and this is Professor Hoffman we're continuing our discussion of drug classifications used for CNS uh disorders uh this is the fourth in the series and there'll be one more video after this one to finish out the topic so in this topic we're looking at the drugs that are used for um the major psychotic disorders so the bipolar um and uh the schizophrenic uh type uh situations and disorders that we're we may encounter so again we're going to look at cap R cap RN information for the anti manics so we're looking again bipolar um drugs and then we're going to look at the cap our information for the antis psychotics that may be involved with schizophrenic um as well as some bipolar involvement so on the antim manic uh the example drug we be using is lithium uh I've been around for a while uh exact action again along with the anti-depressants most of our psych drugs we aren't really clear on why they work or how they work we have some hints at what's going on um and so we sort of focus on that so the overall action is unknown but it does does seem to be involve alteration of sodium transport where this is important in the neuro um with neurons the neurological system is you remember from an& and patho Physiology that action potentials are created by the rapid movement of sodium from the extracellular to the intracellular space through that depolarization process so if we can alter that sodium transport we're going to alter the action potentials and the activity of those neurons um it also seems to have some effect on how uh the catacol amines are actually metabolized within the neurons as part of their production but also as part of um processing them and eventually degrading them so there's going to be some catacol amine of impact as well but not really clear exactly how it happens uh main use for the lithium or the antimic drugs again is going to be for bipolar disorder that extreme High extreme low uh rapid mood changes and ex excessive mood changes uh so our reactions is blackbox warning um lithium has a very narrow therapeutic window which means the distance between a therapeutic level and a tox toxic level is extremely narrow so we have to monitor the drug levels very closely on a regular basis and watch for signs of going into toxicity some of those signs and symptoms are going to be GI with diarrhea and vomiting some of them are going to be um central nervous system effects of drowsiness there's going to be some muscle weakness and lack of coordination um as it becomes more severe we're going to start getting some tenus or ringing in the ear some blur Vision some polyurea very dute dilute dilute urine um so again we want to watch out for those lithium toxicity signs and symptoms uh it also leads to some hyponatremia again it's going to impact muscles we're going to see some Tremor activity uh we can have some impact on the heart with cardiac arism is I've already mentioned the poly UA which may be an indication of the lithium toxicity as well as just a general side effect it's going to be contraindicated when we have renal and cardiovascular disease or dehydration because again the impact on that sodium transport not only in the nerve cells but through other parts of the body so that's going to impact um our fluid balance as well and have some issues there our main nursing considerations for the individuals on lithium is watching for the effectiveness of it to make sure we're getting the results we want um making sure they're compliant uh because maintaining that narrow therapeutic range is extremely important so they have to be compliant and we have to routinely monitor both the serum lith lithium levels for the drug levels as well as watching out for any development of the hyponatremia for the antis psychotics then um we want to look at conventional anti-yo discs and haloperidol or how doll would be an example of that and then the atypical which is a second generation of resperidone um these are going to work by blocking dopamine receptors so again dopamine is one of the neurotransmitters in this case we want to block its actions in certain parts of the brain so it's going to do that by blocking the re receptor site so they can't receive the dopamine um the halap paradol blocks some of the other catac colomines as well uh the atypical or second generation are more selective to specifically the dopamine receptor sites so some purposes again from a CNS um disorders that we've listed initially in the series of videos schizophrenia would be um the disorder that we're going to be looking using how doll for it's also going to be effect effective for Tourette Syndrome um the halop paradol the conventional occasionally be used more we're going to get into the resperidone the atypical or second generation for any acute uh manic issues even if it's not tied into a manic depressive situation uh maybe more um transient uh but it's going to be helpful in uh calming those individuals down it may have some of impact or uses with individuals autism especially if they have um autism with irritability irritability it will be sort of a calming slowing down of that process and in some cases it can be used as an adjunct for depression but our main use that we're be looking at is for schizophrenia uh type disorder uh reactions uh blackbox warning uh for elderly if there's any dementia going on or individuals with elderly patients with uh Parkinson's or dementia that has the presence of Lou bodies which are protein buildups Associated um with some dopamine um neuron issues and breakdowns in increases our risk for infections uh we're going to see some extra parameral um effects uh similar to Parkinson's so we're going to see sort of a pseudo parkinsonism with these individual we're going to see some of discinesia we're going to see some motor instability and postural problems we're going to see some postural hypotension or or static hypotension that type of thing so these drugs are again um yeah as we get the side effects of the extra paramal side effects uh or symptoms again they're going to mimic the um appearance of Parkinson's because again Parkinson's when we talk about that in um the next video we're going to see that that is a result of ineffective availability of dopamine with the antic psychotics we're blocking dopamine receptor so again that's why we get the extra paramal symptoms the of disia um the unsteady gate all those types of things uh our nursing considerations again it's another drug that does not become therapeutic quickly it's going to take a while to act to get to therapeutic levels so individuals have to be patient they're not going to see the effect iness quickly once they're on it they need to be compliant because we need to maintain a steady level and we're going to adjust that level based on um the ability to limit their schizophrenic responses and behaviors but also we want to keep it a level that we can sort of limit the development of the side effects as well so it's a really tight Balancing Act there will be times for some of the patients that the side effects and the reactions that come with the drugs are more disturbing to them than um the schizophrenic environment that they live in without the drug so we just need to be aware of that and so those are the two class we want to look with this video one more video and we will finish out the drug classifications for our CNS agents or medication classes