There are a variety of factors that drive the growing interest in medicinal herbs. Many people believe that herbal treatments are safer because they are “natural” or that they may have fewer side effects than more costly traditional medications.
Herbal treatments have been researched to understand their mechanisms of action and have also been used in clinical trials to determine their safety and efficacy. This is especially true of St. John’s wort. Many medicinal herbs have been found to be nontherapeutic and some even deadly if taken over long periods of time or in combination with other chemical substances and prescription drugs.
The risk of bleeding may be increased in patients taking ginkgo biloba and warfarin, and kava may increase the risk of hepatotoxicity. Chapter 36 covers complementary and integrative approaches in more detail.
Key Points to Remember
• All actions of the brain—sensory, motor, and intellectual—are carried out physiologically through the interactions of nerve cells. These interactions involve impulse conduction, neurotransmitter release, and receptor response. Alterations in these basic processes can lead to mental
disturbances and physical manifestations.
• In particular, it seems that excess activity of dopamine is involved in the thought disturbances of schizophrenia, and deficiencies of norepinephrine, serotonin, or both underlie depression and anxiety. Insufficient activity of GABA also plays a role in anxiety.
• Pharmacological treatment of mental disturbances is directed at the suspected neurotransmitter- receptor problem. Thus antipsychotic drugs decrease dopamine, antidepressant drugs increase synaptic levels of norepinephrine and/or serotonin, and antianxiety drugs increase the
effectiveness of GABA or increase serotonin and/or norepinephrine.
• Because the immediate target activity of a drug can result in many downstream alterations in neuronal activity, drugs with a variety of chemical actions may show efficacy in treating the same clinical condition. Newer drugs with novel mechanisms of action are thus being used in the treatment of schizophrenia, depression, and anxiety.
• Unfortunately, agents used to treat psychiatric disorders can cause various undesired effects.
Prominent among these are sedation or excitement, motor disturbances, muscarinic blockage, alpha antagonism, sexual dysfunction, and weight gain. There is a continuing effort to develop new drugs that are effective, safe, and well tolerated.
Critical Thinking
1. Knowing that no matter where you practice nursing, many individuals under your care will be taking one psychotropic drug or another, how important is it for you to understand normal brain structure and function as they relate to mental disturbances and psychotropic drugs? Include the following in your answer:
a. How nurses can use the knowledge about how normal brain function (control of peripheral nerves, skeletal muscles, the autonomic nervous system, hormones, and circadian rhythms) can be affected by either psychotropic drugs or psychiatric illness
b. How brain imaging can help in understanding and treating people with mental disorders c. How your understanding of neurotransmitters may affect your ability to assess your patients’
responses to specific medications
2. What specific information would you include in medication teaching based on your
understanding of symptoms that may occur when the following neurotransmitters are altered?
a. Dopamine D2 (as with use of antipsychotic drugs)
b. Blockage of muscarinic receptors (as with use of phenothiazines and other drugs) c. Alpha-1 receptors (as with use of phenothiazines and other drugs)
d. Histamine (as with use of phenothiazines and other drugs) e. MAO (as with use of an MAOI)
f. GABA (as with use of benzodiazepines)
g. Serotonin (as with the use of SSRIs and other drugs) h. Norepinephrine (as with the use of SNRIs)
Chapter Review
Questions
1. Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?
a. Antipsychotics b. Mood stabilizers c. Antidepressants
d. Cholinesterase inhibitors
2. What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?
a. “How much sleep do you usually get each night?”
b. “Does your heart ever seem to skip a beat?”
c. “When was the last time you had a fever?”
d. “Do you have problems urinating?”
3. You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:
a. “I have been on this antidepressant for 3 days. I realize that the full effect may not happen for a period of weeks.”
b. “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”
c. “I may ask to have my medication changed to Wellbutrin due to the problems I am having being romantic with my wife.”
d. “I realize that there are many antidepressants and it might take a while until we find the one that works best for me.”
4. A patient being treated for insomnia is prescribed ramel-teon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?
a. Obsessive-compulsive disorder b. Generalized anxiety disorder c. Persistent depressive disorder d. Substance use disorder
5. Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.
a. “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”
b. “I’m happy to hear that I won’t need to worry too much about weight gain.”
c. “It’s okay to take Wellbutrin since I haven’t had a seizure in 6 months.”
d. “I need to be careful about driving since the medication could make me drowsy.”
e. “My partner and I have discussed the possible effects this medication could have on our sex life.”
6. Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?
a. SSRIs
b. antipsychotics c. benzodiazepines
d. tricyclic antidepressants
7. A nurse reviews an order for a CYP450 test. He explains to his patient from Thailand that the test
will determine how the antidepressant will be:
a. Metabolized b. Absorbed c. Administered d. Excreted
8. Psychotropic drugs have been used for more than half a century. What statement regarding their current status is true?
a. Only one classification of psychotropic drugs exists.
b. The Food and Drug Administration no longer approves new antidepressants.
c. We do not know exactly how they work.
d. Chlorpromazine (Thorazine), the first psychotropic, continues to be the treatment of choice with hallucinations.
9. The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:
a. lithium (Eskalith) b. clozapine (Clozaril) c. diazepam (Valium) d. amitriptyline
10. A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:
a. Selective serotonin reuptake inhibitors b. Monoamine oxidase inhibitors
c. Serotonin and norepinephrine reuptake inhibitors d. All of the above
Answers
1. c; 2. a; 3. b; 4. d; 5. a, b; 6. b; 7. a; 8. c; 9. a; 10. b Visit the Evolve website for a posttest on the content in this chapter:
http://evolve.elsevier.com/Varcarolis
References
De Bartolomeis A, Tomasetti C, Iasevoli F. Update on the mechanism of action of aripiprazole: Translational insights into antipsychotic strategies beyond dopamine receptor antagonism. CNS Drugs. 2015;29:773–799.
Hamilton S.P. The promise of psychiatric pharmacogenomics. Biological Psychiatry. 2015;77:29–35.
Holmes J.C, Zacher J.L. Second-generation antipsychotics: A review of recently-approved agents and drugs in the pipeline. Formulary. 2012;47:106–121.
Howes O, McCutcheon R, Stone J. Glutamate and dopamine in schizophrenia: An update for the 21st century. Journal of Psychopharmacology. 2015;29(2):97–115.
Stahl S.W. Stahl’s essential psychopharmacology. 4th ed. New York, NY: Cambridge University Press; 2013.
U N I T I I
Foundations for Practice
OUTLINE
4. Treatment Settings 5. Cultural Implications
6. Legal and Ethical Considerations