1. Psychiatric nursing
Psychopharmacology

2. Objectives
Describe the indications, actions, contraindications, precautions, side effects and nursing implications for the following classifications of drugs:
Antianxiety agents
Antidepressants
Mood stabilizers
Antipsychotics
Antiparkinsonian agents
Sedative-hypnotics
Agents for attention deficit and hyperactivity disorders

3. Structures of Cerebrum: Four Lobes
Frontal lobe
Controls thought processes (executive function)
Parietal lobe
Controls sensory and motor functions
Occipital lobe
Controls visual functions
Temporal lobe
Controls auditory (hearing) functions

5. Specific Functions of Frontal Lobe
Mental activity
Consciousness
Perception of external world
Emotional status
Memory
Voluntary motor activity
Language and communication

6. Frontal Lobe and Schizophrenia
Schizophrenia causes disruption in prefrontal cortex (PFC)
Disruption associated with decreases in:
Executive function
Attention
Impulse control
Socialization
Regulation of drives and emotions

7. Temporal Lobe Structures and Mental Disorders
Hippocampus: learning and memory
Abnormalities in schizophrenia, depressive disorders, posttraumatic stress disorder (PTSD), alcoholism, Alzheimer’s disease
Amygdala: memory and processing of fear and anxiety
Hyperactivity of this structure associated with excessive fear states
Hypoactivity associated with difficulty responding to threats

8. Limbic System (Emotional Brain)
Consists of amygdala, hippocampus, hypothalamus, and thalamus
Controls emotional motivational areas associated with:
Perception
Attention
Memory
Activity slowed by antianxiety medications

9. Basal Ganglia (Subcortical Structure) and Side Effects of Antipsychotics
Allows for smooth physical movement and integration of emotions and thoughts
Dopamine (neurotransmitter) controls extrapyramidal motor system of basal ganglia
Antipsychotic medications
Block dopamine
Cause extrapyramidal system side effects (EPS)
Treated by anticholinergics

10. Thalamus and Hypothalamus
Sensory relay station to cerebral cortex
Abnormalities central to pathophysiology of schizophrenia
Hypothalamus
Homeostasis of multiple body functions
Secretes releasing hormones
Stimulate pituitary hormones that in turn stimulate target endocrine gland hormones

11. Hypothalamus and the Stress Response
Stress causes release of corticotropin-releasing hormone (CRF)
Stimulates anterior pituitary release of corticotropin (ACTH)
Stimulates adrenal cortex release of cortisol (stress hormone)
Function is disrupted in mood disorders, PTSD, and Alzheimer’s disease
Reversal of dysfunction: antidepressants

12. Thyroid Function and Mood Disorders
Hypothalamus secretes thyrotropin-releasing factor (TRF)
Stimulates secretion of pituitary thyrotropin (TSH)
Stimulates thyroid gland to secrete T3 and T4
Thyroid hormones
Can be used to treat mood disorders
Used as replacement for hypothyroidism induced by lithium therapy

13. Prolactin Secretion and Antipsychotic Medications
Prolactin secreted by pituitary gland
Neurotransmitter dopamine inhibits prolactin release
Dopamine blockers (antipsychotics) cause increase levels of prolactin
Responsible for side effects of:
Amenorrhea and galactorrhea (women)
Gynecomastia (men)

14. Autonomic Nervous System and Psychotropic Medications
Sympathetic division (stress response)
Fight-or-flight reaction
Parasympathetic division (reverses stress response)
Slows heart rate, begins process of digestion
Sympathetic nervous system
Activated by sympathomimetic drugs (amphetamines and cocaine)
Activated by withdrawal from sedating drugs (alcohol, benzodiazepines, opioids)

15. Brainstem Functions and Psychotropic Medications
Brainstem regulates vital life functions
Reticular activating system (RAS) regulates level of consciousness and sleep/wake cycle
Psychotropic medications
Interfere with RAS
Side effects of decreased level of alertness and drowsiness
Caution about driving or performing activities requiring mental alertness

16. Neuroimaging of Brain Structure and Function
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Newer function MRI
Positron-emission tomography (PET) and single photon emission computed tomography (SPECT)

17. PET Scan Data Applied to Mental Illness
Schizophrenia and depressive disorders
Decreased brain metabolism evident in individuals with these disorders
Dopamine system dysregulation evident in individuals with schizophrenia
Obsessive-compulsive disorder (OCD)
Increased brain metabolism
Depressive disorder
Evidence of loss of monoamine activity

20. Neurotransmitters (NTs)
Neurons conduct electrical message from one end of cell to another

21. Neurotransmitters (NTs)
Messages conducted across synapses (spaces between neurons) by neurotransmitters
Presynaptic neuron releases NT
NT diffuses across synapse and locks into receptor site on postsynaptic neuron
After affecting target receptor, NT is either destroyed or recycled
Destroyed by enzymes at synapse
Removed by presynaptic neuron in process or reuptake

25. Role of NTs in Psychopharmacology
Most psychotropic medications affect neurotransmitters in one of several ways
Block NTs from entering receptor site on postsynaptic neuron
Prevent destruction of NTs at synapse by interfering with enzymes at synapse
Inhibit reuptake/recycling NTs by presynaptic neuron
Most psychotropic medications can affect more than one NT and thus side effect profiles are related to this phenomenon

26. Dopamine and Mental Illness
Functions of dopamine
Stimulates heart, increases blood flow to organs
Controls muscle movement and motor coordination

27. Dopamine and Mental Illness
Dopamine hypothesis
Excessive levels are related to psychotic symptoms of schizophrenia
Drugs blocking dopamine receptors improve symptoms of schizophrenia
Drugs stimulating dopamine can induce psychotic symptoms
Other mental illnesses associated with altered dopamine activity: mood disorders, substance abuse, attention deficit disorder

28. Neurological causes of mental illness
1- genetic/heredity
2- Stress and the Immune System/ (Psychoimmunology)
3- Infection as a Possible Cause

29. Antipsychotic medications
Antipsychotic medications are beneficial in disorders that include psychotic states. Examples of such disorders are schizophrenia, mood disorders with psychotic features, and dementia with psychotic features.
The major positive effect of antipsychotics is on decreasing the symptoms of delusional thinking, hallucinations, confusion, motor agitation, and motor retardation.
Antipsychotic medications also decrease formal thought disorder, blunted affect, bizarre behavior, social withdrawal, belligerence, and uncooperativeness.
Antipsychotic drugs work by blocking receptors of the neurotransmitter dopamine

30. Side effect
The negative effects are primarily the side effects that may include effects on the autonomic nervous system,
Extrapyramidal symptoms (EPS), serious neurologic symptoms, include
1- acute dystonia, includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.

32. Side effect ‘
2- pseudoparkinsonism, Drug-induced parkinsonism: include a stiff, stooped posture; mask-like facies; decreased arm swing; a shuffling, festinating gait (with small steps); cogwheel rigidity (ratchet-like movements of joints); drooling; tremor; bradycardia; and coarse pill-rolling movements of the thumb and fingers while at rest

33. 3- akathisia: is reported by the client as an intense need to move about.
The client appears restless or anxious and agitated, often with a rigid posture or gait and a lack of spontaneous gestures.
This feeling of internal restlessness and the inability to sit still or rest often leads clients to discontinue their antipsychotic medication.

35. Neuroleptic malignant syndrome (NMS) is a potentially fatal idiosyncratic reaction to an antipsychotic (or neuroleptic) drug
Include: rigidity; high fever; autonomic instability such as unstable blood pressure, diaphoresis, and pallor; delirium; and elevated levels of enzymes, particularly creatine phosphokinase.
Clients with NMS usually are confused and often mute; they may fluctuate from agitation to stupor.

36. Anticholinergic Side Effects
Anticholinergic Side Effects. :include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory.
These side effects usually decrease within 3 to 4 weeks but do not entirely remit.
Tardive Dyskinesia. Tardive dyskinesia (TD), a syndro me of permanent involuntary movements

37. Other Side Effects. Antipsychotic drugs also increase blood prolactin levels. Elevated prolactin may cause breast enlargement and tenderness in men and women; diminished libido, erectile and orgasmic dysfunction, and menstrual irregularities; and increased risk for breast cancer, and may contribute to weight gain

38. Client Teaching
the types of side effects that may occur and encourages clients to report such problems to the physician instead of discontinuing the medication.
methods of managing or avoiding unpleasant side effects and maintaining the medication regimen.
Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth.

39. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth.
Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the client should avoid laxatives.
The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily

40. Antianxiety Drugs (Anxiolytics)
are used to treat anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, and alcohol withdrawal
Benzodiazepines have proved to be the most effective in relieving anxiety, also may be prescribed for their anticonvulsant and muscle relaxant effects.
Buspirone is a nonbenzodiazepine often used for the relief of anxiety

41. Mechanism of Action
Benzodiazepines mediate the actions of the amino acid GABA, the major inhibitory neurotransmitter in the brain.
Because GABA receptor channels selectively admit the anion chloride into neurons, activation of GABA receptors hyperpolarizes neurons and thus is inhibitory.

42. Psychopharmacology: Antianxiety Agents
Examples by chemical class and generic name (see table, page 157):
Antihistamines: Atarax, Vistaril
Benzodiazepines: Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan)
Propanediols: Meprobamate (Miltown)
Azaspirodecanediones: Buspirone (Buspar)

43. Side effect
Anxiolytic medications have the effect of disinhibition of fear-induced behavior. Their side effects include their addictive potential and overdose sequelae. The major classes of drugs used today are the benzodiazepines and nonbenzodiazepines

44. Client Teaching
Clients should not drink alcohol while taking benzodiazepines.
Clients should be aware of decreased response time, slower reflexes, and possible sedative effects of these drugs when attempting activities such as driving or going to work
he or she should never discontinue benzodiazepines abruptly or without the supervision of the physician

45. Anxiolytic medications
These work through a process of synaptic activity involving the neurotransmitter gamma-aminobutyric acid (GABA) in the brain and spinal cord. Benzodiazepines potentiate GABA, producing relaxation. There are two types of benzodiazepine receptors in the CNS. Type 1 receptors are located in parts of the brain responsible for sedation. Type 2 receptors are located in parts of the brain responsible for cognition, memory, and psychomotor functioning

46. Psychopharmacology: Antianxiety Agents
Anxiolytics affect all levels of CNS depression (from mild sedation to coma), except BuSpar which does not depress the CNS but interacts with serotonin, dopamine, & other neurotransmitter receptors.
Contraindications: hypersensitivity, combination with other CNS depressants, pregnancy and lactation, narrow-angle glaucoma, shock, coma.
Precautions: caution with elderly or debilitated (weak) clients, hepatic or renal dysfunction (decrease dosage), history of drug abuse or addiction, depressed or suicidal patients (because CNS depressants can increase symptoms).

47. Psychopharmacology: Antianxiety Agents
Interactions:
Increased effects of antianxiety with alcohol, barbiturates, narcotics (opioids), antidepressants, antipsychotic, neuromuscular blocking agents.
Decreased effects with smoking and caffeine.
Nursing diagnosis: the following diagnoses need to be considered for those on antianxiety medications:
Risk for injury RT seizures; panic anxiety and effects of medications intoxication or overdose.
Risk for activity intolerance RT side effects of sedation & lethargy
Risk for acute confusion RT action of the medication on the CNS

48. Nursing interventions for common side effects
drowsiness, confusion and lethargy. Instruct the client not to drive or operate dangerous machinery when taking the medication.
Tolerance, physical and psychological dependence. Instruct the client on long-term therapy not to quit taking it abruptly. Abrupt withdrawal can be life threatening.
Ability to potentiate the effect of other CNS depressant. Instruct the patient not to drink alcohol or take other medications that depress the CNS.
Possibility of aggravating symptoms in depressed patients. Assess the client’s mood daily and take precaution of potential suicide.

49. Nursing interventions for common side effects
Orthostatic hypotension. Monitor lying and standing blood pressure and pulse every shift. Instruct the patient to stand up slowly from lying or sitting position.
Paradoxical excitement. Patients may develop symptoms opposite to the medication’s desired effect. Withhold the drug and notify the physician.
Dry mouth. Instruct the client to take frequent sips of water.
Nausea and vomiting. Have the client take the drug with food or milk.
Drug dyscrasias. Symptoms of sore throat, fever, malaise, unusual bleeding should be reported to the physician immediately.

50. Nursing interventions for common side effects
Delayed onset (buspirone/buspar only). Ensure that the client understands that there is a lag time of days between the onset of therapy and the subsiding of anxiety symptoms. Client should continue to take the medication and this medication is not p.r.n and has no physical dependence.

51. Antidepressant medications
are primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression.
Off-label uses of antidepressants include the treatment of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, panic disorder, and eating disorders

52. Mechanism of action
Although the mechanism of action is not completely understood, antidepressants somehow interact with the two neurotransmitters, norepinephrine and serotonin, that regulate mood, arousal, attention, sensory processing, and appetite.

53. Antidepressants are divided into four groups
1. Tricyclic and the related cyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRIs)
3. MAO inhibitors (MAOIs)
4. Other antidepressants such as venlafaxine desvenlafaxine (Pristiq) (Effexor), bupropion (Wellbutrin), duloxetine (Cymbalta), trazodone (Desyrel), and nefazodone (Serzone).

54. Side effect
The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision.
More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults.

55. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia.
Clients may develop tolerance to anticholinergic effects, but these side effects are common reasons that clients discontinue drug therapy.

56. Side Effects of
Monoamine Oxidase Inhibitors Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, and sexual dysfunction.

57. Psychopharmacology: Antidepressants
Examples by chemical class and generic name or trade name (se
Tricyclics: Amitriptyline (Elavil), Imipramine (Tofranil)
Monoamine Oxidase inhibitors: Phenelzine (Nardil)
Selective serotonin reuptake inhibitors: Sertraline (Zoloft)
Heterocyclics: Trazodone (Desyrel)
Contraindications: hypersensitivity, recovery from MI, & angle-closure glaucoma.
Precaution: caution with elderly or debilitated clients & hepatic, renal, or cardiac insufficiency, with seizures.

58. Psychopharmacology: Antidepressants
Interactions: antihypertensive drugs (decrease therapeutic response to some antihypertensives & amphetamines)
Nursing diagnosis
Risk for suicide RT depressed mood
Risk for injury RT side effects of sedation, orthostatic HTN
Social isolation RT depressed mood
Constipation RT side effects

59. Nursing interventions for common side effects
Dry mouth. Strict oral hygiene. Sips of water. Offer the patients a sugar less candy.
Sedation.
Nausea.
Discontinuation syndrome. Decreased gradually to avoid withdrawal syndrome.
Blurred vision (hazy and indistinct of the sight). Offer reassurance that this subside after few weeks.
Constipation.

60. Nursing interventions for common side effects
Urinary retention. Intake/output chart.
Orthostatic hypotension.
Tachycardia and arrhythmias. Monitor B.P, P.R and rhythm.
Photosensitivity. Protective sunscreen and sunglasses when outdoor.
Weight gain. Reduce caloric intake.

61. The negative effects of antidepressants include their potential side effects and interactions. The tricyclic antidepressants may aggravate symptoms in a person with, or susceptible to, schizophrenia.
Oral MAOIs may cause a potentially life-threatening hypertensive crisis when combined with foods containing tyramine, sympathomimetic medications, or the SSRIs. MAOIs require the client to follow a diet that restricts tyramine.
The initiation of antidepressants may contribute to the risk of suicide in children, adolescents, and adults.

62. Pt teaching
To minimize side effects, clients generally should take cyclic compounds at night in a single daily dose when possible.
If the client forgets a dose of a cyclic compound, he or she should take it within 3 hours of the missed dose or omit the dose for that day.
Clients should exercise caution when driving or performing activities requiring sharp, alert reflexes until sedative effects can be determined.

63. Mood stabilizers
are used to treat bipolar disorder by stabilizing the client’s mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania.
Lithium is the most established mood stabilizer; some anticonvulsant drugs, particularly carbamazepine (Tegretol) and valproic acid

64. Mood stabilizers: Lithium aids in the reduction of neurotransmitter release into the synapse and enhances its return. Lithium and the anticonvulsants used as mood stabilizers may affect neurocellular changes that occur over weeks and months after their initiation

65. Side effect
lithium therapy include mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, a metallic taste in the mouth, and fatigue or lethargy.
Weight gain and acne are side effects that occur later in lithium therapy;
Taking the medication with food may help with nausea, and the use of propranolol often improves the fine tremor. Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance.

66. Side effects of carbamazepine and valproic acid include drowsiness, sedation, dry mouth, and blurred vision

67. Client Teaching
For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important.
The time of the last dose must be accurate so that plasma levels can be checked 12 hours after the last dose has been taken.
Taking these medications with meals minimizes nausea.
The client should not attempt to drive until dizziness, lethargy, fatigue, or blurred vision has subsided

68. Guidelines for the treatment of bipolar disorder are:
A mood stabilizer is used in all phases of treatment.
Atypical antipsychotics are preferable to conventional older antipsychotics if psychosis is present.
Mild depression is treated initially with a mood stabilizer.
An antidepressant is used in the beginning of severe depression.
Rapid cycling is treated from the beginning with a mood stabilizer alone, preferably divalproex.

69. Psychopharmacology: Mood Stabilizing Agents
Anti manic: Lithium carbonate (Lithane, drug of choice)
Anticonvulsant: Carbamazepine (Tegretol)
Calcium channel blocker: Verapamil (Isoptin)
Indications: Bipolar mania
Action: decrease norepinephrine & serotonin levels in the body resulting in decreased hyperactivity (Symptoms subside in 1-3 weeks).
Contraindications: hypersensitivity, cardiac or renal disease, dehydration (competes with ADH) and cardiogenic shock.
Caution with pregnancy, lactation, children, & elderly.
Interactions: lithium increases neuromuscular blocking agents (block the neuromuscular transmission); may result in neurotoxicity or lithium toxicity (especially in chronic cases).

70. Mood Stabilizing Agents
Nursing diagnosis
Risk for injury RT manic hyperactivity
Risk for violence: self-directed or other-directed RT unresolved anger turned inward on the self or outward on the environment
Risk for injury RT lithium toxicity
Risk for activity intolerance RT side effects of drowsiness & dizziness
Nursing interventions for common side effects.

71. Antipsychotic
All antipsychotic substances, except clozapine, are relatively potent postsynaptic dopamine receptor blockers.
First generation (typical)Traditional neuropleptic modify several neurotransmitter systems, but their clinical effectiveness is most likely due to their ability to antagonize dopamine transmission by competitively blocking the receptors or by inhibiting dopamine release. The most serious and troublesome side effects of these classical antipsychotics are movement disorders that resemble the symptoms of parkinson disease, because the neuroleptics antagonize dopamine receptors broadly, also reducing the normal dopamine-mediated inhibition of cholinergic cells in the striatum.

72. 2nd generation (a typical)
had a greater serotonin/dopamine ratio than did earlier drugs, and might be associated with improved efficacy (particularly for the negative symprtom of psychosis) and reduced extrapyramidal side effect).

73. Psychopharmacology: Antipsychotic Agents
Psychosis: abnormal condition of the mind, in which the thought and emotion are impaired involving loss of contact with reality. .
Phenothiazines: Chloropromazine (Thorazine), Thioridazine (Mellaril)
Butyrophenone: Haloperidol (Haldol)
Indications: acute and chronic psychosis, particularly when accompanied by increased psychomotor activity, treatment of intractable hiccoughs, control of tics & vocal utterances (is a brief, repetitive, purposeless, nonrhythmic, involuntary movement or sound).
Action: block postsynaptic dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem, & medulla.

75. Psychopharmacology: Antipsychotic Agents
Contraindications: hypersensitivity, pregnancy & lactation, diabetic or respiratory insufficiency.
Interactions: antacids & antidiarrheals may decrease absorption of antipsychotic; barbiturates may increase metabolism & decrease effectiveness of antipsychotic.
Nursing diagnosis
Risk for other-directed violence RT panic anxiety & mistrust of others
Risk for injury RT side effects of sedation
Risk for activity intolerance RT side effects of sedation
Noncompliance with medication regimen RT suspiciousness & mistrust of others
Nursing interventions for common side effects.

76. Psychopharmacology: Antiparkinsonian Agents
Examples
Anticholinergics: procyclidine (Kemadrin), Trihexyphenidyl (Artane), Biperiden (Akineton)
Antihistamines: Diphenhydramine (Benadryl)
Indications: agents are indicated for the treatment of all parkinsonism (relief symptoms of Parkinson's disease) and for relief of drug-induced extrapyramidal reactions (movement disorders such as akinesia and akathesia).
Action: restore the balance of acetylcholine and dopamine (increase dopamine or reducing acetylcholine activity in the CNS). Deficiency in dopamine resulting in excessive cholinergic activity (neurotransmitters of the parasympathetic nervous system).
Contraindications: hypersensitivity, duodenal obstruction, peptic ulcer and myasthenia gravis. Caution with tachycardia, cardiac arrhythmias, HTN, & hypotension.

77. Antiparkinsonian Agents
Nursing diagnosis:
Risk for injury RT symptoms of Parkinson's disease
Hyperthermia RT anticholinergic effect of decreased sweating
Activity intolerance RT side effects of the medication
Knowledge deficit RT medication regimen
Nursing interventions for common side effects.

78. Psychopharmacology: Sedative-Hypnotics
Examples: Barbiturates: Phenobarbital (Luminal)
Secobarbital (Seconal)
Indications: various anxiety states, insomnia, anticonvulsant and preoperative sedation.
Action: they cause generalized CNS depression. They may produce dependence and tolerance.
Contraindications: hypersensitivity, hepatic dysfunction, or severe renal impairment. Should be short-term only.
Nursing diagnosis:
Risk for injury r/t abrupt withdrawal from long-term use
Sleep pattern disturbance r/t physical condition
Risk for activity intolerance r/t side effects
Risk for acute confusion r/t action on CNS
Nursing interventions for common side effects.

79. Stimulants pronounced effects of CNS stimulation
Today, the primary use of stimulants is for ADHD in children and adolescents, residual attention deficit disorder in adults, and narcolepsy (attacks of unwanted but irresistible daytime sleepiness that disrupt the person’s life)

80. Psychopharmacology: CNS stimulants for ADHD
Examples: amphetamines –Dextroamphetamines (Dexedrine)
Indications: narcolepsy (excessive daytime sleepiness) & ADHD with hyperactivity in children & adults.
Action: increase level of neurotransmitters (increase mental alertness), diminish sense of fatigue.
Contraindications: hypersensitivity, cardiovascular diseases, hyperthyroidism, and glaucoma.
Nursing diagnosis:
Risk for injury r/t hyperactivity
Risk for suicide r/t abrupt withdrawal after extended use
Sleep pattern disturbance overstimulation
Nursing interventions for common side effects.

81. Side effect
The most common side effects of stimulants are anorexia, weight loss, nausea, and irritability. The client should avoid caffeine, sugar, and chocolate, which may worsen these symptoms.
Less common side effects include dizziness, dry mouth, blurred vision, and palpitations.
The most common long-term problem with stimulants is the growth and weight suppression that occurs in some children

82. Psychopharmacology: Nursing interventions
Drowsiness: no driving, no working with machines,
Tolerance: not to stop medication abruptly, not to take other medications and alcohol,
Physical: assess vital signs for tachycardia, monitor intake and output, observe orthostatic hypotension, teach relaxation techniques, report any abnormalities such as rash, observe extrapyramidal symptoms, …
Dry mouth: sips of water, sugar-free candy, ice, ..
Nutrition: high fiber, milk, take drug with food or milk, oral hygiene, physical exercise, avoid caffeinated food,
Vision: not to drive, clear pathways.

83. Client Teaching
The potential for abuse exists with stimulants, but this is seldom a problem in children.
Taking doses of stimulants after meals may minimize anorexia and nausea.
Caffeine-free beverages are suggested; clients should avoid chocolate and excessive sugar.
Most important is to keep the medication out of the child’s reach because as little as a 10-day supply can be fatal.

84. Other disorder
The treatment of simple insomnia includes antidepressants, benzodiazepines, nonbenzodiazepines, over-the-counter medications, barbiturates, and some miscellaneous substances. The treatment of choice is the nonbenzodiazepines because of their rapid absorption and efficient elimination with little hangover effect.
Acetylcholinesterase inhibitors are used to improve or slow the decline of cognitive functioning and memory problems in clients with dementia of the Alzheimer’s type

85. Acetylcholinesterase inhibitors: These increase available acetylcholine in the CNS, thus improving cognitive functioning and memory. The action is to decrease acetylcholinesterase, an enzyme that breaks down acetylcholine

86. Disulfiram (Antabuse)
Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body.
This agent’s only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism.
It is useful for persons who are motivated to abstain from drinking and who are not impulsive

87. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness.
In severe cases, there may be chest pain, dyspnea, severe hypotension, confusion, and even death. Symptoms progress rapidly and last from 30 minutes to 2 hours. Because the liver metabolizes disulfiram,
it is most effective in persons whose liver enzyme levels are within or close to normal range

88. THANK YOU