Download - Psychotropic Meds

Psychotrophic drugs

• Drugs that can:1. Stimulate the release of neurotransmitters2. Block the receptor/activity of the

neurotransmitter= like dopamine3. Stimulate the receptors in the CNS4. Prevents the breakdown of the

neurotransmitters or the re-uptake mechanism

Anti-Psychotics/Neuroleptics

• Drugs used to treat PSYCHOSES

• MAIN ACTION: Blockage of the DOPAMINE receptor in the CNS

Anti-Psychotics/NeurolepticsClassClass PrototypePrototype OthersOthers

PhenothiazinesPhenothiazines ChlorpromazineChlorpromazine Thioridazine, Thioridazine, Fluphenazine, Fluphenazine, PerphenazinePerphenazine

ButyrophenonesButyrophenones HaloperidolHaloperidol droperidoldroperidol

ThioxanthinesThioxanthines ChlorprothixeneChlorprothixene thirothixenethirothixene

DibenzoxapineDibenzoxapine MolindoneMolindone

DiphenylbutlypipeDiphenylbutlypiperidineridine

PimozidePimozide

Atypical drugsAtypical drugs ClozapineClozapine OlanzapineOlanzapine

RisperidoneRisperidone quetiapinequetiapine


Desired EffectsDesired Effects11 Reduced hallucination and illusionsReduced hallucination and illusions22 CNS sedation and emotional slowingCNS sedation and emotional slowing33 Decreased ambivalence, reduced Decreased ambivalence, reduced

delusiondelusion44 Reduced agitation resulting to Reduced agitation resulting to

calmnesscalmness55 Relief of emotional turmoilRelief of emotional turmoil66 Reduced flattening of affectReduced flattening of affect


Common SECommon SE Nursing InterventionsNursing Interventions

Anticholinergic Anticholinergic effectseffects

Sugarless gum, bed restSugarless gum, bed rest

Photosensitivity Photosensitivity Sunglasses, sunscreen, Sunglasses, sunscreen, avoid sunavoid sun

Postural Postural hypotensionhypotension

Change position slowly, Change position slowly, lie prone for 1 hour lie prone for 1 hour after drug intake, after drug intake, monitor BPmonitor BP

AgranulocytosisAgranulocytosis Instruct to report sore Instruct to report sore throat and fever, throat and fever, monitor WBC monitor WBC

SeizureSeizure Monitor EEGMonitor EEG

SedationSedation Safety, no machine Safety, no machine operationoperation


Extra-Pyramidal Extra-Pyramidal SyndromeSyndrome

Nursing InterventionNursing Intervention

Parkinsonism-Tremor, Parkinsonism-Tremor, rigidity, bradikinesiarigidity, bradikinesia

Avoid abrupt withdrawal, Avoid abrupt withdrawal, give anti-EPS drugs like give anti-EPS drugs like CogentinCogentin

Dystonia- torticollis, Dystonia- torticollis, contraction of face and contraction of face and tonguetongue

Remain with client, Remain with client, administer anti-EPSadminister anti-EPS

Akathisia= motor Akathisia= motor restlessnessrestlessness

Verbalize understanding of Verbalize understanding of the condition, administer the condition, administer anti-EPSanti-EPS

Tardive Dyskinesia= Tardive Dyskinesia= irreversible drooling, irreversible drooling, tongue movement and tongue movement and shuffling gaitshuffling gait

No treatment except No treatment except discontinue drugdiscontinue drug

Neuroleptic Malignant Neuroleptic Malignant syndrome= elevated syndrome= elevated temp, treme muscle temp, treme muscle rigidityrigidity

Notify physician, prepare to Notify physician, prepare to administer dantroleneadminister dantrolene

The ANXIOLYTICS AND HYPNOTICS

• These drugs are used to change the individual’s responses to the environment.


• The medications that can prevent the feelings of tension and fear are called ANXIOLYTICS. – Anti-anxiety drugs


• The drugs that can calm individuals making them unaware of the environment are called SEDATIVES.


• The drugs that can induce sleep are called HYPNOTICS.


• The drugs in this class are the– BENZODIAZEPINES– BARBITURATES

Use of The Drugs

Clinical indications for the use of theanxiolytics, sedatives and hypnotics• 1. Prevention of anxiety• 2. Formation of sedative state• 3. Induction of sleep

The BENZODIAZEPINESThe benzodiazepines are the most frequently used

anxiolytic drugs.

These agents prevent anxiety states without causing much sedation, with less physical dependence than other agents.

The BENZODIAZEPINES

The following are the benzodiazepines• Alprazolam (Xanax)• Chlordiazepoxide (Librium)• clonazepam• clorazepate• Diazepam (Valium)• estazolam• flurazepam• lorazepam• midazolam• oxazepam• quazepam• temazepam• triazolam

The BENZODIAZEPINESSpecial uses

Diazepam(Valium)

Status epilepticus

Chlordiazepoxide (Librium)

Alcohol withdrawal

Alprazolam (Xanax)

Panic attack

The BENZODIAZEPINES

The Mechanism of Action of the Benzodiazepines

• These agents act on the Limbic system and the RAS (reticular activating system) to make the GABA ( Gamma-aminobutyric acid) more effective causing interference with neuron firing.

The BENZODIAZEPINES

The Mechanism of Action of the Benzodiazepines

• The GABA is an inhibitory neurotransmitter.

• This will result to an anxiolytic effect at lower doses than required for sedation/hypnosis.

The BENZODIAZEPINES

These agents are indicated for the treatment of 1. anxiety disorders2. alcohol withdrawal3. hyperexcitability, and agitation4. pre-operative relief of anxiety and tension and

in induction of balanced anesthesia.

The BENZODIAZEPINESPharmacodynamics: The adverse effects• CNS effects= sedation, drowsiness, depression,

lethargy, blurred vision• GIT= dry mouth, constipation, nausea, vomiting• CVS= Hypotension or hypertension,

arrhythmias, palpitations, and respiratory difficulties.

• Hematologic= blood dyscrasias and anemia• GU= urinary retention, hesitancy, loss of libido

and sexual functions changes.

The BENZODIAZEPINESNursing Considerations:• Maintain patients on bed for at least 3

hours after drug administration.• Instruct to avoid hazardous activities

like driving and machine operation. • Instruct to avoid consuming ALCOHOL

while taking the drug.

The BENZODIAZEPINESNursing Considerations:• Provide comfort measures to help

patients tolerate drug effects-– instruct to urinate before taking drug– give high fiber foods– use side-rails and assistance with

ambulation.• Have available FLUMAZENIL as an

antidote for benzodiazepine overdose.

The BARBITURATES

• These are also anxiolytics and hypnotics with a greater likelihood of producing sedation, with increase risk of addiction and dependence.

The BARBITURATESThe following are the barbiturates• amobarbital• aprobarbital• butabarbital• mephobarbital• pentobarbital• Phenobarbital• secobarbital

The BARBITURATES

The Mechanism of Action of the Barbiturates• They depress the motor output from the

brain.• The results of their MOA are sedation,

hypnosis and anesthesia, and if extreme, coma.

The BARBITURATES

Clinical indications of the Barbiturates1. Relief of anxiety manifestations2. For sedation3. For patients with insomnia4. For pre-anesthesia5. seizures/epilepsy6. The rapid acting barbiturates are also used

for the treatment of acute manic reactions and status epilepticus

The BARBITURATESPharmacodynamics: The Adverse effects• CNS= CNS depression, somnolence, vertigo,

lethargy, ataxia, paradoxical excitement, anxiety and hallucinations.

• GIT= nausea, vomiting, constipation/diarrhea and epigastric pain

• CVS= bradycardia, Hypotension and syncope. • Respi= serious hypoventilation, respiratory

depression and laryngospasms• Others= hypersensitivity and Stevens-Johnson

syndrome.

The BARBITURATESNursing Considerations• Provide stand-by life support facilities in

cases of severe respiratory depression or hypersensitivity reaction.

• Taper the drug gradually after long-term therapy to avoid withdrawal syndrome.

• Provide comfort measures including small frequent meals, access to bathroom facilities, high-fiber foods, environmental control, safety precaution and skin care.

The CNS stimulants

These are drugs used to treat certain disorders

1. exogenous obesity2. attention-deficit hyperactivity disorders

(ADHD)3. narcolepsy

The CNS stimulants

What is unusual is the ability of the CNS stimulants to CALM hyperactive children, which allows them to focus on one activity for a longer period.

The CNS stimulants

The following are the CNS stimulants:1. Methylphenidate (Ritalin)= most commonly

used for ADHD 2. Dextroamphetamine= a CNS stimulant that

is used for short tem therapy for obesity.3. Modafinil= used for narcolepsy4. Pemoline= used for ADHD

The CNS stimulantsThe Mechanism of Action

These agents act as to stimulate the cortical and reticular activating system (RAS) of the brain.

This is by releasing neurotransmitters from the nerve cells leading to increased stimulation of the post-synaptic neurons.

The CNS stimulants

• The paradoxical effect of calming hyperexcitability through CNS stimulation seen in ADHD is believed to be related to the increased stimulation of an IMMATURE Reticular Activating System leading to the ability to be more selective in response to incoming stimuli.

The CNS stimulants

Pharmacodynamics: Adverse effects of the CNS stimulants

• CNS= nervousness, insomnia, dizziness, headache, and blurred vision

• GIT= anorexia, nausea and weight loss• CVS= hypertension, tachycardia arrhythmias, and

angina• Others= rashes, physical/psychological dependence.

The CNS stimulantsImplementation• The nurse must ensure that the drug is only given to the

indicated conditions• Administer the drug before 6 pm to reduce the effect of

insomnia• BEST given AFTER meals to prevent the effect of

anorexia• Consult with school personnel to monitor the patient

under therapy• Provide safety measures such as side-rails and assisted

ambulation

The CNS stimulantsEvaluationEvaluate the effectiveness of the drug:1. Calming effect in the patient with ADHD2. Alertness for patients with narcolepsy

The Anti-epileptics

• These agents, also called anticonvulsants, are used to treat epileptic conditions.

• Hydantoins, Barbiturates, benzodiazepines, Succinimides and many others are given to a specific type of seizure.

Anti-epilepticsAgents for treating TONIC-CLONIC SEIZURES1. Hydantoins

– Phenytoin– Ethotoin– Fosphenytoin– Mephenytoin

2. Benzodiazepines– Diazepam– Clonazepam– Clorazepate

3. Barbiturates– Phenobarbital

Anti-epileptics

Agents for treating ABSENCE SEIZURES1. Succinimides

a. Ethosuximide b. Methsuximide c. Phensuximide

2. Valproic Acid3. Zosinamide

Anti-epileptics

Agents for treating Partial FOCAL SEIZURES• 1. Carbamazepine• 2. Gabapentin• 3.Lamotrigine• 4. Tiagabine• 5. Topiramate

The hydantoinsThese agents are utilized for general seizures

because they can depress the central nervous system.

They affect the entire brain and reduce the chance of sudden electrical outburst that causes seizures.

These agents generally are less sedating than other anti-epileptics.

The hydantoins

Mechanism of Action of the HydantoinsThese agents STABILIZE the nerve cell membrane

throughout the brain reducing and limiting the excitability and conduction through nerve pathways.

The hydantoins

Clinical Indications of the hydantoins1. Tonic-clonic seizures2. Status epilepticus3. For the prevention of seizures in

neurosurgery4. For muscle relaxation.

The hydantoins

Contraindications and Precautions Hydantoins are NOT given to pregnant patient

because it can cause fetal hydantoin syndrome.

The hydantoinsPharmacodynamics: Adverse effects of the

Hydantoins• CNS effects- depression, confusion, drowsiness,

lethargy, fatigue• GIT- GI upset, constipation, dry mouth,

GINGIVAL HYPERPLASIA , severe liver toxicity which are all related to cellular toxicity.

• SKIN- hirsutism and coarsening of the facial skin• Bone Marrow depression

The hydantoinsImplementation• Administer the drug with food to alleviate GI

irritation• Discontinue the drug at any sign of

hypersensitivity reaction, severe liver dysfunction and severe skin rashes.

• Provide meticulous mouth oral care• Rule out pregnancy and advise women to use

contraceptive measures to prevent pregnancy.

Download - Psychotropic Meds

Top Related