1 / 44

Drugs Used in Mental Health

Drugs Used in Mental Health. Antianxiety Drugs. 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. Antianxiety Drugs.

lawson
Download Presentation

Drugs Used in Mental Health

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 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 • Other CNS depressants: Increased risk of sedation, confusion, convulsions • Alcohol • Narcotic Analgesics • Other Psychotropics • Digoxin • Increased risk for Digitalis Toxicity

  14. Antidepressants • Depression – feelings of hopelessness that interfere with daily functioning

  15. Antidepressants • Neurotransmisson • Important Neurotransmittors • Dopamine • Epinephrine • Norepinephrine • Serotonin

  16. Antidepressants Types of Antidepressants • Tricyclic Antidepressants (TCA’s) • Monoamine Oxidase Inhibitors (MAOI’s) • Selective Serotonine Reuptake Inhibitors (SSRI’s) • Miscellaneous

  17. Antidepressants • Tricyclic Antidepressants (TCA’s) • Earliest antidepressants • Enhances movement of serotonin from one neuron to the next • Examples • Doxepin (Sinequan) • Imipramine (Tofranil)

  18. Antidepressants • Tricyclic Antidepressants (TCA’s) • Uses • Depressive episodes • Bipolar disorder • Obsessive – compulsion disorder • Chronic neuropathic pain • Depression accompanied by anxiety • Enuresis

  19. Antidepressants • Tricyclic Antidepressants (TCA’s) • Side Effects • Anticholinergic-like side effects (insomnia, dry mouth, lethargy, confusion, blurred vision, urinary retention) • Constipation • Photosensitivity

  20. Antidepressants • Tricyclic Antidepressants (TCA’s) • Contraindications and Precautions • Use with caution in patients with cardiac history • Do not give during pregnancy or lactation • Use with caution with hyperthyroid disease • Use with caution with seizure disorder • Use with caution with hepatic / renal impairment

  21. Antidepressants • Tricyclic Antidepressants (TCA’s) • Interactions • Avoid other CNS depressants, including alcohol • Dicumarol (similar to warfarin): increased bleeding times • Cimetidine (Tagamet): increased anticholinergic-like effects • MAOI’s: hypertension, convulsions, fever • Adrenergics: arrhythmias, hypertension

  22. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • No longer in common use • Inhibit the enzyme responsible for inactivating (destroying) certain neurotransmittors • Example • Phenelzine (Nardil)

  23. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Uses • Depressive episodes • Unlabelled used: bulemia, night terrors, migraines, seasonal affective disorder (SAD), multiple sclerosis

  24. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Side Effects • Orthostatic hypotension • Anticholinergic-like side effects (insomnia, dry mouth, lethargy, confusion, blurred vision, urinary retention) • Constipation • Hypertensive Crisis

  25. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Hypertensive Crisis with Foods Containing the amino acid Tyramine • Cheese • Wines (especially red) • Caffeine • Soy

  26. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Symptoms of Hypertensive Crisis • Headache (usually occipital) • Stiff, sore neck • Nausea, vomiting • Sweating, fever, chest pains, mydriasis • Severe hypertension

  27. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Contraindications and Precautions • Use with caution in patients with cerebrovascular disease • Use with caution in patients with history of hypertension and/or congestive heart failure • Do not give to pregnant women or children • Use with caution with hepatic / renal impairment

  28. Antidepressants • Monoamine Oxidase Inhibitors (MAOI’s) • Interactions • Avoid other CNS depressants, including alcohol • Hydrochlorothiazide: increased hypotension • Tyramine, tryptophan: increased risk of hypertensive crisis • TCA’s: hypertension, convulsions, fever • Adrenergics: arrhythmias, hypertension

  29. Antidepressants Inhibiting Serotonin Reuptake

  30. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Widespread use • Inhibits reuptake of serotonin, thus allowing more serotonin to travel across neurons • Examples • Fluoxetine (Prozac) • Paroxetine (Paxil) • Sertraline (Zoloft)

  31. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Uses • Depressive episodes • Obsessive – compulsion disorder • Bulemia nervosa • Unlabelled uses: menstrual disorders, post traumatic stress disorder (PTSD), phobias • Therapeutic Effect: 2-4 weeks

  32. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Side Effects • Somnolence, insomnia, dizziness • Headache, tremors, weakness • Constipation, dry mouth, nausea • Pharyngitis, rhinitis • Loss of libido, erectile dysfunction • Serotonin syndrome

  33. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Serotonin Syndrome (increased levels of serotonin) • Increased metabolism (diarrhea, vomiting, fever) • Increased cardiovascular (tachycardia, hypertension) • Increased neuromuscular (agitation, ataxia, muscle spasms)

  34. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Contraindications and Precautions • Use with caution in patients with cardiac history • Use with caution in patients with diabetes • Do not give until two weeks after stopping MAOI • Use with caution with hepatic / renal impairment • Monitor closely for serotonin syndrome during first two weeks of therapy or dosage increase

  35. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRI’s) • Interactions • Avoid other CNS depressants, including alcohol • Other antidepressants: increased toxic effects • Cimetidine (Tagamet): increased anticholinergic effects • Aspirin, NSAID’s: increased risk of GI bleeding • Lithium: increased risk of lithium toxicity

  36. Antidepressants • Miscellaneous • Brupropion HCl (Wellbutrin): often used for smoking cessation as well as depression • Duloxetine HCl (Cymbalta): often used for diabetic neuropathy discomfort as well as depression

  37. Drugs Used in Mental Health Antipsychotic Drugs

  38. Antipsychotic Drugs • Psychosis – affects mood and behavior • Characterized by hallucinations and / or delusions

  39. Antipsychotic Drugs Common Uses • Acute and chronic psychoses • Bipolar illness • Agitated behaviors associated with dementia

  40. Antipsychotic Drugs Common Medications • Aripiprazole (Abilify) • Haloperidol (Haldol) • Risperidone (Risperdal) • Lithium

  41. Antipsychotic Drugs Side Effects / Adverse Reactions • Drowsiness / headache • Dry mouth / constipation • Photophobia / photosensitivity • Extrapyramidal symptoms • Tardive dyskinesia • Neuroleptic malignant syndrome

  42. Antipsychotic Drugs Lithium Toxicity • High levels of lithium toxic to body • Antacids: decreased effectiveness of lithium • Loop diuretics: increased risk for lithium toxicity

  43. Psychotropics: Patient Teaching • Take as directed • Do not discontinue abruptly • Avoid hazardous activity • Advise physician of all OTC medications and supplements • Do not drink alcohol • Mouth care, hard candies, sugarless gum for dry mouth • Fluids and fiber to prevent constipation

More Related