Importance of Psychopharmacology

The field of psychopharmacology studies a wide range of substances with

various types of psychoactive properties. Majority of studies are conducted for the
development, study, and use of drugs for the modification of behavior and the
alleviation of symptoms, particularly in the treatment of mental disorders.
Psychopharmacology focuses primarily on the psychoactive and chemical
interactions with the brain. The importance of psychopharmacology is the research
of drugs for their physicochemical properties, physical side effects, and
psychological side effects.

Antidepressants

Definition: Antidepressants, as their name suggests, are medications prescribed to

treat depression. In addition antidepressants are used in the treatment of
dysthymia; anxiety disorders, including obsessive-compulsive disorder, panic
disorder, PTSD; somatoform disorders; eating disorders; and childhood enuresis.
Most antidepressants have been categorized under their chemical structures.

Action: Increases neurotransmitters in synaptic clefts

Types:
1. SSRI (Selective Serotonin Reuptake Inhibitors)
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
2. Tricyclic Antidepressants
imipramine (Tofranil)
amitriptyline (Elavil)
amoxapine (Asendin)
3. MAOI (Monoamine Oxidase Inhibitors)
phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)

S/E:
Sedation Nausea Tremors
Drowsiness Blurred vision Muscle twitching
Dry mouth and eyes Insomnia Orthostatic
Urinary retention Headache hypotension
Constipation Nervousness Edema
Weight gain Suicidal ideation Anorexia
Dizziness Vertigo Hypertensive crisis
Nervousness Fatigue

Nursing Interventions:
1. Limit drug access to suicidal patients
2. Monitor vital signs
3. For MOAI, avoid food containing tyramine (ex. Cheese, cream, yogurt, coffee,
chocolate, bananas, raisins, liver, sausages, soy sauce, pickled herring, yeast,
beer, wine)
 Mood Stabilizers

Definition/Action: A mood stabilizer is a psychiatric medication used to treat mood

disorders characterized by rapid and unstable mood shifts. These disorders include
bipolar disorder, where mood stabilizers suppress swings between mania and
depression, and borderline personality disorder. Most mood stabilizers are
anticonvulsants, with the important exception of lithium.

Types:
1. Lithium
2. Anti-epileptics (Anticonvulsants)
valproic acid (Depakene, Valprotate)
carbamazepine (Tegretol)
oxcarbazepine (Trileptal)
topiramate (Topamax)
3. Antidepressants
phenelzine (Nardil)
isocarboxazid (Marplan )
tranylcypromine (Parnate )
fluoxetine (Prozac)
paroxetine (Paxil)
citalopram (Celexa, Cipramil)
sertraline (Zoloft)
4. Neuroleptics (Anti-psychotics)
risperidone (Risperdal)
clozapine (Clozaril)
olanzapine (Zyprexa)

Side Effects:
Lithium - Up to 75% of patients treated with lithium experience some side effects.
Most of these are minor and can be reduced or eliminated by lowering the lithium
dose or changing the dosage schedule. These include:
Hypothyroidism Arrhythmias
Kidney damage (long Acne
term use) Hair loss

Anti-epileptics (Anticonvulsants)
Weight gain Sedation Indigestion
Tremor Headache Bruising
Dizziness Nausea Hair loss

Neuroleptics (Anti-psychotics)
Restlessness Sleepiness Increased saliva
Tremors Nausea Abdominal pain
Muscle stiffness Abnormal vision

Often, an antidepressant is prescribed in addition to the mood stabilizer during

depressive phases. However this brings some risks, as antidepressants can induce
mania, psychosis, and other disturbing problems in bipolar patients, particularly
when taken alone, but sometimes even when used with a mood stabilizer.

Nursing Interventions include:

1. Monitor patient for emergence of side effects, especially drug-induced mania
2. Halting medications if side effects occur and notifying the physician
3. Management of minor side effects

ANTIPSYCHOTICS (Major Tranquilizers or Neuroleptics)

Definition:
Antipsychotic drugs act against the symptoms of schizophrenia and other
psychoses. These medications can’t “cure” the illness, but they alleviate and
eliminate symptoms. In some cases, they can shorten the course of the illness.
Researchers submit that psychotic disorders, including schizophrenia, substance-
induced and other psychiatric illnesses are linked to increased dopamine activity.

Importance:
Antipsychotic drugs are first-line therapy for schizophrenia and other psychotic
disorders. They have the ability to decrease dopamine activity, leading to the
alleviation of psychotic symptoms.

Types:
1. Conventional/ Typical- chlorpromazine (Thorazine), haloperidol (Haldol),
thioridazine (Mellaril), fluphenazine (Prolixin)
Advantages: cheaper
Disadvantages: many side effects
2. Newer/ Atypical- risperidone (Risperdal), clozapine (Clozaril), olanzapine
(Zyprexa)
Advantages: effective in treating negative symptoms; not likely to cause EPS or
tardive dyskinesia
Disadvantages: expensive, tendency to cause weight gain

MOA: blocks the action of dopamine and thus can be classified as dopamine
receptor antagonist. All antipsychotics block D2 receptor which in turn promotes the
presence of EPS, resulting in pseudoparkinsonism. The atypical antipsychotics have
a weak affinity for D2 receptor and stronger affinity to D4 receptor. They block the
serotonin receptor. These however cause fewer EPS.

Adverse Reactions/Side Effects:

MAJOR MINOR
1. Extrapyramidal Syndrome (EPS) 1. Photosensitivity
a. akathisia- restlessness 2. Weight gain
b. acute dystonia- muscle spasm of the tongue, neck and eyes, 3. Dermatitis
stiff/ wry neck a.k.a. torticollis, oculogyric crisis 4. Dryness
of mucus membranes
c. pseudoparkinsonism- drug induced parkinson’s disease. 5. Urinary
retention
muscle rigidity, shuffling gait, pill-rolling movement 6.
Constipation
of the fingers and drooling 7. Drowsiness
2. NMS (Neuroleptic Malignant Syndrome) 8. Dizziness
a. high fever 9. Jaundice
b. hypotension
c. confusion and restlessness
d. s/s of shock
3. Tardive dyskinesia- irreversible or permanent
-involuntary jerking of the tongue, muscle spasm, constant grimacing,
lip-smacking & worm-like movement of tongue

Nursing Interventions:
1. Anti-psychotics react with alcohol, hypnotics, narcotics, and benzodiazepines
to potentiate the sedative effects of antipsychotics. Instruct the client to avoid
use of alcohol and other CNS depressants.
2. In case of photosensitivity, let the client wear sunglasses.
3. Use caution in potentially hazardous activities.
4. Avoid changing positions (lying, sitting, standing) rapidly.
5. Tell the patient to notify the physician if unusual signs and symptoms
develop (sore throat, bruising/bleeding, tics/spasms, trembling.
6. Do not alter the dosage without the prescriber's order.
 7. Stop drug immediately if any of the adverse reactions occur.
8. Always assess for the presence of extrapyramidal symptoms.

Antianxiety or Anxiolytic Medications

Definition: Used for the treatment of anxiety and also useful in the induction of
sleep. Anti-anxiety drugs are medicines that calm and relax people with excessive
anxiety, nervousness, or tension, or for short-term control of social phobia disorder
or specific phobia disorder.

Action: Exert a general depressing effect on the CNS, many also exert skeletal
muscle-relaxant and anticonvulsant effects. They preferentially act on the limbic
system of the brain where they potentiate inhibitory neurotransmission in those
systems where γ-aminobutyric acid (GABA) is a neurotransmitter. GABA-A receptor
subtype is selectively affected by benzodiazepines.

Side Effects: related to diminished mental alertness; caution about driving or

operating hazardous machinery until tolerance develops
- Drowsiness, dry mouth, dizziness, headache, fatigue, nausea, decreased
coordination, light-headedness

Nursing Interventions:
1. Assess the client's medication history, knowledge level and use of current
medications (prescribed, over-the-counter, and illicit drugs), medication
allergies, and pattern of alcohol use.
2. Explore the client's perceptions and feelings about medications; clarify
misinformation, fears, etc.
3. Instruct patient and significant others that alcohol or sedatives potentiate
depressant effects of the drug.
4. Drugs if taken in large doses or to an extended period of time can lead to
physical and emotional dependence.
5. Benzodiazepine use should not be abruptly discontinued to avoid a
withdrawal syndrome.
6. Overdosage of any benzodiazepine is managed by taking its antidote -
flumazenil (Romazicon)

Examples:
A. Benzodiazepines
• Alprazolam (Xanax)
• Diazepam (Valium)
• 3.Flurazepam (Dalmane)
• Lorazepam (Ativan)
• Triazolam (Halcion)

B. Antihistamines
• hydroxizine HCL (Atarax)

C. Propanediol
• meprobamate (Equanil)

D. Azapirones
• buspirone HCL (BuSpar)

E. Benzodiazepine Antagonist
• Flumazenil (Romazicon)

Prepared by:
BSN4A - Group 2

Reference:
Pharmacology: A nursing Process Approach, 4th Edition by Joyce LeFever Kee and
Evelyn Hayes.