Psychopharmacology PDF

psychopharmacolo gy  objectives   Discuses the classification of psychopharmacology.   Definition of Psychopharmacology  . Classifications of psychopharmacology  psychopharmacology Mood Stabilizers...

psychopharmacolo gy  objectives   Discuses the classification of psychopharmacology.   Definition of Psychopharmacology  . Classifications of psychopharmacology  psychopharmacology Mood Stabilizers Antidepressant Anti-anxiety Antipsychotics Psycho Lithium stimulants TCAs Benzodiazepines Typical ( diazepam ) (Amphetamines antipsychotic SSRIs CARBAMAZE PINE(Anticon (Dexedrine) vulsant) Atypical antipsychoti MAOIs Non methylphenidates benzodiazepin c e: buspirone Sodium NSRIs (Bu Spar) valproate 1-Antipsychotic Drugs  Antipsychotic drugs Antipsychotic drugs, also known as Neuroleptic major tranquillizers, or phenothaiazines. Mechanism of action The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine as positive symptoms of schizophrenia is due to hyper secretion of dopamine in mesolimbic tract which affects ( emotional , sensory, cognitive, endocrinal secretion , motor processes )  Classification of Antipsychotics 1-Dopamine receptor antagonist also called first generation, typical, traditional or conventional antipsychotics. have side effect as, Neuroleptic malignant syndrome and endocrine disturbance and secondary negative symptoms 2-Second generation or A typical antipsychotic is serotonin-dopamine antagonists. These drugs appear to be more specific for the mesolimbic than dopamine system. (Low receptor blocking effect & Reducing the risk for side effects) all of the first-generation agents produce EPS, including parkinsonism, dystonia, akathisia and TD, to a varying degree and increase serum prolactin concentration in the usual clinical dose range. The first-generation agents are usually classified into three groups: phenothiazines, butyrophenones (e.g., haloperidol) and others (e.g., thiothixene, molindone and loxapine), based on their structure.  Second-generation and Novel Antipsychotic Agents  second generation antipsychotics refer to clozapine, Risperidone, olanzapine, quetiapine, ziprasidone, sertindole, amisulpride, zotepine, aripiprazole Indication  Cont.... Organic psychiatric disorders: Delirium Dementia Drug-induced psychosis & other organic mental disorders Childhood disorders: Attention-deficit hyperactivity disorder Autism Enuresis Conduct disorder  Side Effects of typical antipsychotics 1- Extrapyramidal Side Effects, Extrapyramidal symptoms (EPS), Acute dystonia : severe spasms of face , neck , tongue protrusion , oculogyeric crisis Parkinsonism : tremors , rigidity Akathisia : marked motor restlessness Tardive dyskinesia : a syndrome of permanent, involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. The symptoms of TD include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities,.. 2- Neuroleptic malignant syndrome (NMS) is a potentially fatal, The major symptoms of NMS are rigidity; high fever; autonomic instability such as unstable blood pressure, and pallor; delirium; 3- Anticholinergic Side Effects often occur with the use of antipsychotics and include: orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred vision, dry eyes, photophobia, nasal congestion, and decreased memory. 4- Increase blood prolactin level. In men diminished libido; erectile and orgasmic dysfunction and impotence.In women breast enlargement and tenderness; diminished libido; menstrual irregularities and increase risk for breast cancer  Nursing interventions  Nurses need to inform clients about the planned drug therapy, dosage, length of time to achieve therapeutic results, and possible side effects  Instruct the clients to report any physical illnesses or unusual adverse effects  They should be educated about the potential for drug-drug interactions when taking vitamins, minerals, herbs, dietary supplements, or other prescribed  Instructions include  Avoid alcohol and sleeping pills, which can cause drowsiness and decrease awareness of environmental hazards.  Refrain from driving or operating hazardous machinery while taking antipsychotic drugs.  Do not increase, decrease, or cease taking drugs without discussing this step with the physician.  Avoid taking antacids during antipsychotic therapy because antacids might decrease absorption of antipsychotic drugs.  Be aware that dizziness or syncope (caused by a drop in BP with position changes) can occur for about an hour after receiving the drug; take extra caution when walking or moving about to prevent falls and injuries  Indication       - SNRIs: serotonin and noradrenaline reuptake inhibitors             Side Effects of Cyclic Antidepressants       Monoamine Oxide Inhibitors                 Ways to maintain Li level 1. Stabilize dosing schedule. 2. Ensure adequate dietary sodium and fluid intake (2-3 L/day) 3. Replace fluid & electrolytes lost during exercise or gastrointestinal illness. 4. Monitor S/S of lithium side effects and toxicity 5. Follow up on lithium level –every 2 months         4.Anti-anxiety(Anxiolytics)     of Action    Anxiolytics & Sedatives  Benzodiazepines (BZD) :- 1) Diazepam ( valium ) 2) Lorazepam ( ativan ). 3) Bromozepam ( lexotanil ).  They differ in half life time. Dizepam has the longest (HLT) 8 hrs, lorazepam has shortest (HLT) 4 hrs, So it is more likely to be addictive.  Indications  Anxiety disorders in general.  Drug of choice in Panic Attack  Depression mixed with anxiety.  Use full in treatment of insomnia.  Alcohol withdrawal.  Posttraumatic stress disorder.  OCD  Side effects  Common SE >,,  Drowsiness, sedation, ataxia or poor coordination, headache and impaired memory, confusion in elderly.  Tolerance and Addiction > should not be given of more than 2 – 4 weeks.  Other side effects reported are > Respiratory depression if given I/V, convulsions.  Blurred vision  Rash  Hypotension  teaching               