Chapter 28
Anxiolytics 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
Anxiolytics
Antihistamines 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
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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 638
Tricyclics
• 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 inhibitors
SSRIs 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 p638
Adverse 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