Pyschopharmacology Flashcards
are chemicals that affect the brain and nervous system; alter feelings, emotions, and consciousness in various ways; and frequently are used therapeutically in the practice of psychiatry to treat a broad range of mental and emotional illnesses
Psychotropic, or a psychoactive drugs
Categories of psychoactive drugs
- Antipsychotic drugs, neuroleptics and major tranquilizers
- Antianxiety agents, minor tranquilizers and sedative-hypnotics (anxiolytics)
- Antidepressant or mood elevators
- Mood stabilizers
- Anticholinergic/Antiparkinsonism
are represented by over 200 specific chemicals within the brain. These are secreted by the neurons that synthesize them.
Neurotransmitters
Types of Neuro transmitters
excitatory
inhibitory
Is the treatment of most forms of psychosis, such as schizophrenia, schizoaffective disorder, mood disorder with psychosis, and psychoses associated with delirium and dementia.
Symptoms:
Impaired communication or the inability to relate to others, delusions, hallucinations, lack of responsiveness to the external environment, inability to identify reality
Action:
Provide symptomatic control of the patient by blocking the activity of DOPAMINE – a chemical normally occuring in the brain and having the potential to produce psychotic thinking.
too much dopamine causes nerve impulses in the brain stem to be transmitted faster then normal, resulting in strange thoughts, hallucinations and bizarre thinking.
blocking this activity of dopamine lessens or prohibits the development of such thoughts and behavior.
antipsychotic agents
Side effects of antipsychotic agents
- Anticholinergic effects
a. Dry mouth.
b. blurred vision.
c. Constipation
d. urinary retention - nausea, G.I. upset
- skin rash
- sedation
- orthostatic hypotension
- photosensitivity
- hormonal effects
a. Decreased libido, retrograde ejaculation, gynecomastia
b. Amenorrhea
c. Weight gain - Agranulocytosis
- Hypersalivation (with clozapine)
Potentially very serious side-effect, but
relatively rare with most of the
antipsychotic drugs. Usually occurs within the first 3 months of treatment. Observe for symptoms of sore throat, fever, malaise; CBC should be monitored if these symptoms appear.
Note: With clozapine (Clozaril), agranulocytosis occurs in 1 to 2 percent of all clients taking the drug (Pokalo, 1991)
Agranulocytosis
extrapyramidal symptoms (EPS) of antipsychotic agents
- Pseudoparkinsonism
- akathisia (motor restlessness)
- acute dystonic reactions or dystonia
- tardive dyskinesia
- neuroleptic malignant syndrome (NMS)
Motor retardation or akinesia, characterized by masklike appearance, rigidity, tremors, “pill rolling”, salivation
Pseudoparkinsonism
Constant state of movement characterized by restlessness, difficulty sitting still, or strong urge to move about. Referred to as “ Walkies and Talkies”
akathisia (Moto restlessness)
Irregular, involuntary spastic muscle movement wryneck or torticollis, facial grimacing, abnormal eye movements, backward rolling of eyes in the sockets ( oculogyric crisis)
acute dystonic reactions
Most frequent serious side effect resulting from termination of the drug, during reduction in dosage, or after long term, high dose therapy. Characterized by involuntary rhythmic, stereotyped movements, tongue protrusion, cheek puffing , involuntary movements of extremities and trunk , chewing movements, worm like movement of the tongue
Tardive dyskinesia
Idiosyncratic, rare syndrome characterized by hyperpyrexia, severe muscle rigidity, altered consciousness, alteration in blood pressure , elevated creatinine phosphokinase , elevated white blood cell count
neuroleptic malignant syndrome
- Are also called anxiolytics and minor tranquilizers
- They are used in the treatment of anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasm , convulsive disorders, status epilepticus, and preoperative sedation Antianxiety drugs depress subcortical levels of the CNS, particularly the limbic system and reticular formation . They may potentiate the effects of the powerful inhibitory neurotransmitter, gamma-aminobutyric acid (GABA) in the brain, thereby producing a calmative effect.
Antianxiety agents
Excitatory Neurotransmitters
Acetylcholine
Epi and norepi
Serotonin
Dopamine
Inhibitory Neurotransmitters
GABA
Glycine
- Provide the client with sugarless candy or
gum, ice, frequent sips of water - Ensure that client practices strict oral
hygiene.
Dry mouth
- Explain that this symptom will most likely
subside after a few weeks. - Advise client not to drive a car until vision
clears. - Clear small items from pathway to prevent
falls.
Blurred vision
- Order foods high in fiber; encourage
increase in physical activity and fluid intake if
not contraindicated.
Constipation
- Instruct client to report any difficulty
urinating; monitor intake and output.
Urinary Retention
- Tablets or capsules may be administered with
food to minimize GI upset. - Concentrates may be diluted and
administered with fruit juice or other liquid;
they should be mixed immediately before
administration.
Nausea, GI upset
- Report appearance of any rash on skin to
physician. - Avoid spilling any of the liquid concentrate on
skin; contact dermatitis can occur.
Skin rash
- Discuss with physician the possibility of
administering the drug at bedtime. - Discuss with physician a possible decrease in
dosage or an order for less sedating drug. - Instruct client not to drive or operate
dangerous equipment while experiencing
sedation.
Sedation
- Instruct the client to rise slowly from a
lying or sitting position; monitor blood
pressure (lying and standing) each shift;
document and report significant changes.
Orthostatic hypotension
- Ensure that the client wears protective
sunscreens, clothing, and sunglasses while
spending time outdoors.
Photosensitivity
- Provide explanation of the effects and
reassurance of their reversibility; may
discuss with physician possibility of ordering
alternate medication.
Hormonal Effects
a. Decreased
libido, retrograde
ejaculation,
gynecomastia (men)
- Offer reassurance or reversibility and
instruct client to continue us e of
contraception because amenorrhea does
not indicate cessation of ovulation
amenorrhea
Weight client every other day; order
calorie-controlled diet; provide opportunity
for physical exercise; provide diet and
exercise instruction.
Weight gain
Offer support to the client because this
may be embarrassing situation. It may
be even be a safety issue (e.g. risk of
aspiration), if the problem is very severe.
Hypersalivation (with
clozapine)
ONSET/PREVALENCE
Generally occurs after first week of treatment or
before second month (2% -90%)
TREATMENT/INTERVENTION
Dose reduction
Administer anticholinergic agent
PSEUDOPARKINSONISM
ONSET/PREVALENCE
Generally occurs 2 weeks after treatment
begins ( 35%)
TREATMENT/INTERVENTION
Dose reduction or change drug class; give benzodiazepin or beta blocker
Akathisia (Motor Restlessness)
ONSET/PREVALENCE
May occur anytime from a few minutes to several hours after first dose of antipsychotic drug (2%-90%)
TREATMENT/INTERVENTION
Dose reduction or change drug class, give
anticholinergic agent
Acute dystonic reactions (dystonia)
ONSET/PREVALENCE
Occurs approximately 3% to 5% of clients taking anti psychotics in first 10 years
Cumulative prevalence over 10-20 years is about
40-55%.
TREATMENT/INTERVENTION
Reduce or discontinue antipsychotic agents, irreversible side effect
Vitamin E
Benzodiazepines
Beta- Blocker
Clozapine
Tardive Dyskinesia
ONSET/PREVALENCE
May develop within hours after first dose or after years of continued drug exposure; more common in persons under 20 and over 60 years of age
( 0.1%-1%)
TREATMENT/INTERVENTION
Discontinue antipsychotic agent have
cardiopulmonary and renal support available; administer skeletal muscle relaxant ( e.g dantrolene) or centrally acting dopamine receptor
agonist ( e.g bromocriptine) The combination of
benzodiazepines and ECT has been successful in
Neuroleptic Malignant Syndrome (NMS)
Implication of Nursing Action in ANTIPSYCHOTIC
Patients should have an evaluation of BP, CBC,
Liver function test and vision test before
therapy and at periodic intervals thereafter.
Nurses Should be aware of the following
1. if a single dose is ordered, give oral
neuroleptics within 1 or 2 hours of bedtime
whenever possible to aid sleep. Minor side
effects are less bothersome at this time.
2. avoid contact with concentrated solutions
while preparing them since they are irritating
to the skin and may cause contact dermatitis
3. liquid concentrates should be mixed with
at least 60 ml. of fruit juice or water just
before administration to mask the taste of
the concentrate.
4. do not give antipsychotics drugs
subcutaneous unless specifically ordered
since they may cause irritation ,. They should
be given deep IM
Patient Education in ANTIPSYCHOTIC
- sleeping pills , alcohol and other
medication should be avoided during drug
therapy. - patient should avoid being in direct
sunlight for an extended time to prevent
sunburn or pigmentation of the skin. - individuals should be instructed not to
increase, decrease, or cease taking drugs
without discussing this step with the
physician . The drug should be withdrawn
slowly to avoid nausea or seizure - the patient should be told that antacid
might decrease the absorption of
antipsychotic drugs from the intestinal tract. - good oral hygiene should be practiced to
avoid mouth infections , dental carries and ill
fitting dentures. - if children are in the home, tablets or
capsules should be kept in a safe place to
avoid their being mistaken for candy.
Antianxiety Chemical Classes
Antihistamines
Propanediols
Azaspirodecanediones
ANTIANXIETY:
Hydroxyzine (Vistaril; Atarax)
Antihistamines
ANTIANXIETY:
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)
Benzodiazepines
ANTIANXIETY:
Meprobanate (Equanil; Miltown)
Propanediols
ANTIANXIETY:
Buspirone (Buspar)
Azaspirodecanediones
Side EFFECTS of AntiAnxiety
- Drowsiness , confusion, lethargy (Most common side effect)
- Tolerance ; physical and psychological
dependence (does not apply to
buspirone) - Ability to potentiate the effects of other CNS depressant
- Orhostatic Hypotension
- Paradoxical excitement (client develops symptoms opposite of the medications desired effect).
- Dry mouth
- Nausea and Vomiting
- Blood Dyscrasias
- Delayed onset (Buspirone only)
Are used in the short term management of
various anxiety states and in the treatment of
insomnia
Sedative Hypnotics
SEDATIVE HYPNOTICS chemical classes
Barbiturates
Benzodiazepines
Miscellaneous
SEDATIVE HYPNOTICS:
Amobarbital (Amytal)
Aprobarbital (Alurate)
Butabarbital (Butisol)
Mephobarbital (Mebaral)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
Secobarbital (seconal)
Barbiturates
SEDATIVE HYPNOTICS:
Estazolam (Prosom)
Flurazepam (Dalmane)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (halcion)
Benzodiazepines
SEDATIVE HYPNOTICS
miscellaneous
Chloral hydrate (Noctec)
ethclorvynol (Placidyl)
Glutethimide (Doriden)
Zolpidem (Ambien)
Implication for Nursing Actions in Antianxiety/Sedative Hypnotics
1 Give the daily dose at bedtime to promote
sleep, minimize adverse reactions, and allow
more normal daytime activities to occur.
2 Administer IM dosages deeply and slowly
into large masses because they are irritating
to the tissue and can cause pain at the site of
injection
3. observe for adverse side effect such as
over sedation, hypotension, pain at the
injection site, skin rashes , and paradoxic
excitement. Symptoms of paradoxic
excitement include hostility, rage confusion
depersonalization or hyperactivity.
Patient Education in Antianxiety/Sedative Hypnotics
- avoid mixing alcoholic beverages ,
antihistamines, or antipsychotic drugs with
antianxiety agents because they can increase
the depressant effects of those agents,
possibly causing death - avoid ingesting large amounts of
beverages containing caffeine, a stimulant,
because it can decrease the effects of
sedative-hypnotic agents. - report symptoms of fever , malaise sore
throat, petechiae, easy bruising , or bleeding
and skin rash - sudden cessation of these agents can
cause rapid eye movement ( REM) or rebound
with insomnia, dreams , or nightmares, in
addition to hyper excitability, agility, or
convulsion - avoid excessive use of these drugs to
prevent the onset of substance abuse or
addiction
Are used to treat depressive disorders caused
by emotional or environmental stressors,
losses, drugs disease states such as cerebral
vascular accidents, or depression that cannot
be related to an identifiable cause
Antidepressant or Mood Elevation
Antidepressant are classified as
- tricyclic antidepressants ( TCA’s)
- Monoamine Oxidase Inhibitors( MAOI’s)
- selective Serotonin reuptake inhibitor (
SSRI’s)
Increases the level of neurotransmitters
serotonin or norepinephrine in the space
between nerve endings.
Neurotransmitters carry messages from one
nerve cell to another, and a deficiency in
these transmitters is thought to cause
depresssion.
Tricyclic Antidepressants
Tricyclic Antidepressanrs Drugs:
Amitriptyline (Amitril, Elavil, Endep)
Amoxapine (Asendin)
Clomipramine (Anafranil)
Desipramine (Norpramin, pertofrane)
Doxepin (Sinequan,Adapin)
Imipramine Tofranil
Nortripyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (surmontil)
Implication for Nursing Actions in Tricyclic Antidepressants
- assess the patient level or severity of
depression, including the presence of
suicidal ideation - identify usual coping mechanism
- observes for side effects( dry mouth,
blurred vision, tachycardia, urinary retention,
constipation) - observe for drug interactions
- observe for therapeutic effects of TCAs 2
or 3 weeks after the initial dose- therapeutic
window ( serum Plasma Level)
If no therapeutic response is observed within
4-8 weeks another drug is prescribed.
Patient Education in Tricyclic Antidepressants
- take drug as prescribe
- avoid taking OTC cold remedies or other
drugs without the physician knowledge. (
antihistamines and narcotic analgesics will
increase the effect - Avoid excessive exercise and high
temperatures because anticholinergic effects
of these agents block perspiration.
Are well known for the multiple drug and
food interactions because they inhibit the
enzyme that breaks down the amino acid
tyramine and tryptophan
An accumulation of these substance triggers
the release of norepinephrine , and a
HYPERTENSIVE CRISIS may Occur
Clinical Symptoms
Elevation of BP
Headache
Diaphoresis
Dilation of pupils
Rapid heart rate or arrhythmias
Intracerebral hemorrhage
Monoamine Oxidase Inhibitors (MAOI)
Diet Restrictions For Clients on MAOI Therapy
Food containing Tyramine
High Tyramine Content ( Avoid while on MAOI
therapy)
Aged Cheeses, Cheddar, Swiss,, Cammembert, Blue
cheese, Parmesan, Provolone, Romano, Brie
Raisins, favabeans, flat Italian beans, Chinese pea
pods
Red wines ( Chianti,burgundy, sauvignon)
Smoked and processes meats ( salami, bologna,
pepperoni, summer sausage)
Caviar, pickled, herring , corned beef, chicken or beef
liver
Soy sauce, brewer’s yeast, meat tenderizer ( MSG)
Moderate Tyramine Content ( May Eat
occasionally while on MAOI therapy)
Gouda Cheese, Processes American
Cheese , Mozzarella
Yogurt, sour cream
Avocados, Bananas
Beer white wine, coffee, colas, tea, hot
chocolate
Meat extracts, such as bouillon
Chocolate
Low Tyramine Content ( limited quantities permissible while on MAOI therapy)
Pasteurized cheeses ( cream
cheese, cottage cheese,
Ricotta
Figs, Distilled Spirits in
moderation
Drugs for MAOI
- Isocarboxacid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
Medication for overdose:
- Phentolamine (regitine) for excessive response
- Diazepam (Valium)
PAtient education in Antidepressants
- Take the drugs as prescribed
- Avoid ingestion of tyramine- containing
foods, and caffeine- containing or certain
alcoholic beverages - Report any symptoms indicative of a
hypertensive crisis, such as headache or
heart palpitation.
become popular because of its advantageous safety
profile and its broad spectrum of potential
indications.
SSRIs depend on neuronal release of serotonin for
their action, which is the blocking of the neuronal
uptake of serotonin.
The inhibition of serotonin uptake into the nerve
terminal by an SSRI increases synaptic transmitter
levels to exert a clinically significant anti depressant
effect.
Are used in the treatment of depression alone or in
the presence of concurrent disorders such as anxiety,
panic attacks, eating disorders, sleep disorders,
alcoholism, or schizophrenia
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs
Celatopram (Celexa)
Fluoxetine (Prozac)
paroxetine (Paxil)
Sertraline (Zoloft)
LITHIUM SALTS
* Is considered the treatment of choice for the
manic phase of the bipolar disorder formerly
termed manic-depressive illness and for longterm prophylaxis of this bipolar disorder.
Mood Stabilizers
Is considered the treatment of choice for the
manic phase of the bipolar disorder formerly
termed manic-depressive illness and for longterm prophylaxis of this bipolar disorder.
- It is believed to level out the activity of
neurotransmitter in the area of the brain that
controls emotions, thus preventing a decreased
activity of nerve impulses, resulting in depression
or an increased activity of nerve impulses,
resulting in MANIA.
also It is thought to maintain a constant NA
concentrate in the brain, regulating impulses
along the nerve cells as well as mood swings.
the body does not metabolize lithium;
approximately 80% of a lithium dose is
reabsorbed in the proximal renal tubules and
excreted by kidneys
Lithium Salts
Litium Toxicity
for therapeutic mania: 1.0 to 1.5 meq/L
for maintenance: 0.6 to 1.2 meq/L
Symptoms include:
➢ at serum levels of 1.5 to 2.0 meq/L
blurred vision, ataxia, tinnitus, persistent nausea and vomiting, severe diarrhea
➢ At serum level of 2.0 to 3.5 meq/L
excessive output of dilute urine, increasing tremors,
muscular irritability, psychomotor retardation, mental
confusion
➢At serum levels above 3.5 meq/L
impaired consciousness, nystagmus, seizures coma,
oliguria/anuria, arrhythmias, myocardial infarction,
cardiovascular collapse.
mood Stabilizing agents Class
Antimanic
Anticonvulsants
Calcium Channel Blocker
➢ Blocks CNS cholinergic receptors causing
reduced acetylcholine activity.
➢ Anticholinergic agents are not as effective as
levodopa. As such they are often used in
mild cases of Parkinson’s dse. Or in
combination with other antiparkinson drugs.
➢ These drugs can help reduce tremor and
rigidity.
Anticholinergic Drugs
