MENTAL HEALTH

Pharmacology
Classes of drugs used to treat depression:


SSRI’s



MAOI’s



Tricyclic (TCA)



(Atypical antidepressants)
SSRI?


Selective Serotonin Reuptake Inhibitors
(SSRI)


Currently first choice medication for depression
SSRI?


Selective Serotonin Reuptake Inhibitors
(SSRI)







Works by blocking re-absorption of serotonin by
nerve c...
What is Serotonin Syndrome?







Rare life-threatening side effect of SSRI’s
Characterized by dangerously high level...
What is Serotonin Syndrome?


Can occur when SSRI’s are taken with other
medications such as





Pain relief medicati...
Serotonin Syndrome symptoms:













Confusion
Anxiety
Hallucination
Extreme agitation
Fluctuations in bl...
Common side effects of SSRI











Nausea
Sexual dysfunction, including reduced desire or
orgasm difficultie...
Nursing interventions and teaching
concerns for clients:







Advice – effects may not be experienced for
2-4 weeks ...
Commonly used SSRI’s


Prozac



Paxil



Zoloft



Celexa



Lexapro
MAOI


Monoamine oxidase inhibitors
How do MAOI’S work






Help balance certain chemicals in the brain to
relieve symptoms of anxiety associated with pan...
MAOI


Clients taking MAOI’s can develop
hypertensive crisis if they consume what
foods?
MAOI


Clients taking MAOI’s can develop
hypertensive crisis if they consume what
foods?



Some cheeses
Broad beans su...
MAOI




Marplan
Parnate
Nardil
MAOI


Common side effects of MAOI’s











Difficulty getting to sleep
Dizziness, lightheadedness, faintin...
What is action of a Tricyclics?
TCA
Block reuptake of norepinephrine and
serotonin in brain
Tricyclics


Tricyclic antidepressants should be avoided
in patients who have what disorder(s)?







MAOI medicat...
Tricyclics


Common side effects of Tricyclics













Tremor
Unpleasant taste
Nausea
Dry mouth
Fatigue
...
Nursing interventions and teaching
concerns for clients:








Monitor mental status and affect
Assess for suicidal...
TCA’S





Elavil
Sinequan
Tofranil
Nortriptyline
Atypical antidepressants


Wellbutrin





Effexor, Cymbalta




Inhibit serotonin and norepinephrine reuptake

Reme...
What are Anti-anxiety
Medications?






Used to treat a variety of anxiety disorders
Used in treatment of alcohol and drug
withdrawal
Sometime referred ...
Anti anxiety medications









Ativan (lorazepam)
BuSpar (buspirone)
Inderal (propanolol)
Klonopin (clonazepam)...
Anti-anxiety Medications


Common side effects of anti-anxiety agents









Dizziness or lightheaded
Trouble s...
Nursing interventions and teaching
concerns for clients:







Can cause drowsiness
Can cause tiredness
Can cause l...
Antipsychotic Agents
Commonly used to treat:


Positive symptoms






Agitation
Delusion
Hallicinations

Negative symptoms




Social ...


GOAL




suppress acute episode
Prevent acute recurrence
Maintain highest level of functioning
Side effects


Many go away after a few weeks of treatment









Drowsiness, tachycardia, dizziness

Decrease i...
Common side effects defined:


Anticholinergic
 Dry mouth, visual disturbances, acute urinary retention,
constipation an...
What is Neuroleptic Malignant Syndrome?


Uncommon effect that is potentially fatal
when it occurs
Symptoms of Neuroleptic Malignant
Syndrome?






High grade fever
Blood pressure fluctuation
Dysrhythmias
Muscle rig...
Nursing interventions for Neuroleptic
malignant syndrome







Stop the med
Monitor VS
Applying cooling blanket
Ant...
Client teaching topics for clients taking
antipyschotics


Therapeutic effect may be noticed in a few
days but significan...


Conventional





Thorazine
Haldol

Atypical





Seroquel
Abilify
Zyprexa (Olanzepine) and
Resperidol (Resperdo...
What is Tardive Dyskinesia?
Tardive Dyskinesia:






Muscular side effects of anti-psychotic drugs,
especially the older generation like
haloperid...
Tardive Dyskinesia:


Prevention is achieved by using the lowest
effective dose for the shortest time.
Question:


Benadryl, Cogentin and Artane are three
drugs used in mental health to treat what
disorder? _________________...
Anti Manic


What is an antimanic medication




Also know as mood stabilizers and
anticonsulvants
Used to stabilize mo...
List common antimanics




Lithium
Dapakene
Depakote
Lithium level




Therapeutic 0.6 to 1.2mEq/L
Toxicity greater than 1.4mEq/L
Life threatening emergency greater than
2m...
What are signs of lithium toxicity

















Level greater than 1.4 mEq/L
Shakiness
Thirst
Frequent...
Treatment for lithium toxicity





Stopping lithium
IV fluids
Pumping stomach
dialysis
Preventing lithium toxicity





Follow dosing instruction carefully
Drink plenty of fluid
Do not change or restrict s...
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12.pharmacology

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12.pharmacology

  1. 1. MENTAL HEALTH Pharmacology
  2. 2. Classes of drugs used to treat depression:  SSRI’s  MAOI’s  Tricyclic (TCA)  (Atypical antidepressants)
  3. 3. SSRI?  Selective Serotonin Reuptake Inhibitors (SSRI)  Currently first choice medication for depression
  4. 4. SSRI?  Selective Serotonin Reuptake Inhibitors (SSRI)     Works by blocking re-absorption of serotonin by nerve cells in the brain Leaves more serotonin available in the brain Increases amount of serotonin enhances the sending of nerve impulses and increases mood Affect only serotonin not other neurotransmitters
  5. 5. What is Serotonin Syndrome?     Rare life-threatening side effect of SSRI’s Characterized by dangerously high levels of serotonin in the brain Can occur when SSRI interacts with antidepressants called monoamine oxidase inhibitors (MAOI’s) Can occur when SSRI’s are taken with other medications
  6. 6. What is Serotonin Syndrome?  Can occur when SSRI’s are taken with other medications such as    Pain relief medication such as tramadol Migraine medication such as sumatriptan and rizatriptan Supplements that affect secrotoin levels, such as St. John’s Wort
  7. 7. Serotonin Syndrome symptoms:             Confusion Anxiety Hallucination Extreme agitation Fluctuations in blood pressure Increased heart rate Nausea and vomiting Fever Seizures Flu like symptom Lethargy coma
  8. 8. Common side effects of SSRI           Nausea Sexual dysfunction, including reduced desire or orgasm difficulties Dry mouth Headache Diarrhea Nervousness Rash Weight gain Insomnia Agitation, restlessness
  9. 9. Nursing interventions and teaching concerns for clients:     Advice – effects may not be experienced for 2-4 weeks and may take 8-12 month for full benefit to be achieved Continue therapy after notice improvement in symptoms Sudden discontinuation may result in relapse Do not take with MAOI’s
  10. 10. Commonly used SSRI’s  Prozac  Paxil  Zoloft  Celexa  Lexapro
  11. 11. MAOI  Monoamine oxidase inhibitors
  12. 12. How do MAOI’S work    Help balance certain chemicals in the brain to relieve symptoms of anxiety associated with panic disorders Not recommended for children, teens, nursing or pregnant women Inhibit enzyme monoamine oxidase in brain increasing norepinephrine and serotonin
  13. 13. MAOI  Clients taking MAOI’s can develop hypertensive crisis if they consume what foods?
  14. 14. MAOI  Clients taking MAOI’s can develop hypertensive crisis if they consume what foods?   Some cheeses Broad beans such as   Fava beans Pickled foods like    Sauerkraut Beer Red wine
  15. 15. MAOI    Marplan Parnate Nardil
  16. 16. MAOI  Common side effects of MAOI’s           Difficulty getting to sleep Dizziness, lightheadedness, fainting Dry mouth Blurred vision Appetite changes Severe high blood pressure Changes in heart rate and rhythm Muscle twitching and feeling of restlessness Loss of sexual desire or ability Weight gain
  17. 17. What is action of a Tricyclics? TCA Block reuptake of norepinephrine and serotonin in brain
  18. 18. Tricyclics  Tricyclic antidepressants should be avoided in patients who have what disorder(s)?       MAOI medications recently Drinking problem Schizophrenics or manic depressive Cardiac conditions Bone marrow function disorders Blood cell disorder
  19. 19. Tricyclics  Common side effects of Tricyclics             Tremor Unpleasant taste Nausea Dry mouth Fatigue Weakness Anxiety Sensitivity to sunlight Insomnia Sedation Nervousness Excessive sweating
  20. 20. Nursing interventions and teaching concerns for clients:      Monitor mental status and affect Assess for suicidal tendencies Monitor blood pressure and pulse rate before and during therapy Assess for Leukopenia, liver function tests, serum glucose periodically May take 2-3 months to be therapeutic
  21. 21. TCA’S     Elavil Sinequan Tofranil Nortriptyline
  22. 22. Atypical antidepressants  Wellbutrin    Effexor, Cymbalta   Inhibit serotonin and norepinephrine reuptake Remeron   Inhibits dopamine uptake Don’t take with MAOI’s Increase release if serotonin and norepinephrine Trazodone  Blocks serotonin
  23. 23. What are Anti-anxiety Medications?
  24. 24.     Used to treat a variety of anxiety disorders Used in treatment of alcohol and drug withdrawal Sometime referred minor tranquilizers Some are used short term, benzodiazepines, while others are used long term, like buspar. Benzodiazepines are used to treat anxiety, can be addictive.
  25. 25. Anti anxiety medications         Ativan (lorazepam) BuSpar (buspirone) Inderal (propanolol) Klonopin (clonazepam) Librium (chlordiazepoxide) Serax (oxazepam) Valium (diazepam) Xanax (alprazolam
  26. 26. Anti-anxiety Medications  Common side effects of anti-anxiety agents         Dizziness or lightheaded Trouble sleeping Feeling very tired Stomachache Vomiting Rash Diarrhea Constipation
  27. 27. Nursing interventions and teaching concerns for clients:       Can cause drowsiness Can cause tiredness Can cause loss of coordination Do not drink alcohol Caution when operating machinery May have withdrawal symptoms
  28. 28. Antipsychotic Agents
  29. 29. Commonly used to treat:  Positive symptoms     Agitation Delusion Hallicinations Negative symptoms    Social withdrawal Lack of emotion Lack of energy
  30. 30.  GOAL    suppress acute episode Prevent acute recurrence Maintain highest level of functioning
  31. 31. Side effects  Many go away after a few weeks of treatment        Drowsiness, tachycardia, dizziness Decrease in sexual ability or interest Restlessness muscle spasms Shuffling walk Slowed movement and speech Parkinson like symptom
  32. 32. Common side effects defined:  Anticholinergic  Dry mouth, visual disturbances, acute urinary retention, constipation and tachycardia.  Extrapyramydal  Acute dystonia, severe spasms of tongue and jaw spreading to face, neck, and back  Parkinson’s effects  rigidity, shuffling gait, drooling, tremors  Dystonia  Inability to stand still or sit, pacing
  33. 33. What is Neuroleptic Malignant Syndrome?  Uncommon effect that is potentially fatal when it occurs
  34. 34. Symptoms of Neuroleptic Malignant Syndrome?      High grade fever Blood pressure fluctuation Dysrhythmias Muscle rigidity Change in level of consciousness developing into coma – confusion
  35. 35. Nursing interventions for Neuroleptic malignant syndrome       Stop the med Monitor VS Applying cooling blanket Antipyretics Increase fluid intake Benzodiazepines for anxiety
  36. 36. Client teaching topics for clients taking antipyschotics  Therapeutic effect may be noticed in a few days but significant improvement may take 2 to 4 weeks and several months for full effect
  37. 37.  Conventional    Thorazine Haldol Atypical     Seroquel Abilify Zyprexa (Olanzepine) and Resperidol (Resperdone)
  38. 38. What is Tardive Dyskinesia?
  39. 39. Tardive Dyskinesia:    Muscular side effects of anti-psychotic drugs, especially the older generation like haloperidol. Does not occur until after many months or years of taking anti-psychotic drugs. Primarily characterized by random movements in the tongue, lips or jaw as well as of the trunk or hips.
  40. 40. Tardive Dyskinesia:  Prevention is achieved by using the lowest effective dose for the shortest time.
  41. 41. Question:  Benadryl, Cogentin and Artane are three drugs used in mental health to treat what disorder? _______________________  Tardive Dyskinesia
  42. 42. Anti Manic  What is an antimanic medication   Also know as mood stabilizers and anticonsulvants Used to stabilize mood and behavior with bipolar disorders
  43. 43. List common antimanics    Lithium Dapakene Depakote
  44. 44. Lithium level    Therapeutic 0.6 to 1.2mEq/L Toxicity greater than 1.4mEq/L Life threatening emergency greater than 2mEq/L
  45. 45. What are signs of lithium toxicity                 Level greater than 1.4 mEq/L Shakiness Thirst Frequent urination Diarrhea Vomiting Drowsiness Muscle weakness Coordination problems Giddiness Blurred vision Tinnitus Seizure Slurred speech Decrease LOC Possible death
  46. 46. Treatment for lithium toxicity     Stopping lithium IV fluids Pumping stomach dialysis
  47. 47. Preventing lithium toxicity     Follow dosing instruction carefully Drink plenty of fluid Do not change or restrict salt intake Check lithium level regularly

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