Drugs for Psych

• What is the treatment for EPS?

  Vitamin K
• What are the types of EPS?

  Acute dystonia: abnormal muscle tone causing spasms of tongue, face, neck

  Parkinsonism: shuffling gait, rigid muscles, excessive salivation, tremors, mask-like face, motor retardation

  Akathisia: motor restlessness

  Tardive Dyskinesia: involuntary movements of mouth, tongue, trunk, extremities; chewing motions, sucking, tongue, thrusting
• What are the FGAs (conventional) Phenothiazines non-phenothiazines?

  Low Potency: 

  Chlorpromazine 

  Medium Potency: 

  Loxapine 

  Perphenazine 

  High Potency: 

  • Haloperidol (Can be given with benzodiazepine ot control aggressive behavior)
  • Fluphenazine 
• What is the MOA of FGAs (conventional) Phenothiazines non-phenothiazines?


  Block dopamine-2 receptors in the limbic area of the brain
• What are the side and adverse effects of FGAs (conventional) Phenothiazines non-phenothiazines?

  • Extrapyramidal symptoms (acute dystonia, parkinsonism, akathisia, tardive, dyskinesia)
  • Decrease Bp
• What are the types of drugs used for Anti-pyschotics?

  FGAs (conventional) Phenothiazines non-phenothiazines
• What is the mechanism of action of Chlorpromazine?

  High sedative effect
• What is the side and adverse effect of Chlorpromazine?

  Hypotension

  Photosensitivity
• What is the mechanism of action of Loxapine and Perphenazine?

  Perphenazine is an antiemetic
• What is the side and adverse effect of Loxapine and Perphenazine?

  Orthostatic hypotension

  Dry mouth

  Constipation
• What is the mechanism of action of Haloperidol and Fluphenazine ?


  Low sedative effect

  Depot (can be given IM)
• What is the side and adverse effect of Haloperidol and Fluphenazine?

  Pronounced EPS
• What is the nursing implications of Anti-Psychotic drugs

  • Antipsychotic agents should NOT be used to treat dementia in elder
  • Check CBC, hepatic, and renal function
  • Dont stop med abruptly, promote adherence
  • Assess for AE: neuroleptic malignant syndrome (NMS)- higher fever, diaphoresis, muscle rigidty, tachycardia, can happen when abruptly stop taking med
  • Educate pt/family member about EPS
  • Agranulocytosis

  1. Watch for flu-like symptoms (fever) and mucous membrane ulceration
• What is the drug for SGA's (Atypical)?


  Clozapine
• What is the mechanism of action of Clozapine?


  Moderate blockage of dopamine receptor and stronger blockage for serotonin
• What is the side and adverse effect of Clozapine?

  • Metabolic disorders (weight gain, T2D, dyslipidemia) 
  • AE: Agranulocytosis
• What are the drugs used as Antidepressants?

  Tricyclic

  SSRI's

  S/NRI's

  Combination of SNRD/DNRI

  MAOI's
• What are the drugs for Tricyclic?


  Imipramine 

  Amitriptyline 

  Desipramine 

  Nortriptyline
• What is the mechanism of action of Tricyclic?


  Block neural reuptake of NE and serotonin in presynaptic nerve endings leading to increased action of NE and serotonin

  Long half-life allowing a single daily dose

  Treatment for insomnia issues
• What is the side and adverse effects of Tricyclic?


  Sedation orthostatic hypotension, anticholinergic effects(blurred vision, dry mouth, urinary retention, constipation, diaphoresis)

  Cardiac toxicity (dysrhythmia, tachycardia)
• What is the nursing implication for Tricyclic?

  Take it at night!!!

  Toxicity leading to gastric lavage, activated charcoal 

  Wear sunscreen 

  Assess for daily activity/feelings 

  Watch for suicide risk (high after 10-14 days)
• What are the drugs for SSRI's?

  Fluoxetine 

  Sertraline 

  Escitalopram 

  Citalopram 

  Paroxetine
• What is the mechanism of action of SSRI's?

  Produce selective inhibition of serotonin uptake 

  • Increased serotonin level in the brain = CNS excitation

   Vs. TCA: No hypotensive/anti-Ch effect
• What is the side and adverse effect of SSRI's?


  Serotonin syndrome

  Sexual dysfunction
• What is the nursing implication of SSRI's?

  Take it in the morning!! To avoid insomnia 

  Smoking affects effectiveness
• What are the drugs for S/NRI's?

  Venlafaxine

  Duloxetine
• What is the mechanism of action of S/NRI's?

  V: block NE and serotonin uptake 

  D: inhibit NE and serotonin reuptake + weakly inhibit dopamine reuptake 

  Often added onto other antidepressants
• What are the drugs for Combination of SNRD/DNRI (atypicaal)?

  Bupropion
• What is the mechanism of action of Bupropion?

  • Inhibit reuptake of dopamine, NE, and serotonin
  • Stimulate and suppress appetite
  • Does not affect serotonergic; cholinergic; or histaminergic transmission
  • Increase sexual desire and pleasure
• What is the nursing implication of Bupropion?

  May be used for weight management 

  Added onto other depressants to increase sex drive
• What are the drugs used for MAOI's?

  Phenizine sulfate

  Isocarboxazid

  Transylcpromine sulfate
• What is the mechanism of action of MAOI's?

  • Inhibit action of monanibe oxydase (MAO)
  • Which converts monoamine NT’s into inactive products leading to MAOI increases level of monoamine NT’(Ne, serotonin, dopamine)
  • Acts on MAO in two wats; reversible action lasts 3-5 days; irreversible lasts 2 weeks 
• What is the side and adverse effect of MAOI's?

  CNS stimulations 

  Orthostatic hypotension 

  Hypertensive crises with NE release (eating dietary tyramine)
• What is the nursing implication of MAOI's?


  Take in the morning!!

  Drug interactions: other antidepressants, antihypertensive drugs, opiods

  Avoid tyramine foods: aged products

  Avoid caffeine
• What are the drugs used for Bipolar?


  Lithium

  Antiepileptic Drugs
• What are the drugs for Lithium?

  Lithonate 

  Lithotabs
• What is the mechanism of action of Lithium?

  • Alter synthesize and release of NEs, serotonin, dopamine 
  • Mediate intracellular responses to NTs 
  • Increase total gray matter in regions = stabilize grey matter in the cortex
  • Lithium excretion is reduced when low Na (inverse relationship)
• What is the side and adverse effect of Lithium?


  AEs/dose highly individualized

  Gi effects, tremors, polyuria
• What is the nursing implication of Lithium?


  Serum level = 0.5 - 1.5 mEq/L

  Na level <135 = risk of lithium toxicity

  Ask questions of pt’s activities in daily life to assess the effectiveness

  Drug interactions: diuretics, NSAIDs, anticholinergic drug
• What are the drugs for Antiepileptic?

  Valproic acid 

  Carbamazepine