Psychoactive Drugs Professor Lana Chase. Psychoactive Drug Categories Anti-psychotics:...
-
Upload
karen-jacobs -
Category
Documents
-
view
226 -
download
1
Transcript of Psychoactive Drugs Professor Lana Chase. Psychoactive Drug Categories Anti-psychotics:...
Psychoactive DrugsPsychoactive Drugs
Professor Lana Chase
Psychoactive Drug Psychoactive Drug CategoriesCategories
Anti-psychotics: Schizophrenia, AgitationAnti-depressants: Depression, OCD,
AnxietyMood Stabilizers: Bipolar DisorderAnti-Anxiety: Anxiety /Panic DisordersPsycho-stimulants: ADHD, Narcolepsy
Purposes and AdvantagesPurposes and Advantages
Used to affect the brain & behaviorTo treat psychiatric disorders /symptomsUsed 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
NeurohormonesNeurohormonesNeurotransmittersNeurotransmitters
Dopamine
Serotonin
Norepinepherine
AntipsychoticsAntipsychotics
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: Antipsychotics: Conditions TreatedConditions Treated
Psychosis: Schizophrenia /Thought Disorders
SedationHiccoughsDementia- Organic Psychosis / AgitationBipolar Disorder (acute mania)
Anti-psychotic UseAnti-psychotic Use
Treat Positive Symptoms of Schizophrenia– Delusions- false beliefs
– Hallucinations- false sensory perceptions: – auditory, visual, tactile, olfactory,somatic,
gustatory
– Illusions- mistaken sensory perception
PhenothiazinesPhenothiazines
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 PhenothiazinesNon 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 AntipsychoticsNon Traditional Antipsychotics
Less side effectsMore 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 AntipsychoticsNon 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 AntipsychoticsNon 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 EffectsAntipsychotic Side Effects
Less side effects with newer medications Older meds not very user friendlynon
compliance– Sedation: drowsiness– Weight Gain– Photosensitivity– Dizziness (Orthostatic Hypotension)– Sexual Dysfunction
– Elevation in Prolactin Levels
AntipsychoticsAntipsychotics(continued)(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 EPSNursing Interventions for EPS
Notify MD & Obtain order for: Cogentin or Artane (anticholinergics)
– PO or IM
Symmetrel (dopamine agonist)
Benadryl (antihistamine)
Side Effects Antipsychotics Side Effects Antipsychotics (cont.)(cont.)
Tardive Dyskinesia (irreversible) – Wormlike tongue movements, ataxia, lip
smacking, involuntary arm & leg movements, fever. Tx. Decrease dosage or D/C
Side Effects AntipsychoticsSide Effects Antipsychoticscont.cont.
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 CautiouslyUse Antipsychotics Cautiously
DiabeticsChildren under 6GlaucomaUlcersElderly
– Lower doses, hypotension
Drug InteractionsDrug Interactions
Potentiates action of CNS Depressants:
e.g.. narcotics, alcohol
Nursing ImplicationsNursing 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 DrugsAntianxiety DrugsBenzodiazapinesBenzodiazapines
Action– Increase action of GABA that inhibits nerve
transmission in the CNS– Depresses activity in brainstem
Sedative Hyponotic Anticonvulsant
Antianxiety DrugsAntianxiety 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 Commonly Prescribed Antianxiey DrugsAntianxiey 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 MedicatonsAntianxiety 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 OverdoseAntianxiety 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 Teaching for Antianxiety DrugsDrugs
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 elderlyInstruct about risk of addiction /safety from
falls
Antianxiety DrugsAntianxiety 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 DrugsAntianxiety 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.
AntidepressantsAntidepressants
Uses:– Major Depressive Disorder– Premenstrual Dysphoric Disorder– Anorexia /Bulimia– Anxiety Disorders
GAD (Generalized Anxiety Disorder) OCD (Obsessive Compulsive Disorder)
Target Patrticular SymptomsTarget 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 AntidepressantsTricyclic Antidepressants
NorpramineElavilTofranil
Uses: panic disorder, depression, GAD, enuresis, sedation (for insomnia)
***2-4 weeks for antidepressant effect
AntidepressantsAntidepressants
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
22ndnd Generation Generation AntidepressantsAntidepressants
SSRI’sSelective Serotonin Reuptake Inhibitors
increases serotonin reuptake at receptor siteless SE than TCI’s
less anticholinergic, no wt. Gain, safer for cardiac pts.& pregnant women
Prozac
Zoloft
Paxil
Other Newer AntidepressantsOther Newer Antidepressants
Celexa & LexaproSerzoneEffexorVestraRemeronWellbutrin /Zyban
Side Effects of Side Effects of AntidepressantsAntidepressants
**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)
AntidepressantsAntidepressants
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 InhibitorsMonoamine 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 EffectsMAOI’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 SyndromeSeratonin 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 InhibitorsMAO 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’sNursing 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 DrugsMood 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 CarbonateLithium 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 CarbonateLithium Carbonate
Nursing ConsiderationsHold Lithium, Notify MD, get serum lithium level to confirminstruct 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 StabalizersMood 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 StabilizersMood 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