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psychotherapeutic agents
1.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic AgentsPsychotherapeutic Agents AntidepressantsAntidepressants and Antipsychoticsand Antipsychotics
2.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics • The therapy of emotional and mentalThe therapy of emotional and mental disordersdisorders
3.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics • AnxietyAnxiety • GriefGrief • DepressionDepression are normal human emotionsare normal human emotions
4.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics • The ability to cope with these emotions canThe ability to cope with these emotions can range from occasional depression or anxietyrange from occasional depression or anxiety to constant emotional distress to the pointto constant emotional distress to the point ofinterfering with the ability to carry onofinterfering with the ability to carry on normal daily living.normal daily living.
5.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics • When these emotions significantly affect anWhen these emotions significantly affect an individual’s ability to carry out normal dailyindividual’s ability to carry out normal daily functions, treatment with a psychotherapeuticfunctions, treatment with a psychotherapeutic drug is a possible option.drug is a possible option.
6.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics Three main emotional and mental disorders:Three main emotional and mental disorders: • PsychosesPsychoses • Affective disordersAffective disorders • AnxietyAnxiety
7.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics PsychosisPsychosis • A major emotional disorder that impairs the mentalA major emotional disorder that impairs the mental function of the affected individual to the point thatfunction of the affected individual to the point that the individual cannot participate in everyday life.the individual cannot participate in everyday life. • Hallmark: loss of contact with realityHallmark: loss of contact with reality
8.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics Affective DisordersAffective Disorders • Major emotional disorders that impair theMajor emotional disorders that impair the mental function of the affected individual tomental function of the affected individual to the point that the individual cannotthe point that the individual cannot participate in everyday life.participate in everyday life.
9.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics Affective DisordersAffective Disorders • Mania: abnormally pronounced emotionsMania: abnormally pronounced emotions • Depression: abnormally reduced emotionsDepression: abnormally reduced emotions • Bipolar affective disorder: exhibits both maniaBipolar affective disorder: exhibits both mania and depressionand depression
10.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics PathophysiologyPathophysiology Biochemical ImbalanceBiochemical Imbalance • Mental disorders are associated with abnormalMental disorders are associated with abnormal levels of endogenous chemicals, such aslevels of endogenous chemicals, such as neurotransmitters, in the brain.neurotransmitters, in the brain.
11.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics PathophysiologyPathophysiology Biochemical ImbalanceBiochemical Imbalance • Brain levels of certain catecholamines play anBrain levels of certain catecholamines play an important role in maintaining mental health.important role in maintaining mental health. – DopamineDopamine – SerotoninSerotonin – HistamineHistamine
12.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. PsychotherapeuticsPsychotherapeutics PathophysiologyPathophysiology Biochemical ImbalanceBiochemical Imbalance • Other biochemicals are necessary for normalOther biochemicals are necessary for normal mental function.mental function. – GABAGABA – acetylcholineacetylcholine – lithiumlithium
13.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Etiology of DepressionEtiology of Depression Biogenic Amine HypothesisBiogenic Amine Hypothesis • Depression and mania are due to an alteration inDepression and mania are due to an alteration in neuronal and synaptic catecholamine concentrationneuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain.at adrenergic receptor sites in the brain. – Depression: deficiency of catecholamine,Depression: deficiency of catecholamine, especially norepinephrineespecially norepinephrine – Mania: excess aminesMania: excess amines
14.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Instructors may wish to insertInstructors may wish to insert EIC Image #45:EIC Image #45: Biogenic Amine HypothesisBiogenic Amine Hypothesis
15.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Affective DisordersAffective Disorders Drug CategoriesDrug Categories • AntidepressantsAntidepressants • tricyclics, tetracyclics, SSRIs, MAOIstricyclics, tetracyclics, SSRIs, MAOIs • Antimanic AgentsAntimanic Agents • lithiumlithium
16.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntidepressantsAntidepressants Cyclic antidepressantsCyclic antidepressants – tricyclicstricyclics – tetracyclicstetracyclics • Monoamine oxidase inhibitors (MAOIs)Monoamine oxidase inhibitors (MAOIs) • Second-generation antidepressantsSecond-generation antidepressants and SSRIsand SSRIs
17.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Cyclic AntidepressantsCyclic Antidepressants • Tricyclic antidepressants—primary:Tricyclic antidepressants—primary: amitriptyline (Elavil), doxepin (Sinequan),amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil)imipramine (Tofranil) • Tricyclic antidepressants—secondary:Tricyclic antidepressants—secondary: desipramine (Norpramin), nortriptylinedesipramine (Norpramin), nortriptyline (Aventyl), protriptyline (Vivactil)(Aventyl), protriptyline (Vivactil) • Tetracyclic antidepressants:Tetracyclic antidepressants: amoxapine (Asendin), maprotiline (Ludiomil)amoxapine (Asendin), maprotiline (Ludiomil)
18.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Cyclic AntidepressantsCyclic Antidepressants Mechanism of ActionMechanism of Action • Block reuptake of neurotransmitters, causingBlock reuptake of neurotransmitters, causing accumulation at the nerve endings.accumulation at the nerve endings. • It is thought that increasing concentrations ofIt is thought that increasing concentrations of neurotransmitters will correct the abnormallyneurotransmitters will correct the abnormally low levels that lead to depression.low levels that lead to depression.
19.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Cyclic AntidepressantsCyclic Antidepressants Mechanism of Action—Drug EffectsMechanism of Action—Drug Effects Blockade of norepinephrine:Blockade of norepinephrine: – antidepressant, tremors, tachycardia, additiveantidepressant, tremors, tachycardia, additive pressor effects with sympathomimetic drugspressor effects with sympathomimetic drugs Blockade of serotonin:Blockade of serotonin: – antidepressant, nausea, headache, anxiety,antidepressant, nausea, headache, anxiety, sexual dysfunctionsexual dysfunction
20.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Cyclic AntidepressantsCyclic Antidepressants Therapeutic UsesTherapeutic Uses • DepressionDepression • Childhood enuresis (imipramine)Childhood enuresis (imipramine) • Obsessive-compulsive disordersObsessive-compulsive disorders (clomipramine)(clomipramine) • Adjunctive analgesicsAdjunctive analgesics • Trigeminal neuralgiaTrigeminal neuralgia
21.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Cyclic AntidepressantsCyclic Antidepressants Side EffectsSide Effects • SedationSedation • ImpotenceImpotence • Orthostatic hypotensionOrthostatic hypotension • Older patients:Older patients: – dizziness, postural hypotension, constipation,dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremorsdelayed micturation, edema, muscle tremors
22.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Tricyclic Antidepressants OverdoseTricyclic Antidepressants Overdose • Lethal—70 to 80% die before reachingLethal—70 to 80% die before reaching the hospitalthe hospital • CNS and cardiovascular systems areCNS and cardiovascular systems are mainly affectedmainly affected • Death results from seizures or dysrhythmiasDeath results from seizures or dysrhythmias • No specific antidoteNo specific antidote – Decrease drug absorption with activated charcoalDecrease drug absorption with activated charcoal – Speed elimination by alkalinizing urineSpeed elimination by alkalinizing urine – Manage seizures and dysrhythmiasManage seizures and dysrhythmias – Basic life supportBasic life support
23.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntidepressantsAntidepressants Monoamine Oxidase Inhibitors: MAOIsMonoamine Oxidase Inhibitors: MAOIs • Highly effectiveHighly effective • Considered second-line treatment forConsidered second-line treatment for depression not responsive to cyclicsdepression not responsive to cyclics • Disadvantage: potential to causeDisadvantage: potential to cause hypertensive crisis when taken with tyraminehypertensive crisis when taken with tyramine
24.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs • phenelzine (Nardil)phenelzine (Nardil) • tranylcypromine (Parnate)tranylcypromine (Parnate) • isocarboxazid (Marplan)isocarboxazid (Marplan)
25.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs Mechanism of ActionMechanism of Action • Inhibit the MAO enzyme system in the CNSInhibit the MAO enzyme system in the CNS • Amines (dopamine, serotonin,Amines (dopamine, serotonin, norepinephrine) are not broken down,norepinephrine) are not broken down, resulting in higher levels in the brainresulting in higher levels in the brain • Result: alleviation of symptoms ofResult: alleviation of symptoms of depressiondepression
26.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs Therapeutic UsesTherapeutic Uses • Depression, especially types characterizedDepression, especially types characterized by reverse vegetative symptoms such asby reverse vegetative symptoms such as increased sleep and appetiteincreased sleep and appetite • Depression that does not respond to otherDepression that does not respond to other agents such as tricyclicsagents such as tricyclics
27.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs Side EffectsSide Effects • Few side effects—orthostatic hypotensionFew side effects—orthostatic hypotension most commonmost common TachycardiaTachycardia PalpitationsPalpitations DizzinessDizziness DrowsinessDrowsiness InsomniaInsomnia HeadacheHeadache AnorexiaAnorexia NauseaNausea Blurred visionBlurred vision ImpotenceImpotence
28.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs OverdoseOverdose • Symptoms appear 12 hours after ingestionSymptoms appear 12 hours after ingestion • Tachycardia, circulatory collapse,Tachycardia, circulatory collapse, seizures, comaseizures, coma • Treatment: protect brain and heart,Treatment: protect brain and heart, eliminate toxineliminate toxin – Gastric lavageGastric lavage – Urine acidificationUrine acidification – HemodialysisHemodialysis
29.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs Hypertensive Crisis and TyramineHypertensive Crisis and Tyramine • Ingestion of foods and/or drinks withIngestion of foods and/or drinks with the amino acid TYRAMINE leads tothe amino acid TYRAMINE leads to hypertensive crisis, which may leadhypertensive crisis, which may lead to cerebral hemorrhage, stroke,to cerebral hemorrhage, stroke, coma, or deathcoma, or death
30.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antidepressants: MAOIsAntidepressants: MAOIs Hypertensive Crisis and TyramineHypertensive Crisis and Tyramine Avoid foods that contain tyramine!Avoid foods that contain tyramine! • Aged, mature cheeses (cheddar, blue, Swiss)Aged, mature cheeses (cheddar, blue, Swiss) • Smoked/pickled or aged meats, fish, poultrySmoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni,(herring, sausage, corned beef, salami, pepperoni, paté)paté) • Yeast extractsYeast extracts • Red wines (Chianti, burgundy, sherry, vermouth)Red wines (Chianti, burgundy, sherry, vermouth) • Italian broad beans (fava beans)Italian broad beans (fava beans)
31.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Second-Generation AntidepressantsSecond-Generation Antidepressants • NewerNewer • Fewer side effects than tricyclics, but notFewer side effects than tricyclics, but not superior in overall efficacy or onset of actionsuperior in overall efficacy or onset of action – trazodone (Desyrel)trazodone (Desyrel) – bupropion (Wellbutrin, Zyban)bupropion (Wellbutrin, Zyban) – selective serotonin reuptake inhibitors (SSRIs)selective serotonin reuptake inhibitors (SSRIs)
32.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Second-GenerationSecond-Generation Antidepressants and SSRIsAntidepressants and SSRIs Mechanism of ActionMechanism of Action • Selectively inhibit serotonin reuptakeSelectively inhibit serotonin reuptake • Little or no effect on norepinephrine orLittle or no effect on norepinephrine or dopamine reuptakedopamine reuptake • Results in increased serotoninResults in increased serotonin concentrations at nerve endingsconcentrations at nerve endings Advantage over tricyclics and MAOIs:Advantage over tricyclics and MAOIs: Little or no effect on cardiovascular systemLittle or no effect on cardiovascular system
33.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Second-Generation AntidepressantsSecond-Generation Antidepressants Therapeutic UsesTherapeutic Uses • Used for depression—very few serious side effectsUsed for depression—very few serious side effects • Bipolar affective disorderBipolar affective disorder • ObesityObesity • Eating disordersEating disorders • Obsessive-compulsive disorderObsessive-compulsive disorder • Panic attacksPanic attacks • MyoclonusMyoclonus • Treatment of various substance abuse problemsTreatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation(bupropion [Zyban] is used for smoking cessation treatment)treatment)
34.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Second-Generation AntidepressantsSecond-Generation Antidepressants Side EffectsSide Effects Body SystemBody System EffectsEffects CNSCNS Headache, dizziness,Headache, dizziness, tremor, nervousness,tremor, nervousness, insomnia, fatigueinsomnia, fatigue GIGI Nausea, diarrhea,Nausea, diarrhea, constipation, dry mouthconstipation, dry mouth OtherOther Sweating, sexualSweating, sexual dysfunctiondysfunction
35.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Second-Generation AntidepressantsSecond-Generation Antidepressants Drug InteractionsDrug Interactions • Highly bound to plasma proteinsHighly bound to plasma proteins • Compete with other protein-binding drugs,Compete with other protein-binding drugs, resulting in more free, unbound drug toresulting in more free, unbound drug to cause a more pronounced drug effectcause a more pronounced drug effect
36.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntipsychoticsAntipsychotics • Drugs used to treat serious mental illnessDrugs used to treat serious mental illness • Behavioral problems or psychotic disordersBehavioral problems or psychotic disorders
37.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntipsychoticsAntipsychotics • Thioxanthenes: chlorprothixene, thiothixeneThioxanthenes: chlorprothixene, thiothixene (Navane)(Navane) • Butyrophenones: haloperidol (Haldol)Butyrophenones: haloperidol (Haldol) • Dihydroindolones: molindone (Moban)Dihydroindolones: molindone (Moban) • Dibenzoxazepine: loxapine (Loxitane)Dibenzoxazepine: loxapine (Loxitane) • Phenothiazines: three structural groupsPhenothiazines: three structural groups
38.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntipsychoticsAntipsychotics Phenothiazine Structural GroupsPhenothiazine Structural Groups • Aliphatic: chlorpromazine (Thorazine),Aliphatic: chlorpromazine (Thorazine), triflupromazine (Vesprin)triflupromazine (Vesprin) • Piperidine: mesoridazine (Serentil),Piperidine: mesoridazine (Serentil), thioridazine (Mellaril)thioridazine (Mellaril) • Piperazine: fluphenazine (Prolixin),Piperazine: fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazineperphenazine (Trilafon), prochlorperazine (Compazine), trifluoperazine (Stelazine)(Compazine), trifluoperazine (Stelazine) Largest group of psychotropic agentsLargest group of psychotropic agents
39.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. AntipsychoticsAntipsychotics Atypical AntipsychoticsAtypical Antipsychotics • clozapine (Clozaril)clozapine (Clozaril) • risperidone (Risperdal)risperidone (Risperdal) • olanzapine (Zyprexa)olanzapine (Zyprexa) • quetiapine (Seroquel)quetiapine (Seroquel)
40.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Mechanism of ActionAntipsychotics: Mechanism of Action • Block dopamine receptors in the brainBlock dopamine receptors in the brain (limbic system, basal ganglia)—areas(limbic system, basal ganglia)—areas associated with emotion, cognitive function,associated with emotion, cognitive function, motor functionmotor function • Dopamine levels in the CNS are decreasedDopamine levels in the CNS are decreased • Result: tranquilizing effect in psychoticResult: tranquilizing effect in psychotic patientspatients
41.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Mechanism of ActionAntipsychotics: Mechanism of Action • The newer, atypical antipsychotics also blockThe newer, atypical antipsychotics also block specific serotonin receptors (serotonin-2specific serotonin receptors (serotonin-2 [5HT2] receptors).[5HT2] receptors). • This is responsible for their improvedThis is responsible for their improved efficacy and safety profiles.efficacy and safety profiles.
42.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Drug EffectsAntipsychotics: Drug Effects • Block dopamine receptors in CNSBlock dopamine receptors in CNS • Block alpha receptors (causing hypertension,Block alpha receptors (causing hypertension, other cardiovascular effects)other cardiovascular effects) • Block histamine receptors (causingBlock histamine receptors (causing anticholinergic effects)anticholinergic effects) • Block serotoninBlock serotonin • Also function as antiemeticsAlso function as antiemetics • Antianxiety effectsAntianxiety effects
43.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Therapeutic UsesAntipsychotics: Therapeutic Uses • Treatment of serious mental illnesses:Treatment of serious mental illnesses: – Bipolar affective disorderBipolar affective disorder – Depressive and drug-induced psychosesDepressive and drug-induced psychoses – SchizophreniaSchizophrenia – AutismAutism • Movement disorders (such as Tourette’sMovement disorders (such as Tourette’s syndrome)syndrome) • Some medical conditionsSome medical conditions – Nausea, intractable hiccupsNausea, intractable hiccups
44.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Side EffectsAntipsychotics: Side Effects Body SystemBody System EffectsEffects CNSCNS Sedation, deliriumSedation, delirium CardiovascularCardiovascular Orthostatic hypotension,Orthostatic hypotension, syncope, dizziness,syncope, dizziness, ECG changesECG changes DermatologicDermatologic Photosensitivity, skin rash,Photosensitivity, skin rash, hyperpigmentation, pruritushyperpigmentation, pruritus
45.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Antipsychotics: Side EffectsAntipsychotics: Side Effects Body SystemBody System EffectsEffects GIGI Dry mouth, constipationDry mouth, constipation GUGU Urinary hesitancy orUrinary hesitancy or retention, impaired erectionretention, impaired erection HematologicHematologic Leukopenia andLeukopenia and agranulocytosisagranulocytosis Metabolic/endocrineMetabolic/endocrine Galactorrhea, irregularGalactorrhea, irregular mensesmenses increased appetite,increased appetite, polydipsiapolydipsia
46.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications • Before beginning therapy, assess both theBefore beginning therapy, assess both the physical and emotional status of patientsphysical and emotional status of patients • Obtain baseline VS, including postural BPObtain baseline VS, including postural BP readingsreadings • Obtain liver and renal function tests (andObtain liver and renal function tests (and baseline platelet levels for MAOIs)baseline platelet levels for MAOIs)
47.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications • Assess for possible contraindications toAssess for possible contraindications to therapy, cautious use, and potential drugtherapy, cautious use, and potential drug interactionsinteractions • Assess LOC, mental alertness, potentialAssess LOC, mental alertness, potential for injury to self and othersfor injury to self and others • Check the patient’s mouth to make sureCheck the patient’s mouth to make sure oral doses are swallowedoral doses are swallowed
48.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications • Provide simple explanations about the drug,Provide simple explanations about the drug, its effects, and the length of time beforeits effects, and the length of time before therapeutic effects can be expectedtherapeutic effects can be expected • Abrupt withdrawal should be avoidedAbrupt withdrawal should be avoided • Advise patients to change positions slowlyAdvise patients to change positions slowly to avoid postural hypotension and possibleto avoid postural hypotension and possible injuryinjury
49.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications • The combination of drug therapy andThe combination of drug therapy and psychotherapy is emphasized becausepsychotherapy is emphasized because patients need to learn and acquire morepatients need to learn and acquire more effective coping skillseffective coping skills • Only small amounts of medications shouldOnly small amounts of medications should be dispensed at a time to minimize the riskbe dispensed at a time to minimize the risk of suicide attemptsof suicide attempts • Simultaneous use of these agents withSimultaneous use of these agents with alcohol or other CNS depressants canalcohol or other CNS depressants can be fatalbe fatal
50.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications AntidepressantsAntidepressants • Many cautions, contraindications, and interactionsMany cautions, contraindications, and interactions exist pertaining to the use of antidepressants.exist pertaining to the use of antidepressants. • Inform patients that it may take 1 to 3, even 4,Inform patients that it may take 1 to 3, even 4, weeks to see therapeutic effects.weeks to see therapeutic effects. • Monitor patients closely during this time andMonitor patients closely during this time and provide support.provide support.
51.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications AntidepressantsAntidepressants • Sedation often occurs with tricyclic therapy; notifySedation often occurs with tricyclic therapy; notify physician if this lasts more than 2 weeks.physician if this lasts more than 2 weeks. • Assist elderly or weakened patients with ambulationAssist elderly or weakened patients with ambulation and other activities as falls may occur due toand other activities as falls may occur due to drowsiness or postural hypotension.drowsiness or postural hypotension.
52.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications AntidepressantsAntidepressants • Tricyclics may need to be weaned and discontinuedTricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions withbefore undergoing surgery to avoid interactions with anesthetic agents.anesthetic agents. • Monitor for side effects and discuss with patients.Monitor for side effects and discuss with patients. • Encourage patients to wear medication ID badgesEncourage patients to wear medication ID badges naming the agent being taken.naming the agent being taken.
53.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications AntidepressantsAntidepressants • Caffeine and cigarette smoking may decreaseCaffeine and cigarette smoking may decrease effectiveness of medication therapyeffectiveness of medication therapy • Instruct patients and family regarding tyramine-Instruct patients and family regarding tyramine- containing foods and signs and symptoms ofcontaining foods and signs and symptoms of hypertensive crisishypertensive crisis
54.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications Antipsychotics—PhenothiazinesAntipsychotics—Phenothiazines • Instruct patients to wear sunscreen due toInstruct patients to wear sunscreen due to photosensitivityphotosensitivity • Avoid taking antacids or antidiarrheal preparationsAvoid taking antacids or antidiarrheal preparations within 1 hour of a dosewithin 1 hour of a dose • Do not take alcohol or other CNS depressantsDo not take alcohol or other CNS depressants with these medicationswith these medications
55.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications Antipsychotics—PhenothiazinesAntipsychotics—Phenothiazines • Long-term haloperidol therapy may result in tremors,Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of smallnausea, vomiting, or uncontrollable shaking of small muscle groups; these symptoms should be reportedmuscle groups; these symptoms should be reported to the physicianto the physician • Oral forms may be taken with meals to decreaseOral forms may be taken with meals to decrease GI upsetGI upset • These agents may cause drowsiness, dizziness, orThese agents may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowlyfainting; instruct patients to change positions slowly
56.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications Monitor for therapeutic effects:Monitor for therapeutic effects: • Monitor mental alertness, cognition, affect,Monitor mental alertness, cognition, affect, mood,ability to carry out activities of dailymood,ability to carry out activities of daily living, appetite, and sleep patternsliving, appetite, and sleep patterns • Monitor the patient’s potential for self-injuryMonitor the patient’s potential for self-injury during the delay between the start of therapyduring the delay between the start of therapy and symptomatic improvementand symptomatic improvement
57.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications Monitor for therapeutic effectsMonitor for therapeutic effects • For antidepressants:For antidepressants: – Improved sleep patterns and nutrition, increasedImproved sleep patterns and nutrition, increased feelings of self-esteem, decreased feeling offeelings of self-esteem, decreased feeling of hopelessness, increased interest in self andhopelessness, increased interest in self and appearance, increased interest in daily activities,appearance, increased interest in daily activities, fewer depressive manifestations or suicidalfewer depressive manifestations or suicidal thoughts or ideationsthoughts or ideations
58.
Copyright © 2002,
1998, Elsevier Science (USA). All rights reserved. Psychotherapeutic Agents:Psychotherapeutic Agents: Nursing ImplicationsNursing Implications Monitor for therapeutic effectsMonitor for therapeutic effects • For antipsychotics:For antipsychotics: – Improved mood and affect, alleviation ofImproved mood and affect, alleviation of psychotic symptoms and episodespsychotic symptoms and episodes – Decrease in hallucinations, paranoia, delusions,Decrease in hallucinations, paranoia, delusions, garbled speech, inability to copegarbled speech, inability to cope
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