PSYCHOPHARMACOLOGY

Prepared by :Snobia
Manzoor
RN,RM,Post (RN),MPH
PBD IN
Pediatric nursing
 Psychopharmacology

⚫ Psychopharmacology is the study of the

use of medications in treating mental
disorders.

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 ⮚ Principles that Guide Pharmacologic Treatment

⮚ The following are several principles that

guide the use of medications to treat
psychiatric disorders:
⮚ A medication is selected based on its effect
on the client’s target symptoms
,medication’s effectiveness is evaluated
largely by its ability to diminish or
eliminate the target symptoms.

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 Conti…..
⮚ Many psychotropic drugs must be given in
adequate dosages for some time before their full
effects are realized
⮚ The dosage of medication is often adjusted to the
lowest effective dosage for the client.
⮚ Psychotropic medications are often decreased
gradually (tapering) rather than abruptly. This is
because of potential problems with
⚫ rebound (temporary return of symptoms),
⚫ withdrawal (new symptoms resulting from
discontinuation of the drug).
⮚ Follow-up care is essential to ensure compliance
with the medication regimen.

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 Antipsychotic Drugs
⚫ Antipsychotic drugs, formerly known as
neuroleptics, are used to treat the symptoms of
psychosis:
⚫ First generation
⚫ Second generation
⚫ Third generation

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 First Generation Antipsychotics

⚫ The conventional, or first-generation,

antipsychotic drugs are potent
antagonists (blockers) of D2, D3, and
D4. This not only makes them effective
in treating target symptoms but also
produces many extrapyramidal side
effects because of the blocking of the
D2 receptors.

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 Second Generation Antipsychotics

⚫ Newer, atypical or second-generation

antipsychotic drugs, such as clozapine
(Clozaril), are relatively weak blockers of
D2, which may account for the lower
incidence of extrapyramidal side effects.
⚫ Paliperidone (Invega) and lurasidone
(Latuda) are the newest second-generation
agents.

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 Third Generation
⚫ The third generation of antipsychotics,
called dopamine system stabilizers, is
being developed. These drugs are thought
to stabilize dopamine output; that is, they
preserve or enhance dopaminergic
transmission when it is too low and reduce
it when it is too high.
⚫ This results in control of symptoms
without some of the side effects of other
antipsychotic medications. Aripiprazole
(Abilify), the first drug of this type, was
approved for use in 2002.

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 Depot Injection

⚫ Six antipsychotics are available in depot

injection, a time-release form of
intramuscular medication for
maintenance therapy, so the medication is
absorbed slowly over time; thus, less
frequent administration is needed to
maintain the desired therapeutic effects.

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 Mechanism of Action

⚫ The major action of all antipsychotics in the

nervous system is to block receptors for the
neurotransmitter dopamine.
⚫ Dopamine receptors are classified into
subcategories (D1, D2, D3, D4, and D5), and
D2, D3, and D4 have been associated with
mental illness.
⚫ Dopamine is the primary neurotransmitter
affected by taking antipsychotics; an
overactive dopamine system may be one
cause of the hallucinations and delusions
commonly experienced during psychosis.
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 Conti….
⚫ The conventional, or first-generation,
antipsychotic drugs are potent antagonists
(blockers) of D2, D3, and D4. This not only makes
them effective in treating target symptoms but
also produces many extrapyramidal side effects.
⚫ Atypical antipsychotics are relatively weak
blockers of D2, which may account for the lower
incidence of extrapyramidal side
effects.
⚫ The third generation of antipsychotics, called
dopamine system stabilizers, is being developed.
These drugs are thought to stabilize dopamine
output; that is, they preserve or enhance
dopaminergic transmission when it is too low and
reduce it when it is too high.

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 Side Effects
⚫ Extrapyramidal Side Effects.
Extrapyramidal symptoms (EPSs),
serious neurologic symptoms, are the
major side effects of antipsychotic
drugs.
⚫They include acute dystonia
⚫Pseudo-parkinsonism
⚫Akathisia.

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 Neuroleptic Malignant Syndrome (NMS)
⚫ The major symptoms of NMS are
⚫ Rigidity;
⚫ High fever;
⚫ Unstable blood pressure,
⚫ Diaphoresis,
⚫ Pallor;
⚫ Delirium
⚫ Elevated levels of enzymes
(particularly creatine phosphokinas).

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 Other Side Effects
1. Antipsychotic drugs also increase blood
prolactin levels.
2. Elevated prolactin may cause breast
enlargement and tenderness in men and
women
3. Diminished libido
4. Erectile and orgasmic dysfunction
5. Menstrual irregularities
6. Increased risk for breast cancer
7. Weight gain
⚫ Metabolic syndrome(Obesity, Increased blood
pressure ,High blood sugar level, High
15 cholesterol)
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 Client Teaching (when taking
antipsychotics)

1. Encourages clients to report problems to the

physician instead of discontinuing the medication.
2. Maintaining the medication regimen
3. The client should avoid calorie-laden beverages
and candy because they promote dental caries
4. Stool softeners are permissible, but the client
should avoid laxatives.
5. Prevent or relieve constipation include exercising
and increasing water
6. The use of sunscreen is recommended because
photosensitivity can cause the client to sunburn
easily.

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 Conti……….
7. Clients should monitor the amount of sleepiness
or drowsiness they feel.
8. They should avoid driving and performing other
potentially dangerous activities until their
response times and reflexes seem normal.
9. If the client forgets a dose of antipsychotic
medication, he or she can take the missed dose if
it is only 3 or 4 hours late.
10. If the dose is more than 4 hours overdue or the
next dose is due, the client can omit the forgotten
dose.
11. The nurse encourages clients who have difficulty
remembering to take their medication to use a
17 chart and
PREPARED to record
BY SNOBIA doses when taken or to use a
MANZOOR

pillbox.
 [Link] drugs,
⚫ These are specifically amphetamines, were first used to
treat psychiatric disorders in the 1930s for their
pronounced effects on CNS stimulation.
⚫ Today, the primary use of stimulants is for
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).
⚫ Dextroamphetamine (Dexedrine) has been
widely abused to produce a high or to remain
awake for long periods.
⚫ The primary stimulant drugs used to treat ADHD
are methylphenidate (Ritalin), amphetamine
(Adderall), and dextroamphetamine (Dexedrine).

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 Mechanism of Action

 They act by causing release of the

neurotransmitters (norepinephrine,
dopamine, and serotonin) from presynaptic
nerve terminals as opposed to having direct
agonist effects on the postsynaptic receptors.
 They also block the reuptake of these
neurotransmitters.
 They helps in block the reuptake of
norepinephrine into neurons, thereby
leaving more of the neurotransmitter in the
synapse to help convey electrical impulses in
the brain and increase blood glucose level
gives energy to brain to work.

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 Client Teaching
⚫ Taking doses of stimulants after meals
may minimize anorexia and nausea.
⚫ Caffeine-free beverages are suggested;
clients should avoid chocolate and
excessive sugar.
⚫ Most important is to keep the
medication out of the child’s reach.

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 [Link] Drugs (Anxiolytics)
⚫ Anxiety _It's a feeling of fear or apprehension .
⚫ Antianxiety drugs, or anxiolytic drugs, are used
to treat :
• Anxiety and anxiety disorders as social anxiety
• Insomnia,
• Obsessive-compulsive disorder (OCD),
• Depression,
• Posttraumatic stress disorder,
• Alcohol withdrawal

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 Mechanism of Action
⚫ Benzodiazepines act on the GABA Gamma-amino-
butyric acid (the major inhibitory
neurotransmitter) in the brain.
⚫ Because GABA receptor channels selectively admit
the anion chloride into neurons, activation of GABA
receptors hyperpolarizes neurons.
⚫ Benzodiazepines produce their effects by binding to
a specific site on the GABA receptor.
⚫ GABA sits on the binding site and when client take
Benzo it amplify the effect of GABA.
⚫ Hyperpolarize
⚫ Reduce fire potency
⚫ Calm effect produce
⚫ Depressed CNS
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 SIGN OF TOXICITY OF ANTIANXIETY
⚫ABUSE
⚫A-Alter mental status
⚫B- Bradycardia
⚫U-Unable to think
⚫S-Slurred speech
⚫E-Experience memory loss

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 [Link] Drugs
⚫ Antidepressant drugs are primarily used in
the treatment of major depressive illness,
anxiety disorders, the depressed phase of
bipolar disorder, and psychotic depression.

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 Antidepressants are divided into four
groups:

1. Tricyclic and the related cyclic

antidepressants
2. Selective serotonin reuptake inhibitors
(SSRIs)
3. MAO inhibitors (MAOIs)
4. Other antidepressants such as
desvenlafaxine (Pristiq), venlafaxine
(Effexor), bupropion (Wellbutrin

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 [Link] cyclic compounds
antidepressant
⚫ Became available in the 1950s and
for years were the first choice of
drugs to treat depression

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 [Link](Monoamine oxidase inhibitors)
⚫ During that same period, the MAOIs were
discovered to have a positive effect on people
with depression. Although the MAOIs have a
low incidence of sedation and anticholinergic
effects, they must be used with extreme
caution for several reasons:
⚫ • A life-threatening side effect, hypertensive
crisis, may occur if the client ingests foods
containing tyramine (an amino acid) while
taking MAOIs.

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 Side Effects of Monoamine Oxidase
Inhibitors

⚫ The most common side effects of

MAOIs include
⚫ Daytime sedation,
⚫ Insomnia,
⚫ Weight gain,
⚫ Dry mouth,
⚫ Orthostatic hypotension,
⚫ And sexual dysfunction

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 MAOIs with tyramine
⚫ The enzyme MAO is necessary to break down the
tyramine in certain foods, its inhibition results in
increased serum tyramine levels, causing severe
hypertension, hyperpyrexia, tachycardia,
diaphoresis, tremulousness, and cardiac
dysrhythmias.
⚫ Particular concern with MAOIs is the potential for
a life threatening hypertensive crisis if the client
ingests food that contains tyramine.
⚫ The client must be able to follow a tyramine free
diet lists the foods to avoid.

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[Link] serotonin reuptake
inhibitors(SSRIs),

⚫ The selective serotonin reuptake inhibitors

(SSRIs), first available in 1987 with the
release of fluoxetine (Prozac), have replaced
the cyclic drugs as the first choice in treating
depression because they are equal in efficacy
and produce fewer troublesome side effects.
⚫ The SSRIs are effective in the treatment of
obsessive-compulsive disorder (OCD) as
well.

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 Mechanism of Action
⚫ The major interaction is with the monoamine
neurotransmitter systems in the brain,
particularly norepinephrine and serotonin.
Both of these neurotransmitters are released
throughout the brain and help regulate arousal,
attention, mood, sensory processing, and
appetite.
⚫ Normally, Norepinephrine, serotonin, and
dopamine are removed from the synapses by
reuptake into presynaptic neurons.
⚫ But after antidepressant , The SSRIs block the
reuptake of serotonin, the cyclic
antidepressants block the reuptake of
norepinephrine primarily, and the MAOIs interfere
with enzyme metabolism.
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 Conti…….

⚫ The cyclic compounds may take 4 to 6

weeks to be effective, MAOIs need 2 to 4
weeks for effectiveness, and SSRIs may be
effective in 2 to 3 weeks.
⚫ When neurons respond more slowly,
making serotonin available at the
synapses.

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Client Teaching when taking Antidepressant

⚫ To minimize side effects, clients generally should

take cyclic compounds at night in a single daily
dose when possible.
⚫ If the client forgets a dose of a cyclic compound,
he or she should take it within 3 hours of the
missed dose or omit the dose for that day.
⚫ They should receive a written list of foods to
avoid while taking MAOIs.
⚫ Instruct them not to take any additional
medication, without checking with the physician
or pharmacist.

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 [Link]-Stabilizing Drugs

⚫ Mood-stabilizing drugs are used to treat :

⚫ Bipolar disorder by stabilizing the client’s
mood
⚫ Bipolar illness, and treating acute episodes
of mania
⚫ Lithium is the most established mood
stabilizer

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 Mechanism of Action
⚫ Lithium normalizes the reuptake of
certain neurotransmitters such as :
serotonin, norepinephrine, acetylcholine,
and dopamine. .

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 Test /Labs :
⚫ 2/3 days check lithium level when start
⚫ Weekly after this
⚫ Monthly when stable

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 Toxic effect of Lithium
⚫Severe diarrhea
⚫Muscle weakness
⚫Drowsiness
⚫Renal failure if exceed 3mEq/L

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 Client Teaching

⚫Monitor blood levels

⚫Take medicine with food Prevent
nausea
⚫Don't drive
⚫WBC regularly if take
carbamazepine

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 Client Teaching
⚫ Taking doses of stimulants after meals
may minimize anorexia and nausea.
⚫ Caffeine-free beverages are suggested;
clients should avoid chocolate and
excessive sugar.
⚫ Most important is to keep the
medication out of the child’s reach.

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 [Link] (Antabuse)
⚫ These agent are given to desensitize the
effect of alcohol.
⚫ Purpose :
⚫ To stop alcohol effect
⚫ Disulfiram is a sensitizing agent that
causes an adverse reaction when mixed
with alcohol in the body.
⚫ It is useful for persons who are motivated
to abstain from drinking and who are not
impulsive

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 Metabolism
⚫ Disulfiram inhibits the enzyme
aldehyde dehydrogenase, which is
involved in the metabolism of ethanol.
Acetaldehyde levels are then increased
from five to 10 times higher than
normal, resulting in the disulfiram–
alcohol reaction.

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 Should not take :
⚫ Many common products such as
shaving cream, aftershave lotion,
cologne, deodorant, and OTC
medication such as cough preparations
contain alcohol; when used by the
client taking disulfiram, these products
can produce the same reaction as
drinking alcohol.
⚫ The client must read product labels
carefully and select items that are
alcohol free.

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 Side effect of drug
⚫ Decreased memory
⚫ Headache
⚫ Dizziness
⚫ Sexual dysfunction
⚫ Drowsiness
⚫ Tiredness
⚫ Metallic/garlic-like taste in the mouth

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 Client teaching
⚫ Avoid alcohol
⚫ Cough syrup
⚫ Shave lotion
⚫ Perfume
⚫ Identification card always with patient
⚫ If severe symptoms admit in hospital
⚫ No driving
⚫ Follow up

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