PSYCHOPHARMACOLOGYPSYCHOPHARMACOLOGY

DEFINITIONDEFINITION::

Psychopharmacology is the gold standard in Psychopharmacology is the gold standard in treatment of neurobiological illnesses, more treatment of neurobiological illnesses, more and more of which are found to have genetic and more of which are found to have genetic underpinningsunderpinnings..

CLASSIFICATIONCLASSIFICATION::

11--Antianxiety and sedative-hypnotic DrugsAntianxiety and sedative-hypnotic Drugs

22--Antidepressant DrugsAntidepressant Drugs

33--Antipsychotic DrugsAntipsychotic Drugs

55--Mood-Stailizing DrugsMood-Stailizing Drugs

1-Antianxiety and sedative-hypnotic Drugs: Benzodiazepines

GENERIC NAMEGENERIC NAME

((TRADE NAMETRADE NAME))

USUAL ADULT USUAL ADULT DOSAGE RANGE DOSAGE RANGE

)MG/DAY()MG/DAY(PREPARATIONPREPARATION

AlprazolamAlprazolam

( ( XanaxXanax))1-41-4POPO

chlordiazepoxide )Librium(chlordiazepoxide )Librium(10-4010-40PO,IMPO,IM

Clonazepam )Klonopin(Clonazepam )Klonopin(0.5-100.5-10PO,ODTPO,ODT

Clorazepate )Tranxene(Clorazepate )Tranxene(10-4010-40PO,SDPO,SD

LorazepamLorazepam

((AtivanAtivan))1-61-6PO,IM,IVPO,IM,IV

ContCont..

Side effectSide effectNursing Nursing ConsiderationsConsiderations

Drowsiness, sedationDrowsiness, sedationActivity helps: use caution when using Activity helps: use caution when using machinaerymachinaery..

Ataxia, dizzinessAtaxia, dizzinessUse caution with activity , prevent Use caution with activity , prevent fallsfalls..

Feeling of detachmentFeeling of detachmentDiscourage social isolationDiscourage social isolation..

Increased irritability or hostilityIncreased irritability or hostilityObserve, support, be alert for Observe, support, be alert for disinhibitiondisinhibition..

Cognitive effects with long term useCognitive effects with long term use Interference with concentration and of Interference with concentration and of new materialnew material..

Tolerance, dependency, rebound Tolerance, dependency, rebound insomnia/anxietyinsomnia/anxiety

Short-term use: discontinue , using a Short-term use: discontinue , using a slow taper; contraindicated with drug slow taper; contraindicated with drug or alcohol abuseor alcohol abuse..

Anterograde amnesiaAnterograde amnesiaInability to recall events that occur Inability to recall events that occur while on drugwhile on drug..

Sedative-hypnotic Drugs: Benzodiazepines

GENERIC NAMEGENERIC NAME

((TRADE NAMETRADE NAME))

USUAL ADULT DOSAGE USUAL ADULT DOSAGE RANGE )MG/DAY(RANGE )MG/DAY(PREPARATIONPREPARATION

EstazolamEstazolam

((ProSomProSom))1-41-4 HSHSPOPO

FlurazepamFlurazepam

((DalmaneDalmane))15-3015-30 HSHSPOPO

TemazepamTemazepam

((RestorilRestoril))7.5-307.5-30 HSHSPOPO

TriazolamTriazolam

((HalcionHalcion))0.125-0.50.125-0.5 HSHSPOPO

QuazepamQuazepam

((DoralDoral))7.5-157.5-15 HSHSPOPO

ContCont..

Side effectSide effectNursing Nursing ConsiderationsConsiderations

Drowsiness, sedationDrowsiness, sedationActivity helps: use caution when using Activity helps: use caution when using machinaerymachinaery..

Ataxia, dizzinessAtaxia, dizzinessUse caution with activity , prevent Use caution with activity , prevent fallsfalls..

Feeling of detachmentFeeling of detachmentDiscourage social isolationDiscourage social isolation..

Increased irritability or hostilityIncreased irritability or hostilityObserve, support, be alert for Observe, support, be alert for disinhibitiondisinhibition..

Cognitive effects with long term useCognitive effects with long term use Interference with concentration and of Interference with concentration and of new materialnew material..

Tolerance, dependency, rebound Tolerance, dependency, rebound insomnia/anxietyinsomnia/anxiety

Short-term use: discontinue , using a Short-term use: discontinue , using a slow taper; contraindicated with drug slow taper; contraindicated with drug or alcohol abuseor alcohol abuse..

Anterograde amnesiaAnterograde amnesiaInability to recall events that occur Inability to recall events that occur while on drugwhile on drug..

Antidepressant DrugsAntidepressant Drugs

**Indication for Antidepressant DrugsIndication for Antidepressant Drugs::

Major depressionMajor depression::

Acute depression, maintaining Acute depression, maintaining treatment of depression and treatment of depression and prevention of relapse, bipolar prevention of relapse, bipolar depression (when used with a mode depression (when used with a mode stabilizer)stabilizer)

Atypical depression and dysthymic Atypical depression and dysthymic disorderdisorder..

• - -Anxiety disordersAnxiety disorders::

•Panic diorder,obessive-compulsive Panic diorder,obessive-compulsive disorder(OCD),social phobia, generalized disorder(OCD),social phobia, generalized anxiety disoeder,posttraumaticanxiety disoeder,posttraumatic

•- - selective serotonin reptake selective serotonin reptake inhibitors(SSRIs)inhibitors(SSRIs)

11--strong evidencestrong evidence::

•Bulimia, premenstrual dysphoric disorder Bulimia, premenstrual dysphoric disorder full and half cycle administrationfull and half cycle administration))

ContCont..

•22--Moderate evidenceModerate evidence::•Obesity, substance abuse, impulsivity and Obesity, substance abuse, impulsivity and

anger associated with personality anger associated with personality disorders, pain syndromesdisorders, pain syndromes..

•33--preliminary evidencepreliminary evidence::•Body dysmorphic Body dysmorphic

disorder,hypochondriasis,anger attacks disorder,hypochondriasis,anger attacks associated with depression, attention associated with depression, attention deficit/hyperactivity disorder(ADHD)deficit/hyperactivity disorder(ADHD)

ContCont..

•--other newer antidepressantother newer antidepressant

•Moderate: Moderate: evidence:Trazodone:insomnia,demenevidence:Trazodone:insomnia,dementia with agitation,minor sedative tia with agitation,minor sedative hypnotic with drawalhypnotic with drawal

General General namename

Usual adult Usual adult daily dosedaily dose

PreparatioPreparationsns

Receptors/Receptors/neurotransneurotrans

missionmission

Side effectSide effect`̀

Amoxapine(Amoxapine(asendin)asendin)

200-300200-300popoNE-5HT-D2-NE-5HT-D2-Ach-H1Ach-H1

ermors,tachermors,tachycardia,erecycardia,erec

tile/tile/ejaculatory ejaculatory dysfunction,dysfunction,

GI GI disturbancedisturbances(nausea,dias(nausea,diarrhea),sexuarrhea),sexua

l l dysfunctiondysfunction

BupropionBupropion150-450150-450Po.SRPo.SRDA,NEDA,NETermos,tachTermos,tachycardia,erecycardia,erec

tile/tile/ejaculatory ejaculatory dysfunctiondysfunction

Maprotiline(lMaprotiline(ludiomi)udiomi)

50-20050-200POPOH1,ACHH1,ACHtermos.tachtermos.tachycardia,erecycardia,erec

tile/tile/ejaculatorydejaculatorydysfunction,sysfunction,sedation,droedation,drowsiness,hypwsiness,hyp

otentionotention

General General namename

Usual adult Usual adult daily dosedaily dose

PreparatioPreparationsns

Receptors/Receptors/neurotransneurotransmissionmission

Side effectSide effect

MirtazapineMirtazapine15-4015-40POPOH1-ACHH1-ACHSedation,droSedation,drowsinesss,hywsinesss,hypotention,wipotention,wight gainght gain

NefazodoneNefazodone300-500300-500POPO5HT5HTGI GI disturbancedisturbances(nausea,dias(nausea,diarrhea),sexuarrhea),sexual l disfunction,disfunction,priapesmpriapesm

VenlafaxineVenlafaxine75-37575-375PO,XRPO,XRNE-5HT-DANE-5HT-DATermos,tachTermos,tachhycardia,urihycardia,urinary nary retention, retention, sexual sexual dysfunctiondysfunction

Nursing considerationNursing considerationSide effectSide effectNursing care and teaching Nursing care and teaching

conceptconcept

Blurred visionBlurred visionTemporary: avoid hazardous Temporary: avoid hazardous taskstasks

Dry mouthDry mouthEncourage fluids,frequint rinses, Encourage fluids,frequint rinses, sugar-free hard candy and gumssugar-free hard candy and gums

ConstipationConstipationIncrease fluids,dietry fiber and Increase fluids,dietry fiber and roughage,exercise,monitor bowel roughage,exercise,monitor bowel habits, use stool softeners and habits, use stool softeners and laxatives only if increaseslaxatives only if increases

TachycardiaTachycardiaTemporary, usually not significant Temporary, usually not significant except with coronary artery except with coronary artery disease), but can be frightening, disease), but can be frightening, supportive therapysupportive therapy

Urinary retentionUrinary retentionEncourage fluids and frequent Encourage fluids and frequent voiding ,monitor voiding voiding ,monitor voiding patterns,bethanecol,catheterizepatterns,bethanecol,catheterize

InsomniaInsomniaDoes as early in the day as Does as early in the day as possible ,sleep hygiene, possible ,sleep hygiene, decrease evening decrease evening activities,elimitate caffeine, activities,elimitate caffeine, relaxation techniques, relaxation techniques, sedative hyponotic therapysedative hyponotic therapy

Sexual dysfunctionSexual dysfunctionDoes after sexual intercourse, use Does after sexual intercourse, use lubricant if vaginal dryness is lubricant if vaginal dryness is present, antidotes such as present, antidotes such as sildenifal,bupropion or sildenifal,bupropion or bethanecolbethanecol..

AntipsychoticAntipsychotic

DrugDrugUsually adult daily Usually adult daily doesdoes

preparationpreparation

BenztropineBenztropine2-42-4PO,IMPO,IM

TrihexyphenidlTrihexyphenidl4-154-15PO,LPO,L

BiperidenBiperiden2-82-8POPO

ProcyclidineProcyclidine10-2010-20POPO

DiazepamDiazepam2-62-6PO,VIPO,VI

ContCont..

CNS side effectCNS side effectNursing careNursing care

akathisiaakathisiaCannot remain still,pacing,inner Cannot remain still,pacing,inner restlessness, leg aches are restlessness, leg aches are relived by movement, rule out relived by movement, rule out anxiety or agitation, medicateanxiety or agitation, medicate..

Sedation, Wight gainSedation, Wight gainIncrease exercise ,reduced Increase exercise ,reduced calories diet if indicated ,may calories diet if indicated ,may need to change class of drugneed to change class of drug..

Mood-Stabilizing DrugsMood-Stabilizing Drugs

Target Symptoms for mood-Stabilizing drug Target Symptoms for mood-Stabilizing drug therapytherapy

ManiaManiaIrritabilityIrritabilityExpansivenessExpansivenessEuphoriaEuphoriaManipulative nessManipulative nessLability with depressionLability with depressionSleep disturbance (decrease sleep)Sleep disturbance (decrease sleep)Pressure speechPressure speechFlight of ideasFlight of ideasMotor hyperactivityMotor hyperactivityHypergraphiaHypergraphiaHyper sexualityHyper sexualityHallucinationsHallucinations CatatoniaCatatonia

DepressionDepressionIrritabilityIrritability

SadnessSadnessPessimismPessimismAnhedoniaAnhedonia

Self-reproachSelf-reproachGuiltGuilt

HopelessnessHopelessnessMotor retardationMotor retardation

Slowed thinkingSlowed thinkingPoor concentration and memoryPoor concentration and memory

FatigueFatiguehelplessnesshelplessness

Mood-Stabilizing DrugsMood-Stabilizing DrugsDRUG CLASSDRUG CLASS

GENERIC NAMEGENERIC NAME

((TRADE NAMETRADE NAME))

USUAL ADULT USUAL ADULT DOSAGE RANGE DOSAGE RANGE

)MG/DAY()MG/DAY(

PREPARATIONPREPARATION

AntimaniaAntimaniaLithium (Eskalith, Lithium (Eskalith,

lithobidlithobid

600-2400600-2400PO, CR ,SRPO, CR ,SR

Lithium citrateLithium citrate600-2400600-2400L/SL/SCalcium channel Calcium channel

BlockersBlockersVerapamil (Calan)Verapamil (Calan)

240240POPO

Nifedipine Nifedipine (adalat,procardia)(adalat,procardia)

240240POPO

LithiumLithium

Lithium, a naturally occurring salt, is Lithium, a naturally occurring salt, is first-line treatment for patients with first-line treatment for patients with acute mania and for the long term acute mania and for the long term prevention of recurrent episodes. prevention of recurrent episodes. Lithium also has a role in the treatment Lithium also has a role in the treatment of recurrent bipolar depression, of recurrent bipolar depression, unipolar depression, aggressive unipolar depression, aggressive behaviors, conduct disorder and behaviors, conduct disorder and schizoaffective disorderschizoaffective disorder..

Stabilizing Lithium LevelsStabilizing Lithium Levels

Common causes for an increase in lithium Common causes for an increase in lithium levelslevels

Decrease sodium intakeDecrease sodium intake. .

Diuretic therapyDiuretic therapy . .

Decrease renal functioningDecrease renal functioning . .

Fluid and electrolyte loss, sweating, dirrhea, Fluid and electrolyte loss, sweating, dirrhea, dehydration, feverdehydration, fever..

OverdoseOverdose. .

Medical illnessMedical illness. .

Murine EPS Drug DosesMurine EPS Drug DosesIP doses are calibrated to give 0.2 ml IP doses are calibrated to give 0.2 ml

for a 30 g mousefor a 30 g mouse

•Atropine:Atropine:0.5 mg/g = 15 mg IP (Mix 0.2 ml of stock solution in a total of 1 ml)0.5 mg/g = 15 mg IP (Mix 0.2 ml of stock solution in a total of 1 ml)Atropine stock in vial = 0.4 mg/mlAtropine stock in vial = 0.4 mg/ml

•Carbamyl cholineCarbamyl choline::500 ng/g = 15 mg IP (Mix 7.5 mg into 10 ml for a x10 stock solution)500 ng/g = 15 mg IP (Mix 7.5 mg into 10 ml for a x10 stock solution)

•Cefazolin:Cefazolin:200 mg/g/day = 6 mg/day in two divided doses = 3 mg IP bid (Mix 24 200 mg/g/day = 6 mg/day in two divided doses = 3 mg IP bid (Mix 24 mg into 1.6 ml for 8 individual doses)mg into 1.6 ml for 8 individual doses)

•Digoxin:Digoxin:20 ng/g bid = 0.6 mg IP bid on Day 1 (Mix 0.2 ml of stock in a 20 ng/g bid = 0.6 mg IP bid on Day 1 (Mix 0.2 ml of stock in a total of 10 ml). On Day 2 give 10 ng/g bid = 0.3 mg IP bid (0.1 total of 10 ml). On Day 2 give 10 ng/g bid = 0.3 mg IP bid (0.1 ml IP)ml IP)Digoxin stock in vial = 0.1 mg/mlDigoxin stock in vial = 0.1 mg/ml

•Isoproterenol:Isoproterenol:3 ng/g = 90 ng IP (Mix 0.25 ml of x100 stock in a total of 1 ml)3 ng/g = 90 ng IP (Mix 0.25 ml of x100 stock in a total of 1 ml)IsoproterenolIsoproterenol x100 stock = 2 mg/mlx100 stock = 2 mg/ml

ContCont..

•Propranolol:Propranolol:1 mg/g = 30 mg IP (Mix 0.15 ml of stock in a total of 1 mg/g = 30 mg IP (Mix 0.15 ml of stock in a total of 1 ml)1 ml)Propranolol stock in vial = 1 mg/mlPropranolol stock in vial = 1 mg/ml

•IV doses are calibrated to give 0.05 ml for a 30 g IV doses are calibrated to give 0.05 ml for a 30 g mousemouse

•Isoproterenol:Isoproterenol:1 ng/g = 30 ng IV (Mix 0.3 ml of x100 stock in a total of 1 ml)1 ng/g = 30 ng IV (Mix 0.3 ml of x100 stock in a total of 1 ml)Isoproterenol x100 stock = 2 mg/mlIsoproterenol x100 stock = 2 mg/ml

•Procainamide:Procainamide:30 mg/g = 900 mg IV (Add 2.2 ml of procainamide stock to 10 ml for a 30 mg/g = 900 mg IV (Add 2.2 ml of procainamide stock to 10 ml for a total of 12.2 ml which gives a concentration of 18 mg/ml)total of 12.2 ml which gives a concentration of 18 mg/ml)Procainamide stock in vial = 100 mg/mlProcainamide stock in vial = 100 mg/ml

ReferencesReferences

Principles and practice ofPrinciples and practice of

Psychiatric NursingPsychiatric Nursing

GAIL W. STUARTGAIL W. STUART

MICHELE T. LARAIAMICHELE T. LARAIA

88THTH EDITION EDITION

20052005