- type of sedative hypnotic/anxiolytic - increases attraction of GABA receptors to GABA - neuron excitability is reduced - also induces sleep; increased anxiety leads to insomnia

- wide range of safety - not successful to OD

- anxiety=increased BP, possibly reduces anxiety - inderal (propanolol): social anxiety - catapres (clonidine) - inhibits the physiologic feedback

- any drug that modifies psychotic behavior - block D2 receptors = reduce psychotic symptoms=EPS

- block dopamine receptors - Thorazine (chlorpromazine) - Mellaril (Thioridazine) - Prolixin (fluphenzaine) - lower dose with hepatic dysfunction - caution with glaucoma

- more EPS effect - Haldol (haloperidol) - Navane (thiothixene)

anxiolytics & antipsychotics Flashcards by Kimberly Morris

neurotransmitters in anxiety

increased norepinephrine

- decreased serotonin & GABA

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benzodiazepine

type of sedative hypnotic/anxiolytic
increases attraction of GABA receptors to GABA
neuron excitability is reduced
also induces sleep; increased anxiety leads to insomnia

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benzodiazepines + alcohol

additive sedation

- dangerous when OD

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OD of benzodiazepine

wide range of safety

- not successful to OD

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s/e of benzodiazepines

hangover
REM rebound (don’t use 3-4wks+)
dependence
tolerance (after 4 months)
excessive depression
respiratory depression
hypersensitivity

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cross tolerance of benzodiazepines

-tolerant to Xanax, will also be tolerant to Ativan

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contraindications of benzodiazepines

respiratory disorders
pregnancy
small doses for renal/hepatic dysfunction

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withdrawal s/s of benzodiazepines

agitation
insomnia
tremors
mm cramping
sweating
*abrupt stop of a high dose

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geriatric considerations of benzodiazepines

paradoxical reaction: more agitated, talkative, anger, and rage
half dose recommended
avoid Dalmane, Doral, Diazepam (long acting)

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nonadrenergic agents

anxiety=increased BP, possibly reduces anxiety
inderal (propanolol): social anxiety
catapres (clonidine)
inhibits the physiologic feedback

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antipsychotics

any drug that modifies psychotic behavior

- block D2 receptors = reduce psychotic symptoms=EPS

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phenothiazines

block dopamine receptors
Thorazine (chlorpromazine)
Mellaril (Thioridazine)
Prolixin (fluphenzaine)
lower dose with hepatic dysfunction
caution with glaucoma

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drug/food interactions phenothiazines

with kava kava=increased risk and severity of dystonic reactions
not affected by food
with hypotensives=additive decreased BP
antacids decrease absorption
anticonvulsant needs to be increased d/t lowering of seizure threshold

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nonphenothiazines

more EPS effect
Haldol (haloperidol)
Navane (thiothixene)

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Chlorpromazine

-Thorazine
\+++ sedation
\+++ hypotension
\++ EPS
\+++ antiemetic

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Fluphenazine

-Prolixin
\++ sedation
\+ hypotension
\+++ EPS
\+++ antiemetic

Thioridazine

-Mellaril
+++ sedation
+++ hypotension
+ EPS

Haloperidol

-Haldol
\+ sedation
\+ hypotension
\+++ EPS
\+++ antiemetic

Thiothixene

-Navane
+ sedation
+ hypotension
+++ EPS

EPS

extrapyramidal syndrome
tardive dyskinesia
pseudoparkinsonism
acute dystonia
akathesia

tardive dyskinesia

potentially irreversible
worming, protruding tongue
rabbit nose
sucking/smacking lips
chewing
involuntary mvmt of body
anticholinergics have little effect, should stop drug

psedoparkinsonism

tremors
shuffling gait
drooling
rigidity
pill rolling
stooped posturing
bradykinesia
hands behind back could counterbalance pt for risk for falls
tx with anticholinergic

acute dystonia

facial grimacing
oculogyric crisis
involuntary muscle mvmt
involunary upward eye mvmt
cogwheel rigidity
benedryl, cogentin, or Ativan helps reduce these symptoms

akathisia

restless
trouble standing still
pacing
feet in constant motion
rocking back and forth
tx with benzo, or beta blocker

anticholinergic side effects

- dry mouth - blurred vision - constipation - urinary retention - confusion - red flushed skin - very red & hot

neuroleptic malignant syndrome

- increased HR, BP, temp - muscle rigidity - more common d/t typical antipsychotics - potentially fatal

tx of NMS

- immediate withdrawal - hydration - antipyretics - benzos - Bromocriptine (Parlodel) - Dantrolene (Dantrium) muscle relax

other s/e of antipsychotics

- sedation - orthostatic hypotension - photosensitivity - hormonal effects - prolonged QT interval - hypersalivation - agranulocytosis - taper drug to avoid sudden recurrent of psychotic symptoms

rapid tranquilization

- Haldol 5mg - Ativan 2mg - Benadryl 50mg

complaince vs non adherence

- compliance: you know everything, and you don't want to take - non adherence

atypical antipsychotics

- effective in + and - symptoms - not likely to cause EPS and NMS - don't give to dementia related psychosis - clozapine (clozaril) - olanzepine (zyprexa) - quetiapine (seroquel) - ziprasidone (geodon) - riperidone (risperdol)