Drugs Used in Mental Health

Antianxiety Drugs

Antianxiety Drugs

• Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality

• Anxiolytics – another name for antianxiety medications

Antianxiety Drugs

• Block neurotransmitter receptor sites preventing anxious feelings from reaching brain

• Also prevents body’s physical reaction to anxiety

Antianxiety Drugs

Common Uses

• Anxiety disorders and panic attacks

• Preanesthetic sedation and muscle relaxants• Convulsions or seizures - diazepam (Valium)

• Alcohol withdrawal

Antianxiety Drugs

• Benzodiazepines– diazepam (Valium) half life: 36-200 hr

– clonazepam (Klonopin) half life: 18-50 hr

– chlordiazepoxide (Librium) half life: 5-25 hr

– alprazolam (Xanax) half life: 6-12 hr

– lorazepam (Ativan) half life: 10-20 hr

Antianxiety Drugs

• Nonbenzodiazepines– doxepin (Sinequan) half life: 28-52 hr

– buspirone HCl (BuSpar) half life: 2-3 hr

* buspirone (BuSpar) drug of choice with elderly because it does not cause excessive drowsiness and poses less fall risk

Antianxiety Drugs

Side Effects / Adverse Reactions

• Drowsiness / sedation

• Lightheadedness / dizziness

• Headache, visual disturbances

• Lethargy, apathy, fatigue

• Confusion, restlessness, agitation

• GI disturbances, dry mouth

Antianxiety Drugs

• Benzodiazepine Toxicity– Results from overdose

– Sedation, respiratory depression, coma, death

– Antidote: flumazenil (Romazicon)

• Parenteral Alert– IM, IV route may lead to apnea and cardiac arrest

– Use care with elderly, debilitated, respiratory compromised

Antianxiety Drugs

High Risk for Physical Dependence

• Long term use

• Tolerance

• Physical dependence

• Withdrawal symptoms

• After 3 months of use, do NOT discontinue abruptly

Antianxiety Drugs

Withdrawal Symptoms

• Increased symptoms of anxiety

• Fatigue, hypersomnia

• Metallic taste, nausea, sweating

• Headache, difficulty concentrating

• Cramps, tremors

• Hallucinations, convulsions

Contraindications

• Psychoses

• Acute narrow angle glaucoma

• Pregnancy– Floppy infant syndrome

• Lactation– Infant becomes lethargic and loses weight

• Significant hypotension / bradycardia

Precautions

• Use cautiously with elderly– Initial Low Dose: excreted more slowly, high risk

for toxic levels

– Exception: lorazepam (Ativan), safe for elderly at usual ranges

• Use cautiously in patients with– Impaired liver function

– Impaired kidney function

– Overall debilitation

• Avoid alcohol

Interactions

• Use cautiously with elderly– Initial Low Dose: excreted more slowly, high risk for

toxic levels

– Exception: lorazepam (Ativan), safe for elderly at usual ranges

• Use cautiously in patients with– Impaired liver function

– Impaired kidney function

– Overall debilitation

• Avoid alcohol

Nursing Process

• Assessment

• Nursing Diagnoses

• Planning

• Implementation

• Evaluation

Assessment

• Vital Signs

• Allergies

• Labs

• General appearance

• General comfort

• Route of Administration

Nursing Diagnoses

• Risk for injury

• Impaired comfort

• Ineffective individual coping

Planning

• What will the patient require?

• What is the expected outcome?

• What adverse reactions might occur?

Implementation

• Route of administration

• Drug interactions

• Concurrent CNS depression

• Safety concerns

• Mouth care, hard candies, sugarless gum for dry mouth

• Fluids and fiber to prevent constipation

Evaluation

• Is the patient– Less anxious?• subjective evaluations

• objective evaluations

– More comfortable?– Experiencing any adverse reactions?– Developing tolerance / addiction?

Patient Teaching

• Take as directed

• Do not discontinue abruptly

• Avoid hazardous activity

• Advise physician of all OTC medications and supplements

• Do not drink alcohol

Hypnotics

• Hypnotic – drug that induces drowsiness or sleep

Hypnotics

Common Uses

• Insomnia

• Convulsions - Valium

• Adjuncts for anesthesia– Preanesthesia– Conscious sedation

Hypnotics

• Barbiturates– pentobarbital (Nembutal) half life: 15-48 hr

– secobarbital (Seconal) half life: 15-40 hr

Hypnotics

• Benzodiazepines– flurazepam (Dalmane) half life: 40-250 hr

temazepam (Restoril) half life: 8-20 hr

– triazolam (Halcion) half life: half life: 2-3 hr

• Nonbenzodiazepines– Zolpidem tartrate (Ambien) half life: 2-3 hr

Hypnotics

Side Effects / Adverse Reactions

• CNS depression

• Lightheadedness / dizziness

• Headache

• Tolerance, addiction

• Rebound insomnia, hangover

• GI disturbances, dry mouth

Contraindications

• Respiratory problems

• History of substance abuse

• Pregnancy / lactation

Precautions

• Use cautiously with elderly– Elderly– Debilitated– Mental health concerns

• Use cautiously in patients with– Impaired liver function– Impaired kidney function– Overall debilitation

• Avoid alcohol

Interactions

• Increased CNS depression with– Alcohol (Alcohol + Barbituates = Coma, Death )– Opiod (narcotic) analgesics– Antihistamines– Antidepressants– Anxiolytics, antipsychotics– Cimetidine (Tagamet)

Nursing Process

• Assessment

• Nursing Diagnoses

• Planning

• Implementation

• Evaluation

Assessment

• Factors interfering with sleep– Reduce environmental stimuli– Administer pain medication if needed

• Administer at hour of sleep– Not too early– Not too late

Nursing Diagnoses

• Risk for injury

• Ineffective breathing pattern

• Ineffective individual coping

Planning

• What will the patient require?

• What is the expected outcome?

• What adverse reactions might occur?

Implementation

• Supportive care

• Reduce caffeine intake

• Provide safety

Evaluation

• Is the sleep pattern improved?– Rested in the morning?• subjective evaluations

• objective evaluations

– Experiencing any adverse reactions?– Developing tolerance / addiction?