Anxiolytics and Other Agents Used to Treat Psychiatric Conditions Chapter 28 Anxiolytics and Other Agents Used to Treat Psychiatric Conditions

Psychotherapeutics Agents used in the treatment of emotional and mental disorders Commonly prescribed drugs Used when a person’s ability to cope with his or her environment is seriously impaired

Psychotherapeutics p632 Used for treatment of: Anxiety (anxiolytics) Mental and emotional disorders Psychosis (break with reality) Affective disorders (mood disorders)

Anxiety

Anxiolytics p632 Barbiturates The oldest drugs to be used as anxiolytic agents Depress the CNS Suppress REM sleep Carbamates Similar to barbiturates Ex: meprobamate Cause considerable daytime sedation

Anxiolytics Antihistamines and Benzodiazepines p633-634 Used as anxiolytics Cause sedation Example: Hydroxyzine: useful in tx of pruritic dermatoses Benzodiazepines First line of drugs used for anxiety disorders Produce sedation and muscle relaxation

Anxiolytics: Side Effect/Adverse Effects Usually safe Sedation Relaxation Check vital signs Dangerous when taken with: Other CNS depressants Alcohol Respiratory arrest Provide for pt safety

Antipsychotic Agents p643 Treat Schizophrenia Organic psychosis Manic phase of bipolar affective disorder Clients with psychotic disorders show symptomatic improvement Action: Decreased dopamine levels. When dopamine levels are lowered, Ach levels are raised. The increase in acetylcholine accounts for many of the adverse effects of psychotropic medications.

Side effects antipsychotic agents p644 Extrapyramidal symptoms from lowered dopamine levels which result in increased acetylcholine levels Uncontrollable tremors, jerky movements, akathisia, insomnia, pacing, spasms, tics Tardive dyskinesia: can become permanent Rhythmic involuntary movements of facial muscles and tongue EPS symptoms can be reduced with anticholinergics

Side effects antipsychotic agents p644 Impaired temperature regulation Lower the seizure threshold Photosensitivity Interference in ejaculation in males Orthostatic hypotension Examples Chlorpromazine (Thorazine) Prototype

Anti-manic agents p645 Lithium is the drug of choice for treatment of manic episodes Lithium toxicity: N&V diarrhea fatigue tremors ataxia coma convulsions death Low serum sodium levels may cause lithium retention and lithium toxicity

Lithium cont p648 Nursing considerations Anticipate labs for serum lithium levels Teach add salt to food to prevent lithium toxicity No appreciable drug effect for one week.

Other mood stabilizers p648 Anti-convulsants used as mood stabilizers: Valproate (Depakote) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax)

Antidepressant agents p638-643 Classes of antidepressants Tricyclic antidepressants Monoamine Oxidase Inhibitors (MAOIs) Selective Seratonin Reuptake inhibitors (SSRIs) Other antidepressant agents

Tricyclic Antidepressants p 638 Tricyclics Increase norepi levels Used to treat Depression Chronic pain Bedwetting Examples: amitriptyline (Elavil) imipramine (Tofranil)

Tricyclic Antidepressants p638 Adverse/side effects Orthostatic hypotension sedation weight gain dry mouth urinary retention tremors sexual dysfunction

Monoamine Oxidase Inhibitors (MAOIs) p639 Inhibit monoamine oxidase Monoamine oxidase (produced by liver) Normally inactivates neurotransmitters such as serotonin and dopamine Examples: Phenelzine (Nardil) Tranylcypromine (Parnate) Dangerous side effects of MAOIs Hypotension Hypertension Death .

Diet restrictions MAOIs Diet restrictions for pt on MAOIs Avoid tyramine rich foods Table 28-3 page 640 Aged or cured foods are rich in tyramine Potentially fatal hypertension can result when tyramine is ingested

Selective seratonin reuptake inhibitors SSRIs p638 Examples: Fluoxetine HCl (Prozac) Sertraline HCl (Zoloft) Paroxetine HCl (Paxil) Action: increase seratonin levels. For mild to moderate depression Can take several weeks for therapeutic levels to be reached

SSRIs continued p638 Adverse effects and side effects Nausea dry mouth headache Dizziness Decreased libido Agitation Insomnia Potential for suicide attempt

Geriatric Considerations Potential for toxic effects is increased Side effects increased Orthostatic hypotension, sedation, and anticholinergic side effects Increased anxiety is associated with the use of tricyclic antidepressants Lithium is more toxic in elderly clients; lower doses are necessary