Psychotherapeutic Agents

8/7/2019 Psychotherapeutic Agents

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Psychotherapeutic AgentsPsychotherapeutic Agents


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Mental Disorders

caused by inherent dysfunction with in the

brain that leads to abnormal thought

processes responses due to chemical

imbalance.

Schizophrenia

Mania

Narcolepsy

Attention-deficit disorder


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Psychotherapeutic Drugs

Treats psychoses (perceptual & behavioral

disorder)

Not a cure rather help patients function inmore acceptable manner


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Chlorpromazine (Thorazine)

Clozapine (Clozaril)

- Atypical

- Typical

antipsychotic

drug


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Thera e tic acti s a i icati s

Ty ical a ti sychotic

r g

Block dopamine

receptor

Depress RAS (reticular

activating system)

Antcholinergic,antihistamine, alpha-

adrenergic blocking

Atypical antipsychotic

drug

Block dopamine and

Serotonin receptor


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Contraindications and Cautions

Presence of underlying diseases

Central nervous system (CNS) depression,circulatory collapse, Parkinson's disease,

coronary disease, severe hypotension, bonemarrow suppression, and blood dyscrasias

Prolongation of the QTc interval(mesoridazine, thioridazine, and ziprasidone)

Presence of glaucoma, peptic ulcer, andurinary or intestinal obstruction


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Patients with seizure disorders

Patients with thyrotoxicosis

Active alcoholism

Myelography within the last 24 hours orscheduled within the next 48 hours

Pregnancy or lactation

Children younger than 12 years of age who have a

CNS infection or chickenpox Patients who are immunosuppressed and those

who have cancer


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Adverse Effects

CNS effects:sedation, weakness, tremor, drowsiness, and

extrapyramidal effectspseudoparkinsonism,

dystonia, akathisia, tardive dyskinesia, and potentially

irreversible neuroleptic malignant syndrome

Anticholinergic effects:

dry mouth, nasal congestion, flushing, constipation,

urinary retention, sexual impotence, glaucoma, blurred

vision, and photophobia.

Cardiovascular (CV) effects:

hypotension, orthostatic hypotension, cardiac

arrhythmias, congestive heart failure, and pulmonary

edema. For prolongation of the QTc interval, serious or

fatal cardiac arrhythmias.


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Adverse Effects

Diabetes mellitus (use of atypical antipsychotics )

Respiratory effects

laryngospasm, dyspnea, and bronchospasm

The phenothiazines (chlorpromazine, fluphenazine,prochlorperazine, promethazine, and thioridazine) turn

the urine pink to reddish-brown

(has no clinical significance)

Bone marrow suppression


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Nursing

Considerations


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Assessment

Screen for the followingconditions, which could becontraindications orcautions for the use of thedrug:

Any known allergies to these drugs, severe CNSdepression, circulatory collapse, coronarydisease including prolonged QTc interval, braindamage, severe hypotension, glaucoma,respiratory depression, urinary or intestinalobstruction, thyrotoxicosis, seizure disorder,bone marrow suppression, pregnancy or

lactation, and myelography within the past 24hours or scheduled in the next 48 hours. Inchildren younger than 12 years of age, screenfor CNS infections.

Screening for baselinestatus before beginningtherapy and for anypotential adverse effects.

o Temperature; skin color and lesions;

o CNS orientation, affect, reflexes, and bilateralgrip strength;

o Bowel sounds and reported output;

o Pulse, auscultation, and blood pressure,(including orthostatic blood pressure);

o Respiration rate and adventitious sounds;

o Urinary output.

o Lab Tests: Liver and renal function tests,Thyroid function tests, ECG, Complete bloodcount (CBC).


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Nursing Diagnosis

Impaired Physical Mobility related toextrapyramidal effects

Decreased Cardiac Output related tohypotensive effects

Risk for Injury related to CNS effects andsedation

Impaired Urinary Elimination related toanticholinergic effects

Deficient Knowledge regarding drug therapy


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Implementation

Do not allow the patient to crush or chew sustained-release

capsules

If the patient receives parenteral forms, keep the patient

recumbent for 30 minutes Consider warning the patient or the patient's guardians

about the risk of development of tardive dyskinesias with

continued use

Arrange for gradual dose reduction after long-term use

Provide positioning of legs and arms

Provide sugarless candy and ice chips


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Implementation

Frequent mouth care

Encourage the patient to void before taking a dose

Provide safety measures such as siderails and assistancewith ambulation if CNS effects or orthostatic hypotension

occurs Provide for vision examinations

Provide thorough patient teaching, including drug name,prescribed dosage, measures for avoidance of adverseeffects, warning signs, and the need for monitoring and

evaluation Warn patients that urine may have a pink to reddish-brown

color.

Offer support and encouragement


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Evaluation

Monitor patient response to the drug

Monitor for adverse effects

Evaluate effectiveness of teaching plan

Monitor the effectiveness of comfort

measures and compliance with the regimen


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Other Drugs

Typical

Fluphenazine

Haloperidol

Loxapine

Molindone

Atypical

Aripiprazole

Olanzapine

Quetiapine

Risperidone

Ziprasidone


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Lithium Salts (Lithane, Lithotabs)

Antimanic drug: treatment for mania


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Thera e tic Actions andIndications

Alters sodium transport in nerve and muscle cells.

Inhibits the release of norepinephrine anddopamine, but not serotonin, from stimulated

neurons. Increases the intraneuronal stores of

norepinephrine and dopamine slightly.

Decreases intraneuronal content of secondmessengers by selectively modulating theresponsiveness of hyperactive neurons that mightcontribute to the manic state.


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Hypersensitivity to lithium.

Renal or cardiac disease

History of leukemia; metabolic disorders (sodium

depletion); dehydration; and diuretic use Pregnancy and lactation are also

contraindications

Caution should be used in any condition that

could alter sodium levels (protracted diarrhea orexcessive sweating; with suicidal or impulsivepatients; and in patients who have infection withfever)


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Adverse Effects

Serum levels of less than 1.5 mEq/L: CNS problems, includinglethargy, slurred speech, muscle weakness, and fine tremor;polyuria, which relates to renal toxicity; and beginning of gastrictoxicity, with nausea, vomiting, and diarrhea

Serum levels of 1.5 to 2 mEq/L: Intensification of all of the above

reactions, with ECG changes Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects

to ataxia, clonic movements, hyperreflexia, and seizures; possibleCV effects such as severe ECG changes and hypotension; largeoutput of dilute urine secondary to renal toxicity; fatalitiessecondary to pulmonary toxicity

Serum levels greater than 2.5 mEq/L: Complex multiorgan toxicity,with a significant risk of death


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N

ursingC

onsiderations


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Assessment

Screen for the followingconditions, which could becontraindications orcautions for the use of the

drug:Any known allergies to lithium; renal or CV

disease; dehydration; sodium depletion, useof diuretics, protracted sweating, ordiarrhea; suicidal or impulsive patients withsevere depression; pregnancy or lactation;and infection with fever.


o temperature; skin color and lesions

o CNS orientation, affect, and reflexes

o bowel sounds and reportedoutput

o pulse, auscultation, and blood pressure,(orthostatic blood pressure)

o respiration rate and adventitious sounds

o urinary output

o Lav Tests: liver and renal function tests,thyroid function tests, CBC, and baselineECG, and serum lithium


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Nursing Diagnosis

Acute Pain related to GI, CNS, and vision

effects

Risk for Injury related to CNS effects Impaired Urinary Elimination related to renal

toxic effects

DisturbedT

houghtP

rocesses related to CNSeffects



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Implementation

Give the drug cautiously, with daily monitoring ofserum lithium levels, to patients with significantrenal or CV disease, dehydration, or debilitation,as well as those taking diuretics

Give the drug with food or milk

Arrange to decrease dose after acute manicepisodes.

Ensure that the patient maintains adequateintake of salt and fluid

Monitor the patient's clinical status closely,especially during the initial stages of therapy


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Implementation

Arrange for small frequent meals, sugarlesslozenges to suck, and frequent mouth care

Provide safety measures such as siderails and

assistance with ambulation if CNS effects occur Provide thorough patient teaching, including drug

name, prescribed dosage, measures foravoidance of adverse effects, warning signs that

may indicate possible problems, and the need toavoid pregnancy while taking lithium

Offer support and encouragement


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Evaluation



Evaluate the effectiveness of the teaching plan

Monitor the effectiveness of comfort

measures and compliance with the regimen.


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Other Drugs

Aripiprazole

Lamotrigine

Olanzapine

Quetiapine

Ziprasidone


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Methylphenidate (Ritalin, Concerta)

Central Nervous System Stimulant

Treatment ofattention-deficit disorders,

hyperactivity and narcolepsy.


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Thera e tic actions andIndications

Act as cortical and RAS stimulants, possibly by

increasing the release of catecholamines from

presynaptic neurons, leading to an increase in

stimulation of the postsynaptic neurons.


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Known allergy to the drug.

Marked anxiety, agitation, or tension and severefatigue or glaucoma

Cardiac disease

Pregnancy and lactation

Patents with a history of seizures

With a history of drug dependence, includingalcoholism

With hypertension


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Adverse Effects

CNS effects

nervousness, insomnia, dizziness, headache,blurred vision, and difficulty with

accommodation. GI effects

anorexia, nausea, and weight loss

CV effects

hypertension, arrhythmias, and angina. Skin rashes

Physical and psychological dependence


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Nursing Considerations


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Assessment

Screen for the followingconditions, which could becontraindications orcautions for the use of thedrug

Any known allergies to the drug;glaucoma, anxiety, tension, fatigue,or seizure disorder; cardiac diseaseand hypertension; pregnancy orlactation; a history of leukemia; andhistory of drug dependency, including

alcoholism.


o Temperature; skin color and lesions

o CNS orientation, affect, and reflexes

o Ophthalmic examination

o Bowel sounds and reported output

o Pulse, auscultation, and bloodpressure (orthostatic blood pressure)

o Respiration rate and adventitioussounds

o Urinary output

o Obtain a CBC


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Nursing Diagnosis

Disturbed Thought Processes related to CNS

effects of the drug

Decreased Cardiac Output related to CVeffects of the drug

Risk for Injury related to CNS and visual effects

of the drug



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Implementation

Ensure proper diagnosis of behavioral syndromesand narcolepsy

Arrange to interrupt the drug periodically in

children who are receiving the drug forbehavioral syndromes

Arrange to dispense the least amount of drugpossible

Administer the drug before 6 PM

Monitor weight, CBC, and ECG

Consult with the school nurse or counselor


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Implementation

Provide safety measures such as siderails and

assistance with ambulation if CNS effects occur

Provide thorough patient teaching, including drug

name, prescribed dosage, measures for

avoidance of adverse effects, warning signs that

may indicate possible problems, and the need for

monitoring and evaluation to Offer support and encouragement to help the

patient cope with the drug regimen.


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Evaluation



Evaluate the effectiveness of the teaching plan Monitor the effectiveness of comfort

measures and compliance with the regimen.


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THANK YOU!!!!Prepared by:

Ray S. Buencuchillo

Er


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Schizophrenia (Greek: Split mind)

loss of contact with reality, bizarre behavior,

disorganized thinking and speech, decreased

emotional expressiveness, and social

withdrawal.

may have difficulty telling the difference

between real and unreal experiences, logical

and illogical thoughts, or appropriate andinappropriate behavior.


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Mania

elevated or irritable mood, exaggerated self-

importance, racing thoughts, and

hyperactivity.

People with mania often have inflated self-

esteem and self-confidence, and assume they

have more wit, courage, imagination, and

artistry than everyone else.


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Attention-deficit disorder

persistent inability to sit still, focus attention

on specific tasks, and control impulses.


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Narcolepsy

sudden and uncontrollable drowsiness and

attacks of sleep at unexpected and irregular

intervals that may last minutes or hours and

vary in frequency from a few to many in a

single day.


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Antipsychotic/Neuroleptic Drug

known before as Major Tranquilizer: not forsedation yet in change in neuron stimulation andresponse.

Dopamine receptor blockers: used to treatdisorders that involve thought processes.

Neuroleptic: due to adverse effects

Schizophrenia, Hyperactivity, combative behavior,

agitation in the elderly, short-term control.

Types: Typical and Atypical


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Central Nervous System Stimulant

Treat both attention-deficit disorders and

narcolepsy

Calm hyperkinetic children and help them

focus on one

Activity for a longer period

Redirect and excite the arousal stimuli from

the RAS

Psychotherapeutic Agents

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