suddenly and is characterized by
fever, malaise, ulcerative sore throat, and leukopenia.
Other effects of antipsy:
-menstrual irregularities; and increased risk for breast cancer, and may contribute to
weight gain.
- most likely with the second-generation antipsychotic drugs
Client Teaching for antipsy side effects:
- Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth.
- Methods to prevent
-If the client forgets a dose of antipsychotic medication, he or she can:
-If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.
Which of the following drugs would be classified as a conventional antipsychotic?
-Fluphenazine is classified as a conventional antipsychotic.
Clozapine and risperidone are considered atypical antipsychotics. Aripiprazole is considered a new generation antipsychotic.
Antidepressants:
-Four groups (Table 2.5):
-Tricyclic and related cycle antidepressants (TCAs)
-Selective serotonin reuptake inhibitors (SSRIs)
-MAO inhibitors (MAOIs)
-Others (venlafaxine, bupriopion, duloxetine, trazodone, nefazodone)
Antidepressants
-Use: major depressive illness, anxiety disorders, depressed phase of bipolar disorder, psychotic depression. Off-label uses of antidepressants include the treatment of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, d
-SSRIs
-SSRIs
Anxiety, agitation, akathisia, nausea, insomnia, sexual dysfunction
Weight gain
Ex: Prozac(first), paxil, zoloft,celexa, lexapro
Proscribed more bc generally safer.
TCAs/Cyclic
TCAs
Anticholinergic effects
Orthostatic hypotension, sedation, weight gain, tachycardia
Sexual dysfunction
Ex: elavil ,remeron,
MAOIs
MAOIs
Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction
Hypertensive crisis (with foods containing tyramine)
Ex:Nardil, Parnate, Marplan
Other:
-Other agents
Sedation; headache (nefazodone, trazodone)
Loss of appetite, nausea, agitation, insomnia (bupropion, venlafaxine)
Priaprism (trazodone)
Wellbutrin, cymbalta, effexor
Which came first?
What can they cause?
-Cyclic
-first choice of drugs to treat depression even though they cause varying degrees of sedation, orthostatic hypotension (drop in blood pressure on rising), and anticholinergic side effects.
- In addition, cyclic antidepressants are potentially
leth
-Serotonin syndrome:
-Serotonin syndrome
MAOI + SSRI
Agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia
Coma, death (extreme reactions)
-Time of dosage
SSRI first thing in morning
TCAs at night
-Actions for missed dose
SSRI up to 8 hours after misse
You cannot take MAOI with:
-MAOIs cannot be given in combination with other MAOIs, tricyclic antidepressants, meperidine (Demerol), CNS depressants, many antihypertensives, or general anesthetics
-MAOIs were discovered to have a positive effect on people with depression. Although the MAOIs have a low incidence of sedation and anticholinergic effects, they must be used with extreme caution for several reasons:
- A life-threatening side effect, hypertensive crisis, may occur if the client ingests foods
containing tyramine (an amino acid) while taking MAOIs.
-Because of the risk for potentially fatal drug interactions,
MAOIs cannot be given in combination with ot
SSRI
Suicide:
Used to treat what degree of depression?
-The SSRIs, first available in 1987 with the release of fluoxetine (Prozac), have replaced the cyclic drugs as the first choice in treating depression because they are equal in efficacy and produce fewer troublesome side effects.
-SSRIs, venlafaxine, nefa
-SSRIs have fewer side effects compared with the cyclic compounds. Enhanced serotonin transmission can lead to several common side effects:
-SSRIs have fewer side effects compared with the cyclic compounds. Enhanced serotonin transmission can lead to several common side effects such as anxiety, agitation, akathisia (motor restlessness), nausea, insomnia, and sexual dysfunction, specifically d
-Cyclic side effects:
-Cyclic compounds have more side effects than do SSRIs and the newer miscellaneous compounds. The individual medications in this category vary in terms of the intensity of side effects, but generally, side effects fall into the same categories. The cyclic
-Side Effects of Monoamine Oxidase Inhibitors:
-Tyramine foods to avoid:
-What can happen if they eat these?
-The most common side effects of MAOIs include daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, and sexual dysfunction.
- Of particular concern with MAOIs is the potential for a life-threatening hypertensive crisis if the clien
-novel antidepressant medications,
-novel antidepressant medications, nefazodone, trazodone, and mirtazapine commonly cause sedation.
-Sexual dysfunction is much less common with the novel antidepressants, with one notable exception: Trazodone can cause priapism (a sustained and painful er
Which drug can cause priapism?
-Trazodone
-Evaluation of the risk for suicide must continue even after treatment with antidepressants is initiated. Why?
-Evaluation of the risk for suicide must continue even after treatment with antidepressants is initiated. The client may feel more energized but still have suicidal thoughts, which increases the likelihood of a suicide attempt. Also, because it often take
-The precise mechanism by which antidepressants produce their therapeutic effects is:
-The precise mechanism by which antidepressants produce their therapeutic effects is not known, but much is known about their action on the CNS. The major interaction is with the monoamine neurotransmitter systems in the brain
- The SSRIs block the reupta
Whats important to remember about Bupropion?
Can cause seizures at a rate four times that of other antidepressants.
Mood-Stabilizing Drugs
-Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania.
-Lithium is the most established mood stabili
Mood-Stabilizing Drugs (cont'd)
Mechanism of action:
-Normalize reuptake of certain neurotransmitters (lithium)
-Increase levels of GABA (valproic acid, topiramate)
-Kindling process (valproic acid, carbamazepine)
-Exc: Lithium normalizes the reuptake of certain neurotransmitters such a
Which drug is the first line of defense against bipolar disorder and most established mood stabilizer?
Lithium
Lithium:
-When can you get levels checked?
-The effective dosage of lithium is determined by monitoring serum lithium levels and assessing the client's clinical response to the drug. Daily dosages generally range from 900 to 3600 mg; more importantly, the serum lithium level should be about 1.0 mE
Side effects of lithium:
-Common side effects of lithium therapy include mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, a metallic taste in the mouth, and fatigue or lethargy.
-Weight gain and acne are side effects that occur later in lithium therapy
Mood-Stabilizing Drugs: Side Effects (cont'd)
Carbamazepine: rash, orthostatic hypotension
Valproic acid: weight gain, alopecia, hand tremor
Topiramate: dizziness, sedation, weight loss
Antianxiety Drugs:
Mechanism of action:
-Use: treatment of anxiety and anxiety disorders, insomnia, OCD, depression, post-traumatic stress disorder, alcohol withdrawal
-Benzodiazepines, buspirone (Table 2.6)
Mechanism of action:
-Mediation of GABA (benzodiazepines)
-Partial agonist activity at
Benzodiazepines:
Benzodiazepines:
-Benzodiazepines have proved to be the most effective in relieving anxiety and are the drugs most frequently prescribed. Benzodiazepines also may be prescribed for their anticonvulsant and muscle relaxant effects.
-Mechanism of Action:
Be
Buspirone
Buspirone
Dizziness, sedation, nausea, headache
Antianxiety Drugs: Client Teaching
-Safety measures
-Avoidance of alcohol
-Avoidance of abrupt discontinuation
Stimulants:
-Mechanism of action:
-Today, the primary use of stimulants is for
ADHD in children and adolescents, residual attention deficit disorder in adults, and narcolepsy
(attacks of unwanted but irresistible daytime sleepiness that disrupt the person's life).
.....
-WARNING Amphetami
...
WARNING Methylphenidate
Use with caution in emotionally unstable clients such as those with alcohol or drug dependence because they may increase the dosage on their own. Chronic abuse can lead to marked tolerance and psychic dependence.
...
WARNING Pemoline
Can cause life-threatening liver failure, which can result in death or require liver transplantation in 4 weeks from the onset of symptoms. The physician should obtain written consent before the initiation of this drug.
Antabuse
-Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. This agent's only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism.
...
-Use: aversion therapy for alcoholism
Me
CULTURAL CONSIDERATIONS
- African Americans respond more rapidly to antipsychotic medications and tricyclic antidepressants than do whites and have a greater risk for developing side effects from both these classes of drugs. Asians metabolize antipsychotics and tricyclic antidep
Which of the following drugs would the nurse expect to administer to a client with ADHD?
Disulfiram
Methylphenidate
Buspirone
Lithium
Methylphenidate
Methylphenidate is a stimulant used to treat ADHD.
Disulfiram is used to treat alcoholism. Buspirone is used to treat depression. Lithium is used to treat bipolar disorder.
Cultural Considerations (cont'd)
-Increased frequency of herbal medicine use
St. John's wort
Kava
Valerian
Ginkgo biloba
Increased risk for interactions
Self-Awareness Issues
View chronic mental illness as having remissions and exacerbations, just as chronic physical illnesses do
Remain open to new ideas that may lead to future breakthroughs