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Drugs Used in Mental Health. Antianxiety Drugs. Antianxiety Drugs. Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality Anxiolytics – another name for antianxiety medications. Antianxiety Drugs.

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Drugs used in mental health

Drugs Used in Mental Health

Antianxiety Drugs


Antianxiety drugs
Antianxiety Drugs

  • Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality

  • Anxiolytics – another name for antianxiety medications


Antianxiety drugs1
Antianxiety Drugs

  • Block neurotransmitter receptor sites preventing anxious feelings from reaching brain

  • Also prevents body’s physical reaction to anxiety


Antianxiety drugs2
Antianxiety Drugs

Common Uses

  • Anxiety disorders and panic attacks

  • Preanesthetic sedation and muscle relaxants

  • Convulsions or seizures - diazepam (Valium)

  • Alcohol withdrawal


Antianxiety drugs3
Antianxiety Drugs

  • Benzodiazepines

    • diazepam (Valium) half life: 36-200 hr

    • clonazepam (Klonopin) half life: 18-50 hr

    • chlordiazepoxide (Librium) half life: 5-25 hr

    • alprazolam (Xanax) half life: 6-12 hr

    • lorazepam (Ativan) half life: 10-20 hr


Antianxiety drugs4
Antianxiety Drugs

  • Nonbenzodiazepines

    • doxepin (Sinequan) half life: 28-52 hr

    • buspirone HCl (BuSpar) half life: 2-3 hr

      * buspirone (BuSpar) drug of choice with elderly because it does not cause excessive drowsiness and poses less fall risk


Antianxiety drugs5
Antianxiety Drugs

Side Effects / Adverse Reactions

  • Drowsiness / sedation

  • Lightheadedness / dizziness

  • Headache, visual disturbances

  • Lethargy, apathy, fatigue

  • Confusion, restlessness, agitation

  • GI disturbances, dry mouth


Antianxiety drugs6
Antianxiety Drugs

  • Benzodiazepine Toxicity

    • Results from overdose

    • Sedation, respiratory depression, coma, death

    • Antidote: flumazenil (Romazicon)

  • Parenteral Alert

    • IM, IV route may lead to apnea and cardiac arrest

    • Use care with elderly, debilitated, respiratory compromised


Antianxiety drugs7
Antianxiety Drugs

High Risk for Physical Dependence

  • Long term use

  • Tolerance

  • Physical dependence

  • Withdrawal symptoms

    After 3 months of use, do NOT discontinue abruptly


Antianxiety drugs8
Antianxiety Drugs

Withdrawal Symptoms

  • Increased symptoms of anxiety

  • Fatigue, hypersomnia

  • Metallic taste, nausea, sweating

  • Headache, difficulty concentrating

  • Cramps, tremors

  • Hallucinations, convulsions


Contraindications
Contraindications

  • Psychoses

  • Acute narrow angle glaucoma

  • Pregnancy

    • Floppy infant syndrome

  • Lactation

    • Infant becomes lethargic and loses weight

  • Significant hypotension / bradycardia


Precautions
Precautions

  • Use cautiously with elderly

    • Initial Low Dose: excreted more slowly, high risk for toxic levels

    • Exception: lorazepam (Ativan), safe for elderly at usual ranges

  • Use cautiously in patients with

    • Impaired liver function

    • Impaired kidney function

    • Overall debilitation

  • Avoid alcohol


Interactions
Interactions

  • Other CNS depressants: Increased risk of sedation, confusion, convulsions

    • Alcohol

    • Narcotic Analgesics

    • Other Psychotropics

  • Digoxin

    • Increased risk for Digitalis Toxicity


Antidepressants
Antidepressants

  • Depression – feelings of hopelessness that interfere with daily functioning


Antidepressants1
Antidepressants

  • Neurotransmisson

    • Important Neurotransmittors

      • Dopamine

      • Epinephrine

      • Norepinephrine

      • Serotonin


Antidepressants2
Antidepressants

Types of Antidepressants

  • Tricyclic Antidepressants (TCA’s)

  • Monoamine Oxidase Inhibitors (MAOI’s)

  • Selective Serotonine Reuptake Inhibitors (SSRI’s)

  • Miscellaneous


Antidepressants3
Antidepressants

  • Tricyclic Antidepressants (TCA’s)

    • Earliest antidepressants

    • Enhances movement of serotonin from one neuron to the next

    • Examples

      • Doxepin (Sinequan)

      • Imipramine (Tofranil)


Antidepressants4
Antidepressants

  • Tricyclic Antidepressants (TCA’s)

    • Uses

      • Depressive episodes

      • Bipolar disorder

      • Obsessive – compulsion disorder

      • Chronic neuropathic pain

      • Depression accompanied by anxiety

      • Enuresis


Antidepressants5
Antidepressants

  • Tricyclic Antidepressants (TCA’s)

    • Side Effects

      • Anticholinergic-like side effects (insomnia, dry mouth, lethargy, confusion, blurred vision, urinary retention)

      • Constipation

      • Photosensitivity


Antidepressants6
Antidepressants

  • Tricyclic Antidepressants (TCA’s)

    • Contraindications and Precautions

      • Use with caution in patients with cardiac history

      • Do not give during pregnancy or lactation

      • Use with caution with hyperthyroid disease

      • Use with caution with seizure disorder

      • Use with caution with hepatic / renal impairment


Antidepressants7
Antidepressants

  • Tricyclic Antidepressants (TCA’s)

    • Interactions

      • Avoid other CNS depressants, including alcohol

      • Dicumarol (similar to warfarin): increased bleeding times

      • Cimetidine (Tagamet): increased anticholinergic-like effects

      • MAOI’s: hypertension, convulsions, fever

      • Adrenergics: arrhythmias, hypertension


Antidepressants8
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • No longer in common use

    • Inhibit the enzyme responsible for inactivating (destroying) certain neurotransmittors

    • Example

      • Phenelzine (Nardil)


Antidepressants9
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Uses

      • Depressive episodes

      • Unlabelled used: bulemia, night terrors, migraines, seasonal affective disorder (SAD), multiple sclerosis


Antidepressants10
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Side Effects

      • Orthostatic hypotension

      • Anticholinergic-like side effects (insomnia, dry mouth, lethargy, confusion, blurred vision, urinary retention)

      • Constipation

      • Hypertensive Crisis


Antidepressants11
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Hypertensive Crisis with Foods Containing the amino acid Tyramine

      • Cheese

      • Wines (especially red)

      • Caffeine

      • Soy


Antidepressants12
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Symptoms of Hypertensive Crisis

      • Headache (usually occipital)

      • Stiff, sore neck

      • Nausea, vomiting

      • Sweating, fever, chest pains, mydriasis

      • Severe hypertension


Antidepressants13
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Contraindications and Precautions

      • Use with caution in patients with cerebrovascular disease

      • Use with caution in patients with history of hypertension and/or congestive heart failure

      • Do not give to pregnant women or children

      • Use with caution with hepatic / renal impairment


Antidepressants14
Antidepressants

  • Monoamine Oxidase Inhibitors (MAOI’s)

    • Interactions

      • Avoid other CNS depressants, including alcohol

      • Hydrochlorothiazide: increased hypotension

      • Tyramine, tryptophan: increased risk of hypertensive crisis

      • TCA’s: hypertension, convulsions, fever

      • Adrenergics: arrhythmias, hypertension


Antidepressants15
Antidepressants

Inhibiting Serotonin Reuptake


Antidepressants16
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Widespread use

    • Inhibits reuptake of serotonin, thus allowing more serotonin to travel across neurons

    • Examples

      • Fluoxetine (Prozac)

      • Paroxetine (Paxil)

      • Sertraline (Zoloft)


Antidepressants17
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Uses

      • Depressive episodes

      • Obsessive – compulsion disorder

      • Bulemia nervosa

      • Unlabelled uses: menstrual disorders, post traumatic stress disorder (PTSD), phobias

    • Therapeutic Effect: 2-4 weeks


Antidepressants18
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Side Effects

      • Somnolence, insomnia, dizziness

      • Headache, tremors, weakness

      • Constipation, dry mouth, nausea

      • Pharyngitis, rhinitis

      • Loss of libido, erectile dysfunction

      • Serotonin syndrome


Antidepressants19
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Serotonin Syndrome (increased levels of serotonin)

      • Increased metabolism (diarrhea, vomiting, fever)

      • Increased cardiovascular (tachycardia, hypertension)

      • Increased neuromuscular (agitation, ataxia, muscle spasms)


Antidepressants20
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Contraindications and Precautions

      • Use with caution in patients with cardiac history

      • Use with caution in patients with diabetes

      • Do not give until two weeks after stopping MAOI

      • Use with caution with hepatic / renal impairment

      • Monitor closely for serotonin syndrome during first two weeks of therapy or dosage increase


Antidepressants21
Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)

    • Interactions

      • Avoid other CNS depressants, including alcohol

      • Other antidepressants: increased toxic effects

      • Cimetidine (Tagamet): increased anticholinergic effects

      • Aspirin, NSAID’s: increased risk of GI bleeding

      • Lithium: increased risk of lithium toxicity


Antidepressants22
Antidepressants

  • Miscellaneous

    • Brupropion HCl (Wellbutrin): often used for smoking cessation as well as depression

    • Duloxetine HCl (Cymbalta): often used for diabetic neuropathy discomfort as well as depression


Drugs used in mental health1

Drugs Used in Mental Health

Antipsychotic Drugs


Antipsychotic drugs
Antipsychotic Drugs

  • Psychosis – affects mood and behavior

  • Characterized by hallucinations and / or delusions


Antipsychotic drugs1
Antipsychotic Drugs

Common Uses

  • Acute and chronic psychoses

  • Bipolar illness

  • Agitated behaviors associated with dementia


Antipsychotic drugs2
Antipsychotic Drugs

Common Medications

  • Aripiprazole (Abilify)

  • Haloperidol (Haldol)

  • Risperidone (Risperdal)

  • Lithium


Antipsychotic drugs3
Antipsychotic Drugs

Side Effects / Adverse Reactions

  • Drowsiness / headache

  • Dry mouth / constipation

  • Photophobia / photosensitivity

  • Extrapyramidal symptoms

  • Tardive dyskinesia

  • Neuroleptic malignant syndrome


Antipsychotic drugs4
Antipsychotic Drugs

Lithium Toxicity

  • High levels of lithium toxic to body

  • Antacids: decreased effectiveness of lithium

  • Loop diuretics: increased risk for lithium toxicity


Psychotropics patient teaching
Psychotropics: Patient Teaching

  • Take as directed

  • Do not discontinue abruptly

  • Avoid hazardous activity

  • Advise physician of all OTC medications and supplements

  • Do not drink alcohol

  • Mouth care, hard candies, sugarless gum for dry mouth

  • Fluids and fiber to prevent constipation


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