Biological basis for

understanding
Psychopharmacology
Chapter 4
NUR203 Psychiatric Nursing:
Assessment and Management of
Mental Health
NUR222 Nursing III: Psychiatric
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Objectives:
1. Identify at least three major brain structures and eight major brain
functions that can be altered by mental illness and psychotropic
medications.
2. Describe how evidence-based neuroimaging is helpful in understanding
abnormalities of brain function, structure, and receptor pharmacology.
3. Explain the basic process of neurotransmission and synaptic transmission
using Figures 4-5, 4-6, and 4-7.
4. Identify the main neurotransmitter systems affected by the following
psychotropic drugs: Antidepressants, Antianxiety, Sedative hypnotics,
Mood Stabilizers, Antipsychotic agents, Anticholinesterase drugs.
5. Explain the relevance of psychodynamic and psychokinetic drug
interactions in the delivery or safe, effective nursing care.
6. Discuss safety concerns related to dietary and drug restrictions with
monoamine oxidase inhibitors (MAOIs).
7. Compare and contrast typical and atypical antipsychotic drugs with regard
to their side effect profile and quality of life.
8. Discuss the relationship between the immune system and the nervous
system in mental health and mental illness.
9. Describe how genes and culture affect an individual’s response to
psychotropic drugs.

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Mental Illness and the brain

 Psychiatric illness is related to a number of

factors (e.g., genetics, neurodevelopmental
factors, drugs, infection, psychosocial
experience).
 Psychiatric illness results in an alteration in
neurotransmitters.
 These alterations are the targets of
psychotropic drugs.

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Mental Illness and the brain
 All mental activity has its
locus in the brain.

 The primary goals of

psychiatric mental health
nursing is to:

• Understand the biological

basis of both normal and
abnormal brain functions.

• Apply this understanding

to the care of individuals
treated with
psychotropic drugs.
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Functions of the Brain
 Maintenance of homeostasis

 Regulation of autonomic nervous system (ANS) and hormones

 Control of biological drives and behavior

 Cycle of sleep and wakefulness

 Circadian rhythms

 Conscious mental activity

 Memory

 Social skills

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 6
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Neuroimaging techniques can be helpful
in understanding mental illness.
Positron-emission tomography (PET) and single-proton emission
computed tomography (SPECT)

 Localize brain regions associated with perceptual, cognitive, emotional,

and behavioral functions.

 Provide evidence of metabolic changes in unmedicated individuals with

depression, schizophrenia, or obsessive-compulsive disorder (OCD).

Functional magnetic resonance imaging (fMRI)

 Demonstrates cognitive function.

 Maps effects of psychotropic medications.

Antipsychotic medications are now prescribed at a fraction of the dosages

that were once considered standard, in large part because of imaging
studies.

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PET Scan
Identical Twins (31-year-old men)
Note reduced brain activity in frontal lobes of twin with
schizophrenia.

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Neural Synapse

 https://youtu.be/H_81gwAnjDU

 https://youtu.be/p5zFgT4aofA

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Activities of Neurons
Once an electrical impulse reaches the end of
a neuron, a neurotransmitter
(neuromessenger) is released.

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Destruction of Neurotransmitters
First way: Immediate inactivation of the
neurotransmitter at the postsynaptic membrane.

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Second way: After interacting with the postsynaptic
receptor, the neurotransmitter is released and taken
back to the presynaptic cell. The action is called the
reuptake of the neurotransmitter.

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Transmission of Neurotransmitters

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 Antianxiety
Hypnotics
Herbal
Treatment Anti-
s depressants

Psychotro Mood
Alzheime pic Stabilize
r Agents
rs
Drugs

ADHD Anti-
Agents convulsants
Anti-
psychoti
cs

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Pharmacokinetic and pharmacodynamic
drug interactions :
 Psychotropic Drug Interactions

 Drug interactions alter and modify the effects

psychotropic drugs.

Pharmacokinetic interactions:
 Are the effects of drugs on the plasma
concentrations of each other.

Pharmacodynamic interactions:
 Are the combined effects of drugs.

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Monoamine Oxidase Inhibitors
 MAOIs elevate the levels of norepinephrine, serotonin, and
dopamine by inhibiting an enzyme called monoamine
oxidase
 Phenelzine (Nardil)
 Tranylcypromine (Parnate)
 EMSAM (selegiline transdermal system) delivers monoamine
oxidase inhibitors (MAOIs) through the skin.
 Hypertensive crisis: Occurs if patient ingests tyramine
found in some over-the-counter (OTC) medications, beer,
wine, aged cheese, organ meats, avocadoes, and other foods
(see Slide 25).
 Dietary restriction of tyramine must be maintained for 2
weeks after stopping MAOIs.
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Monoamine Oxidase Inhibitors

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Antidepressant Drugs
Tricyclics: amitriptylene (Elavil), nortriptyline (Pamelor)
 Increases norepinephrine.
 Side effects include anticholinergic effects.
Selective serotonin reuptake inhibitors (SSRIs):
fluoxetine (Prozac), sertraline (Zoloft), paroxetine
(Paxil)
 Increases serotonin.
 Side effects include less anticholinergic effects than tricyclic
agents and nausea and vomiting (N/V) .
Serotonin and noradrenaline reuptake inhibitors
(SNRIs): venlafaxine (Effexor), duloxetine (Cymbalta)
 Increases serotonin and norepinephrine.
 Side effects include less anticholinergic side effects than
tricyclic agents and N/V.
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Antidepressant Drugs
Serotonin and norepinephrine disinhibitors
(SNDIs): mirtazapine (Remeron)

 Increases serotonin and norepinephrine.

 Has antianxiety, antidepressant, and antiemetic effects.

 Side effects include sedation and weight gain.

Others: bupropion (Wellbutrin), (Zyban) (smoking
cessation), trazodone (Desyrel)

 Is not the first choice for antidepressant treatment, but

these agents help with insomnia.

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Antianxiety and Hypnotic Drugs Benzodiazepines

Anxiety: diazepam (Valium), clonazepam (Klonopin),

alprazolam (Xanax)
Insomnia: Five benzodiazepine agents approved by
the Food and Drug Administration (FDA):

I D
 flurazepam (Dalmane) O
 triazolam (Halcion) AV

Other benzodiazepine drugs, such as lorazepam

(Ativan) and alprazolam (Xanax), reduce anxiety
without being as soporific (sleep producing) at
lower therapeutic doses.

GABA Receptors
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Antianxiety and Hypnotic Drug
Nonbenzodiazepines
Buspirone (Buspar): Is an anxiolytic agent with less potential for
dependence.

“Z-hypnotics” (nonbenzodiazepine agents): Are short-acting sedative

and hypnotic sleep agents.

Provides sedative effects without the antianxiety, anticonvulsant, or

muscle relaxant effects of benzodiazepines:
• zolpidem (Ambien)
• zaleplon (Sonata)
• eszopiclone (Lunesta)

Melatonin-Receptor Agonist

Ramelteon (Rozerem): Is a hypnotic drug that acts similar to melatonin; is 22

thought to regulate circadian rhythms.
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Quick Question

Tyramine is found in which one of the following?

A. Fresh ground beef

B. Corn
C. Cucumber
D. Avocado

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Answer

Tyramine is found in which one of the following?

A. Fresh ground beef

B. Corn
C. Cucumber
*D. Avocado

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Mood Stabilizers

Lithium (Eskalith, Lithobid):

 Stabilizes depression and mania (bipolar

disorder).

 Narrow therapeutic index.

 Has a potential for toxicity.

 Toxic effects can include tremor, ataxia,

confusion, convulsions, blurred vision, and N/V.

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Anticonvulsant Drugs
Valproate (Depakote/Depakene)

 Is very effective in managing impulsive aggression.

 Inhibits neuronal excitabilty

Carbamazepine (Tegretol)

 Is administered for acute mania.

Lamotrogine (Lamictal)

 Is administered for maintenance therapy.

 Watch for rash; may indicate Stevens-Johnson syndrome.

Off-Label Mood Stabilizers

 oxcarbazepine (Trileptal)
 gabapentin (Neurontin)
 topiramate (Topamax)
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Quick Question

Lithium toxicity may result in which one of the

following?

A. Neuroleptic malignant syndrome

B. Dystonia
C. Blurred vision
D. Akathisia

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Answer

Lithium toxicity may result in which one of the

following?

A. Neuroleptic malignant syndrome

B. Dystonia
*C. Blurred vision
D. Akathisia

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First-Generation Antipsychotics
(Typical)

chlorpromazine (Thorazine) Positive

fluphenazine (Prolixin)
haloperidol (Haldol)
Symptoms
Schizophrenia

Bind to Dopamine receptors = Dopamine

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Extrapyramidal Side Effects and
Adverse Reactions
 Dystonia (muscle stiffness)

 Akathisia (restlessness)

 Tardive dyskinesia (TD)

 Drug-induced parkinsonism

 Neuroleptic malignant syndrome (NMS); rare but

life-threatening

 Orthostatic hypotension

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Second Generation Antipsychotics
(Atypical)

clozapine (Clozaril)
Produce fewer risperadone (Risperdal)
extrapyramidal quetiapine (Seroquel)
side effects (EPS).
olanzapine (Zyprexa)
Iloperidone (Fanapt)
Target negative and lurasidone HCl (Latuda)
positive symptoms ziprasidone HCl (Geodon)
of schizophrenia. aripiprazole (Abilify)

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