THERAPEUTIC MODALITIES –

PSYCHOPHARMACOLOGY

PHARMACODYNAMICS
(What drugs do in the body) =mechanism of action>receptors

D A N G S=Dopamine,AcetylCholine,NorEpinephrine, Gaba receptor, Serotonin(N.trans)

^ v ^ v v =inc,dec,inc.dec,dec
S A M A D=Schizo,Alzheimers,Mania, Anxiety, Depression

Dopamine= hormone of reward, motivation ^ in delusion

AcethylCholine= memory and brain fxn., cognition (helps delay alzheimers)
NorEpinephrine=
GABA(Gamma Amino Butyric Acid) receptor= Relaxation, calming effect main inhibitory
neurotransmitter in the brain
Serotonin=Happy Hormone

PHARMACOKINETICS
(What the body does to the drugs)

Administration= Absorption in stomach(villi)

Distribution= blood stream
Metabolism= kidney/liver
Excretion= urine/feces, sweat

The major action of all antipsychotics in the nervous system is to block

receptors for the neurotransmitter dopamine; however, the therapeutic
mechanism of action is only partially understood.

MAINSTAY NEUROLEPTICS: TYPICAL ANTIPSYCHO.:MPT SHNTS

-MELLARIL
-PROLIXIN
-THORAZINE (CLORPROMAZINE)
-STELAZINE
-HALOPERIDOL
-NAVANE
-TRILAFON
-SERENTIL

M.P.T S.T.S= SIGNS AND SYMPTOMS LIKE OF AMPHETAMINE ABUSE

HALOPERIDOL= POTENT,LESS SIDE/EFFECTS =EPS

CLORPROMAZINE S/E SEDATIVE GIVE AT BEDTIME, MAY HAVE POSTURAL
HYPOTENSION

EPS=
Dystonia-a neurological movement disorder characterized by involuntary (unintended)
muscle contractions that cause slow repetitive movements or abnormal postures
that can sometimes be painful.

Oculogyric crises are defined as spasmodic movements of the eyeballs into a fixed
position, usually upwards. These episodes generally last minutes, but can range from
seconds to hours. 1. At the same time there is often increased blinking of the eyes and
these episodes are frequently accompanied by pain

Pseudo parkinsonism like pill rolling

Akathisia- motor restlessness
Tardive dyskenisea(irreversible s/effect) lip smacking, arching of the back,
twisting of torso

ANTI EPS DRUGS: MOST ARE ANTI PARKINSONS

COGENTIN (out in the market)
AKINETON
BIPERIDINE
AMANTADINE
ARTANE (out in the market)

Second-generation antipsychotics /ATYPICAL

==C.R.O.Q Z.Z==

-WONDER DRUG, LESS EPS

SIDE EFFECT: AGRUNOLOCYTOSIS=
(subject for blood exam. Weekly for 18 weeks)
s/s: fever, sore throat, gum bleeding
CLOZAPINE- wonder drug, less EPS, s/e can be agranulocytosis(life threatening
severely low wbc neutrophils, pt. For blood chem weekly for 18 weeks
RISPERIDONE
OLANZAPINE
QUETIAPINE
ZOTEPINE (used in GERMANY,JAPAN not available in USA, UK, AUS. NZ.CANADA)
ZIPRASIDONE

Third-generation antipsychotics
C.A.B

Cariprazine (Vraylar)
Aripiprazole (Abilify)
Brexpiprazole (Rexulti)

NOTE:
NEUROLEPTIC MALIGNANT SYNDROME IS A LIFE THREATENING NEUROLOGIC
EMERGENCY ASSOCIATED WITH THE USE OF ANTIPSYCHOTIC (NEUROLEPTIC) =
FEVER, RIGIDITY

ANTI PARKINSONS DRUGS

-COGENTIN
-AKINETON
-PARLODEL
-ARTANE
-BENADRYL
-LEVODOPA
-ELDEPRYL
-SYMMETRIL

-ORPHENADINE
-KEMADRINE

Tricyclic Antidepressants (TCA) – Examples:

-PAMELOR
-ANAFRANIL- common
-NORPRAMINE
-AVENTYL
-VIVACTYL
-ELAVIL-
-SINEQUAN
-TOFRANIL- common
-SURMONTIL

(CONTRAINDICATED FROM PREGNANCY!!, BREASTFEEDING, M.I, LIVER AND KIDNEY

DISEASE .BPH (BENIGN PROSTATIC HYPERPLASIA=PROSTATE GLAND ENLARGEMENT)

Side Effects: dry mouth, constipation, urinary hesitancy or retention, dry nasal
passages, and blurred near
vision, delirium and agitation

Selective Serotonin Reuptake Inhibitors (SSRI) – Examples: P.Z.L P.C.L

-PROZAC
-ZOLOFT
-LUVOX
-PAXIL
-CELEXA
-LEXAPRO (Escitalopram)

(DRUG OF CHOICE FOR CHILD, OLDER ADULTS, 3-10 DAYS THERAPEUTIC EFFECTS)
7-10 DAYS=INTEREST IN LIFE IMPROVES

Side Effects: weight gain, anxiety, agitation, akathisia, insomnia, sexual dysfunction,
sedation, hand tremors

Monoamine Oxidase Inhibitors (MAOI) – Examples: PaMaNa

-PARNATE
-MARPLAN
-NARDIL
=S/S HYPERTENSIVE CRISIS=

Side Effects: daytime sedation, insomnia, weight gain, dry mouth, orthostatic
hypotension, and sexual
dysfunction, hypertensive crisis (when client eats foods rich in tyramine)

Important Nursing Considerations

 TCA –medication should be taken at night in a single dose, can be taken 3 hours after a missed
dose or omit that dose for the day

 SSRI –medication should be taken in the morning unless sedation is a problem, can be taken 8
hours after a missed dose
 Drug Interaction:
Serotonin Syndrome (Serotonergic Syndrome)- results from taking SSRI and MAOI at the same
time. This includes agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia
and even coma and death in extreme reactions.

 MAOI - No Tyramine rich foods - aged meats (pepperoni, salami), cheese, beer, yogurt,
avocado (to prevent hypertension, tachycardia, cardiac dysrhythmias)

 Period of Efficacy
 TCA – 4 – 6 weeks
 SSRI – 2 – 3 weeks
 MAOI – 2 – 4 weeks

MOOD STABILIZER:

Mood Stabilizing Drugs/ anti manic

Used to treat bipolar disorder by stabilizing the client’s mood, preventing, or
minimizing the highs and lows that characterized bipolar illness, and treating acute
episodes of mania.

Common Examples
1. Lithium (Most Common)
Lithium Carbonate (7-10days therapeutic effect)
.6-1.2 mEQ/liter of blood therapeutic
1.5-2-toxic

Maintain intake of salt

Drink 3 liters of water

s/s toxicity: N/V Diarrhea, excessive thirst, anorexia, coma

give carbamazepine, tegretol
divalproex (anticonvulsant)

2. Valproic Acid (Depakene, Depakote)

3. Carbamazepine (Tegretol)

If there is toxicity Manitol is administered (Diuretic)

The following are contraindications and cautions for the use of antimanic agents: •
•Allergy to lithium. Prevent hypersensitivity reactions.
• Significant renal and cardiac diseases.
Exacerbated by the toxic effects of the drug.
• History of leukemia, metabolic disorders, dehydration, diuretic use. Lithium depletes sodium
reabsorption which can lead to severe hyponatremia.
• Protracted diarrhea, excessive sweating. Can alter sodium levels.
• Pregnancy, lactation. Potential adverse effects on the fetus or neonate.
• Women of childbearing age are advised to use birth control while taking this drug.

These are vital nursing interventions done in patients who are taking antimanic drugs:
• Administer drug cautiously and monitor serum lithium levels daily to monitor for toxic levels
and to arrange for appropriate drug dose adjustment.
• Administer drug with food or milk to reduce GI discomfort if present.
• Arrange to decrease dose after acute manic episodes because lithium tolerance is greatest
during acute episodes and decreases when the acute episode is over.
• Provide comfort measures (e.g. sugarless lozenges and frequent mouth care, etc.) to help
patient tolerate drug effects.
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote understanding and compliance.

Stimulants
Primarily used for attention deficit/hyperactivity disorder (ADHD) in children and
adolescents, residual attention deficit disorder in adults, and narcolepsy (attacks of
unwanted but irresistible daytime sleepiness that disrupt the
person’s life).
Common Examples
1. Methylphenidate (Ritalin) –ANTI GROWTH (NEEDS DRUG HOLIDAY=REST)
2. Dextroamphetamine (Dexedrine)
3. Pemoline (Cylert)
Works by causes the release of the neurotransmitters (norepinephrine, dopamine, and
serotonin) from presynaptic nerve terminals

Side Effects
Anorexia, weight loss, nausea, and irritability, dizziness, dry mouth, blurred vision,
palpitations
Drug dependence (Dextroamphetamine), Psychological dependence
(Methylphenidate), liver failure (Pemoline)

Important Nursing Considerations

Potential for abuse is high, take according to prescribed dosage and timing only
Take with meals to reduce anorexia and nausea
Avoid chocolate, sugar – rich foods and caffeine
Keep out of the reach of children
Anxiolytics (Anti – Anxiety Drugs)
Used to treat anxiety and anxiety disorders, insomnia, OCD, depression, post-
traumatic stress disorder, and alcohol
withdrawal. These medications only treat the anxiety and not the underlying cause.
Common Examples
1. Benzodiazepines - Alprazolam (Xanax), Diazepam (Valium), Clonazepam (Klonopin),
Triazolam (Halcion), Lorazepam
(Ativan)
2. Non - Benzodiazepines - Buspirone (BuSpar)

Side Effects
Psychological dependence (fear of return of anxiety symptoms), physical
dependence (addiction)
Benzodiazepines - drowsiness, sedation, poor coordination, and impaired memory or
clouded sensorium
Buspirone - dizziness, sedation, nausea, and headache

Important Nursing Considerations

Do not take alcohol while on benzodiazepines
Avoid driving due to sedative effects
Client should be made aware of decreased response time, slower reflexes, or
sedation during work

ANTABUSE:
Disulfiram is an oral drug used for treating alcoholism. Alcohol is converted in the
body into acetaldehyde by an enzyme called alcohol dehydrogenase.
Another enzyme called acetaldehyde dehydrogenase then converts acetaldehyde into
acetic acid. Disulfiram prevents acetaldehyde dehydrogenase from converting
acetaldehyde into acetic acid, leading to a buildup of acetaldehyde levels in the blood.
High acetaldehyde levels cause unpleasant symptoms after drinking alcohol.

1. Taken daily;
2. Do not take within 12 hours of ingesting alcohol;
3.Do not drink alcohol during or for 14 days following Antabuse therapy;
4. Check all medications for alcohol as an ingredient;
5. Use caution when operating vehicles or performing tasks with dangerous equipment;

He should be warned to avoid alcohol in disguised forms, i.e., in sauces, vinegars,

cough mixtures, and even in aftershave lotions and back rubs. He should also be
warned that reactions may occur with alcohol up to 14 days after ingesting disulfiram.