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Psychotherapeutic agents are drugs that are used to treat problems in thought processes of individuals with both perceptual and behavioral disorders. These agents do not provide cure for psychoses but they help both adult and pediatric patients perform activities of daily living and function in a more acceptable manner. Psychotherapeutic Drugs: Generic and Brand NamesHere is a table of commonly encountered psychotherapeutic agents, their generic names, and brand names:
Disease Spotlight: Mental DisordersMental disorders are believed to be caused by inherent dysfunction within the brain that leads to development of abnormal thought processes and responses. Before comprehensive studies were conducted, these were believed to be caused by environmental factors and life experiences (e.g. domestic violence, bullying, etc.) Other theories explain that certain imbalances of chemicals in specific regions of the brain contribute to mental disorders. Diagnosis of mental disorders is based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-V-TR), which contains description of distinguishing characteristics of each mental disorder. The following are mental disorders to which psychotherapeutic agents are most commonly indicated: SchizophreniaSchizophrenia is most common type of psychosis and can be very disabling. Manifestations include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. It has a very strong genetic association. Mania and Bipolar IllnessMania refers to periods of extreme overactivity and excitement that is associated with bipolar illness. Bipolar disorder is characterized by alternating extremes of depression and hyperactivity and excitement. This reflects neuronal overcompensation and subsequent inability to re-establish stability. NarcolepsyNarcolepsy is identified with daytime sleepiness and sudden periods of loss of wakefulness. A problem in the stimulating effect of reticular activating system (RAS) to the brain is one identified error in this disorder. Attention-deficit disordersAttention-deficit disorders include various conditions that usually affect school-aged children more than do adults. They are characterized by inability to concentrate on one activity longer than few minutes and a state of hyperkinesis. Antipsychotic (Neuroleptic) Drugs
Therapeutic ActionThe desired and beneficial actions of antipsychotic or neuroleptic drugs are as follows:
Typical antipsychotics
Atypical antipsychotics
IndicationsAntipsychotic or neuroleptic agents are indicated for the following medical conditions: Typical antipsychotics are indicated for schizophrenia and manifestations of other psychotic disorders including hyperactivity, combative behavior, and severe behavioral problems. Some antipsychotics are approved for treatment of bipolar disorder. Atypical antipsychotics are used for treatment of severely ill patients with schizophrenia but are unresponsive to standard drugs. It also reduces the risk of recurrent suicidal behaviors in patients with schizophrenia and schizoaffective disorders. Chlorpromazine
Haloperidol
Prochlorperazine
Aripiprazole
Risperidone
Here are some important aspects to remember for indication of antipsychotic or neuroleptic agents in different age groups: Children
Adults
Older adults
Pharmacokinetics (Typical Antipsychotics)Here are the characteristic interactions of typical antipsychotics and the body in terms of absorption, distribution, metabolism, and excretion:
Pharmacokinetics (Atypical Antipsychotics)Here are the characteristic interactions of atypical antipsychotics and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of antipsychotic or neuroleptic agents:
Adverse EffectsUse of antipsychotic or neuroleptic agents may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of antipsychotic or neuroleptic agents:
Here are important nursing considerations when administering this drug: Nursing AssessmentThese are the important things the nurse should include in conducting assessment, history taking, and examination:
Nursing DiagnosesHere are some of the nursing diagnoses that can be formulated in the use of this drug for therapy: Implementation with RationaleThese are vital nursing interventions done in patients who are taking antipsychotics:
EvaluationHere are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Antimanic Drugs
Therapeutic ActionThe desired and beneficial actions of antimanic drugs are as follows:
IndicationsAntimanic agents are indicated for the following medical conditions:
Here are some important aspects to remember for indication of antimanic agents in different age groups: Children
Adults
Older adults
PharmacokineticsHere are the characteristic interactions of antimanic agents and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of antimanic agents:
Adverse EffectsDrug effects associated with lithium are directly related to serum levels of the drug:
InteractionsThe following are drug-drug interactions involved in the use of antimanic agents:
Here are important nursing considerations when administering this drug: Nursing AssessmentThese are the important things the nurse should include in conducting assessment, history taking, and examination:
Nursing DiagnosesHere are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Implementation with RationaleThese are vital nursing interventions done in patients who are taking antimanic drugs:
Evaluation Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Central Nervous System Stimulants
Therapeutic ActionThe desired and beneficial actions of CNS stimulants are as follows:
IndicationsCNS stimulants are indicated for the following medical conditions:
Here are some important aspects to remember for indication of CNS stimulants in different age groups: Children
Adults
Older adults
PharmacokineticsHere are the characteristic interactions of CNS stimulants and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of CNS stimulants:
Adverse EffectsUse of CNS stimulants may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of CNS stimulants:
Here are important nursing considerations when administering this drug: Nursing AssessmentThese are the important things the nurse should include in conducting assessment, history taking, and examination:
Nursing DiagnosesHere are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Implementation with RationaleThese are vital nursing interventions done in patients who are taking CNS stimulants:
EvaluationHere are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Practice Quiz: Psychotherapeutic AgentsQuiz time! Enjoy and evaluate yourself with this 8-item quiz about psychotherapeutic agents. 1. Student nurse Anne is currently on her psychiatric ward rotation and her clinical instructor engaged her in an oral quiz on psychotherapeutic agents. She would be right to answer that loxapine, thiothixene, and fluphenazine belong to which psychotherapeutic agent classification? A. Typical antipsychoticsB. Atypical antipsychoticsC. Antimanic drugs D. CNS stimulants 2. All of the following are not true about psychotherapeutic agents, except: A. These agents are not indicated for behavioral disorders.B. Psychotherapeutic agents perform their curative functions in patients with psychoses.C. Antipsychotics address mental disorders mainly through their sedating effects. D. Psychotherapeutic agents help patients perform activities of daily living with ease. 3. Antipsychotic which has a role in managing side effects of chemotherapy. A. RisperidoneB. HaloperidolC. Prochlorperazine D. Aripiprazole 4. What is the top nursing consideration of a nurse who is taking care of an adult client with schizophrenia receiving antipsychotics? A. Monitor urine output.B. Obtain ECG tracing regularly as ordered.C. Assess bowel sounds. D. Provide comfort measures. 5. All of the following are contraindications to neuroleptic agents, except: A. Children below age 12B. DementiaC. Active alcoholism D. None of the above 6. This drug is the mainstay treatment for mania. A. quetiapine (Seroquel)B. olanzapine (Zyprexa)C. lithium salts (Lithotabs) D. lamotrigine (Lamictal) 7. Antimanic drugs have effect on the following neurotransmitters, except: A. NorepinephrineB. DopamineC. Serotonin D. None of the above 8. Which of the following is the most important patient education for a patient receiving CNS stimulants? A. Proper storage of drugsB. Low-sodium dietC. Light to moderate exercises D. All of the above. Answers and Rationale 1. Answer: A. Typical antipsychotics. Loxapine (Loxitane), thiothixene (Navane), and fluphenazine (Prolixin) are some of the most common examples of typical antipsychotics. Typical antipsychotics block dopamine receptors, preventing dopamine from stimulating the postsynaptic neurons. They are also associated to neurological adverse effects, which are relieved by atypical antipsychotics. 2. Answer: D. Psychotherapeutic agents help patients perform activities of daily living with ease. They are indicated for both perceptual and behavioral disorders. They were once called major tranquilizers but later on it was changed because sedation is not their primary or main function. Lastly, they don’t cure psychoses. 3. Answer: C. Prochlorperazine. It is indicated for severe vomiting and nausea associated with surgery and chemotherapy. 4. Answer: B. Obtain ECG tracing regularly as ordered. Usage of drugs in this population requires close monitoring for adverse effects. For example, thioridazine and ziprasidone can cause changes in QT interval. 5. Answer: A. Children below age 12. Caution is used in children younger than 12 years of age who have chickenpox or a CNS infection because children are more likely to develop dystonia and this could cause confusion in the diagnosis of Reye’s syndrome. Use of these agents in patients with dementia increases risk of CV events and death. Lastly, antipsychotics or neuroleptics can potentiate CNS depression in patients with active alcoholism. 6. Answer: C. lithium salts (Lithotabs). All options are antimanic drugs but lithium is the drug of choice for mania. 7. Answer: C. Serotonin. The primary action is to alter transport of sodium in nerve and muscle cells. They also inhibit the release of norepinephrine and dopamine, but not serotonin from stimulated neurons. 8. Answer: A. Proper storage of drugs. Majority of CNS stimulants are controlled substances so it is important for patients to be taught how to secure them to prevent inappropriate use and distribution. Recommended ResourcesRecommended resources and reference books. Disclosure: Includes Amazon affiliate links. See AlsoHere are other nursing pharmacology study guides:
Gastrointestinal System Drugs
Respiratory System Drugs Endocrine System Drugs Autonomic Nervous System Drugs Immune System Drugs Chemotherapeutic Agents Reproductive System Drugs
Nervous System Drugs Cardiovascular System Drugs References and SourcesReferences and sources for this pharmacology guide for Psychotherapeutic Agents:
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