psychotropic meds

Psychotrophic drugsDrugs that can:Stimulate the release of neurotransmittersBlock the receptor/activity of the neurotransmitter= like dopamineStimulate the receptors in the CNSPrevents the breakdown of the neurotransmitters or the re-uptake mechanism

Anti-Psychotics/NeurolepticsDrugs used to treat PSYCHOSES

MAIN ACTION: Blockage of the DOPAMINE receptor in the CNS

Anti-Psychotics/Neuroleptics

ClassPrototypeOthersPhenothiazinesChlorpromazineThioridazine, Fluphenazine, Perphenazine ButyrophenonesHaloperidoldroperidolThioxanthinesChlorprothixenethirothixeneDibenzoxapineMolindoneDiphenylbutlypiperidinePimozideAtypical drugsClozapineOlanzapineRisperidonequetiapine

Anti-Psychotics/Neuroleptics

Desired Effects1Reduced hallucination and illusions2CNS sedation and emotional slowing3Decreased ambivalence, reduced delusion4Reduced agitation resulting to calmness5Relief of emotional turmoil6Reduced flattening of affect

Anti-Psychotics/Neuroleptics

Common SENursing InterventionsAnticholinergic effectsSugarless gum, bed restPhotosensitivity Sunglasses, sunscreen, avoid sunPostural hypotensionChange position slowly, lie prone for 1 hour after drug intake, monitor BPAgranulocytosisInstruct to report sore throat and fever, monitor WBC SeizureMonitor EEGSedationSafety, no machine operation

Anti-Psychotics/Neuroleptics

Extra-Pyramidal SyndromeNursing InterventionParkinsonism-Tremor, rigidity, bradikinesiaAvoid abrupt withdrawal, give anti-EPS drugs like CogentinDystonia- torticollis, contraction of face and tongueRemain with client, administer anti-EPSAkathisia= motor restlessnessVerbalize understanding of the condition, administer anti-EPSTardive Dyskinesia= irreversible drooling, tongue movement and shuffling gaitNo treatment except discontinue drugNeuroleptic Malignant syndrome= elevated temp, treme muscle rigidityNotify physician, prepare to administer dantrolene

The ANXIOLYTICS AND HYPNOTICS

These drugs are used to change the individuals 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.

The ANXIOLYTICS AND HYPNOTICS

The drugs that can induce sleep are called HYPNOTICS.

The ANXIOLYTICS AND HYPNOTICS

The drugs in this class are theBENZODIAZEPINESBARBITURATES

Use of The DrugsClinical indications for the use of theanxiolytics, sedatives and hypnotics1. Prevention of anxiety2. Formation of sedative state3. Induction of sleep

The BENZODIAZEPINES

The 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 benzodiazepinesAlprazolam (Xanax)Chlordiazepoxide (Librium)clonazepamclorazepateDiazepam (Valium)estazolamflurazepamlorazepammidazolamoxazepamquazepamtemazepamtriazolam

The BENZODIAZEPINESSpecial uses

Diazepam(Valium)Status epilepticusChlordiazepoxide (Librium)Alcohol withdrawalAlprazolam (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 anxiety disordersalcohol withdrawalhyperexcitability, and agitationpre-operative relief of anxiety and tension and in induction of balanced anesthesia.

The BENZODIAZEPINES

Pharmacodynamics: The adverse effectsCNS effects= sedation, drowsiness, depression, lethargy, blurred visionGIT= dry mouth, constipation, nausea, vomitingCVS= Hypotension or hypertension, arrhythmias, palpitations, and respiratory difficulties. Hematologic= blood dyscrasias and anemiaGU= urinary retention, hesitancy, loss of libido and sexual functions changes.

The BENZODIAZEPINES

Nursing 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 BENZODIAZEPINES

Nursing Considerations:Provide comfort measures to help patients tolerate drug effects- instruct to urinate before taking druggive high fiber foodsuse side-rails and assistance with ambulation.Have available FLUMAZENIL as an antidote for benzodiazepine overdose.

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

The BARBITURATESThe following are the barbituratesamobarbitalaprobarbitalbutabarbitalmephobarbitalpentobarbitalPhenobarbitalsecobarbital

The BARBITURATESThe Mechanism of Action of the BarbituratesThey depress the motor output from the brain.The results of their MOA are sedation, hypnosis and anesthesia, and if extreme, coma.

The BARBITURATESClinical indications of the BarbituratesRelief of anxiety manifestationsFor sedationFor patients with insomniaFor pre-anesthesiaseizures/epilepsyThe rapid acting barbiturates are also used for the treatment of acute manic reactions and status epilepticus

The BARBITURATESPharmacodynamics: The Adverse effectsCNS= CNS depression, somnolence, vertigo, lethargy, ataxia, paradoxical excitement, anxiety and hallucinations.GIT= nausea, vomiting, constipation/diarrhea and epigastric painCVS= bradycardia, Hypotension and syncope. Respi= serious hypoventilation, respiratory depression and laryngospasmsOthers= hypersensitivity and Stevens-Johnson syndrome.

The BARBITURATESNursing ConsiderationsProvide 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 stimulantsThese are drugs used to treat certain disordersexogenous obesityattention-deficit hyperactivity disorders (ADHD)narcolepsy

The CNS stimulantsWhat 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 stimulantsThe 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 stimulantsThe 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 stimulantsPharmacodynamics: Adverse effects of the CNS stimulantsCNS= nervousness, insomnia, dizziness, headache, and blurred visionGIT= anorexia, nausea and weight lossCVS= hypertension, tachycardia arrhythmias, and anginaOthers= rashes, physical/psychological dependence.

The CNS stimulantsImplementationThe nurse must ensure that the drug is only given to the indicated conditionsAdminister the drug before 6 pm to reduce the effect of insomniaBEST given AFTER meals to prevent the effect of anorexiaConsult with school personnel to monitor the patient under therapyProvide safety measures such as side-rails and assisted ambulation

The CNS stimulantsEvaluationEvaluate the effectiveness of the drug:Calming effect in the patient with ADHDAlertness 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. HydantoinsPhenytoinEthotoinFosphenytoinMephenytoin2. BenzodiazepinesDiazepamClonazepamClorazepate 3. BarbituratesPhenobarbital

Anti-epilepticsAgents for treating ABSENCE SEIZURES1. Succinimides a. Ethosuximide b. Methsuximide c. Phensuximide2. Valproic Acid3. Zosinamide

Anti-epilepticsAgents for treating Partial FOCAL SEIZURES1. Carbamazepine2. Gabapentin3.Lamotrigine4. Tiagabine5. 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 hydantoinsMechanism of Action of the HydantoinsThese agents STABILIZE the nerve cell membrane t