psychopharmacology

objectives
At the end of this presentation you will be
able to learn:
 Neurotransmitters.
Types of neurotransmitters and their
functions.
Discuss the categories of drugs used to
treat mental illness and their mechanism of
action, side effects, and special nursing
considerations.
Neurotransmission
When an action potential arrives at the
synapse's presynaptic terminal button, it
may stimulate the release of
neurotransmitters. These
neurotransmitters are released into the
synaptic cleft to bind onto the receptors of
the postsynaptic membrane and influence
another cell, either in an inhibitory or
excitatory way.
Neurotransmitter
Neurotransmitters, also known as
chemical messengers, are
endogenous chemicals that enable
neuro-transmission.
Neurotransmitters
Chemical substances manufactured in the neuron to aid in
transmission of Information. Either inhibitory or excitatory
Acetylcholine - voluntary movement of the muscles
Nor epinephrine - wakefulness or arousal
Dopamine - voluntary movement and motivation,
"wanting"
Serotonin - memory, emotions, wakefulness, sleep and
temperature regulation
GABA (gamma amino butyric acid) - inhibition of motor
neurons
Glycine - spinal reflexes and motor behavior
Neuromodulators - sensory transmission-especially
pain
It is important to appreciate that it is the receptor
that dictates the neurotransmitter's effect.
Neurotransmitters

I. Synthesis
II. Storage
III. Release
IV. Postsynaptic Receptors Binding
V. Inactivation / reuptake / degradation
Psychopharmacology
Principles that guide the use of medications
include:
• Effect on target symptom
· Adequate dosage for sufficient time
· Lowest dose needed for maintenance
· Lower doses for the elderly
· Tapering rather than abrupt cessation to avoid rebound
or withdrawal
· Follow-up care
· Simplify the regimen for increased compliance
 Antipsychotic Drugs
conventional; atypical; new generation
Uses:
Schizophrenia, acute mania, psychotic depression, drug
Induced psychosis, other psychotic symptoms.
Also known as neuroleptics are used to treat the symptoms of
psychosis
Action
Treat psychotic symptoms such as
Delusions
Hallucinations
Blocks dopamine receptors
Conventional Antipsychotic Drugs
phenothiazines (Thorazine, Prolixin, Mellaril, Stalinize); Navane, Haldol, Loxitane, Moban
Side Effects
 Extra pyramidal side effects Patient Teaching
(EPSs)  Adhering to medication
 Pseudo parkinsonism regimen
 Dystonia (a neurological  Managing side effects
disorder that causes involuntary Thirst
muscle spasms and twisting of Constipation
the limbs ) Sedation
 Akathisia
 Anticholinergic side effects
 Tardive dyskinesia (TD)
 Neuroleptic malignant
syndrome (NMS)
Atypical Antipsychotic Drugs
Clozaril, Risperdal, Zyprexa, Seroquel, Geodon

Patient Teaching
Side Effects  Adhering to medication
Fewer EPSs
regimen
Weight gain  Reducing sugar and caloric
Risk for infection intake
 Clozaril
Weekly WBC
monitoring
Discontinue medication
and seek care at first
sign of infection
New-Generation Antipsychotic Drugs
aripiprazole (Abilify)

Side Effects Patient Teaching

Headache Adhering to
Anxiety medication
Nausea regimen
Antidepressant Drugs
SSRIs; TCAs; MAOIs
Uses:
Major depression, panic disorder and other
anxiety disorders, bipolar depression,
psychotic depression
Action:
Interact with the monoamine
neurotransmitter systems in the brain,
particularly the neurotransmitters
norepinephrine and serotonin
SSRI Antidepressant Drugs
fluoxetine (Prozac), paroxetine (Paxil), sertraline
(Zoloft), citalopram (Celexa), escitalopram (Lexapro)

Side Effects Patient Teaching

Anxiety Take in the morning
Agitation Take with food
Akathisia Propanolol given for
Nausea Akathisia
Insomnia
Sexual dysfunction
(anorgasmia/impotence)
TCA Antidepressant Drugs
imipramine (Tofranil), desipramine (Norpramin), amitriptyline
(Elavil), doxepin (Sinequan), clomipramine (Anafranil)

Side Effects Patient Teaching

Anticholinergic (blurred Taking in the evening
vision, urinary retention,
Using caution when
dry mouth, constipation)
Orthostatic hypotension driving
Sedation
Weight gain
Tachycardia
Sexual dysfunction
MAOI Antidepressant Drugs
phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan)
Patient Teaching
Side Effects Following tyramine-free
Sedation
diet (avoid aged
Insomnia cheeses, aged meats,
Weight gain beer and wine,
Dry mouth sauerkraut, soy)
Orthostatic hypotension Avoiding
Sexual dysfunction sympathomimetic drugs
Hypertensive crisis with Using caution when
excessive tyramine or driving
sympathomimetic drugs
Mood Stabilizing Drugs
lithium; anticonvulsant medications (carbamazepine
(Tegretol), valproic acid (Depakote), lamotrigine
(Lamictal), gabapentin (Neurontin)

Uses:
Bipolar disorder
Action:
Act on the neurotransmitters of the
brain
Mood-Stabilizing Drugs
Side Effects (Lithium) Patient Teaching
Nausea (Lithium)
Diarrhea Taking with food
Anorexia Having monthly blood
Fine hand tremor levels drawn 12 hours
Polydipsia after last dose
Polyuria (maintain therapeutic
levels between 0.5–
Fatigue
1.5 mEq/L)
Weight gain
Acne
Antianxiety Drugs
benzodiazepines; buspirone (BuSpar)

Uses:
Anxiety disorders, insomnia, OCD,
depression, PTSD,
alcohol withdrawal
Action:
Moderate the actions of GABA
Anti anxiety Drugs

Side Effects Patient Teaching

Tolerance and Using caution during
driving due to slower
dependence reflexes and response
Drowsiness time
Sedation Never discontinuing

Poor concentration abruptly as

withdrawal
Impaired memory can be fatal
Clouded sensorium Avoiding
alcohol
Stimulant Drugs
methylphenidate (Ritalin), pemoline (Cylert),
dextroamphetamine

Uses:
ADHD, residual ADD (attention deficit
disorder) in adults, and narcolepsy
(uncontrollable bouts of deep sleep)
Action:
Cause release of neurotransmitters
Stimulant Drugs

Side Effects Patient Teaching

Anorexia Avoiding caffeine,
Weight loss sugar, and chocolate
Nausea Taking after meals
Irritability Long-term use can
cause dependency
Disulfiram
Antabuse

Uses:
Aversion therapy for treatment of alcoholism

Action:
Causes an adverse reaction when alcohol is
ingested
Disulfiram

Side Effects Patient Teaching

Fatigue Avoiding alcohol

Drowsiness (including products

such as shaving cream,
Halitosis aftershave, cologne,
Tremor many OTC medications)
Impotence Family should never
administer without the
person's knowledge
Cultural Considerations

Ethnic backgrounds influence responses to some

psychotropic medications:
African Americans respond more rapidly to
antipsychotic and tricyclic antidepressant
medications than do whites and have a greater
risk of side effects
Asians metabolize antipsychotic and tricyclic
antidepressants more slowly, requiring lower
doses to produce the same effects
Hispanics require lower doses of antidepressants
than whites to achieve desired effects
Asians and African Americans require lower
doses of lithium than whites to produce desired
effects
Any questions?