psychopharmacological agents

8/7/2019 PSYCHOPHARMACOLOGICAL AGENTS

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EDITHA C. SABALBORO


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Social anxiety disorder


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ANTIANXIETY Used for the treatment of anxiety and also

useful in the induction of sleep.

Exert a general depressing effect on the CNS,many also exert skeletal muscle- relaxant and

anticonvulsant effects.

These drugs were formerly called minor

tranquilizers.


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Used when the individual has difficulty incoping with environmental stresses and

accomplishing daily activities.

Although the use of sedative-hypnotics has

declines in the last decade, they are still widely

used to reduce anxiety.

Anxiolytics are available in oral and parental

(IM, IV) preparations.


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TypesA. Benzodiazepines - good to help calm the

patient before OR, anti convulsant, muscle

relaxant

Alprazolam (Xanax)

Chlordiazepxide (Librium)

Clorazepate (Tranxene) Diazepam (Valium)

Estazolam (ProSom)


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Halazepam (Paxipam) Lorazepam (Ativan)

Oxazepam (Serax)

Prazepam (Centrax) Temazepam (Restoril)

Triazolam (Halcion)

Flurazepam (Dalmane)


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Nonbenzodiazepine

Azaspirodecanedione buspirone (BuSpar)

Anticonvulsant benzodiazepine

Clonazepam (Klonopin)

Propanediols

Meprobamate (Equanil or Miltown)

Tybamate (Solacen)

Quinazolines

Methaqualone (Quaalude)


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Precautions Drug interaction: drugs potentiate depressant

effects of alcohol or sedatives.

Tolerance to the sedatives and hypnotic effects

develops eventually with all these drugs,although it develops more slowly with thebenzodiazepines than with the others.

All of these drugs, if taken in large enoughdoses or for extended time periods, can lead tophysical and emotional dependence.


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Adverse side effects and related to diminishedmental alertness; caution about driving or

operating hazardous machinery until tolerance

develops.

A drop of BP OF 20 MMHg. (systolic) on

standing warrants withholding the drug and

notifying the physician.


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Signs and symptoms of toxicityAtaxia

Drowsiness

DizzinessDepressed RR,BP


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Benzodiapine use should not be abruptlydiscontinued to avoid a withdrawal syndrome.

Severe withdrawal symptoms can occur if

agents are taken for long time (over 8 months)

and high doses

Tolerances can contribute to self-medication

and dosage escalation.


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Nursing Care of Clients ReceivingAntianxiety orAnxiolytic Medication

Assess the clients medication history, knowledgelevel and use of current medications (prescribed,

over- the-counter, and illicit drugs), medicationallergies, pattern of alcohol use.

Explore the clients perceptions and feelings aboutmedications; certify misinformation, fears, etc.

Review psychotropic drug references for currentinformation.

Plan for client learning about medication


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Administer medications as prescribed. Teach the client about the medication, desired

effect, side effects, food or activity restrictions,

and lag period between onset of treatment and

symptom remission.

Supplement verbal teaching with appropriate

written or audio- visual materials.

Administer clients response to medication and

understanding of teaching.


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schizophrenia


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ANTIPSYCHOTIC

Used to treat a psychotic symptom; that issymptoms of being out of touch with reality;

Act by blocking dopamine receptors in the CNS

and sympathetic nervous system activity; some also exert antiemetic, anticholinergic,

and antihistamines effects.

Antipsychotics control behavior when theclients uncontrolled actions are destructive toself, others, or the environment.


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May be prescribed in conduction withbenzodiazepines (the diazepam\valium

category), which is thought to minimize the use

of neuroleptics and to diminish the potential for

tardive dyskinesia.

The antipsychotics agents or neuroleptics were

formerly called major tranquilizers.

Available in oral and parental (IM, IV)preparations.


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Types

A. Phenothiazines

Aliphatics

Chlorpromazine (Thorazine)

Promazine (Sparine)

Triflupromazine (Vesprin)

Piperidines Mesoridazine (Serentil)

Thioridazine (Trilafon)


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Piperazines Fluphenazine (Prolixin, Permitil)

Perphenazine (Trilafon)

Triflouperazine (Stelazine)

B. Benzisoxazole

Risperidone (Risperdal)


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C. Butyrophenons Dreperidol (Inaspine)

Haloperidol (Haldol)

D. Thioxanthenes

Chlorprothixene (Taractan)

Thiothixene (Navane)


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E.Dibenzoxazepine Loxapine (Loxatane)

F. DihydroindoloneMolindone (Moban)

G. Dibenzodiazepine Clozapine (Clozaril)


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Precautions Drug interactions: potentiate the action of

alcohol, barbiturates, antihypertensives, and

anticholinergics; concomitant use should be

avoided when possible;


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Adverse effects:

Agranulocytosis

jaundice (caused by hepatotoxicity)

signs of extrapyramidal tract irritation,

orthostatic hypotension ?

constipation and urinary retention

anorexia

hypersensitivity reactions (tissue fluid accumulation,

photoallergic reaction,

impotence, cessation of menses or ovulation


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Extrapyramidal side effects (EPSEs Dystonia: occurs early in treatment, possibly

after initial dosage; involves grimacing,

torticollis, intermittent muscles spasms.

Pseudoparkinsonism: resembles true

Parkinsonism (tremor, masklike facies,

drooling, restlessness, festinating gait, rigidity).


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Akathisia: motor agitation (restless legs,jitters, nervous energy); most common of all

EPESs.

Akinesia: fatigue, weakness (hypotonia), painful

muscles, anergy (lack of energy).


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Tardive dyskinesia: late appearing afterprolonged use of antipsychotic drugs; not most

severe effect characterized by involuntary

movements of cae, jaw, and tongue,

lipsmacking, grinding of teeth, rooling or

protrusion of tongue, tics diaphragmatic

movements that may impair breathing;

condition disappears during sleep; usuallyirreversible; all antipsychotics stopped to see if

symptoms subside.


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Akathisia


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Tardive dyskinesia


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pseudoparkinsonism


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Antiparkinson drugs: block the extrapyramidalsymptoms.

Anticholinergics (Cogentin)

Benztropine (Cogentin)

Trihexyphenidyl(Artane) Procyclidine (Kemadrin)

Biperiden (Akineton)

Antihistaminediphanhydramine (Benadryl)


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Nursing Care of Clients ReceivingAntipsychotic

Agents Monitor for sign of hepatic toxicity (e.g., jaundice).

Monitor for signs of infection (e.g., sore throat)

Monitor blood pressure in standing and supinepositions.

Assist client to get out of bed slowly

Assess for hypotension and tachycardia

If hypotension occurs, monitor by measuring BPbefore each dose is given.

Consult physician as to safe BP systolic/diastolicmargins for each client.


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Offers sugar-free chewing gum of hard candy toincrease salivation and relieve dry mouth.

Assist with ambulation as necessary; keep side

rails up when non-ambulatory.

Assess for extrapyramidal symptoms

(antiparkinsonism agent may be prescribed to

decrease symptoms).

Monitor blood work during long- term therapy.


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Instruct client to:

-Avoid administration with other CNSdepressants, including concurrent use of alcohol.

-Avoid engaging in potentially hazardous

activities.-Avoid exposure to direct sunlight; wear

protective clothing and sunglasses outdoors.

-Recognize extrapyramidal symptoms and

report their occurrence to the physicianimmediately.

-Avoid changing positions rapidly.


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-Notify physician if sore throat, fever, or weakness

occurs, avoid crowded, potentially infectious places.

-Increase water intake and eat high-fiber diet toavoid constipation.

-Expect weight gain (diet pills should not be taken);

control weight with appropriate diet.

-Avoid mixing neuroleptics with certain juices orliquids (coffee, tea, or cola beverages may decrease

effectiveness of drug).

-Avoid antacids or take 1 to 2 hours afterantipsychotic drug is taken (antacids decreaseabsorption of antipsychotics).


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Use precautions when preparing medication toavoid contact with the skin.

Evaluate clients response to medication and



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Antidepressants Used to improve the general behavior and

mood of clients experiencing melancholia;

depressed mood, loss of interests, inability to

respond to pleasurable events,

-a depression that is worst in the morning and

lifts slightly as the day progresses, early

morning awakening (and inability to fall asleepagain), marked psychomotor retardation or

agitation, anorexia, weight loss, and guilt.


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Antidepressant drugs increase the level ofnorepinephrine at subcortical neuroeffector

sites.

Available in oral and parenteral (IM)

preparations.


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Norepinephrine blockers provide elevatedlevels of the neurohormone by preventing

reuptake and storage at the axon (tricyclic

compounds).

Monoamine oxidase inhibitors (MAOIs) elevate

norepinephrine levels in brain tissues by

interfering with the enzyme MAO; act as psychic

energizers. Selective serotonin reuptake inhibitors (SSRIs)

are thought to alleviate depression by

preventing reuptake of serotonin in the CNS.


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Types

Norepinephrine blockers or tricyclic

antidepressants (TCAs)

Amitriptyline (Elavil)

Amoxapine (Asendin)

Clomipramine (Anafranil)

Desipramine (Norpramin) Doxepin (Sinequan)


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Imipramine (

Tofranil

)

Maprotiline (Ludiomil)

Nortriptyline (Pamelor)

Protriptyline (Vivactil) Trimipramine (Surmontil)


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Selective serotonin reuptake inhibitors (SSRIs)

Bupropion (Wellbutrin)

Flouxetine (Prozac)

Sertraline (Zoloft) Paroxetine (Paxil)


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Precautions Norepinephrine blockers or tricyclic

antidepressants (TCAs)

Drug interactions: potentiate effects of

anticholinergic drugs and CNS depressants

(e.g., alcohol and sedatives).


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Adverse effects: orthostatic hypotensions, skin

rash, drowsiness, dry mouth, blurred vision,

constipation, urine retention, tachycardia, CNS

stimulation is elderly clients (excitement,

restlessness, incoordination, fine tremor,nightmares, delusions, disorientation,

insomnia).

TCAs should not be given to clients with narrow-angle glaucoma.


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Monoamine oxidase inhibitors (MAOIs)

Drug interactions: MAOIs potentiate the effects

of alcohol, barbiturates, anesthetic agents

(cocaine), antihistamines, narcotics, corticoids,

anticholinergics, and sympathomimetics drugs.


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Drug-food interactions: hypertensive crisis with

vascular rupture, occipital headache,

palpitations, and stiffness of neck muscles,

emesis, sweating, photophobia, and cardiac

dysrhythmias may occur when neurohormonallevels are elevated by ingestion of foods with

high tyramine content (pickled herring, beer,

wine, chicken livers, aged or natural cheese,chocolate).


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Adverse effects: orthostatic hypotension (CNS

effect); skin rash (hypersensitivity); drowsiness

(CNS depression); dry mouth, blurred vision,

urinary retention, tachycardia (anticholinergic

effect); sexual dysfunction (autonomic effect);nightmares, delusions, disorientation, insomnia

(CNS stimulation).


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Selective serotonin reuptake inhibitors (SSRIs)

Usually these drugs are administered before

noon to avoid insomnia or sleep disturbances.

Drug interactions: may interact with tryptophan;

question concominant use of diazepam,

warfarin, and digoxin; should be discontinued 4

to 6 weeks before switching to MAOIs.

Adverse effects: insomnia, headache, dry

mouth, sexual dysfunction, anxiety, diarrhea

and other gastrointestinal-tract complaints.


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Nursing Care of Clients Receiving

Antidepressants

Assess for effectiveness of drug action.

Maintain suicide precautions, especially as

depression begins to lift; carefully monitor

serum glucose in diabetics.

Instruct client to:

Change positions slowly.

Avoid engaging in hazardous activities.


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Utilize sugar-free chewing gum or hard candy to

stimulate salivation.

Check with physician before taking all OTC

preparations or before consuming alcohol.

Expect therapeutic effect to be delayed; may

take 3 to 4 weeks for the TCAs and shorter for

the MAOIs.


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MAOIs

Maintain dietary restrictions; avoid foods

containing tyramine (aged cheeses, beer,

chianti wine, yogurt, soy sauce, chocolate).

Monitor client for occurrence of hypertensive

crisis (occipital headache, palpitations, and

stiff neck).

Avoid concurrent administration of adrenergic

drugs.

Avaluate clients response to medication and



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Description

Used to control the manic episode of mood

disorders and for maintenance in clients with a

history of mania.

Act by reducing adrenergic neurotransmitter

levels in cerebral tissue through alteration of

sodium transport.

Antimanic agents are available in oral capsules

and tablets, both regular and sustained-release

forms, and in concentrates.


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Types

Antimanic agents and mood stabilizers

Lithium carbonates (Eskalith, Lithane,

Lithonate, Lithizine, Lithobid).

Lithium citrate (concentrate form).

Alternative antimanic agents and mood

stabilizers

Carbamazepine (Tegretol)

Clonazepam (Klonopin)

Valproic acid (Depaneke, Valproate sodium)


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Drug-food interaction: restriction of sodium intake

increases drug substitution for sodium ions,

which causes signs of hyponatremia (nausea,

vomiting, diarrhea, muscle fasciculations,

stupor, and seizures); therefore salt intakemust be maintained.


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Adverse effects: excess voiding and extreme

thirst caused by drug suppression of

antidiuretic hormone (ADH) function, which

causes dehydration; slurred speech,

disorientation, confusion, cogwheel rigidity,ataxia, renal failure, respiratory depression,

and coma are toxic side effects; toxic effects

can easily occur because the differencebetween the therapeutic level and toxic level is

slight.


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Nursing Care of Clients ReceivingAntimanic and

Mood-stabilizingAgents

Recognize that therapeutic effects will be

delayed for several weeks.

Recognize that dehydration and hyponatremia

predispose the client to lithium toxicity.

Assess therapeutic blood levels (0.6 to 1.2

mEq/L) during course therapy.


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Supervise ambulation if necessary.

Administer with meals to reduce GI irritation.

Teach the client that the nausea, polyuria, and

thirst that occur initially will subside after

several days.

Teach client and family to observe for signs of

toxicity (diarrhea, vomiting, drowsiness,

muscular wekness, ataxia, confusion, andtonic-clonic seizures).


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Evaluate clients response to medication and


Draw CBC every 2 to 4 weeks to monitor for

WBC suppression and anemia noted with

carbamazepine.


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psychopharmacological agents

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