psychotropic meds
TRANSCRIPT
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
Anti-Psychotics/Neuroleptics
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
Anti-Psychotics/Neuroleptics
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
Anti-Psychotics/Neuroleptics
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 ANXIOLYTICS AND HYPNOTICS
• The medications that can prevent the feelings of tension and fear are called ANXIOLYTICS. – Anti-anxiety drugs
The ANXIOLYTICS AND HYPNOTICS
• The drugs that can calm individuals making them unaware of the environment are called SEDATIVES.
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.