BASIC CONCEPTS ON PSYCHOPHARMACOLOGY

Oftentimes PHARMACOLOGY is the most dreaded part of a nursing exam. One reason could be that it requires you to memorize facts, and more often than not, it is difficult to decide on WHAT TO MEMORIZE. But not anymore, the CHECK PRINCIPLE provides you with a framework.

It stands for...

C - heck why the medication is given and know classification of the drug. In other words, you should know the purpose why the medication is given.

H - ow will you know if the medication is effective. What are your assessment parameters in monitoring the effects of the drug?

E - xactly what time should the medication be given. Some drugs are best taken with meals, some after meals and some, on an empty stomach. Other drugs may also be taken without regard to meals. You should know all these!

C - lient teaching tips. What would you tell your patient to expect. You should be able to give instructions related the to therapeutic and side effects of the drug.

K - eys to giving it safely. You should be able to identify interventions to counteract the adverse/side effects of the drug.

PSYCHOPHARMACOLOGIC AGENTS

1. Major Tranquilizers/antipsychotics:Common Indication: Schizophrenia

Examples:

• Haloperidol (Hadol)
• Prochlorperazine (Compazine)
• Fluphenazine (Prolixin)
• Chiorprortiazine (Thorazine)
• Clozapine (ClozariI)
• Olanzapine (Zyprexa)

C - Antipsychotics
H - Decreased delusions, hallucinations and looseness of association
E - Best taken after meals
C - Report sore throat and avoid exposure to sunlight Report elevated temperature and muscle rigidity, it indicates Neuroleptic Malignant Syndrome
K - Check the BP the drug causes hypotension, Assess for akathisia, usually described by patients as "I feel as if have ants in my pants". Assess for tardive dyskinesia initially manifested by tongue twitching or lip smacking. Check the CBC, drugs cause leukopenia.

2. ANTI-PARKINSONIAN AGENTS:

Indication:

2 TYPES:

DOPAMINERCIC DRUGS
Examples:Amantadine (Symmetret) Levodopa Levodopa-Carbidopa (Sinemet)

ANTICHOLINERGIC DRUGS
Examples:

• Trihexyphenidyl (Artane)
• Biperiden Hydrochloride (Akineton)
• Benztropine Mesylate (Cogentin)
• Diphenhydramine Hydroch~onde (Benadryl)

C - Anti-parkinsonian agents
H - Muscles become less stiff; decreased pill-rolling tremors
E - Best taken after meals
C - Avoid driving, the drug causes blurred vision
K - Check the BP, the drug may cause hypotension

3. MINOR TRANQUILIZERS/ANXIOLYTICS

Common indication: Anxiety disorders
Examples:

• Diazepam (Valium)
• Oxazepam (Serax)
• Chlordiazepoxide (Librium)
• Chlorazepate Dipotassium (Tranxene)
• Alprazolam (Xanax)

C - Antianxiety; given as a muscle relaxant to patient's in traction.
H - Decreased anxiety, adequate sleep
E - Best taken before meals, food in the stomach delays absorption
C - Avoid driving, intake of alcohol and caffeine containing foods, since it alters the effect of the drug
K - Administer it separately, it is incompatible with any drug

4. TRICYCLIC ANTIDEPRESSANTS
Examples:

• Imipramine (Tofranil)
• Amitriptyline (EIaviI)

C - Tricyclic anti-depressant: prevents the reuptake of norepinephrine
H - Increased appetite; adequate sleep
E - Best given after meals
C - Therapeutic effects may become evident only after 2-3 weeks of intake
B- Check the BP, it causes hypotension Check the heartrate, it causes cardiac arrythmias

5. ANTIDEPRESSANTS-MAO INHIBITORS
Examples:

• Tranylcypromine (Parnate)
• Phenelzine (Nardil)
• Isocarboxazid (Marplan)

C - Antidepressants (MAO inhibitors)
H - Increased appetite; adequate sleep
E - Best taken after meals
C - Report headache; it indicates hypertensive crisis Avoid tyramine containing foods like:

• A-vocado
• B-anana
• C-heddar and aged cheese
• S-oysauce and preserved foods

It takes 2-3 weeks before initial therapeutic effects becomen noticeable
K - Monitor the BP There should be at least a two-week interval when shifting from one antidepressant to another.

6. ANTI-MANIC AGENT

• LITHIUM CARBONATE

C - Antimanic
H - Decreased hyperactivity
E - Best taken after meals
C - Increase fluid intake (3 L/day) and sodium intake (3 gm./day) Avoid activities that increase perspiration
K - It takes 10-14 days before therapeutic effect becomes evident Antipsychotic is administered during the first two weeks to manage the acute symptoms of mania until lithium takes effect Monitor serum level, normal is .5-1.5 meq/L.
Nausea, Anorexia, Vomiting, Diarrhea and Abdominal cramps indicates lithium toxicity
Mannitol is administered if toxicity occurs.

ELECTRO-CONVULSIVE THERAPY
What is the mechanism of action of ECT?

• Unclear at present

What is the voltage of electrical current that is administered to the patient?

• 70-150 volts

How long is the electrical shock applied to the patient?

• About 5-2 seconds

What is the usual number of treatment needed to produce a therapeutic effect?

• 6-12 treatments

How frequent should the treatment be made?

• There should be an interval of 48 hours for each treatment

What are the Indicators of effectiveness of ECT?

• The occurrence of generalized tonic-clonic seizure

What are the Indications for ECT?

• Depression, Mania, Catatonic schizophrenia

What are the contraindications to ECT?

• Fever
• Increased Intracranial tumor
• Cardiac
• TB with history of hemorrhage
• Recent fracture
• Retinal Detachment
• Pregnancy

Is Consent needed prier to ECT?

• Yes

What are the medications which are given to the patient prior to ECT?

• Atropine S04 - to decrease secretions
• Anectine (Succinylcholine) - to promote muscle relaxation
• Methohexital Sodium (Brevital)- serves as an anesthetic agent

What are the common complications of ECT?

• Loss of memory
• Headache
• Apnea
• Fracture
• Respiratory depression