SESSION 8: ANTIPSYCHOTICS & ANXIOLYTICS - Anxiolytics are also used as anticonvulsants,

preoperative drugs, substance abuse

Anxiolytics
withdrawal agents.
- Action is that benzodiazepines enhance the Antipsychotics
action of gamma amino-butyric acid (GABA),
an inhibitory neurotransmitter in the brain. - They are used to treat psychosis present in
patients with schizophrenia.
Anxiolytic and Hypnotic Drugs
- One theory in schizophrenia is the imbalance
- Indicated for patients who have anxiety disorders in the neurotransmitter dopamine in the
(e.g. Generalized anxiety disorder, PTSD, brain.
obsessive-compulsive disorder, panic disorder, - Antipsychotics block D2 dopamine receptors
phobias). in the brain, reducing psychotic symptoms.

• Benzodiazopenes (drugs ending in -am or - Typical Antipsychotics (May Topak PaSHeNTS)

pam) except chlordiazepoxide and ▪ Thioridazine (Mellaril)
chlorazepate. ▪ Perphanazine (Trilafon)
▪ Alpazolam (Xanax)
▪ Fluphazenine (Prolixin)
▪ Chlordiazepoxide (Librium)
▪ Clorazepate (Tranxene) ▪ Mesoridiazine (Serentil)
▪ Diazepam (Valium) ▪ Haloperidol (Haldol)
▪ Estazolam (ProSom) ▪ Thithexene HCl (Navene)
▪ Flurazopam (Dalmane) ▪ Chlorpromazine (Thorazine)
▪ Lorazepam (Activan) ▪ Trifluoroperazine HCl (Stelazine)
▪ Oxazepam (Serax)
▪ Quazepam (Doral) Atypical Antipsychotics
▪ Tamazepam (Restoril)
▪ Clozapine (Clorazil)
▪ Triazolam (Halcoin)
▪ Risperidone (Risperdal)
Nursing considerations:
Side effects (do the Macarena dance to remember):
❖ Warn patients not to drive or operate
heavy machinery since ❖ Atropine-like/Anticholinergic side-effects
benzodiazopenes can cause sedations. (e.g. dry mouth, blurred vision, photophobia,
• Barbiturates (drugs ending in -barbital) such orthostatic hypotension, urinary retention,
as phenobarbital and pentobarbital. constipation)
o Not first in line used for anxiety disorders ❖ Other side effects are sexual dysfunction,
since they can cause serious adverse galactorrhea, and gynecomastia.
effects.
Other side effects (APAT):
▪ Amobarbital (Amytal sodium)
▪ Butabarbital (Butisol) ❖ Akathisia – restless, trouble standing still,
▪ Mephobarbital (Mebaral) paces the floor, feet in constant motion,
▪ Pentobarnital (Nembutal) rocking back and forth.
▪ Phenobarbital (Luminal)
❖ Pseudoparkinsonism – stooped posture,
▪ Secobarbital (Seconal)
shuffling gait, rigidity, bradykinesia, tremors
Nursing considerations: at rest, pill-rolling motion of the hand.
❖ Acute dystonia – facial grimacing; involuntary
❖ Monitor the patient’s RR since they can
cause respiratory depression.
upward eye movement; muscle spasms of
❖ Also advise the patients not to drive or the tongue, face, neck, and back; laryngeal
operate heavy machinery. spasms.
❖ These drugs are no longer considered as ❖ Tardive dyskenisia – protrusion and rolling of
the mainstay treatment for anxiety since tongue; sucking and smacking movements of
they can cause physical tolerance and the lips; chewing motion; facial dyskenisia;
psychological dependence among involuntary movement of the body and
patients. extremities.
• Atypical Anxiolytic – Buspirone (BuSpar)
SESSION 9: ANTIDEPRESSANTS & MOOD STABLIZERS hypertensive crisis when taken with
tyramine-rich foods.
Antidepressants
▪ Isocarboxazid (Parnate)
- Depression is the most common psychiatric ▪ Phenelzine (Nardil)
problem affection approximately 10-20% of ▪ Tranylcypromine (Marplan)
the population. Mnemonic: PaNaMa
- Theory in depression is that there is
Nursing considerations:
insufficient amount of norepinephrine,
serotonin, perhaps dopamine in the brain. ❖ Educate the patient about avoiding
- It is thought to occur together with tyramine-rich foods (e.g. beer, red wine,
norepinephrine. processed meat, soy- based foods, aged
cheese, etc.)
Antidepressant Agents ❖ Watch out for hypertensive crisis in
patients who have accidentally ingested
• Selective Serotonin Reuptake Inhibitors any tyramine-rich food. In order to
(SSRI) – block the reuptake of serotonin. counteract the effect of hypertensive
▪ Fluoxetine (Prozac) crisis, administer Regitine.
▪ Setraline (Zoloft)
▪ Fluvoxamine (Luvox)
PZLPCL
▪ Paroxetine (Paxil) BIPOLAR AFFECTIVE DISORDER
▪ Citolapram (Celexa)
- Involves swings between two moods, the manic
▪ Escitalopram (Lexapro)
(euphoric) and the depressive (dysphoric).
Nursing considerations: Manic phase signs and symptoms would be:
➢ Hyperactivity
❖ Educate the patient about the ➢ Rapid Speech
anticholinergic side-effects of SSRIs (e.g. ➢ Flight of ideas
dry mouth, orthostatic hypotension, ➢ Delusion of grandeur
urinary retention, blurred vision, ➢ Hypersexuality
constipation, etc.).
❖ They can also cause sexual dysfunctions Antimanic Drugs
❖ Advise the patient that antidepressants
usually take effect at around 2-4 weeks • Lithium (Lithane)
after the initial dose. ❖ Monitor serum levels: normal is
• Tricyclic Antidepressants – block the around 0.5-1.5mEq/L.
reuptake of serotonin and norepinephrine. ❖ Monitor for adverse effects such as
▪ Nortripyline (Pamelor) lethargy, slurred speech, muscle
▪ Clomipramine (Anafranil) weakness, and fine tremor.
▪ Amytriptyline (Elavil)
Other antimanic drugs:
▪ Imipramine (Tofranil)
▪ Doxepin (Sinequan) • Carbamazepine (Tegretol)
▪ Desipramine (Norpramine)
• Valproic acid (Depakote, Valproate)
▪ Proptriptyline (Vivactil)
▪ Trimipramine (Surmontil)
▪ Nortriptyline (Aventyl) ATTENTION DEFICIT/HYPERACTIVITY DISORDER
(ADHD)
Nursing considerations:
- It might be caused by a dysregulation of the
❖ TCAs can also cause anticholinergic
transmitters, serotonin, norepinephrine, and
side-effects to patients.
dopamine.
❖ Effect is also at around 2-4 weeks.
- Occurs primarily in children, usually age of 7
• Monoamine Oxidase Inhibitors (MAOIs) – years, and continue throughout the teenage
prevent the breakdown of dopamine, years.
serotonin, and norepinephrine by inhibiting Signs of ADHD:
monoamine oxidase. ➢ Inattention
These are given as the last option in ➢ Hyperactivity
antidepressant therapy since they can cause ➢ Impulsivity