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NOTETAKING GUIDE ON PSYCHOPHAMACOLOGY

Basic Concepts on Psychopharmacology

Psychotropic Agents – pharmacologic agents used to modify behavior.Affects the


Central Nervous System and Autonomic Nervous System.Do not cure disease ,
But relieves symptoms

Sympathetic N.S. Parasympathetic N.S.

Automatic – homeostasis
Nor-epinephrine( adrenergic)- CATECHOLAMINES
(Dopamine ,nor-epi,epinephrine) (+)
and Acetylcholine (cholinergic)(+) ; atrophine (-)

Brain and Spinal Cord

Neurons – stores and transmits information


- 2-3 neurons are lost in a day starting 18 y.o.
- Single neuron transmits only 1 type of neurotransmitter

Neurotransmitters – chemical substances needed for transmission of impulses

Dopamine
Inhibitory – muscle control
GABA
Types
Serotonin
Excitatory- muscle movement Norepinephrine

Acetylcholine

Afferent ----spinal cord,brain----Efferent

Reflex arc
I. ANTI-PSYCHOTICS

SUB-CLASSIFICATIONS
PHENOTHIAZINES NON-PHENOTHIAZINES

Chlorpromazine (Thorazine)
Clozapine ( Clozaril)
Fluphenazine (Prolixin)
Haloperidol ( Haldol)
Perphenazine ( Trilafon)
Olanzapine ( Zyprexa )
Prochlorperazine
Risperidone ( Risperdal)
(Compazine)
THIOXANTHENES
Thioridazine ( Mellaril)
Thiothixene ( Navane)
Triflouperazine (Stelazine)

MOA
- antagonizes dopamine in the CNS and also blocks Cholinergic, Histaminic,
Serotogenic, Adrenergic neurotransmitters
( anticholinergic, antihistaminic, anti-emetic ) blocks activity of the CNS receptors and
sympathetic nervous
system

INDICATION
formerly called major tranquilizers / neuroleptics. used to
relieve psychotic symptoms( delusions , hallucinations
and looseness of association)of schjizophrenia, mania and psychotic
depression and organic mental disorders
- acute management of agitation and hyperactivity

SIDE/ ADVERSE EFFECTS:

 ANTICHOLINERGIC EFFECTS
(EPS)EXTRAPYRAMIDAL SYMPTOMS
PSEUDOPARKINSONISM-tremor , mask like facies drooling , restlesssness
AKATHISIA- restlessness,and anxiety
DYSTONIA-grimacing , torticollis ,oculogyric crisis, intermittent muscle spasms
- TARDIVE DYSKINESIA-lip smaking and tongue and mouth

 (NMS) NEUROLEPTIC MALIGNANT SYNDROME*


- hyperthermia, and severe EPS -muscular rigidity, tremors, trismus,
choreiform movements,autonomic instability /hyperactivity
and alterations in LOC

 SEIZURES
HEPATOTOXICITY*
ORTHOSTATIC HYPOTENSION
PHOTOSENSITIVITY and HYPERSENSITIVITY
ENDOCRINE DISORDERS
DYSCRASIAS *
AGRANULOCYTOSIS – sorethroat,chills,fever,malaise
LEUKOPENIA

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS:


C/I : hypersensitivity , glaucoma , convulsive d/o , pregnancy and lactation, elderly clients

NURSING CARE GUIDELINES:

C- antipsychotics, neuroleptics, major tranquilizers


H- decreased overt or positive manifestations of psychosis
E- p.c.
C- rise slowly
avoid sunlight
Report –sorethroat,fever,muscular rigidity
Reduced psychomotor agitation and insomnia – 1 week
Reduction of hallucinations, delusions and thought disorder takes 6-8 weeks for full
therapeutic effect

BP and temperature
K – monitor blood levels
Seizures, NMS and EPS
L.F.T.’s
CBC with differential

medical management :
NMS – Bromocriptine or Amantadine( dopamine agonist) and
Dantrolene (Dantrium) muscular relaxant
Dystonia – Diphenhydramine,Benztropine , Diazepam, Lorazepam
Pseudoparkinsonism – Antiparkinsonian, Anticholinergic
Akathisia – Anticholinergic, Benzodiazepines, Beta-blockers,Clonidine
Tardive dyskinesia – early referral-dose reduction , no anticholinergics

II. ANTI-PARKINSONIAN AGENTS

CLASSIFICATIONS

2 TYPES :

1.) DOPAMINERGIC DRUGS


MOA: enhance dopaminergic activity
slows deterioration of dopaminergic nerve cells
Increasing dopamine

Carbidopa – Levodopa ( Sinemet)


Amantadine ( Symmetrel)
Bromocriptine Mesylate ( Parlodel)
Levodopa ( Larodopa)
Pergolide Mesylate ( Permax)
Ropinirole(Requip)
Tolcapone ( Tasmar)
2.) ANTI-CHOLINERGIC AGENTS
MOA:inhibit relative excess in cholinergic activity, symptomatic relief
Decrease signs and symptoms ( tremors,rigidity, drooling promote optimal levels
of motor function (gait, posture and speech )

Trihexypheiedil ( Artane)
Biperiden Hydrochloride ( Akineton)
Benztropine Mesylate ( Cogentin)
Diphenhydramine Hydrochloride
(Benadryl)

Misc. agent
Selegiline ( Eldepryl)

INDICATIONS: For management of anti psychotic induced EPS- pseudoparkinsonism

SIDE AND ADVERSE EFFECTS


Anticholinergic Effects Blurring of vision, constipation, 3D’s and orthostatic
hypotension, sorethroat*
Headache, photosensitivity, drowsiness, CHF and halluciantions

CONTRAINDICATIONS AND SPECIAL PRECAUTION


Glaucoma, tachycardia, HPN, Cardiac D/O, asthma, duodenal ulcer

NURSING CARE GUIDELINES


C- dopaminergic or anti-cholinergic
H- decrease tremors and rigidity in 2-3 days
E- p.c.
C- avoid sudden position change
Avoid Vit. B6 and CHON rich foods- dec. absorption of medication
Avoid alcohol-increases sedative effects
K- check BP- orthostatic hypotension
drugs not withdrawn abruptly
III. ANTI DEPRESSANTS

COMMON TYPES

TRICYCLICS MONO AMINE OXIDASE SELECTIVE SEROTONIN


INHIBITORS REUPTAKE INHIBITORS

Imipramine(Tofranil) Citalopram ( Celexa)


Amitriptryline ( Elavil) Flouxetine (Prozac)
Clomipramine (Anafril) Paroxetine ( Paxil)
Doxepin ( Sinequan) Sertraline ( Zoloft)
Nortryptyline ( Aventyl) Fluvoxamine (Luvox)

Tranylcypromine (Parnate)
Isocarboxazid ( Marplan)
Phenelzine (Nardil)

Mechanism of
Action

Prolongs the action Blocks the


of norepinephrine metabolic
Dopamine destruction of
Serotonin by neurotransmitters by
blocking the the enzyme mono- Inhibits reuptake and
reuptake of this amine oxidase destruction of
neurotransmitters serotonin to prolong its
action
CNS STIMULANTS

Ritalin ( Methylphenidate)
Amphetamine ( Benzedrine)

Increases levels of neurotransmitters


in the brain thereby increasing CNS
activity and decreasing
hyperactivity.
INDICATIONS
effective in management and treatment of depression and related mood and depressive
disorders such as:
Obsessive compulsive ,Eating d/o,Obesity,Bipolar disorder,Panic d/o

SIDE EFFECTS AND ADVERSE REACTIONS:

TCA’S MAOI SSRI CNS Stimulants


Cardiac arrhythmias, Hypertensive crisis Tremors, decreased Growth suppression,
palpitations,orthostatic Liver and libido, NAVDA insomnia
hypotension cardiovascular disease Nervousness,
Constipation,Sedation, Weight gain insomnia, drowsiness
anticholinergic effects Sexual dysfunction anxiety
Confusion photosensitivity
Bone marrow
depression

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS

TCA’S MAOI SSRI CNS Stimulants


Hypersensitivity, liver Hypertension same
disease , glaucoma Cardiovascular
disease and Liver
disease

NURSING CARE GUIDELINES

C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleep
E – p.c.

TCA’S MAOI SSRI CNS Stimulants


C-
2-3 wks initial effect 2-3 initial 2-3 initial Give in AM , not
3-6 wks full 3-4 full ther. Effect 3-4 full ther. effect beyond 2 pm
therapeutic effect Avoid foods rich in 6 hours before
tyramine –leads to bedtime
Emphasize hypertensive crisis
compliance ( processed,preserved
Avoid citrus juice – and fermented )
decrease absorption

K-
Monitor BP, HR and Monitor BP and food
ECG items
IV. ANTI – MANIC

EXAMPLES
Lithium Carbonate ( Eskalith,
Lithane, Quilinium –R,
Lithionate)

Carbamazepine (Tegretol )

MOA
Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters

INDICATIONS
Treatment of acute mania and for prophylaxis of recurrent manic and depressive episodes in
bipolar disorder

SIDE AND ADVERSE EFFECTS


NAVDA
Fine tremors leading to coarse tremors
Thirst
Nystagmus
Nephrotoxicity*
Cardiac toxicity*
Hyperthyroidism – Thyroid Crisis*

CONTRAINDICATIONS AND SPECIAL PRECAUTION


Cardiovascular disease , renal disease, clients on low sodium diet and on diuretic therapy, brain
damage, pregnancy and lactation

NURSING CARE GUIDELINES

C- mood stabilizer – anti manic


H- decrease hyperactivity/manic episodes
Initial effect – 10-14 days
Full therapeutic effect 3-4 weeks
E- after meals with milk or food
C- antipsychotics given with lithium for immediate management of
manic episodes.
Diet – Na 6-10 grams a day; fluids- 3 liters per day
Avoid caffeine , diuretics and activities that increase perspiration

K- monitor for untoward signs and symptoms


Monitor serum level at least once a month(A.M. 12 hours after
the last dose
maintenance dose - .5 – 1.2 mEq / L
acute level – 1.5 mEq / L
level for the elderly .4 – 1.0 mEq / L
Antidote for toxicity – Mannitol (Osmitrol) or Acetazolamide (Diamox)
V. ANTI ANXIETY

CLASSIFICATION:

BENZODIAZEPINES AZASPIRONES NON-BENZODIAZEPINE


Miscellaneous agents

Alprazolam ( Xanqax)
Chlordiazepoxide ( Librium) Buspirone
Clorazepate ( Tranxene) Hydroxyzine ( Vistaril)
(Buspar) Meprobamate ( Equanil)
Diazepam ( Valium)
Lorazepam ( Ativan)
Oxazepam ( Serax)

MOA: depresses Reticular Activating system and reduces anxiety by stimulating the action of
an inhibitory neurotransmitter called GABA

INDICATIONS; treatment of anxiety disorders and for short term relief of symptoms of
Anxiety; selective medications effective for skeletal muscle relaxation, pre
and post-op sedation, seizure control.

SIDE AND ADVERSE EFFECTS


Sedation and Dizzinees,drowsiness and dry mouth
Paradoxical reactions*(hallucination and delusions),CNS depression*
Addison’s disease , Dependency*, hepatotoxicity*

CONTRAINDICATIONS AND SPECIAL PRECAUTION


Glaucoma, hypersensitivity, liver and kidney dysfunction, psychoses,
elderly , pregnancy and lactation

NURSING CARE GUIDELINES

C- anxiolytics, minor tranquilizers


H- decrease anxiety
E- a.c. – food delays absorption
C- rise slowly
Avoid caffeine and alcohol

K- monitor CBC, LFT’s,


report sorethroat, jaundice, weakness and fever