Erin Kibbey, RN, BS, CCRN Psychopharmacology

›From a historical perspective, reflect on how psychopharmacology has changed mental health nursing ›Explore why patients may refuse or not follow treatment plants (e.g., non-adherence) ›Illustrate the neurobiological mechanism for various psychotropic medications ›Construct a teaching plan to help patients manage their medications and increase adherence ›Explain the primary clinical indications, major side effects, and significant nursing implications for each of the drug categories Learning Objectives

›Read Ch. 7 & 31 from textbook ›Watch YouTube video on movement disorders associated with psychopharmacologyYouTube video ›Review drug handout Student Assignments

›Before 1950s –Sedatives and amphetamines were the only significant psychotropic drugs available ›Since 1950s, psychopharmacology has expanded to include antipsychotic, antidepressant, and antianxiety drugs ›Psychotropic drugs are intended to be used as an adjunct to individual or group psychotherapy Historical Perspectives Townsend, 2006; Trigoboff, 2013b

›Neurotransmitters –Chemicals stored in axon terminals of presynaptic neuron ›Receptors –Molecules situated on cell membrane that are binding sites for neurotransmitters ›Reuptake –Process of neurotransmitter inactivation by which the neurotransmitter is reabsorbed into the presynaptic neuron from which it had been released How Psychopharmacological Agents Work Townsend, 2006

›Ongoing assessment –side effects/client response –drug interactions –psychosocial implications –educational activities ›Advocate to reduce stigma ›Holistic function –Goal is to promote clients physiologic stability so they can achieve psychological, social, and spiritual growth Nursing Implications Trigoboff 2013a, 2013b

›Nonadherence –YouTube video ›Debilitating side effects ›High Costs ›Toxicity ›Stigmas ›Polypharmacy ›Right to refuse Why treatment of mental illness can be challenging Bonnivier & Magoteaux, 2012; Townsend, 2006; Trigoboff 2013a, 2013b

›Keeping all medications and information about them together in one dry, cool, place ›When to report side effects ›How to report side effects ›Strategies and tools for managing side effects ›Strategies and tools for managing residual symptoms ›The effect of mental illness and psychiatric medications on life goals ›Reinforce learning by providing an opportunity at some point for the client to teach others about medications Medication Teaching Checklist Townsend, 2006; Trigoboff, 2013a, 2013b

›Antipsychotics –Drugs to treat side effects of antipsychotics ›Antidepressants: Tricyclics, MAOIs, SSRIs, SNRIs, ›Anxiolytics: Benzodiazepines & Nonbenzodiazepines ›Mood-stabilizing agents: Lithium, Anticonvulsant agents & atypical agents ›Drugs to treat ADD/ADHD ›Drugs to treat DAT: Atypical antipsychotics, acetylcholinesterase inhibitors, Glutamate pathway modifier Major Drug Categories Bonnivier & Magoteaux, 2012; Townsend, 2006; Trigoboff 2013a, 2013b

›Antianxiety medications produce a calming effect by: –A. Depressing the CNS –B. Decreasing levels of norepinephrine and serotonin in the brain –C. Decreasing levels of dopamine in the brain –D. Inhibiting production of the enzyme MAO Review

›Antianxiety medications produce a calming effect by: –A. Depressing the CNS –B. Decreasing levels of norepinephrine and serotonin in the brain –C. Decreasing levels of dopamine in the brain –D. Inhibiting production of the enzyme MAO Answer

›Antipsychotic medications are thought to decrease psychotic symptoms by: –A. Blocking reuptake of norepinephrine and serotonin –B. Blocking the action of dopamine in the brain –C. Inhibiting production of the enzyme MAO –D. Depressing the CNS Review

›Antipsychotic medications are thought to decrease psychotic symptoms by: –A. Blocking reuptake of norepinephrine and serotonin –B. Blocking the action of dopamine in the brain –C. Inhibiting production of the enzyme MAO –D. Depressing the CNS Answer

›Anticholinergic delirium ›Agranulocytosis ›Neuroleptic malignant syndrome ›Extrapyramidal symptoms/EPSEs –Tardive dyskinesia, drug induced Parkinsonism, akathesia, akinesia, bradykinesia ›Serotonin syndrome (p. 688) ›Cardiac effects/Hypertensive crisis/Orthostatic hypotension Potential Adverse Side Effects of Drugs Trigoboff, 2013a

›Part of the nurse’s continual assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Examples include: –A. Muscular weakness, rigidity, tremors, facial spasms –B. Dry mouth, blurred vision, urinary retention, orthostatic hypotension –C. Amenorrhea, gynecomastia, retrograde ejaculation –D. Elevated blood pressure, severe occipital headache, stiff neck Review Question

›Part of the nurse’s continual assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Examples include: –A. Muscular weakness, rigidity, tremors, facial spasms –B. Dry mouth, blurred vision, urinary retention, orthostatic hypotension –C. Amenorrhea, gynecomastia, retrograde ejaculation –D. Elevated blood pressure, severe occipital headache, stiff neck Answer

›Herbals, minerals, vitamins, & complementary treatment –Herbs and plants usually take longer to work and few have the potency of a prescription ›Benefits ›Potential problems Alternative Medicine Approaches Trigoboff, 2013b

› nformationforPatientsandProviders/ucm htm#tophttp:// nformationforPatientsandProviders/ucm htm#top › › › › › Online Resources

›Bonnivier, J. F., & Magoteaux, A. L. (2012). Innovative teaching strategy for pharmacology in psychiatric-mental health nursing: Moving from content to concepts. Journal of Psychosocial Nursing & Mental Health Services, 50(12), doi: ›Townsend, M. (2006). Psychiatric mental health nursing (5 th ed.). Philadelphia, PA: F. A. Davis ›Trigoboff, E. (2013a). Psychopharmacologic nursing interventions. In C. R. Kneisl & E. Trigoboff (Eds.), Contemporary psychiatric-mental health nursing (3 rd ed.). (pp ). Upper Saddle River, NJ: Prentice Hall ›Trigoboff, E. (2013b). The science of psychopharmacology. In C. R. Kneisl & E. Trigoboff (Eds.), Contemporary psychiatric-mental health nursing (3 rd ed.). (pp ). Upper Saddle River, NJ: Prentice Hall References