1. Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 17 Psychotherapeutic Drugs

2. 2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs  Used in the treatment of emotional and mental disorders  Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress  When emotions significantly affect an individual’s ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option

3. 3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs (cont’d) Three main emotional and mental disorders:  Anxiety  Affective disorders  Psychoses

4. 4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs (cont’d)  Types of psychotherapeutic drugs  Antianxiety drugs  Antimanic drugs  Antidepressant drugs  Antipsychotic drugs

5. 5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Biochemical Imbalance  Other biochemicals are necessary for normal mental function  GABA  Acetylcholine (ACh)  Sodium, potassium, magnesium

6. 6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Anxiety  Unpleasant state of mind, characterized by a sense of dread and fear  May be based on actual anticipated experiences or past experiences  May be exaggerated responses to imaginary negative situations

7. 7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Anxiety Disorders Six major anxiety disorders (persistent anxiety)  Obsessive-compulsive disorder (OCD)  Posttraumatic stress disorder (PTSD)  Generalized anxiety disorder (GAD)  Panic disorder  Social phobia  Simple phobia

8. 8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Affective Disorders (Mood Disorders)  Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions)  Some patients may exhibit both mania and depression: bipolar disorder (BPD)

9. 9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychosis  Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living  Hallmark: loss of contact with reality  Examples  Schizophrenia  Depressive and drug-induced psychoses

10. 10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutics: Pathophysiology  Biochemical imbalance theory  Mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain

11. 11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutics: Pathophysiology Biochemical imbalance theory (cont’d)  Brain levels of certain neurotransmitters play an important role in maintaining mental health  Catecholamines  Dopamine  Norepinephrine  Indolamines  Serotonin  Histamine

12. 12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antianxiety Drugs  Reduce anxiety by reducing overactivity in CNS  Benzodiazepines Depress activity in the brainstem and limbic system Depress activity in the brainstem and limbic system  Miscellaneous drug: Buspirone (BuSpar) Nonsedating and non–habit forming Nonsedating and non–habit forming May have drug interaction with SSRIs (serotonin syndrome) May have drug interaction with SSRIs (serotonin syndrome) Do not administer with MAOIs Do not administer with MAOIs

13. 13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antianxiety Drugs (cont’d)  Barbiturates and carbamates  Previously used to treat anxiety  Replaced by newer drugs

14. 14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antianxiety Drugs: Indications  Anxiety  Insomnia  Sedation  Muscle spasms  Seizure disorders  Adjuncts in anesthesia  Adjuvant therapy for depression  Alcohol (ethanol) withdrawal

15. 15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common Benzodiazepines  diazepam (Valium)  lorazepam (Ativan)  alprazolam (Xanax)  clonazepam (Klonopin)  chlordiazepoxide (Librium)

16. 16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common Benzodiazepines (cont’d)  Midazolam (Versed)*  Reduces anxiety and patient’s memory of painful procedures that do not require general anesthesia (moderate sedation)  Injection only *Limited to use as sedative and anesthetic during invasive medical or surgical procedures

17. 17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Benzodiazepines  Potentially habit-forming and addictive  Should be used at lowest effective dosages and frequencies needed for symptom control and frequencies needed for symptom control

18. 18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Benzodiazepines: Adverse Effects Benzodiazepine adverse effects are an overexpression of their therapeutic effects  Decreased CNS activity, sedation  Hypotension  Drowsiness, loss of coordination, dizziness, headaches  Nausea, vomiting, dry mouth, constipation  Others

19. 19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Benzodiazepines: Overdose  Dangerous when taken with other sedatives or alcohol or alcohol  Treatment is generally symptomatic and supportive supportive  Flumazenil may be used to reverse benzodiazepine effects benzodiazepine effects

20. 20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Affective Disorder Drugs  Mood stabilizers  Used to treat bipolar disorder Involves cycles of mania, hypomania, and depression Involves cycles of mania, hypomania, and depression  Antidepressants  Used to treat depression

21. 21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mood Stabilizers: Antimanic Drugs Lithium is the drug of choice for the treatment of mania  It is thought to potentiate serotonergic neurotransmission  May be used with other medications to stabilize mood  Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L  Monitor sodium levels

22. 22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Depression Etiology  Biogenic amine hypothesis  Depression and mania are caused by an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain Depression: deficiency of catecholamine, especially norepinephrine Depression: deficiency of catecholamine, especially norepinephrine Mania: excess amines Mania: excess amines

23. 23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

24. 24 Depression (cont’d) Etiology (cont’d)  Permissive hypothesis  Affective disorders are caused by decreased concentrations of serotonin Depression results from decreases in both serotonin and catecholamine levels Depression results from decreases in both serotonin and catecholamine levels Mania results from increased catecholamine but decreased serotonin levels Mania results from increased catecholamine but decreased serotonin levels

25. 25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

26. 26 Depression (cont’d) Etiology  Dysregulation hypothesis  Depression and other affective disorders result from a failure in the regulation of catecholamine activity

27. 27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antidepressants  Tricyclic antidepressants  Monoamine oxidase inhibitors (MAOIs)  Newer-generation antidepressants  Selective serotonin reuptake inhibitors (SSRIs)  Second- and third-generation antidepressants

28. 28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Tricyclic Antidepressants: First-Generation Antidepressants  Have largely been replaced by SSRIs as first-line antidepressant drugs  Considered second-line  For patients who fail with SSRIs or other newer- generation antidepressants  As adjunct therapy with newer-generation antidepressants

29. 29 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common Tricyclics  amitriptyline (Elavil, Endep)  doxepin (Sinequan)  imipramine (Tofranil)  desipramine (Norpramin)  nortriptyline (Aventyl, Pamelor)  Others

30. 30 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action  Block reuptake of neurotransmitters, causing accumulation at the nerve endings  It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression

31. 31 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Effects  Blockade of norepinephrine reuptake  Antidepressant,* tremors, tachycardia, others  Blockade of serotonin reuptake  Antidepressant,* nausea, headache, anxiety, sexual dysfunction *Desired therapeutic effects

32. 32 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications  Depression  Childhood enuresis (imipramine)  Obsessive-compulsive disorders (clomipramine)  Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia

33. 33 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects  Sedation  Impotence  Orthostatic hypotension  Others  Older patients  Dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors

34. 34 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Overdose  Lethal—70% to 80% die before reaching the hospital  CNS and cardiovascular systems are mainly affected  Death results from seizures or dysrhythmias

35. 35 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Overdose (cont’d)  No specific antidote  Decrease drug absorption with activated charcoal  Speed elimination by alkalinizing urine  Manage seizures and dysrhythmias  Basic life support

36. 36 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs  Highly effective  Considered second-line treatment for depression, not responsive to cyclics  Disadvantage: potential to cause hypertensive crisis when taken with tyramine

37. 37 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs (cont’d)  Examples  phenelzine (Nardil)  tranylcypromine (Parnate)

38. 38 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs: Mechanism of Action  Inhibit the MAO enzyme system in the CNS  Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain  Result: alleviation of symptoms of depression

39. 39 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs: Indications  Depression, especially types characterized by reverse vegetative symptoms such as increased sleep and appetite  Depression that does not respond to other drugs such as tricyclics

40. 40 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs: Adverse Effects Few adverse effects—orthostatic hypotension most common  Palpitations  Drowsiness  Headache  Nausea  Impotence  Tachycardia  Dizziness  Insomnia  Anorexia  Blurred vision

41. 41 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs: Overdose  Symptoms appear 12 hours after ingestion  Tachycardia, circulatory collapse, seizures, coma  Treatment: protect brain and heart, eliminate toxin  Gastric lavage  Urine acidification  Hemodialysis

42. 42 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hypertensive Crisis and Tyramine  Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death  Avoid foods that contain tyramine!  Aged, mature cheeses (cheddar, blue, Swiss)  Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)  Yeast extracts  Red wines (Chianti, burgundy, sherry, vermouth)  Italian broad beans (fava beans)

43. 43 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MAOIs  Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome  If the decision is made to switch to an SSRI, there must be a 2- to 5-week “wash-out” period between MAOI therapy and SSRI therapy

44. 44 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants  Fewer adverse effects than tricyclics and MAOIs  Very few drug-drug or drug-food interactions  Still take about 4 to 6 weeks to reach maximum clinical effectiveness  Now considered first-line drugs for depression

45. 45 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants (cont’d)  trazodone (Desyrel)  bupropion (Wellbutrin)  SSRIs  fluoxetine (Prozac)  paroxetine (Paxil)  sertraline (Zoloft)  fluvoxamine (Luvox)  citalopram (Celexa)  escitalopram (Lexapro)

46. 46 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants (cont’d)  venlafaxine (Effexor)  nefazodone (Serzone)  mirtazapine (Remeron)  duloxetine (Cymbalta)  desvenlafaxine (Pristiq)

47. 47 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. SSRIs  Mechanism of action  Selectively inhibit serotonin reuptake  Little or no effect on norepinephrine or dopamine reuptake  Result in increased serotonin concentrations at nerve endings  Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system

48. 48 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants: Indications  Depression  Bipolar disorder  Obesity  Eating disorders  Obsessive-compulsive disorder

49. 49 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants: Indications (cont’d)  Panic attacks or disorders  Social anxiety disorders  Posttraumatic stress disorders (PTSDs)  Myoclonus  Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment)

50. 50 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants: Adverse Effects Body SystemEffects CNSHeadache, dizziness, tremor, nervousness, insomnia,* fatigue GINausea, diarrhea, constipation, dry mouth OtherSexual dysfunction, weight gain*, weight loss*, sweating *Most common and bothersome

51. 51 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Serotonin Syndrome  Symptoms  Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse tremors  Symptoms of severe cases  Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC)

52. 52 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newer-Generation Antidepressants: Drug Interactions  Highly bound to plasma proteins  Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect  Inhibition of cytochrome P-450 system  MAOIs

53. 53 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antipsychotics  Drugs used to treat serious mental illness  Behavioral problems or psychotic disorders  Have been known as tranquilizers or neuroleptics

54. 54 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antipsychotics (cont’d)  Thioxanthenes: thiothixene (Navane)  Butyrophenones: haloperidol (Haldol)  Dihydroindolones: molindone (Moban)  Dibenzoxazepine: loxapine (Loxitane)  Phenothiazines: three structural groups  Atypical antipsychotics: new class

55. 55 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action  Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function  Dopamine levels in the CNS are decreased  Result: tranquilizing effect in psychotic patients

56. 56 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Atypical Antipsychotics: Second-Generation Antipsychotics  clozapine (Clozaril)  risperidone (Risperdal)  olanzapine (Zyprexa)  quetiapine (Seroquel)  ziprasidone (Geodon)  aripiprazole (Abilify)  paliperidone (Invega)

57. 57 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Atypical Antipsychotics: Mechanism of Action  Block specific dopamine receptors: dopamine-2 (D2) receptors  Also block specific serotonin receptors: serotonin-2 (5HT2) receptors  This is responsible for their improved efficacy and safety profiles

58. 58 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antipsychotics: Indications  Treatment of serious mental illnesses  Bipolar affective disorder  Depressive and drug-induced psychoses  Schizophrenia  Autism  Movement disorders (such as Tourette’s syndrome)  Some medical conditions  Nausea, intractable hiccups

59. 59 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects Body SystemAdverse Effects CNSSedation, delirium CardiovascularOrthostatic hypotension, syncope, dizziness, ECG changes DermatologicPhotosensitivity, skin rash, hyperpigmentation, pruritus

60. 60 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d) Body SystemAdverse Effects GIDry mouth, constipation GUUrinary hesitancy or retention, impaired erection HematologicLeukopenia and agranulocytosis

61. 61 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d) Body SystemAdverse Effects Metabolic/endocrineGalactorrhea, irregular menses, increased appetite, polydipsia

62. 62 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d)  Neuroleptic malignant syndrome (NMS)  Potentially life threatening  High fever, unstable BP, myoglobinemia  Extrapyramidal symptoms (EPS)  Involuntary muscle symptoms similar to those of Parkinson’s disease  Akathisia (distressing muscle restlessness)  Acute dystonia (painful muscle spasms)  Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)

63. 63 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d)  Tardive dyskinesia (TD)  Involuntary contractions of oral and facial muscles  Choreoathetosis (wavelike movements of extremities)  Occurs with continuous long-term antipsychotic therapy

64. 64 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Herbal Products: St. John’s Wort  Used for depression, anxiety, sleep disorders, nervousness  May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity  Severe interactions if taken with MAOIs and SSRIs; many other drug interactions  Food-drug interaction with tyramine- containing foods

65. 65 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Herbal Products: Ginseng  Three varieties; has been used for over 5000 years  Uses: stress reduction, improvement of physical endurance and concentration  May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms  Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs

66. 66 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications  Before beginning therapy, assess physical and emotional status of patients  Obtain baseline vital signs, including postural BP readings  Obtain liver and renal function tests

67. 67 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Assess for possible contraindications to therapy, cautious use, and potential drug interactions  Assess for LOC, mental alertness, potential for injury to self and others  Check the patient’s mouth to make sure oral doses are swallowed

68. 68 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected  Advise patients to avoid abrupt withdrawal  Advise patients to change positions slowly to avoid postural hypotension and possible injury

69. 69 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills  Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts  Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal

70. 70 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antianxiety drugs  In elderly patients, monitor closely for oversedation and profound CNS depression

71. 71 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antidepressants  Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants  Inform patients that it may take several weeks to see therapeutic effects  Monitor patients closely during this time, assess for suicidal tendencies, and provide support  Assist elderly or weakened patients with ambulation and other activities because falls may occur because of drowsiness or postural hypotension

72. 72 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antidepressants (cont’d)  Tricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions with anesthetic drugs  Monitor for adverse effects, and discuss with patients  Encourage patients to wear medication ID badges naming the drugs being taken

73. 73 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antidepressants (cont’d)  Caffeine and cigarette smoking may decrease effectiveness of medication therapy  Instruct patients and family regarding tyramine- containing foods and signs and symptoms of hypertensive crisis

74. 74 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antipsychotics—phenothiazines  Instruct patients to wear sunscreen because of photosensitivity  Tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose  Inform patients to avoid alcohol or other CNS depressants with these medications

75. 75 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antipsychotics—phenothiazines (cont’d)  Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician

76. 76 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Antipsychotics—phenothiazines (cont’d)  Oral forms may be taken with meals to decrease GI upset  These drugs may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowly

77. 77 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Monitor for therapeutic effects  Monitor mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns  Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement

78. 78 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Monitor for therapeutic effects (cont’d)  For anxiolytics Improved mental alertness, cognition, and mood Improved mental alertness, cognition, and mood Fewer anxiety and panic attacks Fewer anxiety and panic attacks Improved sleep patterns and appetite Improved sleep patterns and appetite Less tension and irritability; fewer feelings of fear, impending doom, and stress Less tension and irritability; fewer feelings of fear, impending doom, and stress More interest in self and others More interest in self and others

79. 79 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Monitor for therapeutic effects (cont’d)  For antidepressants Improved sleep patterns and nutrition Improved sleep patterns and nutrition Increased feelings of self-esteem Increased feelings of self-esteem Decreased feelings of hopelessness Decreased feelings of hopelessness Increased interest in self and appearance Increased interest in self and appearance Increased interest in daily activities Increased interest in daily activities Fewer depressive manifestations or suicidal thoughts/ideations Fewer depressive manifestations or suicidal thoughts/ideations

80. 80 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Monitor for therapeutic effects (cont’d)  For antipsychotics Improved mood and affect Improved mood and affect Alleviation of psychotic symptoms and episodes Alleviation of psychotic symptoms and episodes Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope

81. 81 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Psychotherapeutic Drugs: Nursing Implications (cont’d)  Monitor for therapeutic effects (cont’d)  For lithium Less mania Less mania Therapeutic lithium levels of 0.6 to 1.2 mEq/L Therapeutic lithium levels of 0.6 to 1.2 mEq/L