Download - Psychotherapeutic Agents
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Psychotherapeutic AgentsPsychotherapeutic Agents
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Mental Disorders
caused by inherent dysfunction with in the
brain that leads to abnormal thought
processes responses due to chemical
imbalance.
Schizophrenia
Mania
Narcolepsy
Attention-deficit disorder
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Psychotherapeutic Drugs
Treats psychoses (perceptual & behavioral
disorder)
Not a cure rather help patients function inmore acceptable manner
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Chlorpromazine (Thorazine)
Clozapine (Clozaril)
- Atypical
- Typical
antipsychotic
drug
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Thera e tic acti s a i icati s
Ty ical a ti sychotic
r g
Block dopamine
receptor
Depress RAS (reticular
activating system)
Antcholinergic,antihistamine, alpha-
adrenergic blocking
Atypical antipsychotic
drug
Block dopamine and
Serotonin receptor
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Contraindications and Cautions
Presence of underlying diseases
Central nervous system (CNS) depression,circulatory collapse, Parkinson's disease,
coronary disease, severe hypotension, bonemarrow suppression, and blood dyscrasias
Prolongation of the QTc interval(mesoridazine, thioridazine, and ziprasidone)
Presence of glaucoma, peptic ulcer, andurinary or intestinal obstruction
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Contraindications and Cautions
Patients with seizure disorders
Patients with thyrotoxicosis
Active alcoholism
Myelography within the last 24 hours orscheduled within the next 48 hours
Pregnancy or lactation
Children younger than 12 years of age who have a
CNS infection or chickenpox Patients who are immunosuppressed and those
who have cancer
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Adverse Effects
CNS effects:sedation, weakness, tremor, drowsiness, and
extrapyramidal effectspseudoparkinsonism,
dystonia, akathisia, tardive dyskinesia, and potentially
irreversible neuroleptic malignant syndrome
Anticholinergic effects:
dry mouth, nasal congestion, flushing, constipation,
urinary retention, sexual impotence, glaucoma, blurred
vision, and photophobia.
Cardiovascular (CV) effects:
hypotension, orthostatic hypotension, cardiac
arrhythmias, congestive heart failure, and pulmonary
edema. For prolongation of the QTc interval, serious or
fatal cardiac arrhythmias.
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Adverse Effects
Diabetes mellitus (use of atypical antipsychotics )
Respiratory effects
laryngospasm, dyspnea, and bronchospasm
The phenothiazines (chlorpromazine, fluphenazine,prochlorperazine, promethazine, and thioridazine) turn
the urine pink to reddish-brown
(has no clinical significance)
Bone marrow suppression
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Nursing
Considerations
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Assessment
Screen for the followingconditions, which could becontraindications orcautions for the use of thedrug:
Any known allergies to these drugs, severe CNSdepression, circulatory collapse, coronarydisease including prolonged QTc interval, braindamage, severe hypotension, glaucoma,respiratory depression, urinary or intestinalobstruction, thyrotoxicosis, seizure disorder,bone marrow suppression, pregnancy or
lactation, and myelography within the past 24hours or scheduled in the next 48 hours. Inchildren younger than 12 years of age, screenfor CNS infections.
Screening for baselinestatus before beginningtherapy and for anypotential adverse effects.
o Temperature; skin color and lesions;
o CNS orientation, affect, reflexes, and bilateralgrip strength;
o Bowel sounds and reported output;
o Pulse, auscultation, and blood pressure,(including orthostatic blood pressure);
o Respiration rate and adventitious sounds;
o Urinary output.
o Lab Tests: Liver and renal function tests,Thyroid function tests, ECG, Complete bloodcount (CBC).
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Nursing Diagnosis
Impaired Physical Mobility related toextrapyramidal effects
Decreased Cardiac Output related tohypotensive effects
Risk for Injury related to CNS effects andsedation
Impaired Urinary Elimination related toanticholinergic effects
Deficient Knowledge regarding drug therapy
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Implementation
Do not allow the patient to crush or chew sustained-release
capsules
If the patient receives parenteral forms, keep the patient
recumbent for 30 minutes Consider warning the patient or the patient's guardians
about the risk of development of tardive dyskinesias with
continued use
Arrange for gradual dose reduction after long-term use
Provide positioning of legs and arms
Provide sugarless candy and ice chips
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Implementation
Frequent mouth care
Encourage the patient to void before taking a dose
Provide safety measures such as siderails and assistancewith ambulation if CNS effects or orthostatic hypotension
occurs Provide for vision examinations
Provide thorough patient teaching, including drug name,prescribed dosage, measures for avoidance of adverseeffects, warning signs, and the need for monitoring and
evaluation Warn patients that urine may have a pink to reddish-brown
color.
Offer support and encouragement
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Evaluation
Monitor patient response to the drug
Monitor for adverse effects
Evaluate effectiveness of teaching plan
Monitor the effectiveness of comfort
measures and compliance with the regimen
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Other Drugs
Typical
Fluphenazine
Haloperidol
Loxapine
Molindone
Atypical
Aripiprazole
Olanzapine
Quetiapine
Risperidone
Ziprasidone
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Lithium Salts (Lithane, Lithotabs)
Antimanic drug: treatment for mania
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Thera e tic Actions andIndications
Alters sodium transport in nerve and muscle cells.
Inhibits the release of norepinephrine anddopamine, but not serotonin, from stimulated
neurons. Increases the intraneuronal stores of
norepinephrine and dopamine slightly.
Decreases intraneuronal content of secondmessengers by selectively modulating theresponsiveness of hyperactive neurons that mightcontribute to the manic state.
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Contraindications and Cautions
Hypersensitivity to lithium.
Renal or cardiac disease
History of leukemia; metabolic disorders (sodium
depletion); dehydration; and diuretic use Pregnancy and lactation are also
contraindications
Caution should be used in any condition that
could alter sodium levels (protracted diarrhea orexcessive sweating; with suicidal or impulsivepatients; and in patients who have infection withfever)
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Adverse Effects
Serum levels of less than 1.5 mEq/L: CNS problems, includinglethargy, slurred speech, muscle weakness, and fine tremor;polyuria, which relates to renal toxicity; and beginning of gastrictoxicity, with nausea, vomiting, and diarrhea
Serum levels of 1.5 to 2 mEq/L: Intensification of all of the above
reactions, with ECG changes Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects
to ataxia, clonic movements, hyperreflexia, and seizures; possibleCV effects such as severe ECG changes and hypotension; largeoutput of dilute urine secondary to renal toxicity; fatalitiessecondary to pulmonary toxicity
Serum levels greater than 2.5 mEq/L: Complex multiorgan toxicity,with a significant risk of death
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N
ursingC
onsiderations
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Assessment
Screen for the followingconditions, which could becontraindications orcautions for the use of the
drug:Any known allergies to lithium; renal or CV
disease; dehydration; sodium depletion, useof diuretics, protracted sweating, ordiarrhea; suicidal or impulsive patients withsevere depression; pregnancy or lactation;and infection with fever.
Screening for baselinestatus before beginningtherapy and for anypotential adverse effects.
o temperature; skin color and lesions
o CNS orientation, affect, and reflexes
o bowel sounds and reportedoutput
o pulse, auscultation, and blood pressure,(orthostatic blood pressure)
o respiration rate and adventitious sounds
o urinary output
o Lav Tests: liver and renal function tests,thyroid function tests, CBC, and baselineECG, and serum lithium
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Nursing Diagnosis
Acute Pain related to GI, CNS, and vision
effects
Risk for Injury related to CNS effects Impaired Urinary Elimination related to renal
toxic effects
DisturbedT
houghtP
rocesses related to CNSeffects
Deficient Knowledge regarding drug therapy
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Implementation
Give the drug cautiously, with daily monitoring ofserum lithium levels, to patients with significantrenal or CV disease, dehydration, or debilitation,as well as those taking diuretics
Give the drug with food or milk
Arrange to decrease dose after acute manicepisodes.
Ensure that the patient maintains adequateintake of salt and fluid
Monitor the patient's clinical status closely,especially during the initial stages of therapy
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Implementation
Arrange for small frequent meals, sugarlesslozenges to suck, and frequent mouth care
Provide safety measures such as siderails and
assistance with ambulation if CNS effects occur Provide thorough patient teaching, including drug
name, prescribed dosage, measures foravoidance of adverse effects, warning signs that
may indicate possible problems, and the need toavoid pregnancy while taking lithium
Offer support and encouragement
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Evaluation
Monitor patient response to the drug
Monitor for adverse effects
Evaluate the effectiveness of the teaching plan
Monitor the effectiveness of comfort
measures and compliance with the regimen.
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Other Drugs
Aripiprazole
Lamotrigine
Olanzapine
Quetiapine
Ziprasidone
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Methylphenidate (Ritalin, Concerta)
Central Nervous System Stimulant
Treatment ofattention-deficit disorders,
hyperactivity and narcolepsy.
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Thera e tic actions andIndications
Act as cortical and RAS stimulants, possibly by
increasing the release of catecholamines from
presynaptic neurons, leading to an increase in
stimulation of the postsynaptic neurons.
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Contraindications and Cautions
Known allergy to the drug.
Marked anxiety, agitation, or tension and severefatigue or glaucoma
Cardiac disease
Pregnancy and lactation
Patents with a history of seizures
With a history of drug dependence, includingalcoholism
With hypertension
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Adverse Effects
CNS effects
nervousness, insomnia, dizziness, headache,blurred vision, and difficulty with
accommodation. GI effects
anorexia, nausea, and weight loss
CV effects
hypertension, arrhythmias, and angina. Skin rashes
Physical and psychological dependence
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Nursing Considerations
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Assessment
Screen for the followingconditions, which could becontraindications orcautions for the use of thedrug
Any known allergies to the drug;glaucoma, anxiety, tension, fatigue,or seizure disorder; cardiac diseaseand hypertension; pregnancy orlactation; a history of leukemia; andhistory of drug dependency, including
alcoholism.
Screening for baselinestatus before beginningtherapy and for anypotential adverse effects.
o Temperature; skin color and lesions
o CNS orientation, affect, and reflexes
o Ophthalmic examination
o Bowel sounds and reported output
o Pulse, auscultation, and bloodpressure (orthostatic blood pressure)
o Respiration rate and adventitioussounds
o Urinary output
o Obtain a CBC
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Nursing Diagnosis
Disturbed Thought Processes related to CNS
effects of the drug
Decreased Cardiac Output related to CVeffects of the drug
Risk for Injury related to CNS and visual effects
of the drug
Deficient Knowledge regarding drug therapy
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Implementation
Ensure proper diagnosis of behavioral syndromesand narcolepsy
Arrange to interrupt the drug periodically in
children who are receiving the drug forbehavioral syndromes
Arrange to dispense the least amount of drugpossible
Administer the drug before 6 PM
Monitor weight, CBC, and ECG
Consult with the school nurse or counselor
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Implementation
Provide safety measures such as siderails and
assistance with ambulation if CNS effects occur
Provide thorough patient teaching, including drug
name, prescribed dosage, measures for
avoidance of adverse effects, warning signs that
may indicate possible problems, and the need for
monitoring and evaluation to Offer support and encouragement to help the
patient cope with the drug regimen.
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Evaluation
Monitor patient response to the drug
Monitor for adverse effects
Evaluate the effectiveness of the teaching plan Monitor the effectiveness of comfort
measures and compliance with the regimen.
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THANK YOU!!!!Prepared by:
Ray S. Buencuchillo
Er
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Schizophrenia (Greek: Split mind)
loss of contact with reality, bizarre behavior,
disorganized thinking and speech, decreased
emotional expressiveness, and social
withdrawal.
may have difficulty telling the difference
between real and unreal experiences, logical
and illogical thoughts, or appropriate andinappropriate behavior.
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Mania
elevated or irritable mood, exaggerated self-
importance, racing thoughts, and
hyperactivity.
People with mania often have inflated self-
esteem and self-confidence, and assume they
have more wit, courage, imagination, and
artistry than everyone else.
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Attention-deficit disorder
persistent inability to sit still, focus attention
on specific tasks, and control impulses.
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Narcolepsy
sudden and uncontrollable drowsiness and
attacks of sleep at unexpected and irregular
intervals that may last minutes or hours and
vary in frequency from a few to many in a
single day.
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Antipsychotic/Neuroleptic Drug
known before as Major Tranquilizer: not forsedation yet in change in neuron stimulation andresponse.
Dopamine receptor blockers: used to treatdisorders that involve thought processes.
Neuroleptic: due to adverse effects
Schizophrenia, Hyperactivity, combative behavior,
agitation in the elderly, short-term control.
Types: Typical and Atypical
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Central Nervous System Stimulant
Treat both attention-deficit disorders and
narcolepsy
Calm hyperkinetic children and help them
focus on one
Activity for a longer period
Redirect and excite the arousal stimuli from
the RAS