Psychopharmacologic

al Therapies &
Nursing Implications
Antianxiety

agents
Antidepressant Agents
Mood stabilizers
Antipsychotic agents

Psychotropic medications &

usage

Anxiolytics- Antianxiety
agents
Used for treatment of anxiety disorders
Panic disorder (++++ efficacy)
Generalized Anxiety Disorder (GAD)
(++++ efficacy)
Obsessive-Compulsive Disorder (OCD)
(+ efficacy)
Posttraumatic Stress Disorder (PTSD)
(+ efficacy)
Simple Phobias
Social Phobias

Benzodiazepines
Action CNS depressants
Depress activity in the brain stem and
limbic system
Increase action of gamma-aminobutyric
acid GABA (inhibitory neurotransmitter)
thus inhibiting nerve transmission is the
CNS
Benzos bind with receptor proteins>
effects of sedation/muscle relaxation.

Anxiolytics Nursing
implications
Benzodiazepines
(CNS depressants)

Alprazolam(Xanex)
Lorazepam(Ativan)
Clonazepam(Klonopin)
Diazepam(Valium)
Oxazepam (Serax)

Do not give with other

CNS depressants
Use cautiously in elderly
Monitor for physical &
psychological dependence
with long term use
Monitor confusion, memory
impairment & motor
coordination- ataxic gait
Decreased effects with
cigarettes/caffeine

 Monitor drowsiness,
Hypnotic-sleep
Benzodiazepines
sedation
the day
agents

Temazepam(restoril)
Triazolam(halcion)
Flurazepam
( Dalmane)
Chlordiazepoxide
(Librium)
Diazepam(Valium)

Nonbenzodiazepine
Buspirone(Buspar)

following
use hangover effect
Elderly have more
difficulty with side
effects i.e. confusion,
unsteady gait, urinary
incontinence.
Assess for nausea,
headache, dizziness
Not for immediate
relief

Anti-convulsants-Mood
stabilizers

Used for treatment of manic episodes and

Bipolar disorder

Mood stabilizer --Nursing

Implications

Valproic
Acid(Depakote) etc.

Carbamazepine
(Tegretol)

Check liver functions

(at start & q 6 mos.)
Can cause hepatic
failure/life threatening
pancreatitis
Can cause aplastic
anemia &
agranulocytosis
(5-8xs greater than
population)

Mood stabilizer --Nursing

Implications
Lamotrigine (Lamictal)
(3rd generation
anti-convulsant)

Topiramate(Topamax)
Gabapentin
(Neurontin)
Oxcarbazepine
(Trileptal)

Can cause serious

rashes > in children; eg.
Stevens-Johnson
syndrome (severe form
of erythemia
multiforme)

Common side effects of

all mood stabilizers:
Dizziness, hypotension,
ataxia- Monitor gait, &
B/P ;give w/food;
Pt. teaching re: s/es

Antidepressant ---Nursing
Implications
SSRIs:
Fluoxetine(Prozac)
give in AM
Sertaline (Zoloft)
give in PM if drowsy
Paroxetine (Paxil)
give in PM if drowsy
Citalopram(Celexa)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)

Monitor for:
Hyponatremia/sexual
dysfunction;
orthostatic B/P
Give w/food;encourage
adequate fluids

Selective Serotonin
Reuptake Inhihibitors

Atypical Antidepressant
Actions
Mirtazapine(Remeron)
promotes presynaptic release of two
neurotransmitters(norepinephrie &
seratonoin)
No inhibition of neurotransmitters in presynaptic or post synaptic reuptake.
Bupropion(Wellbutrin); Venlafaxine (Effexor)
Affect all 3 major neurotransmitters
Seratonin, norepinephrine & dopamine.

Atypical
antidepressants- -Nursing
Implications
May alter labs: AST ALT, alk
Venlafaxine(Effexor)

phos, Createnine,gluc,lytes;

Duloxetine(Cymbalta)
Bupropion(Wellbutrin)
Nefazodone(Serzone)

Mirtazapine(Remeron)

Monitor for inc B/P & HR

Can lower seizure threshold;
inc. B/P,HR
(as above)
Check labs:AST,ALT
LDH,chol,
gluc,Hct
Sedation: Give in PM,
Monitor wt. gain,
Monitor: sex dysfunction,
constipation

Tricyclic
Antidepressants--Nursing
Implications

Amitriptyline(elavil)
Amoxapine(Asendin)
Doxepin(Sinequan)
Imipramine(Tofranil)
Desipramine(Norprami
ne)
Nortriptyline
(Pamelor)

Monitor & educate re:

cholinergic s/es: dry
mouth, blurred vision,
constipation,OrthoB/P, **cardiac
dysrhythmias/functionl
ethal in OD
*caution use in elderly

Monoamine
Oxidase Inhibitors-----Nursing
Implications
Used in treatment
resistant depression
Work to increase levels
of norepinephrine,
seratonin tyramine &
dopamine
Isocarboxazid
(Marplan)
Phenelzine (Nardil)
Tranlcypromine
(Parnate)

Educate re:
low tyramine diet;
*Hypertensive crisis if
diet is contains
tyramine foods.
potentially fatal drug
to drug interactions
i.e. Meperidine,
SSRIs,TCAs,
Amphetamines
*can be lethal in OD

CLINICAL USE //EFFICACY

Antipsychotic medications
*MOST TOXIC DRUGS USED IN
PSYCHIATRY!!
Use lowest possible dose especially in
Geriatric client start low go slow!
Positive (aggressive symptoms) most
responsive-relieved within hours
Negative( Affective symptoms)- may take
up to 2-4 weeks to respond.

Use/clinical efficacy
Antipsychotic medications

Cognitive/Perceptual symptoms i.e.:

cont
hallucinations, delusions, thought
broadcasting 2 to 8 weeks to respond
Increasing meds will not hasten relief of
slow responding symptoms
Usually start with divided doses
(minimizes s/es)
Once effective change to Daily or BID
dosing (increases med compliance)

Use/clinical efficacy
Antipsychotic medications
Absorption absorbed well in GI tract
cont
Metabolism metabolized in the liver
Half Life Adults (20 40 hours)
Half Life Elderly client may be doubled
Adult steady state 4-7 days
Monitor liver functions esp. elderly and
physically compromised

Use/clinical efficacy
Antipsychotic medications

INJECTABLE form I M use for

cont

emergencies only
(client imminent danger to self/others)
Simultaneous use of a benzodiazepine
may help client to gain control more
rapidly ie: combination of Haldol and
Ativan
LIQUID form-used when client has hx. of
non-compliance or has been suspected of
cheeking meds.

Antipsychotic medications

LONG ACTING INJECTABLE

Used to increase compliance
Eg. Haldol Decanoate/Prolixin Decanoate
Given monthly or bi-weekly
Half life Haldol decanoate- 21 days
Half-life for Prolixin decanoate 14 days
Monitor carefully as out patient

Extrapyramidal Side
Effects- EPS

Serious neurological symptoms that are

major side effects of antipsychotic drugs.

Cause: Blockade of D2(dopamine)in

midbrain region of the brainstem

EPS- Acute dystonia

Symptoms may include:

Blepharospasm [eye
closing]
Torticolis [neck muscle
contraction pulling head
to side]
Oculogyric Crisis [severe
upward deviation of
eyeballs]
Opisthotonos [severe
dorsal arching of neck and
back]
Larngospasm/involvement of tongue
[dysphasia- difficulty
swallowing]

EPS Parkinsonism
symptoms

Tremors
Bradykinesia/akinesia
[slowness, absence of
movement]
Cogwheel rigidity[slow
regular muscular jerks]
Postural instability
Stooped/hunched posture
Shuffling gait
Restricted movements
Masked face[loss of
mobility in facial muscles]
Hypersalivation &drooling

EPS Akathesia symptoms

AKATHISIA not sitting

Pacing, Motor restlessness,Rocking, Foot taping
Subjective c/o inner restlessness, irritability,
inability to sit still or lie down.
Need to differentiate between Akathisia and
psychomotor agitation or restlessness

Neuroleptic Malignant
Syndrome

A rare but potentially

fatal complication of
treatment with
neuroleptic drugs.
Can occur within first 2
weeks of use
Increased risk with
high dose- high
potency drugs,
concurrent medical
conditions
(dehydration, poor
nutrition)

Assessment check
elevation of-B/P, high
fever-(hyperpyrexia),
rigidity, diaphoresis,
pallor, delirium
LABS elevated CPK
(createnine
phosphokinase)

Neuroleptic Malignant
Syndrome

Severe
Opisthotonos
[severe dorsal
arching of neck
and back]
As seen in NMS

TARDIVE DYSKINESIA
Effects 4% of persons taking
( late occurring abnormal
movements)
antipsychotics

Choreoathetoid
movements [rapid,jerky
and slow,writhing
movements] may occur
anywhere in the body
arms,feet,legs,trunk
Classic description
oral,buccal, lingual,&
masticatory
movements[ tongue
thrusting,lip pursing &
smacking,facial
grimaces and chewing
movements.