PSYCHO-

PHARMACOLOGY
Psychotropic drugs
A psychotropic drug is a drug that
affects behavior, mood, thoughts, or
perception/senses.
◦antipsychotics,
◦antidepressants,
◦mood stabilizers,
◦anxiolytics, and
◦stimulants
Psychotropic drugs

Efficacy refers to the maximal

therapeutic effect that a drug can
achieve.
Psychotropic drugs
Potency is the amount of drug needed to
achieve the maximum effect;
◦ low-potency drugs require higher dosages to
achieve efficacy
◦ high-potency drugs achieve efficacy at lower
dosages.
Psychotropic drugs
 Half-life is the time it takes for half of the drug
to be removed from the bloodstream
◦ Drugs with a shorter half-life may need to be
given three or four times a day,
◦ Drugs with a longer half-life may be given
once a day
Psychotropic drugs
Example of drugs with shortest half-life
◦ Heroin: Between 2 and 6 minutes.
◦ Cocaine: 1 hour.
◦ Marijuana/THC: Between 4 and 6 days.
◦ Methamphetamine(Desoxyn) : About 11 hours.
◦ MDMA(Molly or Ecstacy): Around 8 hours.
Example of drugs with longest half-life?
◦ Aripiprazole - about 75 hours
Principles That Guide Pharmacologic
Treatment
Many psychotropic drugs must be given in
adequate dosages for some time before
their full effect is realized.
◦ TCAs can require 4 to 6 weeks before the client
experiences optimal therapeutic benefit.
Principles That Guide Pharmacologic
Treatment
Psychotropicmedications often are
decreased gradually rather than abruptly.
◦ rebound (temporary return of symptoms)
◦ withdrawal (new symptoms resulting from
discontinuation of the drug).
Antipsychotic Drugs
also known as Neuroleptics
are used to treat the symptoms of
psychosis, such as the:
◦ delusions and hallucinations
Antipsychotic Drugs
 Mechanisms of action:
◦ block receptors for the neurotransmitter
dopamine;
◦ Increases in dopamine activity -contribute to
the positive symptoms of schizophrenia.
◦ Reduced dopamine activity may affect
negative and cognitive symptoms.
Antipsychotic Drugs

◦ Typical antipsychotic are potent antagonists

 Treat target symptoms but also produces many
EPS

◦ Atypical antipsychotic drugs, such as

clozapine (Clozaril), are relatively weak blocker
 lower incidence of EPS
Antipsychotic Drugs
◦ Third generation antipsychotics called
dopamine system stabilizers.
◦ These drugs stabilize dopamine output
◦ Used in clinical practice:

aripiprazole(Abilify), cariprazine(Vraylar
and Reagila), brexpiprazole(Rexulti ), and
lumateperone(Caplyta);
Antipsychotic Side Effects
Antipsychotic Side Effects
Extrapyramidal symptoms (EPS)
◦ serious neurologic symptoms

Examples of symptoms include paralysis,
muscle weakness, poor coordination, loss of
sensation, seizures, confusion, pain and
altered levels of consciousness
◦ are the major side effects of antipsychotic drugs.
◦ They include :
1. acute dystonia,
2. pseudoparkinsonism,
3. akathisia.
Antipsychotic Side Effects
Acute dystonia
◦ includes acute muscular rigidity and cramping,
a stiff or thick tongue with difficulty swallowing,
and, in severe cases, laryngospasm and
respiratory difficulties.
◦ Torticollis (twisted head and neck)
◦ Opisthotonus (tightness in the entire body with
the head back and an arched neck)
◦ Oculogyric crisis (eyes rolled back in a locked
position)
Antipsychotic Side Effects
Acute dystonia occurs
◦ in the first week of treatment
◦ in those receiving high-potency drugs such as
haloperidol and thiothixene
Antipsychotic Side Effects
Treatment for Acute dystonia
◦ Anticholinergics
 Benztropine mesylate (Cogentin) or
 intramuscular or intravenous diphenhydramine
(Benadryl)
Antipsychotic Side Effects
Pseudoparkinsonism
◦ Drug-induced parkinsonism
◦ Manifestations:
 a stiff, stooped posture;
 mask-like facies;
 decreased arm swing;
 A shuffling, festinating gait ;
 cogwheel rigidity ;
 drooling;
 tremor;
 bradycardia; and
 coarse pill-rolling movements of the thumb and
fingers while at rest.
Antipsychotic Side Effects
 Treatment of Pseudoparkinsonism
◦ changing antipsychotic medication that has a lower
incidence of EPS
◦ adding an oral anticholinergic agent or amantadine
Antipsychotic Side Effects
Akathisia
◦ an intense need to
move about
◦ appears restless or
anxious and
agitated, often with
a rigid posture or
gait and a lack of
spontaneous
gestures.
Antipsychotic Side Effects
Treatment for Akathisia
◦ change in antipsychotic medication or
◦ by the addition of an oral agent such as:
1. beta-blocker(Propanolol),
2. anticholinergic,
3. benzodiazepine.
Antipsychotic Side Effects
Tardive Dyskinesia
◦ a syndrome of permanent involuntary
movements,
◦ most commonly caused by the long-term use of
conventional/typical antipsychotic drugs.
Antipsychotic Side Effects
Tardive Dyskinesia
◦ Manifestations:
 involuntary movements of the tongue, facial and
neck muscles, upper and lower extremities and
truncal musculature
 Tongue thrusting and protruding, lip smacking,
blinking, grimacing, and other excessive
unnecessary facial movements .
 irreversible
Antipsychotic Side Effects
Tardive Dyskinesia
◦ Treatment: Change medication- 2nd gen
antipsychotic- preferred like Clozaril & Seroquel
Antipsychotic Side Effects
 Neuroleptic Malignant Syndrome (NMS)
◦ is a potentially fatal idiosyncratic/distinct reaction to an
antipsychotic drug
◦ Symptoms:
 rigidity;
 high fever;
 autonomic instability such as unstable blood pressure,
diaphoresis, and pallor; delirium; and
 elevated levels of enzymes, particularly creatinine
phosphokinase.
Antipsychotic Side Effects
Treatmentfor Neuroleptic Malignant
Syndrome (NMS)
◦ immediate discontinuance of all antipsychotic
medications
◦ institution of supportive medical care to treat
dehydration and hyperthermia until the
client’s physical condition stabilizes.
Antipsychotic Side Effects
Anticholinergic Side Effects
◦ orthostatic hypotension, dry mouth,
constipation, urinary hesitance or retention,
blurred near vision, dry eyes, photophobia
nasal congestion, and decreased memory.
◦ Preventions:
 Using calorie-free beverages or hard candy may
alleviate dry mouth;
 stool softeners, adequate fluid intake, and
the inclusion of grains and fruit in the diet
for constipation.
Antipsychotic Side Effects
 Other Side Effects:
◦ Elevated prolactin may cause breast
enlargement
◦ Diminished libido, erectile and orgasmic
dysfunction
◦ Menstrual irregularities; and
◦ increased risk for breast cancer,
◦ may contribute to weight gain
Antipsychotic Side Effects
 Other Side Effects:
◦ Metabolic syndrome
◦ Signs and symptoms:
 Obesity
 HPN
 Hyperglycemia
 hypercholesterolemia
Antipsychotic Side Effects
 Clozapine-sold under the brand name Clozaril
was the first atypical antipsychotic to be
discovered
◦ Has potentially fatal side effect of
agranulocytosis
◦ Agranulocytosis occurs when there is an
extremely low number of granulocytes in the
blood.
◦ Should have a monitoring of WBC and
neutrophils every 2 weeks for 6 months, and
then every 4 weeks.
Client Teaching
 Drinking sugar-free fluids and eating sugar-free
hard candy ease dry mouth.
 Methods to prevent or relieve constipation include
exercising and increasing water and bulk-forming
foods in the diet.
 The use of sunscreen is recommended because
photosensitivity can cause the client to sunburn
easily.
 Avoid driving and performing other potentially
dangerous activities
Client Teaching
 Ifthe dose is more than 4 hours overdue or the
next dose is due, the client can omit the forgotten
dose
◦ use a chart and to record doses when taken
◦ use a pillbox that can be prefilled
Antidepressant Drugs
areprimarily used in the treatment of major
depressive illness, anxiety disorders, the
depressed phase of bipolar disorder, and
psychotic depression.
Antidepressant Drugs
Antidepressant Drugs
Cyclic compounds
◦ were the first choice of drugs to treat depression
even though they cause:
1. varying degrees of sedation,
2. orthostatic hypotension
3. anticholinergic side effects
Antidepressant Drugs
◦SSRI produce fewer troublesome side
effects.
(MAOIs) replaced the cyclic drugs as the
first choice in treating depression and are
a class of drugs that were developed in
the 1950s.
◦MAOIs used less frequently than SSRIs
and other antidepressants because of
necessary dietary precautions and
risks of adverse reactions when
mixed with certain drugs.
Mechanism of Action
The cyclic compounds may take 4 to 6
weeks to be effective.
MAOIs need 2 to 4 weeks for effectiveness.
SSRIs may be effective in 2 to 3 weeks.
Side Effects of Selective Serotonin
Reuptake Inhibitors
 have fewer side effects compared with the cyclic
compounds.
 agitation,
 Akathisia,
 nausea,
 insomnia,
 sexual dysfunction, specifically diminished sexual
drive or difficulty achieving an erection or
orgasm.
 weight gain
Side effects Treatment
Nausea Taking medications with
food
akathisia beta-blocker such as propranolol (Inderal)
or a benzodiazepine-Valium®, Xanax®,
Halcion®, Ativan®, and Klonopin®.
Insomnia take the medication in the morning
sedative-hypnotic or low-dosage
trazodone(antidepressant)
Side Effects of Cyclic Antidepressants
 anticholinergic effects such as:
◦ Dry mouth,
◦ constipation,
◦ urinary hesitancy or retention,
◦ Dry nasal passages, and blurred near vision
◦ agitation, delirium, and ileus
◦ orthostatic hypotension
◦ sedation,
◦ weight gain, and
◦ Tachycardia
◦ sexual dysfunction
Side Effects of Monoamine Oxidase
Inhibitors
 Anticholinergic effects:
◦ sedation, insomnia, weight gain, dry mouth,
orthostatic hypotension, and sexual dysfunction
 Life-threatening hypertensive crisis
◦ Occurs when MAOI is taken with food that
contains tyramine or takes sympathomimetic
drugs
◦ Manifestations:
 hypertension, hyperpyrexia-high fever,
tachycardia, diaphoresis,
tremulousness/tremors, and cardiac
dysrhythmias/an abnormal rhythm.
Side Effects of Monoamine Oxidase
Inhibitors
 Drug-to-drug interactions with MAOI:
◦ SSRIs, certain cyclic compounds, buspirone
(BuSpar)-anxiolytic, dextromethorphan , and
opiate derivatives such as meperidine
FOODS (CONTAINING TYRAMINE) TO AVOID WHEN TAKING
MAOIS
• Mature or aged cheeses or dishes made with cheese,
such as lasagna or pizza. All cheese is considered aged
except cottage cheese, cream cheese, ricotta cheese,
and processed cheese slices.
• Aged meats such as pepperoni, salami, mortadella, summer
sausage, beef logs, meat extracts, and similar products.
Make sure meat and chicken are fresh and have
been properly refrigerated.
• Italian broad beans (fava), bean curd (tofu), banana peel,
overripe fruit, and avocado.
• All tap beers and microbrewery beer. Drink no more than
two cans or bottles of beer (including nonalcoholic beer)
or 4 ounces of wine per day.
• Sauerkraut, soy sauce or soybean condiments, or marmite
(concentrated yeast).
• Yogurt, sour cream, peanuts, Brewer’s yeast, and
monosodium glutamate (MSG).
Drug Interactions
 Serotonin syndrome
◦ can result from taking a MAOI and an SSRI at the
same time
◦ Symptoms include
 agitation, sweating, fever, tachycardia,
hypotension, rigidity, hyper-reflexia and, in
extreme reactions, even coma and death
Mood-Stabilizing Drugs
 are used to treat bipolar disorder by:
1. stabilizing the client’s mood,
2. preventing or minimizing the highs and lows
that characterize bipolar illness, and
3. treating acute episodes of mania
 Examples:
◦ Lithium;
◦ some anticonvulsant drugs, particularly
carbamazepine (Tegretol) and valproic acid
(Depakote, Depakene)
Mechanism of Action
 Lithium
◦ is considered a first-line agent in the treatment
of bipolar disorder
◦ Lithium is a medicine with:
1. a narrow range of safety and
2. toxicity can occur if taken only slightly more
than a recommended dose.
Dosage

◦ 0.5 mEq/L and below = rarely therapeutic

◦ 1.0 mEq/L = normal serum lithium
◦ more than 1.5 mEq/L = considered toxic
lithium level should be monitored every 2
to 3 days
Toxicity begins at around 1.3 to 1.5
mmol/L
Normal level-0.6 to 1.2 mEq/L.
Side Effects
side effects of lithium therapy:
◦ mild nausea or diarrhea,
◦ anorexia,
◦ fine hand tremor,
◦ polydipsia
◦ polyuria,
◦ a metallic taste in the mouth,
◦ fatigue or lethargy
◦ Weight gain, and
◦ acne
Side Effects
 Toxic effects of lithium:
◦ severe diarrhea,
◦ vomiting,
◦ drowsiness,
◦ muscle weakness,
◦ lack of coordination.
◦ Untreated, these symptoms worsen and can lead to
renal failure, coma, and death.
 NOTE:
◦ the drug should be discontinued immediately.
◦ If lithium levels exceed 3.0 mEq/L, dialysis may be
indicated.
Mechanism of Action
 Anticonvulsants
◦ Ex:Valproic acid(Depakote) and
topiramate(Topamax)
◦ known to increase levels of the inhibitory
neurotransmitter GABA

◦ Side Effects
◦ Side effects of carbamazepine(Tegretol) and
valproic acid(Depakote);
◦ drowsiness, sedation, dry mouth, and blurred
vision
Antianxiety Drugs (Anxiolytics)
are used to treat anxiety and anxiety
related disorders, insomnia, OCD,
depression, PTSD, and alcohol withdrawal.
Benzodiazepines
◦ type of sedative medication
◦ the most effective in relieving anxiety
◦ drugs most frequently prescribed.
◦ anticonvulsant and muscle relaxant effects.
Antianxiety Drugs (Anxiolytics)
Mechanism of Action
 Benzodiazepines
◦ mediate the actions of the amino acid GABA, the major inhibitory
neurotransmitter in the brain.
◦ Side effects can cause :

physical dependence

Psychological dependence

Hangover effect.
◦ Buspirone(Non - Benzo)

does not cause this type of physical dependence.
◦CNS depression, such as

drowsiness,

sedation,

poor coordination, and

Impaired memory or clouded sensorium.
Client Teaching
Benzodiazepines
strongly potentiate
the effects of
alcohol: One drink
may have the
effect of three
drinks.
Client Teaching
Take precautions when attempting activities
such as driving or going to work.
withdrawal can be fatal
Stimulants
primary stimulant drugs used to treat
ADHD:
◦ methylphenidate (Ritalin),
◦ amphetamine (Adderall),
◦ dextroamphetamine (Dexedrine).
◦ atomoxetine (Strattera), a selective
norepinephrine reuptake inhibitor,
Mechanism of Action
Dopamine and norepinephrine are two
neurotransmitters that may play a role in
ADHD.
The inhibitory centers in the brain are
stimulated, so the client has greater abilities
to filter out distractions and manage his or
her own behavior.
Inhibitory centers-are cognitive process
that allows people to control their impulses
and choose more appropriate behaviors
Side Effects
anorexia, weight loss, nausea, and
irritability.
The most common long-term problem with
stimulants is the growth and weight
suppression that occurs in some children

Client Teaching
Caffeine-free beverages are suggested;
clients should avoid chocolate and excessive
sugar
Disulfiram (Antabuse)
Is useful for persons who are motivated
to abstain from drinking and who are not
impulsive.
It causes unpleasant effects when even
small amounts of alcohol are consumed
◦ facial and body flushing from vasodilation, a throbbing
headache, sweating, dry mouth, nausea, vomiting,
dizziness, and weakness
◦ chest pain, dyspnea, severe hypotension,anxiety,
confusion, and even death.
Disulfiram (Antabuse)
Client teaching:
◦ Avoid products that contain alcohol
◦ Shaving cream,
◦ aftershave lotion,
◦ cologne,
◦ deodorant and
◦ over-the-counter medications such as cough
preparations
Acamprosate (Campral)
◦ is a medication used along with counselling to
treat alcohol use disorder.
◦ is sometimes prescribed for persons in recovery
from alcohol abuse or dependence.
◦ is a drug used for the maintenance of alcohol
abstinence.
◦ It helps reduce the physical and emotional
discomfort encountered during the first weeks or
months of sobriety/non-indulgence, such as
sweating, anxiety, and sleep disturbances .
Acamprosate(Campral)
◦Mechanisms of Action:
◦ stabilize chemical signaling in the brain that
would be disrupted by alcohol withdrawal.
◦ NOTE:
◦ Suicidal thoughts may occur during treatment with
Campral.