Psychopharmacology

Mental Health Factors

Neurobiological, genetic, and environmental.

Mental Health Factors Brain

Chemical function, Anatomical function,

Neurotransmitters

are functioning of these and can be manipulated through

Brain Function – Complexity

The exact pathophysiology of many mental health disorders remains largely misunderstood.

Neurons

communicate information by sending and receiving electrochemical messages from one neuron to another.

Neurotransmitters

Dopamine, Norepinephrine, Serotonin, Acetylcholine, Gama-amino butyric acid (GABA).

Reuptake

The process in which neurotransmitters are reabsorbed by the synapse that created it.

Deactivate/Inactivate

This is the process of inactivating neurotransmitters through enzymes such as Monoamine oxidate.

Monoamine Oxidate

An enzyme responsible for deactivating monoamine neurotransmitters.

Dopamine

Is an excitatory neurotransmitter that transmits information about emotional responses, complex movements, cognition, A person experiencing pleasure. Affected by stress.

Serotonin

The function is primarily inhibitory. Emotional regulation, Sexual behavior, Temperature regulation, Sleep-wake cycle, Pain management

Norepinephrine

Is an excitatory Neurotransmitter. Responsible for Response to stress, Most prevalent in the nervous system and is a derivative of Epinephrine.

Patients with trauma have increased Levels of

Norepinephrine.

Norepinephrine Manifestations

Anxiety and depression.

Norepinephrine Deficits contribute to memory loss

social withdrawal and depression.

Histamine

Unique role in neuromodulation. in the Brain mediates the effects of Alertness, Wakefulness

Gama amino butyric acid (GABA)

Amino acid that serves as an inhibitory neurotransmitter. modulates other neurotransmitters. Improves sleeplessness. Minimizes manifestations of depression, reduces anxiety and induces sleep.

Glutamine

Excitatory neurotransmitter. Motor and Affective and cognitive function.

Acetylcholine

Has Inhibitory and Excitatory properties Found in skeletal muscles. Primary neurotransmitter for muscle function.

Alzheimer’s disease clients have decreased Levels of

Acetylcholine.

Neurobiological causes of mental illness

Neurobiology, Genetics, Family study, adoptive study, and twin study

Stress

Psychoimmunology and Infection

Anxiolytic (Antianxiety)

Benzodiazepines

Most prescribed medications for treating anxiety. There is a high potential for physical dependency!! Use less than 3 week

Benzodiazepines meds

alprazolam, diazepam, lorazepam, chlordiazepoxide

Buspirone

A serotonin receptor agonist. Used to treat anxiety. Doesn’t cause any physical dependency!! It takes several weeks for the patient to feel the effects of medications.

Benzodiazepines side effects

Manifestations Related to CNS depression!, Sedation, Poor concentration, Impaired memory, Drowsiness, Next day sedation, paradoxical response

Paradoxical Response Define

side effect observe are that are opposite to intended effect

Benzodiazepines safety

FALL RISK!!

Benzodiazepine Toxicity

Flumazenil is given to reverse the sedative effects. Caution can produce seizures in patients with seizure disorders or taking tricyclic antidepressants.

Teaching Anxiolytics only treat

the manifestations of anxiety, Not the cause.

Teaching Benzodiazepines potentiate

the effects of Alcohol.

Teaching Anxiolytic Sedation effects can disrupt

client/patient activities. Such as ambulation and grooming

Teaching Prolonged use of Benzodiazepines the body adapts. Causes

tolerance depenace

Benzodiazepines Do Not

abruptly STOP after prolonged use! The patient must use a taper schedule. Risk of developing addiction!!

Antidepressants

Monoamine Oxidase Inhibitors (MAOIs) , Tricyclic antidepressants (TCA’s) , Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin Norepinephrine Inhibitors (SNRI’s)

Other medications used for their antidepressant properties include

trazodone, nefazodone, bupropion, mirtazapine

Antidepressants Treat depression and anxiety, such as

Major depression, Bipolar disorder, general anxiety disorder

Adverse Effects of MAOI’s

Weight Gain, Daytime sedation, Sexual dysfunction, Insomnia

Adverse Effects of TCA’s

Causes anticholinergic effects., dry mouth, constipation, Risk for orthostatic hypotension, Over time, clients may develop tolerance to the anticholinergic effects

Adverse Effects of SSRIs

Nausea, Agitation, Sexual dysfunction

Adverse Effects of SNRI’s

Similar SE of SSRI’s, Unique side effect appetite suppression.

Anyone beginning or increasing the dosage of any antidepressants should be

watched closely for worsening depression, behavior, and increased Risk for Suicide.

Antidepressants Client/Patient Teaching

The medication may take a few weeks before the client experiences relief of symptoms. If the client experiences sedation, it may be better for them to take the medication at night. The client should take time to see how they tolerate the medication side effects before engaging in activities that require alertness or reflexes. (Operating heavy machinery).

SSRI may take up to

4 to 6 weeks for therapeutic response.

TCA’s may take up to

2 to 4 weeks for therapeutic response.

Especially when taking Bupropion

as it carries a higher risk of seizures

MAOI, the client must refrain from

eating foods containing tyramine due to increased risk for Hypertensive Crisis!!

A client should avoid taking MAOIs with

other TCAs.

Antidepressants Avoid

over-the-counter OTC drugs that contain Ephedrine.

Foods High in Tyramine

and foods that are aged or fermented. Aged, smoked meats – such as pepperoni, salami, and other processed meats. All tap beers Yogurt, sour cream Cured and processed meats with nitrates and salt. They are high in tyramines, Dried/overripened fruits, like raisins, prunes, avocados, and bananas, may contain high levels of tyramine. This may also include foods prepared with ripened fruits like wine.

Alternatives of Tyramine foods,

like fresh poultry, fish, and beef. mayonnaise, vinegar, ketchup, or mustard., like apples, grapes, and oranges.

Antipsychotics (Neuroleptics) Used to treat

Schizophrenia Spectrum and other psychotic-related disorders.

Antipsychotics (Neuroleptics) herapeutic use and mechanisms of action

Work by blocking the dopamine receptors.

First Generation Antipsychotics (FGA also, - conventional/typical)

Haloperidol, Haldol decanoate IM, fluphenazine, loxapine, chlorpromazine ( only work on positive signs)

Second-Generation Antipsychotics (SGA also – conventional/typical) Therapeutic use and mechanisms of action

Works by blocking the Dopamine receptors to a lesser degree and by inhibiting the reuptake of Serotonin.

Second-Generation Antipsychotics Leads to the treatment of

both Positive and Negative symptoms of Schizophrenia.

SGA is not as

potent as FGA lesser severity of side effects (SE).

Second-Generation Antipsychotics Drugs commonly prescribed

Clozapine, Quetiapine, Lurasidone, Paliperidone

FGA and SGA Adverse effects Metabolic side effects

Increased blood sugar, Increased blood pressure, Increased cholesterol

Third Generation Antipsychotics (TGA) meds

aripiprazole, brexpiprazole, cariprazine

Antipsychotics Adverse Effects Anticholinergic manifestations

Dry mouth, Constipation, Blurred vision, Orthostatic hypotension, May cause gynecomastia, Decreased sex drive, Menstrual irregularities, Weight gain

Antipsychotics Client/Patient Teaching

Assist the client with the importance of continuing treatment even after manifestations S/S resolve. Medication Compliance is essential. Encourage clients to speak with the provider regarding side effects of medications. Encourage the client to have a support person who can help identify early signs of relapse.

Mood Stabilizers

It is used to help relieve manifestations of mood dysregulation found in disorders such as bipolar disorder.

Mood Stabilizers Therapeutic mechanism of action

mood stabilizing properties of Lithium need to be clearly understood.

Lithium

effects regulating the reuptake of monoamine neurotransmitters.

Lithium is the most

established mood stabilizer.

Anticonvulsants If Lithium is not well tolerated anticonvulsants such as

Carbamazepine (Tegretal), Valproic acid (Depakote), Toprimate (Topamax)

Both Lithium and Anticonvulsants

help with manifestations of mood dysregulation and inhibit the kindling process.

Kindling process

a gradual increase in neurological stimulus that results in seizure activity

Lithium Adverse Effects

Diarrhea, Nausea increased thirst, Fine hand tremor, Weight gain

Most clients/patients who discontinue lithium do so because

of the adverse effects.

Anticonvulsants Adverse Effects

Sedation, Dry mouth, Can have weight gain or weight loss.

Anticonvulsants Client/Patient Teaching

Emphasize nonpharmacological interventions in helping the client reduce stress. Relapse is possible if the client experiences unmanageable physical or psychological stress.

The patient taking Lithium needs to consume

2 or 3 liters of water per day and consume adequate salt in their diet to help the kidneys excrete med and minimize the risk of toxicity.

Lithium Therapy Serum Levels Range less than 0.5

no therapuctic effect

Lithium Therapy blood test

Weekly or every two weeks until therapeutic

Lithium Therapy Therapeutic levels

1-1.5

Manifestations of Lithium toxicity often appear with levels greater than

1.5 mEq/L

Lithium Therapy Function tests

Liver and Kidney

Sedatives – Hypnotics

Often prescribed to treat the sleep-wake disorder insomnia. Work on GABA

Nonbenzodiazepines (hypnotics) meds

Zolpidem, Zaleplon, Eszopiclone

Nonbenzodiazepines (hypnotics) meds have Fewer

adverse reactions than benzodiazepines.

Melatonin receptor agonist

activate the melatonin receptors Primarily used for clients who have difficulty falling asleep. Example

Nonbenzodiazepines (hypnotics) meds Adverse effects

Headache, Fatigue, Dizziness, Nausea

Nonbenzodiazepines (hypnotics) meds More serious SE include

Sleep-driving, Sleepwalking, Amnesia, Hallucinations, Suicidal ideation

Nonbenzodiazepines (hypnotics) meds Client/Patient Teaching

Caution driving Never take meds before operating a vehicle. SAFETY Short-term treatment of insomnia.

Stimulants Therapeutic use and mechanism of action

Narcolepsy and Commonly prescribed for children and adolescents with ADHD.

Stimulants drugs

Methylphenidate, Dextroamphetamine

Stimulants Adverse effects

Nausea, Dry mouth, Heart palpitations, Irritability, Monitor for decreased appetite. May lead to weight loss.

Stimulants Client/Patient

Emphasize diet considerations., Avoid foods that contain caffeine.

Herbals Remedies Over the Counter Common Types

St. Johns Wart, Ginseng, Echinacea

Clients taking St. John’s Wart with

fluoxetine can cause Serotonin syndrome.

Serotonin Syndrome Description

High influx of Serotonin a severe drug reaction resulting in high levels of serotonin

Serotonin Syndrome causes

Intentional overdose, Taking multiple classes of antidepressants, Illicit use of drugs like LSD and ecstasy, Combining herbal remedies.

Serotonin Syndrome Manifestations

Restlessness, Sweating, Dilated pupils, Tachycardia and blood pressure, Muscle rigidity

Serotonin Syndrome Nursing Interventions

Vital Signs, Sedation with a benzodiazepine, Adm. Of serotonin antagonists such as cyproheptadine.

Activation Syndrome Description Common causes

manifestation may present after staring antidepressant few hour after admin for first does or though first few weeks of SSRI

Activation Syndrome Manifestations

Irritability, anxiety, impulsivity, aggressiveness, agitation, Possible increased thoughts of suicide

Activation Syndrome Nursing Interventions

Awareness of client’s behavior Ex. Giving away precious belongings, Calling friends to say goodbye, Requesting to write a will