Discuss the therapeutic indication, mechanism of action, recommended dosage, routes of administration, side effects, potential adverse effects, contraindications, and nursing implications for major psychotropic medications.

QUESTION

Case Study, Mohr

CHAPTER 16, Psychopharmacology

In completing the case study, students will be addressing the following learning objective:

Discuss the therapeutic indication, mechanism of action, recommended dosage, routes of administration, side effects, potential adverse effects, contraindications, and nursing implications for major psychotropic medications.

1. The student was reviewing the medication record for a client diagnosed with major depressive disorder with psychotic features. The client has been on medications for the past 12 years, has exhibited many side effects, and experienced multiple medication changes. On this admission, the client has developed abnormal movements of the tongue, a masklike face, shuffling gait, and constipation. The client is taking a selective serotonin reuptake inhibitor (SSRI) and an antipsychotic.

(Learning Objective: 6)

a. Identify the medication classification that may be responsible for the side effects and explain your choice.

b. Discuss the most important nursing implication related to the side effects the client is experiencing.

c. Explain why psychiatric clients experience multiple side effects and often need medication changes.

ANSWER

Side Effects and Medication Changes in Psychiatric Clients: A Comprehensive Review

Medication Classification Responsible for Side Effects

Psychiatric clients experiencing major depressive disorder with psychotic features often require a combination of selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. However, it is the class of antipsychotics that can be attributed to the side effects observed in this case study. Antipsychotics, particularly typical antipsychotics like haloperidol or chlorpromazine, are dopamine receptor antagonists and are known to cause a range of side effects, including tardive dyskinesia, parkinsonism, shuffling gait, and constipation.

Recognizing the Nursing Implication: Managing Extrapyramidal Side Effects (EPS)

Nursing implications play a crucial role in managing the side effects experienced by psychiatric clients. In the case study, the client exhibits extrapyramidal side effects (EPS), including abnormal tongue movements, masklike face, shuffling gait, and constipation. The nurse’s primary responsibility is to monitor and assess the client regularly for these side effects. Early recognition is essential to prevent irreversible conditions and ensure timely intervention (Gray & Gournay, 2000). Nursing interventions include notifying the healthcare provider, adjusting medication dosages, switching to antipsychotics with lower EPS risk, providing symptomatic relief through physical therapy or occupational therapy, and administering antiparkinsonian medications. Educating the client and their family about potential side effects and the importance of prompt reporting is also crucial.

Factors Contributing to Multiple Side Effects and Medication Changes

Psychiatric clients often experience multiple side effects and necessitate medication changes due to several reasons. Firstly, the complex neurochemical imbalances in individuals with psychiatric disorders make achieving an optimal medication balance challenging. Psychotropic medications target various neurotransmitter systems, and individual variations in receptor sensitivity can result in different responses and side effects (Tango, 2003). Secondly, finding the right medication and dosage often involves a process of titration and adjustments to achieve the therapeutic range that effectively manages symptoms while minimizing side effects. This trial and error approach can be time-consuming. Additionally, the side effect profile varies across different classes of psychotropic medications, necessitating medication changes to find alternatives with more tolerable side effects (Semahegn et al., 2020). Finally, some side effects, such as tardive dyskinesia, may develop after prolonged use, requiring adjustments in the treatment plan to prevent further complications.

Conclusion

In conclusion, the side effects experienced by psychiatric clients, such as the client in this case study, often stem from the class of antipsychotic medications. Recognizing and managing extrapyramidal side effects (EPS) is crucial for nurses, as these side effects significantly impact clients’ well-being and treatment adherence. Understanding the factors contributing to multiple side effects and medication changes is essential for optimizing treatment outcomes. By considering the complex neurochemical imbalances, individual variations, and the varied side effect profiles of psychotropic medications, healthcare providers can work collaboratively with nurses and clients to identify the most effective medication regimen with tolerable side effects.

References

Gray, R., & Gournay, K. (2000). What can we do about acute extrapyramidal symptoms? Journal of Psychiatric and Mental Health Nursing, 7(3), 205–211. https://doi.org/10.1046/j.1365-2850.2000.00296.x 

Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic Reviews, 9(1). https://doi.org/10.1186/s13643-020-1274-3 

Tango, R. C. (2003). Psychiatric side effects of medications prescribed in internal medicine. Dialogues in Clinical Neuroscience, 5(2), 155–165. https://doi.org/10.31887/dcns.2003.5.2/rcasagrandetango