Mental And Behavioral Health Drugs PDF

MENTAL AND BEHAVIORAL HEALTH DRUGS ANTIPSYCHOTICS AND ANXIOLYTICS Antipsychotics - neuroleptics or psychotropics Anxiolytics - also called antianxiety drugs or sedative-hypnotics Psychosis - loss of contact with reality (difficulty in processing information, disorganized thoughts, distor...

MENTAL AND BEHAVIORAL HEALTH DRUGS ANTIPSYCHOTICS AND ANXIOLYTICS Antipsychotics - neuroleptics or psychotropics Anxiolytics - also called antianxiety drugs or sedative-hypnotics Psychosis - loss of contact with reality (difficulty in processing information, disorganized thoughts, distortion of reality, delusions, hallucinations, incoherence, catatonia, aggressive or violent behavior) Schizophrenia - chronic psychotic disorder ○ Cognitive symptoms - disorganized thinking, memory difficulty, decreased ability to focus attention ○ Positive symptoms - exaggeration of normal function, incoherent speech, hallucinations, delusions, and paranoia ○ Negative symptoms - decrease or loss in function and motivation, simplicity of speech, blunted affect, inertia, poor self-care, and social withdrawal Antipsychotics - These drugs improve the thought process and behavior of patients with psychotic symptoms, especially those with schizophrenia and other psychotic disorders 2 Categories of Antipsychotics 1. Typical (first-generation antipsychotics) conventional, or traditional group of antipsychotics helpful for managing positive symptoms Phenothiazines - Chlorpromazine hydrochloride, Fluphenazine, Thioridazine Nonphenothiazines ○ Drug dose of Haloperidol is 0.5-5 mg; the drug dose of chlorpromazine is 10-25 mg. ○ Administration for haloperidol is slow release via injection every 2-4 weeks. ○ Administration precautions should be taken to prevent soreness and inflammation at the injection site. ○ Injection sites should not be massaged, and sites should be rotated. 2. Atypical (second-generation antipsychotics) treatment for both positive and negative symptoms 2 Advantages 1. Effective in treating negative symptoms 2. Unlikely to cause symptoms of EPS, including tardive dyskinesia Clozapine - first atypical antipsychotic agent, not as likely to cause EPS AR: seizures and agranulocytosis Monitor WBC WBC < 3000 mm3 - DC Olanzapine Risperidone Aripiprazole Mechanisms of Action Antipsychotics block the actions of dopamine = dopaminergic antagonists 5 subtypes of dopamine receptors numbered D1 - D5 ○ Blocking D2 receptors - promotes the presence of EPS resulting in drug-induced pseudo-parkinsonism Atypical antipsychotics ○ weak affinity to D2 receptors → fewer EPS than typical ○ stronger affinity to D4 receptors → block the serotonin receptor Adverse Reactions (Extrapyramidal Syndrome) 1. Pseudoparkinsonism Risk patients that take high-potency typical antipsychotics (chlorpromazine) Symptoms BRAT, shuffling gait, pill-rolling motions, stopped posture, mask-like face Treatment Anticholinergic drugs 2. Acute Dystonia Risk 5% of those typical antipsychotics Symptoms Muscle spasms of the face, tongue, neck, and back, facial grimacing abnormal or involuntary upward movement laryngeal spasms Treatment Anticholinergic drugs, Benzodiazepine 3. Akathisia Risk 20% of patients who take antipsychotic drug Symptoms Trouble standing still, Restless, Paces the floor, In constant motion (feet rocking back and forth) Treatment Benzodiazepine, beta-blocker 4. Tardive Dyskinesia Risk 20%-30% of patients who have taken a typical antipsychotic drug for more than 1 year Old adults, cigarette smoker Symptoms Protrusion and rolling of the tongue, Sucking and smacking movements of the lips Chewing motion, Involuntary movement of the body and extremities Facial dyskinesia Treatment Benzodiazepines Beta-blockers Clozapine Calcium-channel blockers E, Vitamin E DDI: Atropine counteracts EPS and potentiates antipsychotic effects. Older Adults: require smaller doses of antipsychotics (from 25% to 50% less than young and middle age) Antipsychotics block the chemoreceptor trigger zone (CTZ) and vomiting center in the brain → antiemetic effect. Neuroleptic malignant syndrome (NMS) - a rare but potentially fatal condition associated with antipsychotic drugs. Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants. Observable therapeutic response: 7 to 10 days Full therapeutic effect: 3 to 6 weeks Nonadherence with antipsychotics is common. SE: drowsiness; anticholinergic effects: mouth ( ), HR ( ), BP ( ), urine ( ), GI movement ( ) Antipsychotics should not be given with other antipsychotic or antidepressant drugs EXCEPT to control psychotic behavior for selected individuals who are refractory to drug therapy. Anxiolytics I: anxiety and insomnia Benzodiazepines Examples: Chlordiazepoxide Diazepam Clorazepate dipotassium Lorazepam Alprazolam major anxiolytic group considered more effective than barbiturates enhance the action of gamma-aminobutyric acid (GABA) ○ GABA - an inhibitory neurotransmitter within the CNS Long-term use of barbiturates = drug tolerance and dependence, respiratory distress Avoid withdrawal - tapering teratogenic SE: sedation, dizziness, incontinence, constipation AR: leukopenia, drug tolerance dependence Withdrawal: agitation, nervousness, insomnia, tremor 2 Types of Anxiety 1. Primary 2. Secondary - due to GMC or psychiatric disorder - not usually managed with anxiolytics unless GMC is untreatable, severe, or causes disability Avoid Alcohol/CNS depressants respiratory depression Tobacco, caffeine, and sympathomimetics decreased the effectiveness Treatment for Benzodiazepines Overdose 1. Airway, Oxygen, RR 2. Medication Management a. Conscious? Emetic & Activated Charcoal b. Unconscious? Gastric Lavage c. Antidote Flumazenil IV d. Hypotension IV Vasopressors 3. Mental Health consultation for the patient Miscellaneous Anxiolytics Buspirone hydrochloride binds to serotonin and dopamine receptors. Effective until 1 to 2 weeks after continuous use interaction with grapefruit juice that may lead to toxicity ANTIDEPRESSANTS AND MOOD STABILIZERS Depression mood changes and loss of interest in normal activities Women between the ages of 25 and 45 years (more likely than men) 3 Types of Depression 1. Reactive depression - sudden onset after a precipitating event 2. Major depression - loss of interest in work and home, inability to concentrate and complete tasks, difficulty sleeping or excessive sleeping, feelings of fatigue and worthlessness, and deep depression (Dysphoria) 3. Bipolar disorder - swings between two moods, the manic (euphoric) and the depressive (dysphoric) Pathophysiology Insufficient amount of brain monoamine neurotransmitters (norepinephrine, serotonin, perhaps dopamine) ( ) serotonin ( ) norepinephrine CAM for Depression: St. John’s wort and Gingko biloba Class Example Action SE/ AR Tricyclic Amitryptiline Block the reuptake of NE Orthostatic hypotension, sedation, anticholinergic Antidepressants (TCA) Imipramine and SE · therapeutic: 2-4 effects, cardiotoxicity, and seizures. Nortriptyline weeks Selective serotonin Sertraline Block reuptake of SE Fluoxetine - dry mouth, blurred vision, insomnia, reuptake inhibitor Citalopram Do not block the reuptake of headache, nervousness, anorexia, nausea, (SSRI) Escitalopram dopamine and NE diarrhea, and suicidal ideation. I: Anxiety disorders (OCD, Sertraline – dizziness, headache, insomnia, panic disorders, phobias, nausea, diarrhea, orthostatic hypotension, and PTSD)· Steven Johnson’s syndrome Serotonin-norepinephrine Venlafaxine Inhibit the reuptake of SE & drowsiness, dizziness, insomnia, headache, reuptake inhibitor (SNRI) Protein binding capacity euphoria, amnesia, blurred vision, and ejaculation (27%) dysfunction. Atypical Antidepressants Trazodone Acts on SE, NE, and drowsiness, dizziness, EPS, postural hypotension, (second-generation Dopamine increased appetite, and urinary retention antidepressants) Caution: Do not take with MAOI, up to 14 days after DC. Monoamine oxidase Isocarboxazid Background: CNS stimulation (agitation, restlessness, and inhibitor (MAOIs) Selegiline MAO-A - inactivates Dopa insomnia), orthostatic hypotension Phenelzine MAO-B - inactivates NE & SE sulfate Avoid: cheese, red wine, beer, liver, bananas, Tranylcypromine yogurt, and sausage. Polydrug therapy - the practice of giving several antidepressants or antipsychotics together, should be avoided if possible because of potential serious side effects. Possible Nursing Diagnosis Risk for Self-directed Violence MOOD STABILIZERS treat bipolar affective disorder Lithium Control manic behavior Therapeutic serum range: 0.8-1.2 mEq/L Toxicity Level: 1.5 mEq/L t (1/2): 18 to 36 hours onset: fast & metabolized by the liver Caution: diuretic intake Adequate fluid intake: 1-2 Li/day SE/AR dry mouth, thirst, increased urination, weight gain, bloated feeling, metallic taste, and edema of the hands and ankles Teratogenic Mild toxicity: Diarrhea, Vomiting, Stomach pains, Fatigue, Tremors, Uncontrollable movements, Muscle weakness, Drowsiness, and Weakness. Severe toxicity (> 2.0 mEq/Li): heightened reflexes, seizures, agitation, slurred speech, kidney failure, rapid heartbeat, hyperthermia, uncontrollable eye movements, low blood pressure, confusion, coma, delirium, and death Other Points Lithium & NSAIDs → Toxicity AEDs: carbamazepine, lamotrigine, and divalproex/valproic acid for BPD Antipsychotic drugs: olanzapine, ziprasidone, and aripiprazole for acute mania and mixed episodes.