Psychotherapeutic Agents

Psychotherapeutic Agents

Psychotherapeutic Agents

  • Used to treat psychoses: perceptual and behavioral disorders
  • Drugs do not cure psychoses: they help patients function in a more acceptable manner and carry on activities of daily living
  • Used in both children and adults

Mental Disorders and Their Classifications

  • Schizophrenia
  • Mania/bipolar disease
  • Narcolepsy
  • Attention-deficit disorder

Schizophrenia

  • Characteristics
    • Hallucinations, paranoia, delusions, speech abnormalities, and affective problems
  • Causes
    • Strong genetic association
    • May reflect a fundamental biochemical abnormality

Mania/Bipolar Illness

  • Characteristics
    • Mania: periods of extreme overactivity and excitement
    • Bipolar illness: extremes of depression followed by hyperactivity and excitement
  • Cause
    • May reflect a biochemical imbalance followed by overcompensation on the part of neurons and their inability to re-establish stability

Narcolepsy

  • Characteristics
    • Daytime sleepiness and sudden periods of loss of wakefulness
  • Causes
    • Problems with stimulation of the brain by the reticular activating system (RAS)
    • Problems with response to that stimulation

Characteristics of Attention-Deficit Disorders

  • Inability to concentrate on one activity for longer than a few minutes
  • State of hyperkinesis
  • Usually diagnosed in school-age children but can occur in adults

Sites of Action of the Drugs Used to Treat Mental Disorders

Sites of Action of the Drugs Used to Treat Mental Disorders

Sites of Action of the Drugs Used to Treat Mental Disorders

 

 

Classifications of Antipsychotics

  • Typical
    • Primarily dopamine receptor blockers
    • Cause several adverse effects including hypotension, anticholinergic effects, and extrapyramidal side effects (EPS)
  • Atypical
    • Block both dopamine receptors and serotonin receptors
    • May alleviate some of the unpleasant neurological effects and depression caused by typical antipsychotics

Types of Extrapyramidal Effects

  • Pseudoparkinsonism
  • Dystonia
  • Akathisia
  • Tardive dyskinesia
  • Potentially irreversible neuroleptic malignant syndrome

Antipsychotic/Neuroleptic Drugs

  • Actions
    • Typical antipsychotic drugs block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
    • Depress the RAS, limiting the stimuli coming into the brain
    • Atypical antipsychotics block both dopamine and serotonin receptors
  • Indications
    • Schizophrenia, hyperactivity, combative behavior, agitation in the elderly, and severe behavioral problems in children
  • Pharmacokinetics
    • Absorbed from the GI tract
    • IM dose provides 4 to 5 times the active dose as oral doses
    • Widely distributed in the tissues
    • Metabolized in the liver
    • Excreted through bile and urine
    • Cross placenta and enter breast milk
  • Contraindications
    • Underlying diseases that could be exacerbated by the dopamine-blocking effects of these drugs
    • CNS depression
    • Circulatory collapse
    • Parkinson’s disease
    • Coronary disease
    • Severe hypotension
    • Prolonged QT interval
  • Adverse reactions
    • Sedation
    • Weakness
    • Tremors
    • Drowsiness
    • Extrapyramidal effects
    • Dry mouth
    • Nasal congestion
    • Constipation
  • Drug-to-drug interactions
    • Beta blockers, alcohol, mesoridazine, thioridazine

Drugs Used to Treat Mania/Bipolar Disease

  • Lithium salts (Lithane, Lithotabs)
  • Lamotrigine (Lamictal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)

Action of Lithium

  • Alters sodium transport in nerve and muscle cells
  • Inhibits the release of norepinephrine and dopamine—but not serotonin—from stimulated neurons
  • Increases the intraneuronal stores of norepinephrine and dopamine slightly
  • Decreases intraneuronal content of second messengers

Antimanic Drugs

  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 30 minutes
    • Same distribution pattern in the body as water
    • Slowly crosses the blood–brain barrier
    • Excreted from the kidney, 80% is reabsorbed
    • Crosses the placenta: associated with congenital abnormalities
    • Enters the breast milk
  • Contraindications
    • Known allergy, renal or cardiac disease, leukemia, metabolic disorders, pregnancy, and lactation
  • Adverse reactions
    • Effects directly related to the lithium serum level
      • Levels less than 1.5: lethargy, slurred speech, muscle weakness, nausea, and vomiting
      • Levels 1.5 to 2: above reactions plus ECG changes
      • Levels 2 to 2.5: ataxia, clonic movements, hyperreflexia, and seizures
      • Levels less than 2.5: complex multiorgan toxicity and significant risk of death
  • Drug-to-drug interactions
    • Haloperidol
    • Carbamazepine
    • Thiazide diuretic

Site of Action of the CNS Stimulants in the RAS

Site of Action of the CNS Stimulants in the RAS

Site of Action of the CNS Stimulants in the RAS

 

 

Central Nervous System Stimulants

  • Action
    • CNS stimulants act as cortical and RAS, possibly by increasing the release of catecholamines from presynaptic neurons; this leads to an increase in stimulation of the postsynaptic neurons
  • Indications
    • Treatment attention: deficit syndromes
    • Narcolepsy
  • Pharmacokinetics
    • Rapidly absorbed from the GI tract
    • Peak in 2 to 4 hours
    • Metabolized in the liver
    • Excreted in the urine
    • T½ 2 to 15 hours
  • Contraindications
    • Known allergy, marked anxiety, agitation, tension, severe fatigue, and glaucoma
  • Adverse effects
    • Nervousness, insomnia, dizziness, headache, blurred vision, anorexia, nausea, and weight loss
  • Drug-to-drug interactions
    • MAOIs
    • Guanethidine
    • Tricyclic antidepressants
    • Phenytoin

Use of Psychotherapeutic Agents Across the Lifespan

Use of Psychotherapeutic Agents Across the Lifespan

Use of Psychotherapeutic Agents Across the Lifespan

Prototype Typical Antipsychotic Drugs

Prototype Typical Antipsychotic Drugs

Prototype Typical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs

Prototype Central Nervous System Stimulants

Prototype Central Nervous System Stimulants

Prototype Central Nervous System Stimulants

Nursing Considerations for Antipsychotic/Neuroleptic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimanic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Central Nervous System Stimulants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
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