Transcript Psychoactive Drugs

Psychoactive Drugs
Professor Lana Chase
Psychoactive Drug
Categories

Anti-psychotics: Schizophrenia, Agitation
 Anti-depressants: Depression, OCD,
Anxiety
 Mood Stabilizers: Bipolar Disorder
 Anti-Anxiety: Anxiety /Panic Disorders
 Psycho-stimulants: ADHD, Narcolepsy
Purposes and Advantages

Used to affect the brain & behavior
 To treat psychiatric disorders /symptoms
 Used in conjunction with other treatments
such as psychosocial rehabilitation,
psychotherapy, crisis intervention
 To control symptoms & allow consumer to
participate in therapy & re-enter job market
Neurohormones
Neurotransmitters
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Dopamine
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Serotonin
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Norepinepherine
Antipsychotics
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Mainly cause blockade of Dopamine &
Serotonin in post synaptic membrane of
CNS
 Also act on other neurotransmitters which
may cause increase in side effects
(movement disorders)
Antipsychotics:
Conditions Treated

Psychosis: Schizophrenia /Thought
Disorders
 Sedation
 Hiccoughs
 Dementia- Organic Psychosis / Agitation
 Bipolar Disorder (acute mania)
Anti-psychotic Use

Treat Positive Symptoms of Schizophrenia
– Delusions- false beliefs
– Hallucinations- false sensory perceptions:
– auditory, visual, tactile, olfactory,somatic,
gustatory
– Illusions- mistaken sensory perception
Phenothiazines

Developed in 1950’s 1st . Tranquilizer
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Thorazine (Chlorpromazine)
sedation, anticholinergic side effects
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Prolixin Decanoate (Fluphenazine)
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IM for Non-compliant patients
Viscous liquid – use 21 gauge needle ,
Z track
Q 2-4 week admin.(absorbs slowly)
Non Phenothiazines
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Haldol (haloperidol):
 used extensively in psychiatric emergencies to
sedate patient frequently with Ativan and Benadryl
 I M or PO
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Haldol Decanoate IM
– For non-compliant pts.
– Absorbed slowly over 2-4 weeks
– Large gauge needle, Z track
Non Traditional Antipsychotics
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Less side effects
 More effective with:
 Negative Symptoms of Schizophrenia.
– flat affect (mood), alogia(poverty of speech),
avolition(apathy), anhedonia(no pleasure),
asociality(loner), attentional impairment (poor
concentration).
Non Traditional Antipsychotics

Clozaril(clozapine)
– Biweekly WBC--risk agranulocytosis
– Stop med for WBC below 2.5 (do not restart)
– Start low dose 25 mg (max dose 900 mg)
– Benefits: low side effect profile, pts. like how
they feel on it.
– Effective antipsychotic especially for neg. s/s
Non Traditional Antipsychotics
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Zyprexa (olanzapine)
– Dopamine and serotonin blocking agent
– Effective antipsychotic and for bipolar pts
– Serious Side effects: weight gain , diabetes
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Seroquel (quetiapine)
– Little or no EPS(same as placebo)
– Effective antipsychotic, sedative
Antipsychotic Side Effects

Less side effects with newer medications
 Older meds not very user friendlynon
compliance
– Sedation: drowsiness
– Weight Gain
– Photosensitivity
– Dizziness (Orthostatic Hypotension)
– Sexual Dysfunction
– Elevation in Prolactin Levels
Antipsychotics
(continued)

Side Effects
– Tardive Dyskenesia: irreversible
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Snake like tongue movements /thrusting, invol. movements
– Anticholinergic: from acetylcholine blockade
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blurred vision, dry mouth,constipation,GI distress, urinary ret.
– Extrapyramidal (EPS): movement disorders
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Dystonia,akathesia , tremors, shuffling gait, muscle stiffness
(stiff neck, cogwheel rigidity), masked facies, oculogyric crisis
(eyes roll back), diff. swallowing
Nursing Interventions for EPS
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Notify MD & Obtain order for:
 Cogentin or Artane (anticholinergics)
– PO or IM
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Symmetrel (dopamine agonist)
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Benadryl (antihistamine)
Side Effects Antipsychotics
(cont.)
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Tardive Dyskinesia (irreversible)
– Wormlike tongue movements, ataxia, lip
smacking, involuntary arm & leg movements,
fever. Tx. Decrease dosage or D/C
Side Effects Antipsychotics
cont.
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Neuroleptic Malignant Syndrome (rare)
– 14-30 % mortality
– Tachicardia, high fever, muscle rigidity
– risk for cardiovascular collapse
Nursing Measures:
discontinue medication, Notify MD,
treat symptomatically: cooling blanket,
Bromocriptine, cardiac meds if necessary.
Use Antipsychotics Cautiously
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Diabetics
 Children under 6
 Glaucoma
 Ulcers
 Elderly
– Lower doses, hypotension
Drug Interactions
Potentiates action of CNS
Depressants:
e.g.. narcotics, alcohol
Nursing Implications
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Baseline assessment: EKG, liver function
Long term use: assess for adverse effects
Assess for movement disorder: EPS, T.D.
Observe for hording /”cheeking” meds
Administer liquid med in juice
Is it effective? monitor mental status
Safety : orthostatic hypotension, monitor for
seizures
D/C or switch to new med gradually (cont)
Antianxiety Drugs
Benzodiazapines
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Action
– Increase action of GABA that inhibits nerve
transmission in the CNS
– Depresses activity in brainstem
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Sedative
Hyponotic
Anticonvulsant
Antianxiety Drugs
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Therapeutic Uses:
– sedative agent/conscious sedation
– Treat psychiatric emergencies /agitation
– Treat panic disorder, social phobia, anxiety
– Treat alcohol withdrawal & seizures
– Treat anxiety assoc with medical disorders
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COPD
– **use should be brief except with panic disorders due
to risk of addiction
Commonly Prescribed
Antianxiey Drugs
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Ativan PO or IM
– Used for psych emergencies / severe agitation
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Valium (diazepam) PO or IV
– good IV anticonvulsant 2-40 mg qd
– Muscle relaxant action used for neck & back pain
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Xanax
 Versed –conscious sedation, anesthesia induction
 Tranxene, Librium
– freq. Used for alcohol detoxification in tapering doses
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Dalmane/Restoril
– sedative sleeping medications
Antianxiety Medicatons
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Common Side Effects
– Sedation, impaired consciousness,daytime
sedation (hangover), ataxia, dizziness, feelings
of detachment, rebound insomnia, amnesia,
euphoric mood
– TOLERANCE

MUST INCREASE DOSE FOR SAME EFFECT
– PHYSIOLOGICAL DEPENDENCY
Antianxiety Drug Overdose
– Overdose alone almost never fatal (safe)
– Benzo + alcohol  respiratory depression
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Treatment for Benzodiazapine Overdose:
– Romazicon(flumazenil)
(Antagonist) benzodiazapine receptor blocker
Teaching for Antianxiety Drugs
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Drugs should be tapered to prevent
withdrawal symptoms / DT’s
 Drugs can store in fat cells and prolong
withdrawal symptoms
 Dosages ½ to 1/3rd. for elderly
 Instruct about risk of addiction /safety from
falls
Antianxiety Drugs
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Buspar (buspirone)
– Potent antianxiety drug
– no muscle relaxant, anticonvulsant or sedative,
or alcohol potentiating action
– Takes several weeks for antianxiety effects
** works best with people who never took benzo’s
because they are accustomed to immediate
effect.
Antianxiety Drugs
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Inderal (propranolol)
– Beta Blocker
 Used to decrease symptoms that lead to anxiety like
tachicardia rather than centrally acting on anxiety
– Treatment for “performance anxiety” found in social
phobia.
Antidepressants
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Uses:
– Major Depressive Disorder
– Premenstrual Dysphoric Disorder
– Anorexia /Bulimia
– Anxiety Disorders
 GAD (Generalized Anxiety Disorder)
 OCD (Obsessive Compulsive Disorder)
Target Patrticular Symptoms
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Goal: to normalize transmission of impulses at
the synapse
 Amine Hypothesis: low norepinepherine
(catacholamine) at synapse
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Permissive Hypothesis: deficiency of serotonin at
the synapse
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Dysregulation Hypothesis: Failure to regulate
catacholomine system
Tricyclic Antidepressants

Norpramine
 Elavil
 Tofranil
Uses: panic disorder, depression, GAD,
enuresis, sedation (for insomnia)
***2-4 weeks for antidepressant effect
Antidepressants
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Trazadone
– Drug of choice for sedation (sleep disturbances)
– **Can cause priapism in males
Antidepressant TX
4-9 mos tx or may be lifetime if depression recurrent
Anxiety Disorders: SSRI (Paxil) now treatment of choice
2nd Generation
Antidepressants
SSRI’s
Selective Serotonin Reuptake Inhibitors
increases serotonin reuptake at receptor site
less SE than TCI’s
less anticholinergic, no wt. Gain, safer for cardiac pts.
& pregnant women
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Prozac
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Zoloft
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Paxil
Other Newer Antidepressants
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Celexa & Lexapro
 Serzone
 Effexor
 Vestra
 Remeron
 Wellbutrin /Zyban
Side Effects of
Antidepressants
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**Overdose of TCA’s can be fatal due to Cardiac arrhythmias
Anticholinergic Side Effects
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SSRI’s Psychomotor excitement / insomnia (take in morning),
tremor,headache, nervousness
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TCA’s: Sedation, drowsiness especially 1st week (instruct to start
on weekend), often added as nighttime dose for insomnia
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Sexual Side Effects
– Ejaculatory disturbances & decreased libido, priapism (Deseryl)
Antidepressants
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MAOI’s
– Monoamine Oxidase Inhibitors
 Action: Inhibit enzyme activity resulting in
decreased amount of MAO in the body
 Used for non responders to other antidepressant tx.
 Effective for atypical depression, panic, and phobias
Monoamine Oxidase Inhibitors
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Role of Tyramine and Dietary Restrictions
– MAO metabolizes neurotransmitters related to
depression. Also linked to control of BP due to
inhibition of norepinepherine.
– Need to avoid norepinepherine agonists like
dietary TYRAMINE.
– HYPERTENSIVE CRISIS (life threatening)
can occur from increased levels of
norepinepherine ie risk of strokes (CVA)
MAOI’s Side Effects
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Life Threatening if taken with drugs or foods
containing TYRAMINE
 Hypertensive Crisis (Malignant Hypertesion)
– Sudden elevation of BP, palpitations,chest
–
–
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pain,sweating , fever, N&V
HOLD MAOI : do not lie down (inc. BP in brain)
Treatment: Thorazine 100 mg IM (blocks
norepinepherine), Cooling blanket,
Phentolamine IV in 5 mg doses (binds with
norepinepherine)
Cooling blanket
Seratonin Syndrome
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Risk
– May occur when SSRI’s are administered too close to the
discontinuation of MAOI’s or other drugs affecting serotonin
reuptake are taken together
Signs and Symptoms
confusion , disorientation, mania, restlessness, diaphoresis,
shivering, diarrhea, nausea.
Treatment:
D/C all serotonergic drugs including
SSRI’s, MAOI’s, anticonvulsants, Ativan, Klonapin
** do not reintroduce serotonin drugs
MAO Inhibitors
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Only 3 Drugs in this Class
– Nardil
– Parnate
– Marplan
– Side effects: extreme hypotension
– Toxic effect : malignant hypertension (if taken
with sympathomimetic substance (Tyramine)
Nursing Interventions MAOI’s
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Careful teaching on diet and drug reactions
Dietary Restrictions: aged cheese (blue, brick, brie),
organ meats, pickled herring, bologna, pepperoni,
salami, fava beans,avacado,red wine (Chianti),
beer, tofu, miso soup
– over ripe fruit (banana, raisons)
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In moderation: chocolate, soy sauce, yogurt
Drug Restrictions
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OTC drugs with epinepherine like effects: sudafed, sinus ,
allergy remedies
Narcotics (Demerol especially), other antidepressant drugs,
Cocaine, amphetamines
Mood Stabalizing Drugs
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Lithium Carbonate
– Classic Drug for Bipolar Disorder (Manic Depression)
– Action: lithium replaces sodium in the cells
– **Dosage adjusted by Serum Lithium Level (weekly
then monthly levels), not by symptoms
– Narrow Therapeutic Index: Risk of toxicity
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Toxic and Theraputic serum levels are close
.5-1.5 meq./l therapuetic above 2 meq. toxic
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Usual dosage 900 mg. but depends on rate of excretion
Lithium Carbonate
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Side Effects
– : fine hand tremor,mental dullness,weight gain,
polyuria, kidney impairment
– Secondary hypothyroidism: give Synthroid
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Lithium Toxicity (Flu like Symptoms)
– ataxia(may look intoxicated),diarrhea,GI
distrubance (N &V)
Lithium Carbonate
Nursing Considerations
Hold Lithium, Notify MD, get serum lithium
level to confirm
instruct patient in S/S of toxicity
excessive sweating: will raise serum lithium
levels (caution for people who have outdoor
jobs in the heat (roofer)
contraindicated/caution with diuretics such
as Hydrodiuril (HCTZ)
Mood Stabalizers

Anticonvulsant Mood Stabalizers
– Enhances effect of GABA
– 2nd. Line treatment for lithium intolerant pts.
– Use is increasing –less Side Effects

Used to Treat:
– Bipolar disorder (rapid cyclers),Schizoaffective Disorder,
BorderlinePersonality Disorder, Schizophrenia
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Given in combo with other meds
**Give Mood Stabalizer with SSRI to avoid Mania
– Tegretal (carbamazapine) most studied
– Depakote (valproic acid) most studied
– Neurontin,Lamictal, Topramax (newer)
Mood Stabilizers
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Anticonvulsant Mood Stabilizers
– Response in 1-2 weeks
– Side effects:
 sedation, dizziness (subside over time), skin reaction
may require D/C, Depakote-pancreatitis risk (liver
func. Tests)
– Nursing Implications
 Monitor serum levels, WBC,hepatic/renal function
 Can be lethal in overdose