Psychotropic Medications Brady student

Psychotherapeutic Agents

  • Presented by: Beth A. Ready MSN, RN, CNE

Learning Objectives

  • Understand synaptic functioning and the role of monoamine neurotransmitters.

  • Compare neurobiological causes of mental illness.

  • Differentiate psychotherapeutic medications based on the disorders treated.

  • Explain serious side effects of psychotherapeutic medications.

  • Discuss the necessity of detoxification protocols in interprofessional care.

Overview of Mental Health Factors

  • Factors impacting mental health include:

    • Neurobiological

    • Genetic

    • Environmental

  • Importance of brain chemistry and anatomy in mental health:

    • Understand chemical and anatomical functions.

    • Role of neurotransmitters in pharmacological and non-pharmacological treatments.

Neurotransmitters

  • Neurons: Nerve cells conducting electrical impulses.

  • Neurotransmitter: Chemicals released in response to an electrical impulse (neuromessengers).

    • Bind to receptors on cell surfaces; can inhibit or excite.

    • Primary target for psychotropic drugs.

Neurotransmission Process

  • Involves presynaptic and postsynaptic neurons.

  • Transmission occurs through neurotransmitter release.

Types of Neurotransmitter Drugs and Their Indications

  • Acetylcholine:

    • Medications: Acetylcholinesterase inhibitors.

    • Disorders: Dementia, Alzheimer's Disease.

  • Dopamine:

    • Medications: Antipsychotics.

    • Disorders: Schizophrenia, Parkinson’s, Psychotic Disorders.

  • GABA:

    • Medications: Anti-anxiety medications.

    • Disorders: Anxiety Disorders.

  • Glutamate:

    • Medications: Memantine (Namenda).

    • Disorders: Alzheimer’s Disease.

  • Norepinephrine:

    • Medications: Mood stabilizers, antidepressants.

    • Disorders: Bipolar disorder, mood disorders.

  • Serotonin:

    • Medications: Antidepressants.

    • Disorders: Depression, suicidal thoughts.

Neurobiological Causes of Mental Illness

  • Key contributing factors include:

    • Neurobiology and genetics.

    • Psychiatric pharmacogenomic testing and family studies.

    • Psychological and immunological stressors.

    • Infections and neuroplasticity.

Neuroplasticity

  • Involves:

    • Chemical change.

    • Structural change.

    • Functional change.

Anxiolytic (Antianxiety) Medications

  • Drug Classes:

    • Benzodiazepines (e.g., diazepam, lorazepam).

    • Buspirone.

  • Mechanism of Action:

    • Benzodiazepines enhance GABA's inhibitory effects.

    • Decrease neuronal excitability leading to anxiolytic effects.

Benzodiazepines

  • Pharmacokinetics:

    • Variable onset: short and long-acting forms.

    • Highly lipid soluble, protein-bound.

    • Metabolized by the liver.

  • Adverse Effects:

    • CNS depression, anterograde amnesia, sleep disturbances.

    • Risk for paradoxical effects, respiratory depression, and abuse.

  • Nursing Implications:

    • Assess anxiety signs, vital signs, and history.

    • Implement safety measures and non-drug anxiety relief.

    • Taper usage gradually to avoid withdrawal symptoms.

Buspirone (Buspar)

  • Mechanism of Action:

    • Affects serotonin and dopamine receptors; non-sedating.

  • Pharmacokinetics:

    • Slow onset; takes 1-2 weeks for response.

  • Adverse Effects:

    • Headaches, nausea, dizziness, insomnia.

Types of Antidepressants

  • Classes:

    • Tricyclic Antidepressants (TCAs)

    • Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

    • Monoamine Oxidase Inhibitors (MAOIs)

    • Atypical Antidepressants.

Tricyclic Antidepressants (TCAs)

  • History: Available since the 1950s.

  • Mechanism:

    • Blocks reuptake of norepinephrine; varied patient response.

  • Adverse Effects:

    • Sedation, orthostatic hypotension, anticholinergic effects.

    • Other indications for use include bipolar disorder and chronic pain syndromes.

SSRIs Overview

  • Common SSRIs:

    • Fluoxetine, sertraline, paroxetine, citalopram, escitalopram.

  • Mechanism:

    • Block serotonin reuptake; generally safer than TCAs.

  • Adverse Effects:

    • Nausea, weight gain, sexual dysfunction, and withdrawal symptoms.

SNRIs Overview

  • Examples include venlafaxine, duloxetine, and desvenlafaxine.

  • Common Side Effects:

    • Nausea, dizziness, sweating, insomnia.

Monoamine Oxidase Inhibitors (MAOIs)

  • Indication: Not first-line due to dietary restrictions.

  • Common Medications:

    • Nardil, Marplan, Parnate.

  • Risks:

    • Hypertensive crisis and interactions with SSRIs and tyramine-rich foods.

Patient Education for MAOIs

  • Avoid aged cheese, fermented foods, red wine, and certain fruits.

  • Watch for signs of hypertensive crisis including severe headache and chest pain.

Atypical Antidepressants

  • Example: Bupropion (Wellbutrin), indicated for depression and smoking cessation.

  • Mechanism: Inhibits reuptake of dopamine, norepinephrine, and serotonin.

  • Adverse Effects: Risk of seizures and minimal cardiovascular side effects.

Nursing Implications

  • Monitor for depression signs, assess risk for suicide, encourage safety.

  • Educate on gradual discontinuation to avoid withdrawal symptoms.