PSYCHOTROPIC DRUGS

Antipsychotic Drugs

A. Also known as ataractic or neuroleptic

B. Action: to block the dopamine receptors in the CNS
C. Antipsychotic drugs relieve positive psychotic symptoms and assist in
controlling behavior - medication can calm an excited client without
producing marked impairment of motor function or sleep.
D. Most common are phenothiazine derivatives (typical: Thorazine, Stelazine, Trilafon, and the long-acting
phenothiazine, Prolixin)
E. Another common antipsychotic drug (classification-butyrophenones) is haloperidol (Haldol)
1. Less sedative than phenothiazines
2. Indicated fro use with psychosis, Tourette's disorder, and as antiemetic
3. Incidence of severe extrapyramidal side effects
4. Other side effects include leukocytosis, blurred vision, dry mouth, and urinary retention
5. Avoid alcohol and other CNS depressants
F. Clozapine (Clozaril) and Loxitane are antipsychotics for management of psychotic symptoms in clients
who do not respond to other antipsychotics.
1. Side effects similar to other antipsychotics; be aware of blood dyscrasias (leucopenia, neutropenia,
agranulocytosis, eosinophilia)
2. Requires weekly WBC count to determine potential for agranulocytosis. (Drug is discontinued if
WBC is < 2000 juL or granulocyte is < 1000L)
3. Monitor monthly bilirubin, liver function studies.
G. Other classes of drugs are thioxanthenes (Taractan and Navane) and
dibenzoxapines (Loxitane)
H. Other classes of drugs are the "atypical" antipsychotics such as Risperdal, Seroquel, and Zyprexa.
1. These drugs have few or no extrapyramidal symptoms.
2. Target positive and negative symptoms of schizophrenia I. Side effects
1. Blood dyscrasias
a. Agranulocytosis occurs in first 4-18 weeks of treatment.
Symptoms: fever, sore throat, malaise, infection
b. Leukopenia, preceded by altered white blood count
2. Extrapyramidal side effects (EPSEs), affecting the voluntary
movements and skeletal muscles.
a. Parkinsonism: symptoms occur 1 to 4 weeks; signs are similar to classic Parkinsonism:
rigidity, shuffling
gait, pill-
rolling hand movement, tremors, dyskinesia, and mask like face.
b. Akathisia: very common; occurs in 1 to 6 weeks; signs:
uncontrolled motor restlessness, foot tapping, agitation,pacing
c. Dystonia: occurs early, 1 to 2 days; signs: limb and neckspasms; uncoordinated jerky
movements; difficulty in speaking and swallowing; and rigidity and spasms of muscles.
d. Tardive dyskinesia; develops late in treatment;
Antiparkinson drugs are of no help in decreasing
symptoms. This is a permanent side effect; signs: shuffling gait, drooling, and general
dystonic symptoms
3. Hypotension: orthostatic hypotension may occur. Monitor closely when client is elderly. Keep
client supine for 1 hour and advise to change positions slowly.
4. Anticholinergic effects: dry mouth, blurred vision, tachycardia, nasal congestion, and constipation.
Treat symptomatically.
5. Neuroleptic malignant syndrome - a rare complication caused by an antipsychotic. It is a medical
emergency and must be recognized and treated immediately
 a. Signs and symptoms: irregular vital signs, hyperpyrexia, altered mental status, autonomic
instability, elevated creatinine phosphokinase, and possible acute renal failure
b. Treatment: immediate discontinuation of drug, medical monitoring, administration of a
dopamine-enhancing drug and/or Dantrium

Antiparkinson Drugs (Antidyskinetics)

A. The term extrapyramidal disease refers to a motor disorder often associated with pathologic dysfunction
in the basal ganglia. Antiparkinson drugs block the extrapyramidal symptoms.
1. Clinical symptoms of the disease include abnormal involuntary movement, change in tone of the
skeletal muscles, and a reduction of automatic associated movements
2. Reversible extrapyramidal reactions may follow the use of certain drugs - the most common are
the phenothiazine derivatives.
B. Antiparkinson drugs act on the extrapyramidal system to reduce disturbing symptoms experienced from
antipsychotic medications.
1. They are usually given in conjunction with antipsychotic
drugs
2. The most common drugs are anticholinergics: Artane, Cogentin, Kemadrin, and Akineton.
3. Side effects are dizziness, gastrointestinal disturbance, headaches, urinary hesitancy, and memory
impairment
C. Benadryl, an antihistamine is often given in place of Artane or Cogentin,because it does not cause as many
untoward side effects as the other antiparkinson drugs.
D. Other drugs occasionally ordered in this category are Amantadine,
benzodiazepines, propranolol, clonidine, nifedipine (Procardia), verapamil, and dantrolene (Dantrium)
used for treating neuroleptic malignant syndrome.

Antianxiety Drugs

A. Drugs induce sedation, relax muscles, and inhibit convulsions; major use toreduce anxiety
B. Demand is great for relief from anxiety and they are safer than sedative-hypnotics
C. Potentiate drug abuse. Greatest harm occurs when combined with alcohol
D. Prescribed for neuroses, psychosomatic disorders, but do not modify
psychotic behaviors.
E. Drugs from two major classes.
1. Benzodiazepines: safer and more common (Librium, Valium, Ativan, restoril, Centrax, Serax, and
Xanax - being tested for use in depression, panic, and obsessive-compulsive disorders)
2. Nonbenzodiazepines: Vistaril, Buspar
E. Side effects.
1. Drowsiness (avoid driving or working around equipment)
2. Blurred vision, constipation, dermatitis, mental confusion, anorexia, polyuria, menstrual
irregularities, and edema
3. Habituation and increased tolerance
4. Pancytopenia, thrombocytopenia, and agranulocytopenia
5. Withdrawal symptoms occur with prolonged use (6+ months) and high doses

Antidepressant Drugs

A. Tricyclics, one of the most commonly used antidepressants; includes Elavil, Norpramin, Tofranil, Aventyl,
Vivactil, and Pamelor.
1. Blocks uptake of norepinephrine and serotonin
 2. A lag period of 1 to 6 weeks between starting the medication and experiencing symptom relief
exists
3. Anticholinergic effect - produces antagonism of the parasympathetic system

4. Side effects:
a. Anticholinergic effects: dry mouth, blurred vision,
constipation, postural hypotension
b. CNS effects: tremor, agitation, angry states, mania, seizures
c. Cardiovascular effects: palpitations. Exerts a quinidine like
effect on the heart, so assess any client with a history of
myocardial infarction
d. Alterations in sexual functioning
e. Orthostatic hypotension
f. Sedation
g. Weight gain
h. Most side effects appear in first 1 to 2 weeks and diminish over a period of a few weeks or
months.
5. If client is switched from a tricyclic drug to MAOI, a period of 1 to 3 weeks must elapse between
drugs.
6. Blood levels assay provide therapeutic levels of tricyclic antidepressants

B. MAO inhibitors include Marplan, Nardil, and Parnate

1. MAO inhibitors are toxic, potent, and produce many side effects
2. They should not be the first antidepressant drug used; side effects are more dangerous than TCA
3. Side effects;
a. Most dangerous is hypertensive crisis
b. Drug interactions can cause severe hypertension,
hypotension, or CNS depression
c. Postural hypotension, headaches, constipation, anorexia,
diarrhea, and chills
d. Tachycardia, edema, impotence, dizziness, insomnia, and
restlessness
e. Manic episodes and anxiety
4. All clients must be warned not to eat foods with high tyramine content (aged cheese, wine, beer,
chicken liver, yeast), drink alcohol or take other drugs, especially sympathomimetic drugs
(amphetamines, L-dopa, epinephrine)
5. MAO inhibitors must not be used in combination with tricyclics

C. Hypertensive Crisis, due to elevated tyramine levels

1. Severe symptoms: throbbing, occipital headache, confusion, drowsiness, vomiting, stiff neck, chills,
chest pain
2. Monitor for potential complications: encephalopathy, heart failure
3. Treatment
a. Drug of choice: Regitine IV 5 mg with close monitoring; antihypertensive
b. Monitor vital signs, ECG, and neurological signs; BP q 5 min.
c. Norepinephrine is administered for severe hypotension

D. Trazodone HC1 (Desyrel) is a class of antidepressant drugs unrelated to

tricyclics
1. Inhibits the reuptake of serotonin
2. Well-tolerated with minimal side effects (sedation and orthostatic hypotension)
3. Warning: has been associated with priapism - persistent abnormal erection. If symptom occurs,
 immediately discontinue drug.

E. Serotonin
1. Relatively free of side effects
2. Useful in treatment of severely depressed and melancholic
clients
3. Some clients experience heightened anxiety, nausea, vomiting, and dizziness
4. Some clients experience abnormal ejaculation, and male impotence
F. Selective Serotonin reuptake inhibitors (SSRIs)
1. Examples are Prozac, Zoloft, Paxil, and Luvox
2. Exhibit less side effects than other antidepressant drugs
a. Anticholinergic side effects such as dry mouth, constipationare fewer
b. Side effects observed are nausea, the most common,
anxiety or nervousness, insomnia, drowsiness, and
headache

Anti manic Drugs (Mood Stabilizers)

A. These drugs control mood disorders, especially the manic phase

B. Elevate mood when client is depressed; dampen mood when client is in
manic episode
C. Baseline studies of renal, cardiac, and thyroid status must be obtained before
lithium therapy
D. The most common form of drug is lithium carbonate. Other forms: lithium
citrate, Tegretol, Klonopin, Valproic acid
E. Drug must reach a certain blood level before it is effective.
1. Stabilizing concentration occurs in 5 to 7 days; therapeutic effect 7 to 28 days or more
F. Lithium is metabolized by the kidney.
1. Deficiency of sodium results in more lithium being reabsorbed, thus increasing risk of toxicity
2. Excessive sodium causes more lithium to be excreted and may lower level to a nontherapeutic
range

3. Normal dietary intake of sodium with adequate fluids to prevent dehydration is necessary
4. Diuretics will increase absorption of lithium leading to toxic
effects
5. Serum levels measured 2 to 3 times weekly (12 hours after last doe) in beginning of therapy; for
long-term maintenance therapy, every 2 to 3 months.
G. Drug concentration and side effects
1. Therapeutic range of serum levels is 0.6 to 1.2 mEq/L; for acute manic state, 1.0 to 1.5 mEq/L
2. Side effects occur at upper ranges, usually above 1.5 mEq/L
3. Gastrointestinal disturbances, metallic taste in mouth, muscle weakness, fatigue, thirst, polyuria,
and fine hand tremors are common side effects
4. Hypothyroidism is a long-term side effect of lithium therapy
H. Lithium toxicity
1. Appears when blood levels exceed 1.5 to 2.0 mEq/L.
2. Central nervous system is the chief target
3. Initial symptoms include nausea, vomiting, drowsiness, tremors, slurred speech, blurred vision,
muscle twitching, oliguria
4. If drug is continued, coma, convulsions, and death may result
5. Treatment for toxicity: gastric lavage, correction of fluid balance, administration of Mannitol to
increase urine excretion