Psych Drugs Pt1_Student version PDF

Psychotherape utic Drugs: Part 1 ATI Chapters 6 - 10 Antipsychotic s for Schizophrenia ATI Ch. 9  Chronic psychotic illness that effects ability to feel and think clearly Etiology: ? Combination of...

Psychotherape utic Drugs: Part 1 ATI Chapters 6 - 10 Antipsychotic s for Schizophrenia ATI Ch. 9  Chronic psychotic illness that effects ability to feel and think clearly Etiology: ? Combination of genetic, neurobiologic & Positive nongenetic factors Review of Schizophre Three types of symptoms Negative nia Dx is characterized by acute episodes with periods of Cognitive remission or semi-remission Chronic  Cognitiv Positive Negative e Hallucinations Social withdrawal Disordered thinking Delusions Poor self-care Lack of focus Agitation Lack of motivation Learning disability Disordered speech Poverty of speech Bizarre behaviors Blunted affect Memory problems Two Main Classes of Antipsychotics First-Generation Second-Generation Antipsychotics Antipsychotics FGAs SGAs - Pharmacology is very similar - Effectiveness is about the same - Adverse effects & tolerance vary greatly  Prototype: Chlorpromazine Haloperidol (Haldol), thiothixene (Navane) First- MOA: block several receptors in the CNS – dopamine, Acetylcholine, Generatio histamine, norepinephrine Takes 2-4 weeks, several months for full effect n Inhibits Positive symptoms best Antipsych Classified by potency: otics low, medium, high (FGAs) Contributes to severity of adverse effects Administration: Give with food Swallow whole- do not crush IM into large muscle- lie flat for 30 minutes Antacids/antidiarrheals- 2 hours FGAs Adverse Effect: Extrapyramidal Symptoms (EPS) Acute Dystonia Occurs hours to days Spasms of tongue, face, neck, back muscles Parkinsonism Occurs within 1 month Looks just like Parkinson’s Dz (tremor, rigidity, shuffling, drooling) Akathisia Occurs within 2 months Pacing, restless, agitated, squirming, need for constant motion Occurs months to years Tardive Dyskinesia Involuntary twisting, writhing movements of tongue and face, progresses to difficulty speaking, swallowing, down the body  Neuroleptic Malignant Syndrome “lead pipe” muscle rigidity, sudden very high fever, labile BP, dysrhythmias Anticholinergic effects Other FGA Orthostatic hypotension Neuroendocrine effects (gynecomastia & galactorrhea) Adverse Sedation Effects Seizures Sexual dysfunction Agranulocytosis Dysrhythmias Photosensitivity  Contraindications: Alcohol withdrawal Bone marrow suppression CNS depression Pregnancy and lactating FGA Contraindication Precautions: s, precautions, COPD and interactions Glaucoma DM HTN Prostatic hypertrophy Thyroid/cardiac/liver disorders  FGA Interactions Anticholinergic drugs CNS Depressants Levodopa & direct dopamine Overdose of FGAs: receptor agonists Hypotension, CNS depression, EPS  Prototype: risperidone (Risperdal) olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon) Second- MOA: Generation block dopamine & serotonin receptors in the CNS Antipsychoti Takes 2-4 weeks, several months for full effect cs (SGAs) or Uses: Schizophrenia, Bipolar Disorder, irritability Atypical associated with Autism Antipsychoti cs Administration: Oral solutions mix with juice, milk, water, coffee Remove from packaging immediately before admin Long-acting IM every 2 weeks  Extrapyramidal Symptoms (less likely, but can still occur) Neuroleptic Malignant Syndrome Metabolic effects Weight gain Diabetes Hyperlipidemia Myocarditis (rare) Anticholinergic effects SGA Adverse Effects Orthostatic hypotension Neuroendocrine effects (gynecomastia & galactorrhea) Sedation Seizures Sexual dysfunction Agranulocytosis Dysrhythmias Photosensitivity  Contraindications: Breastfeeding (Lactating) Severe CNS disorders ECG abnormalities Psychosis Increased risk for CVA or stroke SGA Precautions: Contraindication Frequently exposed to sunlight or tanning beds s, Precautions, Children younger than 13 (Schizophrenia) and Interactions Caution: Older adults with Parkinson’s, Liver and renal disorders, Hypotension, Seizure disorders, Fluid or electrolyte imbalances, DM, Seizure disorders Interactions: Phenytoin (Phenobarbital), Rifampin- decrease risperidone levels Antiparkinson’s Drugs- may have an increase in Parkinson's’ symptoms Nursing Considerations Patient/family Education EPS and to notify provider if symptoms appear Tips to help anticholinergic effects (sip liquids, chew gum, lubricating eye drops, increase fluids & fiber) Move slowly when standing (orthostatic hypotension) Avoid driving & alcohol and take med at bedtime (sedation) Notify provider if sexual effects are bothersome (low libido, ED) Report nipple discharge (neuroendocrine effects) Report signs of infection immediately (agranulocytosis) Report fatigue, dyspnea, tachypnea, chest pain, & palpitations (myocarditis) Goals of Therapy SUPPRESS ACUTE PREVENT PROMOTE HIGH QUALITY EPISODES EXACERBATIONS OF LIFE & FUNCTION  Table Overview of Antipsychotics First-Generation (FGAs) Second Generation (SGAs) AKA Conventional Atypical Blocks dopamine & serotonin receptors MOA Blocks several receptors in the CNS (dopamine, acetylcholine, (but also acetylcholine, norepinephrine, norepinephrine, histamine) histamine) High potency - haloperidol Classification Medium potency - loxapine Prototype is clozapine No differing classifications Low potency - chlorpromazine Inhibits both positive and negative Effect Inhibits positive symptoms best symptoms EPS (more common with high potency) Same as FGAs except SGAs have: Neuroleptic Malignant Syndrome Metabolic effects: weight gain, diabetes, Adverse Effects Anticholinergic effects, hypotension, sedation, & hyperlipidemia neuroendocrine effects, seizures, sexual dysfunction, Myocarditis agranulocytosis, dysrhythmias Questions? These materials were developed using: Assessment Technologies Institute. (2023). RN Pharmacology for Nursing Edition 9.0 Antidepressa nts Depression Most common psychiatric disorder Depressed mood, loss of pleasure or interest in nearly all of one’s usual activities Treatment can help! 30% achieve full remission with medication 50% improve symptoms with medications Treatment includes: 1. Pharmacotherapy (meds) 2. Psychotherapy (counseling) 3. Somatic therapy (ECT or TMS) Antidepressants: shared properties Response takes several weeks Initial response in 1-3 weeks (watch for SI) Maximal therapeutic response in 12 weeks All classes are equally effective, but have different adverse effects & interactions Drug choice based on tolerability and safety  Antidepress ants TCAs SSRIs amitriptyline Fluoxetine SNRI MAOIs Atypical venlaxafine Phenelzine Bupropion Tricyclic Antidepressants (TCAs): amitriptyline (Elavil) MOA: prevents reuptake of norepinephrine (NE) and serotonin Also blocks histamine, acetylcholine, and NE receptors (causes many side effects) Uses: Depression, insomnia, pain Administration PO- at bedtime, well-absorbed Several weeks to exert therapeutic relief Continue using the drug for 6 to 12 months to prevent relapse DO NOT STOP ABRUPTLY- Taper over 2 weeks Withdrawal sx- headache, anxiety, muscle pain, nausea Risk for overdose- dysrhythmias, confusion, seizures Treatment- gastric lavage > activated charcoal > sodium bicarb Tricyclic Antidepressants (TCAs): amitriptyline (Elavil) Interactions Adverse Effects MAOIs (severe HTN) Orthostatic hypotension Sympathomimetics Sedation Anticholinergic effects Anticholinergics Diaphoresis CNS depressants QT prolongation Herbal supplements Seizures H2 blocker: cimetidine Hypomania (Tagamet) Suicide risk Overdose can be deadly Nursing Considerations Monitor BP Advise night-time Advice for anticholinergic effects Monitor EKG Monitor for seizures Monitor for suicidal ideation Should not stop abruptly Contraindicated: children younger than 12, recent MI, cardiac dysrhythmias, MAOI Caution: angle closure glaucoma, prostatic hypertrophy, urinary retention, liver/renal disorders, respiratory disorders, DM, alcoholism Selective Serotonin Reuptake Inhibitor (SSRIs): fluoxetine (Prozac) citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil) MOA: Prevents 5-HT (receptors) reuptake of serotonin Uses: depression, panic disorder, OCD, premenstrual dysphoric disorder, and bulimia nervosa; (first choice) Administration/Absorption PO, well-absorbed 94% protein-bound Metabolism: Initially converted to norfluoxetine, an active metabolite total T1/2 ~ 9 days Selective Serotonin Reuptake Inhibitor (SSRIs): fluoxetine (Prozac) Interactions Any drug that increases serotonin activation (MAOIs, herbal supplement) Adverse Effects Nausea & HA TCAs & lithium (fluoxetine raises the Insomnia levels of these drugs) Sexual dysfunction Antiplatelets & anticoagulants Weight gain (fluoxetine displaces warfarin for Hyponatremia protein binding) Withdrawal syndrome NSAIDS increase the risk of GI bleeding Serotonin syndrome Suicidal Ideation Serotonin Syndrome A group of symptoms caused by excessive accumulation of serotonergic transmission in the CNS Develops within hours or days Risk higher with concurrent use of other drugs that increase serotonin Symptoms Altered mental status – agitation, confusion, disorientation, hallucinations, poor concentration Increased SNS activity – incoordination, hyperreflexia, excessive sweating, tremor, fever Can be fatal if not treated Treatment: stop the SSRI Serotonin/Norepinephrine Reuptake Inhibitor (SNRIs): venlafaxine (Effexor XR) MOA: Block the neuronal uptake of both serotonin and norepinephrine Similar to SSRIs Uses: major depression, social anxiety, generalized anxiety Adverse Effects Similar to SSRI Most common- Nausea Also, anorexia and HTN Serotonin/Norepinephrine Reuptake Inhibitor (SNRIs): venlafaxine (Effexor XR) Administration Start low and titrate DO NOT STOP ABRUPTLY- taper Withdrawal sx- anxiety, tremors, headache, tachycardia, nausea, tinnitus, vertigo Contraindications MAOI or within 14 days of last dose Same as other SSRIs Interactions Trazadone and St. John’s Wort- increase Serotonin Syndrome Cimetidine (Tagamet)- increase blood levels of SNRI Nursing Considerations SSRI/SNRI Serotonin syndrome Suicide risk Educate that effects will build slowly Don’t stop the drug abruptly (SNRI > SSRI) Report sexual dysfunction Monitor for headaches and weight throughout therapy Monitor blood pressure Monitor serum sodium level Less than 7 should not take Caution for older adults and clients who have liver disease, peptic ulcer disease, or diabetes These materials were developed using: Assessment Technologies Institute. (2023). RN Pharmacology for Nursing Edition 9.0 Questions? MonoAmine Oxidase Inhibitors (MAOIs): phenelzine (Nardil) MOA: irreversibly inhibits MAO (enzyme that degrades 5-HT, NE, & dopamine) Allows more uptake of NE & serotonin Uses: depression, OCD Pharmacokinetics PO, well-absorbed There is a patch- Emsam MonoAmine Oxidase Inhibitors (MAOIs): phenelzine (Nardil) Interactions Adverse Effects Get ALL new meds approved CNS stimulation (OTC & Rx) Orthostatic hypotension TCAs & SSRIs GI symptoms- N/V, constipation Meds for HTN Hypertensive crisis (from dietary tyramine) Dietary tyramine Foods Containing Tyramine Tyramine – a dietary substance that promotes the release of NE from sympathetic neurons Nursing Considerations Monitor for CNS stimulation Monitor BP, education to stand slowly Monitor for suicidal ideation Educate on foods to avoid Educate on s/s of hypertensive crisis Contraindicated for clients older than 60 or younger than 6; taking an SSRI, or have a history of glaucoma or alcohol or drug addiction Use with caution in patients who have epilepsy, DM, schizophrenia, or mania Atypical Antidepressants: bupropion (Wellbutrin) MOA: Prevents reuptake of NE & dopamine Uses: Depression, smoking Benefits: cessation aid Weight loss Increased libido Administration/Absorption PO, well absorbed Do not crush/chew XR Metabolized by CYP P450 enzyme Atypical Antidepressants: bupropion (Wellbutrin) Interactions Adverse Effects Some SSRIs (d/t CYP enzymes, Seizures use lowest bupropion dosage) CNS stimulation (agitation, MAOIs (can cause bupropion tremors, tachycardia, insomnia) toxicity) N/V Increased risk for psychosis, hallucinations, delusions, as well as suicidal ideation (young) Nursing Considerations Monitor for seizures Thorough health history Educate to take in AM Give with food to decrease GI symptoms Monitor weight (anorexia) Monitor for CNS effects Discuss to take exactly as prescribed to avoid accidental overdose These materials were developed using: Assessment Technologies Institute. (2023). RN Pharmacology for Nursing Edition 9.0 Questions?  Management of Anxiety Disorders  Generalized Anxiety Disorder (GAD) Panic Disorder Anxiety Obsessive-Compulsive Disorder (OCD) Disorder s Social Anxiety Disorder Post-Traumatic Stress Disorder (PTSD) Anxiety Disorder Treatment Cognitive Behavioral Medications Therapy General Anxiety Disorder Serotonin Reuptake Inhibitors (SRIs) Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) Benzodiazepines (not first line) Anxiolytic drug: buspirone Anxiolytic: buspirone (Buspar) MOA: Unclear, but thought to bind to serotonin receptors (and some dopamine receptors) Not a CNS depressant, but just as effective No abuse potential No cross-dependence with benzos Therapeutic effect takes 1 week Uses: Anxiety control Administration/Absorption PO daily- not PRN Begin drug therapy 2 to 4 weeks before tapering Benzodiazepines Food delays absorption Anxiolytic: buspirone (Buspar) Adverse effects: Nausea HA Dizziness/ Lightheadedness Sedation in some, excitement in others Interactions: Grapefruit juice, erythromycin, ketoconazole (can increase buspirone levels) Concurrent use with MAOIs can cause severe HTN Nursing Considerations Make sure clients report any occurrences of paradoxical, GI, or CNS effects Suggest taking with food Suggest OTC analgesic for relief of HA Advise slow positional changes Caution use in clients who have liver or kidney insufficiency Contraindication: concurrent use of MAOI These materials were developed using: Assessment Technologies Institute. (2023). RN Pharmacology for Nursing Edition 9.0 Questions?