Mental health medications Flashcards
(22 cards)
Review of the nervous system and neurotransmitters
Excitatory: these ‘fire off’ the chemical message and pass it along to the next cell;
Inhibitory: these ‘block’ or prevent the chemical message from being passed along;
Modulatory: these ‘tweak’ or modulate the chemical message and adjust the communication at the synapse
What are Monoamine neurotransmitters
They are hormones derived from amino acids. They are called monoamine as they contain one amino group. They include catecholamine and tryptamine hormones.
What is Catecholamine hormones
Derived from the amino acid tyrosine;
Include:
Dopamine;
Epinephrine (adrenaline);
Norepinephrine (noradrenaline)
What is tryptamine hormones
Derived from the amino acid tryptophan;
Include:
Serotonin;
Melatonin
Dopamine
Dopamine, a catecholamine hormone, plays a role in the body’s reward system (arousal, feeling pleasure, and learning) as well as concentration, memory, motivation and sleep. It can be both excitatory and inhibitory.
Serotonin
A tryptamine chemical messenger, regulates sleep, mood, anxiety, hunger and pain. It is an inhibitory neurotransmitter.
Mood disorders
Depression:
Mood disorder characterised by lowering of mood, loss of interest and enjoyment. Is associated with an imbalance of serotonin.
Bipolar affective disorder
Mood disorder characterised by episodes of mania and depression. Is associated with a dopamine dysfunction.
Anxiety
Characterised by constant fears or thoughts that are distressing and affect daily living.
May be associated with an imbalance of serotonin.
Personality disorders
Characterised by long-term dysfunctional thinking, feeling and behaving.
Usually results in difficulty relating to people and situations.
Psychotic disorders
Characterised by confused thinking, people can experience delusions and hallucinations.
May be associated with a dopamine dysfunction.
Trauma related disorders
Conditions that develop as a response to a traumatic event e.g. physical or sexual assault, torture, and natural disasters.
Substance use/abuse disorders
Inability to control use of legal or illegal substances despite harmful consequences.
What are Antipsychotic medications
Antipsychotic medications are used to treat psychoses (i.e. schizophrenia, delirium, dementia). They act upon dopamine receptors and are often referred to as major tranquilisers. They can be classified as either typical (first generation) or atypical (second generation) antipsychotic medications
Typical antipsychotic medications
Examples: Haloperidol, Fluphenazine, Chlorpromazine
Indications/Use
Psychoses
Act on dopamine D2 receptors.
Side effects include: sedation, photosensitivity, decreased libido, rash;
As a result of extrapyramidal disturbances (drug induced Parkinsonism, facial grimacing; akasthasia/fidgeting; tardive dyskinesia/involuntary movements), this class of drugs is used less often that atypical antipsychotics.
Nursing considerations
Assess effectiveness of medication;
Monitor cardiac, liver and renal function;
Observe for hypotension
Atypical antipsychotic medications
Examples: Risperidone, Clonazepine, Olanzapine
Indications/Use
Less effect on D2 receptors;
Side effects similar to typical (first generation) antipsychotics, however fewer extrapyramidal effects.
Nursing considerations
Assess effectiveness of medication;
Monitor cardiac, liver and renal function;
Observe for hypotension
What are Anxiolytic and hypnotic medications
Anxiolytic medications are used to treat anxiety. They act on GABA receptors and are sometimes termed ‘minor tranquilisers’, as they have a sedative effect and can be addictive. Benzodiazepines (‘benzos’) are the most common anxiolytics
Hypnotics and used to induce sleep. They also act on GABA receptors. Hypnotic drugs should be only used short term and deaths have occurred when used in combination with alcohol
Anxiolytic and hypnotic medications
Examples: Diazepam, Temazepam, Oxazepam, Midazolam, Nitrazepam, Lorazepam, Flunitrazepam, Phenobarbitone, Chloralhydrate.
Indications/Use
Act on GABA receptors;
Opens the cells chloride ion channel;
Side effects: sedation, ‘groggy feeling’, memory impairment, mood swings, tolerance/dependence, GIT disturbance, tachycardia, hypotension.
Nursing considerations
Older people are at greater risk of falls;
Long term use is not recommended;
If used longer term, avoid abrupt withdrawal
Antidepressants
Antidepressants are medications used to treat depression. They work by increasing serotonin and noradrenaline, which are believed to be low in people with depression. It takes at least 4 weeks for the medication to start working, and treatment usually lasts 4 to 12 months per depressive episode. Two common types of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).
Mood stabilisers
Mood stabilisers are used for manic or cyclic depressive states. These medications enhance the action of the amine reuptake pump, thus inhibiting noradrenaline release and decreasing the neurotransmitter in the synapse
Selective serotonin reuptake inhibitors (SSRIs)
Examples: Fluoxetine (Prozac), Paroxetine, Sertraline.
Indications/Use
Used as a first line therapy for depressive disorders, obsessive compulsive disorder (OCD);
Works to block the reuptake of serotonin and noradrenaline;
Side effects: tremor, nausea, headache, anorexia, sweating, fatigue; produces less of a sedative effect.
Nursing considerations
Monitor blood pressure,
Educate person to take drug with food;
Ensure gradual withdrawal of drug
Tricyclic antidepressants (TCAs)
Examples: Doxepin, Amitriptyline, Imipramine.
Indications/Use
Second line therapy for depressive disorders;
Block the amine reuptake pump resulting in increased serotonin and noradrenaline;
Side effects: dry mouth, blurred vision, tachycardia, constipation, increased sedation, mental confusion.
Nursing considerations
Closely monitor blood pressure;
Inform the person to avoid operating machinery
Mood stabilisers
Examples: Lithium carbonate
Indications/Use
Used to prevent mania and cyclic depressive states (bipolar)
Enhance the action of the amine reuptake pump, inhibiting noradrenaline release and decreasing neurotransmitters in the synapse;
Side effects: GIT disturbance, tremor, muscle weakness, polyuria, toxicity (narrow therapeutic range), cardiac arrhythmia, renal failure.
Nursing considerations
Regular monitoring of serum concentrations of lithium and renal function;
Assess for, and education person about, the early signs of lithium toxicity (thirst, vomiting, polyuria);
Educate person about not taking lithium with NSAID (causes lithium toxicity)
