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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.

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psychoactive drugs

Psychoactive Drugs

Professor Lana Chase

psychoactive drug categories
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
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
NeurohormonesNeurotransmitters
  • Dopamine
  • Serotonin
  • Norepinepherine
antipsychotics
Antipsychotics
  • 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
Antipsychotics: Conditions Treated
  • Psychosis: Schizophrenia /Thought Disorders
  • Sedation
  • Hiccoughs
  • Dementia- Organic Psychosis / Agitation
  • Bipolar Disorder (acute mania)
anti psychotic use
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
Phenothiazines
  • Developed in 1950’s 1st . Tranquilizer
  • Thorazine (Chlorpromazine)

sedation, anticholinergic side effects

  • Prolixin Decanoate (Fluphenazine)
    • IM for Non-compliant patients
    • Viscous liquid – use 21 gauge needle ,
    • Z track
    • Q 2-4 week admin.(absorbs slowly)
non phenothiazines
Non Phenothiazines
  • Haldol (haloperidol):
  • used extensively in psychiatric emergencies to sedate patient frequently with Ativan and Benadryl
  • I M or PO
  • Haldol Decanoate IM
    • For non-compliant pts.
    • Absorbed slowly over 2-4 weeks
    • Large gauge needle, Z track
non traditional antipsychotics
Non Traditional Antipsychotics
  • 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 antipsychotics11
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 antipsychotics12
Non Traditional Antipsychotics
  • Zyprexa (olanzapine)
    • Dopamine and serotonin blocking agent
    • Effective antipsychotic and for bipolar pts
    • Serious Side effects: weight gain , diabetes
  • Seroquel (quetiapine)
    • Little or no EPS(same as placebo)
    • Effective antipsychotic, sedative
antipsychotic side effects
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
Antipsychotics(continued)
  • Side Effects
    • Tardive Dyskenesia: irreversible
      • Snake like tongue movements /thrusting, invol. movements
    • Anticholinergic: from acetylcholine blockade
      • blurred vision, dry mouth,constipation,GI distress, urinary ret.
    • Extrapyramidal (EPS): movement disorders
      • Dystonia,akathesia , tremors, shuffling gait, muscle stiffness (stiff neck, cogwheel rigidity), masked facies, oculogyric crisis (eyes roll back), diff. swallowing
nursing interventions for eps
Nursing Interventions for EPS
  • Notify MD & Obtain order for:
  • Cogentin or Artane (anticholinergics)
    • PO or IM
  • Symmetrel (dopamine agonist)
  • Benadryl (antihistamine)
side effects antipsychotics cont
Side Effects Antipsychotics (cont.)
  • Tardive Dyskinesia (irreversible)
    • Wormlike tongue movements, ataxia, lip smacking, involuntary arm & leg movements, fever. Tx. Decrease dosage or D/C
side effects antipsychotics cont17
Side Effects Antipsychoticscont.
  • 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
Use Antipsychotics Cautiously
  • Diabetics
  • Children under 6
  • Glaucoma
  • Ulcers
  • Elderly
    • Lower doses, hypotension
drug interactions

Drug Interactions

Potentiates action of CNS Depressants:

e.g.. narcotics, alcohol

nursing implications
Nursing Implications
  • 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
Antianxiety DrugsBenzodiazapines
  • Action
    • Increase action of GABA that inhibits nerve transmission in the CNS
    • Depresses activity in brainstem
      • Sedative
      • Hyponotic
      • Anticonvulsant
antianxiety drugs
Antianxiety Drugs
  • 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
      • COPD
    • **use should be brief except with panic disorders due to risk of addiction
commonly prescribed antianxiey drugs
Commonly Prescribed Antianxiey Drugs
  • Ativan PO or IM
    • Used for psych emergencies / severe agitation
  • Valium (diazepam) PO or IV
    • good IV anticonvulsant 2-40 mg qd
    • Muscle relaxant action used for neck & back pain
  • Xanax
  • Versed –conscious sedation, anesthesia induction
  • Tranxene, Librium
    • freq. Used for alcohol detoxification in tapering doses
  • Dalmane/Restoril
    • sedative sleeping medications
antianxiety medicatons
Antianxiety Medicatons
  • 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
Antianxiety Drug Overdose
    • Overdose alone almost never fatal (safe)
    • Benzo + alcohol  respiratory depression
  • Treatment for Benzodiazapine Overdose:
    • Romazicon(flumazenil)

(Antagonist) benzodiazapine receptor blocker

teaching for antianxiety drugs
Teaching for Antianxiety Drugs
  • 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 drugs27
Antianxiety Drugs
  • 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 drugs28
Antianxiety Drugs
  • 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
Antidepressants
  • Uses:
    • Major Depressive Disorder
    • Premenstrual Dysphoric Disorder
    • Anorexia /Bulimia
    • Anxiety Disorders
      • GAD (Generalized Anxiety Disorder)
      • OCD (Obsessive Compulsive Disorder)
target patrticular symptoms
Target Patrticular Symptoms
  • Goal: to normalize transmission of impulses at the synapse
  • Amine Hypothesis: low norepinepherine (catacholamine) at synapse
  • Permissive Hypothesis: deficiency of serotonin at the synapse
  • Dysregulation Hypothesis: Failure to regulate catacholomine system
tricyclic antidepressants
Tricyclic Antidepressants
  • Norpramine
  • Elavil
  • Tofranil

Uses: panic disorder, depression, GAD, enuresis, sedation (for insomnia)

***2-4 weeks for antidepressant effect

antidepressants32
Antidepressants
  • 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

2 nd generation antidepressants
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

  • Prozac
  • Zoloft
  • Paxil
other newer antidepressants
Other Newer Antidepressants
  • Celexa & Lexapro
  • Serzone
  • Effexor
  • Vestra
  • Remeron
  • Wellbutrin /Zyban
side effects of antidepressants
Side Effects of Antidepressants
  • **Overdose of TCA’s can be fatal due to Cardiac arrhythmias
  • Anticholinergic Side Effects
  • SSRI’s Psychomotor excitement / insomnia (take in morning), tremor,headache, nervousness
  • TCA’s: Sedation, drowsiness especially 1st week (instruct to start on weekend), often added as nighttime dose for insomnia
  • Sexual Side Effects
    • Ejaculatory disturbances & decreased libido, priapism (Deseryl)
antidepressants36
Antidepressants
  • 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
Monoamine Oxidase Inhibitors
  • 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
MAOI’s Side Effects
  • Life Threatening if taken with drugs or foods containing TYRAMINE
  • Hypertensive Crisis (Malignant Hypertesion)
    • Sudden elevation of BP, palpitations,chest 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
Seratonin Syndrome
  • 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
MAO Inhibitors
  • 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
Nursing Interventions MAOI’s
  • 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)
      • In moderation: chocolate, soy sauce, yogurt
  • Drug Restrictions
      • OTC drugs with epinepherine like effects: sudafed, sinus , allergy remedies
      • Narcotics (Demerol especially), other antidepressant drugs,
      • Cocaine, amphetamines
mood stabalizing drugs
Mood Stabalizing Drugs
  • 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
      • Toxic and Theraputic serum levels are close

.5-1.5 meq./l therapuetic above 2 meq. toxic

      • Usual dosage 900 mg. but depends on rate of excretion
lithium carbonate
Lithium Carbonate
  • Side Effects
    • : fine hand tremor,mental dullness,weight gain, polyuria, kidney impairment
    • Secondary hypothyroidism: give Synthroid
  • Lithium Toxicity (Flu like Symptoms)
    • ataxia(may look intoxicated),diarrhea,GI distrubance (N &V)
lithium carbonate44
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
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
  • 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
Mood Stabilizers
  • 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
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