Pharmacological Therapy in Mental Disorders

A. List names of antipsychotic medications and their usual range of daily dose for adults.
Antipsychotic Medications Generic Name Chlorpromazine Fluphenazine Prochlorperazine Thioridazine Trifluoperazine Trade Name Thorazine Prolixine Ultrazine Mellaril Stelazine Dosage 1025 mg 24 times daily; may increase dose is 200mg/day; up to 1 g/day or 3030mg 13 times daily as extended-release capsules 0.510 mg/day in divided doses q 68 hr (maximumdose = 40mg/day) 510mg 34 times daily; may be increased q 23 days (up to 150 mg/day) 50100 mg tid initially; may be gradually increased to a dose of up to 800mg/day 25mg 12 times (up to 40mg/day) Nonphenothiazine Antipsychotic Medications Generic Name Aripiprazole Haloperidol Risperidone Ziprasidone Clozapine Trade Name Abilify Haldol Risperdal Geodon Clozaril Dosage 10 -15 mg/day as a single dose, doses up to 30 mg/ day have been used; increments in dosing should not be made before 2 wk at a given dose 0.55mg 23 times daily. Patients with severe symptomsmay require up to 100mg/ day 1mg twice daily, increased by 12mg/day no more frequently than every 24 hr to 48mg daily 20mg twice daily initially; dose increments may be made at 2-day intervals up to 80mg twice daily 25mg 12 times daily initially; and extremities, lip smacking or puckering, increase by 2550mg/day over a period of 2 wk to target dose of 300450 mg/day .May increase by up to 100 mg/day once or twice further (not to exceed 900 mg/day); treatment should be continued for at least 2 yr in patients with suicidal behavior 25mg twice daily initially, increased by 2550mg 23 times daily over 3 days, up to 300400 mg/day in 23divided doses by the 4th day (not to exceed 800 mg/day); or 300 mg once daily as XR tablets, increased by 300 mg/day, up to 400800 mg/day (not to exceed 800 mg/day) 510 mg/day initially; may increase at weekly intervals by 5 mg/day (not to exceed 20 mg/day) 6mg/day; may be titrated as needed (range 312mg/day)

Quetiapine

Seroquel

Olanzapine Paliperidone

Zyprexa Invega

Extracted: Assignment in Pharmacology (2010)

B. What are the target symptoms of antidepressants? List at least 8 accurate examples. Depressed mood Decreased attention to and enjoyment from previously pleasurable activities Change in sleep pattern Agitation or psychomotor retardation Tiredness Worthlessness or guilt inappropriate to the situation Difficulty thinking, focusing, or making decisions Hopelessness, helplessness, and/or suicidal ideation

C. Below are list of drugs and foods that are contraindicated with each other. Match which food that must be avoided when taking the medications in column 2. You can match more than once.
Column 1 Aged Cheese Liver Sausages Bologna Salami Pepperoni Tofu Pickled foods Column 2 Percocet, Percodan SSRI Stimulants Hydrocodone Morphine Codeine Meperidine Nonprescription Sleeping Pills

Cyrus Cesar R. Tejam BSN 3B

Psychiatric Mental Health Nursing

Smoked foods Snow pea pods Sauerkraut Fava Beans Avocado More than 1 oz chocolate Red wine Beer MSG Brewers Yeast Hydrolized protein extracts

Nasal Decongestants OTC Cough, cold, and sinus medications Ritalin Asthma or hay fever medications Local or spinal anesthetics containing epinephrine or levonordefrin General Anesthetics Amphetamines

Answers:
Percocet, Percodan (Opioids Agonist) SSRI Stimulants (Adrenergics) Hydrocodone (Opioids Agonist) Morphine (Opioids Agonist) Codeine (Opioids Agonist) Meperidine (Opioids Agonist) Nonprescription Sleeping Pills (possibly Barbiturates) Nasal Decongestants (Adrenergics) OTC Cough, cold, and sinus medications (Adrenergics + Antihistamine + Acetaminophen) Ritalin (CNS Stimulant) Asthma or hay fever medications (Xanthenes or Adrenergic +/- Corticosteroids) Local or spinal anesthetics containing epinephrine or levonordefrin (Anesthetics + Adrenergic) General Anesthetics Amphetamines Red wine, Beer Red wine, Beer Red wine, Beer, More than 1 oz chocolate Red wine, Beer Red wine, Beer Red wine, Beer Red wine, Beer Red wine, Beer Red wine, Beer, More than 1 oz chocolate Red wine, Beer, More than 1 oz chocolate Red wine, Beer, More than 1 oz chocolate Red wine, Beer, More than 1 oz chocolate; Avocado (High Fat meals increases bioavailability of bronchodilators) Red wine, Beer Red wine, Beer Red wine, Beer, More than 1 oz chocolate; Avocado, Snow pea pods, Fava Beans (Urine Alkalinizers like fruits , nuts and vegetables decrease excretion, increases effects) All the rest are tyramine-containing foods and are notably contraindicated in patients taking in Monoamine Oxidase Inhibitors, certain TB drugs, among others.

Alcohol is contraindicated with the intake of drugs that affect the nervous system. Chocolate contains stimulating plant alkaloids that increase Nervous System function.

D. Explain why Beta Blockers are used in Psychiatry? Beta adrenergic blockers control restlessness and inability to stay still (akathisia). They help control physical manifestations of anxiety such as an increase in heart rate and blood pressure. They also control tremors and other signs and symptoms typical of increased sympathetic nervous stimulation or stimulant adrenergic overdose. E. Explain why Cholinergic Agonist are used in Psychiatry? They help in the replacement therapy of neurotransmitters depleted in dementia. They also help in controlling aggressive behaviors. They also minimize the anticholinergic effect of antipsychotic drugs like dry mouth, photosensitivity, and constipation. Explain why Thyroid Medications are used in Psychiatry? Thyroid medications help control mental changes associated with an increase or decrease in basal body metabolism. An increase in metabolism causes alertness and hyperactivity while a decrease in metabolism promotes rest and somnolence.

F.

Cyrus Cesar R. Tejam BSN 3B

Psychiatric Mental Health Nursing

G. Explain why Beta Blockers are used in Psychiatry? Beta adrenergic blockers control restlessness and inability to stay still (akathisia). They help control physical manifestations of anxiety such as an increase in heart rate and blood pressure. They also control tremors and other signs and symptoms typical of increased sympathetic nervous stimulation or stimulant adrenergic overdose. H. List at least 10 reasons clients fail to take medications correctly? Excessive cost of medications Lack of information regarding importance of taking medications Persistence of superstitious practices and beliefs Altered state of consciousness and memory which impairs the scheduling and recall of doses Lack of caregivers for clients who are unable to remember medication therapy Delayed onset of effect of certain medications, some lasting weeks, to produce desired effect. Use of medications for substance abuse Presence of undesirable and side effects the client could not tolerate Changes in sexual functioning and performance Withdrawal, isolation and refusal to participate in treatment I. List ideas how the nurse can do to improve compliance in mentally challenged clients? Coordinate with agencies as appropriate to lower cost of medications or increase availability of medications for free Look for generic preparations of medications Stress the importance of complying with therapy stating in plain terms the indications, food and drug interactions, common side effects of a drug, and the lag period for the desired effect Orient client with the disorder, possible causes, risk factors, common manifestations and other possible complications whether psychological or physical. Encourage use of memory aids Orient caregivers with the drug therapy Advice to avoid over the counter medications without the knowledge of a health practitioner Prevent or minimize the undesirable effects of medications. For example, give ice chips to clients with dry mouth due to drug therapy Encourage necessary modifications to address sexual functioning Encourage participation in the decision-making process What are sexual side effects of Antipsychotic Medications? List at least 3. Loss of sexual drive Prolonged sustained erection Breast enlargement from edema

J.

Cyrus Cesar R. Tejam BSN 3B

Psychiatric Mental Health Nursing