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- BY
- Pat Woodbery, MSN, ARNP-CS
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- All psychopharmacological drugs produce their therapeutic effects by
influencing synaptic transmission of neurotransmitters
- GABA: mood
- Serotonin: mood
- Norepinephrine: alertness
- Dopamine: thinking
- Aceteylcholine: cognition
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- Benzodiazepines
- Drugs of abuse
- Cause physiologic dependence
- Watch for withdrawal symptoms
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- Mechanism of action
- Enhances the effect of GABA
- Causes muscle relaxation
- Does not interfere with REM sleep
- Safe, unless taken with CNS depressants like ETOH
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- Not a benzodiazepine
- Interacts with serotonin and dopamine
- Does not cause muscle relaxation
- Does not cause sedation
- Does not cause dependance
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- Treat anxiety disorders
- Phobias, panic, obsessive compulsive disorders (OCD), post-traumatic
stress disorder (PTSD), atypical disorders and generalized anxiety
disorder (GAD)
- Preoperative sedation
- Prevention of agitation
- Treat withdrawal from ETOH
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- Severe respiratory disorders
- ETOH/drug abuse history
- When CNS depressants are already in use
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- Addicting
- Control substance (theft)
- Don’t discontinue suddenly, taper
- Safety precautions: falls, machinery
- Avoid ETOH and other CNS depressants
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- Anxiety
- Insomnia
- Irritability
- Tremor
- Palpitations
- Headache
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- Confusion
- Psychosis
- Seizures
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- Flumazenil (Anexate) = Antidote
- Reverses sedation, coma and respiratory depression caused by
benzodiazepines. It has NO effect on opioids, ETOH, Barbiturates
- Given IV
- Slow administration with repeated dosing
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- Observe for therapeutic effects
- Observe for excessive sedation
- Observe for drug interactions
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- Questions about Antianxiety drugs?
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- Used mainly to treat psychosis
- Psychosis is seen as altered thinking
- Hallucinations, delusions, bizarre behaviors
- Psychosis = elevated dopamine at synaptic junction
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- Occupy or block dopamine receptors
- Decrease dopamine at the receptor site
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- Schizophrenia
- Psychotic symptoms caused by:
- Head injury
- Stroke
- ETOH withdrawal
- Medications
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- Look for therapeutic effects
- Look for side effects:
- Dry mouth
- Sun sensitive
- Extrapyramidal symptoms (EPS)
- Anticholinergic effects
- Do not discontinue
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- Page 145 Abrams
- Akathisia
- Parkinsonism
- Dyskinesias
- Tardive Dyskinesia
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- Page 145 Abrams
- Hypotension, tachycardia, dizziness, dry mouth, blurred vision,
constipation, urinary retention
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- Page 145 Abrams
- Observe for therapeutic effects
- Observe for toxic effects
- Identify Neuroleptic malignant syndrome (NMS)
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- Questions about antipsychotic medications?
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- Depression
- Panic disorders
- Smoking cessation
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- Increase the availability of neurotransmitters by blocking their
reuptake
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- 1.Tricyclic (TCA)
- 2.Selective Serotonin reuptake inhibitors (SSRI)
- 3.Monoamine Oxidase inhibitors (MAOI)
- 4.Miscellaneous
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- First generation antidepressant
- Increases norepinephrine and serotonin
- Not used as the first line of treatment
- Should NOT be used for elderly
- High incidence of sedation
- Hypotension
- Arrhythmias
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- Selects serotonin and inhibits it’s reuptake
- First line treatment
- Watch for anxiety, restlessness
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- Not used as first line treatment
- Inhibits MAO which metabolizes norepinephrine and serotonin
- MAO is also responsible for metabolism of tyramines. If tyramines are not metabolized then
blood vessels constrict
- Hypertension
- Chest pain intracranial bleed
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- Page 153
- Red wine, beer, aged cheese, smoked meats, organ meats, yeast extracts,
sour cream, avocados, yogurt, ripe bananas, chocolate
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- Avoid tyramine rich foods because of chance of hypertensive crisis
- Do not stop abruptly
- Do not take with other antidepressant drugs
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- Inhibits dopamine, norepinephrine, serotonin
- Watch for anxiety
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- Monitor suicide
- Orthostatic hypotension
- Anticholenergic effects
- Avoid ETOH and other CNS depressants
- Evidence of successful treatment 2-4 weeks
- Do not stop abruptly-taper
- Dizziness, nausea, headache, mood disturbance, suicide
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- Mechanism of action: unknown
- Indications for use: bipolar
disorder
- Contraindications: renal failure, thyroid malfunction, pregnancy
- Side effects: memory loss,
tremors, weight gain, thirst
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- Causes:
- Water loss (vomiting,diarrhea, dehydration)
- Overdose
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- Mild Toxicity:
- Lethargy, drowsiness, muscle weakness, twitching, ataxia
- Moderate Toxicity:
- N/V, diarrhea, slurred speech, blurred vision
- Severe Toxicity: (2.5 mEq/L)
- Hallucinations, oliguria, seizures, coma, death
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- Stop Drug
- Hydrate
- Stabilize Vascular System
- Severe=Dialysis
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- Questions about antipsychotic medications?
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- Antipsychotic medications can create Parkinson’s like symptoms due to
blockade of DOPAMINE at synapse
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- Parkinson’s disease is characterized by:
- (Page 190)
- 1. Abnormalities in movement
- 2. Accelerated gait
- 3. Salivation, drooling
- 4. Pill rolling motions of
hands
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- Treats Parkinson’s like symptoms by increasing the amount of Dopamine
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- Observe for therapeutic effects
- Observe for anticholinergic effects
- Tachycardia, palpitations, sedation, constipation, urinary retention
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- Questions about antipsychotic medications?
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