PSYCHOPHARMACOLO

GY
ADAN, JALENE M.
GROUP 1
• Study of how drugs affect
behavior. If a drug changes your
perception, or the way you feel or
think, the drug exerts effects on your
brain and nervous system.

• Medication management is a
crucial issue that greatly influences the
outcomes of treatment for many clients
with mental disorder.
 Categories of Drug Used
to Treat Mental Disorders:
• Antipsychotics
• Anti Depressants
• Mood Stabilizers
• Anxiolytics
• Stimulants
Must Know Terminologies:
EFFICACY- Maximum therapeutic effect that a drug can
achieve.
POTENCY- The amount of drug needed to achieve that
maximum effect.
HALF LIFE- The time it takes for the half of the drug to be
removed from the bloodstream.
OFF LABEL USE
BLACK BOX WARNING
Principles:
• A medication is selected based on its effect on the clients target symptoms such as
delusional thinking, panic attacks or hallucinations.
• Many psychotropic drugs must be given in adequate dosages for some time before
their full effects are realized.
• The dosage of medication is often adjusted to the lowest effective dosage for the
client.
• As a rule, older adults require lower dosages of medication than to younger clients to
experience therapeutic effects.
• Psychotropic medications are often decreased gradually rather than abruptly.
• Follow up care is essential to ensure compliance with the medication regimen.
 Antipsychotic Drugs
• Formerly known as neuroleptics.
• Used to treat the symptoms of psychosis such as delusions
and hallucinations seen in schizophrenia, schizoaffective
disorder and manic phase of bipolar disorder.
• Off label uses: Anxiety and insomnia; aggressive behavior;
delusions and hallucinations, Alzheimers disease.
• Major action in the nervous system is to block receptors of
neurotransmitter dopamine.
First Generation Antipsychotic drugs

Generic (Trade) Name Forms Daily Dose (mg) Extreme Dosage Ranges

Chlorpromazine T,L, INJ 200-1600 25-2000

(Thorazine)

Pherpenazine (Trilafon) T, L, INJ 16-32 4-64

Fluphenazine (Prolixin) T, L, INJ 2.5-20 1-60

Thioridazine (Mellaril) T, L 200-600 40-800

Mesoridazine (Serentil) T, L, INJ 73-300 30-400

Triflouperazine (Stelazine) T, L, INJ 6-50 2-80

Atypical or Second generation antipsychotics
Generic (Trade) Name Forms Daily Dose (mg) Extreme Dosage Ranges

Clozapine (Clorazil) T 150-500 75-700

Risperidone (Risperdal) T, L, DT 2-8 1-16

Olanzapine (Zyprexa) T 5-15 5-20

Quetiapine (Seroquel) T 300-600 200-750

Ziprasidone (Geodon) C, INJ 40-160 20-200

Third Generation Antipsychotics

Generic (Trade) Name Forms Daily Dose (mg) Extreme Dosage Ranges

Aripiprazole (Abilify) T 15-30 10-40

Cariprazine (Vraylar) C 3-6 1.5-6

Brexiprazole (Rexulti) T 1-3 5.4

 Side Effects of
Antipsychotic Drugs
• Extrapyramidal symptoms
 Dystonia
 Pseudo parkinsonism
 Akathisia
• Neuroleptic Malignant Syndrome
• Tardive Dyskinesia
• Anticholinergic side effects
 Orthostatic Hypotension
 Dry Mouth
 Constipation Urinary Hesitance
 Blurred near Vision
 Photophobia
 Nasal Congestion
 Decreased Memory
 Increased blood prolactin levels
 Client Teaching
• Inform client about the types of side effects
that may occur and encourage client to report
such problems.
• Drinking sugar-free fluids and eating sugar-
free hard candy ease dry mouth.
• Client should avoid calorie-laden beverages.
• Client should monitor the amount of
sleepiness or drowsiness they feel.
• Clients who have difficulty remembering to
take their medication are encouraged to use
chart and record doses when taken.
Antidepressant Drugs
• Used primarily in the treatment of major
depressive illness, anxiety disorders, depressed
phase of bipolar disorder, and psychotic
depression.

• Aims to correct chemical imbalances of

neurotransmitters in the brain that are believed
to be responsible for changes in mood and
behavior.
 Four groups of
Antidepressants
1. Tricyclic and the related cyclic
antidepressants
2. Selective serotonin reuptake inhibitors
(SSRIs)
3. MAO inhibitors (MAOIs)
4. Other antidepressants such as
desvenlafaxine (Pristiq) venlafaxine
(Effexor) bupropion (Wellbutrin) ,
duloxetine (Cymbalta), trazodone
(Desyrel), and nefazodone (Serzone)
Selective Serotonin Reuptake Inhibitors
Generic (Trade) Name Forms Use Daily Doses Extreme Dosage Ranges

Fluoxetine (Prozac) C, L 20-60 10-80

Fluvoxamine (Luvox) T 150-200 50-300

Paroxetine (Paxil) T 20-40 10-50

Setraline (Zoloft) T 100-150 50-200

Citalofram (Celexa) T, L 20-40 20-60

Escitalofram (Lexapro) T 10-20 5-30

Cyclic Compounds
Generic (Trade) Name Forms Use Daily Doses Extreme Dosage Ranges

Imipramine (Trofanil) T, C, INJ 150-200 50-300

Desipramine (Norpramin) T, C 150-200 50-300

Amitriptaline (Elavil) T, INJ 150-200 50-300

Nortriptyline (Pamelor) C, L 75-100 25-150

Doxepin (Sinequan) C,L 150-200 10-60

Timipramine (Surmontil) T 150-200 50-300

Protyptyline (Vivactil) T 15-40 10-60

Other Compounds
Generic (Trade) Name Forms Use Daily Doses Extreme Dosage Ranges

Bupropion (Wellbutrin) T 200-300 100-450

Venlafaxine (Effexor) T, C 75-225 75-375

Desvenlafaxine (Pristiq) T 50-100 50 every other day 400

Trazodone (Desyrel) T 200-300 100-600

Nefazodone (Serzone) T 300-600 100-600

Deluxetine (Cymbalta) C 60 30-90

Villazodone (Viibryd) T 20-40 10-60

Menoamine Oxidase Inhibitors
Generic (Trade) Name Forms Use Daily Doses Extreme Dosage Ranges

Phenezeine (Nardil) T 45-60 15-90

Tranylcypromine T 30-50 10-90

(Parnate)

Isocarboxazid (Marplan) T 20-40 10-60

 Side Effects of
Antidepressant Therapy
• SSRIs
 Anxiety
 Agitation
 Nausea
 Insomnia
 Sexual dysfunction
• Cyclic Antidepressants
 Dry mouth
 Constipation
 Urinary Hesitancy or retention
 Dry nasal passages
 Blurred near vision
 Agitation
 Delirium
 Ileus
Continuation…
• Monoamine Oxidase Inhibitors
 Daytime sedation
 Insomnia
 Weight gain
 Dry mouth
 Orthostatic Hypotension
 Sexual Function
• Other Antidepressants
 Loss of appetite
 Nausea
 Agitation
 Insomnia
 Dizziness
 Sweating
 Sedation
Client Teaching
• Client should take SSRIs first thing in the
morning unless sedation is a problem;
• Client should exercise caution when
driving and performing activities requiring
sharp alert reflexes until sedative effects
can be determined.
• Clients taking MAOIs need to be aware
that a life threatening hyperadrenergic
crisis can occur if they do not observe
certain dietary restrictions.
Mood-Stabilizing Drugs
• Used to treat bipolar disorders by stabilizing the
clients mood, preventing or minimizing the highs and
lows that characterize bipolar illness , and treating
acute episodes of mania.
• Lithium is the most established mood stabilizer;
• Some anticonvulsants drugs; Carbamazepine and
Valproic acid are effective mood stabilizer.

Generic Name Forms Usual Daily Extreme

Dosage (mg) Dosage
Ranges
Lithium T, C, L 900-3,600
Carbamazepin L, T 800-1,200 750-3,000
e
 Side Effects of
Lithium Therapy
• Mild Nausea
• Diarrhea
• Anorexia
• Fine Hand Tremors
• Polydipsia
• Polyuria
• Metallic taste in the mouth
• Fatigue
Client Teaching
• Monitor blood levels periodically
• Time of the last dose must accurate so
that the plasma levels can be checked
12 hours after the last dose has been
taken.
• Taking medication with meals
minimizes nausea.
• The client should not attempt to drive
until dizziness, lethargy, fatigue, or
blurred vision has subsided.
 Anxiolytic Drugs
• Used to treat anxiety and anxiety
disorders, insomnia, obsessive-
compulsive disorder (OCD),
depression, post traumatic stress
disorder and alcohol withdrawal.
• Benzodiazepines have proved to be
the most effective in relieving anxiety
and are drugs frequently prescribed.
• Benzodiazepines mediate the actions
of the amino acid GABA.
Antianxiety (Anxiolytic) Drugs
Generic (Trade) Name Daily Dosage Range Half Life (h) Speed of Onset

Benzodiazepines

Alprazolam (Xanax) 0.75-1.5 12-15 Intermediate

Chlordiazeporoxide 15-100 50-100 Intermediate

(Librium)

Clonazepam (Tranxene) 1.5-20 18-50 Intermediate

Diazepam (Valium) 15-60 30-200 Fast

Flurazepam (Dalmane) 4-40 30-100 Very Fast

Lorazepam (Ativan) 25-30 47-100 Fast

 Client Teaching
• Clients need to know that antianxiety
agents are aimed at relieving
symptoms such as anxiety or
insomnia but do not treat underlying
problems that cause the anxiety.
• Client should not drink alcohol while
taking benzodiazepines .
• Client should be aware of the
decreased response time, and slower
reflexes.
Stimulant Drugs
• First used to treat psychiatric
disorders in 1930’s for their
pronounced effects on CNS
stimulation. (Amphetamines)
• In the past used to depression and
obesity .
• Today, primary use is for ADHD in
children and adolescents, residual
attention deficit disorder in adults and
narcolepsy.
Drugs Used to Treat Attention Deficit/Hyperactivity Disorder
Generic (Trade) Name Dosage
Stimulants
Methylphenidate (Ritalin) Adults: 20-200 mg/day, orally, in divided doses
Children: 10-60 mg/day, orally, 2-4 divided doses

Sustained Release (Ritalin-SR, Concerta Metadate-CD) 20-60 mg/day orally, single dose

Transdermal patch (Daytrana) Adults and children; 15 mg patch worn for 9 hours/day

Dextroamphetamine (Dexedrine) Adults 20-200 mg/day orally, in divided doses

Sustained-release (Dexedrine-SR) 10-30 mg/day, orally in 2 or 3divided doses
Amphetamine (Adderall) 5-40 mg/day, orally in single dose
 Side Effects of
Stimulants
• Anorexia
• Weight loss
• Nausea
• Irritability
• Dizziness
• Dry mouth
• Blurred vision
• Palpitations
 Client Teaching
• Taking doses of stimulants
after meals may minimize
anorexia and nausea.
• Caffeine free beverage are
suggested; client should avoid
chocolate and excessive.
• Keep medications out of the
child’s reach as a little 10 day
supply can be fatal.