Elsevier items and derived items © 2005 by Mosby, Inc. Chapter 7 Psychotherapeutic Drug Therapy

Elsevier items and derived items © 2005 by Mosby, Inc. Powerful chemicals produce profound effects on mind, emotions, and body. Act mainly on CNS by altering its chemical modulators Interrupt neurotransmission by suppressing major nerve pathways that connect brain to frontal lobes and limbic system Frontal lobe of brain responsible for higher human functions such as Love, creativity, planning, judgement, insight and abstract thinking The Limbic system is responsible for emotions, motivation, memory These areas of the brain functions are altered by medication to produce a change in behavior. Psychotherapeutic Drugs

Elsevier items and derived items © 2005 by Mosby, Inc. Divisions of the Nervous System

Elsevier items and derived items © 2005 by Mosby, Inc. Synapse and neurotransmitters

Elsevier items and derived items © 2005 by Mosby, Inc. Neurotransmitters There are Four groups  Monoamines e.g. dopamine, serotonin  Cholinergics e.g. acetylcholines  Amino Acids e.g. GABA  Neuropeptides e.g. enkephalin

Elsevier items and derived items © 2005 by Mosby, Inc. Antianxiety agents or anxiolytics  Reduce psychic tension of stress Antidepressants  Act by increasing certain neurotransmitter activities Antimanics  Work as naturally occurring mood stabilizers Antipsychotics  Have profound effects on brain and nervous system Classifications of Psychotherapeutic Drugs

Elsevier items and derived items © 2005 by Mosby, Inc. Azaspirones e.g. Buspirone (Buspar)  Take 2 to 4 weeks to relieve symptoms  Minimal side effects Benzodiazepines e.g. Lorazepam, Diazepam,  Oldest anxiolytics and fast acting  Major side effect is drowsiness  Potential for dependency  Withdrawal occurs if stopped abruptly Beta-blockers e.g. Inderal  Used to treat social phobias Antianxiety Agents/Anxiolytics

Elsevier items and derived items © 2005 by Mosby, Inc. Nursing consideration for Anxiolytics  Accurate client Assessment  Monitor for therapeutic action and side effects.  Avoid taking antacids, or CNS depressants

Elsevier items and derived items © 2005 by Mosby, Inc. Actions of Antidepressants It exerts its action by increasing certain neurotransmitter activities Classes  Tricyclics e.g Elavil, Immipramine  Monoamine oxidase inhibitors (MAOIs)e.g. Nardil  Selective serotonin-reuptake inhibitors (SSRIs) e.g. Prozac, Zoloft, Paxil, Effexor  Atypical e.g. Remeron, Bupropion Antidepressant Medications

Elsevier items and derived items © 2005 by Mosby, Inc. Antidepressants Teaching points  One to four weeks before effects are noted  Client should be assessed for changes in attitude and suicide gesture  Some side effects may be experienced soon after medication is started  Medication must be taken regularly despite side effects  Client instruction: Contact physician if side effects become bothersome  Avoiding certain food or its products must be emphasized for those taking MAOI’s

Elsevier items and derived items © 2005 by Mosby, Inc. Action of Antimaniacs e.g Lithium Action of Antimaniacs e.g Lithium Helps to stabilizes mood and is indicated in the treatment of acute Mania Helps to stabilizes mood and is indicated in the treatment of acute Mania Caring for Clients on Lithium Help with prelithium workup  Complete physical, history, ECG, and several blood studies Teach client to maintain stable blood level of drug  Teach client and family about expected side effects and difference between common side effects and those requiring immediate notification of physician Monitor client for side effects and toxic reactions  Reinforce information about side effects with written instructions Antimanic Medications

Elsevier items and derived items © 2005 by Mosby, Inc. Antipsychotics/Neuroleptics  Antipsychotics are used to treat the symptoms of major mental disorders such as Schizophrenia, acute mania, and organic mental illness.  Both the Central and the perpheral nervous systems are affected by neuroleptics.  Examples on Page 67 : Box 7-5  May result in imbalance of neuro transmitters in the brain causing EPSE characterized by abnormal movement

Elsevier items and derived items © 2005 by Mosby, Inc. Assess client for physical and psychosocial effects Coordinate care  Ensure that each component of treatment plan is carried out Administer medications as ordered Monitor clients for drug effectiveness and adverse reactions such as Neuroleptic Malignant Syndrome Teach client about new medications, actions and side effects Nursing Guidelines for Clients on Psychotherapeutic Drugs