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Basic Concepts On Psychopharmacology

This document provides information on various psychopharmacology concepts and medications. It discusses: 1. The DERUG mnemonic for desired effects, reportable signs/symptoms, undesirable effects, and guidelines for medication administration. 2. Common classes of psychiatric medications including major tranquilizers, anti-parkinsonian agents, minor tranquilizers, tricyclic antidepressants, MAO inhibitors, anti-manic agents, and ECT. 3. Guidelines for administration and monitoring of specific medications as well as common side effects and interventions for adverse effects.

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177 views47 pages

Basic Concepts On Psychopharmacology

This document provides information on various psychopharmacology concepts and medications. It discusses: 1. The DERUG mnemonic for desired effects, reportable signs/symptoms, undesirable effects, and guidelines for medication administration. 2. Common classes of psychiatric medications including major tranquilizers, anti-parkinsonian agents, minor tranquilizers, tricyclic antidepressants, MAO inhibitors, anti-manic agents, and ECT. 3. Guidelines for administration and monitoring of specific medications as well as common side effects and interventions for adverse effects.

Uploaded by

jisoo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BASIC CONCEPTS ON

PSYCHOPHARMACOLOGY
D –ESIRED EFFECT - you should know why the
Medication is given and know the classification of
the drug. In other words , you should know why
the medication is given.

R-EPORTABLE SIGNS AND SYMPTOMS - YOU


SHOULD KNOW WHAT ARE THE SIGNS AND
SYMPTOMS WHICH WOULD WARRANT
IMMEDIATE REPORTING TO THE DOCTOR.
U-NDESIRABLE EFFECTS - AS A NURSE YOU
ARE EXPECTED TO PROVIDE THE PATIENT
WITH INFORMATION ON THE UNDESIRABLE
EFFECTS OF A DRUG.

 G-UIDELINES- EXACT TIME, WHAT PATIENT TO


EXPECT, GIVE INSTRUCTIONS RELATED TO THE
SIDE EFFECTS OF THE DRUG. PROVIDE KEYS
TO GIVING IT SAFELY. IDENTIFY
INTERVENTIONS TO COUNTERACT THE
ADVERSE/SIDE EFFECTS OF THE DRUG.
MAJOR TRANQUILIZERS/ANTIPSYCHOTICS

COMMON INDICATION: SCHIZOPHRENIA


EXAMPLES: HALOPERIDOL (HALDOL)
PROCHLORPERAZINE (COMPAZINE)
FLUPHENAZINE (PROLIXIN)
CHLORPROMAZINE (THORAZINE)
CLOZAPINE (CLOZARIL)
OLANZAPINE (ZYPREXA)
ASSESS FOR TARDIVE DYSKINESIA INITIALLY
MANIFESTED BY TONGUE TWITCHING OR
LIP SMACKING.

G- BEST TAKEN AFTER MEALS.


CHECK THE BP, THE DRUG CAUSES
HYPOTENSION
CHECK CBC, THE DRUG CAUSES
LEUKOPENIA
ANTI-PARKINSONIAN AGENTS

INDICATION: PREVENTION OF
PSEUDOPARKINSONISM
2 TYPES:
1. DOPAMINERGIC DRUGS
EXAMPLES: AMANTADINE (SYMMETREL)
LEVODOPA
LEVODOPA-CARBIDOPA (SINEMET)
 D- DECREASED DELUSIONS,HALLUCINATIONS,
AND LOOSENESS OF ASSOCIATION.
R-REPORT SORE THROAT AND AVOID
EXPOSURE TO SUNLIGHT
REPORT ELEVATED TEMPERATURE AND
MUSCLE RIGIDITY, IT INDICATES NEUROLEPTIC
MALIGNANT SYNDROME.
U-ASSESS FOR AKATHISIA,USUALLY
DESCRIBED BY PATIENTS AS “I FEEL AS IF I
HAVE ANTS IN MY PANTS.”
ANTICHOLINERGIC DRUGS
EXAMPLES:
TRIHEXYPHENIDYL (ARTANE)
BEPERIDEN HYDROCHLORIDE (AKINETON)
BENZTROPINE MESYLATE (COGENTIN)
DIPHENHYDRAMINE HYDROCHLORODE
(BENADRYL)
D- MUSCLES BECOME LESS STIFF;
DECREASEDPILL-ROLLING TREMORS.
R-NAUSEA,VONITING AND ANOREXIA,IT
INDICATES ADVERSE EFFECTS .
U-LEUKOPENIA, AGRANULOCYTOSIS,
HEPATOTOXICITY, SEIZURES.
G-BEST TAKEN AFTER MEALS
CHECK THE B/P,THE DRUG MAY CAUSE
HYPOTENSION
AVOID USE OF THE HERB KAVA AS IT
INCREASES PARKINSONIAN SYMPTOMS.
AVOID DRIVING, THE DRUG CAUSES
BLURRED VISION
AVOID BITAMIN B6 OR PROTEIN RICH FOODS
BECAUSE IT DECREASES ABSORPTION OF
THE DRUG.
MINOR TRANQUILIZERS/ANXIOLYTICS

COMMON INDICATION: ANXIETY DISORDERS


EXAMPLES:
DIAZEPAM (VALIUM)
OXAZEPAM (SERAX)
CHLORDIAZEPOXIDE(LIBRIUM)
CHLORAZEPATE DIPOTASSIUM (TRANXENE)
ALPRAZOLAM (XANAX)
D-DECREASED ANXIETY, ADEQUATE SLEEP,
GIVEN AS A MUSCLE RELAXANT TO
PATIENT’S IN TRACTION.
R-REPORT DECREASED RESPIRATORY RATE,
IT INDICATES CNS DEPRESSION
U-MAY CAUSE DROWSINESS AND PHYSICAL
OR PSYCHOLOGICAL DEPENDENCE
G-ADMINISTER VALIUM SEPARATELY, IT IS
INCOMPATIBLE WITH ANY DRUG
BEST TAKEN BEFORE MEALS, FOOD IN THE
STOMACH DELAYS ABSORPTION
AVOID DRIVING, INTAKE OF ALCOHOL AND
CAFFEINE CONTAINING FOODS, SINCE IT
ALTERS THE EFFECT OF THE DRUG.
TRICYCLIC ANTIDEPRESSANTS

EXAMPLES:
IMIPRAMINE (TOFRANIL)
AMITRIPTYLINE (ELAVIL)
D- PREVENTS THE REUPTAKE OF
NOREPINEPHRINE; INCREASED APPETITE;
ADEQUATE SLEEP
R
U-BEST GIVEN AFTER MEALS
G-THERAPEUTIC EFFECTS MAY BECOME
EVIDENT ONLY AFTER 2-3 WEEKS OF INTAKE
CHECK THE BP, IT CAUSES HYPOTENSION
CHECK THE HEARTRATE, IT CAUSES CARDIAC
ARRYTHMIAS.
ANTIDEPRESSANTS-MAO INHIBITORS

EXAMPLES:
TRANYLCYPROMINE (PARNATE)
PHENELZINE (NARDIL)
ISOCARBOXAZID (MARPLAN)
D-INCREASED APPETITE; ADEQUATE SLEEP
R-REPORT HEADACHE; IT INDICATES
HYPERTENSIVE CRISIS
U-MAY CAUSE DIZZINESS, DROWSINESS,
CONSTIPATION AND DIAPHORESIS
G-BEST TAKEN AFTER MEALS
MONITOR THE BP
THERE SHOULD BE AT LEAST TWO-WEEK
INTERVAL WHEN SHIFTING FROM ONE
ANTI-DEPRESSANT TO ANOTHER
AVOID TYRAMINE CONTAINING FOODS LIKE;
AVOCADO
BANANA
CHEDDAR AND AGED CHEESE
SOYSAUCE AND PRESERVED FOODS
IT TAKES 2-3 WEEKS BEFORE INITIAL
THERAPEUTIC EFFECTS BECOME
NOTICEABLE
ANTI-MANIC AGENT

LITHIUM CARBONATE
D-DECREASED HYPERACTIVITY
R-NAUSEA,ANOREXIA, VOMITING, DIARRHEA
AND ABDOMINAL CRAMPS INDICATES
LITHIUM TOXICITY
U-MAY CAUSE LETHARGY, COMA SEIZURES,
ATAXIAAND TREMORS
G-BEST TAKEN AFTER MEALS
INCREASE FLUID INTAKE (3L/DAY) AND
SODIUM INTAKE (3 GM./DAY)
AVOID ACTIVITIES THAT INCREASE
PERSPIRATION
IT TAKES 10-14 DAYS BEFORE THERAPEUTIC
EFFECT BECOMES EVIDENT.
AN 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-
1.5mEq/L.
MANNITOL OR DIAMOX IS ADMINISTERED IF
TOXICITY OCCURS.
ELECTRO-CONVULSIVE THERAPY

MECHANISM OF ACTION - UNCLEAR


VOLTAGE-ELECTRICAL CURRENT
ADMINISTERED TO THE PATIENT 70-150
VOLTS
HOW LONG IS THE ELECTROCAL SCHOCK
APPLIED TO PATIENT
ABOUT .5-2 SECONDS
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.
INDICATIONS FOR ECT?
DEPRESSION
MANIA
CATATONIC SCHIZOPHRENIA
WHAT IS THE ABSOLUTE
CONTRAINIDICATION TO ECT?
INCREASED INTRACRANIAL PRESSURE.
WHAT ARE THE RELATIVE CONTRAINDICATIONS TO ECT?

FEVER
CARDIAC ARRYTHMIAS
TB WITH HISTORY OF HEMORRHAGE
RECENT FRACTURE
RETINAL DETACHMENT
PREGNANCY (WITH COMPLICATIONS)
CONSENT IS NEEDED PRIOR TO ECT

WHAT ARE THE MEDICATIONS WHICH ARE


GIVEN TO THE PATIENT PRIOR TO ECT?
ATROPINE SO4- TO DECREASE SECRETIONS.
ANECTINE (SUCCINYLCHOLINE)- TO PROMOE
MUSCLE RELAXATION
METHOHEXITAL SODIUM (BREVITAL)-SERVES
AS ANESTHETIC AGENT
COMMON COMPLICATIONS

LOSS OF MEMORY
HEADACHE
APNEA
FRACTURE
RESPIRATORY DEPRESSION
COMMON PSYCHOTHERAPEUTIC INTERVENTIONS

1. REMOTIVATION THERAPY

TREATMENT MODALITY THAT PROMOTES


EXPRESSION OF FEELING THROUGH
INTERACTION FACILITATED BY DISCUSSION
OF NEUTRAL TOPICS
5 DIFFERENT STEPS

1. CLIMATE OF ACCEPTANCE


2. CREATING OF BRIDGE TO REALITY
3. SHARING THE WORLD WE LIVE IN
4. APPRECIATION OF THE WORKS OF THE
WORLD.
5. CLIMATE OF APPRECIATION
MUSIC THERAPY

INVOLVES THE USE OF MUSIC TO


FACILITATE RELAXATION OF FEELINGS AND
OUTLET OF TENSION.

PLAY THERAPY
TREATMENT MODALITY WHICH ENABLES
THE PATIENT TO EXPERIENCE INTENSE
EMOTION IN A SAFE ENVIRONMENT WITH
THE USE OF PLAY.
GROUP THERAPY

TREATMENT MODALITY INVOLVING


INTERACTIONS OF 3 OR MORE PATIENTS
WITH A THERAPIST
TO RELIEVE EMOTIONAL DIFFICULTIES,
INCREASE SELF ESTEEM,
DEVELOP INSIGHT AND IMPROVE BEHAVIOR
IN RELATION WITH OTHERS.
THE MINIMUM NUMBER OF MEMBERS IN A
GROUP THERAPY IS 3 WHILE THE IDEAL
NUMBER IS 8-10.
MILIEU THERAPY

CONSISTS OF TREATMENT BY MEANS OF


CONTROLLED MODIFICATION OF THE
PATIENTS ENVIRONMENT TO FACILITATE
POSITIVE BEHAVIORAL CHANGE.
FAMILY THERAPY

A METHOD OF PSYCHOTHERAPY WHICH


FOCUSES ON THE TOTAL FAMILY AS AN
INTERACTIONAL SYSTEM.

PSYCHOANALYSIS- A METHOD OF
PSYCHOTHERAPY WHICH FOCUSES ON THE
EXPLORATION OF THE UNCONSCIOUS, TO
FACILITATE IDENTIFICATION OF THE
PATIENT’S DEFENSES.
HYPNOTHERAPY

A THERAPEUTIC MODALITY WHICH


INVOLVES VARIOUS METHODS AND
TECHNIQUES TO INDUCE A TRANCE STATE
WHERE THE PATIENT BECOMES SUBMISSIVE
TO INSTRUCTIONS.

HUMOR THERAPY-INVOLVES THE USE OF


HUMOR TO FACILITATE EXPRESSION OF
FEELINGS AND TO ENHANCE INTERACTION.
BEHAVIOR MODIFICATION

A THERAPEUTIC INTERVENTION INVOLVING THE


APPLICATION OF LEARNING PRINCIPLES IN
ORDER TO CHANGE MALADAPTIVE BEHAVIOR.

AVERSION THERAPY
AN EXAMPLE OF BEHAVIOR MODIFOCATION IN
WHICH A PAINFUL STIMULUS IS INTRODUCED IS
INTRODUCED TO BRING ABOUT AN AVOIDANCE
OF ANOTHER STIMULUS WITH THE END VIEW
OF FACILITATING BEHAVIORAL CHANGE. IT IS
USUALLY INDICATED FOR ALCOHOLIC PATIENTS.
TOKEN-ECONOMY

AN EXAMPLE OF BEHAVIOR MODIFICATION


TECHNIQUE WHICH UTILIZES THE
PRINCIPLE OF REWARDING DESIRED
BEHAVIOR TO FACILITATE CHANGE.
DESENSITIZATION

PERIODIC EXPOSURE OF THE INDIVIDUAL TO A


FEARED OBJECT, UNTIL THE UNDESIRABLE
BEHAVIOR DISAPPEARS OR IS LESSENED. IT IS
USUALLY INDICATED FOR PATIENTS WITH PHOBIA.

COGNITIVE THERAPY
SHORT TERM STRUCTURED THERAPY BETWEEN
THE PATIENT AND THE THERAPIST ORIENTED
TOWARDS PRESENT PROBLEMS AND SOLUTIONS.
THE MAIN FOCUS OF COGNITIVE THERAPY IS
DEPRESSIVE DISORDERS.
CRISIS AND CRISIS INTERVENTION

WHAT IS A CRISIS?
SITUATION THAT OCCURS WHEN AN
INDIVIDUAL’S HABITUAL COPING ABILITY
BECOMES INEFFECTIVE TO MEET THE
DEMANDS OF A SITUATION.
CHARACTERISTICS OF A CRISIS STATE

 HIGHLY INDIVIDUALIZED
LASTS FOR 4-6 WEEKS
PERSON AFFECTED BECOMES PASSIVE AND
SUBMISSIVE
AFFECTS A PERSONS’ SUPPORT SYSTEM
THE PERSON IS AMENABLE TO SUGGESTIONS
HAS A GROWTH POTENTIAL
TYPES OF CRISES

MATURATIONAL/DEVELOPMENTAL CRISIS
EXPECTED, PREDICTABLE AND INTERNALLY
MOTIVATED.
EXAMPLES: GROWTH, PARENTHOOD
SITUATIONAL/ACCIDENTAL - UNEXPECTED,
UNPREDICTABLE AND EXTERNALLY MOTIVATED
EXAMPLE: CAR ACCIDENT
SOCIAL CRISIS-DUE TO ACTS OF NATURE
EXAMPLES: EARTHQUAKE, TIDAL WAVES
ADVENTITIOUS CRISIS: RAPE; TRAUMA
CRISIS INTERVENTION

A WAY OF ENTERING INTO THE LIFE


SITUATION OF AN INDIVIDUAL, FAMILY,
GROUP, OR COMMUNITY TO HELP THEM
MOBILIZE THEIR RESOURCES AND TO
DECREASE THE EFFECT OF A CRISIS
INDUCING STRESS.
STEPS IN CRISIS INTERVENTION

1. ASSESS THE SITUATION


2. ASSESS THE CLIENT TO DEVELOP
COGNITION/AWARENESS OF THE EVENT.
3. ASSESS THE CLIENT IN MANAGING
FEELINGS
4. EXPLORE WITH THE CLIENT THE
RESOURCES AVAILABLE.
5. ASSIST THE CLIENT IN AN ACTION
PLANNING.
GOAL OF CRISIS INTERVENTION

TO ENABLE THE PATIENT TO ATTAIN AN


OPTIMUM LEVEL OF FUNCTIONING.
PHASES OF A CRISIS

DENIAL - INITIAL REACTION


INCREASED TENSION-THE PERSON
RECOGNIZES THE PRESENCE OF A CRISIS
AND CONTINUES TO DO ACTIVITIES OF DAILY
LIVING (ADL)
DISORGANIZATION - THE PERSON IS
PREOCCUPIED WITH THE CRISIS AND IS
UNABLE TO DO ADL
ATTEMPTS TO REORGANIZE-THE INDIVIDUAL
MOBILIZES PREVIOUS COPING MECHANISMS.
LEVELS OF PREVENTION

PRIMARY - INTERVENTIONS AIMED AT THE


PROMOTION OFMENTAL HEALTH AND
LOWERING THE RATE OF CASES BY
ALTERING THE STRESSORS.

EXAMPLES: HEALTH EDUCATION


INFORMATION DISSEMINATION COUNSELING
SECONDARY: INTERVENTIONS THAT LIMIT
THE SEVERITY OF A DISORDER
2 COMPONENTS
CASE FINDING
PROMPT TREATMENT
EXAMPLES: CRISIS INTERVENTION
ADMINISTRATION OF MEDICATIONS
TERTIARY LEVEL

INTERVENTIONS AIMED AT REDUCING THE


DISABILITY AFTER A DISORDER
2 COMPONENTS
1.PREVENTION OF COMPLICATION
2.ACTIVE PROGRAM OF REHABILITATION

EXAMPLES: ALCOHOLICS ANONYMOUS


OCCUPATIONAL THERAPY

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