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PSYHCHOPHARMACOLOGIC AGENTS
I. ANTI-PSYCHOTICS
SUB-CLASSIFICATIONS
PHENOTHIAZINES NON-PHENOTHIAZINES
MOA
- antagonizes dopamine in the CNS and also blocks Cholinergic, Histaminic,Serotogenic, Adrenergic neurotransmitters
-- (( aannttiicchhoolliinneer r ggiicc,, aannttiihhiissttaammiinniicc,, aannttii--eemmeettiicc )) bblloocckkss aaccttiivviittyy oof f tthhee CCNNSS
r r eecceeppttoor r ss aanndd ssyymmppaatthheettiicc nneer r vvoouuss ssyysstteemm
INDICATION
-- f f oor r mmeer r llyy ccaalllleedd mmaa j joor r ttr r aannqquuiilliizzeer r ss // nneeuur r oolleeppttiiccss.. uusseedd ttoo r r eelliieevvee ppssyycchhoottiicc ssyymmppttoommss(( ddeelluussiioonnss ,, hhaalllluucciinnaattiioonnss aanndd lloooosseenneessss oof f aassssoocciiaattiioonn))oof f sscchh j jiizzoopphhr r eenniiaa,, mmaanniiaa aanndd ppssyycchhoottiicc ddeeppr r eessssiioonn aanndd oor r ggaanniicc mmeennttaall ddiissoor r ddeer r ss
- acute management of agitation and hyperactivity
SIDE/ ADVERSE EFFECTS:
ANTICHOLINERGIC EFFECTS ((EEPPSS))EEXXTTRR A APPYYRR A AMMIIDD A ALL SSYYMMPPTTOOMMSS
– – PPSSEEUUDDOOPP A ARRKKIINNSSOONNIISSMM--ttr r eemmoor r ,, mmaasskk lliikkee f f aacciieess ddr r oooolliinngg ,, r r eessttlleessssssnneessss – – A AKK A ATTHHIISSII A A-- r r eessttlleessssnneessss,,aanndd aannxxiieettyy – – DDYYSSTTOONNII A A--ggr r iimmaacciinngg ,, ttoor r ttiiccoolllliiss ,,ooccuullooggyyr r iicc ccr r iissiiss,, iinntteer r mmiitttteenntt mmuussccllee ssppaassmmss - TARDIVE DYSKINESIA-lip smaking and tongue and mouth
(NMS) NEUROLEPTIC MALIGNANT SYNDROME*- hyperthermia, and severe EPS -muscular rigidity, tremors, trismus, choreiform
movements,autonomic instability /hyperactivity
and alterations in LOC
SEIZURESHEPATOTOXICITY*
ORTHOSTATIC HYPOTENSION
PHOTOSENSITIVITY and HYPERSENSITIVITYENDOCRINE DISORDERS
DYSCRASIAS *
AGRANULOCYTOSIS – sorethroat,chills,fever,malaise
LEUKOPENIA
CONTRAINDICATIONS AND SPECIAL PRECAUTIONS:
CC//II :: hhyyppeer r sseennssiittiivviittyy ,, ggllaauuccoommaa ,, ccoonnvvuullssiivvee dd//oo ,, ppr r eeggnnaannccyy aanndd llaaccttaattiioonn,, eellddeer r llyy cclliieennttss
NURSING CARE GUIDELINES:
C- antipsychotics, neuroleptics, major tranquilizersH- decreased overt or positive manifestations of psychosisE- p.c.C- rise slowly
avoid sunlightReport –sorethroat,fever,muscular rigidity
Reduced psychomotor agitation and insomnia – 1 week
Reduction of hallucinations, delusions and thought disorder takes 6-8 weeks for full
Chlorpromazine (Thorazine)Fluphenazine (Prolixin)
Perphenazine ( Trilafon)Prochlorperazine (Compazine)
Thioridazine ( Mellaril)
Triflouperazine (Stelazine)
Clozapine ( Clozaril)Haloperidol ( Haldol)
Olanzapine ( Zyprexa )Risperidone ( Risperdal)
THIOXANTHENES
Thiothixene ( Navane)
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therapeutic effect
BP and temperatureK – monitor blood levels
Seizures, NMS and EPSL.F.T.’s
CBC with differential
medical management :
NMS – Bromocriptine or Amantadine( dopamine agonist) and
Dantrolene (Dantrium) muscular relaxant
Dystonia – Diphenhydramine,Benztropine , Diazepam, Lorazepam
Pseudoparkinsonism – Antiparkinsonian, AnticholinergicAkathisia – Anticholinergic, Benzodiazepines, Beta-blockers,Clonidine
Tardive dyskinesia – early referral-dose reduction , no anticholinergics
II. ANTI-PARKINSONIAN AGENTS
CLASSIFICATIONS
2 TYPES :
1.) DOPAMINERGIC DRUGS MOA: enhance dopaminergic activity
slows deterioration of dopaminergic nerve cells
Increasing dopamine
2.) ANTI-CHOLINERGIC AGENTS
MOA:inhibit relative excess in cholinergic activity, symptomatic reliefDecrease signs and symptoms ( tremors,rigidity, drooling promote optimal levels
of motor function (gait, posture and speech )
INDICATIONS: For management of anti psychotic induced EPS- pseudoparkinsonism
SIDE AND ADVERSE EFFECTS
Anticholinergic Effects Blurring of vision, constipation, 3D’s and orthostatic hypotension,sorethroat*
Headache, photosensitivity, drowsiness, CHF and halluciantions
CONTRAINDICATIONS AND SPECIAL PRECAUTION
Glaucoma, tachycardia, HPN, Cardiac D/O, asthma, duodenal ulcer
Carbidopa – Levodopa ( Sinemet)Amantadine ( Symmetrel)
Bromocriptine Mesylate ( Parlodel)
Levodopa ( Larodopa)Pergolide Mesylate ( Permax)
Ropinirole(Requip)
Tolcapone ( Tasmar)
Trihexypheiedil ( Artane)Biperiden Hydrochloride ( Akineton)
Benztropine Mesylate ( Cogentin)
Diphenhydramine Hydrochloride(Benadryl)
Misc. agent
Selegiline ( Eldepryl)
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NURSING CARE GUIDELINES
C- dopaminergic or anti-cholinergic H- decrease tremors and rigidity in 2-3 days
E- p.c.
C- avoid sudden position change
Avoid Vit. B6 and CHON rich foods- dec. absorption of medication
Avoid alcohol-increases sedative effects K - check BP- orthostatic hypotension
drugs not withdrawn abruptly
III . ANTI DEPRESSANTS
COMMON TYPES
TRICYCLICS MONO AMINE OXIDASE SELECTIVE SEROTONIN
INHIBITORS REUPTAKE INHIBITORS
Mechanism of
Action
CNS STIMULANTS
INDICATIONS
effective in management and treatment of depression and related mood and depressive disorders
such as:
Obsessive compulsive ,Eating d/o,Obesity,Bipolar disorder,Panic d/o
Imipramine(Tofranil)Amitriptryline ( Elavil)
Clomipramine (Anafril)Doxepin ( Sinequan)
Nortryptyline ( Aventyl)
Tranylcypromine (Parnate)Isocarboxazid ( Marplan)
Phenelzine (Nardil)
Citalopram ( Celexa)Flouxetine (Prozac)
Paroxetine ( Paxil)Sertraline ( Zoloft)
Fluvoxamine (Luvox)
Inhibits reuptake anddestruction of
serotonin to prolong its
action
Blocks the
metabolicdestruction of
neurotransmitters by
the enzyme mono-
amine oxidase
Prolongs the action
of norepinephrineDopamine
Serotonin by
blocking thereuptake of this
neurotransmitters
Ritalin ( Methylphenidate)Amphetamine ( Benzedrine)
Increases levels of neurotransmitters
in the brain thereby increasing CNS
activity and decreasing
hyperactivity.
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SIDE EFFECTS AND ADVERSE REACTIONS:
TCA’S MAOI SSRI CNS Stimulants
Cardiac arrhythmias,
palpitations,orthostatic
hypotension
Constipation,Sedation,anticholinergic effects
Confusion
Bone marrow depression
Hypertensive crisis
Liver and cardiovascular
disease
Weight gainSexual dysfunction
photosensitivity
Tremors, decreased
libido, NAVDA
Nervousness, insomnia,
drowsinessanxiety
Growth suppression,
insomnia
CONTRAINDICATIONS AND SPECIAL PRECAUTIONS
TCA’S MAOI SSRI CNS Stimulants
Hypersensitivity, liver
disease , glaucoma
Hypertension
Cardiovascular disease
and Liver disease
same
NURSING CARE GUIDELINES
C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleepE – p.c.
TCA’S MAOI SSRI CNS Stimulants
C-
2-3 wks initial effect
3-6 wks full therapeuticeffect
Emphasize compliance
Avoid citrus juice –decrease absorption
K-
Monitor BP, HR andECG
2-3 initial
3-4 full ther. EffectAvoid foods rich in
tyramine –leads to
hypertensive crisis
( processed,preserved andfermented )
Monitor BP and food
items
2-3 initial
3-4 full ther. effect
Give in AM , not
beyond 2 pm6 hours before bedtime
IV. ANTI – MANIC
EXAMPLES
MOA
Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters
INDICATIONS
•• TTr r eeaattmmeenntt oof f aaccuuttee mmaanniiaa aanndd f f oor r ppr r oopphhyyllaaxxiiss oof f r r eeccuur r r r eenntt mmaanniicc aanndd ddeeppr r eessssiivvee eeppiissooddeess iinn bbiippoollaar r ddiissoor r ddeer r
SIDE AND ADVERSE EFFECTS
NAVDA
Fine tremors leading to coarse tremors
Thirst
Nystagmus
Nephrotoxicity*
Cardiac toxicity*
Hyperthyroidism – Thyroid Crisis*
Lithium Carbonate ( Eskalith,
Lithane, Quilinium –R,Lithionate)
Carbamaze ine Te retol
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CONTRAINDICATIONS AND SPECIAL PRECAUTION
Cardiovascular disease , renal disease, clients on low sodium diet and on diuretic therapy, brain damage,
pregnancy and lactation
NURSING CARE GUIDELINES
C- mood stabilizer – anti manic
H - decrease hyperactivity/manic episodesInitial effect – 10-14 days
Full therapeutic effect 3-4 weeks
E- after meals with milk or food C- antipsychotics given with lithium for immediate management of
manic episodes.Diet – Na 6-10 grams a day; fluids- 3 liters per day
Avoid caffeine , diuretics and activities that increase perspiration
K - monitor for untoward signs and symptoms
Monitor serum level at least once a month(A.M. 12 hours after
the last dose
maintenance dose - .5 – 1.2 mEq / L
acute level – 1.5 mEq / Llevel for the elderly .4 – 1.0 mEq / L
Antidote for toxicity – Mannitol (Osmitrol) or Acetazolamide (Diamox)
V. ANTI ANXIETY
CLASSIFICATION:
BENZODIAZEPINES AZASPIRONES NON-BENZODIAZEPINE
Miscellaneous agents
MOA: depresses Reticular Activating system and reduces anxiety by stimulating the action of an inhibitory
neurotransmitter called GABA
INDICATIONS; treatment of anxiety disorders and for short term relief of symptoms ofAnxiety; selective medications effective for skeletal muscle relaxation, pre
and post-op sedation, seizure control.
SIDE AND ADVERSE EFFECTS
Sedation and Dizzinees,drowsiness and dry mouth
Paradoxical reactions*(hallucination and delusions),CNS depression*
Addison’s disease , Dependency*, hepatotoxicity*
CONTRAINDICATIONS AND SPECIAL PRECAUTION
Glaucoma, hypersensitivity, liver and kidney dysfunction, psychoses,
elderly , pregnancy and lactation
NURSING CARE GUIDELINES
C - anxiolytics, minor tranquilizers
H- decrease anxiety
E- a.c. – food delays absorption
C - rise slowly
Avoid caffeine and alcohol
K - monitor CBC, LFT’s,
report sorethroat, jaundice, weakness and fever
Alprazolam ( Xanqax)
Chlordiazepoxide ( Librium)
Clorazepate ( Tranxene)Diazepam ( Valium)
Lorazepam ( Ativan)Oxazepam ( Serax)
Buspirone
(Buspar)
Hydroxyzine ( Vistaril)Meprobamate ( Equanil)