12.pharmacology
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  • 1. MENTAL HEALTH Pharmacology
  • 2. Classes of Drugs Used to Treat Depression:  SSRI’s (page 167 ATI)  MAOIs (page 170 ATI)  Tricyclic (TCAs)  Atypical antidepressants (page 165 ATI) (page 172 ATI)
  • 3. SSRI?  Selective Serotonin Reuptake Inhibitors (SSRI)  Currently first choice medication for depression
  • 4. Commonly used SSRIs  Prozac  Paxil  Zoloft  Celexa  Lexapro
  • 5. 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
  • 6. Common Side Effects of SSRIs           Nausea Sexual dysfunction, including reduced desire or orgasm difficulties Dry mouth Headache Diarrhea Nervousness Rash Weight gain Insomnia Agitation, restlessness
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. Nursing interventions and teaching     Advise – 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
  • 11. Antidepressant Medications MAOI  Monoamine oxidase inhibitors
  • 12. MAOI  Marplan Parnate Nardil  “No Popular Meds”  
  • 13. How Do MAOIs 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
  • 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. Common Side Effects of MAOIs           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
  • 16. Tricyclic Antidepressant Medications (TCAs)
  • 17. TCA’S     Elavil Sinequan Tofranil Nortriptyline
  • 18. What is the Action of a Trycyclic?  Block reuptake of norepinephrine and serotonin in brain
  • 19. Tricyclics (TCAs)  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
  • 20. Common Side Effects of Tricyclics (TCAs)             Tremor Unpleasant taste Nausea Dry mouth Fatigue Weakness Anxiety Sensitivity to sunlight Insomnia Sedation Nervousness Excessive sweating
  • 21. Nursing Interventions and Teaching      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
  • 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. Anti-Anxiety Medications
  • 24. Anti-Anxiety Medications (Anxiolytics) Usually ends in “pam” Ativan (lorazepam) BuSpar (buspirone) Inderal (propanolol) Klonopin (clonazepam) Librium (chlordiazepoxide) Serax (oxazepam) Valium (diazepam) Xanax (alprazolam
  • 25. Anti-Anxiety Medications (Anxiolytics)     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 that are used to treat anxiety, can be addictive.
  • 26. Common Side Effects of Anti-Anxiety Medications         Dizziness or lightheaded Trouble sleeping Feeling very tired Stomachache Vomiting Rash Diarrhea Constipation
  • 27. Nursing Interventions and Teaching        Can cause drowsiness Can cause tiredness Can cause loss of coordination Do not drink alcohol Caution when operating machinery May have withdrawal symptoms May take 1-3 weeks until symptoms start to improve. Results are not immediate!
  • 28. Anti-Psychotic Medications
  • 29. Anti-Psychotic Medication Examples  Conventional (high risk for EPS)    Thorazine Haldol Atypical (low risk for EPS)      Seroquel Abilify Zyprexa (Olanzepine) Resperidol (Resperdone) Clozaril
  • 30. Anti-Psychotic Medications  What are they used for?  Primary use is for Schizophrenia  Also used for  Bipolar disorder  Tourette’s syndrome  Dementia
  • 31. Anti-Psychotic Medications  GOAL    Suppress acute episode Prevent acute recurrence Maintain highest level of functioning
  • 32. Anti-Psychotic Medications Common 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
  • 33. Conventional Anti-Psychotic Medications Common side effects defined:   Anticholinergic  Dry mouth, blurred vision, acute urinary retention, constipation, and tachycardia. Late-Extrapyramidal (Tardive Dyskinesia) KNOW!!!  Involuntary movements of the tongue and face (lip smacking), involuntary movements of the arms, legs, and trunk     Does not occur until after many months or years of taking anti-psychotic drugs. HALDOL Parkinson’s effects  Rigidity, shuffling gait, drooling, tremors Acute Dystonia  Severe spasm of the tongue, neck, face, and back
  • 34. What is Neuroleptic Malignant Syndrome?   Uncommon effect that is potentially fatal when it occurs (pg 190 ATI) Symptoms      High grade fever Blood pressure fluctuation Dysrhythmias Muscle rigidity Change in level of consciousness developing into coma – confusion
  • 35. Nursing Interventions for Neuroleptic Malignant Syndrome       Stop the anti-psychotic medication Monitor VS Applying cooling blanket Antipyretics Increase fluid intake Benzodiazepines for anxiety
  • 36. Teaching Topics for Clients Taking Atypical Anti-Psychotics   Therapeutic effect may be noticed in a few days but significant improvement may take 2 to 4 weeks and several months for full effect Watch for Agranulocytosis!!! (what is this?)    Tell patient to observe for signs of infection such as fever or sore throat. Clozaril Page 196 ATI
  • 37. Teaching Topics for Clients Taking Atypical Anti-Psychotics   May cause sedation, orthostatic hypotension, anticholinergic effects, tremor, and weight gain Watch for increased blood sugar   Zyprexa Page 195 ATI
  • 38. Three Meds to Remember!    Haldol-high risk of Tardive Dyskinesia Clozaril-can cause agranulocytosis-watch for any signs of infection Zyprexa-watch for increased blood sugar
  • 39. Question:  Benadryl, Cogentin and Artane are three drugs used in mental health to treat what disorder? _______________________  Tardive Dyskinesia
  • 40. Mood Stabilizing Medications  What is an mood stabilizing medication?   Also know as mood stabilizers and antiepileptic drugs Used to stabilize mood and behavior with bipolar disorders
  • 41. Mood Stabilizing Medications     Lithium-very important medication to remember! Carbamazepine (Tegretol) Depakote (Valproic Acid) Lamictal (Lamotrigine)
  • 42. Mood Stabilizing Medications  All of these meds can cause     Birth defects-teratogenisis Skin rashes-serious Hepatotoxicity GI effects
  • 43. Mood Stabilizing Medications Page 184 ATI  Lamictal   Depakote   Monitor for adverse affects May have to adjust phenytoin and phenobarbital levels Tegretol    Use alternate form of BCP Avoid drinking grapefruit juice May have to adjust phenytoin and phenobarbital levels
  • 44. Lithium Levels       Therapeutic-0.6 to 1.2mEq/L Toxicity-greater than 1.4mEq/L Sodium depletion can cause lithium toxicity What is a normal Sodium level?? Life threatening emergency greater than 2mEq/L Check levels every 2-3 days initially, then every 1-3 months thereafter
  • 45. 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. Treatment for lithium toxicity     Stopping lithium IV fluids Pumping stomach Dialysis
  • 47. Preventing Lithium Toxicity     Follow dosing instructions carefully Drink plenty of fluid Do not change or restrict salt intake-Why? Check lithium level regularly-How often should the levels be checked???
  • 48. Medications for Substance Abuse
  • 49. Detoxification (Alcohol)   Medications are used to decrease the intensity of withdrawal symptoms, decreases the risk of seizures, and maintains vital signs within normal limits Benzodiazepines    diazepam (Valium) lorazepam (Ativan) Page 220 ATI
  • 50. Abstinence Maintenance (Alcohol)  Disulfiram (Antabuse) KNOW!!!    Type of behavioral therapy (negative feedback) Drinking alcohol and taking this can progress to death (page 220 ATI) Effects of taking this medication along with alcohol causes N/V, weakness, sweating, palpitations, and hypotension
  • 51. Medications to Support Withdrawal from Opioids  Methadone    Do not abruptly discontinue Replaces the opioid to which clients are addicted Clonidine   Assists with therapy, does not reduce craving for opioids Page 221 ATI