PHARMACOTHERAPEUTICS/

PSYCHOPHARCOLOGY

PREPARED BY:
MARY RUTH V. ENRIQUEZ, RN MAN

PHARMACOTHERAPEUTICS/
PSYCHOPHARCOLOGY
Drugs that treat the symptoms of mental
illness, and whose actions in the brain
provides us with models to better
understand the mechanism of mental
disorders.
1. ANTIPSYCHOTIC DRUGS (NEUROLEPTICS)
2. ANTIDEPRESSANTS DRUGS
3. MOOD STABLIZING DRUGS
4. ANTIANXIETY DRUGS (ANXIOLYTICS)
5. STIMULANTS/PSYCHOSTIMULANTS

Antipsychotic Drugs (Neuroleptic)

Are used to alleviate psychotic
symptoms (hallucination, delusions,
paranoid thinking, poor reality
contact) that may occur in clients with
SCHIZOPHRENIA, BIPOLAR
DISORDERS and COGNITIVE
IMPAIRMENT DISORDERS.
ANTIPSYCHOTIC DRUGS CLASSIFIED
into:
1. Typical
2. Atypical

Typical Antipsychotic drug

Block selected dopamine receptors in the
striatal and limbic areas of the brain, an
action believe to reduce symptoms.
Dopamine: is a neuroChemical that our bodies
Contain naturally.
If overproduced or utilized
Incorrectly, it can cause
Someone to exhibit
Psychotic behavior.

Typical

Uses : treatment for schizophrenia and

other acute or chronic psychotic behavior
that is violent or potentially violent.
Treat positive symptoms of schizophrenia
such as hallucinations, delusions, and
suspiciousness.

Side effects: Antipsychotics

Certain blood dyscrasia

Photosensitivity (especially Thorazine)
Darkening of the skin from increased
pigmentation
Neuroleptic malignant syndrome
A group of side effects called
Extrapyramidal side effects (EPSEs)
There is less risk of EPSEs with
atypical agents.

Neuroleptic Malignant
Syndrome

Is an uncommon but potentially fatal

reaction to treatment with Neuroleptic
medications.
Symptoms include muscle rigidity,
hyperpyrexia, fluctuations in blood
pressure, and altered level of
consciousness. Early recognition and
immediate medical care is important.

EXTRAPYRAMIDAL SIDE
EFFECTS:

Drug -induced Parkinsonism

(pseudoparkinsonism):
symptoms appear 1 to 8 weeks after
patient begins the medication
The major symptom is AKINESIA,
manifested as shuffling gait, drooling,
fatigue, mask like facial expression,
tremors, and muscle rigidity

EPSEs

AKATHISIA: symptoms appear 2 to 10

weeks after patient taking the
medication.
Symptoms : agitation and motor
restlessness, and seem to appear more
frequently in women. There is no
absolute reason for this, but it is
suggested that it may be due to
hormonal interaction with the medication.

EPSEs

Dystonia : symptoms appear 1 to 8

weeks after the patient starts taking the
medication.
Symptoms manifest as bizarre
distortions or involuntary movements of
any muscle group. Tongue, eyes , face,
neck, or larger muscle mass can become
tightened into an unnatural position or
have irregular spastic movements.

TYPES OF DYSTONIA
1. TORTICOLLIS: contracted
positioning of the neck.
2. OCULOGYRIC CRISIS: contracted
positioning of the eyes upward.
3. WRITERS CRAMP: fatigue
spasm affecting a hand.
4. LARYNGEAL-PHARYNGEAL
:constriction (potentially lifethreatening)

EPSEs

Tardive dyskinesia (TD): symptoms

appear within 1 to 8 weeks after the
patient starts taking the medication. The
frequently seen manifestations are
rhythmic, involuntary movements that
look like chewing, sucking, or licking
motions (ex. Beating, spanking). Frowning
and blinking constantly are also common.
TD is irreversible

ATYPICAL ANTIPSYCHOTIC
DRUG

Block dopamine receptors in the

limbic system and affect serotonin
receptors in the cortical areas of the
brain.
Block both dopamine and
Serotonin receptors.

ATYPICAL

Indication, contraindication and interactions are

similar to those of typical antipsychotic agents.
Advantages over typical agent:
1. reduce positive symptoms of
schizophrenia
( hallucination, delusions) as well as the
negative symptoms (blunted affect, apathy,
and social withdrawal).
2. these agent cause decreased or no
extrapyramidal effects, because they do not
affect dopamine in striated areas.

ATYPICAL
Atypical Antipsychotic Agents:
RAPID-DISSOLVING PREPARATIONS of :
OLANZAPINE (ZYPREXIA)
RISPERIDONE (RISPERAL)
They begin to dissolve with saliva and
can be swallowed without water.

Contraindications: Antipsychotics
Agent

Should be used carefully in

patients who are
hypersensitive to medications
or who have brain damage or
blood dyscrasia.

Commonly used Antipsychotic Agents

Typical :
Thorazine (chlorpromazine)
Haldol (haloperidol)
Stelazine (trifluoperazine)
Mallaril (trioriazine)
Loxitane (loxapine)
Prolixin (fluphenazine)
Atypical
Risperdol (risperidone)
Clozaril (clozapine

Nursing Considerations:

Carefully teaching by doctors and nurses

can help the patient to understand that
these are very strong medications. The
possibility of seizures increases in
patients who require antipsychotic
medications.
Observe for any sign of EPSEs or NMS
and carefully monitor blood work for
abnormal results.

Nursing Considerations

Careful instruction to the patient and

family regarding wearing a widebrimmed hat, covering all exposed skin,
and using a sunscreen when in the sun ,
especially if the patient is using
Thorazine.
Patient should be taught to avoid
alcohol.
Over -the counter (OTC) products,
should not be taken w/out doctor
approval.

Nursing Considerations

Instruct the patient not to alter the dose w/out

first discussing it w/ the doctor.
This classification of medication should be
discontinued slowly
If medication is ordered once daily, teaching the
patients to take the medication 1 to 2 hours
before going to bed works well and promotes
sleep.
Antacid decrease the absorption of antipsychotics,
these type of medications should be taken 1 to 2
hours after oral administration of antipsychotics.

ANTIDEPRESSANTS
(MOOD ELEVATORS)

Are group of drugs generally to treat

depression, including symptoms of
depressed mood, loss of interest in
activities or pleasure, altered sleep
patterns, and somatic complaints.
They are also used to treat anxiety
disorders (especially panic attacks),
phobic disorders and obsessivecompulsive disorders
Antidepressants may be further
classified based on their mechanism of

Classification of Antidepressants:
Tricyclic antidepressants
Monoamine Oxidase Inhibitors
Selective Serotonin Reuptake
Inhibitors
Atypical antidepressants
Serotonin Norepinephrine
Reuptake Inhibitors

TETRACYCLIC ANTIDEPRESSANT
(Heterocyclic Antidepressant)

The actions, uses, contraindications, side

effect and nursing considerations for the
tetracyclic antidepressants are similar
for those of SSRIs and tricyclic
antidepressants.
Commonly used: Ludiomil (maprotiline) ,
Wellbutrin or Zyban (bupropion),
Remeron (mirtazapine), Desyrel
(trazodone)

MONOAMINE OXIDASE INHIBITORS

(MAOIs)

ACTION: prevents the metabolism of

neurotransmitters by an enzyme, monoamine
oxidase. Too much monoamine oxidase can
lead to destructive, psychotic behaviors.
Uses : generally used for patients with varied
types of depression who have not been helped
by other depressants.
Nursing considerations: teach patient to avoid
foods containing the amino acid tyramine, a
precursor of Norepinephrine, while taking these
medications.

MAOIs

Block the metabolism of tyramine, resulting in increased

Norepinephrine. A hypertensive crisis may occur.
Foods containing significant amount of tyramine:
Aged cheese (cheddar)
Avocados
Yogurt, sour cream
Chicken and beef liver, corned beef
Bean pods
Banana, raisins
Smoke and processed meat (salami, pepperoni, and bologna)
Chocolate
Beer, red wines, caffeine
Yeast supplement

SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIs) (Bicyclic
Antidepressant)

ACTION: increase the availability of

serotonin, which is decreased in the
brains of depressed individuals.
Uses: treatment of depression, anxiety,
obsessive disorders, impulse control
disorders.
Side effects: dependence, suicidal
tendencies, sedation, dry mouth,
agitation, postural hypotension,
headache, arthralgia (joint pain),
dizziness, insomnia, confusion, and

SSRIs

Nursing considerations: do not abruptly

discontinue the medications.
Caution should be used with driving or activities
that require alertness.
Alcohol and CNS depressants should be avoided
Hard , sugarless candy can be used for dry
mouth
The patient should change positions slowly to
avoid a sudden drop in blood pressure
Monitor the patient for suicidal ideation

Tricyclic Antidepressants
Action: these drugs increase the level of
serotonin and norepinephrine, thereby
increasing the ability of the nerve cells
to pass information to each other.
Patients with depressive disorders
generally have decreased amounts of
these two neurochemicals.
Uses : treatment symptoms of
depression, including
Sleep disturbances, sexual function
disturbances, changes in appetite, and

Tricyclic Antidepressant

Nursing considerations:
Patients should not stop using abruptly
Medications ( including over the counter
medications such as cold preparations) that
contain antihistamins, alcohol, sodium
bicarbonate, benzodiazepines, and narcotic
analgesics can increase the effects of tricyclic
antidepressants.
Nicotine, barbiturates, and the hypnotic chloral
hydrate decrease the effect of the tricyclic
antidepressant.

SEROTONIN NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIs)

ACTION: increases the availability of

serotonin and norepinehrine, which are
decrease in the brains of depressed
individuals
The uses, contraindications, side effects
and nursing considerations are similar
for those of the SSRIs.

MOOD STABILIZERS(antimanic agents)

Are a dose of drugs that include antimanic

and anticonvulsants.
Used to treat bipolar disorder by stabilizing
the clients mood, preventing or minimizing
the highs and lows that characterize bipolar
illness, and treating acute episodes of mania.
Ex. Antimanic Agent: Lithium Carbonate
(Eskalith, Lithane). Drug of choice for
treatment and management of bipolar mania.
Anticonvulsants Agents: Gabapentin
(Neurontin), Carbamazepine (Tegretol)

ANTIANXIETY DRUGS (ANXIOLYTIC)

They are generally prescribed to treat

anxiety and symptoms associated with
anxiety disorders.
BENZODIAZEPINES (BZAs): drug of
choice for treatment of anxiety and
sleep disorders
They are also used in ACUTE
ALCOHOL, WITHDRAWAL,
PREOPERATIVE SEDATION, SEIZURE
DISORDERS, SHORT-TERM
TREATMENT OF ACUTE MANIA and

Additional, BENZODIAZEPINES are used to treat agitation

and hyperactivity in Cognitive Impairment Disorders.
Anxiolytic Benzodiazepines Medications:
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Diazepam (Valium)

Psychostimulants

Hyperactivity :
ADHD: ATTENTION DEFICIT HYPEACTIVITY DISORDER
(CHILDREN)
RADD: RESIDUAL ATTENTION DEFICIT DISORDER
(ADULT)

STIMULANTS

Are readily available over the counter as well by

prescription.
They are found over the counter in diet
preparations, pills to prevent sleep, in
cigarettes, and in beverages such as coffee and
soda.
They are used medically to combat narcolepsy
and attention deficit disorder in children.
Amphetamines are one type of stimulant, can
be abused, and they have street names,
including uppers, speed, and bennies.

STIMULANTS/
PSYCHOSTIMULANTS

Are commonly used to treat children and

adult with ADHD, they also may be used
to treat NARCOLEPSY in adult.
NARCOLEPSY: a condition characterized by
sudden attacks of sleep occurring repeatedly
during the day.
Excessive sleepiness characterized by
repeated, irreversible sleep attacks. After
10 to 20 minutes, the person is briefly
refreshed until the next asleep attack.

Psychostimulant

Detroamphetamine (Dexedrine)
Methylphenidate (Ritalin, Concerta,
Addreral,)
Pemoline (Cylert)
Methamphetamine (Desoxyn)

Nursing consideration

Tolerance and physical and psychological

dependence can occur with CNS
stimulant, especially with long term use.
Do not discontinue medication abruptly.
Monitor for suicide potential.
Diabetic patients who take
amphetamines may cause changes in
their insulin requirements.
Encourage frequent rinsing of mouth
with water or use of hard, sugarless
candy to relieve dry mouth.

THE END