Medication management is a crucial issue that greatly
influences the outcomes of treatment for many clients
with mental disorders. The following sections will discuss
several categories of drugs used to treat mental
disorders (psychotropic drugs): antipsychotics, antidepressants,
mood stabilizers, anxiolytics, and stimulants.
Nurses should understand how these drugs
work; their side effects, contraindications, and interactions;
and the nursing interventions required to
help clients manage medication regimens.
Several terms used in discussions of drugs and
drug therapy are important for nurses to know. Efficacy
refers to the maximal therapeutic effect that a
drug can achieve. Potency describes the amount of
the drug needed to achieve that maximum effect.
Low-potency drugs require higher dosages to achieve
efficacy, whereas high-potency drugs achieve efficacy
at lower dosages. Half-life is the time it takes for
half of the drug to be removed from the bloodstream.
Drugs with a shorter half-life may need to be given
three or four times a day, but drugs with a longer halflife
may be given once a day. The time that a drug
needs to leave the body completely after it has been discontinued is about five times its half-life (Maxmen
& Ward, 2002).
The U.S. Food and Drug Administration (FDA)
is responsible for supervising the testing and marketing
of medications for public safety. These activities
include clinical drug trials for new drugs and
monitoring the effectiveness and side effects of medications.
The FDA approves each drug for use in a
particular population and for specific diseases. At
times, a drug will prove effective for a disease that
differs from the one involved in original testing and
FDA approval. This is called off-label use. An example
is some anticonvulsant drugs (approved to
prevent seizures) that are prescribed for their effects
in stabilizing the moods of clients with bipolar disorder
(off-label use). The FDA also monitors the occurrence
and severity of drug side effects. When a
drug is found to have serious or life-threatening side
effects, even if such side effects are rare, the FDA may
issue a black box warning. This means that package
inserts must have a highlighted box, separate
from the text, that contains a warning about the serious
or life-threatening side effect(s). Several psychotropic
medications discussed later in this chapter have
black box warnings.
