The
pharmacology of psych disorder
Made
by
B.Sc.N
Hadi K. ALABEDI
Supervised
by
Dr.
Hussam M. ALkrwi
The
pharmacology of psych disorder is very important in mental health , so this
drug main classification about many properties and uses , so we are
classification to main group and categories :
Group I : Antidepressants
The cyclic compounds became available in the 1950s and for years
were the first choice of drugs to treat depression even though they cause
varying degrees of sedation, orthostatic hypotension (drop in blood pressure on
rising), and anticholinergic side effects. In addition, cyclic antidepressants
are poten - tially lethal if taken in an overdose.
Antidepressants are divided into four groups:
1.
Tricyclic
and the related cyclic anti- depressants
2.
Selective
serotonin reuptake inhibitors (SSRIs)
3.
Monoamine
oxidase inhibitors (MAOIs)
4.
Atypical
anti- depressants
1.
Tricyclic and the related cyclic anti- depressants
These drugs
typically block the reuptake of norepinephrine and serotonin, although there
are exceptions.The tricyclics
include:
|
Drug
|
Dose
|
Adverse effects
|
|
Mg /day
|
||
|
Imipramine (Tofranil)
|
150–200
|
·
sexual
dysfunction.
·
Hypotension.
·
Sedation.
·
Dry
mouth.
·
Dizziness
.
·
Urinary
retention.
·
Serotonin
syndrome
·
Constipation
.
|
|
Desipramine(Norpramin)
|
150–200
|
|
|
Amitriptyline (Elavil)
|
150–200
|
|
|
Nortriptyline (Pamelor)
|
75–100
|
|
|
Doxepin (Sinequan)
|
150–200
|
|
|
Trimipramine(Surmontil)
|
150–200
|
|
|
Protriptyline (Vivactil)
|
15–40
|
|
|
Maprotiline (Ludiomil)
|
100–150
|
|
|
Mirtazapine (Remeron)
|
15–45
|
|
|
Amoxapine (Ascendin)
|
150–200
|
|
|
Clomipramine(Anafranil)
|
150–200
|
2.
Selective serotonin reuptake inhibitors (SSRIs)
Selective
serotonin reuptake inhibitors, (very commonly abbreviated to SSRIs) are thought
to prevent the reuptake of serotonin (also known as 5-hydroxytryptamine, or
5-HT) by the presynaptic neuron, thus initially maintaining higher levels of
5-HT in the synapse.
|
Drug
|
Dose
|
Adverse effects
|
|
Mg / day
|
||
|
Fluoxetine (Prozac)
|
20
|
·
sexual
dysfunction.
·
Insomnia.
·
GI
disturbance .
·
Dry
mouth
·
Anorexia
·
Headache
·
Somnolence
|
|
Fluvoxamine (Luvox)
|
150–200
|
|
|
Paroxetine (Paxil)
|
20
|
|
|
Sertraline (Zoloft)
|
100–150
|
|
|
Citalopram (Celexa)
|
20–40
|
|
|
Escitalopram (Lexapro)
|
10–20
|
3.
Monoamine oxidase inhibitors
(MAOIs)
Monoamine
oxidase inhibitors are sometimes used, but are not a "first-line"
treatment class; i.e. a psychiatrist will generally try a patient on other
drugs due to their tendency to interact with many medications. They inhibit the
enzyme monoamine oxidase, which breaks down the
neurotransmitters dopamine, serotonin, and norepinephrine.There are two types with regard to the effect on the enzyme, the
irreversible and the newer reversible inhibitors
|
Drug
|
Dose
|
Adverse effects
|
|
Mg / day
|
||
|
Phenelzine (Nardil)
|
45–60
|
o Sedation
o Insomnia
o weight gain
o dry mouth
·
hypotension
·
sexual
dysfunction
|
|
Tranylcypromine (Parnate
|
30–50
|
|
|
Isocarboxazid (Marplan)
|
20–40
|
4.
Atypical anti- depressants
|
Drug
|
Dose
|
Adverse effects
|
|
Mg / day
|
||
|
Bupropion (zyban)
|
75-100
|
·
Increase
BP & HR
·
Nausea
·
Dry
mouth
·
Headache
·
sexual
dysfunction
·
blurred
vision
·
vomiting
.
|
|
Duloxetine (Cymbalta)
|
40-60
|
|
|
Mirtazapine (remeron )
|
15
|
|
|
Nefazodone
|
50-100
|
|
|
Trazodone (desyrel )
|
150
|
|
|
Venlafaxine (Effexor )
|
25-125
|
Uses of Antidepressant :
1.
The
SSRIs, first choice in treating depression because they are equal in efficacy
and produce fewer trouble-some side effects.
2.
To treatment of OCD . ( 7 – 60) days
3.
To
treat mood disorder . (7-30) days
4.
To
treat phobia . (7-30) days
5.
To
treat obsessive – compulsive behavior . (7-30) days
6.
Panic.
(7-30) days
7.
Anxiety.
(7-30) days
Nursing intervention :
1.
Use
the five right .
2.
Administer :
A.
Give
most selective serotonin reuptake inhibitors (SSRIs) once daily in the morning;
citalopram and sertraline may begiven morning or evening. Mix sertraline oral
concentrate (20 mg/mL) in 4 oz of water,
B.
ginger
ale, lemon/lime soda, lemonade, or orange juice only;
C.
give
immediately after mixing.
D.
c.
Give tricyclic antidepressants (TCAs) and mirtazapine at bedtime.
E.
d.Give
venlafaxine and lithium with food.
3.
Sportive
the client's usual mechanism for handling .
4.
Call
the client by name and encourage self-care activation .
5.
Allow
him or her client participate in setting goals .
6.
Relive
adverse effect
7.
When
sign and symptoms of detrition are observed , initiate treatment
8.
encourage the client to drink 8 -12 glasses of
fluid .
9.
Anticholinergic
effects are common. Hypoglycemia results from a drug-induced reduction in blood
sugar.
10.
Monitor
cardiovascular status. (Hypertension and stroke or MI and heart fail-ure may be
observed.)
11.
Ensure
client safety. (Dizziness caused by postural hypotension increases the risk of
fall injuries.)
Group II : BENZODIAZEPINES and NONBENZODIAZEPINE
A benzodiazepine (sometimes colloquially "benzo";
often abbreviated "BZD") is a psychoactive drug whose core chemical
structure is the fusion of a benzene ring and a diazepine ring. The first such drug, chlordiazepoxide (Librium), was discovered accidentally by Leo
Sternbach in 1955, and made available in
1960 by Hoffmann–La Roche, which has also marketed the benzodiazepine diazepam
(Valium) since 1963.
|
Drug
|
Adverse effects
|
|
BENZODIAZEPINES
1.
Alprazolam
(Xanax)
2.
Chlordiazepoxide
(Librium)
3.
Clonazepam
(Klonopin)
4.
Chlorazepate
(Tranxene)
5.
Diazepam
(Valium)
6.
Flurazepam
(Dalmane)
7.
Lorazepam
(Ativan)
8.
Oxazepam
(Serax)
9.
Temazepam
(Restoril)
10. Triazolam (Halcion)
NONBENZODIAZEPINE
1.
Buspirone
(BuSpar)
|
· sedating
· muscle-relaxing action.
· drowsiness,
· dizziness,
· decreased alertness
·
concentration
·
headache
·
renal
impairment .
|
Uses :
1.
alcohol
dependence, (30-60)days
2.
seizures,
3.
anxiety, (7-30)days.
4.
panic,
(8-30) days.
5.
Insomnia
(1 – cure ).
Nursing intervention :
1.
Use
the five right for administration.
2.
Monitor
vital signs. Observe respiratory patterns, especially during sleep, for evidence
of apnea or shallow breathing. (Benzodiazepines can reduce the res-piratory
drive in susceptible clients.)
3.
Avoid
abrupt discontinuation of therapy. (Withdrawal symptoms, including rebound
anxiety and sleeplessness, are possible with abrupt discontinuation after
long-term use.)
4.
Assess
prior methods of stress reduction. Reinforce previously used effective methods
and teach new coping skills. (This will assist client to use medications for
the shortest time possible and build self-confidence.)
5.
Group III : Antipsychotics
(also known as
neuroleptics or major tranquilizers) are a class of psychiatric
medication primarily used to manage psychosis (including
delusions, hallucinations,
or disordered thought), particularly in schizophrenia and bipolar
disorder, and is increasingly being used in the management of non-psychotic
disorders
|
Drug
|
Adverse effects
|
|
CONVENTIONAL
ANTIPSYCHOTICS
Chlorpromazine
(Thorazine)
Trifluoperazine
(Trilafon)
Fluphenazine
(Prolixin)
Thioridazine
(Mellaril)
Mesoridazine
(Serentil)
Thiothixene
(Navane)
Haloperidol
(Haldol)
Loxapine
(Loxitane)
Molindone
(Moban)
Perphenazine
(Etrafon)
Trifluoperazine
(Stelazine)
ATYPICAL
ANTIPSYCHOTICS
Clozapine
(Clozaril)
Risperidone
(Risperdol)
Olanzapine
(Zyprexa)
Quetiapine
(Seroquel)
Ziprasidone
(Geodon)
|
•
Sedation
•
Headaches
•
Dizziness
•
Diarrhoea
•
Anxiety.
•
Extrapyramidal side effects :
v - Akathisia - Dystonia
v - Parkinsonism
v - Tremor
•
Hyperprolactinaemia include :
v Galactorrhoea
v - Gynaecomastia
v - Sexual dysfunction
v - Osteoporosis
•
Orthostatic hypotension
•
Weight gain
•
Anticholinergic side effects such as:
v - Amnesia
v - Angle-closure glaucoma
v - Blurred vision
v - Constipation
v - Dry mouth
v - Reduced perspiration
|
Uses :
1.
Schizophrenia
2.
Schizoaffective
disorder
3.
Bipolar
disorder
4.
Psychotic
depression
5.
Treatment-resistant
(and not necessarily psychotic) major depression as an adjunct to standard
antidepressant therapy
Nursing intervention :
1.
Monitor
for decrease of psychotic symptoms. (If client continues to exhibit symptoms of
psychosis, the drug or dose may not be effective.)
2.
Monitor
for side effects. (Problems with side effects may cause a decrease
incompliance.)
3.
Monitor
for anticholinergic side effects such as orthostatic hypotension, con-stipation,
anorexia, GU problems, respiratory changes, and visual distur-bances. (These
side effects may need to be treated so the client can continue with the
medication.)
4.
Monitor
for EPS and NMS. (Presence of EPS may be sufficient reason for the client to
discontinue the antipsychotic. NMS is life threatening and must be reported and
treated immediately.)
5.
Monitor
for alcohol/illegal drug use. (Used concurrently, these cause an increased CNS
depressant effect.)
6.
Monitor
caffeine use. (Use of caffeine-containing substances negates the effects of
antipsychotics.)
7.
Monitor
for smoking. (Heavy smoking may decrease metabolism of haloperidol, leading to
decreased efficacy.)
8.
Monitor
lab results, including RBC and WBC counts, and drug levels. (Use of some
medications may cause changes in blood counts. Some medications can cause
toxicity.)
Group iv : Lithium
Lithium (Eskalith) :
is a naturally occurring metallic salt that is used in bipolar disorder, mainly
to treat and prevent manic episodes. It is well absorbed after oral
administration, with peak serum levels in 1 to 3 hours after a dose and
steady-state concentrations in 5 to 7 days. Serum lithium concentra-tions
should be monitored frequently because they vary widely among clients taking
similar doses and because of the narrow range
between therapeutic and toxic levels. Lithium salts have a narrow therapeutic/toxic
ratio and should only be prescribed if there
are facilities for monitoring serum lithium concentrations. Doses are adjusted
to achieve serum-lithium concentrations
of 0.4–1 mmol/litre (lower end of range for maintenance therapy and the elderly) on
samples taken 12 hours after the preceding dose. The optimum range for each patient
should be determined.
Lithium carbonate
Tablets, capsules, lithium carbonate 300 mg
treatment and prophylaxis of mania, prophylaxis of bipolar disorder
and recurrent depression
Adverse effects:
gastrointestinal disturbances, fine tremor, renal impairment
(particularly impaired urinary
concentration and polyuria), polydipsia, weight gain and oedema (may
respond
to dose reduction); hyperparathyroidism andhypercalcaemia reported; signs
of
intoxication include blurred vision, muscle weakness, increasing
gastrointestinal disturbances (anorexia, vomiting, diarrhoea),
increased CNS disturbances (mild drowsiness and sluggishness, increasing to
giddiness with ataxia, coarse tremor, lack
of co-ordination, dysarthria) and require withdrawal of treatment;
with severe over dosage
(serum concentrations above 2 mmol/litre), hyperreflexia and
hyperextension
of the limbs, convulsions, toxic psychoses, syncope, renal failure,
circulatory
failure, coma, occasionally death; goitre, raised antidiuretic hormone
concentration, hypothyroidism, hypokalaemia, ECG changes,
exacerbation of psoriasis and kidney changes may occur
nursing
intervention :
1.
With
lithium, observe for decreases in manic behavior and
mood
swings.
2.
observe
for:
(1)
Metallic taste, hand tremors, nausea, polyuria, poly-dipsia, diarrhea, muscular
weakness, fatigue, edema, and weight gain
(2)
More severe nausea and diarrhea, vomiting, ataxia, in-coordination, dizziness,
slurred speech, blurred vision, tin-nitus, muscle twitching and tremors,
increased muscle tone
3.
Monitor
renal status, CBC, differential, BUN, creatinine, uric acid, and urinaly-sis.
(Lithium may cause degenerative changes in the kidney, which increases drug
toxicity.)
4.
Monitor
cardiovascular status, vital signs including apical pulse, and status. (Lithium
toxicity may cause muscular irritability resulting in cardiac dysrhyth-mias or
angina. Use with caution in clients with a history of CAD or heart disease.)
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