Psychotherapeutic Drugs (p. 261) Used in the treatment of emotional and mental disorders Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress When emotions significantly affect an individual’s ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option Three main emotional and mental disorders: Anxiety, affective disorders, psychoses NURSING APPLICATION: Would the nurse suspect that Ms. Jackson might have an emotional disorder? Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Anxiety Disorders (p. 261) Six major anxiety disorders (persistent anxiety) Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) Panic disorder Social phobia Simple phobia Mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain. Obsessive-compulsive disorder was previously thought to be rare but is now observed to be twice as common as schizophrenia or panic disorder in the general population. Anxiety may occur because of a wide range of medical illnesses (e.g., cardiovascular or pulmonary disease, hypothyroidism, hyperthyroidism, pheochromocytoma, and hypoglycemia). NURSING APPLICATION: What type of anxiety would Ms. Jackson have? Copyright © 2011 by Elsevier Inc. All rights reserved.

Antianxiety Drugs (p. 278) Reduce anxiety by reducing overactivity in CNS Benzodiazepines Depress activity in the brainstem and limbic system Miscellaneous drug: Buspirone (BuSpar) Nonsedating and non–habit forming May have drug interaction with SSRIs (serotonin syndrome ) Do not administer with MAOIs Barbiturates and carbamates were previously used to treat anxiety and have been replaced by newer drugs. NURSING APPLICATION: Would Ms. Jackson need a medication to help with her anxiety? Why or why not? Copyright line.

Copyright © 2011 by Elsevier Inc. All rights reserved. Benzodiazepines (p. 262) Potentially habit-forming and addictive Should be used at lowest effective dosages and frequencies needed for symptom control Common benzodiazepines: diazepam, lorazepam, alprazolam, clonazepam, chlordiazepoxide Contraindications to benzodiazepines include known drug allergy; angle-closure glaucoma, due to their ability to cause mydriasis; and pregnancy, due to their sedative properties. A history of seizure is a relative contraindication. NURSING APPLICATION: If Ms. Jackson were prescribed a benzodiazepine, what side effects would be possible, for which the nurse should be vigilant? Copyright © 2011 by Elsevier Inc. All rights reserved.

Mood Stabilizers: Antimanic Drugs (p. 278) Lithium is the drug of choice for the treatment of mania It is thought to potentiate serotonergic neurotransmission May be used with other medications to stabilize mood Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L Monitor sodium levels Safe use of lithium depends on adequate hydration and electrolyte status. NURSING APPLICATION: Explain to Ms. Jackson’s nephew the difference between an antimanic drug and an antianxiety drug. Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Antidepressants (p. 279) Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) Newer-generation antidepressants Selective serotonin reuptake inhibitors (SSRIs) Second- and third-generation antidepressants Used for major depressive disorders Tricyclic antidepressants have largely been replaced by SSRIs as first-line antidepressant drugs. Effective in treating depression, they are also useful in treating other disorders, such as dysthymia (chronic low-grade depression), schizophrenia (as an adjunctive drug), eating disorders, and personality disorders. NURSING APPLICATION: How would the nurse explain the precautions to follow while taking MAOIs? Copyright © 2011 by Elsevier Inc. All rights reserved.

Monoamine Oxidase Inhibitors (MAOIs) (p. 280) Highly effective Considered second-line treatment for depression not responsive to cyclics Disadvantage: potential to cause hypertensive crisis when taken with tyramine Amines are not broken down, resulting in higher levels in the brain which alleviates the symptoms of depression. Patient teaching about MAOIs is important, especially about their serious potential to cause a hypertensive crisis when taken with a substance containing tyramine, which is found in many common foods and beverages. NURSING APPLICATION: How would the nurse explain the precautions to follow while taking MAOIs? Copyright line.

Hypertensive Crisis and Tyramine (p. 270) Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death Avoid foods that contain tyramine! Aged, mature cheeses (cheddar, blue, Swiss) Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté) Yeast extracts Red wines (Chianti, burgundy, sherry, vermouth) Italian broad beans (fava beans) Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome. There must be a 2- to 5-week "wash-out" period between MAOI therapy and SSRI therapy. NURSING APPLICATION: Explain where tyramine is found in foods and drinks. Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Antipsychotics (p. 274) Treatment of serious mental illnesses Bipolar affective disorder Depressive and drug-induced psychoses Schizophrenia Autism Movement disorders (such as Tourette’s syndrome) Some medical conditions Nausea, intractable hiccups Have also been referred to as tranquilizers or neuroleptics because they produce a state of tranquility. Phenothiazines constitute approximately two thirds of all antipsychotics. Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function Dopamine levels in the CNS are decreased Result: tranquilizing effect in psychotic patients NURSING APPLICATION: What side effects of antipsychotics need to be watched closely? Copyright © 2011 by Elsevier Inc. All rights reserved.

Psychotherapeutic Drugs: Nursing Implications (cont’d) (p. 277) Antipsychotics: phenothiazines Instruct patients to wear sunscreen because of photosensitivity Tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose Inform patients to avoid alcohol or other CNS depressants with these medications Taking anticholinergics and phenothiazines with TCAs may result in increased anticholinergic effects. NURSING APPLICATION: Does Ms. Jackson need to wear a sunscreen when out in the sun? Why or why not? Copyright © 2011 by Elsevier Inc. All rights reserved.