Transcript File - zander nursing

PSYCHOPHARMACOLOGY
ANTI - PSYCHOTIC
• Formerly known as MAJOR
TRANQUILIZERS; other known as
NEUROLEPTIC
• Indications – PSYCHOSIS, DELUSIONS,
HALLUCINATION.
• Blocks receptors of DOPAMINE
TYPICAL ANTI - PSYCHOTICS
- Potent blockers of DOPAMINE
- Can produce EPS,
• Haloperidol ( Haldol,
Seredol, Serenace, )
- tablet, liquid, IV/ IM
• Chlorpromazine HCl
( Thorazine – T, L,
Laractyl - T)
• Fluphenazine
Decanoate ( Modezine
- , Sydepres)
ATYPICAL ANTI - PSYCHOTICS
- weak blockers of dopamine
- low S/Es of EPS
• Clozapine ( Clozaril,
Leponex – T)
• Risperdone (
Risperdal – T, L, IV/
IM; Risperdal Consta)
Side effects:
• EPS ( Extra Pyramidal Syndrome)
1. aKATHIsia – Restlessness, inability to sit
still
2. aKINEsia – generalized muscle rigidity
3. Acute DYSTONIA –
• Torticollis ( wry neck)
• Oculogyric Crisis ( fixed stare)
• Opisthotonos ( arched back)
Side effects:
Neuroleptic Malignant Syndrome ( NMS)
• EARLY SIGNS:
- stiffness
- fever
- diaphoresis
- tremors
• LATE SIGNS
- dysphagia
- unstable BP
- respiratory
depression
Side effects:
• Tardive Dyskinesia ( TD)
- permanent involuntary movements
- lip smacking
- tongue protruding
- cheeks puffing
- S/ Es are IRREVERSIBLE
Side effects:
• Anti – Cholinergic Side Effects
- dry mouth
- constipation
- urinary retention
• Photosensitivity
• Agranulocytosis – fever, sore throat, leukopenia
** Clozapine ( Clozaril) – fewer S/Es but LIFE
threatening
ANTI – PARKISONIAN
• Used to treat parkinsonian syndrome,
dyskinesias to restore neurotransmitters:
DOPAMINE & ACETYLCHOLINE.
• Anti - Cholinergic action
• Dopaminergic agonists – mimicks action of
Dopamine
Anti – Cholinergic action
• Biperiden HCl (
Akineton)
• DI: antagonize action
of Metoclopramide,
enhance psychotropic
drugs.
• Levodopa +
Carbidopa (Ledocar),
(Sinemet)
• DI: Anesthesia,
MAOIs, Haldol
Dopamine Agonists
• Bromocriptine (
Parlodel, Provasyn)
• NMS – given in PO
• Amantadine ( PK –
Merz) –
• DI: amiodarone,
quinidine, anti –
histamine, macrolide
anti – biotics.
ANXIOLYTICS
• Treat anxiety and anxiety disorders
• Insomnia
• Benzodiazepines – most effective, also an
Anti – Convulsant
• Enhances action of Alcohol
ANXIOLYTICS - Benzodiazepines
• Diazepam ( Valium),
( Anxiol),
- very fast acting,
- Tab.,amp.
• Alprazolam ( Xanor)
- intermediate action
• Chlorazepate
( Tranxene)
- fast acting
ANTI - DEPRESSANTS
• Treatment of major
depressive illness
• Panic Disorder
• Bipolar Disorder
• Groups:
1. SSRIs
2. Tricyclics
3. MAOIs
Selective Serotonin Re – Uptake Inhibitors
• Treat some
personality disorders
• Anxiety Disorders
• Depression
• Increases Serotonin
levels
• Anti – Cholinergic
effect
• Fluoxetine ( Prozac), (
Deprizac, Deprexone)
• Sertraline ( Zoloft)
• Paroxetine ( Seroxat)
- Bulimia Nervosa,
OCD, Depression
Tricyclic Compounds
• TCA ( Tricyclic Anti –
Depressants)
• ADHD
• Anxiety
• Smoking Cessation
• Schizophrenia
• Bulimia Nervosa
** potentially lethal
when overdosed
• Imipramine ( Tofranil,
• Trimipramine
(Surmontil)
• Clomipramine (
Anafranil)
- OCD, Depression,
Panic Attacks
MAOIs
• Also effective in
helping smokers to
quit smoking
• Depression
• Agoraphobia/ Social
Anxiety
• Potentially lethal diet
& drug interaction
with SSRI & Tricyclic,
Demerol, Tramadol
• Hypertensive Crisis
• Phenelzine ( Nardil)
• Tranycypromine
(Parnate)
• Isocarboxazid
(Marplan)
- Stay out of
TYRAMINE rich
foods:
- Wine, cheese, liver
MOOD STABILIZING DRUGS
• Treat BIPOLAR
DISORDER, Manic State
• Most established mood
stabilizer
• 95% excreted in the
KIDNEYS
• Renal function tests
• Electrolyte – Na ( 135 145 mEq/L)
• Therapeutic range – 0.5
to 1.5 mEq/L
• Lithium level monitoring –
Q 2-3 days then weekly
• S/E: metallic taste,
fatigue, polyuria/ dipsia
• 3 signs of TOXICITY:
- Nausea
- Vomiting
- Diarrhea
• Drug Compliance!
MOOD STABILIZING DRUGS
• Carbamazepine (
Tegretol) –
• Rashes
• Orthostatic
hypertension
• Clonazepam (
Klonopin)
- Acute Mania
- Also an anxiolytic with
almost same action.
ADHD Drug
• Methylphenedate ( Ritalin)
• Stimulates neurotransmitters ( Dopamine,
Serotonin, Norepinephrine)
• Mild CNS stimulation
• Reverse effect – calming, slowing of
activity
• S/Es: anorexia, weight loss, nausea
• C/Is: caffeine, sugar, chocolate.
• Disulfiram ( Antabuse)
- Px receiving tx for Alcoholism
- C/Is: Alcohol, any product with containing
alcohol
- S/Es: flushing, headache, diaphoresis,
N/V, dizziness, halitosis, tremor,
incompetence
- A/Rs: chest pain, dyspnea, severe
hypotension, DEATH
- Liver enzyme tests
- D/I: Dilantin, INH, Warfarin, diazepam
ANXIETY
ANXIETY vs FEAR
• Anxiety – vague
feeling of dread
• Sense of impending
doom
• No Identifiable
object
• Fear – almost the
same emotional
feelings with anxiety
but with identifiable
object
LEVELS of ANXIETY
1. Mild Anxiety –
- enhance learning
- relaxed; slightly restless
- attentive
- make decisions fast
2. Moderate Anxiety –
- pacing
- slightly disorganized
- “butterflies in the stomach”
- urinary frequency
- decreased attention span
** may give PRN medication – muscle
relaxants
3. Severe Anxiety –
- don’t know what to do or say
- no direction at all
- hyperventilation
- gnash teeth
- increased diaphoresis
- wringing hands
- Agitation, Confusion
4. Panic –
- SNS activation
- Disorganized
- Gross motor agitation
- Freeze
- Distorted thoughts
- Cannot solve problems
- personality disorganized
- out of control, helpless, overwhelmed
• Delusion – fixed, false belief not based in
reality
• Hallucination – false sensory perception or
perceptual experiences that do not exist in
reality
• Illusion – other known as deception
PHOBIAS
• Intense fear of a
SPECIFIC OBJECT/
SITUATION
• ILLOGICAL
• Cause extreme
DISTRESS/ PANIC
• Pharmacologic Tx.:
- Anxiolytics
- SSRIs
- Propanolol ( Inderal) –
beta – blocker to
reduce HR &
decrease BP
• Psychotherapy
- identify anxiety reaction
- relaxation techniques
- self control
- Desensitization – progressive exposure
- Flooding – rapid desensitization
OBSESSIVE – COMPULSIVE DISORDER
• Obsession – recurrent • Compulsion –
thoughts, ideas,
behaviors or rituals
visualizations, anxiety
carried – out to get rid
producing
of obsessive thoughts
or reduce anxiety
• Affects interpersonal
relationship
• Aware of excessive
thoughts
• Common Compulsions:
- handwashing
- counting
- checking
- touching
- arranging/ rearranging
- cleanliness
• Psychophramacoligic Tx:
- SSRIs – recent drugs indicated to treat
OCD
- Anxiolytics
• Nursing intervention:
- frequency of rituals
- do not stop px from doing his/her rituals
- reduction techniques
POST TRAUMATIC STESS DISORDER
• Witness of an extraordinarily terrifying/ deadly
event.
• Experiences FLASHBACKS, recollection,
nightmares
• Assessment: Startled, hypervigilance, insomnia
Tx:
- anxiolytics
- anti – depressants
- psychotherapy – group or individual therapy
- in large groups – CISD
ABUSE & VIOLENCE
• Child abuse
- physical abuse
- sexual abuse
- neglect
- psychological abuse
• Assessment:
- burns
- bruises
• Tx:
- ensure safety
- social well being
- therapy – play, family
• Rape
- violence & humiliation expressed through
sexual means
- sexual intercourse without consent
Tx/ intervention:
- secure safety
- ensure confidentiality
- referral to psychiatric, gynecologic
management and rape crisis centers
- group therapy
SCHIZOPHRENIA
• Disease affecting the brain resulting to
distorted & bizaare mental, cognitive,
emotional, behavioral perceptions.
Types of Schizophrenia
• Paranoid Type – persecutory, hostile
behavior
- feeling of being spied on
- grandiose delusions
- hallucinations
• Disorganized type – inappropriate or flat
affect, loose associations, disorganized
behavior
• Catatonic Type – psychomotor
disturbance, motionless or excessive
motor activity, echolalia, echopraxia
• Undifferentiated Type – mixed
schizophrenic symptoms, with thought,
affect, behavior.
• Residual Type – social withdrawal, flat
affect, looseness of association
Symptoms of Schizophrenia
Positive/ Hard symptoms
Hallucinations
False sensory perception,
does not exist in reality
Delusions
Fixed false beliefs that have
no basis in reality
Echopraxia
Imitation of action form one
person
Rapid verbalization of one
topic to another
Flight of Ideas
Perseveration
Verbal repitition of a
sentence
Positive/ Hard symptoms
Ideas of reference
False impressions
Ambivalence
Two opposing feelings about
the same person, event,
situation
Negative/ Soft Symptoms
Apathy
Feelings of indifference to
people, events
Alogia
Tendency to speak very little
content with little substance
Absence of facial expression
that would indicate feeling,
mood
Restricted range of
emotional feeling or mood
Feeling of no joy or pleasure
in life ( work,relationships)
Psychologically induced
immobility
Absence of will, ambition, to
accomplish tasks
Flat affect
Blunted affect
Anhedonia
Catatonia
Lack of volition
• Pharmacologic tx:
- Anti – Psychotics
• Psychotherapy:
- Group therapy
- Family therapy
Suicide
• Common in patients with mood disorders,
DEPRESSION
• Intentional act of killing oneself
• Suicidal ideation – having thought of killing
oneself
•
-
Assessment:
Age
Sex
Marital status
Employment
Interpersonal
relationship
- Family background
• Factors:
1. - 45 y.o. – older
2. - alcohol
dependence
3. - violence
4. - male
5. - depression
6. - loss physical
health
7. - singled, widowed,
divorced
Evaluation of Suicide Risk
High risk
Low risk
Suicidal Ideation
Frequent, intense, Infrequent, low
prolonged
Suicidal attempt
Multiple
First
Rescue unlikely
Rescue inevitalble
Self – blame
Verbalized anger
Method: lethal
available
Not readily
available
Physical
Mental
High risk
Low risk
Chronic illness
Good health
Excessive
substance intake
Low
Severe depression
Psychosis
Sever personality
disorder
Substance abuse
Mild
Neurosis
Normal
Hopelessness
Optimism
Social drinker
• Treatment:
- Hospitalization
- Out – patient management
- Pharmacotherapy
- Psychotherapy
PERSONALITY DISORDERS
• When persons personality traits become
inflexible and maladaptive, interferes
optimum level of functioning.
• Longstanding due to personality
characteristics are not easily changed
TYPES
Cluster A:
Characteristics
Odd/ eccentric
1. Paranoid
Suspicious, mistrust
2. Schizoid
Detached social
relationships; involved
with things than with
people
Acute discomfort in
relationships, cognitive
& perceptual alteration
3. Schizotypal
Cluster B:
Appear, emotional,
erratic
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
Characteristics
Unruly, disrespectful,
rude
Unstable interpersonal
relationships, self image,
self mutilation
Acting-out, manipulative
Excessive emotionally
attention seeker
Need for admiration,
grandiose
Cluster C:
Characteristics
Anxious or fearful
1. Avoidant
Social inhibitions
2. Dependent
Submissive, clinging
behavior
Perfectionism, control,
orderliness
3. Obsessive –
Compulsive
Eating Disorders
•
•
•
•
•
•
•
Anorexia Nervosa
Life-threatening
Refusal to eat
Maintain body weight
Fear of gaining weight
Binge eating
Purging
• Bulimia Nervosa
• Recurrent episodes of
binge eating
• Purging( self induced
vomiting)
• Use laxatives
• Dental caries,ragged
chipped
Complications:
• Loss of muscle mass
• Hypothyroidism ( weakness,
hypoglycemia)
• Bradycardia, hypotension
• Abdominal pain, diarrhea
• Amenorrhea
• Anemia, Leukopenia
SUBSTANCE ABUSE
• Use of drug in a way that is inconsistent with
medical or social norms.
• Polysubstance abuse – use of more than one
drug.
• Intoxication - use of drug resulting to
maladaptive behavior
• Withdrawal syndrome – negative psychological
& physical reactions when drug is stopped
abruptly
• Detoxification – process of safely withdrawing
substance.
• CNS depressants
• Sedatives, Hypnotics, Anxiolytics,
cannabis, Opioids,, Inhalants, Alcohol
• Antidote: Naloxone
• CNS stimulants
• Amphetamines, cocaine, Hallucinogens
WITHDRAWAL & DETOXIFICATION with
CNS Depressants
• Tapering of dosage
• Symptoms are similar
to alcohol withdrawal
• Inc. HR, BP, RR
• Gastric lavage for
overdose PO.
• Antidotes are given in
severe cases
WITHDRAWAL & DETOXIFICATION with
CNS Stimulants
• High euphoric feeling,
hyperactive
• hallucinations
• Overdose – seizures,
coma, DEATH
• Thorazine is given
during psychosis
Treatment/ therapy:
•
•
•
•
Encourage to join Alcoholics Anonymous
Group therapy
Contracts
Health teaching on client & family
members
THE END
THANK YOU VERY MUCH