Transcript PSYCHOPHARMACOLOGY

PSYCHOPHARMACOLOGY
DEFINITION:
Psychopharmacology is the gold standard in
treatment of neurobiological illnesses, more
and more of which are found to have genetic
underpinnings.
CLASSIFICATION:
1-Antianxiety and sedative-hypnotic Drugs
2-Antidepressant Drugs
3-Antipsychotic Drugs
5-Mood-Stailizing Drugs
1-Antianxiety and sedative-hypnotic
Drugs: Benzodiazepines
GENERIC NAME
(TRADE NAME)
USUAL ADULT
DOSAGE RANGE
(MG/DAY)
PREPARATION
Alprazolam
(Xanax)
1-4
PO
chlordiazepoxide (Librium)
10-40
PO,IM
Clonazepam (Klonopin)
0.5-10
PO,ODT
Clorazepate (Tranxene)
10-40
PO,SD
Lorazepam
(Ativan)
1-6
PO,IM,IV
Cont.
Side effect
Nursing Considerations
Drowsiness, sedation
Activity helps: use caution when using
machinaery.
Ataxia, dizziness
Use caution with activity , prevent falls.
Feeling of detachment
Discourage social isolation.
Increased irritability or hostility
Observe, support, be alert for disinhibition.
Cognitive effects with long term use
Interference with concentration and of new
material.
Tolerance, dependency, rebound
insomnia/anxiety
Short-term use: discontinue , using a slow
taper; contraindicated with drug or alcohol
abuse.
Anterograde amnesia
Inability to recall events that occur while on
drug.
Sedative-hypnotic Drugs:
Benzodiazepines
GENERIC NAME
(TRADE NAME)
USUAL ADULT DOSAGE
RANGE (MG/DAY)
PREPARATION
Estazolam
(ProSom)
1-4 HS
PO
Flurazepam
(Dalmane)
15-30 HS
PO
Temazepam
(Restoril)
7.5-30 HS
PO
Triazolam
(Halcion)
0.125-0.5 HS
PO
Quazepam
(Doral)
7.5-15 HS
PO
Cont.
Side effect
Nursing Considerations
Drowsiness, sedation
Activity helps: use caution when using
machinaery.
Ataxia, dizziness
Use caution with activity , prevent falls.
Feeling of detachment
Discourage social isolation.
Increased irritability or hostility
Observe, support, be alert for disinhibition.
Cognitive effects with long term use
Interference with concentration and of new
material.
Tolerance, dependency, rebound
insomnia/anxiety
Short-term use: discontinue , using a slow
taper; contraindicated with drug or alcohol
abuse.
Anterograde amnesia
Inability to recall events that occur while on
drug.
Antidepressant Drugs
*Indication for Antidepressant Drugs:
Major depression:
Acute depression, maintaining treatment of
depression and prevention of relapse,
depression (when used with a bipolar
mode stabilizer)
Atypical depression and dysthymic disorder.
- Anxiety disorders: •
Panic diorder,obessive-compulsive •
disorder(OCD),social phobia, generalized
anxiety disoeder,posttraumatic
-selective serotonin reptake inhibitors(SSRIs) •
1-strong evidence:
Bulimia, premenstrual dysphoric disorder full and
half cycle administration)
•
Cont.
2-Moderate evidence: •
Obesity, substance abuse, impulsivity and anger
associated with personality disorders, pain
syndromes.
3-preliminary evidence: •
Body dysmorphic disorder,hypochondriasis,anger
attacks associated with depression, attention
deficit/hyperactivity disorder(ADHD)
•
•
Cont.
-other newer antidepressant •
Moderate: •
evidence:Trazodone:insomnia,dementia
with agitation,minor sedative hypnotic
with drawal
General
name
Usual adult
daily dose
Preparation
s
Receptors/n
eurotransmi
ssion
Side effect
`
Amoxapine(as
endin)
200-300
po
NE-5HT-D2Ach-H1
ermors,tachyc
ardia,erectile/
ejaculatory
dysfunction,GI
disturbances(
nausea,diarrh
ea),sexual
dysfunction
Bupropion
150-450
Po.SR
DA,NE
Termos,tachyc
ardia,erectile/
ejaculatory
dysfunction
Maprotiline(lu
diomi)
50-200
PO
H1,ACH
termos.tachyc
ardia,erectile/
ejaculatorydys
function,sedat
ion,drowsines
s,hypotention
General
name
Usual adult
daily dose
Preparation
s
Receptors/n Side effect
eurotransmi
ssion
Mirtazapine
15-40
PO
H1-ACH
Sedation,drow
sinesss,hypot
ention,wight
gain
Nefazodone
300-500
PO
5HT
GI
disturbances(
nausea,diarrh
ea),sexual
disfunction,pri
apesm
Venlafaxine
75-375
PO,XR
NE-5HT-DA
Termos,tachh
ycardia,urinar
y retention,
sexual
dysfunction
Nursing consideration
Side effect
Nursing care and teaching
concept
Blurred vision
Temporary: avoid hazardous tasks
Dry mouth
Encourage fluids,frequint rinses,
sugar-free hard candy and gums
Constipation
Increase fluids,dietry fiber and
roughage,exercise,monitor bowel
habits, use stool softeners and
laxatives only if increases
Tachycardia
Temporary, usually not significant
except with coronary artery disease),
but can be frightening, supportive
therapy
Urinary retention
Encourage fluids and frequent voiding
,monitor voiding
patterns,bethanecol,catheterize
Insomnia
Does as early in the day as
possible ,sleep hygiene, decrease
evening activities,elimitate
caffeine, relaxation techniques,
sedative hyponotic therapy
Sexual dysfunction
Does after sexual intercourse, use
lubricant if vaginal dryness is present,
antidotes such as sildenifal,bupropion
or bethanecol.
Antipsychotic
Drug
Usually adult daily
does
preparation
Benztropine
2-4
PO,IM
Trihexyphenidl
4-15
PO,L
Biperiden
2-8
PO
Procyclidine
10-20
PO
Diazepam
2-6
PO,VI
Cont.
CNS side effect
akathisia
Sedation, Wight gain
Nursing care
Cannot remain still,pacing,inner
restlessness, leg aches are relived by
movement, rule out anxiety or
agitation, medicate.
Increase exercise ,reduced calories
diet if indicated ,may need to change
class of drug.
Mood-Stabilizing Drugs
Target Symptoms for mood-Stabilizing drug
therapy
Mania
Irritability
Expansiveness
Euphoria
Manipulative ness
Lability with depression
Sleep disturbance (decrease sleep)
Pressure speech
Flight of ideas
Motor hyperactivity
Hypergraphia
Hyper sexuality
Hallucinations
Catatonia
Depression
Irritability
Sadness
Pessimism
Anhedonia
Self-reproach
Guilt
Hopelessness
Motor retardation
Slowed thinking
Poor concentration and memory
Fatigue
helplessness
Mood-Stabilizing Drugs
DRUG CLASS
GENERIC NAME
(TRADE NAME)
USUAL ADULT
DOSAGE RANGE
(MG/DAY)
PREPARATION
Antimania
600-2400
PO, CR ,SR
Lithium citrate
600-2400
L/S
Calcium channel
Blockers
240
PO
240
PO
Lithium (Eskalith, lithobid
Verapamil (Calan)
Nifedipine
(adalat,procardia)
Lithium
Lithium, a naturally occurring salt, is firstline treatment for patients with acute
mania and for the long term prevention of
recurrent episodes. Lithium also has a role
in the treatment of recurrent bipolar
depression, unipolar depression,
aggressive behaviors, conduct disorder
and schizoaffective disorder.
Stabilizing Lithium Levels
Common causes for an increase in lithium levels
Decrease sodium intake .
Diuretic therapy.
Decrease renal functioning.
Fluid and electrolyte loss, sweating, dirrhea,
dehydration, fever.
Overdose .
Medical illness .
Murine EPS Drug Doses
IP doses are calibrated to give 0.2 ml for a
30 g mouse
Atropine: •
0.5 mg/g = 15 mg IP (Mix 0.2 ml of stock solution in a total of 1 ml)
Atropine stock in vial = 0.4 mg/ml
Carbamyl choline: •
500 ng/g = 15 mg IP (Mix 7.5 mg into 10 ml for a x10 stock solution)
Cefazolin: •
200 mg/g/day = 6 mg/day in two divided doses = 3 mg IP bid (Mix 24 mg into
1.6 ml for 8 individual doses)
Digoxin: •
20 ng/g bid = 0.6 mg IP bid on Day 1 (Mix 0.2 ml of stock in a total of
10 ml). On Day 2 give 10 ng/g bid = 0.3 mg IP bid (0.1 ml IP)
Digoxin stock in vial = 0.1 mg/ml
Isoproterenol: •
3 ng/g = 90 ng IP (Mix 0.25 ml of x100 stock in a total of 1 ml)
Isoproterenol x100 stock = 2 mg/ml
Cont.
Propranolol: •
1 mg/g = 30 mg IP (Mix 0.15 ml of stock in a total of 1 ml)
Propranolol stock in vial = 1 mg/ml
IV doses are calibrated to give 0.05 ml for a 30 g mouse •
Isoproterenol: •
1 ng/g = 30 ng IV (Mix 0.3 ml of x100 stock in a total of 1 ml)
Isoproterenol x100 stock = 2 mg/ml
Procainamide:
•
30 mg/g = 900 mg IV (Add 2.2 ml of procainamide stock to 10 ml for a total of
12.2 ml which gives a concentration of 18 mg/ml)
Procainamide stock in vial = 100 mg/ml
References
Principles and practice of
Psychiatric Nursing
GAIL W. STUART
MICHELE T. LARAIA
8TH EDITION
2005