Psychotropic drugs DEFINITIONS psychotropic drugs I: Chemical agents that affect the brain and nerv ous system

, alter the feelings, emotions and consciousness in various ways. Neur otransmitters: Chemicals that allow transmission of electrical impulses from one neuron to another across the synapse. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 2 DEFINITIONS III Neuroleptic malignant syndrome: rare, but potentially lethal, tr eatment with antipsychotic drugs. Symptoms include severe muscle rigidity, hyper thermia, hypertension, tachycardia, diaphoresis, and increased creatine. Electro convulsive therapy (ECT): induction of a tonic-clonic seizure (generalized) by a pplying an electric current to the brain. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 3 Extrapyramidal system DEFINITIONS II: Routes of motor neurons from the brain to areas of the spinal cord, this system has complex relay and connections to areas of the cerebral cortex, cerebellum, brainstem and thalamus. The extrapyramidal system helps maintain balance and muscle tone. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 4 I FUNDAMENTAL CONCEPTS Psychotropic medications are not used to cure mental illness, only relieve the p hysical and behavioral symptoms. Biological therapies can induce healing by prod ucing changes in cellular functions of the CNS. Such changes make the emergence of new behaviors. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 5

FUNDAMENTAL CONCEPTS II Some neurotransmitters, and their relationship to mental disorders are: n Dopamine: Excessive dopaminergic activity is associated with schizophrenia. Sero tonin and norepinephrine: causal factors of depression and mania. Currently it i s believed that mood disorders are the result of different chemicals such as neu rotransmitters and hormones. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 6 n BASIC CONCEPTS III n Gamma-aminobutyric acid (GABA): the creation of a inhibitory effect on anxiety. Acetylcholine: it is postulated that the cognitive deficits of Alzheimer's disea se are due to a reduction of acetylcholine. Monoamine oxidase: enzyme responsibl e for the destruction of some neurotransmitters U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 7 n n FUNDAMENTAL CONCEPTS IV Some depressed individuals improve with ECT, having failed other forms of treatm ent. Classification of major psychotropic drugs: 1 .- 2 .- Antidepressants Antip

sychotics antimanic 3 .- 4 .- 5 .- Benzodiazepine Sedative-hypnotics U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 8 MAIN psychotropic drugs Antipsychotic drugs Antipsychotics Atypical Antipsychotics Antipsychotic drugs I Antipsychotic agents (neuroleptics) classical outlined in the following table: Class Generic Name Trade Name Daily Dose of more frequent maintenance Phenothiazines Perphenazine Thioridazine Trifluoperazine Chlorpromazine Trifluopromazina mesoxi dazina fluphenazine Chlorpromazine Largactil Meleril Eskazine modecate --- Decent 50-400 mg 50-400 mg 2-30 mg 8-24 mg 60-150 mg 30-150 mg 2.5-20 mg U.S. PSYCHOPHARMACOLOGY Walter Cortes 11 butyrophenones thioxanthenes thiothixene haloperidol chlorprothixene --- haloperidol 50-400 mg 1-15 mg 6-30 mg dihidroindolonas molindone 40-225 mg dibenzoxacepinas loxapine disconnection 25-250 mg U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 12 Antipsychotic drugs II Antipsychotic agents (neuroleptics) atypical outlined in the following table: Class Generic Name Trade Name Daily Dose of more frequent maintenance 300-450 mg 300-450 mg 4-6 mg Others

Pimozide Clozapine Risperidone Orap Leponex Risperidal U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 13 INDICATIONS I 1 .- Antipsychotics used to treat positive symptoms of schizophrenia. The new atypical antipsychotics such as cloz apine and risperidone, help reduce the negative symptoms of schizophrenia. 2 .Antipsychotics may also be used to treat symptoms of bipolar disorder and psycho tic disorder, cognitive impairment U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 14 INDICATIONS II 3 .- They can also be treated with antipsychotics symptoms such a s agitation, anger, hyperactivity, sensory stimuli, hallucinations, delusions, p aranoia and aggressiveness. 4 .- Other indications include the treatment of vomi ting, hiccups, and refractory vertigo. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 15 MECHANISM OF ACTION 1 .- Antipsychotics produce blockade of postsynaptic dopamin e receptors in the limbic system, hypothalamus and cerebral cortex. 2 .- The sam e blocking dopamine occurs at the level of the basal ganglia,€produce undesirabl e extrapyramidal side effects and other types. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 16 MECHANISM OF ACTION 3 .- The atypical antipsychotics act through a combined dopaminergic and seroton ergic antagonism. These new drugs are lacking in many of the side effects of cla ssic antipsychotics. 18 GENERAL I Antipsychotics PRINCIPLES: Initial treatment may require parenteral doses. According recedes conduct disord er is changed to oral tablets or concentrated preparations. The doses are calcul ated according to the needs of each individual. To achieve symptomatic changes, it is essential guideline doses carefully.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 18 GENERAL I The divided doses are changed to single doses, primarily administered at bedtime to maximize the sedative properties of these drugs.

To achieve sustained improvements, most clients need maintenance dose. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 19 GENERAL II In elderly clients recommended low-dose treatment. Adverse side effects and are more common in elderly clients, which is due to their lower renal and hepatic fu nction and to their smaller muscle mass compared with fat tissue. Its half-life in serum is about 24 hours. The drug accumulates in fatty tissue. After stopping the medication, fat is releasing the drug, so side effects may persist.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 20 GENERAL II High therapeutic index and can be administered at high doses with minimal risk. These drugs are not addictive and do not produce euphoria. Not recommended durin g pregnancy.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 21 CONTRAINDICATIONS In cases of severe CNS depression due to excessive use of alcohol, barbiturates or narcotics when there is brain damage, or in case of injury. Do not administer to clients with known hypersensitivity. Clients with Parkinson's disease may ex perience an increase in their symptoms.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 22 CONTRAINDICATIONS Probable development of blood dyscrasia side effect of pharmacotherapy clients w ith a history of previous dyscrasia. Use with caution if there is a history of l iver injury or jaundice. Clients with acute narrow-angle glaucoma or prostatic h ypertrophy can experience increased intraocular pressure and urinary retention, respectively, due to property anticholinergic drugs.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 23

SIDE EFFECTS I Antipsychotics: s d. e. f. s i. j. k. l. m. Type cardiovascular: Hypotension. Orthostatic hypotension, tachycardia. Antichol inergic Type: urinary retention and hesitancy. Constipation Blurred vision. Nasa l congestion. Dry mouth U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 24 SIDE EFFECTS II 1. b. c. Extrapyramidal: Seudoparkinsonismo (mask facies, stooped, rigid posture, shuffli ng gait, drooling, tremors, movement of "counting money"). Acute dystonic reacti on (contractions of the tongue, face, neck and back; opisthotonos, where the who le body arches so tetanus, and oculogyric crisis, in which the eyes are facing u p). U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 25 SIDE EFFECTS II b. Acaticia (restlessness and excessive walking). d. Tardive dyskinesia (writhing movements and remove the tongue, puffs, pops and li cking. Spastic distortion may also occur on the face and choreic or athetoid mov ements of the limbs) irreversible symptom. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 26 SIDE EFFECTS III 1. b. c. d. e. f. Other side effects: sedation. Skin disorders (hives or contact dermatitis). Phot osensitivity endocrine disorders (moderate increase in breast and galactorrhea i n women, gynecomastia in males, altered sex drive, loss of libido in both sexes and possibly amenorrhea in females). Weight gain. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 27

SIDE EFFECTS IV 1. b. c. d. Serious side effects but rare: Agranulocytosis. Cholestatic jaundice (fever, nau sea, abdominal pain and jaundice). Neuroleptic malignant syndrome U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 28 SIDE EFFECTS V atypical antipsychotics: s Agranulocytosis: incidence of 1 to 2% in clients treated with clozapine. Idem se izures that typical antipsychotics: sedation, orthostatic hypotension, constipat ion, effects on the SEP, neuroleptic malignant syndrome). U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 29 5. s Antidepressant drugs TRICICLOS Monoamine Oxidase Inhibitors (MAOIs) otonin reuptake inhibitors (SSRIs) NO INHIBITORS TRICICLOS ser

Antidepressant drugs generic name brand name class daily maintenance dose Frequently 50-100 mg 50-150 mg 75-200 mg 75-100 mg 15-45 mg 75-150 mg 75-300 mg 150-225 mg Tricyclic antidepressants (TCA) Imipramine Amitriptyline Desipramine Nortriptyline Protriptyline Doxepin Clomipr amine Maprotiline Tofranil-Martimil Tryptizol, paxtibi - Ludiomil Sinequan Anafranil Monoamine oxidase inhibitors (MAOIs) Toranilcipromina isocarboxazid phenelzine Parnate - Nardelzine 10-30 mg 10-30 mg 15-90 mg 31 U.S. PSYCHOPHARMACOLOGY Walter Cortes Antidepressant drugs No tricyclic Trazodone Venlafaxine bupropion (bupropion) Fluoxetine Paroxetine S ertraline Dobupal, vandral Deprax - Prozac, Adolf Besitrán Frosinor, Seroxat 150 -375 mg 150-400 mg 200-450 mg 50-200 mg 20-40 mg 20-50 mg Inhibitors of serotonin reuptake inhibitors (SSRIs), second-generation antidepre ssants U.S. PSYCHOPHARMACOLOGY Walter G. Cortes

32 INDICATIONS 1. Used in the treatment of depressive disorders, they can positively change the de gree of withdrawal, the level of activity and vegetative signs of depression. those of the 3. Use in the treatment of anxiety disorders, enuresis and childhood hyperactivity, and chronic pain. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 33 MECHANISM OF ACTION 2. It depends on the type of antidepressant Tricyclic antidepressants (TCA): Increa se the levels of neurotransmitters by blocking reuptake of norepinephrine and se rotonin at the level of the presynaptic neuron. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 34 MECHANISM OF ACTION 2. Monoamine oxidase inhibitors (MAOIs) inhibit monoamine oxidase, which is the enz yme responsible for metabolizing the neurotransmitters. Atypical antidepressants or selective inhibitors of serotonin reuptake inhibitors (SSRIs) act selectivel y on the neurotransmitter serotonin by blocking its reuptake at the presynaptic cell. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 35 GENERAL I 1. The TCAs are potentially lethal if taken in quantities of 10 to 30 times ommended daily dose. The client may not respond to antidepressants until he three weeks of the first dose. Clients with severe depression and who lusions or other psychotic symptoms, they may need the administration of psychotic with an antidepressant. 3. 5. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 36 the rec after t have de an anti

GENERAL II 1. Before TCAs were the drugs of choice for the treatment of nonpsychotic unipolar depression. Currently, the drug of choice might be an SSRI. MAOIs are effective antidepressants can be helpful to some clients who do not respond to TCAs and SS RIs or who can not tolerate them. In clients who take antidepressants should be monitored the emergence of suicidal ideation, and that the drugs increase levels of energy consumption and its ability to carry out such plans. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 37 3. 5. I CONTRAINDICATIONS AND PRECAUTIONS 2. ATC: pre-existing cardiovascular disease. Background convulsionews. Narrow angle glaucoma. Prostatic hypertrophy. Pregnancy and lactation.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 38 I CONTRAINDICATIONS AND PRECAUTIONS 2. MAOI: Lack of compliance with the diet without food containing tyramine. History of cerebrovascular defects or cardiovascular disease. Age (over 60 years). Live r disease. Drugs that can precipitate hypertensive crisis.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 39 CONTRAINDICATIONS AND PRECAUTIONS II 1. SSRIs: Impaired hepatic or renal function. Pregnancy and lactation. History of s eizures. Concurrent treatment with MAOIs. Clients at risk of suicide. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 40 SIDE EFFECTS I 1. b. c. d. e. f. ATC: Anticholinergic effects. Cardiovascular effects. Sedation. Photosensitivity. Oth er uncommon: Decreased seizure threshold. Decreased or increased libido and erectile dysfunct

ion ejaculation. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 41 SIDE EFFECTS II 1. b. c. d. e. MAOI: They may cause diarrhea, abdominal pain, restlessness, insomnia and dizzin ess. The worst are the hypertensive crisis, appear to consume foods with tyramin e or with drugs that increase noradrenergic activity. Symptoms of hypertensive c risis include generalized headache, nausea, vomiting, pallor, chills, stiff neck , muscle twitching, palpitations and chest pain.€Treatment: slow administration of phentolamine mesylate, hydration and electrolyte balance restoration. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 42 SIDE EFFECTS III 1. b. c. SSRIs: Similar to the ATC. Customers treated with SSRIs have a lower incidence o f anticholinergic side effects and have less cardiotoxicity. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 43 Antimanic drugs LITHIUM CARBONATE LITHIUM CITRATE INDICATIONS I 1. Lithium carbonate and lithium citrate are used primarily antimanic agents: Acute mania. Episodes of hypomania. Long-term prophylaxis of bipolar disorders. Effective in preventing recurrent manic episodes. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 45

INDICATIONS II 1. It is used experimentally to treat other psychiatric disorders that appear in mo od disorders, such as: Alcoholism. Drug Abuse. Premenstrual syndrome. Pathological sexual behaviors and phobias. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 46

MECHANISM OF ACTION 1. 2. 3. 4.

The exact mechanism of action is not well known. Interferes with the metabolism of norepinephrine, dopamine and serotonin. Electrolyte balance affect the brain and alter sodium transport in nerve cells and muscle. Experts believe that lithi um corrects an abnormality of ion exchange. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 47 GENERAL I 2. Lithium is a natural salt found in the minerals, sea water, plants and animals. Be absorbed rapidly after oral administration. Compete with sodium reabsorption in renal proximal tubule. 4. 6. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 48 GENERAL I 2. It has a success rate of 70-80% in the treatment of bipolar disorder. Lithium en hances the effects of antidepressants and is effective in the resolution and pre vention of recurrent major depression 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 49 GENERAL II 2. Antipsychotics can be used with lithium in acute manic episodes to treat behavio ral and psychotic manifestations. The onset of lithium therapy is usually 300 mg three times a day for several days, increasing the dose until reaching a stable level. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 50 GENERAL II • During stabilization, regularly measured serum levels of lithium to identify the therapeutic level. After resolution of symptoms, decrease the lithium to achiev e the maintenance dose. Check blood levels every 2 or 3 months. •

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 51 GENERAL III 1. s h.

Before initiating treatment with lithium, make the client a medical history and complete physical examination, with the following information: Renal function: c reatinine 24 hours. Blood urea nitrogen (BUN). Electrolyte levels. Personal or f amily history of kidney disease or diabetes mellitus. Use of diuretics or analge sics. Thyroid function: Evaluation of thyroid function and hematological tests. Personal or family history of thyroid disease U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 52 IV GENERAL 1. The following are other anticonvulsant drugs that are used as antimanic: carbama zepine (Tegretol), valproic acid (Depakine), clonazepam. Used when lithium is in effective or not tolerated. They can also be used in combination with lithium. B ecause anticonvulsant drugs, can not be stopped sharply, because it can trigger an epileptic state. c. d. f. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 53 CONTRAINDICATIONS AND PRECAUTIONS 1. 2. 3. Lithium has a narrow therapeutic window, the therapeutic dose is only slightly l ower than toxic. Dehydration or sodium depletion may precipitate lithium toxicit y. Administered with caution in clients: Elderly or debilitated. Kidney or thyroid disease. With seizure disorder. Take m edications incompatible U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 54 POTENTIAL DRUG INTERACTIONS LITHIUM DRUG EFFECT Antidepressants Antipsychotics Neurotoxicity with lithium manic rela pse Aminophylline or theophylline decreased serum levels of lithium sodium bicarbona te or sodium chloride Diuretics Tetracycline, streptomycin, or NSAIDs. Muscle re laxants and anesthetics. Increases lithium reabsorption by the kidney, triggerin g poisoning Increased serum lithium levels Extension neuromuscular blockade with succinylcholine and pancuronium. Suspend lithium from 48 to 72 hours prior to a dministration of these agents and to resume oral feeding after surgery.€Walter P SYCHOPHARMACOLOGY 55 EU

G. Cortes SIDE EFFECTS I 2. Nausea, abdominal discomfort, diarrhea, loose stools (mild and temporary). Tremo rs (fine to coarse). Sed. Weight gain. or 4. 6. 8. PSYCHOPHARMACOLOGY 56 EU Walter Cortes SIDE EFFECTS I 2. Temporary muscle weakness). and fatigue (Benign and 4. Hair loss (temporary). Polyuria (benign but progress to diabetes insipidus). pos sibility 6. 8. Lithium intoxication (serum lithium levels higher than 2.0 mEq / L). U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 57 SIDE EFFECTS II Mild intoxication (serum level approx. 1.5 mEq / L): Slight apathy, lethargy, de creased concentration, muscle weakness, mild ataxia, coarse tremor of hands, sli ght muscle contractions. Moderate intoxication (serum level between 1.5 and 2.5 mEq / L): severe diarrhea, nausea, vomiting, mild to moderate ataxia, incoordina tion, slurred speech, tinnitus, blurred vision, muscle twitching frank, ataxia, tremors, irregular.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 58 SIDE EFFECTS II

Severe intoxication (serum level greater than 2.5 mEq / L): nystagmus, muscle tw itching, deep tendon hyperreflexia, visual or tactile hallucinations, oliguria o r anuria, severe impairment of consciousness, grand mal seizures, coma, death.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 59 And sedative-hypnotics anxiolytic drugs Anxiolytic drugs generic name brand name class daily maintenance dose most often used as a hypnot ic 5-25 mg 2-10 mg 10-30 mg 15-60 mg 2-6 0.5-1.5 mg 1.5-10 mg 30-60 mg mg benzodiazepines Oxazepam Diazepam Flurazepam Chlordiazepoxide Clonazepam Clorazepate Prazepam Al prazolam Lorazepam Valium Librium Dormodor overshadowing, aplakil Tranxilium Orfidal, Rivotril Tran kimazin idalprem Demetrin U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 61 Anxiolytic drugs Diphenylmethane Hydroxyzine hydrochloride Hydroxyzine pamoate Atarax 200-400 mg buspirone Antihistamines --200-400 mg others buspar 15-30 mg Beta adrenergic blockers propranolol sumial 30-80 mg U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 62 Sedative-hypnotic DRUGS generic class Butalbital Phenobarbital Secobarbital Amobarbital Pentobarbital Th iopental Methohexital trade name normal sedative dose (3-4 times / day) 30 mg 30 -50 mg 30-50 mg 15-30 mg 16-32 mg 30-90 mg Used as an anesthetic, a period ultar

corto action hypnotic dose 100-200 mg 100-200 mg 100-200 mg 100-200 mg 100-200 m g 100-200 mg 100-200 mg Barbiturates Isoamitil ---- - --- Luminal Sodium Pentothal U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 63 Sedative-hypnotic DRUGS Glutethimide nonbarbiturate methyprylon -------- Chloral hydrate 500 mg Ethchlor vynol - 250 mg - 0.5 to 2 mg 250-500 mg 200-400 mg 500-750 mg Benzodiazep INAS (used as hypnotics) Flurazepam Temazepam Triazolam Zolpidem Halcion Dasuén Dormodor Stilnox --------0.25 to 0.5 mg 5-10 mg 15-30 mg 15-30 mg U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 64 INDICATIONS I 2. Treatment for anxiety and sleep disorders. The anxiety that requires drug treatm ent and has no connection with any more specific syndrome is usually treated wit h a benzodiazepine. Sedative-hypnotics can be used to relieve anxiety or induce sleep. 4. 6. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 65 INDICATIONS I 2. Use in the treatment of alcohol withdrawal syndrome and drugs, as preoperative m edication or muscle relaxants and anticonvulsants. Barbiturates may be used for treatment of seizure disorders or as a preoperative sedative. Beta blockers used to treat stress or anxiety is leading to vegetative symptoms such as tremors, p alpitations, diaphoresis, or tachycardia. 4. 6. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes

66 MECHANISM OF ACTION 2. It is believed that benzodiazepines enhance the neurotransmitter gamma-aminobuty ric acid (GABA), causing muscle relaxation and relief from anxiety. Barbiturates barbiturate sedative-hypnotics produce CNS depression. and 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 67 MECHANISM OF ACTION 2. Beta blockers induce a beta-adrenergic blockade and probably an effect on the CN S. Antihistamines are used as anxiolytics act as CNS depressants subcortical lev el. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 68 GENERAL I 2. Benzodiazepines are the drug of choice for anxiety and sleep disorders. Benzodia zepines and sedative hypnotic tolerance to their effects occur within days and m ay also have cross-tolerance between drugs. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 69 GENERAL I 2. Continued use can lead to emotional and physical dependence;€abrupt suspension w ithdrawal symptoms may occur. Barbiturates, have narrow safety margin, there let hality with increasing doses. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 70 GENERAL II 2. It is recommended to treat anxiety and sedative hypnotics are of short duration. Benzodiazepines are administered orally or intramuscularly.

4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 71 GENERAL II 2. All benzodiazepine treatment should be discontinued gradually, independent of th eir lifetime. Sedative-hypnotics are taken at bedtime. May be repeated if the cl ient does not sleep in the required time. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 72 4. CONTRAINDICATIONS AND PRECAUTIONS 2. Avoid benzodiazepines to manage clients with a history of alcohol or drug abuse by the possible cross-tolerance and increased risk of abuse. Customers with urem ia or hepatic insufficiency should not take or barbiturates or benzodiazepines. 4. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 73 CONTRAINDICATIONS AND PRECAUTIONS 2. No sedation pregnancy and lactation. or anxiolytics in 4. Propranolol is contraindicated in heart and lung diseases. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 74 SIDE EFFECTS 2. CNS depression by combining benzodiazepines with other CNS depressants, particul arly alcohol. Benzodiazepine withdrawal symptoms: tremors, insomnia, headache, t innitus, anorexia and dizziness. Side effects of barbiturates: suppression of th e phase of rapid eye movement (REM) sleep, sleepiness during the day and morning hangover effect. 4. 6.

U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 75 SIDE EFFECTS 3. Propranolol can induce insomnia, hallucinations, impaired metabolism of other dr ugs, lethargy and depression. Antihistamines may cause sedation, anticholinergic side effects and decreased seizure threshold. 5. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 76 Electroconvulsive therapy (ECT) INDICATIONS 1. Treatment of severe depression, high suicide risk, who refuse to eat that do not respond to or can not tolerate antidepressant medication. Indicated in lithiumresistant manic customers and antipsychotics and customers whose body quickly cy cles drugs. 3. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 78 MECHANISM OF ACTION 1. It is unknown the exact mechanism of action. Electrical stimulation leads to inc reased circulating levels of various neurotransmitters. 3. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 79 CONTRAINDICATIONS AND PRECAUTIONS 1. The only absolute contraindication to ECT is the increased intracranial pressure . Conditions that pose a high risk to the client are: Cardiovascular disorders. Aortic aneurysm or stroke. Severe hypertension. Osteop orosis intense. Acute or chronic lung disorders. Pregnancy. U.S. PSYCHOPHARMACOLOGY Walter G. Cortes 80 3. END OF SUBMISSION

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