Of these which is not a Role of the RN in Psychopharmacology

Monitoring drug effects , Medication education, Drug maintenance programs, Clinical research drug trials,   Prescriptive authority, Patient assessment,     Coordination of treatment modalities, Drug administration

What is a Neurotransmitters

Chemical messengers that transmit thought from one cell to the next- allowing the brain cells to “talk to each other.” 

Depression, Lifelessness, Moods, Irritability, Sleeplessness, Anxiety/panic, Brain Fog, Stress damage

Neurotransmitter

Can either........

Neurotransmitter

“Feel Good” or excitatory type

Norepinephrine, Dopamine, Acetylcholine, Endorphins

 Neurotransmitter

Inhibitory type 

GABA

What is the roll of the Neuron

—  Respond to stimuli

—  Conduct electrical impulses

—  Inward flow of sodium

—  Outward flow of potassium

—  Release chemicals- Neurotransmitters

An impulse can be transmitted electrically across the synaptic cleft

True or False?

False

—   when impulse reaches the end of the axon, it triggers the release of neurotransmitters.  They cross the synaptic cleft and attach themselves to receptors on the dendrite of the other neuron. 

—  Some transmitters stimulate the neuron to produce a nerve impulse (EXCITATORY)

Others tend to prevent the neuron from producing an impulse (INHIBITORY) 

What can destroy the neurotransmitters?

2

Enzymes

—  Reuptak 

the  neurotransmitter is taken back into the axon terminal that released it. They are removed from the synaptic cleft so they cannot bind to receptors.

Neurotransmitter

Glutamate

Found in all cells

Major excitatory

Stored in CNS in vesicles for neurotransmisison

Neurotransmitter

GABA – Gamma-aminobutyric Acid

Major post-synaptic

inhibitory 

Neurotransmitter

Acetylcholine

Located in the brain and spinal cord

Excitatory or inhibitory; sleep/wake cycle

Neurotransmitter

Dopamine

Located in the substantia nigra of the brainstem

movement; psychiatric symptoms; endocrine function

involved in control of movement, motivation, cognition, emotional regulation, pleasure

Neurotransmitter

Histamine

Regulates arousal and appetite

H₁ antagonist: sedates; ↑ appetite; ↑ weight

Many psych meds block H₁ = weight gain

Neurotransmitter

Norepinephrine

Located in brainstem

Responsible for cognition, mood, vigilance and attentiveness to environment

Fight or flight (mostly excitatory)

Neurotransmitter

Serotonin (derived from tryptophan)

Found in the raphe nuclei of brainstem

Role in arousal and onset of sleep, mood and anxiety (mostly inhibitory)

Plays a role with dopamine in psychosis and anxiety

Depression may result for a dysfunction of which neurotransmitters

Deficiency of norepinephrine

Deficiency of serotonin

Deficiency of both

Schizophrenia may result for a dysfunction of which neurotransmitters

Excess transmission of dopamine

Deficiency of g-aminobutyric acid (GABA)

How do Antipsychotic Medications work?

Exert most effects by blocking dopamine receptors

Also called Neuroleptics

Acute Psychotic Disorder , Bipolar Disorder  Aggressive behavior, Agitation, Impulsivity, Self injury. Tourette’s syndrome. Chronic psychotic disorders. Obsessive-Compulsive Disorder. Schizophrenia. Parkinson’s disease (psychotic episodes). Cocaine Withdrawal. Emesis (neuroleptics are potent anti-emetics)

Is   Phenothiazines a

Typical or Atypical Antipsychotics

—  TYPICAL

Is Thorazine, Mellaril, Serentil, Trilafon, Stelazine, Prolixin a Typical or Atypical Antipsychotics

—  TYPICAL

Is Clozaril a Typical or Atypical Antipsychotic?

Is Thioxanthene a  Typical or Atypical Antipsychotic

Navane- Typical Antipsychotic

Butyrophenone- Typical Antipsychotic

Haldol- Typical Antipsychotic

Seroquel- Atypical Antipsychotic

Geodon-Atypical Antipsychotic

Abilify-Atypical Antipsychotic

What are the side effects of Typical Antipsychotics

Hepatic, EKG changes, seizures, hematologic

Dermatitis, photosensitivity

↑Prolactin levels

Neuroleptic Malignant Syndrome (NMS)

Weight gain

Sexual dysfunction

Extrapyramidal Side Effects (EPS)

Insomnia

What are the characteristics of Atypical Antipsychotics

Less EPS and side effects

Better improvement in negative symptoms

Also used in mood stabilization

Effective for symptoms that are refractory to treatment by typical antipsychotics

1^st to appear; most dramatic

Spasms of major muscle groups- Neck Back Eyes

Occurs suddenly

Frightening, painful

Extrapyramidal Symptoms (EPS) ) 

Akathisia

Motor restlessness

Pacing

“Ants in pants"

Extrapyramidal Symptoms (EPS) 

Parkinsonism

Muscle rigidity

Pill rolling

Shuffling Gait

Mask-like affect

Treatment of EPS

What three types of drugs should you know to give?

Anticholinergics: Benzotropine (Cogentin), Trihexphenidyl (Artane)

Antihistamine: Diphenhydramine (Benadryl)

Antiviral: Amantadine (Symmetrel

Anticholinergic Adverse Reactions

Mad as a hatter (unresponsive)

Red as a beet (red skin)

Hot as a hare  (febrile)

Dry as a bone  (dry)

Blind as a bat (dilated pupils)

TARDIVE DYSKINESIA

Tends to occur after months/years of meds

No particular treatment, only management

Abnormal Involuntary Movement Scale (AIMS) rating scale

Change meds (weigh the pros & cons)

Benzodiazepines or mood stabilizers may reduce

Clozapine (Clozaril)

Possibly fatal side effects

Agranulocytosis, convulsions, myocarditis

Drowsiness, sedation, hypersalivation, tachycardia, dizziness

Risperidone (Risperdal)

Side effects

Motor difficulties, orthostatic hypotension, sedation

Neuroleptic Malignant Syndrome (NMS)

Neuroleptic = Antipsychotic drugs

Generally the -↑ dose, ↑ occurrence rate

Neuroleptic Malignant Syndrome (NMS)

mortality rate 

High mortality rate 14-30%  (potentially fatal)

—  Early recognition essential

Neuroleptic Malignant Syndrome (NMS)

Treatment:  

Neuroleptic Malignant Syndrome (NMS)

 Signs/Symptoms

Muscle rigidity. Fever. Tachycardia. Sweating . Tremor. Incontinence. Stupor. Leukocytosis. ↑ CPK        Renal failure

More common in high potency drugs and dehydrated patients

What are Mood Stabilizers used to treat?

Bipolar Disorder

What types of druges are used as Mood Stabilizers

Lithium – commonly used

Anticonvulsant (Antiepileptic) drugs

Carbamazepine (Tegretol)

Divalproex (Depakote)

Lamotrigine (Lamictal)

Gabapentin (Neurontin)

Topiramate (Topamax)

Clonazepam (Klonopin)

What is Kindling r/t Bipolar Disorder

(repeated sub-threshold stimuli that eventually generates an action potential)

When not medicated, bipolar disorder can worsen due to “kindling”

1^st manic or depressive episode due to some kind of life stress.  After a few triggered episodes, electrical wiring of brain changes and mania or depression  occurs with only a small trigger. Eventually the brain becomes so sensitized that it triggers with no apparent reason. 

It is ease to stabilize a pt once Kindling has begun if they go back on their meds

Fales

It is difficult to restabilize a client after going off their medications

Lithium side effects

Acute

thirst

nausea

urination

fine hand tremor

Lithium side effects

Chronic

urination

wt. loss

hair loss

acne

cognitive impairment

hypothyroidism

What should the nurse know about

Monitoring Lithium Levels

narrow therapeutic window:

Lab range 0.4 – 1.4

Levels drawn - 12 hr after last dose

Takes 5 days for dose to stabilize levels

Coarse hand tremor, vomiting & diarrhea, blurred vision, drowsy, slurred speech, confusion, coma, seizure

THESE ARE LIFE THREATENING

Nausea/Vomiting, Diarrhea

Thirst, Polyuria

Slurred speech

Muscle weakness

What can Lithium use  in first trimester of pregnancy cause?

teratogenic effects: Ebstein’s anomaly (of the tricuspid heart valve).

Fatal or brain damage in overdose 

—  Hypothyroidism

Impairment of kidney’s 

Lithium Can be removed via dialysis

True or False?

What are the two types of Older Antidepressant?

Tricyclic (TCAs)

Monoamine Oxidase Inhibitors (MAOIs

Selective Serotonin Reuptake Inhibitors (SSRIs)

Combination reuptake inhibitors: serotonin/norepinephrine, dopamine/norepinephrine

Blocks reuptake of serotonin – more available for action at receptors

What are the three Tricyclic antidepressants (TCAs) drugs?

Amitriptyline (Elavil)

Imipramine (Tofranil)

Nortriptyline (Pamelor)

Selective serotonin reuptake inhibitors (SSRIs)

5 Drugs

Fluoxetine (Prozac)

Sertraline (Zoloft)

Paroxetine (Paxil)

Citalopram (Celexa)

Escitalopram (Lexapro)

SEROTONIN SYNDROME

Signs and Symptoms

 sweating, chills, nausea, vomiting, diarrhea, restlessness, myoclonus, insomnia, agitation, and possibly delirium

SEROTONIN SYNDROME

Treatment:

 Stopping the drug and call the physician

 Institute supportive measures

What are the Monoamines that our bodies use?

Monoamine oxidase – breaks down _______

What are the Monoamine oxidase inhibitors (MAOIs) drugs?

3

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

MAOI restricted foods
(because of tyramine)

Pickled or smoked foods (herring)

Aged cheese- cause 80% of hypertensive crises

Soy sauce, alcohol- beer and wine (esp sherry, red wines)

Liver, lima beans, aspartame

What are the MAOI reactions the nurse needs to be awair of?

Severe headache, stiff neck, sweating, nausea, vomiting, HTN

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Mirtazapine (Remeron)

Trazodone (Desyrel)

Dopamine-norepinephrine reuptake inhibitor

What are the drugs in this class?

Bupropion (Wellbutrin/Zyban)

Side Effects of Antidepressants

GI side effects

Side Effects of Antidepressants

Sexual

Sexual dysfunction- delayed orgasm

Side Effects of Antidepressants

CNS

Agitation, dizziness, fatigue, headache, anxiety, insomnia, tremors , —  Yawning

Side Effects of Antidepressants

Effexor

Side Effects of Antidepressants

Wellbutrin

ANXIOLYTIC MEDICATION
Benzodiazepines

5

Alprazolam (Xanax) —                            Chlordiazepoxide (Librium)

—  Clonazepam (Klonopin)                              —  Diazepam (Valium)

—  Lorazepam (Ativan)

What can BENZODIAZEPINES be used to treat

6

Alcohol Withdrawal, Phobias, Mania, Panic disorder, Anxiety, Insomnia, Convulsions

Shorter acting benzodiazepines with

strong effects.... 

are more addictive due to rapid highs and lows

E.g.. Xanax 

Ataxia. Dizziness, drowsiness. Erectile dysfunction. Disinhibition

Tolerance increases

is life threatening - similar to alcohol and barbiturate withdrawal

What should the nurse know about Benzodiazepine Rebound anxiety

occurs with abrupt cessation or increased time between dosing

What drug is used for anxiety and , is nonaddictive

What drugs are used for attention deficit hyperactivity disorder

Methylphenidate (Ritalin) - stimulant

Dextroamphetamine (Adderall) - stimulant

—  Potential for abuse (Housewife, Dieter)

—  Withdraw gradually

Atomoxetine hydrochloride (Strattera) - nonstimulant

What drugs are used to try  to slow Alzheimer's disease

Tacrine (Cognex)

Donepezil (Aricept)

Memantine (Namenda)

Lithium drug responses among ethnic groups

Greater toxicity in African Americans than in whites

Haloperidol drug responses among ethnic groups

Same dose, but plasma concentrations 50% higher in Asians than in whites

Clozapine drug responses among ethnic groups

Life-threatening side effect, agranulocytosis, more prevalent in Ashkenazi Jews than in other ethnic groups