psychopharmacology

Question 1

describe of pharmacotherapeutic agents used in the
treatment of mental illness

Answer 1

• Anti-Psychotics
  (Neuroleptics): 1st and 2nd (atypical) gen
• Anxiolytics (Anti-anxiety) and hypnotics
• Anti-Depressants
• Mood-Stabilizers

Question 2

analyse actions, clinical use, and side effects of Anti-Psychotics
(Neuroleptics): 1st and 2nd (atypical) gen

• NOT suitable for elderly (why?)

Answer 2

Gen 1:
1. Low Potency
* Highly sedating
* Postural hypotension, dizziness, dry mouth,
blurred vision, & difficulty in urinating.
eg: Chloropromazine (CPZ): Largactil

2. High Potency
   *These groups produce least sedative &
   anticholinergic effects but most Extrapyramidal
   Side Effects (EPSE)
   Haloperidol: Haldol
   Trifluoperazine: Stelazine
    Fluphenazine Decanoate: IM Modecate

side effects:
Cardiovascular -*Orthostatic Hypotension
*Arrhythmias *tachycardia

Anti-cholinergic
blurred vision,
-dry mouth *constipation
*urinary retention
*increased ocular
pressure

EPSE:
* Neuroleptic Malignant Syndrome (differentiates g1 and g2, tgt w epse)
*Acute Dystonia: Occulogylric Crisis. repetitive muscle contractions
*Akathisia: Inner restlessness (Unable to sit still)
*Akinesia: Mask-like face, pin-rolling, drooling
*Dystonia: Cogwheel rigidity (Toy solider)
*Tardive Dyskinesia: Tongue protrusion,
Rapid chewing movement (Rabbit chewing)
*Parkinsonism: Abnormal gait, fine tremors
- treat epse with:
*I / M Cogentin: Benztropine
*Tab Artane: Trihexyphenidyl
*Diphenhydramine (Benadryl)

Gen 2:
- Clozapine / Clozaril: may have agranulocytosis –>WBC monitoring (Once /week x 6 months)
- Risperidone /Risperdal
- Olanzapine / Zyprexa: may cause weight gain and T2DM
- Quetiapine Fumarate / Seroquel
- Aripiprazole / Abilify

• Blocks Dopamine (D2) & Serotonin (5HT2) receptor
• Improves positive symptoms
  *More Effective for negative symptoms
  Asocial behaviour, *Amotivation
  Avolitional attitude, Attention Deficit
  Alogia (restricted thought & speech)
  Anhedonia (Inability to experience pleasure)

Question 3

analyse actions, clinical use, and side effects of Anxiolytics (Anti-anxiety) and Hypnotics

Answer 3

1. Short acting Benzodiazepine (BZP): Triazolam (Halicon)
2. Intermediate acting BZP: Lorazepam (Ativan)
3. Long acting BZP: Diazepam (Valium)
4. Novel non-BZP: Buspirone (BuSpar)
5. Sedating antihistamine: Hydroxyzine Hydrochloride
   (Atarax)

Nursing Implications
1. Give daily dose during bedtime; promote more daytime activities.
2. Observe for therapeutic effects
3. Observe for adverse effects (Over-sedation, hypotension,
paradoxica excitement eg, hostility, confusion or hyperactivity.
4. Monitor adverse effects from beta blockers. Hypotension,
bronchospasm, bradycardia
5. Know that lorazepam can be given sublingually for rapid effect
6. Instruct client not to use anxiolytics together with alcohol

Question 4

analyse actions, clinical use, and side effects of Anti-Depressants (TCA, SSRI, MAOI)

Answer 4

TRICYCLICS ( T C A )
-e.g. Amitriptylline , Clomipramine, Imipramine
- Treat depression
- not used often for depressive episodes
-Block the reuptake of Norepinephrine (NE) & Serotonin (SE) at receptor sites
-thus increase NE & SE levels
side effects
1. Dry mouth
2. Blurred vision
3. Tachycardia
4. Urine retention; constipation
5. Loss of appetite
6. Increase ocular pressure

SELECTIVE SEROTONIN REUPTAKE INHIBITORS
( SSRI )
e.g. Fluoxetine (Prozac), Sertraline Hydrochloride (Zoloft)
- Mood disturbances, altered cognition, anxiety, aggressiveness
Often used as 1st line drug for depression
Side effects:
1. Nausea, vomiting, diarrhea
2. Tremors
3. Insomnia
4. Headache
5. Weight loss

MONOAMINE OXIDASE INHIBITORS ( MAOIs)
e.g Isocarboxaid (Marplan), Phenelzine(Nardil)
-If not responding to TCAs, SSRIs & ECT
-Atypical depression
-increase biogenic amines
- blocking the MAO (monoamines) from
degradation/oxidation
side effects:
1. Orthostatic Hypotension
2. Abnormal heart rate
3. Drowsiness; headache; dizziness
4. Blurred vision; vertigo
5. Dry mouth; nausea; vomitting
6. risk of hypertensive crisis due to drug food interaction
-> food to AVOID with MAOI
 Aged cheese
 Avocados
 Bananas
 Beer
 Caffeine
 Chocolates
 Pickled foods
 Soya by-products eg. Miso, Soy sauce
 Raisins
 Yogurts
 Wines

Question 5

analyse actions, clinical use, and side effects of Mood-Stabilizers

Answer 5

i. Lithium Carbonate:
- Balance the serotogenic neurotransmission. (0.8 to 1.2mEq/L)
side effects:
* G.I. Effects – severe nausea,
polyuria & thirst
* Endocrine: Risk of hypothyroidism
* Cardiovascular: ECG changes
* Haematological Disorders – Leucocytosis

ii. Carbamazepine (anticonvulsant): Blocks the nero-sodium channel (calms neurons)
-side effects:
* Neurological:
dizziness, sedation,
headache, confusion
* G.I.Effects: nausea,dry
mouth, constipation

iii. Sodium Valporate (anticonvulsant): Enhancing serotogenic and reducing dopaminergic
actions
-side effect:
* Neurological:
sedation, tremor,
headaches, visual
disturbances, tinnitus,
agitation
* G.I. Effects : nausea,
diarrhoea, abdominal
cramps, heartburn

Question 6

describe the roles of nurses in pharmacological
treatment

Answer 6

Anxiolytics and hypnotics Nursing Implications:
1. Give daily dose during bedtime; promote more daytime activities.
2. Observe for therapeutic effects
3. Observe for adverse effects (Over-sedation, hypotension, paradoxica excitement eg, hostility, confusion or hyperactivity.
4. Monitor adverse effects from beta blockers. Hypotension,
bronchospasm, bradycardia
5. Know that lorazepam can be given sublingually for rapid effect
6. Instruct client not to use anxiolytics together with alcohol

Question 7

most severe form of EPSE are (2)

Answer 7

1. neuroleptic malignant syndrome
   * Rare but potentially Life-threatening
   * Rapid onset/ medical emergency
   *Unknown cause: Maybe due to effects on medulla
   and hypothalamus
   * Symptoms:
   - Hyperprexia (41oC) fever
   - Unstable blood pressure
   - Stupor, muscular rigidity
   - Alteration in consciousness (delirium or agitation)
   - Elevated blood creatinine phosphokinase
   - Profuse diaphoresis
   - Urinary incontinence
   - Acute renal failure
2. Tardive diskinesia
   irreversible, Caused by long-term use of neuroleptic drugs.

Features:
*grimacing, tongue protrusion, lip smacking, puckering
& pursing, & rapid eye blinking.
*Rapid movements of arms, legs, & trunk
*Impaired movements of fingers :like playing an invisible guitar or piano
*repetitive, involuntary, purposeless movements