Psych Drugs
Psych Drugs
Psych Drugs
Psychosis
symptomatic thought disorder.
chemical imbalance within brain
Schizophrenia
MC psychosis
characterized by:
a. positive symptoms
exaggeration of normal function
incoherent speech
hallucination
delusion
paranoia
b. negative symptoms
loss in function & motivation
poverty of speech content
poor self-care
social withdrawal
Antipsychotics
• block dopamine receptor improve thought processes & behavior , EPS
• block chemoreceptor trigger zone & vomiting antiemetic effect
SE:
1. drowsiness
2. hypotension
3. anticholinergic effects
a. dystonia
spasms of tongue, neck, back & legs
facial grimacing
involuntary upward eye movement
unnatural positioning of the neck
excessive salivation
b. akathisia
uncontrolled restlessness
inability to sit & stand still
foot tapping
hand movements
c. pseudoparkinsonism
muscle tremors at rest
rigidity
bradykinesia
shuffling gait
stooped posture
pill-rolling motion of hand
drooling
anticholinergics
o trihexyphenidyl (Artane)
o biperiden (Akineton)
o benztropine (Cogentin)
benzodiazepine ie lorazepam
beta-blockers ie propanolol
d. tardive dyskinesia
• lip smacking, tongue darting, chewing
• involuntary movements of body & extremities
• facial dyskinesia
3. blood dyscrasias
I. Typical Antipsychotics
A. Phenothiazines
1. alipathic
• chlorpromazine (Thorazine)
• promazine (Sparine)
• triflupromazine (Vesprin)
2. piperazines
• fluphenazine (Prolixin)
• perphenazine (Trilafon)
• prochlorperazine (Compazine)
• trifluoperazine (Stelazine)
3. piperidines
• thioridazine ( Mellaril)
• mesoridazine (serentil)
B. Non-phenothiazines
1. butyrophenone
• haloperidol (Haldol)
• droperidol (Inapsine)
2. dibenzoxazepine
• loxapine (Loxitane)
3. dihydroindolone
• molindone (Moban)
4. thioxanthenes
• chlorprothixene (Taractan)
• thiothixene (Navane)
5. diphenylbutylpiperidine
• pimozide (Orap)
I. Typical Antipsychotics
A. Phenothiazines
block Dopaminergic 2 (D2) receptor EPS
block NE sedative & hypotensive effect
indications:
1. treat psychosis
2. tx of intractable hiccups
3. preoperative sedation
4. behavioral problems in children
5. control N & V
1. Alipathic
• chlorpromazine (Thorazine)
cause sun-sensitive skin
low potency antipsychotic
• promazine (Sparine)
• triflupromazine (Vesprin)
SE:
o sedation & dizziness
o headache
o dry mouth & eyes
o urinary retention
o EPS
2. Piperazines
• fluphenazine (Prolixin)
• perphenazine (Trilafon)
• prochlorperazine (Compazine)
• trifluoperazine (Stelazine)
3. Piperidines
• thioridazine ( Mellaril)
• mesoridazine (serentil)
B. Non-phenothiazines
block dopaminergic 2 severe EPS & less sedation
indications:
1. treat psychosis
2. tx children with severe behavior problems
3. tx schizophrenia resistant to other drugs
4. tx of Tourette’s disorder
1. butyrophenone
• haloperidol (Haldol)
high-potency antipsychotic
• droperidol (Inapsine)
2. dibenzoxazepine
• loxapine (Loxitane)
moderate sedative & orthostatic hypotension
strong EPS effects
3. dihydroindolone
• molindone (Moban)
low sedative & hypotension
strong EPS
4. thioxanthenes
• chlorprothixene (Taractan)
• thiothixene (Navane)
highly potent
same SE with molindone
5. diphenylbutylpiperidine
• pimozide (Orap)
1. clozapine (Clozaril)
SE:
Blood dyscrasias
seizures
dizziness & sedation
tachycardia
orthostatic hypotension
constipation
sialorrhea
Indication:
tx of severe schizophrenia unresponsive to
typical antipsychotics
2. olanzapine (Zyprexa)
3. quetiapine (Seroquel)
4. risperidone (Risperdal)
5. ziprasidone (Geocodon)
few or no EPS
target + & - sxs of schizophrenia
Nursing implications:
Monitor VS
Remain with client while he takes the medication.
Avoid skin contact with liquid concentrates.
Protect liquid prep from light & dilute with juice.
Administer oral dose with food or milk.
Administer IM drug deep.
Observe for EPS.
Monitor for signs of neuroleptic malignant syndrome.
Client teachings:
• Take drug exactly as ordered.
• Meds take 6 wks or longer to achieve full clinical effect.
• WBC monitored for 3 months. (WOF signs of infection)
• Avoid driving & operating machineries.
• Avoid direct sunlight.
• Avoid extremes in temperatures & increased exercise.
• Change positions slowly.
• Alipathic phenothiazines pink-red brown urine.
• Suggest lozenges, hard candy for dry mouth.
• Changes to sexual functioning & menstruation.
ANXIOLYTICS
Anxiolytics
drugs used to induce sedation, relax muscles & inhibit convulsions.
Major uses:
o Tx anxiety
o Tx insomnia
2 types of anxiety:
1. Primary anxiety
• not caused by medical condition or drug use.
• if severe & disabling anxiolytic may be prescribed.
2. Secondary anxiety
• related to medical or psychiatric disorders, drug use.
S/Sxs:
dyspnea
choking sensation
chest pain
palpitations
sweating
trembling
Nonpharmacologic measures:
relaxation techniques
psychotherapy
support groups
Pharmacologic measures:
I. Benzodiazepines
1. chlordiazepoxide (Librium)
2. diazepam (Valium) *
3. clorazepate (Tranxene)
4. lorazepam (Ativan) *
5. oxazepam (Serax)
6. alprazolam (Xanax) *
7. prazepam (Centrax)
II. Nonbenzodiazepines
A. Antihistamines
1. hydroxyzine (Vistaril, Atarax)
2. diphenyhramine (Benadryl)
B. Propanediol
1. meprobamate (Equanil, Miltown)
C. Azapirones
1. buspirone (BuSpar)
I. Benzodiazepines
1. chlordiazepoxide (Librium)
2. diazepam (Valium) *
3. clorazepate (Tranxene)
4. lorazepam (Ativan) *
5. oxazepam (Serax)
6. alprazolam (Xanax) *
7. prazepam (Centrax)
Drug interactions:
• Alcohol & other CNS depressants respiratory depression
• Tobacco, caffeine & sympathomimetics decrease effect of benzod.
CI : pregnancy
II. Nonbenzodiazepines
A. Antihistamines
1. hydroxyzine (Vistaril, Atarax)
2. diphenyhramine (Benadryl)
• short-term relief of anxiety
B. Propanediol
1. meprobamate (Equanil, Miltown)
• short-term relief of anxiety
• muscle relaxant effect
C. Azapirones
1. buspirone (BuSpar)
• newest
• lesser SE
Nursing implications:
Administer by IM route slowly in large muscle mass.
Observe for SE.
Monitor VS (hypotension, bradycardia)
Donot mix diazepam with other drugs forms precipitate.
Client teachings
• Donot drive or operate machineries
• Donot consume alcohol, CNS depressants (narcotics).
• Effective response may take 1-2 wks.
• Strictly follow drug regimen withdrawal symptoms.
ANTIDEPRESSANTS (Mood Elevators)
3 types of Depression:
1. Reactive (Exogenous) depression
• sudden onset
• “blues”
• results from a precipitating event
• tx: benzodiazepines
SE:
• strong anticholinergic effects
• orthostatic hypotension
• sedation
• GI sxs
• Allergic reactions
• sexual dysfunction
• blood dyscrasias
• seizures
• cardiac toxicity fatal cardiac dysrhythmias
1. isocarboxazid (Marplan)
2. phenelzine (Nardil)
3. tranycypromine (Parnate)
MOA: inhibit MAO (inactivates NE, dopamine & serotonin) increase in NE,
serotonin,dopamine.
Indication:
o tx depression unresponsive to TCAs & atypical (2nd generation)
antidepressants.
Indications:
1. major (unipolar) depression
2. reactive depression
3. anxiety
SE:
• orthostatic hypotension
• drowsiness
• anticholinergic effects
must not be taken with MAOIs
Indications:
1. major (unipolar) depression
2. anxiety d.o. (Obs.-Compulsive,phobias etc.)
Nursing Implications:
check liver & renal function.
Observe for s/sxs of depression.
Monitor VS (orthostatic hypotension & anticholinergiclike effects)
Monitor for suicidal tendencies when marked depression is present.
Avoid tyramine-rich foods if taking MAOIs.
Avoid alcohol & other CNS depressants additive effect.
Antidepressants lower seizure threshold anticonvulsant dose might need to be increased.
Compliance is very impt. Full effectiveness may not be evident 1-2 wks after start of tx.
I. Lithium
controls manic phase of bipolar disorder
narrow therapeutic range : 0.6 -1.2mEq/L
acute mania : 1 -1.5 mEq/L
metabolized by kidney
Na deficiency increase lithium absorption increase risk of toxicity.
Na excess lower lithium below therapeutic range.
Side Effects:
• dry mouth & thirst
• increase urination
• wt gain
• bloated feeling/ edema
• metallic taste
• hypothyroidism ( with prolonged use)
Drug interactions:
o NSAIDS, diuretics, tetracyclines increase risk of lithium toxicity.
o Caffeine products (coffee, tea cola) aggravate manic phase
Nursing implications:
Monitor VS.
Monitor renal & hepatic function.
Draw weekly blood levels (12hrs after last dose) initially, then every 1-2 months.
Monitor UO & wt.
Monitor for signs of lithium toxicity.
Maintain adequate fluid intake 2-3L /day initially & 1-2L/day maintenance.
Maintain adequate Na intake.