Chapter 28Anxiolytics and Other Agents Used to

Treat Psychiatric Conditions

Psychotherapeutics • Agents used in the treatment of emotional

and mental disorders• Commonly prescribed drugs

– Used when a person’s ability to cope with his or her environment is seriously impaired

Psychotherapeutics p632• Used for treatment of:

– Anxiety (anxiolytics)– Mental and emotional disorders– Psychosis (break with reality)– Affective disorders (mood disorders)

Anxiety

Anxiolytics p632• Barbiturates

– The oldest drugs to be used as anxiolytic agents• Depress the CNS• Suppress REM sleep

• Carbamates– Depress the CNS– Similar to barbiturates– Ex: meprobamate – Cause considerable – daytime sedation

AnxiolyticsAntihistamines and Benzodiazepines

p633-634 • Antihistamines– Used as anxiolytics– Cause sedation– Example: Hydroxyzine: useful in tx of pruritic

dermatoses• Benzodiazepines

– First line of drugs used for anxiety disorders– Produce sedation and muscle relaxation

Anxiolytics: Side Effect/Adverse Effects

• Usually safe– Sedation– Relaxation

• Check vital signs

• Dangerous when taken with:– Other CNS depressants

– Alcohol• Respiratory arrest

• Provide for pt safety

Antipsychotic Agents p643• Treat

– Schizophrenia– Organic psychosis– Manic phase of bipolar affective disorder

• Clients with psychotic disorders show symptomatic improvement

• Action: Decreased dopamine levels. When dopamine levels are lowered, Ach levels are raised. The increase in acetylcholine accounts for many of the adverse effects of psychotropic medications.

Side effects antipsychotic agents p644

• Extrapyramidal symptoms– from lowered dopamine levels which

result in increased acetylcholine levels• Uncontrollable tremors, jerky

movements, akathisia, insomnia, pacing, spasms, tics

– Tardive dyskinesia: can become permanent

• Rhythmic involuntary movements of facial muscles and tongue

• EPS symptoms can be reduced with anticholinergics

Side effects antipsychotic agents p644

• Impaired temperature regulation• Lower the seizure threshold• Photosensitivity• Interference in ejaculation in males• Orthostatic hypotension• Examples

– Chlorpromazine (Thorazine)• Prototype

Anti-manic agents p645• Lithium is the drug of choice for treatment of manic episodes• Lithium toxicity:

– N&V – diarrhea – fatigue – tremors – ataxia – coma – convulsions – death

– Low serum sodium levels may cause lithium retention and lithium toxicity

Lithium cont p648• Nursing considerations

– Anticipate labs for serum lithium levels– Teach add salt to food to prevent lithium toxicity– No appreciable drug effect for one week.

Other mood stabilizers p648• Anti-convulsants used as

mood stabilizers:– Valproate (Depakote)– Carbamazepine

(Tegretol)– Lamotrigine (Lamictal)– Gabapentin (Neurontin)– Topiramate (Topamax)

Antidepressant agents p638-643

• Classes of antidepressants– Tricyclic antidepressants– Monoamine Oxidase Inhibitors (MAOIs)– Selective Seratonin Reuptake inhibitors (SSRIs)– Other antidepressant agents

Tricyclic Antidepressants p 638Tricyclics

• Increase norepi levels– Used to treat

• Depression• Chronic pain• Bedwetting• Examples:

• amitriptyline (Elavil) • imipramine (Tofranil)

Tricyclic Antidepressants p638• Adverse/side effects

– Orthostatic hypotension – sedation – weight gain – dry mouth – urinary retention – tremors– sexual dysfunction

Monoamine Oxidase Inhibitors (MAOIs) p639

• Inhibit monoamine oxidase– Monoamine oxidase (produced by liver)

• Normally inactivates neurotransmitters such as serotonin and dopamine

• Examples:– Phenelzine (Nardil)– Tranylcypromine (Parnate)

• Dangerous side effects of MAOIs• Hypotension• Hypertension• Death

.

Diet restrictions MAOIs • Diet restrictions for pt on MAOIs

• Avoid tyramine rich foods Table 28-3 page 640– Aged or cured foods are rich in tyramine

• Potentially fatal hypertension can result when tyramine is ingested

Selective seratonin reuptake inhibitorsSSRIs p638

• Examples:– Fluoxetine HCl (Prozac) – Sertraline HCl (Zoloft) – Paroxetine HCl (Paxil)

• Action: increase seratonin levels. For mild to moderate depression

• Can take several weeks for therapeutic levels to be reached

SSRIs continued p638Adverse effects and side effects

– Nausea – dry mouth – headache– Dizziness– Decreased libido– Agitation– Insomnia– Potential for suicide attempt

Geriatric Considerations– Potential for toxic effects is increased• Side effects increased

– Orthostatic hypotension, sedation, and anticholinergic side effects

• Increased anxiety is associated with the use of tricyclic antidepressants

• Lithium is more toxic in elderly clients; lower doses are necessary

28 - 21