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Psychoactive Drugs

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

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  1. Psychoactive Drugs Professor Lana Chase

  2. 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

  3. 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

  4. NeurohormonesNeurotransmitters • Dopamine • Serotonin • Norepinepherine

  5. 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)

  6. Antipsychotics: Conditions Treated • Psychosis: Schizophrenia /Thought Disorders • Sedation • Hiccoughs • Dementia- Organic Psychosis / Agitation • Bipolar Disorder (acute mania)

  7. 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

  8. 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)

  9. 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

  10. 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).

  11. 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

  12. 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

  13. 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

  14. 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

  15. Nursing Interventions for EPS • Notify MD & Obtain order for: • Cogentin or Artane (anticholinergics) • PO or IM • Symmetrel (dopamine agonist) • Benadryl (antihistamine)

  16. Side Effects Antipsychotics (cont.) • Tardive Dyskinesia (irreversible) • Wormlike tongue movements, ataxia, lip smacking, involuntary arm & leg movements, fever. Tx. Decrease dosage or D/C

  17. 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.

  18. Use Antipsychotics Cautiously • Diabetics • Children under 6 • Glaucoma • Ulcers • Elderly • Lower doses, hypotension

  19. Drug Interactions Potentiates action of CNS Depressants: e.g.. narcotics, alcohol

  20. 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)

  21. Antianxiety DrugsBenzodiazapines • Action • Increase action of GABA that inhibits nerve transmission in the CNS • Depresses activity in brainstem • Sedative • Hyponotic • Anticonvulsant

  22. 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

  23. 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

  24. 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

  25. Antianxiety Drug Overdose • Overdose alone almost never fatal (safe) • Benzo + alcohol  respiratory depression • Treatment for Benzodiazapine Overdose: • Romazicon(flumazenil) (Antagonist) benzodiazapine receptor blocker

  26. 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

  27. 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.

  28. 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.

  29. Antidepressants • Uses: • Major Depressive Disorder • Premenstrual Dysphoric Disorder • Anorexia /Bulimia • Anxiety Disorders • GAD (Generalized Anxiety Disorder) • OCD (Obsessive Compulsive Disorder)

  30. 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

  31. Tricyclic Antidepressants • Norpramine • Elavil • Tofranil Uses: panic disorder, depression, GAD, enuresis, sedation (for insomnia) ***2-4 weeks for antidepressant effect

  32. 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

  33. 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

  34. Other Newer Antidepressants • Celexa & Lexapro • Serzone • Effexor • Vestra • Remeron • Wellbutrin /Zyban

  35. 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)

  36. 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

  37. 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)

  38. 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

  39. 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

  40. 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)

  41. 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

  42. 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

  43. 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)

  44. 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)

  45. 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)

  46. 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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