Drugs in Psychiatric Nursing

8/2/2019 Drugs in Psychiatric Nursing

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DRUGS IN PSYCHIATRIC

NURSING



Objectives.•

Describe the physiological &therapeutic effects of psychotropicmedications.

•

Describe the side effects & toxiceffects of psychotropicmedications.

•

Describe the use of psychotropicmedication with specialpopulations.

•

Describe the process of clienteducation teachin .



ACTIONS OF PSYCHOTROPHICDRUGS

• Mainly there are two concept inpsychopharmacology they areneurotransmitters & blood-brain barrier.

• Lipid solubility is the most important of the chemical properties that determinewhether a molecule may pass throughBBB.

• Neurotransmitters are synthesized fromnatural precursors which are extractedfrom the blood stream &are synthesizedin the cells and stored in storagevesicles in the presynaptic terminals of

the cells.



Classifications of Psychotrophicmedications

• 1. The anti-anxiety drugs/anxiolytics.

• 2. Antidepressants.

•

3. Mood stabilizers• 4. Antipsychotics/neuroleptics



Antianxiety drugs.

(Benzodiazepines.) (Non-benzodiazepines.)Benzodiazepines. Azapirones. Beta-blockers.

Alprazolam. Buspirone. Propanolol.

Diazepam.

Chlordiazepoxide.

Lorazepam.





Cont…

•

Include drowsiness,reduced mentalacuity& impaired motor activity.

• Other effects such as headache,dizziness, feeling of detachment,

nausea, hypotension & restless nessmay be experienced.

• Addiction may not occur but physicaldependency can cause developmentof tolerance & onset of withdrawalsyndromes.

• Contraindications/precautions:

don’t take any CNS depressantsincludin alcohol &avoid in



Cont…•

Interactions: interaction mayoccur with alcohol,MAO-inhibitor,antacids & agents withanticholinergic activity.

• Patient education:Driving or operating machinery

should be avoided until tolerance

develop.Alcohol and other CNS depressants

potentiate the effects of benzodiazepines, so they should

be avoided.



Cont…• Non-benzodiazepine are

propanalol& buspiron.• Propanalol is a betablocker that is

useful in the treatment of anxiety.

•

They reduce certain symptoms of anxiety,especiallytachycardia,rather than workingdirectly on the anxiety.

• Buspiron is a potent anxiolytic drugwith no sedative or addictiveproperties.

•

It is effective in the treatment of



Antidepressant drugs.•

Drug groups & examples.Tricyclics. SSRIs MAOIs

Amitriptyline. Flouxetine. Isocarboxazid.

Trandazon. Paroxetine. Phenelzine.

Lofepramine. Venlafaxine. Tranylcypromine.



Cont…antidepressants• Depression are thought to be

deregulation of neurochemicals,particularly serotonin& nor-epinephrine.

• Tricyclic antidepressants, selectiveserotonin reuptake inhibitor&mono-amine oxidase inhibitors.

• Action: Block the reuptake of neurotransmitters (tricyclic), inhibittheir metabolism/destruction(MAOI`s) & enhancesthe activity of receptors (SSRI`s)

•

in short they elevate the mood.



Cont…• Indications: in the treatment of

major depression, dysthymicdisorder & prevent its relapse,& insome anxiety disorders as panic

disorders and OCD.• Side effects:

Tricyclic antidepressants-amitriptyline, fluxetine.

Sedation, dry mouth, constipation,blurred vision, seizures& urinaryretention& an over dose can cause

life threatening emergencies.



Cont…Mono-amine oxidase inhibitor-

phenelzine,isocarboxazid.

Drowsiness/insomnia,agitation,fatigu

e, GI disturbances,weight gain,hypotension& dizziness,dry mouth,skin & sexual dysfunction,constipation & blurred vision.

Major concern is the interaction withspecific food that containtyramine& other amine drugs such

as found in any cough preparation.



Cont…Foods & drugs to be avoided in

patients taking MAOIs• Cheeses, especially matured one.• Pickled herrings, cured meat& beef

extracts.• Liver& chicken liver.• Whole broad beans,soybean

paste,&figs.

• Alcoholic drinks especially redvine.• Other antidepressant drugs, nasal/

sinus decongestants, narcotics,

epinephrine.



Cont…

Selective serotonin reuptakeinhibitors-fluoxetine,paroxetine.

Side effects are similar to tricyclics

but they don't causecardiovascular, sedative &anticholenergic side effects,theycan cause withdrawal syndromesuch as paraesthesia,dizziness,anxiety, sleep disturbances,agitation & tremor if stop abruptly.



Cont…•

Contraindication/precautions:caution is warranted in allantidepressants since once thedrugs start to take effects & thepatient`s mood lifts, they can be atthe risk of suicide.

• SSRIs shouldn’t be given withMAOIs& MAOIs shouldn’t be

started within one week of tricyclictherapy & conversely.• Interactions: they can cause

hypertensive crisis since they

prevent antihypertensive action of certain dru s.



Cont…• Patient education:

Mark commencing time & instructthem that action may start within 2-3 weeks,even though they may notbe able to notice any change.

Warn the problems when driving oroperating machineries if sedation isexperienced.

Warn about the effect that alcohol &possible interaction of foods andmedicines to the drugs.

Declare the pregnancy to thetreating doctor and if intend tobreast feed.



Mood stabilizers.

• Drug group & examples.

Lithium. Anticonvulsants.

Lithium carbonate. Carbamazepine.

Sodium Valporate.



Cont…

•

main mood stabilizers used arelithium &anticonvulsants.

• Lithium is the naturally occurringsalt, & is the drug of choice for thetreatment of acute mania &ongoing maintenance of patientswith history of mania.

• Action: the action is unknown butit is believed to regulate thecatecholamine release in the CNS.



Cont…•

Indications: acute mania,aggression, conduct disorder&schezoaffective disorder.

• Side effects:

Lithium- drowsiness,metallic tastein mouth, difficulty inconcentration,increased

thirst,dizziness,head ache,GITupset,fine handtremor,hypotension, arrhythmias,polyuria, dehydration& weight

gain.



Cont…• Contraindications/precautions:

Lithium:-should not be used incardiac or renal disease,sodiumdepletion,brain damage,

pregnancy& lactation. Therapeutic level for lithium in

the blood is between .6-1.2

mmols/L for acute mania &.6-.8/Lin maintenance of mania.the toxiclevel is if it exceed 1.5 mmols/L,if

so next dose should be with held.



Cont…

Signs of Lithium toxicity.• Early

stages:anorexia,nausea,vomiting,

diarrhea, handtremor,twitching,lethargy,dyarrthmia, ataxia hypercaptivedeep tendon

reflexes,tinnitus,vertigo,drowsiness.

• Later stages:fever,decreased

urinary output,low BP,irregular



Cont…• Patient education:

Lithium- educate the patient aboutthe side effects & signs of toxicity.

• Encourage a regular intake of

about 10 glasses of water everyday.

• Take medications everyday evenwhen feeling well.

• Don't operate machinery untilinitial drowsiness subsides.

• Discuss risk of pregnancy while

taking lithium.



Cont… Anticonvulsants-inform about

avoiding sudden cessation of thedrugs.

• Encourage to report unusualsymptoms such as unusualbleeding/bruise,jaundice etc.

• Take medications with meals toavoid GI symptoms.

•

Avoid alcohol,consult doctor forany medication.• Avoid pregnancy during

medication ,use other than OC pills

for family planning while taking

Antips chotic/ne roleptic



Antipsychotic/neuroleptics.

• Drug types & examples.Typical/traditional. Atypical/newer.

Butriphenones-eg.Haloperidol.

Risperidone.

Phenothiazine-

eg.Thioridazine.

Clozapine.

Thioxanthines-

eg. Flupenthixol.

Olazipine.

Diphenylbutylpiperidine

Eg. Pimozide.

Quetiapine.



Cont…

• two types of antipsychotics – traditional antipsychotics or

typical antipsychotics

newer antipsychotics or

atypical antipsychotics• The atypical antipsychotics are

better tolerated & less likely to lead

to problems with medicaladherence.



Cont…• Action:

Typical -are dopamineantagonists.They blockpostsynaptic D2 receptors

primarily but also exert othersynaptic effects& reduce positivesymptoms of schizophrenia.

Atypical -have dopamine receptorsubtype 2 (5HT2) blockingaction.They reduce both positive &

negative symptoms without



Cont…• Indications: Acute &chronic

psychosis, delusional disorder,severe depression, schizophrenia &schizoaffective disorder.Phenothiazine : group of

antipsychotics have other uses suchas antiemetic (prochlorperazine) & inthe treatment of intractablehiccoughs (chlorpromazine)

•

Side effects:Typical –affects every system& CNS

disorders (movement disorder,sedation & seizures), extrapyramidal

reactions, tardive dyskynesia &



Cont…

Atypical- May cause someannoying side effects such asweight gain,constipation,dizziness&paradoxical

hypersalivation.on higher dosesthey can cause EPS.

• Contraindications/precautions:

Typical- older adults,medically ill ordiabetic.Avoid extremes of temperature.

Aty ical:- risk of agranulocytosis &



Cont…•

Interactions:Typical- alcohol may causeadditional CNS depression,antacids&antidiarrhoeals can disrupt the

absorption .concurrent use withantidepressants, antihistamines&antiparkinsonians may result in

additional anticholinergic action. Atypical- enhance the effect of alcohol& other CNSdepressants.drugs that can

depress bone marrow should be



Cont…•

Patient education:Typical- educate the client about

the side effects and help with

improving adherence. They shouldbe careful about the sun &extremes of temperature.

Atypical- regular blood levelchecking.important of seeking adoctor immediately for any flu likesymptoms(while taking clozapine).



PRN antipsychotics.•

The need to reduceagitation,distress or aggressionrapidly often result in prescription &administration of PRN

antipsychotics.• The drug most often prescribed forPRN have been typicalantipsychotics,particularly

Halloperidol & benzodiazepines.• When nurses give PRN medication

they are often required to makedecisions of what to give from a

range of medications,as well as the



Depot preparations.• They have been introduced in

1960s due to the problems incompliance with oral medications.• They are long acting, injectable

forms of a typical antipsychotic,

produced mostly in decanoateesters dissolved in an oily base.• When administered in deep IM, the

drug is de-esterifies to release the

active drug, which slowly diffuse into the circulation.

• The injection is usually given every2-4 weeks. Eg.Flupenazinedecanoate,IM,200-400mg,2-

P h t i & i l



Psychotropics&specialpopulation.

•

Pregnant & lactating women:Risk to the unborn or to the newborn.

untreated psychiatric disordersduring pregnancy must beweighed against the risk of prenatal exposure to drugs,as

antenatal psychological distress isknown to be linked to prematurelabor,LBWB,microcephali etc.

Tetragenic effects should beassessed.



Cont…• Children:

They are to be monitored while onpsychotropic as they are prone forcardio toxicity & seizures.

Death has been reported afteroverdose of as little as few mgs.

• Old age:

Adverse reaction are morecommon due to slower drugmetabolism& excretion.

Polypharmacy.



Tutorial outline.•

Group-1; Discuss the legal &ethical issues in psychotropic drugadministration.

•

Group-2; Discuss about theproblems of drug complaints/adherence in psychiatric patients.

• Group-3; Discuss the adjuvanttherapies used along withpsychotropic.

• Group-4; Discuss about CNSstimulants used in ractice.



Tutorial activity

• Discuss mental disorders due to thefollowing

• Stimulants

• Hallucinogens

• Cannabinoids

•

Alcohol• Opioids



• Substance dependence

• Acute intoxication

•

Tolerance• withdrawal

Documents

Drugs in Psychiatric Nursing