Guide For Medication Used In The Treatment Of Mental Disorde Assignment
Guide For Medication Used In The Treatment Of Mental Disorde Assignment
Introduction
Schizophrenia is a mental disorder in which a person’s mental process including thoughts, perceptions, and behaviors becomes out of contact with reality. It has both positive and negative symptoms. The positive symptoms include symptoms of psychosis and these include hallucinations, delusions, and disorganized speech. The behavior of these patients is also usually disorganized (Frankenburg, 2021). Negative symptoms include lack of speech (alogia), a flat affect, associability (does not have interest in socializing), avolition (Little or no motivation), apathy (Lacking interest), and anhedonia (difficulty in experiencing pleasure)Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
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Other symptoms that these patients may exhibit include catatonia, which is mostly a catatonic stupor. In this state, the patient may be immobile and mute, yet conscious. Cognitive symptoms may also present where the patient will be slow in analyzing and interpreting information. Motor disturbances may present as catatonia (stupor and excitement). The schizophrenic spectrum comprises psychotic disorders which include schizophrenia, schizoaffective disorder, catatonia, and delusion disorders. Treatment of schizophrenic spectrum and other psychotic disorders is usually done with antipsychotic medications.
Chlorpromazine
Chlorpromazine (CPZ) is an antipsychotic medication marketed under the brand names Thorazine and Largactil (Mann & Marwaha, 2021). Chlorpromazine is its generic name.
Structure of Chlorpromazine
The medication is a white, or a slightly creamy white crystalline powder with a chemical designation of 2-Chloro-10-[3-(dimethylamino)propyl].
It can either be used as a deep intramuscular injection or as an oral tablet. The injectable solution contains 25mg of Chlorpromazine per ml of the solution. The oral tablets come in different concentrations (10mg, 100mg, 200mg, 25mg, and 50mg)Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
The drug is used to treat schizophrenia symptoms and other psychotic disorders. It can also be used to treat nausea and vomiting, relieve apprehension and restlessness before surgery, as an adjunct in tetanus treatment, control the mania manifestation in the manic-depressive illness, and in relieve intractable hiccups. It is also be used to treat behavioral problems in children between 1 to 12 years of age especially those with combative or explosive hyperexcitable behavior.
A bottle of Chlorpromazine oral tablets 25mg
Drug Classification
Chlorpromazine is a phenothiazine antipsychotic drug that falls under the class of drugs known as typical antipsychotics or neuroleptics (Frankenburg, 2021). This class is also known as first-generation antipsychotics.
Mechanism of Action
The medication blocks the D2 receptors in the mesolimbic pathway producing its antipsychotic effects. The blockage of the D2 receptors reduces the levels of dopamine accumulation in the brain which leads to reduced psychotic symptoms such as delusions and hallucinations. A blockage of the D2 receptors in the nigrostriatal pathway causes extrapyramidal side effects of the drug. Its antiemetic effects are derived from its ability to block Histamine 1 (H1), dopamine D2 and muscarinic (M1) receptors found in the vomiting center.
Pharmacokinetics
The pharmacokinetics of the drug varies as per the route of administration. Approximately 43-65% of the daily dose of the drug is excreted by the kidneys 24 hours after administration. The elimination half-life occurs in phases, with an early phase of between 2-3 hours. The intermediate phase lasts about 15 hours while the late phase can last up to 60 days (PubChem, 2022)Guide For Medication Used In The Treatment Of Mental Disorde Assignment. With a lingering half-life, the effects of the medication can be prolonged leading to the occurrence of side effects even after the dose is administered.
Pharmacodynamics
It is a very effective drug against D2 dopamine receptors and other receptors of similar nature. It has a high affinity for D1 receptors as well.
Appropriate dosages:
The drug dosage is given depending on the reason for treatment. In the treatment for schizophrenia and other psychotic disorders, an initial dose of 30-75mg/day is given orally in divided doses of 6-12 hourly. Some patients are given 200mg/day and up to 800mg/day (Dudley et al., 2017). Some may require about 1-2g per day.
On the IV/IM route, an initial dose of 25mg is given followed by a dose of 25-50mg PRN every 1-4 hours. It can then be increased to a maximum of 400mg every 4-6 hours until the patient’s symptoms are effectively controlled. The usual dosage is 300-800mg/day.
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Nausea & Vomiting
PO: Give 10-25 mg every 4-6 hours as required.
IV/IM: Give 25-50 mg every 4-6 hours as required.
To treat Preoperative Apprehension
25-50 mg PO 2-3 hours before the surgical procedure.
12.5-25 mg IM 1-2 hours before the procedure.
For Intraoperative Sedation
Give 12.5 IM for 30 minutes or 2 mg IV for 2 minutes; the total should not exceed 25 mgGuide For Medication Used In The Treatment Of Mental Disorde Assignment.
Intractable Hiccups
Give 25-50 mg PO every 6-8 hours; if the hiccups persist after 2-3 days of oral therapy change the route and give 25-50 mg IM every 3-4 hours; and if symptoms still persist, administer 25-50 mg by slow IV infusion with the patient lying flat in bed; monitor the patient’s blood pressure.
Acute Intermittent Porphyria
25-50 mg PO every 6-8 hourly
Migraine Headache (Off-label)
Administer 5-50 mg IV as single dose.
Dose considerations in special populations
Children
The dosage in children is administered per kilogram. Administer 0.5mg per kg of body weight every 4 – 6 hours to children between 1 and 5 years (Physiopedia, 2022). The maximum recommended dose is 40mg per day
Adolescents
Give a third to half the normal adult dose of 75 mg daily.
Elderly or debilitated patients
Give a third to half the normal adult dose and increase gradually.
Half-Life definition and importance
A drug’s half-life is defined as the amount of time it will take to reduce the amount of the drug’s active substance in the body by half. It depends on how the body metabolizes and eliminates the drug and can take a few hours to days and sometimes even weeks.
Knowledge of a drug’s half-life is important because it will help in determining the drug’s excretion rates and its steady concentration. This helps in determining the dosage of a drug to ensure it is within the normal therapeutic range at any given time during treatment and prevents toxicity.
Side effects of Chlorpromazine
The drug has some extrapyramidal side effects which are Parkinson-like symptoms, dystonia (involuntary muscle contractions), akathisia (Muscle quivering and restlessness), and tardive dyskinesia (inability to control facial movements)Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
Parkinson-like side effects of Chlorpromazine.
Contraindications for use
The drug is contraindicated for patients with cancer of the breast, those who are overweight, have high prolactin levels, those with anemia, those with low levels of platelets, low levels of white blood cells, and with alcoholism. It is also contraindicated in those with Parkinson’s disease, angina, chronic heart failure, and seizures among others.
Considerations in drug overdose
Symptoms of overdose include loss of consciousness, drowsiness, tachycardia, hypotension, severity in extrapyramidal dyskinesia, changes in the electrocardiogram, hypothermia, and ventricular arrhythmias.
Symptomatic treatment should be done including monitoring respirations and cardiac monitoring. Gastric lavage can be attempted 6 hours after ingesting a toxic dose. Give activated charcoal. Fluid replacement should be initiated to correct circulatory collapse and if ineffective, administer positive inotropic agents such as dopamine.
Diagnostics and labs monitoring
Monitoring of the patient’s complete blood count should be done due to blood dyscrasias (blood disorders). Discontinue treatment if any marked changes are observed, for example, hyperleukocytosis, and granulocytopenia among others.
Symptoms that need to be monitored include complaints of fever, sore throat, and infections.
Monitor for signs of neuroleptic malignant syndrome including hyperthermia, autonomic dysfunction, rigidity of muscles, alteration in consciousness, and pallor (Zare & Bazrafshan, 2017). Autonomic instability symptoms such as irregular blood pressure and hyperhidrosis should also be monitored as they constitute the signs of neuroleptic malignant syndrome Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
Chlorpromazine tablets
Drug interactions
Citalopram /Escitalopram should not be used with this drug.
Chlorpromazine may interact with products that increase the dopamine levels in the body such as levodopa, pergolide, and ropinirole. Medications that cause drowsiness or dizziness such as opioids and cough relievers such as codeine or hydrocortisone may cause serious side effects if used together with this drug.
Other drugs that affect the heart rhythm (causing prolongation of QT intervals) such as amiodarone, quinidine, and macrolide antibiotics such as erythromycin, among others may also result in serious side effects if used together with Chlorpromazine (Dr. Reddy’s Laboratories, 2022).
Adrenaline should be avoided in patients with chlorpromazine overdose. Anticholinergic drugs can reduce the antipsychotic effects of the drug, and this can lead to heat stroke and constipation. Drugs such as levodopa, clonidine, adrenaline, and guanethidine may oppose the actions of Chlorpromazine. Administering deferoxamine and Chlorpromazine simultaneously may lead to the development of transient metabolic encephalopathy, which can make the patient lose consciousness for over 72 hours. Concurrent use of neuroleptics and carbamazepine may increase the risk of agranulocytosis.
Contraindicated combinations include drugs used to treat Parkinson’s disease.
The use of Chlorpromazine and antidiabetic agents requires special precautions as this can increase levels of blood sugar as a result of the decreased release of insulin. Advise the patient to increase the monitoring of blood sugar and levels of urine. Antidiabetic doses should be adjusted after discontinuing treatment with neuroleptics.
Administration of topical gastrointestinal agents such as Aluminium and calcium salts should be administered at least two hours apart as Chlorpromazine can lead to decreased absorption of these topical agents.
Undesirable Effects
Chlorpromazine can cause agranulocytosis and leukopenia in the blood and lymphatic system. It can also cause immune system disorders such as bronchospasms, systemic lupus erythematosus, and severe anaphylactic reactions among other effects. Amenorrhea in the endocrine system is common with its use. It can also cause sexual arousal disorders in females, erectile dysfunction in males, and even impotence. These symptoms, among many others, may be unwanted and undesirable with the use of ChlorpromazineGuide For Medication Used In The Treatment Of Mental Disorde Assignment.
Legal and Ethical considerations
There has been increased use of psychotropic medications in the treatment of individuals with psychiatric disorders. With the adverse effects discussed above, ethical considerations should be made in the administration of Chlorpromazine. Most psychiatric patients are incapable of giving consent to be treated with psychotropic drugs and questions arise about whether it is ethical to continue administering this drug in such cases. Individuals with psychiatric conditions are vulnerable to abuse and questions arise on who should sign consent for these patients in case the need for such medications arises. Forceful administration of psychotropic drugs and using psychotic drugs to treat conditions that are not approved by the FDA should also be investigated are these provide ethical violations of the fundamental rights of patients.
Considerations for patient education
Provide education on the proper use of the drug, both the injectables and the tablet depending on the type of medication the patient is on. Stress on the side effect of the medications, explaining to the patient the extrapyramidal side effects to expect with the drug use (Boyd-Kimball et al, 2018). Advise the patient to seek emergency treatment in case of an overdose and explain to the patient the symptoms of overdose which include stomach cramps, stiffness of muscles, change in the heart rate, increased drowsiness, fainting, or convulsions. It is also important to advise the patient to avoid activities that can put them at risk such as driving as the use of the medication can cause increased drowsiness causing accidents.
Alcohol use is contraindicated with the use of this drug and it is therefore important to inform the patient to avoid alcoholic beverages. The use of Chlorpromazine should not be stopped suddenly as this may lead to the development of withdrawal symptoms which may be unpleasant. Advise the patient to seek advice from a healthcare provider before stopping the use of the medication. Chlorpromazine may increase the patient’s light sensitivity. The use of protective gear such as sunglasses and sun shields should be promoted Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
Conclusion
Psychotropic medications are used in the treatment of different symptoms of mental illness such as delusions and hallucinations. Chlorpromazine is one such medication. In as much as it has been widely used in the treatment of symptoms of schizophrenia and other psychotic disorders, the drug has several side effects and some highly undesirable. Therefore, special considerations need to be made before prescribing it to patients. Healthcare providers should ensure that the drug is of benefit to the patient and that the benefits of treatment outweigh the risks.
References
Frankenburg F.R. (2021). Schizophrenia: Practice Essentials. PubMed. Retrieved on 16th July 2022 from https://emedicine.medscape.com/article/288259-overview
Mann, S. K., & Marwaha, R. (2021). Chlorpromazine. In StatPearls [Internet]. StatPearls Publishing.
Dudley, K., Liu, X., & De Haan, S. (2017). Chlorpromazine dose for people with schizophrenia. Cochrane Database of Systematic Reviews, (4).
Boyd-Kimball, D., Gonczy, K., Lewis, B., Mason, T., Siliko, N., & Wolfe, J. (2018). Classics in chemical neuroscience: Chlorpromazine. ACS Chemical Neuroscience, 10(1), 79-88.
Zare, M., & Bazrafshan, A. (2017). Chlorpromazine versus metiapine for schizophrenia. Cochrane Database of Systematic Reviews, (3).
PubChem (2022). Chlorpromazine (compound). Retrieved on 16th July 2022. From https://pubchem.ncbi.nlm.nih.gov/compound/Chlorpromazine#section=3D-Conformer
Physiopedia (2022). Chlorpromazine in the treatment of psychosis. Retrieved on 16th July 2022 from https://www.physio-pedia.com/Chlorpromazine_in_the_Treatment_of_Psychosis#:~:text=patient’s%20mental%20state.-,Pharmacokinetics,of%20which%20are%20biologically%20active.
Dr. Reddy’s laboratories (2022). Chlorpromazine 100mg tablets. Retrieved on 16th July 2022. From https://www.medicines.org.uk/emc/product/3476/smpc#gref
Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources Guide For Medication Used In The Treatment Of Mental Disorde Assignment.
Areas of importance you should address, but are not limited to, are:
Title page
Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses
Any supporting, valid and reliable research for non-FDA uses
Drug classification
The medication mechanism of action
The medication pharmacokinetics
The medication pharmacodynamics
Mechanism of Action
Appropriate dosing, administration route, and any considerations for dosing alterations
Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.
Definition of Half-life, why half-life is important, and the half-life for your assigned medication
Side effects/adverse reaction potentials
Contraindications for use including significant drug to drug interactions
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Overdose Considerations
Diagnostics and labs monitoring
Comorbidities considerations
Legal and ethical considerations
Pertinent patient education considerations
Reference Page
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. Guide For Medication Used In The Treatment Of Mental Disorde Assignment