Psychopharmacology faster than normal, resulting in strange

thoughts, hallucinations, and bizarre

Pharmacodynamics – is the study of the
biochemical and physiological effects of
drugs and the mechanisms by which the
effects are produced. It simply describes the
effects of a drug on the body. Several terms
are used to describe the effects of a drug on
the body.
They include:
Potency of a drug – refers to the relative
dosage of a drug that is required to achieve a
desired effect.
Example: 10mg of the antidepressant
Paroxetine (Paxil) would be considered as
potent as 100mg of the antidepressant
Sertraline (Zoloft) if it achieved the same
desired effect as Sertraline.
Use of Antipsychotic Medication
These are used primarily to treat most forms
of psychosis, such as schizophrenia,
schizoaffective disorder, delusional disorder,
and mood disorder with psychosis and
psychoses associated with delirium and
dementia.
Symptoms may include impaired
communication or the inability to relate to
others, delusions, hallucinations, lack of
responsiveness to external stimuli, and the
inability to identify reality.
Antipsychotic agents that produce
significant neurologic adverse effects have
been referred to as Neuroleptics.
These agents provide symptom control by
blocking the activity of dopamine, which
has the potential to produce psychotic
thinking.
Excess amounts of dopamine cause nerve
impulses in the brain stem to be transmitted
behavior.
Blocking dopamine activity lessens or
prohibits the development of such thoughts
and behaviors. These agents also have
antiemetic properties, used to treat
intractable hiccoughs and control pain when
combined with other drugs.
New-generation antipsychotics, referred to
as atypical antipsychotics, have been
developed that block the activity of
serotonin and dopamine. Thus, they treat
both positive and negative symptoms of
disorders such as schizophrenia.
These agents produce fewer motor adverse
effects than neuroleptic agents do.
Examples of these include:
 Clozapine (Clozaril)
 Risperidone (Risperidol)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Ariprazole (Abilify)
Common Adverse Effects of Psychotropics
 Blurred vision
 Constipation
 Drowsiness
 Dry mouth – GI disturbances
 Hypo – or hyperglycemia
 Hypotension (Orthostatic)
 Insomnia
 Libido changes (Sexual dysfunction)
 Tachycardia
 Urinary Retention
 Weight gain
 Neuromuscular or Neurologic Adverse
Effects
Acute dyskinesia (any disturbance of
movement)
Parkinsonism – Motor retardation or
akinesia, characterized by masklike
appearances, rigidity, tremors, “pill-rolling”
salivation
Akathisia – Constant state of movement,
characterized by restlessness, difficulty
sitting still, or a strong urge to move about.
(Collectively called extrapyramidal adverse
effects EPS)
Tardive dyskinesia – the most frequent
serious side effect resulting from
termination of the drug, during a reduction
in dosage, or after long-term, high-dose
therapy. Characterized by involuntary
rhythmic, stereotyped movements, tongue
protrusion, cheek puffing, and involuntary
movements of extremities and trunk.
Neuroleptic Malignant Syndrome (NMS)
is an idiosyncratic, rare syndrome
characterized by hyperpyrexia, severe
muscle rigidity, altered consciousness,
alterations in blood pressure, elevated
creatinine phosphokinase, and elevated
white blood cell count.
Signs of Agranulocytosis
 Sore throat
 Fever
 Discomfort
Drug-induced, endocrine-related changes
such as menstrual irregularities, breast
enlargement, lactation, and changes in
libido.
Signs of jaundice, high fever, upper
abdominal pain, nausea, diarrhea, and skin
rash.
Client Education
How long before these medications start
to work?
People should begin to feel better within six
weeks of starting to take antipsychotic
medication. However, it can take several
months before the full benefits are felt.
After the psychotic episode has passed
‘Maintenance’ doses of antipsychotic
medications are important to minimize the
risk of further psychotic episodes. If a
person suddenly stops taking antipsychotic
medication against their doctor’s advice, it
can lead to a return of the psychotic
symptoms.
Antipsychotic Medications
Antipsychotics for Schizophrenia
Conventional (traditional-typical)
 Chlorpromazine
(Thorazine/Largactil)
 Fluphenazine (Prolixin)
 Haloperidol (Haldol/Serenase)
 Trifluoperazine (Stelazine) – elderly
Atypicals (newer over last ten years)
 Clozapine (Clozaril)
 Risperidone (Risperdal)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Ziprasidone (Geodon)
 Ariprazole (Abilify)
Anti-anxiety (Anxiolytic) Agents
Indications for use
 Anxiety and anxiety disorders
 Acute alcohol withdrawal
 Skeletal muscle spasms
 Convulsive and seizure disorders
 Status epilepticus
 Preoperative sedation
Therapeutic Antianxiety Agents
 Non-benzodiazepines
 Benzodiazepines
Why are anxiolytics used?
Anxiolytics are often prescribed to treat (but
not cure) general symptoms of anxiety and
panic disorder, with or without agoraphobia.
Drugs in this group also act as muscle
relaxants and are sometimes used to treat
epilepsy.
How do anxiolytics work?
These medications are thought to work
primarily by enhancing the effects of the
neurotransmitter GABA. This
neurotransmitter promotes feelings of
calmness. However, these drugs’ full
mechanisms of action are only partially
understood.
Types of anxiolytics
Anxiolytics are generally divided into two
groups of medication, benzodiazepines and
non-benzodiazepines.
Benzodiazepines
Benzodiazepines are prescribed for short-
term relief of severe and disabling anxiety
Common medications are:
 Lorazepam (Ativan)
 Alprazolam(Xanax)
 Diazepam (Valium)
Benzodiazepines may also be indicated to
cover the latent periods associated with the
medications prescribed to treat an
underlying anxiety disorder.
They are used to treat various conditions and
symptoms and are usually a first choice
when short-term CNS sedation is needed.
Longer-term uses include treatment for
severe anxiety and psychosis.
Withdrawal – refers to the characteristic
signs and symptoms that appear when a drug
that causes a physical dependency is
regularly used for a long time and then
suddenly discontinued or decreased in
dosage.
Classical benzodiazepines
 Clonazepam (Klonopin)
 Chlordiazepoxide (Librium)
 Diazepam (Valium)
 Alprazolam (Xanax)
 Lorazepam (Ativan or Temesta)
Uses of Benzodiazepines
Use as anticonvulsants
Benzodiazepines are potent anticonvulsants
and have life-saving properties in the acute
management of status epilepticus. The most
commonly used benzodiazepines for seizure
control are lorazepam and diazepam.
Use as anxiolytics
Benzodiazepines possess anti-anxiety
properties and can be useful for the short-
term treatment of severe anxiety.
Benzodiazepines are usually administered
orally for the treatment of anxiety; however,
occasionally, lorazepam or diazepam may be
given intravenously for the treatment of
panic attacks.
Use for insomnia
Hypnotic benzodiazepines have strong
sedative effects, and certain
benzodiazepines, therefore, are often
prescribed for the management of insomnia.
Use as a premedication before procedures
Benzodiazepines can be very beneficial as
premedication before surgery, especially in
anxious patients. Usually administered a
couple of hours before surgery,
benzodiazepines will bring about anxiety
relief and also produce amnesia.
Use in intensive care
Benzodiazepines can be very useful in
intensive care to sedate patients receiving
mechanical ventilation or those in extreme
distress or severe pain. Caution should be
exercised in this situation due to the
occasional scenario of respiratory
depression, and benzodiazepine overdose
treatment facilities should be available.
Use in alcohol dependence
In the management of alcohol withdrawal,
benzodiazepines can have potentially
lifesaving effects by ameliorating the
alcohol withdrawal syndrome. Delirium
tremens, which can be potentially fatal, can
be effectively treated by benzodiazepines
and often prevented from occurring in the
first place. The usual benzodiazepines used
in the management of alcohol withdrawal
are Chlordiazepoxide (Librium) or
Diazepam (Valium).
Side effects
 Drowsiness
 Dizziness
 Upset stomach
 Blurred vision
 Headache
 Confusion
 Depression
 Impaired coordination
 Changes in heart rate
Non-benzodiazepines
Buspirone (Buspar) is a serotonin 1A
agonist. It lacks the sedation and the
dependence associated with benzodiazepines
and causes much less cognitive impairment.
It may be less effective than
benzodiazepines in patients who have been
previously treated with benzodiazepines, as
the medication does not provide the
euphoria and sedation that these patients
may expect or equate with anxiety relief.
Agonists – An agonist is a substance that
binds to a receptor and triggers a response in
the cell.
Addiction is a chronic disorder proposed to
be precipitated by a combination of genetic,
biological/pharmacological, and social
factors.
Antidepressants
What are antidepressants?
Antidepressants are drugs that relieve the
symptoms of depression. They were first
developed in the 1950s and have been used
regularly since then. There are almost thirty
different kinds of antidepressants available
today, and there are four main types.
Types of antidepressants:
 Tricyclics
 MAOIs (Monoamine oxidase
inhibitors)
 SSRIs (Selective Serotonin Reuptake
Inhibitors)
 SNRIs (Serotonin and Noradrenaline
Reuptake Inhibitors)
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
the eye is affected)
 Decreased gastrointestinal motility
and secretion. This may lead to
constipation
 Urinary retention or difficulty with
urination
 Memory Difficulties
SSRI antidepressants are not just for
depression.
SSRI stands for 'selective serotonin
reuptake inhibitor.’ They are a group of
antidepressant drugs that are used to treat
depression. They are also used to treat some
other conditions, such as bulimia, panic
disorder, and obsessive-compulsive disorder.
How quickly do SSRI antidepressants
work?
An antidepressant takes 2-4 weeks to build
up its effect and work fully. Some people
stop treatment after a week or so, thinking it
is not helping. It is best to wait for 3-4
weeks before deciding if treatment with an
SSRI is helping or not.
If you find that the treatment is helpful after
3-4 weeks, it is usual to continue. A normal
course of antidepressants lasts up to six
months or more after symptoms have eased.
Some people with recurrent depression need
longer courses of treatment.
What about side effects?
Most people have either minor or no, side-
effects. Possible side effects vary between
different preparations. The most common
ones include the following:
 Diarrhea
 Feeling sick
 Vomiting
 Headaches.
Some people develop a feeling of
restlessness or anxiety. Sexual problems
sometimes occur. It is worth keeping on with
treatment if side effects are mild at first.
Minor side effects may wear off after a week
or so.
Drowsiness is an uncommon side-effect
with SSRI antidepressants, but do not drive
or operate machinery if you become drowsy
while taking one.
MAOI’S
Monoamine oxidase is an enzyme that is
found in many parts of the body. In the
brain, monoamine oxidase destroys
neurotransmitters such as norepinephrine
and serotonin. So, MAO inhibitors, by
limiting the activity of monoamine oxidase,
block the breakdown of those
neurotransmitters. They work more quickly
than tricyclics, but they have more severe
side effects and require a change in diet.
Leading MAOIs are:
 Phenelzine (Nardil)
 Tranylcypromine (Parnate)
 Seligiline (Eldepryl)
 Isocarboxazid (Marplan).
MAOIs are generally prescribed:
For people who don't respond to tricyclics
and SSRIs.
For cases of atypical depression.
Because of their stimulating rather than
sedating effect, MAOIs may be preferable to
TCAs for treating dysthymia, a chronic,
low-level depression.
Side Effects of MAOIs
 Dizziness
 Rapid heartbeat
 Loss of sexual interest
Food Interaction
MAOIs react with certain foods and
alcoholic beverages, and some medications
to produce a severe reaction. The reaction,
which often does not appear for several
hours after taking the medication, may
include a dangerous rise in blood pressure,
as well as headache, nausea, vomiting, rapid
heartbeat, possible confusion, psychotic
symptoms, seizures, stroke and coma.
The foods that interact with MAOIs include
aged cheeses; smoked, pickled, fermented,
and otherwise processed meats; fish and soy
products; Chianti and other red wines; fava
beans and ripe figs; and foods containing
monosodium glutamate (MSG). These foods
all contain large amounts of the amino acid
tyramine, which, when it interacts with
MAOIs, dramatically raises blood pressure.
SNRI Antidepressants
This new class of antidepressants is known
as SNRIs (serotonin-norepinephrine
reuptake inhibitors) because they affect not
only serotonin but also norepinephrine and
other neurotransmitter systems. These
medications are thought to work similarly to
SSRIs in that they inhibit the reuptake of
neurotransmitters known to have an effect
on mood at the synaptic junction.
Buproprion (Wellbutrin)
It is sometimes used as a first-line treatment
for bipolar disorder (alongside mood
stabilizer medications). It is as effective as
comparable SSRI treatments for combating
depressive episodes and seems to have the
added benefit of lessening the risk of
precipitating manic episodes (compared to
SSRI antidepressants). The side effect
profile is often perceived as milder as well.
Venlafaxine (Effexor)
It has also been rated highly for the
treatment of manic-depressive illness, but
definitive studies are lacking at this time.
There is some evidence that it relieves the
symptoms of depression more quickly than
other medications, has fewer side effects,
and can be taken in combination with other
medications easily. More research is needed
to solidify the role of venlafaxine in bipolar
disorder treatment.
Mood Stabilizing Drug Agents
Indications for use
 Manic episodes associated with
bipolar disorders
 Bipolar maintenance therapy
 Migraine headaches
 Schizoaffective disorders
Antimanic
 Lithium carbonate (Eskalith)
Anticonvulsants
Calcium-channel blocker
Anti-manic medications
They are used to treat a mental illness called
bipolar disorder. Bipolar disorder, or manic-
depressive illness, is characterized by
cycling mood changes: severe highs (mania)
and lows (depression). Cycles may be
mostly manic or depressive, with normal
mood between cycles.
Lithium, anticonvulsants, and antipsychotics
are the main types of drugs used for bipolar.
Some benzodiazepines also may be
prescribed for short-term manic and
occasionally on an ongoing basis.
Lithium is the medication used most often to
control a manic "high." Mania is usually
paired with subsequent or preceding
depression. Lithium evens out mood swings
in both directions.
Lithium reduces severe manic symptoms in
about five to 14 days, but it may take
anywhere from days to several months until
the condition is fully controlled.
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.