PSYCHOTROPIC MEDICATIONS Connie K. Cupples, MS, MSN, RN Union University

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PSYCHOTROPIC MEDICATIONSConnie K. Cupples, MS,
MSN, RNUnion University
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Classifications

• Antipsychotics (neuroleptics)
• Anxiolytics (antianxiety meds)
• Side Effect Meds (anticholinergic/antiparkinsonism
  drugs)
• Antidepressants
• Mood Stabilizers

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Psychosis

• Symptoms delusions, hallucinations, difficulty
  processing information, incoherence
• Schizophrenia chronic psychotic disorder which
  has both positive and negative symptoms

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Positive Symptoms

• Characterized by exaggeration of normal function
• Examples delusions, hallucinations, paranoia,
  agitation

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Negative Symptoms

• Characterized by decrease or lessening of
  function and motivation
• Examples Poverty of speech content, poor self
  care, social withdrawal, flat affect, avolition,

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Categories of Antipsychotic Meds

• Traditional (phenothiazines nonphenothiazines)
• Atypical

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Mechanism of Action

• Block actions of dopamine
• Five subtypes of dopamine receptors D1 to D5
• All block D2 (dopaminergic) receptor promotes
  ERS resulting in pseudoparkinsonism
• Atypicals have weak affinity to D2 receptors
  cause fewer EPS

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Adverse Reactions to Antipsychotics

• Extrapyramidal Side Effects (EPS)
• Anticholinergic Effects
• Cardiovascular Effects
• Rare Toxic Effects (Neuroleptic Malignant
  Syndrome NMS)

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Extrapyramidal Side EffectsEPS

• Pseudoparkinsonism
• Acute Dystonic Reactions
• Akathisia
• Tardive Dyskinesia

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Pseudoparkinsonism

• Rigidity, masklike facies, stooped posture,
  drooling, shuffling gait, pill-rolling, tremor
• Treat with trihexyphenidyl (Artane) or
  benztropine (Cogentin)

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Acute Dystonic Reactions

• Opisthotonos
• Oculogyric Crisis
• Torticollis
• Treat with diphenhydramine hydrochloride
  (Benedryl) 25-50 mg IM/IV (Cogentin 1-2 mg IM/IV
  may be second choice)

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Akathisia

• Motor innerdriven restlessness
• May be treated with propanolol (Inderal) or
  benzodiazapenes

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Tardive Dyskinesia

• Facial protruding tongue, smacking, licking,
  spastic facial distortion, smacking movements
• Limbs choreic, athetoid
• Trunk pelvic thrusts, neck shoulder movements

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Anticholinergic Side Effects

• Dry Mouth
• Urinary Retention
• Constipation
• Blurred vision
• Photosensitivity
• Dry Eyes
• Impotence

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Cardiovascular Effects

• Hypotension and postural hypotension
• Tachycardia

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Rare and Toxic Effects

• Agranulocytosis
• Jaundice
• Neuroleptic Malignant Syndrome hyperpyrexia,
  severe muscle rigidity, elevated BP, tachycardia,
  diaphoresis, incontinence

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Prototypes

• Fluphenazine (Prolixin) p. 379
• Haloperidol (Haldol) p. 380
• Haloperidol Decanoate

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Phenothiazines Nonphenothiazines

• Refer to p. 382 - 383
• Low to High Potency

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Nursing Process with Antipsychotic Medications

• Assessment
• Planning
• Nursing Interventions Discuss with different
  routes for meds
• Patient Teaching
• Evaluation

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Anxioloytics

• Benzodiazepines
• Buspirone (Buspar)
• Used to treat primary anxiety and secondary
  anxiety
• Nonpharmacologic measures to treat anxiety

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Mechanism of Action

• Enhance action of gamma-aminobutyric acid (GABA),
  an inhibitory neurotransmitter within the CNS

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Side Effects of Anxiolytics

• Sedation
• Dizziness
• Headache
• Dry Mouth
• Blurred Vision
• Constipation

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Adverse Reactions

• Leukopenia (decreased WBCs)
• Fever, Malaise, Sore throat
• Tolerance
• Physical dependence (SHOULD NOT BE ABRUPTLY
  DISCONTINUED) MAY SHOW WITHDRAWAL SYMPTOMS

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List of Anxiolytics

• See page 387
• Prototype Lorazepam Ativan pg. 388.

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Nursing Process with Anxiolytics

• Assessment
• Planning
• Interventions Discuss difference in nursing
  interventions and teaching with Buspar
• Teaching
• Evaluation

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Antidepressants

• Used to treat three types of depression
  reactive, major, bipolar affective disorder
• Depressive episodes are accompanied by anhedonia,
  depressed mood, hopelessness, helplessness, along
  with other signs and symptoms

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Four Groups of Antidepressants

• Tricyclics (TCAs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Atypicals
• Monoamine Oxidase Inhibitors (MAOIs)

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Prototype

• See page 392 Amitriptyline (Elavil)
• Action Block the uptake of norepinephrine and
  serotonin in the brain
• Clinical response occurs 2-4 weeks

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Side Effects of TCAs

• Orthostatic hypotension
• Sedation
• Anticholinergic side effects
• Cardiotoxity
• Seizures
• Blood dyscrasias
• Sexual dysfunction

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Selective Serotonin Reuptake Inhibitors

• Action block reuptake of serotonin into the
  nerve terminal of CNS enhancing its transmission
  at the serotonergic synapse
• Prototype page 394 fluoxetine (Prozac)
• List of meds page 393

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Side Effects of SSRIs

• Fewer than with TCAs
• Dry mouth, blurred vision, insomnia, headache,
  nervousness, anorexia, nausea, diarrhea, suicidal
  ideation

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Atypical Antidepressants

• Second generation
• Action affect either serotonin, norepinephrine
  and dopamine
• See page 394 for examples
• See page 395 for side effects

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Monoamine Oxidase Inhititors (MAOIs)

• Action Inhibits monoamine oxidase so that the
  levels of norepinephrine, dopamine, epinephrine,
  serotonin rise thus relieving symptoms of
  depression
• Tranylcypromine sulfate (Parnate), isocarboxazid
  (Marplan), phenelzine sulfate (Nardil)

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Drug Food Interactions

• Can be fatal
• Avoid foods containing tyramine cheese, cream,
  coffee, chocolate, cured meats, bananas, raisins,
  red wines, beer, yeast (see page 395 for complete
  list).
• Avoid meds containing phenylephrine and
  pseudoephedrine

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Nursing Process with Antidepressants

• Assessment
• Nursing Diagnoses
• Planning
• Nursing Interventions (include teaching)
• Evaluation

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Mood Stabilizer Lithium

• Action alters sodium, potassium ion transport
  across cell membrane in nerve cells may balance
  biogenic amines of norepinephrine
• Alternate meds carbamazepine (Tegratol),
  valproic acid (Depakote), lamotrigine (Lamictal)

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Side Effects of Lithium

• Dry mouth
• Thirst
• Nausea
• Polyuria
• Weight gain
• Fine hand tremor

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Early Signs of Toxicity

• Nausea
• Vomiting
• Diarrhea
• Thirst
• Polyuria
• Slurred speech
• Muscle weakness
• Varcarolis, E.M. (2006) p. 372

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Advanced Signs of Toxicity

• Coarse hand tremor
• Persistant GI disturbances
• Mental confusion
• Muscle hyperirritability
• ECG changes
• Incoordination
• Varcarolis, p. 372

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Severe Toxicity

• Ataxia
• Clonic movements
• Large amounts of dilute urine
• Severe hypotension
• Coma
• Cardiac dysrhymias
• Death

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Nursing Process with Lithium

• Assessment
• Nursing Diagnoses
• Planning
• Nursing Interventions watch lithium level
  PATIENT TEACHING Dietary considerations
• Evaluation