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Chapter 28 Anxiolytics and Other Agents Used to Treat Psychiatric Conditions Psychotherapeutics 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 28 - 2 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Treatment Drug agents used for treatment of: Anxiety Mental and emotional disorders Psychoses Psychosis and affective disorders 28 - 3 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytic Groups Four groups of anxiolytics (antianxiety) drugs used in the U.S. Barbiturates Carbamates Antihistamines Benzodiazepines 28 - 4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Affective Disorders Two classes of agents used to treat affective disorders Antidepressant agents Antimanic agents 28 - 5 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytics Barbiturates The oldest drugs to be used as anxiolytic agents Depress the CNS Suppress REM sleep Carbamates Depress the CNS Similar to barbiturates 28 - 6 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antihistamines and Benzodiazepines Antihistamines Used as anxiolytics Cause sedation Benzodiazepines First line of drugs used for anxiety disorders Produce sedation and muscle relaxation 28 - 7 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytics: Side Effect/Adverse Effects Usually safe Sedation Relaxation Check vital signs Dangerous when taken with: Other sedating medications Alcohol Respiratory arrest Check kidney and liver labs 28 - 8 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antipsychotic Agents Treat mood disorders 28 - 9 Schizophrenia Organic psychoses Manic phase of bipolar affective disorders (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Antipsychotic Agents Clients with psychotic disorders show symptomatic improvement Action Inhibit or alter the dopamine-mediated response in the brain 28 - 10 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Side Effects/Adverse Effects Extrapyramidal symptoms Tardive dyskinesia Impaired temperature regulation Lower the seizure threshold Endocrine changes Dermatological changes Photosensitivity 28 - 11 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Clozapine (Clozaril) An example of an antipsychotic drug agent Very effective Produces fewer side effects and adverse effects Agranulocytosis 28 - 12 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antidepressant Agents Cyclic antidepressants Tricyclics Work by correcting an imbalance in the norepinephrine transmitter 28 - 13 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Tricyclic Antidepressants Used to treat Depression Chronic pain Bedwetting Examples: amitriptyline and imipramine 28 - 14 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Cyclic Antidepressants Adverse/side effects Orthostatic hypotension, extrapyramidal effects, sedation, weight gain, dry mouth, tachycardia, urinary retention, tremors, sexual dysfunction 28 - 15 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Monoamine Oxidase Inhibitors (MAOIs) Inhibit monoamine oxidase Monoamine oxidase Normally inactivates neurotransmitters such as serotonin and dopamine Dangerous side effects Hypotension Hypertension Death 28 - 16 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Newer Agents Sertraline HCl (Zoloft), Fluoxetine HCl (Prozac), Paroxetine HCl (Paxil) Action: act in a similar fashion to the tricyclic antidepressants Produce fewer sedative and anticholinergic effects Adverse effects and side effects • Nausea, dry mouth, headache, and dizziness 28 - 17 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pediatric Considerations Higher risk for side effects, especially extrapyramidal symptoms Lithium, an antimanic agent, may lead to: Decreased bone density Decreased bone formation Children are very sensitive to these agents. 28 - 18 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Geriatric Considerations The elderly process these agents much slower Toxic effects Side effects 28 - 19 Orthostatic hypotension, sedation, and anticholinergic side effects Increased anxiety is associated with the use of tricyclic antidepressants (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Geriatric Considerations May experience higher incidence of cardiac dysfunction such as a myocardial infarction Lithium is more toxic in elderly clients; lower doses are necessary. 28 - 20 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.