Psychotherapeutic agents

Question 1

Effects on children

Answer 1

• close monitoring needed: may need to frequently change dosages
• can have an impact on learning & social development
• CNS stimulants are often the go to for treating ADD

Question 2

Effects on older adults

Answer 2

• more susceptible to adverse effects
• reduced dosages may be needed in renal & hepatic impairment
• SHOULD NOT BE USED TO CONTROL BEHAVIOR WITH DEMENTIA
• pt should be urged to maintain fluid & salt intake
• START LOW, GO SLOW

Question 3

Drugs for bipolar disorders

Answer 3

lithium (Lithobid):

-Action:

=alters NA+ transport

=inhibits the release of NE & dopamine

• Uses: managing manic episodes
• Considerations:

=adverse reactions: severe CNS (lethargy, slurred speech, muscle weakness, renal (polyuria) , & pulmonary problems tht can lead to death

=fluid intake is really important

=crosses the placenta, enters breast milk, and has been associated with congenital abnormalities

=contraindications:

Hx of Leukemia

metabolic disorders

use of diuretics as lithium decreases sodium reabsorption, and severe hyponatremia can occur

dehydration

pregnancy or lactation

excessive sweating

suicidal or impulsive pts

fever

Question 4

CNS stimulants

Answer 4

Action

• increases release of catecholamines
• stimulate cortical levels and the RAS to increase RAS activity
• improve concentration & the ability to filter & focus incoming stimuli

Uses:

-Treatment of ADD & narcolepsy

Ex:

• methylphenidate (ritalin)
• modafinil (Provigil)

Nursing responsibilities:

-assessment:

=get the baselines

 =contraindications:
glaucoma
anxiety
tension
fatigue
seizure disorder
cardiac disease & hypertension
history of leukemia
history of drug dependence including alcoholism

-Monitor

=effectiveness
=side effects

-Pt teaching

=take these meds before 6 pm to reduce the incidence of insomnia