1 / 38

Drugs for Psychiatric Disorders

Drugs for Psychiatric Disorders. By Dr. L. Saarmann, RN. Mechanism of Action - TCAs. Factors Affecting Antipsychotic Response. Metabolism Smoking ETOH Diet Herbals Prescribing bias. Antipsychotic Agents. Typical antipsychotics: 1. Phenothiazines a. Aliphatics [ eg . Thorazine ]

iliana
Download Presentation

Drugs for Psychiatric Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Drugs for Psychiatric Disorders By Dr. L. Saarmann, RN

  2. Mechanism of Action - TCAs

  3. Factors Affecting Antipsychotic Response • Metabolism • Smoking • ETOH • Diet • Herbals • Prescribing bias

  4. Antipsychotic Agents • Typical antipsychotics: • 1. Phenothiazines • a.Aliphatics [eg. Thorazine] • b. Piperidine [eg. Mellaril] • c. Piperazine [eg. Stelazine] • 2. Thioxanthenes [eg. Navane] • 3. Butyrophenones [eg. Haldol]] 4. Dihydroindolones[eg. Moban] • 5. Dibenzoxazepines [eg. Loxitane]

  5. Antipsychotic Agents • Atypical antipsychotics: Dibenzodiazepines[Clozaril, Zyprexa] Benzioxazoles[eg. Risperdal] Quetiapine[Seroquel]

  6. Action • Block dopamine receptors in the brain and thus decrease the dopamine concentration in the CNS • Also produce alpha-blocking effect or blockade of dopamine in the CTZ, and peripheral inhibition of the vagus nerve in the GI tract. • Depress RAS

  7. Dopamine Pathways • 1. Mesolimbic-mesocorticalB • 2. NigrostriatalB • 3. TuberoinfundibularB • 4. Medullary-periventricular B • 5. Incertohypothalamic B

  8. Uses • 1. Psychosis • 2. N/V • 3. Pain and sedation • 4. Adjuncts to tx of tetanus • 5. Acute intermittent porphyria • 6. Intractable hiccups • 7. Tourette=s syndrome

  9. Kinetics • Onset gradual • Dosage varies • Reduce gradually • Long duration and ½ life

  10. Side Effects • Most frequent: sleepiness, dizziness, dry mouth, constipation, nasal congestion Also • a. Thioxanthenes = sun sensitivity • b. Haldol = blurred vision, inc weight • c. Clozapine = insomnia, HA, tremors, nausea

  11. Side Effects • Most serious: • Visual changes, hypotensive episodes • dystonia and/or Parkinson like effects [EPS] • akathisia, pacing, insomnia • tardive dyskinesia • clozapine can cause agranulocytosis, hypotension, tachycardia, seizures. • Neuroleptic malignant syndrome -

  12. Neuroleptic Malignant Syndrome • SX : • Rigidity • Autonomic instability – • Hyperthermia - • Change in LOC • Labs: • CPK high • WBC high with shift to the left • ABG = resp acidosis and later metabolic acidosis

  13. Drugs • Phenothiazines: • Chlorpromazine [Thorazine] • Fluphenazine[Prolixin] -   • Thioxanthenes: • Thiothixene[Navane] – • Butyrophenones • Haloperidol [Haldol] - often EPS, low others • Dihydroindolones • Molindone[Moban] - • Dibenzoxazepines: • Loxapine[Loxitane]

  14. Drugs • Dibenzodiazepines: • Clozapine [Clozaril] - unique - works on serotoninergic, adrenergic, and cholinergic neurotransmitter systems of the brain, as well as dopaminergic. high risk of agranulocytosis.. • Olanzapine (Zyprexa) – • Benzisoxazoles: • Risperidone [Risperdal] -. Blocks serotonin and dopamine receptors. Indicated for schizophrenic sx, such as delusion, hallucinations, depression and apathy. SE: wt gain, dec. BP, difficulty c concentration • quetiapine [Seroquel] – blocks serotonin and dopamine receptors. Taken BID or TID.

  15. Drugs • Aripiprazole [Abilify] – for both positive and negative symptoms. Low EPS. Relatively high cardiovascular risk. • Is both a dopamine antagonist and agonist in different parts of the brain.

  16. Geriatrics • Higher serum levels • Need lower doses • More prone to • orthostatic hypotension, anticholinergic SE, EPS, and sedation • Increased anxiety c TCAs • Lithium more toxic

  17. Peds • Greater risk of EPS • TCAs usually not for kids • Lithium decreased bone formation/density

  18. Nursing • be alert for signs of agranulocytosis • make sure they get eye checks. • Look for signs of tardive dyskinesia • Look for signs of NMS. • Give IMs slowly into big muscle • Ptmay need drug holidays to decrease SE. • Phenothiazines – • avoid ETOH and other CNS depressants. • Increase intake of Vit B2 - • Avoid extremes of temperature.

  19. TCAs • Major differences in SE - sedation, anticholinergic, postural hypotension • Action: correct imbalance of neurotransmitter at the nerve endings in the CNS. Long 2 life - 15-30 hrs, • Effects: also block muscarinic, histaminergic, adrenergic, dopaminergic, and serotonergic receptors.

  20. TCAs • Uses: • txdepression. • enuresis. • obsessive-compulsive disorders.

  21. TCAs • SE: • tachycardia, • HA, • nausea, • dry mouth, constipation, urinary retention, • blurred vision, • sedation • wtgain, • hypotension, • EPS.

  22. TCAs • Drugs: • amitriptyline [Elavil] • Amoxapine[Asendin] – • Doxepine[Sinequan]

  23. SSRIs • Action: inhibit reuptake of serotonin at synapse • Uses: • depression, • bipolar disorder, • obsessive-compulsive disorder, • panic attacks, • myoclonus. • substance abuse problems.

  24. SSRIs • SE: • HA, • dizziness, • tremor, • insomnia, • fatigue, • N/D/C, dry mouth, • sweating, • male sexual dysfunction. • Central serotonin syndrome

  25. Interactions • all SSRIs inhibit liver isoenzymes [P-450] • B-blockers, TCA=s, antipyschotics, antiarrhythmic. • very protein bound

  26. Drugs • bupropion [Wellbutrin] • Trazadone[Desyrel] • Fluoxetine [Prozac] – • Paroxetine [Paxil] • Sertraline [Zoloft] • Venlafaxine [Effexor]

  27. MAOIs • Action: inhibit MAO --> increased levels of neurotransmitter • Interactions: DO NOT GIVE WITHIN 2 WEEKS OF TRICYCLICS OR SSRI’S • interacts with foods containing tyramine hypertensive crisis.

  28. Tyramine Foods • High - not allowed at all: • aged cheeses [cheddar, blue, Swiss, Camembert, etc] • smoked or pickled meats, fish, poultry [herring, sausage, salami, pepperoni, corned beef] • yeast extracts [Brewer’s yeast] • red wines • fava beans

  29. Tyramine Foods • Moderate - may eat small amts • meat extracts [bouillon, consomme] • light and pale beer • ripe avocado

  30. Tyramine Foods • Small - may eat • distilled spirits [vodka, gin, rye, scotch] • American cheese, mozzarella cheese, cottage cheese, cream cheese • chocolate and caffeine • fruit [figs, raisins, grapes, pineapple, oranges] • soy sauce • yogurt, sour cream

  31. MAOIs • Drugs • phenelzine [Nardil] • tranylcypromine [Parnate] • Contraindications: • active ETOH abuse, CHF, pheochromocytoma, serverehepatic impairment, renal impairment.  

  32. Lithium • Action: • Decrease postsynaptic receptor sensitivity • Stabilize cell membranes • Blockade of tri-and diphosphate system in CNS • Kinetics • Not metabolized

  33. Lithium SE • Most common: • cognitive dysfunction - confusion, poor memory, slowness. • Less common: • tremors of hands, thirst, nausea, increased urination, diarrhea. tachycardia, increased weakness, weight gain, resp difficulties on exertion, fainting, irreg pulse. • Early signs of tox include: • anorexia, diarrhea, muscle weakness, nausea, vomiting, slurred speech, drowsiness.

  34. Antianxiety Agents • Benzodiazepines - depress activity in the limbic system by increasing GABA. •  Uses: • anxiety, • sedation, • muscle relaxation, • seizures, • ETOH withdrawal, etc.

  35. Antianxiety Agents • SE: • drowsiness, sedation, • loss of coordination, • dizziness, • blurred vision, • HA, • N/V/C, dry mouth, • paradoxical reactions

  36. Antianxiety Agents • Drugs: • alprazolam [Xanax] • Chlordiazepoxide [Librium] • Diazepam [Valium] • Lorazepam [Ativan]

More Related