Drugs Used in Mental Health

1. Drugs Used in Mental Health Antianxiety Drugs

2. Antianxiety Drugs • Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality • Anxiolytics – another name for antianxiety medications

3. Antianxiety Drugs • Block neurotransmitter receptor sites preventing anxious feelings from reaching brain • Also prevents body’s physical reaction to anxiety

4. Antianxiety Drugs Common Uses • Anxiety disorders and panic attacks • Preanesthetic sedation and muscle relaxants • Convulsions or seizures - diazepam (Valium) • Alcohol withdrawal

5. Antianxiety Drugs • Benzodiazepines • diazepam (Valium) half life: 36-200 hr • clonazepam (Klonopin) half life: 18-50 hr • chlordiazepoxide (Librium) half life: 5-25 hr • alprazolam (Xanax) half life: 6-12 hr • lorazepam (Ativan) half life: 10-20 hr

6. Antianxiety Drugs • Nonbenzodiazepines • doxepin (Sinequan) half life: 28-52 hr • buspirone HCl (BuSpar) half life: 2-3 hr * buspirone (BuSpar) drug of choice with elderly because it does not cause excessive drowsiness and poses less fall risk

7. Antianxiety Drugs Side Effects / Adverse Reactions • Drowsiness / sedation • Lightheadedness / dizziness • Headache, visual disturbances • Lethargy, apathy, fatigue • Confusion, restlessness, agitation • GI disturbances, dry mouth

8. Antianxiety Drugs • Benzodiazepine Toxicity • Results from overdose • Sedation, respiratory depression, coma, death • Antidote: flumazenil (Romazicon) • Parenteral Alert • IM, IV route may lead to apnea and cardiac arrest • Use care with elderly, debilitated, respiratory compromised

9. Antianxiety Drugs High Risk for Physical Dependence • Long term use • Tolerance • Physical dependence • Withdrawal symptoms • After 3 months of use, do NOT discontinue abruptly

10. Antianxiety Drugs Withdrawal Symptoms • Increased symptoms of anxiety • Fatigue, hypersomnia • Metallic taste, nausea, sweating • Headache, difficulty concentrating • Cramps, tremors • Hallucinations, convulsions

11. Contraindications • Psychoses • Acute narrow angle glaucoma • Pregnancy • Floppy infant syndrome • Lactation • Infant becomes lethargic and loses weight • Significant hypotension / bradycardia

12. Precautions • Use cautiously with elderly • Initial Low Dose: excreted more slowly, high risk for toxic levels • Exception: lorazepam (Ativan), safe for elderly at usual ranges • Use cautiously in patients with • Impaired liver function • Impaired kidney function • Overall debilitation • Avoid alcohol

13. Interactions • Use cautiously with elderly • Initial Low Dose: excreted more slowly, high risk for toxic levels • Exception: lorazepam (Ativan), safe for elderly at usual ranges • Use cautiously in patients with • Impaired liver function • Impaired kidney function • Overall debilitation • Avoid alcohol

14. Nursing Process • Assessment • Nursing Diagnoses • Planning • Implementation • Evaluation

15. Assessment • Vital Signs • Allergies • Labs • General appearance • General comfort • Route of Administration

16. Nursing Diagnoses • Risk for injury • Impaired comfort • Ineffective individual coping

17. Planning • What will the patient require? • What is the expected outcome? • What adverse reactions might occur?

18. Implementation • Route of administration • Drug interactions • Concurrent CNS depression • Safety concerns • Mouth care, hard candies, sugarless gum for dry mouth • Fluids and fiber to prevent constipation

19. Evaluation • Is the patient • Less anxious? • subjective evaluations • objective evaluations • More comfortable? • Experiencing any adverse reactions? • Developing tolerance / addiction?

20. Patient Teaching • Take as directed • Do not discontinue abruptly • Avoid hazardous activity • Advise physician of all OTC medications and supplements • Do not drink alcohol

21. Hypnotics • Hypnotic – drug that induces drowsiness or sleep

22. Hypnotics Common Uses • Insomnia • Convulsions - Valium • Adjuncts for anesthesia • Preanesthesia • Conscious sedation

23. Hypnotics • Barbiturates • pentobarbital (Nembutal) half life: 15-48 hr • secobarbital (Seconal) half life: 15-40 hr

24. Hypnotics • Benzodiazepines • flurazepam (Dalmane) half life: 40-250 hr temazepam (Restoril) half life: 8-20 hr • triazolam (Halcion) half life: half life: 2-3 hr • Nonbenzodiazepines • Zolpidem tartrate (Ambien) half life: 2-3 hr

25. Hypnotics Side Effects / Adverse Reactions • CNS depression • Lightheadedness / dizziness • Headache • Tolerance, addiction • Rebound insomnia, hangover • GI disturbances, dry mouth

26. Contraindications • Respiratory problems • History of substance abuse • Pregnancy / lactation

27. Precautions • Use cautiously with elderly • Elderly • Debilitated • Mental health concerns • Use cautiously in patients with • Impaired liver function • Impaired kidney function • Overall debilitation • Avoid alcohol

28. Interactions • Increased CNS depression with • Alcohol (Alcohol + Barbituates = Coma, Death ) • Opiod (narcotic) analgesics • Antihistamines • Antidepressants • Anxiolytics, antipsychotics • Cimetidine (Tagamet)

29. Nursing Process • Assessment • Nursing Diagnoses • Planning • Implementation • Evaluation

30. Assessment • Factors interfering with sleep • Reduce environmental stimuli • Administer pain medication if needed • Administer at hour of sleep • Not too early • Not too late

31. Nursing Diagnoses • Risk for injury • Ineffective breathing pattern • Ineffective individual coping

32. Planning • What will the patient require? • What is the expected outcome? • What adverse reactions might occur?

33. Implementation • Supportive care • Reduce caffeine intake • Provide safety

34. Evaluation • Is the sleep pattern improved? • Rested in the morning? • subjective evaluations • objective evaluations • Experiencing any adverse reactions? • Developing tolerance / addiction?