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Mental Health Nursing Psychopharmacology Worksheets

There are 4 drug worksheets in all:1. Anxiolytics, hypnotics & sedatives (6 questions) – Week 52. Antidepressant (10 questions) – Week 63. Mood stabilisers (10 questions) – Week 64. Antipsychotic (9 questions) – Week 7

Student Name:Student Number:

Lab Group / Day:Tutor:

ANXIOLYTIC WORKSHEET(Incorporating anxiolytics, hypnotics &

sedatives)

OBJECTIVES:

At the completion of this worksheet, the student will be able to:

1. State 5 disorders for the use of anxiolytic drugs.

2. List the generic name and trade name & dosages for at least 5 anxiolytic drugs.

3. Summarise the precautions to be observed when a person is to receive anxiolytic drugs.

4. Outline the nursing management for a person receiving anxiolytic medication.

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ANTI ANXIETY MEDICATIONS

(ANXIOLYTICS : MINOR TRANQUILLISERS)

This group of drugs include Benzodiazepines, Barbiturates, bromides and Meprobamate. This worksheet will concentrate on the Benzodiazepines as they are the most widely used group of drugs in the treatment of Anxiety.The Benzodiazepine group of drugs is used in the treatment of anxiety, tension and aggression. Treatment is commenced only if the anxiety is severe enough to interfere with a persons' activities of daily living.They are not appropriate for relieving chronic anxiety or the anxieties of everyday living. These drugs should be only an adjunct to other non-pharmalogic therapies eg. Psycho-therapy, Relaxation Therapy, Hypno-therapy.The Benzodiazepines have a very real possibility of fostering dependency, therefore, all benzodiazepines should be withdrawn gradually.

Question 1Briefly state a definition of Anxiety:

Actions & UsesMode of action largely unknown; some suggestion of their action on the limbic system and on the brain stem reticular system and at the myoneural junction which produces its muscle relaxant properties.Question 2List five (5) disorders/conditions for which Benzodiazepines may be prescribed.1.2.3.4.5.

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QUESTION 3

Complete the following table:

GENERIC BRAND DAILY DOSE RANGE (MG) oral

Alprazolam 0.5 – 5Bromazepam 3 – 30Clobazam 10 – 30Clonazepam 0.5 – 6Clorazepate 5 – 30Chlordiazepoxide 10 – 50Diazepam *

*2 - 25

Flunitrazepam 1 – 2Flurazepam 15 – 30Lorazepam 1 – 6

Nitrazepam **

5 - 10

Oxazepam **

10 – 90

Temazepam ***

10 – 20

Triazolam 0.125 –0.25NON – BENZODIAZEPINE

ANXIOLYTIC

Buspirone 15 - 60FOR AKATHISIA, ANXIETY

TREMOR

Propranolol 40 - 160

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CONTRAINDICATIONS AND PRECAUTIONS

QUESTION 4List 5 contraindications / precautions with the use of Benzodiazepines:1.2.3.4.5.

ADVERSE REACTIONS

Adverse Reactions tend to be rare, but can range from mild discomfort to gross pathological changes which needs termination of treatment.

QUESTION 5List ten (5) adverse reactions / side effects that may occur with the use of Benodiazepines:1.2.3.4.5.

The safety margin for Benzodiazepines is wide, they are comparatively safe in overdose eg. a suicide attempt using 2250 mg of Chlordiazepoxide remain unsuccessful.

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QUESTION 6Outline the nursing implications related to the use of Benzodiazepines.

BIBLIOGRAPHY:

Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:

Pearson.

MIMS Annual 2006 - Supplement No. 1 Sydney : MIMS Australia, 2006.

Pharmacology and drug information for nurses / Society of Hospital Pharmacists of Australia .

(4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,

Treatment Protocol Project 2000. Management of Mental Disorders (third edition), Sydney, World

Health Organisation Collaborating Centre for Mental Health and Substance Abuse, Volumes 1 & 2.

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ANTIDEPRESSANT MEDICATION WORKSHEET

OBJECTIVESUpon completion of this worksheet, the student will be able to:

1. Distinguish between the major drug classes used in the treatment of depression.

2. List the disorders for which they may be prescribed.

3. Name drugs from each group and the average daily dose.

4. Outline the possible adverse reactions that can occur with each drug group.

5. Describe the medical and nursing precautions needed for each group.

6. Propose the nursing management of a client receiving antidepressants.

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INTRODUCTION

There are a number of drug classes used in the treatment of depression:1. Tricyclic antidepressant.2. Tetracyclic antidepressant.3. Selective Serotonin Reuptake Inhibitors (SSRIs)4. Monoamine Oxidase Inhibitors (MOAIs).5. Serotonin – noradrenaline reuptake inhibitors (SNRIs)6. Post – synaptic serotonin receptor blockers & reuptake inhibitors

These drugs elevate the mood of the depressed patient. There are different types of depression with different symptoms and each type would have a different treatment.

Tricyclic AntidepressantsQuestion 1List the disorders for which tricyclic antidepressants may be prescribed:1.2.3.4.5.

MODE OF ACTIONThe antidepressant activity of the tricyclics is thought to be due to the inhibition of the synaptic re uptake of amines such as noradrenaline and serotonin. This increases the neurotransmitter concentration in the brain. Other actions of these drugs include anticholinergic, antihistamine, hypothermic and antiemetic reactions.

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Question 2Complete the following table:

GENERIC TRADE /

BRAND

Daily dose range

MG

SEDATION ANTICHOLINERGIC

Amitriptyline **

100 - 250 xxxx xxxx

Imipramine **

100 - 250 xxx xxx

Desipramine 100 - 250 x xClomipramine 100 - 250 x xDoxepin *

*100 - 300 xxxx xxx

Nortriptyline 50 - 150 xxx xxx

Trimipramine 100 - 300 xxxx xxxxDothiepin 100 - 200 xxx xxx

Adverse Reactions / Side effectsMany adverse reactions have been reported during Tricyclic Antidepressant therapy. However, serious adverse reactions mainly occur with higher doses ie. over 200mg/day) and in the elderly. The most common reactions that may occur are sedation and anticholinergic reactions.

Question 3List possible adverse reactions that may occur with the use of Tricyclic Antidepressants, under the following headings:Autonomic Nervous System:

Cardiovascular:

Other:

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Question 4Outline the nursing implications for Tricyclic Antidepressants.

TETRACYCIC ANTIDEPRESSANTSMianserin Tolvon 30 - 120mg daily.

It is effective in all types of depression, has minimal cardiovascular effects, it reduces anticholigenic symptoms, it produces no significant cognitive impairment, it is relatively safe with the elderly. But adverse reactions still occur.Question 5List the possible adverse reactions of Mianserin.

IRREVERSIBLE MONOAMINE OXIDASE INHIBITORS (MAOIs)These are not the drug of choice in depressive illness, usually reserved when other drug treatment and other forms of therapy have not worked.Mode of ActionThe drugs act by decreasing the metabolism of certain neuro-transmitters in the brain, thereby making more biogenic amines available for release in the brain.

Question 6Complete the following table:

GENERIC NAME TRADE NAME USUAL DAILY DOSE

Tranylcypromine 20 - 60Phenelzine 30 - 90

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Question 7List the possible adverse reactions that may occur with the use of the MAOI's:

Question 8List the contra-indications and nursing implications for MAOI's:

REVERSIBLE MAOIEffective as irreversible MAOIs for treatment of depression, much safer in overdose, and Tyramine-free diet is not required.

Generic Trade

Moclobemide Aurorix 300 – 900 mg

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SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI’S)

Question 9– complete table:

Generic Brand / Trade name Daily Dosage mgCitalopram 20 - 60Fluoxetine 20 - 80Fluvoxamine 100 - 300Paroxetine 20 – 60Sertraline 50 - 200

Effectiveness of these agents is considered equivalent to that of tricyclic antidepressants, and in clinical use have:* lack of CVS effects (orthostatic hypotension); * few extra-pyramidal effects* less sedation, weight gain or impairment of cognitive or psychomotor function; * less dry mouth, * constipation

Question 10:List common Adverse Reactions / side effects of SSRIs:

** They must not be given with an irreversible MAOI as DEATH MAY OCCUR from “serotonergic syndrome”.

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BIBLIOGRAPHY:


Pearson.






Various Australian Pharmacology handouts and booklets.

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MOOD STABILISERSWORKSHEET

OBJECTIVES:At the completion of this worksheet, the student will be able to:

1. Name the trade names of different mood stabilisers used in Australia

2. List the disorders for which they can be used and the adverse reactions a person may experience.

3. Evaluate the medical and nursing procedures that should be preformed when a person is prescribed this

medication.

4. Outline the nursing precautions and management for a person receiving mood stabilisers.

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Mood stabilisers

Mood stabilisers are drugs used for use in people with bipolar illnesses: mixed, manic or depressed for long term prophylaxis. The main drug used is Lithium. In the 1880s, Lithium Salts were used for gout treatment and also in the 1940s as a salt substitute, but because of serious toxic problems, both were discontinued. In 1949, Australian John Cade discovered its antimanic properties. Since the 1960s, it has been used as the main antimanic drug of choice.

Question 1 – complete the table and answer the following questions:

Generic name Brand / trade name Usual daily dose mgLithium carbonate

Lithium carbonate has a therapeutic range of _______________ mmol/L. For prophylaxis treatment in bipolar

disorders, the common range is _____________ mmol/L . Symptoms of Lithium toxicity occur above __________

mmol/L .

Question 2:

List at least 4 uses of Lithium Carbonate:

Question 3:

List common side effects or adverse reactions that a person may experience when receiving Lithium Carbonate:

Question 4:Describe Lithium toxicity and the symptoms that can occur:

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Question 5:Outline the medical and nursing procedures that should be preformed prior to a person commencing on Lithium Carbonate:

Question 6:Summarise the nursing management and precautions for a person receiving Lithium Carbonate:

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Question 7: Complete the following: Generic name Brand / trade name Usual daily dose mgCarbamazepineSodium Valproate

List the psychiatric uses for Carbamazepine and Sodium Valproate:

Question 8: List the adverse reactions / side effects for Carbamazepine:

Question 9:

List the adverse reactions / side effects for Sodium Valproate:

Question 10:Summarise medical and nursing precautions prior to taking Carbamazepine and Sodium Valproate:

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BIBLIOGRAPHY:


Pearson.


Pharmacology and drug information for nurses / Society of Hospital Pharmacists of Australia. (4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,

Treatment Protocol Project 2000. Management of Mental Disorders (third edition),

Sydney, World Health Organisation Collaborating Centre for Mental Health and Substance

Abuse, Volumes 1 & 2.


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ANTIPSYCHOTIC(NEUROLEPTIC)

MEDICATION WORKSHEET(INCLUDING ANTIPARKINSONIAN MEDICATIONS)

OBJECTIVES

1. Identify the generic and trade / brand names of Neuroleptic drugs.

2. Outline the mode of action.

3. Select (5) disorders for which neuroleptics may be used.

4. Identify and define adverse reactions of neuroleptics.

5. Evaluate the nursing management of a person receiving neuroleptic drugs and

precautions to be observed when a person is receiving neuroleptics.

6. Identify neuroleptic malignant syndrome.

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NEUROLEPTICS

Also known as major tranquillisers or anti psychotic medication.

Prior to their inception, barbiturates and some Rauwolfa Agents were used for psychotic disorders.

These had many disadvantages (eg. general sedation and depression) and resulted in a search for other

drugs to use.

Chlorpromazine, introduced in 1952, revolutionised the treatment of psychotic disorders. It belongs to the

Phenothiazine class of Neuroleptics. Other classes include the Butyrophenones introduced after

successful trails, in 1958. The anti psychotics tend to be divided into low potency drugs – which are more

sedating and more likely to have anticholinergic side effects than the high potency drugs which produce

more extrapyramidal side effects, but tend to be less sedating – see table.

Neuroleptics alleviate symptoms of psychotic disorders, they DO NOT cure mental illness.

Question 1:


GENERIC TRADE or

BRAND

ORAL

DAILY

DOSE

RANGE

(MG)

SEDATION

-

HYPO-

TENSION

ANTI -

CHOLINERGIC

EXTRA

PYRAMIDAL

SIDE

EFFECTS

Chlorpromazine * 75 - 1000 XXX XXX XX x

Thioridazine *

*

50 - 800 XXX XXX XXX X

Fluphenazine *Anatensol

*

2.5 - 20

12.5 - 100 IM

every 14 to

35 days

xx x x xxx

Trifluoperizine 10 - 60 xx x x xxx

Droperidol 10 - 60 IM xx x x xxx

Haloperidol *

*Haldol

depot inj.

25 - 300

IM every 4

weeks

x x x xxx

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Pimozide 2 - 20 X x x xxx

ATYPICAL

Clozapine 25 - 600 Xxx xx xx x

Risperidone 2 - 8 Little xx not common x

Thiothixene 6 - 50 X x x xxx

Zuclopenthixol

decanoate

Clopixol depot

inj.

200 – 400

every 2 - 4

weeks

X x x xx

Flupenthixol 20 – 80

every 2 - 4

weeks

X X X x

Mode of Action

Neuroleptics are thought to act by blocking dopamine, the chemical neurotransmitter in the basal ganglia.

The drugs reduce or minimise the occurrence of cognitive dysfunction, without clouding of consciousness

- clients seem to have intact intellectual function and are less agitated, restless and impulsive. Sedative

properties are secondary to the anti-psychotic effects.

Question 2

List five psychiatric uses and non-psychiatric uses for which an antipsychotic / neuroleptic may be

prescribed.

PSYCHIATRIC NON-PSYCHIATRIC

1

2

3

4

5

Adverse Reactions

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During the course of treatment, adverse effects may occur depending on the dose, length of time and

frequency of use of the drug. A long list of possible reactions under different heading follows:

Question 3

Using the following headings, list the most common possible adverse effects of antipsychotic /

neuroleptic drugs.

AUTONOMIC (more common with chlorpromazine and thioridazine)

CARDIOVASCULAR

DERMATOLOGICAL

HEPATIC

OCULAR

SEIZURES

SEDATION

OTHERS

EXTRAPYRAMIDAL REACTIONS

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All antipsychotic / neuroleptics cause some extrapyramidal effects possibly due to their dopamine -

blocking action. They may start after only a few hours but are usually from long term use.

Question 4

Define and describe the clinical picture of each of the following extrapyramidal reactions:

Akathesia:

Dyskinesia:

Dystonia:

Pseudo-Parkinsonism:

Tardive Dyskinesia:

Question 5Outline the medical and nursing precautions that should be observed when a person is to receive neuroleptic drugs.

Question 6Summarise the nursing management of a person receiving neuroleptic drugs

ANTICHOLINERGICS - (ANTIPARKINSONIAN AGENTS)These are potent anticholinergic medication and are often used to treat most of the extrapyramidal effects. Benztropine tends to be the most commonly used (probably as it is available as an injection and has a longer duration of action).

Question 7

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(GENERIC

NAME

TRADE NAME USUAL DAILY DOSE

MG

SEDATION

Benztropine 0.5 to 6 oral, 1 to 2 IM/IV Sedating

Benzhexol 5 to 15 oral Stimulating

Orphenadrine 100 to 300 oral Sedating

Procyclidine 5 to 60 oral, 5 - 20 IM Sedating

Question 8

List some of the possible adverse reactions of Anticholinergic drugs.

Question 9

What is neuroleptic malignant syndrome (NMS)? List common features and symptoms of this syndrome.

BIBLIOGRAPHY: Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:

Pearson.







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