1 / 60

PSYCHOPHARMACOLOGY

PSYCHOPHARMACOLOGY. ANTI - PSYCHOTIC. Formerly known as MAJOR TRANQUILIZERS; other known as NEUROLEPTIC Indications – PSYCHOSIS, DELUSIONS, HALLUCINATION. Blocks receptors of DOPAMINE. Haloperidol ( Haldol, Seredol, Serenace, ) - tablet, liquid, IV/ IM Chlorpromazine HCl

swann
Télécharger la présentation

PSYCHOPHARMACOLOGY

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. PSYCHOPHARMACOLOGY

  2. ANTI - PSYCHOTIC • Formerly known as MAJOR TRANQUILIZERS; other known as NEUROLEPTIC • Indications – PSYCHOSIS, DELUSIONS, HALLUCINATION. • Blocks receptors of DOPAMINE

  3. Haloperidol ( Haldol, Seredol, Serenace, ) - tablet, liquid, IV/ IM Chlorpromazine HCl ( Thorazine – T, L, Laractyl - T) Fluphenazine Decanoate ( Modezine - , Sydepres) TYPICAL ANTI - PSYCHOTICS - Potent blockers of DOPAMINE - Can produce EPS,

  4. Clozapine ( Clozaril, Leponex – T) Risperdone ( Risperdal – T, L, IV/ IM; Risperdal Consta) ATYPICAL ANTI - PSYCHOTICS - weak blockers of dopamine - low S/Es of EPS

  5. Side effects: • EPS ( Extra Pyramidal Syndrome) • aKATHIsia – Restlessness, inability to sit still • aKINEsia – generalized muscle rigidity • Acute DYSTONIA – • Torticollis ( wry neck) • Oculogyric Crisis ( fixed stare) • Opisthotonos ( arched back)

  6. EARLY SIGNS: - stiffness - fever - diaphoresis - tremors LATE SIGNS - dysphagia - unstable BP - respiratory depression Side effects:Neuroleptic Malignant Syndrome ( NMS)

  7. Side effects: • Tardive Dyskinesia ( TD) - permanent involuntary movements - lip smacking - tongue protruding - cheeks puffing - S/ Es are IRREVERSIBLE

  8. Side effects: • Anti – Cholinergic Side Effects - dry mouth - constipation - urinary retention • Photosensitivity • Agranulocytosis – fever, sore throat, leukopenia ** Clozapine ( Clozaril) – fewer S/Es but LIFE threatening

  9. ANTI – PARKISONIAN • Used to treat parkinsonian syndrome, dyskinesias to restore neurotransmitters: DOPAMINE & ACETYLCHOLINE. • Anti - Cholinergic action • Dopaminergic agonists – mimicks action of Dopamine

  10. Biperiden HCl ( Akineton) DI: antagonize action of Metoclopramide, enhance psychotropic drugs. Levodopa + Carbidopa (Ledocar), (Sinemet) DI: Anesthesia, MAOIs, Haldol Anti – Cholinergic action

  11. Bromocriptine ( Parlodel, Provasyn) NMS – given in PO Amantadine ( PK – Merz) – DI: amiodarone, quinidine, anti – histamine, macrolide anti – biotics. Dopamine Agonists

  12. ANXIOLYTICS • Treat anxiety and anxiety disorders • Insomnia • Benzodiazepines – most effective, also an Anti – Convulsant • Enhances action of Alcohol

  13. Diazepam ( Valium), ( Anxiol), - very fast acting, - Tab.,amp. Alprazolam ( Xanor) - intermediate action Chlorazepate ( Tranxene) - fast acting ANXIOLYTICS - Benzodiazepines

  14. Treatment of major depressive illness Panic Disorder Bipolar Disorder Groups: 1. SSRIs 2. Tricyclics 3. MAOIs ANTI - DEPRESSANTS

  15. Treat some personality disorders Anxiety Disorders Depression Increases Serotonin levels Anti – Cholinergic effect Fluoxetine ( Prozac), ( Deprizac, Deprexone) Sertraline ( Zoloft) Paroxetine ( Seroxat) Bulimia Nervosa, OCD, Depression Selective Serotonin Re – Uptake Inhibitors

  16. TCA ( Tricyclic Anti – Depressants) ADHD Anxiety Smoking Cessation Schizophrenia Bulimia Nervosa ** potentially lethal when overdosed Imipramine ( Tofranil, Trimipramine (Surmontil) Clomipramine ( Anafranil) - OCD, Depression, Panic Attacks Tricyclic Compounds

  17. Also effective in helping smokers to quit smoking Depression Agoraphobia/ Social Anxiety Potentially lethal diet & drug interaction with SSRI & Tricyclic, Demerol, Tramadol Hypertensive Crisis Phenelzine ( Nardil) Tranycypromine (Parnate) Isocarboxazid (Marplan) Stay out of TYRAMINE rich foods: Wine, cheese, liver MAOIs

  18. Treat BIPOLAR DISORDER, Manic State Most established mood stabilizer 95% excreted in the KIDNEYS Renal function tests Electrolyte – Na ( 135 -145 mEq/L) Therapeutic range – 0.5 to 1.5 mEq/L Lithium level monitoring – Q 2-3 days then weekly S/E: metallic taste, fatigue, polyuria/ dipsia 3 signs of TOXICITY: - Nausea - Vomiting - Diarrhea Drug Compliance! MOOD STABILIZING DRUGS

  19. Carbamazepine ( Tegretol) – Rashes Orthostatic hypertension Clonazepam ( Klonopin) - Acute Mania - Also an anxiolytic with almost same action. MOOD STABILIZING DRUGS

  20. ADHD Drug • Methylphenedate ( Ritalin) • Stimulates neurotransmitters ( Dopamine, Serotonin, Norepinephrine) • Mild CNS stimulation • Reverse effect – calming, slowing of activity • S/Es: anorexia, weight loss, nausea • C/Is: caffeine, sugar, chocolate.

  21. Disulfiram ( Antabuse) • Px receiving tx for Alcoholism • C/Is: Alcohol, any product with containing alcohol • S/Es: flushing, headache, diaphoresis, N/V, dizziness, halitosis, tremor, incompetence • A/Rs: chest pain, dyspnea, severe hypotension, DEATH • Liver enzyme tests • D/I: Dilantin, INH, Warfarin, diazepam

  22. ANXIETY

  23. Anxiety – vague feeling of dread Sense of impending doom No Identifiable object Fear – almost the same emotional feelings with anxiety but with identifiable object ANXIETY vs FEAR

  24. LEVELS of ANXIETY 1. Mild Anxiety – - enhance learning - relaxed; slightly restless - attentive - make decisions fast

  25. 2. Moderate Anxiety – - pacing - slightly disorganized - “butterflies in the stomach” - urinary frequency - decreased attention span ** may give PRN medication – muscle relaxants

  26. 3. Severe Anxiety – - don’t know what to do or say - no direction at all - hyperventilation - gnash teeth - increased diaphoresis - wringing hands - Agitation, Confusion

  27. 4. Panic – - SNS activation - Disorganized - Gross motor agitation - Freeze - Distorted thoughts - Cannot solve problems - personality disorganized - out of control, helpless, overwhelmed

  28. Delusion – fixed, false belief not based in reality • Hallucination – false sensory perception or perceptual experiences that do not exist in reality • Illusion – other known as deception

  29. Intense fear of a SPECIFIC OBJECT/ SITUATION ILLOGICAL Cause extreme DISTRESS/ PANIC Pharmacologic Tx.: - Anxiolytics - SSRIs - Propanolol ( Inderal) – beta – blocker to reduce HR & decrease BP PHOBIAS

  30. Psychotherapy - identify anxiety reaction - relaxation techniques - self control - Desensitization – progressive exposure - Flooding – rapid desensitization

  31. Obsession – recurrent thoughts, ideas, visualizations, anxiety producing Affects interpersonal relationship Aware of excessive thoughts Compulsion – behaviors or rituals carried – out to get rid of obsessive thoughts or reduce anxiety OBSESSIVE – COMPULSIVE DISORDER

  32. Common Compulsions: - handwashing - counting - checking - touching - arranging/ rearranging - cleanliness

  33. Psychophramacoligic Tx: - SSRIs – recent drugs indicated to treat OCD - Anxiolytics • Nursing intervention: - frequency of rituals - do not stop px from doing his/her rituals - reduction techniques

  34. POST TRAUMATIC STESS DISORDER • Witness of an extraordinarily terrifying/ deadly event. • Experiences FLASHBACKS, recollection, nightmares • Assessment: Startled, hypervigilance, insomnia Tx: - anxiolytics - anti – depressants - psychotherapy – group or individual therapy - in large groups – CISD

  35. Child abuse - physical abuse - sexual abuse - neglect - psychological abuse Assessment: - burns - bruises Tx: - ensure safety - social well being - therapy – play, family ABUSE & VIOLENCE

  36. Rape - violence & humiliation expressed through sexual means - sexual intercourse without consent Tx/ intervention: - secure safety - ensure confidentiality - referral to psychiatric, gynecologic management and rape crisis centers - group therapy

  37. SCHIZOPHRENIA • Disease affecting the brain resulting to distorted & bizaare mental, cognitive, emotional, behavioral perceptions.

  38. Types of Schizophrenia • Paranoid Type – persecutory, hostile behavior - feeling of being spied on - grandiose delusions - hallucinations

  39. Disorganized type – inappropriate or flat affect, loose associations, disorganized behavior • Catatonic Type – psychomotor disturbance, motionless or excessive motor activity, echolalia, echopraxia • Undifferentiated Type – mixed schizophrenic symptoms, with thought, affect, behavior. • Residual Type – social withdrawal, flat affect, looseness of association

  40. Symptoms of Schizophrenia

  41. Pharmacologic tx: - Anti – Psychotics • Psychotherapy: - Group therapy - Family therapy

  42. Suicide • Common in patients with mood disorders, DEPRESSION • Intentional act of killing oneself • Suicidal ideation – having thought of killing oneself

  43. Assessment: Age Sex Marital status Employment Interpersonal relationship Family background Factors: - 45 y.o. – older - alcohol dependence - violence - male - depression - loss physical health - singled, widowed, divorced

  44. Evaluation of Suicide Risk

  45. Treatment: - Hospitalization - Out – patient management - Pharmacotherapy - Psychotherapy

  46. PERSONALITY DISORDERS • When persons personality traits become inflexible and maladaptive, interferes optimum level of functioning. • Longstanding due to personality characteristics are not easily changed

  47. TYPES

More Related