Week 15: Psychopharmacology/Anxiety and OCD/Disordered Eating

What is dopamine responsible for?

-memory

-motor skills

-behavior

-learning

-sleep

-mood focus

-attention

-immune health

motivation and reward

-pleasure

Which mental health disorder is affected by dopamine?

Schizophrenia

MOA of typical vs first generation antipsychotics:

antagonize (block) dopamine receptors

MOA of atypical vs second generation antipsychotics:

antagonize serotonin receptors, partial D2 agonism, and other receptor action

Specific actions of typical antipsychotics for Schizophrenia:

-reduces positive symptoms of schizophrenia

-more risk of induced movement disorders (TARDIVE DYSKINESIA)

Specific actions of atypical antipsychotics for Schizophrenia:

-reduces positive symptoms

-more action on affective symptoms

-antidepressant, anti-mania, anti-anxiety, and sleep effects

-less risk for induced movement disorders and tardrive dyskinesia

-higher risk of metabolic side effects

What is the main side effect of Clozaril?

AGRANULOCYTOSIS

-monitor WBC levels

Common anticholinergic side effects:

-constipation

-blurred vision

-dry mouth

-drowsiness

Neuroleptic malignant syndrome (NMS):

life threatening (dopamine)

-muscle rigidity

-increased temp, tachycardia, tachypnea, and diaphoresis

-leukocytosis, myoglobinuria

Which neurotransmitter is associated with NMS?

dopamine

Which neurotransmitter is associated with serotonin syndrome?

serotonin

Nursing considerations for NMS:

-discontinue antipsychotics

-check VS

-balance electrolytes

-monitor mental status

-antiparkinsonian meds to reduce dystonia

What is tardive dyskinesia?

involuntary movements of tongue, lips, face, and trunk

What is akathiasia?

subjective restlessness

Nursing considerations for lithium:

INVERSE relationship between lithium and fluids

-high lithium=low fluids

-monitor sodium intake

-ensure hydration

S/s of lithium toxicity:

-ataxia

-slurred speech

-tremor

-tinnitus

-blurred vision

What is the severe side effect associated with Lamotrigine?

Steven Johnsons syndrome

-deadly rash

-titrated slowly to prevent this

S/s of serotonin syndrome:

-tremor

-myoclonus

-diaphoresis

-hyperreflexia

-fever

MAOIs food interaction note:

TYRAMINE interaction

-causes hypertension crisis

Nursing considerations for Benzodiazepines:

-controlled substances (monitor for dependence and withdrawal)

-adverse effects: sedation, dizziness, sleepiness

-avoid alcohol and opioids on this med

Nursing considerations for Buspirone (antiaxiety):

partial serotonin agonist

NO ABUSE POTENTIAL

-monitor adherence (normally taken 2-3x per day)

-RARE cardiac side effects

S/s of generalized anxiety disorder (GAD):

-trouble sleeping

-difficulty concentrating

-feeling tired

-anxiety spread over multiple areas ("what if")

S/s and treatment of panic disorder

4 s/s must be present:

-palpitations

-sweating

-trembling or shaking

-SOB/choking feeling

-nausea/abdominal distress

-dizzy/unsteady/faint

-fear of losing control/dying

treatment= SSRIs first line

S/s of OCD:

-thoughts (obsessions)

-harm to self or others

-behaviors (compulsions)

-cleaning

-counting

-symmetry

What is response prevention:

allowing the feeling of anxiety to remain

-ex: not washing hands, not organizing spaces, not retrieving a discarded object

What is exposure prevention:

exposure to anxiety producing topic or content

-ex: germs, disorganized space, throwing away something hoarded

What are the two evidence-based treatments for OCD?

exposure prevention

response prevention

What is eye movement desensitization and reprocessing?

psychotherapy w/components of CBT and exposure therapy with saccadic eye movement

-patient tracks fingers until anxiety decreases

TCAs

inhibit seretonin and norepi reuptake

increased risk for overdose

lots of drug interaction

social anxiety treatment

SSRIs, SNRIs and CBT

medications for dementia and delirium

cholinesterase inhibitors

doesn’t prevent progression but improves symptoms

anorexia nurisng care

assess for suicide risk

DBT, acceptance and neurocognitive therapy

monitor for refeeding syndrome (occurs within first 5 days of refeeding)

anorexia s/s

low body mass

hypotension

bradycardia

muscle weakness

brittle hair/ hair loss

bulimia

eat in binges and then purge

do not have body image distortion like anorexia

nursing: suicidal ideation, hypokalemia, oral and gi assessment

binge eating disorder

lack of control, ashamed of eating problems

nursing: weight loss, pharmacotherapy and psychotherapy