psychotropic drugs Flashcards
sometimes referred to as the biological approach is a theoretical approach to understanding mental health disorders as biological malfunctions of the nervous system
biopsychiatry
what are the disturbances of mental function?
environment
genes
altered neurons
norepinephrine
serotonin
dopamine
glutamate
y-aminobutyric acid (GABA)
exerts an inhibitory effect on neurons in many parts of the brain. drugs that enhance this effect exert a sedative-hypnotic action on brain function or reduce anxiety
GABA
can be used to decrease the tachycardia and agitation associated with anxiety
Beta-blockers
most commonly used because of quick onset of action
bind to specific receptors adjacent to GABA receptors (accounts for its use as an anticonvulsant and its efficacy in reducing neuronal overexcitement in alcohol withdrawal)
Benzodiazepines
what are the side effects of benzodiasepines?
interfere with motor ability, attention, and judgement
what are examples of antianxiety and hypnotic drugs?
Diazepam (Valium)
Clonazepam (Rivotril)
Alprazolam (Xanax)
Lorazepam (Ativan)
Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Nitrazepam (Mogadon)
Oxazepam (Serax)
A newer class of hypnotic, termed a Z drug.
Promotes GABA and inhibits the release of neurotransmitters
As a result, it has sedative effects as well as hypnotic, anxiolytic,
anticonvulsant, and muscle-relaxant effects
Onset of action is faster than that of most benzodiazepines
It is important to inform patients taking non-benzodiazepine hypnotic
drugs about the quick onset and advise them to take the drug only
when they are ready to go to sleep
short-acting sedative-hypnotic sleep agents (Z-hypnotics)
what is an example of short-acting sedative-hypnotic sleep agents?
zopiclone (imovane)
what is an example of a melatonin receptor agonist?
Buspirone hydrochloride (bustab)
evidence points to the cause of depression as a transmission deficiency or norepinephrine or serotonin or both within the limbic system
antidepressant drugs
block muscarinic receptors, giving
anticholinergic effects. Some TCAs block H1
receptors in the brain, producing drowsiness.
Improvement in mood may take one to three
weeks or longer
Tricyclic antidepressants (TCAs)
what are triclyclic antidepressants used to treat?
symptoms of depression
(insomnia, appetite, excessive fatigue,
libido, difficulty thinking/concentrating,
feelings of worthlessness)
what are the side effects of tricyclic antidepressants (TCAs)?
Dry mouth, blurred vision, tachycardia, urinary
retention & constipation, orthostatic hypotension
Potentially lethal if taken in overdose
MAOI’s contraindicated
Most serious effects are cardiovascular
what should the client know about tricyclic antidepressants?
Take drugs as prescribed (do not alter dosage)
Therapeutic effects may not occur for 2-3 wks
after initial therapy
Avoid alcohol; be careful driving, and working
around machinery
what are examples of tricyclic antidepressants?
Nortriptyline hydrochloride (Aventyl, Norventyl)
Amitriptyline hydrochloride (Elavil, Levate)
Imipramine hydrochloride (Impril)
Doxepin (Sinequan
- First line therapy for most types of depression
- Block the reuptake of serotonin which increases
the availability of serotonin at the synaptic gap - Low adverse-effect profile
- MAOI’s should be discontinued for 14 days before
starting SSRI’s - Avoid alcohol and OTC Meds
selective serotonin reuptake inhibitors
what are examples of selective serotonin reuptake inhibitors (SSRIs)?
Fluoxetine hydrochloride (Prozac)
Paroxetine hydrochloride (Paxil)
Citalopram hydrobromide (Celexa)
Escitalopram oxalate (Cipralex)
Fluvoxamine maleate (Luvox)
Sertraline hydrochloride (Zoloft)
what are the side effects of SNRIs?
hypertension, dry mouth, sexual dysfunction
Increase both serotonin and norepinephrine
Flexibility of working as an SSRI at lower doses (75
mg/day), affecting the reuptake of serotonin, and as
an SNRI at higher doses (150–225 mg/day)
serotonin-norepinephrine reuptake inhibitors (SNRIs)
what are examples of SNRIs?
Venlafaxine hydrochloride (Effexor XR)
Venlafaxine succinate (Pristiq)
Duloxetine hydrochloride (Cymbalta)
Class is represented by only one drug
Acts by increasing norepinephrine, dopamine, and serotonin
transmission by acting as an antagonist at central
presynaptic α2-adrenergic receptors
The normal function of these receptors is to inhibit
neurotransmitter release when norepinephrine binds to
them.
any drug that prevents noradrenaline from binding to these
receptors will potentiate neurotransmitter release – reason
why this drug is called a disinhibitor
serotonin and norepinephrine disinhibitors (SNDIs)
Inhibits the enzyme MAO(located in neurons in liver),
interfering with the destruction of monoamine
neurotransmitters and increasing the synaptic level of the
transmitters norepinephrine, serotonin, dopamine, and
tyramine
In the presence of MAO inhibitors (MAOIs), tyramine is not
destroyed in the liver, resulting in hypertensive crisis
When MAOIs are taken, the patient must observe a tyramine-
free diet (See Table 13.5, pg 239: Foods that contain tyramine
monoamine oxidase inhibitors (MAOIs)
what should the client know about MAOIs?
Instruct clients not to eat foods containing tyramine &
tryptophan, caffeine-containing beverages, and beer &
wine
Take drugs as prescribed; avoid altering dosage or
discontinuing the drug
Avoid over activity b/c agents suppress angina pain
Have vision checked periodically – optic toxicity
Carry medic alert card
what are examples of MAOIs?
Phenelzine sulfate (Nardil)
Tranylcypromine sulfate (Parnate)
Selegiline hydrochloride (Anipryl)
what are other antidepressant drugs?
Bupropion hydrochloride (Wellbutrin, Zyban)
Trazodone hydrochloride (Oleptro, Trazodone,
Trazorel)
Used to treat Bipolar Disorder (mania)
Lithium carbonate inhibits 80% of acute manic and hypomanic
episodes within 10-21 days
Anticonvulsants are also used
Mechanism of action of lithium is unknown but is probably
related to affecting electrical conductivity in neurons
May interact with sodium and potassium at the cell
membrane to stabilize electrical activity. Such a mechanism of
action would explain its ability to induce cardiac
dysrhythmias, convulsions, and tremor
Lithium can also create fluid balance disturbances. For these
reasons, it has a low therapeutic index (ratio of lethal dose to
effective dose) and requires close monitoring of serum lithium
level (initially 3 times/week)
mood stabilizers
what is an example of a mood stabilizer?
lithium carbonate
Alter electrical conductivity in membranes and reduce
the firing rate of very-high-frequency neurons in the
brain
Used in reducing mood swings in bipolar patients
anticonvulsant drugs
what are examples of anticonvulsant drugs?
Valproate (available as sodium divalproex and valproic
acid [Depakene])
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Gabapentin (Neurontin)
Topiramate (Topamax)
Oxcarbazepine (Trileptal)
what is the therapeutic level of lithium?
<0.4-1.2 mEq/L
what is the toxicity level of lithum?
> 1.5-2.0 mEq/L
what are the side effects of lithium toxicity?
Severe vomiting, slurred speech, muscle
weakness, lack of coordination, convulsions,
renal failure, and death may occur as a result of
lithium toxicity
First generation antipsychotic
Strong antagonists (blocking agents)
Bind to D2 receptors
Block attachment of dopamine
Reduce dopaminergic transmission
Blocking dopamine reduces the positive
symptoms of schizophrenia, such as delusions and
hallucinations
Produce neurologic adverse side effects
(Extrapyramidal side effects- EPS)
Available in a depot (long-acting injectiable)
conventional (typical) antipsychotic drugs
Antagonists (a substance that interferes with
or inhibits the action of another)of receptors
for
Acetylcholine
Norepinephrine
Histamine
first-gen antipsychotic (conventional) drugs
what are examples of first-gen antipsychotic drugs?
haloperidol (haldol)
thoridazine (mellaril)
what are the motor disturbance adverse effects of first gen antipsychotic drugs?
parkinsonism,
akinesia, akathisia, dyskinesia, and tardive
dyskinesia
what are the anticholinergic effects of first gen antipsychotic drugs?
blurred vision, dry mouth,
constipation, and urinary hesitancy
what are the major adverse effects of first-gen antipsychotic drugs?
Vasodilation, orthostatic hypotension, &
ejaculatory failure, sedation and substantial
weight gain
Produce fewer extrapyramidal side effects
(EPS)
Target both the negative and positive
symptoms
Often chosen as first-line treatment
second-gen (atypical) antipsychotic drugs
what are examples of dopamine and serotonin blockers?
clozapine
risperidone
olanzapine
ziprasidone hydrochloride monohydrate
paliperidone
paliperidone palmitate
Induce agranulocytosis (decreased white blood cell
(WBC); pts at risk for infections)
clozapine
Reduces delusions and hallucinations
Can cause orthostatic hypotension and sedation and
weight gain
EPS are few
risperidone
Adverse effects include sedation, weight gain,
hyperglycemia with new-onset type 2 diabetes, and
higher risk for metabolic syndrome
olanzapine
dopamine stabilizer
aripiprazole
what are drugs for attention deficit hyperactivity disorder (ADHD)?
Methylphenidate hydrochloride (Biphentin,
Concerta, Ritalin)
Dextroamphetamines, such as amphetamine
aspartate monohydrate (Adderall XR)
what are drugs for Alzheimer’s disease?
Donepezil hydrochloride (Aricept)
Galantamine hydrobromide (Reminyl)
Rivastigmine hydrogen tartrate (Exelon)
Memantine hydrochloride (Ebixa), a
noncompetitive N-methyl-D-aspartate (NMDA)
receptor antagonist
Other Drugs
(Cont.)
what are the potential long-term effects of natural products?
Nerve damage
Kidney damage
Liver damage
what are examples of natural products?
St. Johns wort
ginkgo biloba
Improves mood
Taken with SSRI’s can result in serotonin syndrome
(life-threatening)
St. Johns wort
Used for prevention and treatment of cognitive
decline, depression and memory loss associated with
ECT
ginkgo biloba
