Psychotherapeutic Drug Therapy Chapter 7 Psychotherapeutic Drug Therapy Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Learning Objectives Briefly explain how psychotherapeutic medications affect human beings. Identify four classifications of psychotherapeutic medications. Discuss three classes of antianxiety agents and the side effects associated with each. Prepare a list of three teaching points for clients who are beginning antidepressant therapy. Explain the three major guidelines for care of clients taking lithium. Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Learning Objectives Identify one central nervous system and three peripheral nervous system side effects of antipsychotic (neuroleptic) drug therapy. Describe five care guidelines for clients receiving psychotherapeutic drugs. Discuss three topics for teaching clients about their medications. Explain how informed consent and noncompliance relate to psychotherapeutic medications. Copyright ©2013 by Elsevier Inc. All rights reserved.

How Psychotherapeutic Drug Therapy Works (p. 66) Psychiatric medications act on the body’s nervous system primarily by altering the delicate chemical balances within that system. Most interrupt the chemical messenger (neurotransmitter) pathways within the brain. A primary responsibility of health care providers, especially nurses, is to differentiate therapeutic from unwanted effects How do psychotherapeutic drugs work on human beings? Copyright ©2013 by Elsevier Inc. All rights reserved.

Classifications of Psychotherapeutic Drugs (p. 68) Four classes of psychotherapeutic drugs: Antianxiety agents Antidepressants Antimanics Antipsychotics People who are receiving medications must be monitored routinely for effectiveness, side effects, and life-threatening adverse reactions. List and identify the four classes of psychotherapeutic drugs Copyright ©2013 by Elsevier Inc. All rights reserved.

Antianxiety Medications (p. 68) Antianxiety agents are drugs that reduce the psychic tension of stress. Anxiolytics or “minor tranquilizers” Medications in the antianxiety group are divided by their chemical formulas into categories. List and discuss three classes of antianxiety agents. List the side effects associated with each. Copyright ©2013 by Elsevier Inc. All rights reserved.

Antianxiety Medications cont’d. (p. 69) Benzodiazepines Mainly used to decrease anxiety Act by increasing gamma-aminobutyric acid (GABA) activity, which results in decreased anxiety Because long-term use of antianxiety drugs can result in dependence, therapy for clients usually is limited to a few months. Benzodiazepines indications: antianxiety, sleep, sedation, antiseizure. Copyright ©2013 by Elsevier Inc. All rights reserved.

Antianxiety Medications cont’d. (p. 69) Buspirone (BuSpar) Belongs to the azaspirone drug class Does not cause the sleepiness or muscle relaxation associated with benzodiazepines Therapeutic effects not seen for 3 to 6 weeks after treatment initiation Pregabalin (Lyrica) Side effects are fewer than those of other antianxiety drugs, so patients are more likely to comply with treatment. Copyright ©2013 by Elsevier Inc. All rights reserved.

Antianxiety Medications cont’d. (p. 70) Interactions Central nervous system (CNS) depression when combined with CNS depressants Increased concentrations of the cardiac drug digoxin Interfere with absorption into the bloodstream when taken with antacids These drugs require frequent nursing assessment for therapeutic actions and side effects. Why might some patients not want to continue pharmacologic therapy? (negative side effects) Copyright ©2013 by Elsevier Inc. All rights reserved.

Antidepressant Medications (p. 70) Antidepressant medications act on the body by increasing certain neurotransmitter activities. The physician’s first choice for the treatment of depression is often an antidepressant. Antidepressants are divided into categories: Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) Atypical antidepressants Selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) List teaching points for clients who are beginning antidepressant therapy. Treatment is recommended if mood begins to interfere with the person’s ability to perform activities of daily living. Copyright ©2013 by Elsevier Inc. All rights reserved.

Antidepressant Medications cont’d. (p. 70) Antidepressant medications may be taken 1 to 4 weeks before symptom relief is noted. Side effects include dry mouth, nose, and eyes; urinary retention; and hypertensive crisis. These discomforts can be so bothersome that some people refuse to take their medications regularly. MAOIs have many drug and food interactions. Clients may attempt suicide while on antidepressants because energy levels increase. Special precautions for patients using MAOIs include no foods containing tyramine. Why? (Hypertensive crisis can develop if tyramine-containing foods are ingested. Symptoms of hypertensive crisis include severe occipital or temporal headache, sweating, dilated pupils, increased systolic and diastolic pressure, neck stiffness, and neuromuscular excitation.) Copyright ©2013 by Elsevier Inc. All rights reserved.

Antimanic Medications (p. 71) Lithium Naturally occurring salt used to treat the manic phase of bipolar depression Well absorbed into the bloodstream and excreted faster than sodium by the kidneys Important for clients to balance their salt intake, fluid intake, and activity Interacts with a variety of other drugs Levels higher than 1.5 mEq/L are considered toxic. Clinical improvement commonly takes as long as 3 weeks. What is mania? (a state characterized by excitement or great elation, overtalkativeness, increased motor activity, fleeting grandiose ideas, and agitated behaviors) What are the guidelines of care for patients on lithium? Lithium is contraindicated for patients who are pregnant or have kidney impairment/ failure. Lithium values should be monitored every 1 to 3 months after therapeutic levels have been reached. Monitor thyroid function and kidney function every month. What laboratory values show kidney function? (BUN, creatinine) Copyright ©2013 by Elsevier Inc. All rights reserved.

Antipsychotic Medications (p. 72) Antipsychotics also are called major tranquilizers or neuroleptics. Used to treat the symptoms of major mental disorders (schizophrenia, acute mania, and organic mental illnesses) and resistant bipolar (manic-depressive), paranoid, and movement disorders Copyright ©2013 by Elsevier Inc. All rights reserved.

Antipsychotic Medications cont’d. (p. 72) Interactions Antacids Hinder the absorption of antipsychotics into the bloodstream Alcohol Antianxiety medications Antihistamines Antidepressants Barbiturates Meperidine (Demerol) and morphine Produce severe CNS depression when mixed with antipsychotics List the central nervous system side effects of antipsychotic (neuroleptic) drug therapy. List the peripheral nervous system side effects of antipsychotic (neuroleptic) drug therapy. Copyright ©2013 by Elsevier Inc. All rights reserved.

Client Care Guidelines (p. 73) For nurses and those who administer psychotherapeutic drugs: Assess the client. Coordinate care. Administer the medication. Monitor and evaluate responses. Provide client teaching. Describe five care guidelines for clients receiving psychotherapeutic drugs. List three topics that should be discussed when one is teaching clients about their medications. Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Client Teaching (p. 75) Every client has a right to be informed of his or her diagnosis and treatment plan. Nurses should explain in terms the client will understand. Nurses should provide information in writing. Well-informed clients and families are better able to cope. Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Noncompliance (p. 76) Noncompliance is an informed decision made by a client not to follow a prescribed treatment program. The physician should be notified. Work with your clients to find and eliminate the factors that lead to noncompliance. How do informed consent and noncompliance relate to psychotherapeutic medications? Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Informed Consent (p. 76) Presenting clients with information about the benefits, risks, and side effects of specific treatments Enabling them to make voluntary and knowledgeable decisions about their care Patient Self-Determination Act States that clients have the right to accept or refuse care and cannot be pushed, coerced, or talked into following a certain course Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Question 1 Which of the following is not one of the four classes of psychotherapeutic medications? Antianxiety agents Antidepressants Antipsychotics Antiaffectics Correct Answer: 4 Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Question 2 The client is being treated with a benzodiazepine medication. The nurse knows that the main side effect of this drug is: Photophobia Tachycardia Agitation Gastrointestinal disturbance Correct Answer: 4 Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Question 3 Antidepressant medications treat depression and other mood disorders by: Increasing neurotransmitter activity in the brain Decreasing certain neurotransmitter activity in the brain Altering certain brain waves Enhancing certain naturally occurring mood stabilizers Correct Answer: 1 Copyright ©2013 by Elsevier Inc. All rights reserved.

Copyright ©2013 by Elsevier Inc. All rights reserved. Question 4 The nurse is administering psychotherapeutic drugs to her client. Which of the following is not one of her responsibilities? Assessing the client Coordinating care Administering the medication Informing family members about side effects and effectiveness Correct Answer: 4 Copyright ©2013 by Elsevier Inc. All rights reserved.