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

2. 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

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

4. Anxiety

5. 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

6. 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

7. 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

8. 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.

9. 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

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

11. 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

12. 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.

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

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

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

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

17. 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 .

18. 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

19. 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

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

21. 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