Psychopharmacology faster than normal, resulting in strange

thoughts, hallucinations, and bizarre

Pharmacodynamics – is the study of the
behavior.
biochemical and physiological effects of
drugs and the mechanisms by which the Blocking dopamine activity lessens or
effects are produced. It simply describes the prohibits the development of such thoughts
effects of a drug on the body. Several terms and behaviors. These agents also have
are used to describe the effects of a drug on antiemetic properties, used to treat
the body. intractable hiccoughs and control pain when
combined with other drugs.
They include:
New-generation antipsychotics, referred to
Potency of a drug – refers to the relative
as atypical antipsychotics, have been
dosage of a drug that is required to achieve a
developed that block the activity of
desired effect.
serotonin and dopamine. Thus, they treat
Example: 10mg of the antidepressant both positive and negative symptoms of
Paroxetine (Paxil) would be considered as disorders such as schizophrenia.
potent as 100mg of the antidepressant
These agents produce fewer motor adverse
Sertraline (Zoloft) if it achieved the same
effects than neuroleptic agents do.
desired effect as Sertraline.
Examples of these include:
Use of Antipsychotic Medication
 Clozapine (Clozaril)
These are used primarily to treat most forms
 Risperidone (Risperidol)
of psychosis, such as schizophrenia,
 Olanzapine (Zyprexa)
schizoaffective disorder, delusional disorder,
 Quetiapine (Seroquel)
and mood disorder with psychosis and
 Ariprazole (Abilify)
psychoses associated with delirium and
dementia. Common Adverse Effects of Psychotropics
Symptoms may include impaired  Blurred vision
communication or the inability to relate to  Constipation
others, delusions, hallucinations, lack of  Drowsiness
responsiveness to external stimuli, and the  Dry mouth – GI disturbances
inability to identify reality.  Hypo – or hyperglycemia
 Hypotension (Orthostatic)
Antipsychotic agents that produce
 Insomnia
significant neurologic adverse effects have
 Libido changes (Sexual dysfunction)
been referred to as Neuroleptics.
 Tachycardia
These agents provide symptom control by  Urinary Retention
blocking the activity of dopamine, which  Weight gain
has the potential to produce psychotic
thinking.
Excess amounts of dopamine cause nerve
impulses in the brain stem to be transmitted
 Neuromuscular or Neurologic Adverse Signs of jaundice, high fever, upper
Effects abdominal pain, nausea, diarrhea, and skin
rash.
Acute dyskinesia (any disturbance of
movement) Client Education
Parkinsonism – Motor retardation or How long before these medications start
akinesia, characterized by masklike to work?
appearances, rigidity, tremors, “pill-rolling”
People should begin to feel better within six
salivation
weeks of starting to take antipsychotic
Akathisia – Constant state of movement, medication. However, it can take several
characterized by restlessness, difficulty months before the full benefits are felt.
sitting still, or a strong urge to move about.
After the psychotic episode has passed
(Collectively called extrapyramidal adverse
effects EPS) ‘Maintenance’ doses of antipsychotic
medications are important to minimize the
Tardive dyskinesia – the most frequent
risk of further psychotic episodes. If a
serious side effect resulting from
person suddenly stops taking antipsychotic
termination of the drug, during a reduction
medication against their doctor’s advice, it
in dosage, or after long-term, high-dose
can lead to a return of the psychotic
therapy. Characterized by involuntary
symptoms.
rhythmic, stereotyped movements, tongue
protrusion, cheek puffing, and involuntary Antipsychotic Medications
movements of extremities and trunk.
Antipsychotics for Schizophrenia
Neuroleptic Malignant Syndrome (NMS)
is an idiosyncratic, rare syndrome Conventional (traditional-typical)
characterized by hyperpyrexia, severe  Chlorpromazine
muscle rigidity, altered consciousness, (Thorazine/Largactil)
alterations in blood pressure, elevated  Fluphenazine (Prolixin)
creatinine phosphokinase, and elevated  Haloperidol (Haldol/Serenase)
white blood cell count.  Trifluoperazine (Stelazine) – elderly
Signs of Agranulocytosis Atypicals (newer over last ten years)
 Sore throat  Clozapine (Clozaril)
 Fever  Risperidone (Risperdal)
 Discomfort  Olanzapine (Zyprexa)
Drug-induced, endocrine-related changes  Quetiapine (Seroquel)
such as menstrual irregularities, breast  Ziprasidone (Geodon)
enlargement, lactation, and changes in  Ariprazole (Abilify)
libido.

Anti-anxiety (Anxiolytic) Agents

Indications for use Benzodiazepines may also be indicated to
cover the latent periods associated with the
 Anxiety and anxiety disorders
medications prescribed to treat an
 Acute alcohol withdrawal
underlying anxiety disorder.
 Skeletal muscle spasms
 Convulsive and seizure disorders They are used to treat various conditions and
 Status epilepticus symptoms and are usually a first choice
 Preoperative sedation when short-term CNS sedation is needed.
Longer-term uses include treatment for
Therapeutic Antianxiety Agents
severe anxiety and psychosis.
 Non-benzodiazepines
Withdrawal – refers to the characteristic
 Benzodiazepines
signs and symptoms that appear when a drug
Why are anxiolytics used? that causes a physical dependency is
regularly used for a long time and then
Anxiolytics are often prescribed to treat (but suddenly discontinued or decreased in
not cure) general symptoms of anxiety and dosage.
panic disorder, with or without agoraphobia.
Drugs in this group also act as muscle Classical benzodiazepines
relaxants and are sometimes used to treat
 Clonazepam (Klonopin)
epilepsy.
 Chlordiazepoxide (Librium)
How do anxiolytics work?  Diazepam (Valium)
 Alprazolam (Xanax)
These medications are thought to work  Lorazepam (Ativan or Temesta)
primarily by enhancing the effects of the
neurotransmitter GABA. This Uses of Benzodiazepines
neurotransmitter promotes feelings of
Use as anticonvulsants
calmness. However, these drugs’ full
mechanisms of action are only partially Benzodiazepines are potent anticonvulsants
understood. and have life-saving properties in the acute
management of status epilepticus. The most
Types of anxiolytics
commonly used benzodiazepines for seizure
Anxiolytics are generally divided into two control are lorazepam and diazepam.
groups of medication, benzodiazepines and
Use as anxiolytics
non-benzodiazepines.
Benzodiazepines possess anti-anxiety
Benzodiazepines
properties and can be useful for the short-
Benzodiazepines are prescribed for short- term treatment of severe anxiety.
term relief of severe and disabling anxiety Benzodiazepines are usually administered
orally for the treatment of anxiety; however,
Common medications are: occasionally, lorazepam or diazepam may be
 Lorazepam (Ativan) given intravenously for the treatment of
 Alprazolam(Xanax) panic attacks.
 Diazepam (Valium) Use for insomnia
Hypnotic benzodiazepines have strong  Depression
sedative effects, and certain  Impaired coordination
benzodiazepines, therefore, are often  Changes in heart rate
prescribed for the management of insomnia.
Non-benzodiazepines
Use as a premedication before procedures
Buspirone (Buspar) is a serotonin 1A
Benzodiazepines can be very beneficial as agonist. It lacks the sedation and the
premedication before surgery, especially in dependence associated with benzodiazepines
anxious patients. Usually administered a and causes much less cognitive impairment.
couple of hours before surgery,
It may be less effective than
benzodiazepines will bring about anxiety
benzodiazepines in patients who have been
relief and also produce amnesia.
previously treated with benzodiazepines, as
Use in intensive care the medication does not provide the
euphoria and sedation that these patients
Benzodiazepines can be very useful in
may expect or equate with anxiety relief.
intensive care to sedate patients receiving
mechanical ventilation or those in extreme Agonists – An agonist is a substance that
distress or severe pain. Caution should be binds to a receptor and triggers a response in
exercised in this situation due to the the cell.
occasional scenario of respiratory
Addiction is a chronic disorder proposed to
depression, and benzodiazepine overdose
be precipitated by a combination of genetic,
treatment facilities should be available.
biological/pharmacological, and social
Use in alcohol dependence factors.
In the management of alcohol withdrawal, Antidepressants
benzodiazepines can have potentially
What are antidepressants?
lifesaving effects by ameliorating the
alcohol withdrawal syndrome. Delirium Antidepressants are drugs that relieve the
tremens, which can be potentially fatal, can symptoms of depression. They were first
be effectively treated by benzodiazepines developed in the 1950s and have been used
and often prevented from occurring in the regularly since then. There are almost thirty
first place. The usual benzodiazepines used different kinds of antidepressants available
in the management of alcohol withdrawal today, and there are four main types.
are Chlordiazepoxide (Librium) or
Diazepam (Valium). Types of antidepressants:

Side effects  Tricyclics

 MAOIs (Monoamine oxidase
 Drowsiness inhibitors)
 Dizziness  SSRIs (Selective Serotonin Reuptake
 Upset stomach Inhibitors)
 Blurred vision  SNRIs (Serotonin and Noradrenaline
 Headache Reuptake Inhibitors)
 Confusion How do they work?
We don't know for certain, but we think that increase blood pressure, so this may need to
antidepressants work by increasing the be monitored.
activity of certain chemicals that work in our
brains called neurotransmitters. They pass MAOIs
signals from one brain cell to another. The This type of antidepressant is rarely
chemicals most involved in depression are prescribed these days. MAOIs can give you
thought to be Serotonin and Noradrenaline. dangerously high blood pressure if you eat
Tricyclics foods containing a substance called
Tyramine. If you agree to take an MAOI
These commonly cause a dry mouth, a slight antidepressant, your doctor will give you a
tremor, a fast heartbeat, constipation, list of foods to avoid.
sleepiness, and weight gain. Particularly in
older people, they may cause confusion, Medication Trade Name Group
slowness in starting and stopping when Amitriptyline Elavil Tricyclic
passing water, faintness through low blood Clomipramine Anafranil Tricyclic
pressure, and falls. If you have heart trouble, Imipramine Tofranil Tricyclic
it may be best not to take one of this group Paroxetine Paxil SSRI
of antidepressants. Men may experience Sertraline Lustral/Zoloft SSRI
difficulty in getting or keeping an erection Fluoxetine Prozac SSRI
or delayed ejaculation. Tricyclic Phenelzine Nardil MAOI
antidepressants are dangerous in overdose. 
Isocarboxazid Marplan MAOI
SSRIs Tranylcypromine Parnate MAOI
Reboxetine Edronax SNRI
During the first couple of weeks of taking
Venlafaxine Effexor SNRI
them, you may feel sick and more anxious.
Some of these tablets can produce nasty
indigestion, but you can usually stop this by Key
taking them with food. More seriously, they
may interfere with your sexual function. SSRI = Selective Serotonin Reuptake
There have been reports of episodes of Inhibitor
aggression, although these are rare. Inhibitor SNRI =Serotonin Noradrenaline
The more serious ones - problems with Reuptake Inhibitor
urinating, difficulty in remembering, falls, MAOI =Monoamine oxidase inhibitor
and confusion - are uncommon in healthy,
younger, or middle-aged people. It is TCA = Tricyclic antidepressant
common, if you are depressed, to think of
Side effects of TCA’A
harming or killing yourself. Tell your doctor
– that suicidal thoughts will pass once the Many side effects are related to tricyclics
depression starts to lift. anti-muscarinic actions. The anti-muscarinic
side effects are relatively common and
SNRIs
include the following:
The side effects are very similar to SSRIs,
 Dry mouth (salivary secretion is
although Venlafaxine should not be used if
affected)
you have a serious heart problem. It can also
 Dry nose
  Blurred vision (accommodation in sometimes occur. It is worth keeping on with
the eye is affected) treatment if side effects are mild at first.
 Decreased gastrointestinal motility Minor side effects may wear off after a week
and secretion. This may lead to or so.
constipation
 Urinary retention or difficulty with Drowsiness is an uncommon side-effect
urination with SSRI antidepressants, but do not drive
 Memory Difficulties or operate machinery if you become drowsy
while taking one.
SSRI antidepressants are not just for
depression. MAOI’S

SSRI stands for 'selective serotonin Monoamine oxidase is an enzyme that is

reuptake inhibitor.’ They are a group of found in many parts of the body. In the
antidepressant drugs that are used to treat brain, monoamine oxidase destroys
depression. They are also used to treat some neurotransmitters such as norepinephrine
other conditions, such as bulimia, panic and serotonin. So, MAO inhibitors, by
disorder, and obsessive-compulsive disorder. limiting the activity of monoamine oxidase,
block the breakdown of those
How quickly do SSRI antidepressants neurotransmitters. They work more quickly
work? than tricyclics, but they have more severe
side effects and require a change in diet.
An antidepressant takes 2-4 weeks to build
up its effect and work fully. Some people Leading MAOIs are:
stop treatment after a week or so, thinking it
is not helping. It is best to wait for 3-4  Phenelzine (Nardil)
weeks before deciding if treatment with an  Tranylcypromine (Parnate)
SSRI is helping or not.  Seligiline (Eldepryl)
 Isocarboxazid (Marplan).
If you find that the treatment is helpful after
3-4 weeks, it is usual to continue. A normal MAOIs are generally prescribed:
course of antidepressants lasts up to six For people who don't respond to tricyclics
months or more after symptoms have eased. and SSRIs.
Some people with recurrent depression need
longer courses of treatment. For cases of atypical depression.

What about side effects? Because of their stimulating rather than

sedating effect, MAOIs may be preferable to
Most people have either minor or no, side- TCAs for treating dysthymia, a chronic,
effects. Possible side effects vary between low-level depression.
different preparations. The most common
ones include the following: Side Effects of MAOIs

 Diarrhea  Dizziness
 Feeling sick  Rapid heartbeat
 Vomiting  Loss of sexual interest
 Headaches. Food Interaction
Some people develop a feeling of MAOIs react with certain foods and
restlessness or anxiety. Sexual problems alcoholic beverages, and some medications
to produce a severe reaction. The reaction, symptoms of depression more quickly than
which often does not appear for several other medications, has fewer side effects,
hours after taking the medication, may and can be taken in combination with other
include a dangerous rise in blood pressure, medications easily. More research is needed
as well as headache, nausea, vomiting, rapid to solidify the role of venlafaxine in bipolar
heartbeat, possible confusion, psychotic disorder treatment.
symptoms, seizures, stroke and coma.
Mood Stabilizing Drug Agents
The foods that interact with MAOIs include
aged cheeses; smoked, pickled, fermented, Indications for use
and otherwise processed meats; fish and soy  Manic episodes associated with
products; Chianti and other red wines; fava bipolar disorders
beans and ripe figs; and foods containing  Bipolar maintenance therapy
monosodium glutamate (MSG). These foods  Migraine headaches
all contain large amounts of the amino acid  Schizoaffective disorders
tyramine, which, when it interacts with
MAOIs, dramatically raises blood pressure. Antimanic

SNRI Antidepressants  Lithium carbonate (Eskalith)

This new class of antidepressants is known Anticonvulsants

as SNRIs (serotonin-norepinephrine Calcium-channel blocker
reuptake inhibitors) because they affect not
only serotonin but also norepinephrine and Anti-manic medications
other neurotransmitter systems. These
They are used to treat a mental illness called
medications are thought to work similarly to
bipolar disorder. Bipolar disorder, or manic-
SSRIs in that they inhibit the reuptake of
depressive illness, is characterized by
neurotransmitters known to have an effect
cycling mood changes: severe highs (mania)
on mood at the synaptic junction.
and lows (depression). Cycles may be
Buproprion (Wellbutrin) mostly manic or depressive, with normal
mood between cycles.
It is sometimes used as a first-line treatment
for bipolar disorder (alongside mood Lithium, anticonvulsants, and antipsychotics
stabilizer medications). It is as effective as are the main types of drugs used for bipolar.
comparable SSRI treatments for combating Some benzodiazepines also may be
depressive episodes and seems to have the prescribed for short-term manic and
added benefit of lessening the risk of occasionally on an ongoing basis.
precipitating manic episodes (compared to
Lithium is the medication used most often to
SSRI antidepressants). The side effect
control a manic "high." Mania is usually
profile is often perceived as milder as well.
paired with subsequent or preceding
depression. Lithium evens out mood swings
in both directions.
Venlafaxine (Effexor)
Lithium reduces severe manic symptoms in
It has also been rated highly for the about five to 14 days, but it may take
treatment of manic-depressive illness, but anywhere from days to several months until
definitive studies are lacking at this time. the condition is fully controlled.
There is some evidence that it relieves the
Antipsychotics are sometimes used in the switch to a low-salt diet can cause body
first several days of treatment to control changes that interfere with lithium levels.
manic symptoms until the lithium starts Also, some diuretics, or anything that
working. Then, antidepressants may be removes water from the body, can increase
needed along with lithium during the the level of lithium to dangerous levels.
depressive phase. Response to Other diuretics, like coffee and tea, can
lower the level of lithium.
treatment with lithium varies for each
person, and the doctor cannot tell A serious lithium overdose can be life-
beforehand who will do well on it. threatening. But, with regular monitoring by
your doctor, lithium is a safe drug that helps
Side effects many people lead normal lives.
Lithium levels must be checked every so
Trade Name Generic Name
often to be sure how much medication is in
the body. This may be checked often when
the medication is started but eventually may Carbolith Lithium
be checked every few months if there are no Cibalith-S Carbonate
signs of there being too much in the body. Duralith
Eskalith
If too little lithium is taken, lithium won't Lithane
work. If too much is taken, side effects may Lithizine
occur. The range between an effective dose Lithobid
and a toxic one is small. How much lithium Lithonate
someone needs may change over time, Lithotabs
depending on the severity of the illness,
body chemistry, and the person's physical
condition.
Warnings:
Considerations with lithium
It may affect judgment. Do not drive until
Lithium either may not be recommended or you know how this drug affects you. Be sure
may be given with caution when a person your doctor knows I you have existing
has existing thyroid, kidney, or heart thyroid, kidney, or heart disorders, epilepsy,
disorders, epilepsy, or brain damage. or brain damage. Can cause birth defects.
Keeping tabs on your thyroid is part of
treatment with lithium because of the Possible Side Effects:
possibility of the thyroid gland becoming
 Frequent urination
underactive or enlarged. You may need a
 hand tremor
thyroid hormone pill along with lithium.
 increased thirst
Women of childbearing age should be aware  nausea
that lithium increases the risk of birth  vomiting
defects. Special caution should be taken  stomach pain
during the first three months of pregnancy.  weight gain
 sleepiness
Many factors, including dangerous  dizziness
interactions with other medications, affect  memory problems
lithium levels. An unusual amount of  vision problems
exercise, fever, vomiting, diarrhea, or a
  anxiety Artane (trihexyphenidyl hydrochloride) Dry
 slurred speech, mouth, nervousness, blurred vision, nausea
 irregular heart beat
Benadryl (diephenhydramine
Anticonvulsants hydrochloride) Dizziness, sleepiness, upset
stomach, decreased coordination
Not everyone with mania symptoms gets
relief through lithium. Some do best with Cogentin (benztropine mesylate)
anticonvulsants - drugs that are usually used Constipation, dry mouth, nausea and
to treat epilepsy. Carbamazepine vomiting, rash
(Tegretol®, Equetro®) is an anticonvulsant
prescribed for people with bipolar disorder Akineton (Biperiden Hcl)
who rapidly change from mania to
depression and back again over hours or
days, rather than months.
Valproic acid (Depakene®) can be as
effective as lithium in controlling mania.
Because valproic acid can cause liver
problems, blood tests to check the liver
should be done before starting medication
and then regularly, particularly during the
first six months.
Neurontin - Gabapentin
If you take an antacid, take Neurontin two
hours before. Dizziness, vision problems,
clumsiness, sleepiness, tremor, swelling of
hands or feet, diarrhea
Lamotrigine (Lamictal®)
It was approved as a maintenance therapy
along with standard medications. It has been
effective in delaying disordered mood
episodes (depression and mania). A rare
but serious side effect is a rash called
Steven-Johnson syndrome that may need
hospitalization. For this reason, people
taking lamotrigine should call the doctor
immediately. The dose is increased very
slowly to reduce the risk of this type of rash.
Definition of Anti-parkinsonian
Medication
Anti-parkinsonian drugs are medicines that
relieve the symptoms of Parkinson's disease
and other forms of parkinsonism.