Psycho Pharmacology

PsychopharmacolPsychopharmacologyogy

Anti-Anxiety DrugsAnti-Anxiety Drugs

www.nursingdepartment.blogwww.nursingdepartment.blogspot.comspot.com

The ANXIOLYTICS AND The ANXIOLYTICS AND HYPNOTICSHYPNOTICS

These drugs are used to change These drugs are used to change the individual’s responses to the the individual’s responses to the environment. environment.


The medications that can prevent The medications that can prevent the feelings of tension and fear are the feelings of tension and fear are called ANXIOLYTICS. called ANXIOLYTICS. Anti-anxiety drugsAnti-anxiety drugs


The drugs that can calm The drugs that can calm individuals making them unaware individuals making them unaware of the environment are called of the environment are called SEDATIVES. SEDATIVES.


The drugs that can induce sleep The drugs that can induce sleep are called HYPNOTICS. are called HYPNOTICS.


The drugs in this class are theThe drugs in this class are the BENZODIAZEPINESBENZODIAZEPINES BARBITURATES BARBITURATES

Use of The DrugsUse of The Drugs

Clinical indications for the use of theClinical indications for the use of the

anxiolytics, sedatives and hypnoticsanxiolytics, sedatives and hypnotics 1. Prevention of anxiety1. Prevention of anxiety 2. Formation of sedative state2. Formation of sedative state 3. Induction of sleep3. Induction of sleep

The BENZODIAZEPINESThe BENZODIAZEPINESThe benzodiazepines are the most The benzodiazepines are the most

frequently used anxiolytic drugs. frequently used anxiolytic drugs.

These agents prevent anxiety states These agents prevent anxiety states without causing much sedation, with without causing much sedation, with less physical dependence than other less physical dependence than other agents.agents.

The BENZODIAZEPINESThe BENZODIAZEPINES

The following are the benzodiazepinesThe following are the benzodiazepines Alprazolam (Xanax)Alprazolam (Xanax) Chlordiazepoxide (LibriumChlordiazepoxide (Librium)) clonazepamclonazepam clorazepateclorazepate Diazepam (Valium)Diazepam (Valium) estazolamestazolam flurazepamflurazepam lorazepamlorazepam midazolammidazolam oxazepamoxazepam quazepamquazepam temazepamtemazepam triazolamtriazolam

The BENZODIAZEPINESThe BENZODIAZEPINESSpecial usesSpecial uses

Diazepam(Valium)

Status epilepticus

Chlordiazepoxide (Librium)

Alcohol withdrawal

Alprazolam (Xanax)

Panic attack


The Mechanism of Action of the BenzodiazepinesThe Mechanism of Action of the Benzodiazepines

These agents act on the Limbic These agents act on the Limbic system and the RAS (reticular system and the RAS (reticular activating system) to make the activating system) to make the GABA ( Gamma-aminobutyric acid) GABA ( Gamma-aminobutyric acid) more effective causing interference more effective causing interference with neuron firing. with neuron firing.


The Mechanism of Action of the BenzodiazepinesThe Mechanism of Action of the Benzodiazepines

The GABA is an inhibitory The GABA is an inhibitory neurotransmitter. neurotransmitter.

This will result to an This will result to an anxiolytic effect at lower anxiolytic effect at lower doses than required for doses than required for sedation/hypnosis.sedation/hypnosis.


These agents are indicated for the These agents are indicated for the treatment of treatment of

1.1. anxiety disordersanxiety disorders2.2. alcohol withdrawalalcohol withdrawal3.3. hyperexcitability, and agitationhyperexcitability, and agitation4.4. pre-operative relief of anxiety and pre-operative relief of anxiety and

tension and in induction of tension and in induction of balanced anesthesia. balanced anesthesia.

The BENZODIAZEPINESThe BENZODIAZEPINESPharmacodynamics: The adverse effectsPharmacodynamics: The adverse effects CNS effects= CNS effects= sedation, drowsiness, sedation, drowsiness,

depression, lethargy, blurred visiondepression, lethargy, blurred vision GIT= GIT= dry mouth, constipationdry mouth, constipation, nausea, , nausea,

vomitingvomiting CVS= CVS= HypotensionHypotension or hypertension, or hypertension,

arrhythmias, palpitations, and arrhythmias, palpitations, and respiratory difficulties. respiratory difficulties.

Hematologic= blood dyscrasias and Hematologic= blood dyscrasias and anemiaanemia

GU= urinary retention, hesitancy, loss GU= urinary retention, hesitancy, loss of libido and sexual functions changes.of libido and sexual functions changes.

The BENZODIAZEPINESThe BENZODIAZEPINESNursing Considerations:Nursing Considerations: Maintain patients on bed for Maintain patients on bed for

at least 3 hours after drug at least 3 hours after drug administration.administration.

Instruct to avoid hazardous Instruct to avoid hazardous activities like driving and activities like driving and machine operation. machine operation.

Instruct to avoid consuming Instruct to avoid consuming ALCOHOL while taking the ALCOHOL while taking the drugdrug..

The BENZODIAZEPINESThe BENZODIAZEPINESNursing Considerations:Nursing Considerations: Provide comfort measures to Provide comfort measures to

help patients tolerate drug help patients tolerate drug effects-effects- instruct to urinate before instruct to urinate before

taking drugtaking drug give high fiber foodsgive high fiber foods use side-rails and assistance use side-rails and assistance

with ambulation.with ambulation. Have available Have available FLUMAZENIL FLUMAZENIL

as an antidote for as an antidote for benzodiazepine overdose.benzodiazepine overdose.

The BARBITURATESThe BARBITURATES These are also anxiolytics and These are also anxiolytics and

hypnotics with a greater hypnotics with a greater likelihood of producing likelihood of producing sedation, with increase risk of sedation, with increase risk of addiction and dependence. addiction and dependence.

The BARBITURATESThe BARBITURATES

The following are the barbituratesThe following are the barbiturates amobarbitalamobarbital aprobarbitalaprobarbital butabarbitalbutabarbital mephobarbitalmephobarbital pentobarbitalpentobarbital PhenobarbitalPhenobarbital secobarbitalsecobarbital


The Mechanism of Action of the The Mechanism of Action of the BarbituratesBarbiturates

They depress the motor output from They depress the motor output from the brain.the brain.

The results of their MOA are The results of their MOA are sedation, hypnosis and anesthesia, sedation, hypnosis and anesthesia, and if extreme, coma.and if extreme, coma.


Clinical indications of the Clinical indications of the BarbituratesBarbiturates

1.1. Relief of anxiety manifestationsRelief of anxiety manifestations2.2. For sedationFor sedation3.3. For patients with insomniaFor patients with insomnia4.4. For pre-anesthesiaFor pre-anesthesia5.5. seizures/epilepsyseizures/epilepsy6.6. The rapid acting barbiturates are The rapid acting barbiturates are

also used for the treatment of also used for the treatment of acute manic reactions and status acute manic reactions and status epilepticusepilepticus

The BARBITURATESThe BARBITURATESPharmacodynamics: The Adverse effectsPharmacodynamics: The Adverse effects CNS= CNS= CNS depressionCNS depression, somnolence, somnolence, ,

vertigo, lethargy, ataxia, paradoxical vertigo, lethargy, ataxia, paradoxical excitement, anxiety and hallucinations.excitement, anxiety and hallucinations.

GIT= GIT= nausea, vomiting,nausea, vomiting, constipation/diarrhea and epigastric constipation/diarrhea and epigastric painpain

CVS= bradycardia, Hypotension and CVS= bradycardia, Hypotension and syncope. syncope.

Respi= serious hypoventilation, Respi= serious hypoventilation, respiratory depression and respiratory depression and laryngospasmslaryngospasms

Others= Others= hypersensitivity and Stevens-hypersensitivity and Stevens-Johnson syndrome.Johnson syndrome.

The BARBITURATESThe BARBITURATESNursing ConsiderationsNursing Considerations Provide stand-by life support Provide stand-by life support

facilities in cases of severe facilities in cases of severe respiratory depression or respiratory depression or hypersensitivity reaction.hypersensitivity reaction.

Taper the drug gradually after long-Taper the drug gradually after long-term therapy to avoid withdrawal term therapy to avoid withdrawal syndrome.syndrome.

Provide comfort measures including Provide comfort measures including small frequent meals, access to small frequent meals, access to bathroom facilities, high-fiber foods, bathroom facilities, high-fiber foods, environmental control, safety environmental control, safety precaution and skin care.precaution and skin care.

The CNS stimulantsThe CNS stimulants

These are drugs used to treat These are drugs used to treat certain disorderscertain disorders

1.1. exogenous obesityexogenous obesity

2.2. attention-deficit hyperactivity attention-deficit hyperactivity disorders (ADHD)disorders (ADHD)

3.3. narcolepsynarcolepsy


What is unusual is the What is unusual is the ability of the CNS ability of the CNS stimulants to CALM stimulants to CALM hyperactive children, which hyperactive children, which allows them to focus on allows them to focus on one activity for a longer one activity for a longer period.period.


The following are the CNS The following are the CNS stimulants:stimulants:

1. 1. Methylphenidate (Ritalin)= most Methylphenidate (Ritalin)= most commonly used for ADHDcommonly used for ADHD

2. Dextroamphetamine= a CNS 2. Dextroamphetamine= a CNS stimulant that is used for short stimulant that is used for short tem therapy for obesity.tem therapy for obesity.

3. Modafinil= used for narcolepsy3. Modafinil= used for narcolepsy

4. Pemoline= used for ADHD4. Pemoline= used for ADHD

The CNS stimulantsThe CNS stimulantsThe Mechanism of Action The Mechanism of Action

These agents act as to stimulate the These agents act as to stimulate the cortical and reticular activating cortical and reticular activating system (RAS) of the brain. system (RAS) of the brain.

This is by releasing neurotransmitters This is by releasing neurotransmitters from the nerve cells leading to from the nerve cells leading to increased stimulation of the post-increased stimulation of the post-synaptic neurons.synaptic neurons.


The paradoxical effect of calming The paradoxical effect of calming hyperexcitability through CNS hyperexcitability through CNS stimulation seen in ADHD is stimulation seen in ADHD is believed to be related to the believed to be related to the increased stimulation of an increased stimulation of an IMMATURE Reticular Activating IMMATURE Reticular Activating System leading to the ability to be System leading to the ability to be more selective in response to more selective in response to incoming stimuli.incoming stimuli.


Pharmacodynamics: Adverse effects of the Pharmacodynamics: Adverse effects of the CNS stimulantsCNS stimulants

CNS= CNS= nervousness, insomnianervousness, insomnia, dizziness, , dizziness, headache, and blurred visionheadache, and blurred vision

GIT=GIT= anorexiaanorexia, nausea and weight loss, nausea and weight loss CVS= hypertension, tachycardia CVS= hypertension, tachycardia

arrhythmias, and anginaarrhythmias, and angina Others= rashes, physical/psychological Others= rashes, physical/psychological

dependence.dependence.

The CNS stimulantsThe CNS stimulantsImplementationImplementation The nurse must ensure that the drug is only The nurse must ensure that the drug is only

given to the indicated conditionsgiven to the indicated conditions Administer the drug before 6 pm to Administer the drug before 6 pm to

reduce the effect of insomniareduce the effect of insomnia BEST given AFTER meals to prevent the BEST given AFTER meals to prevent the

effect of anorexiaeffect of anorexia Consult with school personnel to monitor the Consult with school personnel to monitor the

patient under therapypatient under therapy Provide safety measures such as side-rails Provide safety measures such as side-rails

and assisted ambulationand assisted ambulation

The CNS stimulantsThe CNS stimulantsEvaluationEvaluation

Evaluate the effectiveness of the drug:Evaluate the effectiveness of the drug:

1.1. Calming effect in the patient with Calming effect in the patient with ADHDADHD

2.2. Alertness for patients with Alertness for patients with narcolepsynarcolepsy

Psycho Pharmacology

Documents

Transcript of Psycho Pharmacology