Pharmacology

Psychopharmacology Self-Study Module & Take Home Exam
Objectives for the module series
• Review the major features of the anatomy and physiology of the central nervous system relevant to understanding the pharmacokinetics of psychotropic medications
• Overview the major classes and subclasses of psychotropic medications, using prototypes.
1. Mechanisms of action on neurotransmitter level in synaptic cleft
2. Common therapeutic uses.
3. Major side effects, medical management (if any), patient monitoring and patient education
4. Major contraindications, diagnostic procedures to identify these, and patient education
5. Major drug-drug interactions, nursing monitoring, and patient education
6. Major long term effects, ethical considerations and nursing implications
Assigned (Required) Readings
• Chapter 3 of Varcarolis
• Sections of Varcarolis related to therapeutic medication usage, chapters 12 – 14 NOTE: In some instances it may be overly confusing to compare information from several references due to the rapid development of the psychotropic medication market and somewhat diverse drug classification schemes. However, if additional information beyond that provided in the textbook is desired, please use Sakai psychopharm folder.

Essential vocabulary/concepts
• See medication related items under Psychopharm Sakai resources.

Media
• May use resource and internet media.
Introduction
The ANA Psychopharmacology Task Force Report and BSN provides guidelines for psychiatric-mental health nurses regarding psychotropic medications: Summarized:
• PMH nurses expected to use current knowledge from the neurosciences and psychopharmalogy in clinical management of patients (including the areas of assessment, diagnosis, and treatment)
• Biological, behavioral, and social sciences upon which PMH nursing is based are undergoing rapid changes with the acquisition of new knowledge. Therefore, ongoing/continuing education for PMH nurses is increasingly essential.
Specific areas of accountability and responsibility for psychiatric-mental health nurses:
I. Assessment: “The PMH nurse has the knowledge, skills, and ability to conduct and interpret patient assessments of psychopharmacological agents. Assessments include physical, neuropsychiatric, psychosocial, and psychopharmacological parameters.”
II. Diagnosis: “The PMH nurse has the knowledge, skills, and ability to use appropriate nursing, psychiatric, and medical diagnostic systems to guide the psychopharmacological management of patients with mental illness.”
III. Treatment: “The PMH nurse takes an active role in the treatment of patients with mental illnesses and integrates prescribed psychopharmacological interventions in a cohesive, multidimensional plan of care.”
Section one: Overview
Psychiatric disorders and the use of medications
Study these items in your book and in the resources. Complete the following with/without your book. (2 pts)
Table 1
Major mental disorders

Major symptoms of the disorder Neurotransmitter (NT) involved—specify whether it is increased or decreased Medication class and action on the NT
Depression

Bipolar

Schizophrenia

Anxiety

Many medical problems either mimic psychiatric problems, or are treated with medications that create psychological problems. Using old textbooks from pathology, med/surg, and the like, identify some of these. Be creative! There are many more than are listed here!
Complete Table 2 below as best you can. Discuss these with peers, at clinical and in class. (5 pts)
Major medical conditions Symptoms that mimic psychiatric conditions (if any) Medications that may mimic psychiatric conditions (if any) Commonly
Co existing psychological (behavioral) problems (if any)
Cardiac conditions
(Digoxin)

Respiratory conditions
(COPD)

Renal conditions
(End-stage)

AIDS
(Dementia)

Hormonal conditions
(Steroids)

Study Table 3 lists major classes, types of medications within classes, and the most commonly-used medications (by brand and generic name) from within each class and type of medication. Students should be thoroughly familiar with both the class and types of medication. Name specific medications under the drug class most commonly used. (4 pts)
Table 3. Classes, Types, and Specific Psychotropic Medications
Drug Class Types of medications within classes
Antianxiety medications

Antidepressant medications

Mood Stabilizing medications

Antipsychotic (neuroleptic) medications

Study Table 4, which shows the major classes of psychotropic medications and the major (primary) uses of these medications for the treatment of psychiatric disorders. Note: many drugs may have secondary uses of a non-psychiatric nature. Note also that some non-psychiatric medications are used for their psychiatric effects or their side-effects. Students should be aware of any of the secondary uses of the medications. For example, Benadryl (diphenhydramine) is used to treat allergic reactions and seasonal rhinitis, Depakote/Depakene (valproate) is used to treat seizure disorders, and Inderal (propranolol) is used to treat hypertension. (4 pts)
Table 4. Major Uses of Psychotropic Medications
Class of psychotropic medication Major uses for the treatment of psychiatric disorders (Symptoms)
Antianxiety medications

Antidepressant medications

Mood Stabilizing medications

Antipsychotic (neuroleptic) medications

Miscellaneous Stimulants –

Sedative-hypnotics –
Cholinesterase inhibitor –

Neurotransmitters
A neurotransmitter is any one of a number of chemicals that modify/result in transmission of nerve impulses between synapses (regions surrounding the points of contact between a neuron and a receptor neuron). There are four types of neurotransmitters which are of key relevance in understanding the mechanisms of action of psychotropic medications: USE YOUR OWN WORDS (5 pts)
• GABA (gamma-aminobutyric acid) –

• Norepinephrine (NE) –

• Serotonin (ST; 5-HT) –

• Dopamine (DA) –

Complete definition below and describe in your words—pictures welcome too!
Description of synaptic activity:

Section two: use of psychotropic medication in the treatment of psychotic disorders.
Study and complete the following chart. Look for these side effects in clinical. (5 pts)
Table 5
Side effect type
Typically associated with which class/type of medication Medical and nursing remedy for this side effect Patient education for this side effect
Agranulocytosis

Anticholinergic side effects:
1. Blurred vision
2. Constipation
3. Dry mouth
4. Urinary retention
Extrapyramidal symptoms (EPS):
1. Acute dystonic reaction
2. Cogwheel rigidity
3. Akathisia
4. Oculogyric crisis
5. Pseudo-parkinsonism/drug-induced Parkinson’s
Neuroleptic malignant syndrome (NMS)

Orthostatic hypotension

Tardive Dyskinisia (note that this is an irreversible neurological syndrome that is the result of drug toxicity to the central nervous system; it is not a potentially reversible extrapyramidal side effect)