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PSYCHOPHARMACOLOGY

PSYCHOPHARMACOLOGY. ANTI - PSYCHOTIC. Formerly known as MAJOR TRANQUILIZERS; other known as NEUROLEPTIC Indications – PSYCHOSIS, DELUSIONS, HALLUCINATION. Blocks receptors of DOPAMINE. Haloperidol ( Haldol, Seredol, Serenace, ) - tablet, liquid, IV/ IM Chlorpromazine HCl

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PSYCHOPHARMACOLOGY

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  1. PSYCHOPHARMACOLOGY

  2. ANTI - PSYCHOTIC • Formerly known as MAJOR TRANQUILIZERS; other known as NEUROLEPTIC • Indications – PSYCHOSIS, DELUSIONS, HALLUCINATION. • Blocks receptors of DOPAMINE

  3. Haloperidol ( Haldol, Seredol, Serenace, ) - tablet, liquid, IV/ IM Chlorpromazine HCl ( Thorazine – T, L, Laractyl - T) Fluphenazine Decanoate ( Modezine - , Sydepres) TYPICAL ANTI - PSYCHOTICS - Potent blockers of DOPAMINE - Can produce EPS,

  4. Clozapine ( Clozaril, Leponex – T) Risperdone ( Risperdal – T, L, IV/ IM; Risperdal Consta) ATYPICAL ANTI - PSYCHOTICS - weak blockers of dopamine - low S/Es of EPS

  5. Side effects: • EPS ( Extra Pyramidal Syndrome) • aKATHIsia – Restlessness, inability to sit still • aKINEsia – generalized muscle rigidity • Acute DYSTONIA – • Torticollis ( wry neck) • Oculogyric Crisis ( fixed stare) • Opisthotonos ( arched back)

  6. EARLY SIGNS: - stiffness - fever - diaphoresis - tremors LATE SIGNS - dysphagia - unstable BP - respiratory depression Side effects:Neuroleptic Malignant Syndrome ( NMS)

  7. Side effects: • Tardive Dyskinesia ( TD) - permanent involuntary movements - lip smacking - tongue protruding - cheeks puffing - S/ Es are IRREVERSIBLE

  8. Side effects: • Anti – Cholinergic Side Effects - dry mouth - constipation - urinary retention • Photosensitivity • Agranulocytosis – fever, sore throat, leukopenia ** Clozapine ( Clozaril) – fewer S/Es but LIFE threatening

  9. ANTI – PARKISONIAN • Used to treat parkinsonian syndrome, dyskinesias to restore neurotransmitters: DOPAMINE & ACETYLCHOLINE. • Anti - Cholinergic action • Dopaminergic agonists – mimicks action of Dopamine

  10. Biperiden HCl ( Akineton) DI: antagonize action of Metoclopramide, enhance psychotropic drugs. Levodopa + Carbidopa (Ledocar), (Sinemet) DI: Anesthesia, MAOIs, Haldol Anti – Cholinergic action

  11. Bromocriptine ( Parlodel, Provasyn) NMS – given in PO Amantadine ( PK – Merz) – DI: amiodarone, quinidine, anti – histamine, macrolide anti – biotics. Dopamine Agonists

  12. ANXIOLYTICS • Treat anxiety and anxiety disorders • Insomnia • Benzodiazepines – most effective, also an Anti – Convulsant • Enhances action of Alcohol

  13. Diazepam ( Valium), ( Anxiol), - very fast acting, - Tab.,amp. Alprazolam ( Xanor) - intermediate action Chlorazepate ( Tranxene) - fast acting ANXIOLYTICS - Benzodiazepines

  14. Treatment of major depressive illness Panic Disorder Bipolar Disorder Groups: 1. SSRIs 2. Tricyclics 3. MAOIs ANTI - DEPRESSANTS

  15. Treat some personality disorders Anxiety Disorders Depression Increases Serotonin levels Anti – Cholinergic effect Fluoxetine ( Prozac), ( Deprizac, Deprexone) Sertraline ( Zoloft) Paroxetine ( Seroxat) Bulimia Nervosa, OCD, Depression Selective Serotonin Re – Uptake Inhibitors

  16. TCA ( Tricyclic Anti – Depressants) ADHD Anxiety Smoking Cessation Schizophrenia Bulimia Nervosa ** potentially lethal when overdosed Imipramine ( Tofranil, Trimipramine (Surmontil) Clomipramine ( Anafranil) - OCD, Depression, Panic Attacks Tricyclic Compounds

  17. Also effective in helping smokers to quit smoking Depression Agoraphobia/ Social Anxiety Potentially lethal diet & drug interaction with SSRI & Tricyclic, Demerol, Tramadol Hypertensive Crisis Phenelzine ( Nardil) Tranycypromine (Parnate) Isocarboxazid (Marplan) Stay out of TYRAMINE rich foods: Wine, cheese, liver MAOIs

  18. Treat BIPOLAR DISORDER, Manic State Most established mood stabilizer 95% excreted in the KIDNEYS Renal function tests Electrolyte – Na ( 135 -145 mEq/L) Therapeutic range – 0.5 to 1.5 mEq/L Lithium level monitoring – Q 2-3 days then weekly S/E: metallic taste, fatigue, polyuria/ dipsia 3 signs of TOXICITY: - Nausea - Vomiting - Diarrhea Drug Compliance! MOOD STABILIZING DRUGS

  19. Carbamazepine ( Tegretol) – Rashes Orthostatic hypertension Clonazepam ( Klonopin) - Acute Mania - Also an anxiolytic with almost same action. MOOD STABILIZING DRUGS

  20. ADHD Drug • Methylphenedate ( Ritalin) • Stimulates neurotransmitters ( Dopamine, Serotonin, Norepinephrine) • Mild CNS stimulation • Reverse effect – calming, slowing of activity • S/Es: anorexia, weight loss, nausea • C/Is: caffeine, sugar, chocolate.

  21. Disulfiram ( Antabuse) • Px receiving tx for Alcoholism • C/Is: Alcohol, any product with containing alcohol • S/Es: flushing, headache, diaphoresis, N/V, dizziness, halitosis, tremor, incompetence • A/Rs: chest pain, dyspnea, severe hypotension, DEATH • Liver enzyme tests • D/I: Dilantin, INH, Warfarin, diazepam

  22. ANXIETY

  23. Anxiety – vague feeling of dread Sense of impending doom No Identifiable object Fear – almost the same emotional feelings with anxiety but with identifiable object ANXIETY vs FEAR

  24. LEVELS of ANXIETY 1. Mild Anxiety – - enhance learning - relaxed; slightly restless - attentive - make decisions fast

  25. 2. Moderate Anxiety – - pacing - slightly disorganized - “butterflies in the stomach” - urinary frequency - decreased attention span ** may give PRN medication – muscle relaxants

  26. 3. Severe Anxiety – - don’t know what to do or say - no direction at all - hyperventilation - gnash teeth - increased diaphoresis - wringing hands - Agitation, Confusion

  27. 4. Panic – - SNS activation - Disorganized - Gross motor agitation - Freeze - Distorted thoughts - Cannot solve problems - personality disorganized - out of control, helpless, overwhelmed

  28. Delusion – fixed, false belief not based in reality • Hallucination – false sensory perception or perceptual experiences that do not exist in reality • Illusion – other known as deception

  29. Intense fear of a SPECIFIC OBJECT/ SITUATION ILLOGICAL Cause extreme DISTRESS/ PANIC Pharmacologic Tx.: - Anxiolytics - SSRIs - Propanolol ( Inderal) – beta – blocker to reduce HR & decrease BP PHOBIAS

  30. Psychotherapy - identify anxiety reaction - relaxation techniques - self control - Desensitization – progressive exposure - Flooding – rapid desensitization

  31. Obsession – recurrent thoughts, ideas, visualizations, anxiety producing Affects interpersonal relationship Aware of excessive thoughts Compulsion – behaviors or rituals carried – out to get rid of obsessive thoughts or reduce anxiety OBSESSIVE – COMPULSIVE DISORDER

  32. Common Compulsions: - handwashing - counting - checking - touching - arranging/ rearranging - cleanliness

  33. Psychophramacoligic Tx: - SSRIs – recent drugs indicated to treat OCD - Anxiolytics • Nursing intervention: - frequency of rituals - do not stop px from doing his/her rituals - reduction techniques

  34. POST TRAUMATIC STESS DISORDER • Witness of an extraordinarily terrifying/ deadly event. • Experiences FLASHBACKS, recollection, nightmares • Assessment: Startled, hypervigilance, insomnia Tx: - anxiolytics - anti – depressants - psychotherapy – group or individual therapy - in large groups – CISD

  35. Child abuse - physical abuse - sexual abuse - neglect - psychological abuse Assessment: - burns - bruises Tx: - ensure safety - social well being - therapy – play, family ABUSE & VIOLENCE

  36. Rape - violence & humiliation expressed through sexual means - sexual intercourse without consent Tx/ intervention: - secure safety - ensure confidentiality - referral to psychiatric, gynecologic management and rape crisis centers - group therapy

  37. SCHIZOPHRENIA • Disease affecting the brain resulting to distorted & bizaare mental, cognitive, emotional, behavioral perceptions.

  38. Types of Schizophrenia • Paranoid Type – persecutory, hostile behavior - feeling of being spied on - grandiose delusions - hallucinations

  39. Disorganized type – inappropriate or flat affect, loose associations, disorganized behavior • Catatonic Type – psychomotor disturbance, motionless or excessive motor activity, echolalia, echopraxia • Undifferentiated Type – mixed schizophrenic symptoms, with thought, affect, behavior. • Residual Type – social withdrawal, flat affect, looseness of association

  40. Symptoms of Schizophrenia

  41. Pharmacologic tx: - Anti – Psychotics • Psychotherapy: - Group therapy - Family therapy

  42. Suicide • Common in patients with mood disorders, DEPRESSION • Intentional act of killing oneself • Suicidal ideation – having thought of killing oneself

  43. Assessment: Age Sex Marital status Employment Interpersonal relationship Family background Factors: - 45 y.o. – older - alcohol dependence - violence - male - depression - loss physical health - singled, widowed, divorced

  44. Evaluation of Suicide Risk

  45. Treatment: - Hospitalization - Out – patient management - Pharmacotherapy - Psychotherapy

  46. PERSONALITY DISORDERS • When persons personality traits become inflexible and maladaptive, interferes optimum level of functioning. • Longstanding due to personality characteristics are not easily changed

  47. TYPES

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