Transcript Chapter_17
CHAPTER 17 Psychotherapeutic Drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs Used in the treatment of emotional and mental disorders Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress When emotions significantly affect an individual’s ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Psychotherapeutic Drugs (cont’d) Three main emotional and mental disorders: Anxiety Affective disorders Psychoses Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Psychotherapeutic Drugs (cont’d) Types of psychotherapeutic drugs Antianxiety drugs Antimanic drugs Antidepressant drugs Antipsychotic drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Biochemical Imbalance Other biochemicals are necessary for normal mental function GABA Acetylcholine (ACh) Sodium, potassium, magnesium Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Anxiety Unpleasant state of mind, characterized by a sense of dread and fear May be based on actual anticipated experiences or past experiences May be exaggerated responses to imaginary negative situations Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Anxiety Disorders Six major anxiety disorders (persistent anxiety) Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) Panic disorder Social phobia Simple phobia Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Affective Disorders (Mood Disorders) Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions) Some patients may exhibit both mania and depression: bipolar disorder (BPD) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Psychosis Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living Hallmark: loss of contact with reality Examples Schizophrenia Depressive and drug-induced psychoses Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Psychotherapeutics: Pathophysiology Biochemical imbalance theory Mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Psychotherapeutics: Pathophysiology Biochemical imbalance theory (cont’d) Brain levels of certain neurotransmitters play an important role in maintaining mental health Catecholamines Dopamine Norepinephrine Indolamines Serotonin Histamine Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Antianxiety Drugs Reduce anxiety by reducing overactivity in CNS Benzodiazepines • Depress activity in the brainstem and limbic system Miscellaneous drug: Buspirone (BuSpar) • Nonsedating and non–habit forming • May have drug interaction with SSRIs (serotonin syndrome) • Do not administer with MAOIs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Antianxiety Drugs (cont’d) Barbiturates and carbamates Previously used to treat anxiety Replaced by newer drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Antianxiety Drugs: Indications Anxiety Insomnia Sedation Muscle spasms Seizure disorders Adjuncts in anesthesia Adjuvant therapy for depression Alcohol (ethanol) withdrawal Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Common Benzodiazepines diazepam (Valium) lorazepam (Ativan) alprazolam (Xanax) clonazepam (Klonopin) chlordiazepoxide (Librium) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Common Benzodiazepines (cont’d) Midazolam (Versed)* Reduces anxiety and patient’s memory of painful procedures that do not require general anesthesia (moderate sedation) Injection only *Limited to use as sedative and anesthetic during invasive medical or surgical procedures Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Benzodiazepines Potentially habit-forming and addictive Should be used at lowest effective dosages and frequencies needed for symptom control Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Benzodiazepines: Adverse Effects Benzodiazepine adverse effects are an overexpression of their therapeutic effects Decreased CNS activity, sedation Hypotension Drowsiness, loss of coordination, dizziness, headaches Nausea, vomiting, dry mouth, constipation Others Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Benzodiazepines: Overdose Dangerous when taken with other sedatives or alcohol Treatment is generally symptomatic and supportive Flumazenil may be used to reverse benzodiazepine effects Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Affective Disorder Drugs Mood stabilizers Used to treat bipolar disorder • Involves cycles of mania, hypomania, and depression Antidepressants Used to treat depression Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Mood Stabilizers: Antimanic Drugs Lithium is the drug of choice for the treatment of mania It is thought to potentiate serotonergic neurotransmission May be used with other medications to stabilize mood Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L Monitor sodium levels Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Depression Etiology Biogenic amine hypothesis Depression and mania are caused by an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain • Depression: deficiency of catecholamine, especially norepinephrine • Mania: excess amines Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Depression (cont’d) Etiology (cont’d) Permissive hypothesis Affective disorders are caused by decreased concentrations of serotonin • Depression results from decreases in both serotonin and catecholamine levels • Mania results from increased catecholamine but decreased serotonin levels Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Depression (cont’d) Etiology Dysregulation hypothesis Depression and other affective disorders result from a failure in the regulation of catecholamine activity Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Antidepressants Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs) Newer-generation antidepressants Selective serotonin reuptake inhibitors (SSRIs) Second- and third-generation antidepressants Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Tricyclic Antidepressants: First-Generation Antidepressants Have largely been replaced by SSRIs as first-line antidepressant drugs Considered second-line For patients who fail with SSRIs or other newergeneration antidepressants As adjunct therapy with newer-generation antidepressants Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Common Tricyclics amitriptyline (Elavil, Endep) doxepin (Sinequan) imipramine (Tofranil) desipramine (Norpramin) nortriptyline (Aventyl, Pamelor) Others Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Mechanism of Action Block reuptake of neurotransmitters, causing accumulation at the nerve endings It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Drug Effects Blockade of norepinephrine reuptake Antidepressant,* tremors, tachycardia, others Blockade of serotonin reuptake Antidepressant,* nausea, headache, anxiety, sexual dysfunction *Desired therapeutic effects Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Indications Depression Childhood enuresis (imipramine) Obsessive-compulsive disorders (clomipramine) Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Adverse Effects Sedation Impotence Orthostatic hypotension Others Older patients Dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Overdose Lethal—70% to 80% die before reaching the hospital CNS and cardiovascular systems are mainly affected Death results from seizures or dysrhythmias Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Overdose (cont’d) No specific antidote Decrease drug absorption with activated charcoal Speed elimination by alkalinizing urine Manage seizures and dysrhythmias Basic life support Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 35 MAOIs Highly effective Considered second-line treatment for depression, not responsive to cyclics Disadvantage: potential to cause hypertensive crisis when taken with tyramine Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 36 MAOIs (cont’d) Examples phenelzine (Nardil) tranylcypromine (Parnate) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 37 MAOIs: Mechanism of Action Inhibit the MAO enzyme system in the CNS Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain Result: alleviation of symptoms of depression Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 38 MAOIs: Indications Depression, especially types characterized by reverse vegetative symptoms such as increased sleep and appetite Depression that does not respond to other drugs such as tricyclics Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39 MAOIs: Adverse Effects Few adverse effects—orthostatic hypotension most common Tachycardia Dizziness Insomnia Anorexia Blurred vision Palpitations Drowsiness Headache Nausea Impotence Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 40 MAOIs: Overdose Symptoms appear 12 hours after ingestion Tachycardia, circulatory collapse, seizures, coma Treatment: protect brain and heart, eliminate toxin Gastric lavage Urine acidification Hemodialysis Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Hypertensive Crisis and Tyramine Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death Avoid foods that contain tyramine! Aged, mature cheeses (cheddar, blue, Swiss) Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté) Yeast extracts Red wines (Chianti, burgundy, sherry, vermouth) Italian broad beans (fava beans) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 42 MAOIs Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome If the decision is made to switch to an SSRI, there must be a 2- to 5-week “wash-out” period between MAOI therapy and SSRI therapy Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Newer-Generation Antidepressants Fewer adverse effects than tricyclics and MAOIs Very few drug-drug or drug-food interactions Still take about 4 to 6 weeks to reach maximum clinical effectiveness Now considered first-line drugs for depression Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Newer-Generation Antidepressants (cont’d) trazodone (Desyrel) bupropion (Wellbutrin) SSRIs fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) fluvoxamine (Luvox) citalopram (Celexa) escitalopram (Lexapro) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Newer-Generation Antidepressants (cont’d) venlafaxine (Effexor) nefazodone (Serzone) mirtazapine (Remeron) duloxetine (Cymbalta) desvenlafaxine (Pristiq) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 46 SSRIs Mechanism of action Selectively inhibit serotonin reuptake Little or no effect on norepinephrine or dopamine reuptake Result in increased serotonin concentrations at nerve endings Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Newer-Generation Antidepressants: Indications Depression Bipolar disorder Obesity Eating disorders Obsessive-compulsive disorder Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Newer-Generation Antidepressants: Indications (cont’d) Panic attacks or disorders Social anxiety disorders Posttraumatic stress disorders (PTSDs) Myoclonus Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Newer-Generation Antidepressants: Adverse Effects Body System Effects CNS Headache, dizziness, tremor, nervousness, insomnia,* fatigue Nausea, diarrhea, constipation, dry mouth Sexual dysfunction, weight gain*, weight loss*, sweating GI Other *Most common and bothersome Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Serotonin Syndrome Symptoms Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse tremors Symptoms of severe cases Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Newer-Generation Antidepressants: Drug Interactions Highly bound to plasma proteins Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect Inhibition of cytochrome P-450 system MAOIs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Antipsychotics Drugs used to treat serious mental illness Behavioral problems or psychotic disorders Have been known as tranquilizers or neuroleptics Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 53 Antipsychotics (cont’d) Thioxanthenes: thiothixene (Navane) Butyrophenones: haloperidol (Haldol) Dihydroindolones: molindone (Moban) Dibenzoxazepine: loxapine (Loxitane) Phenothiazines: three structural groups Atypical antipsychotics: new class Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 54 Mechanism of Action Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function Dopamine levels in the CNS are decreased Result: tranquilizing effect in psychotic patients Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 55 Atypical Antipsychotics: Second-Generation Antipsychotics clozapine (Clozaril) risperidone (Risperdal) olanzapine (Zyprexa) quetiapine (Seroquel) ziprasidone (Geodon) aripiprazole (Abilify) paliperidone (Invega) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 56 Atypical Antipsychotics: Mechanism of Action Block specific dopamine receptors: dopamine-2 (D2) receptors Also block specific serotonin receptors: serotonin-2 (5HT2) receptors This is responsible for their improved efficacy and safety profiles Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 57 Antipsychotics: Indications Treatment of serious mental illnesses Bipolar affective disorder Depressive and drug-induced psychoses Schizophrenia Autism Movement disorders (such as Tourette’s syndrome) Some medical conditions Nausea, intractable hiccups Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 58 Adverse Effects Body System Adverse Effects CNS Cardiovascular Sedation, delirium Orthostatic hypotension, syncope, dizziness, ECG changes Photosensitivity, skin rash, hyperpigmentation, pruritus Dermatologic Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 59 Adverse Effects (cont’d) Body System GI Adverse Effects Dry mouth, constipation GU Urinary hesitancy or retention, impaired erection Hematologic Leukopenia and agranulocytosis Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 60 Adverse Effects (cont’d) Body System Metabolic/endocrine Adverse Effects Galactorrhea, irregular menses, increased appetite, polydipsia Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 61 Adverse Effects (cont’d) Neuroleptic malignant syndrome (NMS) Potentially life threatening High fever, unstable BP, myoglobinemia Extrapyramidal symptoms (EPS) Involuntary muscle symptoms similar to those of Parkinson’s disease Akathisia (distressing muscle restlessness) Acute dystonia (painful muscle spasms) Treated with benztropine (Cogentin) and trihexyphenidyl (Artane) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 62 Adverse Effects (cont’d) Tardive dyskinesia (TD) Involuntary contractions of oral and facial muscles Choreoathetosis (wavelike movements of extremities) Occurs with continuous long-term antipsychotic therapy Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 63 Herbal Products: St. John’s Wort Used for depression, anxiety, sleep disorders, nervousness May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity Severe interactions if taken with MAOIs and SSRIs; many other drug interactions Food-drug interaction with tyraminecontaining foods Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 64 Herbal Products: Ginseng Three varieties; has been used for over 5000 years Uses: stress reduction, improvement of physical endurance and concentration May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 65 Psychotherapeutic Drugs: Nursing Implications Before beginning therapy, assess physical and emotional status of patients Obtain baseline vital signs, including postural BP readings Obtain liver and renal function tests Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 66 Psychotherapeutic Drugs: Nursing Implications (cont’d) Assess for possible contraindications to therapy, cautious use, and potential drug interactions Assess for LOC, mental alertness, potential for injury to self and others Check the patient’s mouth to make sure oral doses are swallowed Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 67 Psychotherapeutic Drugs: Nursing Implications (cont’d) Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected Advise patients to avoid abrupt withdrawal Advise patients to change positions slowly to avoid postural hypotension and possible injury Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 68 Psychotherapeutic Drugs: Nursing Implications (cont’d) The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 69 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antianxiety drugs In elderly patients, monitor closely for oversedation and profound CNS depression Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 70 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antidepressants Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants Inform patients that it may take several weeks to see therapeutic effects Monitor patients closely during this time, assess for suicidal tendencies, and provide support Assist elderly or weakened patients with ambulation and other activities because falls may occur because of drowsiness or postural hypotension Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 71 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antidepressants (cont’d) Tricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions with anesthetic drugs Monitor for adverse effects, and discuss with patients Encourage patients to wear medication ID badges naming the drugs being taken Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 72 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antidepressants (cont’d) Caffeine and cigarette smoking may decrease effectiveness of medication therapy Instruct patients and family regarding tyraminecontaining foods and signs and symptoms of hypertensive crisis Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 73 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antipsychotics—phenothiazines Instruct patients to wear sunscreen because of photosensitivity Tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose Inform patients to avoid alcohol or other CNS depressants with these medications Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 74 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antipsychotics—phenothiazines (cont’d) Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 75 Psychotherapeutic Drugs: Nursing Implications (cont’d) Antipsychotics—phenothiazines (cont’d) Oral forms may be taken with meals to decrease GI upset These drugs may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowly Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 76 Psychotherapeutic Drugs: Nursing Implications (cont’d) Monitor for therapeutic effects Monitor mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 77 Psychotherapeutic Drugs: Nursing Implications (cont’d) Monitor for therapeutic effects (cont’d) For anxiolytics • Improved mental alertness, cognition, and mood • Fewer anxiety and panic attacks • Improved sleep patterns and appetite • Less tension and irritability; fewer feelings of fear, impending doom, and stress • More interest in self and others Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 78 Psychotherapeutic Drugs: Nursing Implications (cont’d) Monitor for therapeutic effects (cont’d) For antidepressants • Improved sleep patterns and nutrition • Increased feelings of self-esteem • Decreased feelings of hopelessness • Increased interest in self and appearance • Increased interest in daily activities • Fewer depressive manifestations or suicidal thoughts/ideations Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 79 Psychotherapeutic Drugs: Nursing Implications (cont’d) Monitor for therapeutic effects (cont’d) For antipsychotics • Improved mood and affect • Alleviation of psychotic symptoms and episodes • Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 80 Psychotherapeutic Drugs: Nursing Implications (cont’d) Monitor for therapeutic effects (cont’d) For lithium • Less mania • Therapeutic lithium levels of 0.6 to 1.2 mEq/L Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 81