* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Ch. 15-Drugs Used for Mental Health Disorders
Survey
Document related concepts
Pharmacognosy wikipedia , lookup
Prescription costs wikipedia , lookup
Serotonin syndrome wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Drug interaction wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Polysubstance dependence wikipedia , lookup
Neuropharmacology wikipedia , lookup
Neuropsychopharmacology wikipedia , lookup
Dydrogesterone wikipedia , lookup
Theralizumab wikipedia , lookup
Transcript
Chapter 15 Drugs Used for Mental Health Disorders People with mental health disorders have problems with coping and adjusting to stress in their lives Causes of mental health disorders: - not being able to cope/adjust to stress - chemical imbalances - genetics - drug/substance abuse - social/cultural factors Anxiety Disorders Obsessive-Compulsive Disorder (OCD) obsession: recurrent/unwanted thought, idea, image compulsion: repeating an act over and over again with OCD the act may not make sense, but the person has a lot of anxiety if it is not performed rituals can include many things: hand washing, checking stove, checking locks, counting things these rituals can be very time consuming and usually are distressing and affect daily life Anxiety Disorders continued… Panic Disorder panic: highest level of anxiety intense and sudden feeling of fear, anxiety, terror or dread onset is usually sudden, and usually no obvious reason signs and symptoms: - chest pain - shortness of breath - heart pounding - numbness/tingling in hands - dizziness - feeling of impending doom/loss of control can last 10 minutes or longer Anxiety Disorders continued… Phobia intense fear of object, situation or activity that has little to no actual danger when faced with fear the person has high anxiety and cannot function common phobias: - being in large, crowded places (agoraphobia) - being in pain or seeing others in pain (algophobia) - water (aquaphobia) - being trapped in closed/narrow space (clasutrophobia) - the slightest uncleanliness (mysophobia) - night/darkness (nyctophobia) - fire (pyrophobia) - strangers (xenophobia) Anxiety Disorders continued… Post-Traumatic Stress Disorder (PTSD) occurs after a terrifying ordeal this may have involved physical harm or threat of harm most people have flashbacks (reliving trauma in thoughts and nightmares) flashbacks may involve: - images, sounds, smells, feelings - often triggered by everyday things - during flashback person loses touch with reality signs/symptoms usually develop 3 months after event or can be years later can develop at any age Mood Disorders Bipolar Disorder: - severe extremes in mood, energy and ability to function - there emotional lows (depression) and highs (mania) - tends to run in families - requires life-long management - mood changes are called episodes Major Depression: - involves body, mood, thoughts - can affect work, sleep, eating - usually very sad, loss of interest in daily activities - can occur because of stressful events, physical disorders, hormones (see box 15-2, 15-3 pg. 197 for signs and symptoms) Mood Disorders Continued... Schizophrenia: - means split mind - severe, chronic, disabling brain disorder - severe mental impairment (psychosis) - thinking and behavior are affected - false beliefs (delusions) - hallucinations - paranoid about people and situations - unorganized thoughts, disturbed communication hard to understand, makes up words - may withdraw, lack on interest in others - can have disorders with movement - do not tend to be violent, if paranoid schizophrenia usually violence is directed at family members -some attempt suicide Drugs Used for Mental Health Disorders (Delegation Guidelines) Some used to treat mental health disorders are given parenternally (by injection) You do NOT give parenteral dose forms Should a nurse delegate the administration to you REFUSE the delegation, explain why Do NOT ignore request, makes sure nurse knows you cannot give the drug and why Drugs used for anxiety disorders Anti-anxiety drugs are also known as tranquilizers Benzodiazepines: - have few side effects - consistently effective - less likely to have drug interactions - lower risk for abuse - examples: alpraolam (Xanax, Niravam, Xanax XR chlordiazepoxide (Liprium) clorazepate (Tranxene) diazepam (Valium) lorazepam (Ativan) oxazepam (Serax) Drugs used for anxiety disorders continued… Assisting with nursing process for benzodiazepines ASSESSMENT: -measure BP in sitting and supine positions -observe for signs/symptoms of anxiety PLANNING: see table 15-1 (pg. 198) for “oral dose forms” IMPLEMENTATION: see table 15-1 (pg. 198) for “initial adult dose” and “maximum daily dose” -long term use may cause physical and psychological dependence - mild withdrawal symptoms can occur after taking drug 4-6 weeks signs/symptoms: restlessness, worsening of anxiety, insomnia, tremors, muscle tension, rapid pulse, hearing sensitivity, delirium, seizures EVALUATION: report and record: - drowsiness, hangover, sedation, lethargy, provide safety - orthostatic hypertension, provide safety - excessive use or abuse - anorexia, nausea, vomiting, jaundice Drugs used for anxiety disorders continued… Other anti-anxiety agents: Buspirone (BuSpar) - causes less sedation than other meds - does not alter psycho-motor function - improvement after 7-10 days - 3-4 weeks of therapy - risk of abuse is low Assisting with nursing process for buspirone (BuSpar): ASSESSMENT: -observe for signs/symptoms of anxiety PLANNING: - 5, 10, 15, 30 mg tablets (15/30 are scored to divide into 2 or 3 doses) IMPLEMENTATION - initial adult does is 5-7.5mg orally 2x/day - dosage may be increased by 5mg every 2-3 days - maximum daily dose is 60mg EVALUATION: - report and record: - insomnia, nervousness, drowsiness, light-headedness, provide for safety - slurred speech, dizziness (excess dosing) Drugs used for anxiety disorders continued… Fluvoxamine (Luvox) - used to treat OCD - symptoms reduced but not prevented - person has more control - intent is to: - decrease anxiety - improve coping with obsessions - reduce frequency of compulsive activity - for Assisting with nursing process see p. 203 for SSRI’s Other anti-anxiety agents continued…. hydroxyzine (Vistaril and Atarax) - produce sedation and reduce anxiety (can be used pre-op) - also prevent vomiting and control allergic reactions (and itching) - decrease anxiety - reduce need for pain meds post-op Assisting with the Nursing Process for hydroxyzine: ASSESSMENT: observe for signs/symptoms of anxiety PLANNING: oral dose forms are: -Vistaril: 25 and 50mg capsules or 10mg/5mL syrup -Atarax: 10, 25, 50, 100mg tablets or 10mg/5mL syrup IMPLEMENTATION: 25-100mg are given orally 3-4x/day EVALUATION: report and record: - blurred vision, provide for safety - constipation, give stool softeners as ordered - dryness of mouth, nose and throat, hard candy, ice, gum if nurse allows - sedation, see pg. 199 - dizziness, slurred speech (excess dosing) Drugs used for mood disorders Before regaining full function person must pass through 3 therapy phases: Acute phase: - time from diagnosis to 1st treatment response - symptoms reduced - usually takes 6-8 weeks Continuation phase: - involves preventing relapse and reaching a full recovery - should be symptom free for 6 months Maintenance phase: - goal is to prevent disorder from recurring Mood disorders are treated with anti-depressants These drugs prolong action of neurotransmitters: - norepinephrine - doapmine - serotonin The drug classes are: - monoamine oxidase inhibitors (MAOI’s) - tri-cyclic anti-depressants (TCA’s) - selective serotonin re-uptake inhibitors (SSRI’s) **anti-depressants may increase risk of suicidal thinking and behavior, when started observe person carefully, report concerns to nurse. Follow precautions according to care plan Anti-depressants continued… MAOI’s: - prevent breakdown of neurotransmitters that are involved in areas of the brain that control mood and emotion - effects usually seen in 2-4 weeks - serious side effects when taken with certain drugs, fluids, foods (pg. 202 for list) - last dose given no later than 6:00 (1800) to prevent insomnia Examples of MAOI’s: - phenelzine (Nardil) - tranylcypromine (Parnate) - isocarboxazid (Marplan) - selegiline (Emsam) MAOI’s continued… Assisting With the Nursing Process for MAOI’s: ASSESSMENT: - measure pulse rate -measure BP (supine and standing positions) - measure blood glucose - ask about food/fluids consumed in past few days PLANNING: - see table 15-2 (p. 201) for “oral dose forms” IMPLEMENTATION: - see table 15-2 for “Initial Adult Dose, Daily Maintenance Dose and Maximum daily dose” EVALUATION: - report and record: orthostatic hypertension: most common side effect, provide for safety dizziness and weakness drowsiness/sedation, provide for safety restlessness, agitation, insomnia, last dose given before 1800 (6:00pm) blurred vision, provide for safety constipation, urinary retention, follow care plan dryness of mouth, nose, throat, hard candy, ice, gum if nurse allows hypertension, many foods can cause serious hypertension see chart p. 202 Anti-depressants continued… SSRI’s: -these affect serotonin -re-uptake means re-absorption - SSRI’s block certain nerve cells from re-absorbing serotonin - mood improved because the sending of nerve impulses is improved - used to improve mood and reduce depression - effect of drug seen in 2-4 weeks Examples of SSRI’s - citalopram (Celexa) - escitalopram (Lexapro) - fluvoxamine (Luvox) -sertraline (Zoloft) - duloxetine (Cymbalta) - fluoxetine (Prozac) - paroxetine (Paxil or Paxil CR) SSRI’s continued… Assisting With the Nursing Process for SSRI’s ASSESSMENT: - measure blood pressure, supine and standing - weigh person weekly - observe for insomnia, nervousness and other CNS signs and symptoms - ask person about GI symptoms PLANNING: see table 15-2 for oral dose forms (p. 202) IMPLEMENTATION: see table 15-2 for “Initial Adult Dose, Daily Maintenance Dose and Maximum daily dose” EVALUATION: report and record: - restlessness, agitation, anxiety, insomnia, give drug before 1800 (6:00pm) - sedative effects - GI effects, give drug with food - suicidal actions, see promoting safety and comfort for mood disorders p. 200 Anti-depressants continued… TCA’s - prolong action of norepinephrine, dopamine, serotonin - blocks re-uptake of these neurotransmitters - these drugs produce anti-depressant and tranquilizing effects - 2-4 weeks of therapy and then usually they elevate mood, improve appetite and increase alertness - several other uses for these drugs: -phantom limb pain -chronic pain -cancer pain -peripheral neuropathy with pain -arthritic pain -eating disorders -pre-menstrual symptoms TCA’s continued… Examples of TCA’s: - amitriptyline (Elavil) - amoxapine - clomipramine (Anafranil) - desipramine (Norpramin) - doxepin (Sinequan) - imipramine (Tofranil) - nortriptyline (Aventyl, Pamelor) - protriptyline (Vivactil) - trimipramine (Surmontil) TCA’s continued… Assisting With the Nursing Process for TCA’s ASSESSMENT: -constipation is common, ask about bowel movements -measure blood pressure, supine and sitting -measure pulse rate and rhythm, report tachycardia or irregular pulse PLANNING: see table 15-2 (p. 201) for “Oral Dose Forms” IMPLEMENTATION: see table 15-2 for “Initial Adult Dose, Daily Maintenance Dose and Maximum daily dose”, dose increases usually started in evening because of sedation EVALUATION: report and record -blurred vision, provide for safety -constipation, urinary retention, follow care plan -dryness of mouth, nose, throat, hard candy, ice, gum if nurse allows -orthostatic hypertension, provide for safety -sedative effects, provide for safety -tremors, numbness, tingling, parkinsons-like symptoms, provide for safety -tachycardia, dysrhythmias, signs/symptoms heart failure, see ch.20/21 -seizures, see ch.16 -suicidal actions, see promoting safety and comfort.. p. 200 Other anti-depressants bupropion hydrochloride (Wellbutrin) - weak inhibitor of re-uptake of neurotransmitters - used for those who do not respond to TCA’s - used if person cannot tolerate the adverse effects of TCA’s Assisting With the Nursing Process for buproprion (Wellbutrin) ASSESSMENT: weigh the person PLANNING: oral dose forms are: 75 and 100mg tablets 100, 150, 200mg sustained-release tablets 150, 300 mg extended-release tablets IMPLEMENTATION: initial dose usually 100mg 2x/day, may be increased to 3x/day after several days, maximum daily dose is 450mg. Avoid a dose close to bedtime EVALUATION: report and record: - GI effects, give with food, stool softeners as ordered - restlessness, agitation, anxiety, insomnia, avoid bedtime doses - seizures, see ch.16 - suicidal actions, see promoting safety and comfort….p.200 Other anti-depressants continued… maprotiline - enhances norepinephrine and serotonin at nerve endings - elevates mood and reduces depression symptoms - used to treat: - depression - treat depressive phase of bipolar disorder - relief of anxiety associated with depression Assisting With the Nursing Process for maprotiline ASSESSMENT: measure blood pressure in supine and standing positions, weigh person weekly PLANNING: oral dose forms 25, 50, 75 mg tablets IMPLEMENTATION: adult starting dose is 75 mg daily in 2 or 3 doses usual maintenance dose is 150mg/day maximum daily dose 225mg dose increases usually made in the evening, increased sedation EVALUATION: report and record see TCA’s on p. 203 Other anti-depressants continued… mirtazapine (Remeron) - serotonin antagonist (antagonist exerts opposite action to that of another, or competes for receptor sites) - elevates mood and reduces depression symptoms Assisting With the Nursing Process: ASSESSMENT: measure blood pressure in supine, sitting, standing positions weigh weekly PLANNING: oral dose 15, 30, 45 mg tablets, 15 mg Soltabs (dissolves on tongue) IMPLEMENTATION: starting dose is 15 mg daily, every 1-2 weeks dosage may be increased, maximum daily dose 45mg. Increases made in evening because of sedation EVALUATION: see TCA’s on p. 203 Other anti-depressants continued… nefazodone - inhibits serotonin and norepinephrine re-uptake - blocks some serotonin receptors - elevates mood - reduces symptoms of depression - carries risk of life-threatening liver failure Assisting With the Nursing Process for nefazodone: ASSESSMENT: measure blood pressure in supine, sitting and standing position, measure heart rate, ask about GI symptoms, observe CNS symptoms PLANNING: oral dose 50, 100, 150, 200, 250 mg tablets IMPLEMENTATION: adult starting dose is 100mg 2x/day, dosage increased by 100200mg 2x/day. Normal dose range is 300-600mg daily EVALUATION: report and record: - drowsiness, sedations, symptoms tend to disappear with continued therapy or dose adjustment - blurred vision, provide safety - constipation, urinary retention, follow care plan - dryness of mouth, throat and nose, hard candy, ice or gum if nurse allows - orthostatic hypotension, provide for safety - sedative effects Other anti-depressants continued… trazodone hydrochloride (Desyrel) - elevates mood - reduces symptoms of depression - treats: - depression - depression associated with schizophrenia - depression/tremors/anxiety - insomnia in persons with substance abuse Assisting With the Nursing Process for trazodone (Desyrel): ASSESSMENT: measure blood pressure in supine, sitting and standing positions PLANNING: oral dose forms 50, 100, 150 and 300mg tablets IMPLEMENTATION: starting dose is 150mg, divided into 3 doses drug is increased by 50mg/day every 3-4 days maximum daily dose is 400mg (600mg for hospital patients) dose increases in evening bc of sedation, give drug with meal or light snack EVALUATION: report and record: - confusion, dizziness, light-headedness, provide for safety - drowsiness - orthostatic hypotension, provide for safety -dysrhythmias, tachycarida, report irregular pulse Other anti-depressants continued… venlafaxine (Effexor) - strong inhibitor of the re-uptake of serotonin and norepinephrine - used to treat and reduce symptoms of depression and anxiety - elevates mood - reduces Assisting With the Nursing Process for venlafaxine(Effexor): ASSESSMENT: measure blood pressure, measure weight, ask about GI symptoms, observe for CNS symptoms such as insomnia or nervousness PLANNING: oral dose forms: 25, 37.5, 50, 75, and 100mg tabs 37.5, 75, 150mg sustained-release capsules IMPLEMENTATION: daily adult does is 75mg in 2 or 3 doses dosages may be increased by 75mg daily after every 4 days maximum dose is 375mg/day, usually divided into 3 doses drug is given with food EVALUATION: report and record: - dizziness, drowsiness - nausea, anorexia, give drug with food - restlessness, agitation, anxiety, insomina, usually occur early in therapy, avoid bedtime doses - suicidal actions, see promoting safety and comfort….p. 200 Anti-Manic agents - Lithium is used to treat acute mania - Eskalith and Lithane are brand names for lithium carbonate - also used to prevent manic and depressive episodes in bipolar disorder - goal of therapy is maintain at optimal level of functioning with few mood swings - acute anti-manic effect occurs within 5-7 days - therapeutic effect takes 10-21 days - lithium may cause a loss of sodium (drink 10-12 glasses of 8oz water) report and record: - nausea, vomiting, anorexia, abdominal cramps excessive thirst and increased/decreased urination, fine hand tremor vomiting, diarrhea, increased reflex reactions, lethargy, weakness progressive fatigue, weight gain itching, ankle edema, metallic taste, hyperglycemia Lithium continued… Assisting With the Nursing Process for Lithium: ASSESSMENT: measure blood pressure in supine, sitting standing, measure weight, record intake and output, measure blood glucose PLANNING: oral dose forms are: 150, 300, 600mg capsules and tablets 300 and 450 mg slow-release tablets 300 mg/5 mL syrup IMPLEMENTATION: daily adult dose is 300 to 600 mg, 3 or 4x/day, give food or milk with drug EVALUATION: report and record: - nausea, vomiting, anorexia, abdominal cramps, usually mild - excessive thirst and increased/decreased urination, fine hand tremor - vomiting, diarrhea, increased reflex reactions, lethargy, weakness, signal toxicity, next dose only with nurses permission - progressive fatigue, weight gain, early signs of thyroid problem - itching, ankle edema, metallic taste, hyperglycemia, rare - increased or decreased urinary output, renal toxicity Drugs Used for Psychoses - psychosis: state of severe mental impairment Person does not view real/unreal correctly Common symptoms: -Delusion: false belief -Hallucination: seeing, hearing, smelling or feeling something that isn’t real -Paranoia: a disorder of the mind, person has false beliefs (delusions) usually suspicious about a person or situation -Delusion of grandeur: exaggerated belief about one’s importance, wealth, power or talents -Delusion of persecution: false belief that on is mistreated, abused or harassed - Schizophrenia is the most common psychotic disorder - Psychotic symptoms can occur from medical problems: - Dementia and delirium - Mood disorders - Drugs and substance abuse Drugs Used for Psychoses continued… - Drug and non-drug therapies used to treat Unless the psychosis is caused by medical problem, symptoms will re-occur most of persons life - Anti-psychotic drugs: - - Typical or first-generation anti-psychotic agents - these antagonize dopamine in CNS - Atypical or second-generation - Inhibit dopamine receptors, also serotonin - Tend to be more effective than typical/first-generation - Fewer side effects that typical/first-generation Drugs Used for Psychoses continued… Initial goals of therapy: -calm agitated person - begin treatment Therapy often involves benzodiazepines and anti-psychotics -this allows a lower dose of the anti-psychotic Most disorders are treated with a low maintenance dose Drugs Used for Psychoses continued… Assisting With the Nursing Process for anti-psychotics: ASSESSMENT: measure blood pressure supine, sitting and standing, measure weight and height, measure blood glucose PLANNING: see table 15-3 (p. 208) for oral and rectal “dose forms” IMPLEMENTATION: see 15-3 for “adult dosage range”, dosage adjusted according to degree of mental/emotional disturbance. Takes several weeks to show desired improvement EVALUATION: Report or record: -fatigue, drowsiness, dose usually ordered for bedtime -orthostatic hypotension, provide for safety -blurred vision, provide for safety -constipation, give stool softeners as ordered -dryness of mouth, nose, throat, hard candy, ice chips or gum if nurse allows -seizures, see ch.16 -Parkinsons-like symptoms, provide for safety -involuntary body movements, see box 15-6 (p. 209), provide for safety -anorexia, nausea, jaundice, signal liver toxicity -hives, itching, rash, signal allergic rea Drugs Used for Psychoses continued… Typical (first-generation): -Phenothiazines -chlorpromazine (Thorazine) -fluphenazine (Prolixin) -perphenazine -prochlorperazine (Compazine) -thioridazine -trifluoperazine -Thioxanthenes -thiothixene (Navane) -Non-Phenothiazines -haloperidol (Haldol) -loxapine (Loxitane) -molindone (Moban) Drugs Used for Psychoses continued… Atypical (second-generation): -aripiprazole (Abilify) -clozapine (Clozaril) -olanzapine (Zyprexa) -quetiapine (Seroquel) -risperidone (Risperdal) -ziprasidone (Geodon) Drugs Used for Alcohol Rehabilitation - - - alcohol slows down brain activity over time heavy drinking damages the brain, CNS, liver, heart, kidneys and stomach it causes changes in heart and blood vessels alcoholism is a chronic disease, lasts throughout life risk factors: life-style and genetics there is no cure, but it can be treated through counseling and drugs 2 main drugs used to treat alcoholics: - acamprosate (Campral) - disulfiram (Antabuse) Drugs Used for Alcohol Rehabilitation continued… acamprosate (Campral): - used for chronic alcohol patients who want to be sober - enhances ability not to drink - does NOT treat withdrawal symptoms - reduces drinking rates for those who stop drinking at start of tx Assisting With the Nursing Process for acamprosate (Campral): ASSESSMENT: observe persons level of alertness and orientation to person, time and place, measure vital signs, ask about GI symptoms PLANNING: oral dose form is two 333mg delayed-release tablets IMPLEMENTATION: adult dose is two 333mg tablets 3x/day, tablets taken without regards to meals EVALUATION: report and record: - diarrhea, usually mild and tends to resolve as tx continues - suicidal actions, observe for negative thoughts, feelings, behaviors, depression or suicidal thinking, report to nurse, follow suicide precautions according to care plan Drugs Used for Alcohol Rehabilitation continued… disulfiram (Antabuse): - produces a very unpleasant reaction when taken before alcohol - nausea, severe vomiting, sweating, throbbing headache, dizziness, blurred vision, confusion - reactions depend on amount alcohol in the blood, can last 30-60 minutes or hours - taking the drug over prolonged period does NOT produce tolerance, person becomes more sensitive to alcohol - person should not consume any OTC products with alcohol, including: sleep aids, cough/cold products, after-shave lotions, mouthwash, rubbing alcohol or foods/sauces containing alcohol Drugs Used for Alcohol Rehabilitation continued… Assisting with Nursing Process for disulfiram (Antabuse): ASSESSMENT: observe persons level of alertness and orientation to person, time and place, measure vital signs, ask about GI symptoms PLANNING: oral dose form is 250 mg tablets IMPLEMENTATION: initial adult dose is 500mg once/day for 1-2 weeks, maintenance dose ranges from 125-500mg daily, max daily dose 500mg, never give drug to intoxicated person, person cannot have alcohol for 12 hours prior to receiving drug EVALUATION: report and record: -drowsiness, fatigue, headache, impotence, metallic taste -anorexia, nausea, vomiting, jaundice, may signal liver toxicity -hives rash, itching, signal allergic reaction, tell nurse immediately