PSYCHOPHARMACOLOG

Y
PSYCHOTROPHIC or
PSYCHOACTIVE DRUGS
 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
 CATEGORIES:
1. Antipsychotic drugs, neuroleptics and
major tranquilizers
2. Antianxiety agents, minor tranquilizers and
sedative-hypnotics (anxiolytics)
3. Antidepressant or mood elevators
4. Mood stabilizers
5. Anticholinergic/Antiparkinsonism

Neurotransmitters are represented by over

200 specific chemicals within the brain.
These are secreted by the neurons that
synthesize them.
PRINCIPAL NEUROTRANSMITTERS OF THE BRAIN
TYPES OF NEUROTRANSMITTE FUNCTION
NEUROTRANSMITTE R
R
A. EXCITATORY ACETYLCHOLINE Facilitates
transmission of nerve
impulses across
synapses.
Epinephrine, Arouse the brain and
norepinephrine maintain alertness
Serotonin Temperature
regulation, sensory
perception, onset of
sleep
Dopamine Motor control
B. INHIBITORY Gamma-aminobutyric Motor coordination
acid (GABA) through inhibition of
certain neurons
Glycine Inhibits transmission
along certain spinal
1. ANTIPSYCHOTIC
AGENTS
> 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.
SIDE-EFFECTS
Nursing Interventions
1. Anticholinergic
Effects 1. Provide the client with sugarless candy
a. Dry mouth or gum, ice, frequent sips of water
2. Ensure that client practices strict oral
hygiene.
b. Blurred 1. Explain that this symptom will most
vision likely subside after a few weeks.
2. Advise client not to drive a car until
vision clears.
3. Clear small items from pathway to
prevent falls.
c. Constipation 1. Order foods high in fiber; encourage
increase in physical activity and fluid intake
if not contraindicated.
d. Urinary 1. Instruct client to report any difficulty
retention urinating; monitor intake and output.
2. Nausea, GI 1. Tablets or capsules may be
upset administered with food to minimize GI
upset.
2. Concentrates may be diluted and
administered with fruit juice or other
liquid; they should be mixed
immediately before administration.
3. Skin rash 1. Report appearance of any rash on skin to
physician.
2. Avoid spilling any of the liquid concentrate
on skin; contact dermatitis can occur.
4. Sedation 1. Discuss with physician the possibility of
administering the drug at bedtime.
2. Discuss with physician a possible decrease
in dosage or an order for less sedating drug.
3. Instruct client not to drive or operate
dangerous equipment while experiencing
sedation.
5. Orthostatic 1. Instruct the client to rise slowly
Hypotension from a lying or sitting position;
monitor blood pressure (lying and
standing) each shift; document and
report significant changes.
6. Photosensitivity 1. Ensure that the client wears protective
sunscreens, clothing, and sunglasses while
spending time outdoors.
7. Hormonal Effects 1. Provide explanation of the effects and
a. Decreased reassurance of their reversibility; may
libido, retrograde discuss with physician possibility of
ejaculation, ordering alternate medication.
gynecomastia (men)
b. amenorrhea 1. Offer reassurance or reversibility and
instruct client to continue us e of
contraception because amenorrhea does
not indicate cessation of ovulation
c. Weight gain 1. Weight client every other day; order
calorie-controlled diet; provide opportunity
for physical exercise; provide diet and
exercise instruction.
8. Agranulocytosis 1. 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)
9. Hypersalivation 1. Offer support to the client because this
(with clozapine) may be embarrassing situation. It may
be even be a safety issue (e.g. risk of
aspiration), if the problem is very
severe.
 NEUROMUSCULAR/NEUROLEPTIC SIDE EFFECTS
OF TYPICAL ANTIPSYCHOTIC (EXTRAPYRAMIDAL
SYMPTOMS (EPS))
SIDE-EFFECT DEFINITION/ ONSET/ TREATMENT/
SYMPTOMS PREVALENCE INTERVENTIO
N
1. PSEUDO- Motor Generally Dose reduction
PARKINSONISM retardation or occurs after Administer
akinesia, first week of anticholinergic
characterized treatment or agent
by masklike before second
appearance, month (2% -
rigidity, 90%)
tremors, “pill
rolling”,
salivation
 NEUROMUSCULAR/NEUROLEPTIC SIDE EFFECTS
OF TYPICAL ANTIPSYCHOTIC (EXTRAPYRAMIDAL
SYMPTOMS (EPS))

SIDE-EFFECT DEFINITION/ ONSET/ TREATMENT/

SYMPTOMS PREVALENCE INTERVENTIO
N
2. Akathisia Constant Generally Dose reduction
( Motor state of occurs 2 weeks or change drug
Restlessness) movement after treatment class; give
characterized begins benzodiazepin
by ( 35%) or beta blocker
restlessness,
difficulty
sitting still, or
strong urge to
move about.
Referred to as
“ Walkies and
Talkies”
 NEUROMUSCULAR/NEUROLEPTIC SIDE EFFECTS
OF TYPICAL ANTIPSYCHOTIC (EXTRAPYRAMIDAL
SYMPTOMS (EPS))

SIDE-EFFECT DEFINITION/ ONSET/ TREATMENT/

SYMPTOMS PREVALENCE INTERVENTIO
N
3. Acute dystonic Irregular, May occur Dose reduction
reactions involuntary anytime from a or change drug
spastic few minutes to class, give
muscle several hours anticholinergic
movement after first dose agent
wryneck or of
torticollis, antipsychotic
facial drug
grimacing, (2%-90%)
abnormal eye
movements,
backward
rolling of eyes
in the
sockets
( oculogyric
 NEUROMUSCULAR/NEUROLEPTIC SIDE EFFECTS
OF TYPICAL ANTIPSYCHOTIC (EXTRAPYRAMIDAL
SYMPTOMS (EPS))

SIDE-EFFECT DEFINITION/ ONSET/ TREATMENT/

SYMPTOMS PREVALENC INTERVENTIO
E N
4 Tardive Most frequent serious Occurs Reduce or
Dyskinesia side effect resulting approximately discontinue
from termination of 3% to 5% of antipsychotic
the drug, during
clients taking agents,
reduction in dosage,
or after long term, anti irreversible side
high dose therapy. psychotics in effect
Characterized by first 10 years
involuntary rhythmic, Cumulative Vitamin E
stereotyped prevalence Benzodiazepine
movements, tongue over 10-20 s
protrusion, cheek years is about Beta- Blocker
puffing , involuntary
movements of
40-55%. Clozapine
extremities and
trunk , chewing
movements, worm
like movement of the
 NEUROMUSCULAR/NEUROLEPTIC SIDE EFFECTS
OF TYPICAL ANTIPSYCHOTIC (EXTRAPYRAMIDAL
SYMPTOMS (EPS))

SIDE-EFFECT DEFINITION/ ONSET/ TREATMENT/

SYMPTOMS PREVALENC INTERVENTION
E
5.Neuroleptic Idiosyncratic, May develop Discontinue
Malignant rare syndrome within hours antipsychotic agent
Syndrome characterized after first have
( NMS) by dose or after cardiopulmonary
hyperpyrexia, years of and renal support
severe muscle continued available;
rigidity, altered drug administer skeletal
consciousness, exposure ; muscle relaxant
alteration in more ( e.g dantrolene) or
blood common in centrally acting
pressure , persons under dopamine receptor
elevated 20 and over agonist
creatinine 60 years of ( e.g bromocriptine)
phosphokinase age The combination of
, elevated ( 0.1%-1%) benzodiazepines
white blood and ECT has been
Implication of Nursing
Action
Patients should have an evaluation of BP,
CBC, Liver function test and vision test
before therapy and at periodic intervals
thereafter.
Implication Of Nursing
Action
 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
Implication of Nursing
Implication
 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
 1. sleeping pills , alcohol and other
medication should be avoided during drug
therapy.
 2. patient should avoid being in direct
sunlight for an extended time to prevent
sunburn or pigmentation of the skin.
 3. 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
Patient Education
 4. the patient should be told that antacid
might decrease the absorption of
antipsychotic drugs from the intestinal
tract.
 5. good oral hygiene should be practiced to

avoid mouth infections , dental carries and

ill fitting dentures.
 6. if children are in the home, tablets or

capsules should be kept in a safe place to

avoid their being mistaken for candy.
Antianxiety Agents, and
Sedative Hypnotics
Antianxiety Agents
- 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
Action
 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.
Chemical Class Generic Name Trade Name

Antihistamines hydroxyzine Vistaril; Atarax

Benzodiazepines Alprazolam Xanax
Chlordiazepoxide Librium
Clonazepam Klonopin
Clorazepate Tranxene
Diazepam Valium
Lorazepam Ativan
Oxazepam Serax
Propanediols Meprobanate Equanil;
Miltown
Azaspirodecanedi Buspirone Buspar
ones
Side Effects
Side Effects Nursing Implication
1. Drowsiness , Instruct the client not to
confusion, lethargy drive or operate
( Most common side dangerous machinery
effect) while taking the
medication
2. Tolerance ; physical Instruct the client
and psychological receiving long term
dependence therapy not to quit taking
( does not apply to the drug abruptly
buspirone)
3. Ability to potentiate Instruct the client not to
the effects of other drink alcohol or take
CNS depressant other medications that
4. Orhostatic Monitor lying and
Hypotension standing blood
pressure and pulse
every shift
Instruct the client
to arise slowly
from a lying and
sitting position
5. Paradoxical Withhold drug and
excitement ( client notify the physician
develops symptoms
opposite of the
medications desired
effect.
6. Dry mouth Have the client take
7. Nausea and Have the client take
Vomiting the drug with food or
milk
8. Blood Dyscrasias Symptoms of sore throat,
fever, malaise, easy
bruising , or unusual
bleeding should be
reported to the physician
immediately
9. Delayed onset Ensure that the client
(Buspirone only) understands there is a
lag time of 10 to 14 days
between onset of
therapy with buspirone
and subsiding of anxiety
symptoms. Client should
continue to take the
medication during this
Sedative Hypnotics
 Are used in the short term management of
various anxiety states and in the treatment
of insomnia
Chemical Generic Trade
Class Name Mark
Barbiturates Amobarbital Amytal
Aprobarbital Alurate
Butabarbital Butisol
Mephobarbita Mebaral
l
Pentobarbital Nembutal
Phenobarbital Luminal
Secobarbital seconal
Chemical Generic Trade
Class Name Name

Benzodiazepi Estazolam Prosom

nes
Flurazepam Dalmane

Quazepam Doral

Temazepam Restoril

Triazolam halcion
Miscellane Generic Trade
ous name Name
Chloral Noctec
hydrate

ethclorvynol Placidyl

Glutethimide Doriden

Zolpidem Ambien
Implication for Nursing
Actions
 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
Implication for Nursing
Actions
 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
 1. avoid mixing alcoholic beverages ,
antihistamines, or antipsychotic drugs with
antianxiety agents because they can
increase the depressant effects of those
agents, possibly causing death
 2. avoid ingesting large amounts of

beverages containing caffeine, a stimulant,

because it can decrease the effects of
sedative-hypnotic agents.
Patient Education
 3. report symptoms of fever , malaise sore
throat, petechiae, easy bruising , or bleeding
and skin rash
 4. 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
 5. avoid excessive use of these drugs to
prevent the onset of substance abuse or
addiction
Antidepressant or Mood
Elevation
 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:
 These drugs are classified as:
 1. tricyclic antidepressants ( TCA’s)
 2. Monoamine Oxidase Inhibitors( MAOI’s)
 3. selective Serotonin reuptake inhibitor
( SSRI’s)
a. Tricyclic
Antidepressants
 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.
Generic Name Trade Name
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
Action
 1. assess the patient level or severity of
depression, including the presence of
suicidal ideation
 2. identify usual coping mechanism
 3. observes for side effects( dry mouth,
blurred vision, tachycardia, urinary retention,
constipation)
 4. observe for drug interactions
 5. observe for therapeutic effects of TCAs 2 or
3 weeks after the initial dose- therapeutic
window ( serum Plasma Level)
Implication for nursing
action
 If no therapeutic response is observed
within 4-8 weeks another drug is prescribed.
Patient Education
 1. take drug as prescribe
 2. avoid taking OTC cold remedies or other

drugs without the physician knowledge.

( antihistamines and narcotic analgesics will
increase the effect
3. Avoid excessive exercise and high
temperatures because anticholinergic
effects of these agents block perspiration.
Monoamine Oxidase (MAO)
Inhibitors
 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
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)
Foods Containing Tyramine
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
Foods Containing Tyramine
Low Tyramine Content ( limited
quantities permissible while on
MAOI therapy)

Pasteurized cheeses ( cream

cheese, cottage cheese,
Ricotta
Figs, Distilled Spirits in
moderation
Drugs:

1. Isocarboxacid (Marplan)
2. Phenelzine (Nardil)
3. Tranylcypromine (Parnate)
• Maximum therapeutic effect: 2-6 weeks of
therapy
• Medication for overdose:
1. Phentolamine (regitine) for excessive response
2. Diazepam (Valium)
Patient Education

1. Take the drugs as prescribed

2. Avoid ingestion of tyramine- containing
foods, and caffeine- containing or certain
alcoholic beverages
3. Report any symptoms indicative of a
hypertensive crisis, such as headache or
heart palpitation.
c. Selective Serotonin Reuptake
Inhibitors ( SSRIs)
 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
GENERIC TRADE NAME
NAME
Celatopram Celexa
Fluoxetine Prozac
paroxetine Paxil
Sertraline Zoloft
Client Education

1. Take the drugs as prescribed. Avoid altering

the dosage of the medication. Contact the
physician before discontinuing use of the
drugs.
2. Report any unusual symptoms such as
tremors, nausea and vomiting, anorexia,
weight loss, nervousness, or sexual
dysfunction.
3. Avoid the use of diazepam, alcohol and
tryptophan.
4. Inform the physician if taking an
anticoagulant or theophylline.
5. Avoid operating hazardous machinery,
including an automobile, if drowsiness
occurs.
6. Have their blood pressure and pulse
monitored initially and after each dosage
change to detect hypotension,
hypertension and irregular heart rates.
D. Mood Stabilizers
 LITHIUM SALTS
• Is considered the treatment of choice for the
manic phase of the bipolar disorder formerly
termed manic-depressive illness and for long-
term 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 Toxicity
◦ The usual ranges of therapeutics serum
concentrations are:
 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
CLASSIFICATION GENERIC NAME TRADE NAME

Antimanic lithium carbonate Eskalith, Lithane,

Lithobid, Eskalith
CR
lithium citrate
Cibalith- S
Anti convulsants Clonazepam Klonopin
carbamazepine Tegretol
valproic acid Depakene,
gabapentin Depakote
lamotrigine Neurontin
topiramate Lamictal
Topamax
Calcium Channel verapamil Calan, Isoptin
Blocker
ANTICHOLINERGIC DRUGS
 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.
 PATIENT INSTRUCTION:
1. To relieve dry mouth, take sugarless candy or gum,
drink plenty of fluids, and rinse mouth frequently.
2. Increase fluids and fiber in the diet to prevent
constipation.
3. Avoid activities that require increased alertness as
the drug can cause drowsiness and dizziness.
4. Avoid alcohol and other drugs that contain
antihistamines such as cough and cold remedies
as these can increase CNS depression.
5. Instruct patient to have routine eye examination
for intraocular pressure.
6. Encourage patient to avoid alcohol, smoking,
caffeine and aspirin to reduce gastric acidity that
exacerbate drug induced GI distress.
Generic Name Trade Name Maximum Available in
Daily Dosage injectable
form?
amantadine Symmetrel 300 mg No

benztropine Cogentin 8 mg Yes

biperiden Akineton 8 mg Yes

diphenhydramin Benadryl 100 mg Yes

e

procyclidine Kemadrin 15 mg No

trihexyphenidyl Artane 15 mg No