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Sedatives, hypnotics, affective and antipsychotic medications for odla exercise
1. Pharmacology of the Central Nervous System
Sedatives, Hypnotics, Affective, and Antipsychotics
2. Teaching and Learning
Objectives
Sedative-Hypnotic and Antianxiety Drugs
• Name the 2 major types of sedative-
hypnotic and antianxiety drugs.
• Describe the general mechanism of action
of all 2 of the types of drugs.
• Discuss problems and adverse effects of
these types of drugs.
• Compare/contrast sedative-hypnotic and
antianxiety drugs.
3. Teaching and Learning
Objectives
• List the major types of antianxiety drugs
• Describe the problems and adverse
effects of these drugs
• Discuss the implications for the PT
management of patients taking sedative-
hypnotic and antianxiety drugs
• Modify PT interventions for persons taking
these drugs
4. Teaching and Learning
Objectives
Antidepressive and Bipolar Drugs
• Describe the clinical signs of depression
• Describe the theoretical neurotransmitter
basis of depression
• Explain the mechanism of action of
antidepressive drugs
• List the 3 major groups of antidepressive
drugs
5. Teaching and Learning
Objectives
• Describe the mechanism of action of the 3
groups of antidepressant drugs
• Discuss the problems and adverse effects
of the 3 groups
• Explain the use of antidepressant drugs in
the management of chronic pain
• Define Bipolar Disorders
• Discuss the use of Lithium for bipolar
disorders
6. Teaching and Learning
Objectives
• Discuss the special concerns for
rehabilitation in patients taking
antidepressant and bipolar drugs
• Modify PT management of patients taking
antidepressant and bipolar drugs
7. Teaching and Learning
Objectives
Antipsychotic Drugs
• Define Psychosis and list the associated
symptoms
• Describe the theoretical neurotransmitter
basis of psychosis
• Explain the mechanism of action of
antipsychotic drugs
• Explain the major difference in traditional
and atypical antipsychotic drugs
8. Teaching and Learning
Objectives
• Explain the use of antipsychotic drugs in
persons with dementia
• Define “extrapyramidal” symptoms
• Recognize extrapyramidal symptoms
• Describe Tartive Dyskinesis
• List non-motor side effects of antipsychotic
drugs
• Describe special PT rehabilitation concerns in
persons taking antipsychotic medications
• Modify PT strategies for patients taking
antipsychotic drugs
9. Sedative-Hypnotic Drugs
• Used to relax ( low doses)
• Used to promote sleep (higher doses)
• Very commonly used by inpatients and
outpatients.
• 2 general categories of drugs
Benzodiazepines
Nonbenzodiazepines
All sedative/hypnotic drugs act as GABA receptor
agonists, ie., increase chloride entry to the post-
synaptic membrane, thus inhibiting the synapse.
12. Side Effects
• Dependence- Withdrawal symptoms associated with
cessation of the drug
• Tolerance- Necessity of increasing dosage to attain
therapeutic effect
• Day after residual effects- especially important for
PTs to be aware of.
• Drowsiness and decreased motor performance day
after taking drug
• Anteriorgrade amnesia- poor recall of details and
events for a period of time after taking the drug
13. Nonbenzodiazepines
• Barbituates- hypnotics
Uncommonly used today due to risk of
overdose, tolerance and dependence.
Tolerance- more drug necessary for an effect
Dependence- withdrawal symptoms
• Newer Drugs
– Zolpidem (Ambien) and Zaleplon (Sonata)
• Sedative/hypnotic effects
• Less risk of overdose , tolerance and
dependence
14. Antianxiety Drugs
• Benzodiazepines
Used at lower doses for antianxiety
than as for sedative/hypnotic effects.
• Nonbenzodiazepines
Buspirone (BuSpar)- Acts through the
serotonin receptor as an agonist, not
GABA.
Least risk of tolerance, dependency and
sedation effects of available antianxiety
drugs.
15. PT Implications of Sedative/Hypnotic/Antianxiety
Drugs
Assignment
• May be helpful in gaining patient cooperation with
therapy.
• May be detrimental if patient drowsy, so scheduling
therapy should take into account the time of maximal
effect of sedation.
• May increase the risk of falls, so that balance training
and environmental modifications may be provided by the
therapist.
• Non-pharmacologic measures to reduce anxiety and
insomnia such as therapeutic massage, exercise, and
relaxation techniques may avoid the need or reduce the
effective dose of these drugs. (Instructor may make a
cloud display containing all of the answers and post for
17. Neurotransmitter Basis of
Depression
• http://www.metacafe.com/watch/3486985/how_s
sris_and_mao_inhibitors_work/?fb_xd_fragment
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• Drugs that prolong the action of serotonin
and dopamine, decrease sensitivity to
these neurotransmitters by down
regulating the excessive stimulation which
is thought to cause depression.
18. 3 Types of Antidepressant
Drugs
• Tricyclics Amitriptyline, Imipramine
• Monoamine Oxidase Inhibitors (MAOI)
• Serotonin Reuptake Inhibitors (SSRI) -
Prozac, Paxil, Zoloft
Since all of these drugs act by
desensitization of the synapse to the
neurotransmitters, they often require 2-4
weeks for therapeutic effect to occur.
22. Adverse Effects
• SSRI
Lesser degree of sedation,
anticholinergic, and cardiovascular effects
than tricyclics and MAOI.
Serotonin Syndrome- Life threatening
http://www.medclip.com/index.php?page=
videos§ion=view&vid_id=105700
24. Bipolar Disorders
• Pendulum-like swings between mania and
depression.
• Treatment designed to prevent the swings by
dampening neuronal (synaptic) transmission.
• Lithium is drug most often used. Tendency to
accumulate in body reaching toxic levels.
• Side effects include tremor, weakness,
confusion, ataxia, dysarthria, nystagmus,
increased DTRs, choreoathetoid movements,
coma and death
25. Psychosis
• Thought process disturbance with
impaired perception of reality.
• Schizophrenia most common form
Effects 1% of world population
Symptoms include bizarre delusions,
hallucinations, poor social relations and
self-care.
70-80% genetic tendency.
27. Antipsychotic Drugs
• Traditional antipsychotics- Haldol, Prolixin,
Thorazine, Mellaril
Side effects include extrapyramidal signs,
sedative and anticholinergic effects.
• Atypical antipsychotics- First line drugs of choice
Significantly fewer (lesser) side effects than
traditional drugs
Often used in Alzheimers and other persons
with dementia to control agitation and
aggression.
28. Side Effects of Antipsychotic
Drugs
http://www.youtube.com/watch?v=Ki9t2sSBFmA
