Chapter 2: Neurobiologic Theories and Psychopharmacology

Chapter 2: Neurobiologic Theories and Psychopharmacology

Key Terms:
o Akathisia: intense need to move about; characterized by restless movement, pacing, inability to remain
still, and the clients report of inner restlessness
o Anticholinergic Side Effects: dry mouth, constipation, urinary hesitancy or retention, dry nasal passages,
and blurred near vision; commonly seen as side effects of medication
o Antidepressant Drugs: primarily used in treatment of major depressive illness, anxiety disorders, the
depressed phase of bipolar disorder, and psychotic depression
o Antipsychotic Drugs: also known as neuroleptic; used to treat the symptoms of psychosis such as
delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and the manic phase of
bipolar disorder
o Black Box Warning: medication package inserts must have a highlighted box, separate from the text, that
contains a warning about the life-threatening or otherwise serious side effect(s) of the medication
o Computed Tomography (CT): a diagnostic procedure in which a precise x-ray beam takes cross-sectional
images (slices) layer by layer
o Depot Injection: a slow release, injectable for on antipsychotic medication for maintenance therapy
o Dopamine: a neurotransmitter located primarily in the brain stem; has been found to be involved in the
control of complex movements, motivation, cognition, and regulation of emotional responses
o Dystonia: extrapyramidal side effects to antipsychotic medication; includes acute muscular rigidity and
cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasms and
respiratory difficulties; also, called dystonic reactions
o Efficacy: refers to the maximal therapeutic effect a drug can achieve
o Epinephrine: derivative of norepinephrine, the most prevalent neurotransmitter in the nervous system,
located primarily in the brain stem, and plays a role in changes in attention, learning and memory, sleep
and wakefulness, and mood regulation
o Extrapyramidal Symptoms (EPSs): neurologic side effects of antipsychotic medications that are drug and
dose related; treated with anticholinergic medication; includes dystonia, pseudoparkinsonism, and
akathisia
o Half-life: the time it takes for half the drug to be eliminated from the blood stream
o Kindling Process: the snowball-like effect seen when a minor seizure activity seems to build up into more
frequent and severe seizures
o Limbic System: an area of the brain located above the brain stem that includes the thalamus,
hypothalamus, hippocampus, and amygdala (although some sources differ regarding the structures that
this system includes)
o Magnetic Resonance Imagining (MRI): diagnostic test used to visualize soft tissue structures; energy field
is created with a magnet and radio waves, and then converted into a visual image
o Mood-stabilizing Drugs: used to treat bipolar disorder by stabilizing the clients mood, preventing or
minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania
o Neuroleptic Malignant Syndrome (NMS): a potentially fatal, idiosyncratic reaction to an antipsychotic (or
neuroleptic) drug
o Neurotransmitter: the chemical substances manufactured in the neuron that aid in the transmission of
information throughout the body
o Norepinephrine: the most prevalent neurotransmitter in the nervous system
o Off-label Use: a drug will prove effective for a disease that differs from the one involved in original
testing and FDA approved
o Positron Emission Tomography (PET): a diagnostic test used to examine the function of the brain by
monitoring the flow of radioactive substances that are injected into the bloodstream
o Postinjection Delirium/Sedation Syndrome (PDSS): cluster of symptoms, such as slurred speech,
confusion, sedation, altered gait, or unconsciousness that result from accidental intravascular injection of
a portion of olanzapine (Zyprexa Relprevv)
o Potency: describes the amount of a drug needed to achieve maximum effect

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Chapter 2: Neurobiologic Theories and Psychopharmacology
o Pseudoparkinsonism: a type of extrapyramidal side effect of antipsychotic medications; drug-included
parkinsonism; includes shuffling gait, masklike facies, muscle stiffness (continuous) or cogwheeling
rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness and difficulty initiating
movement)
o Psychoimmunology: examines the effect of psychosocial stressors on the bodys immune system
o Psychopharmacology: the use of medications to treat mental illness
o Psychotropic Drugs: drugs that affect mood, behavior, and thinking that are used to treat mental illness
o Rebound: temporary return of symptoms; may be more intense than original symptoms
o Serotonin: a neurotransmitter found only in the brain
o Serotonin Syndrome: uncommon but potentially life-threating disorder called serotonin or serotonergic
syndrome; characterized by agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia,
confusion, and in extreme cases, coma and death; most commonly results from a combination of two or
more medications with serotonin-enhancing properties, such as taking MAOI and SSRI antidepressants at
the same tome or too close together
o Single Photon Emission Computed Tomography (SPECT): a diagnostic test used to examine the function
of the brain by following the flow of an injected radioactive substance
o Stimulant Drugs: drugs that stimulate or excite the central nervous system
o Tardive Dyskinesia (TD): a late-onset, irreversible neurologic side effect of antipsychotic medications;
characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing,
blinking, grimacing, and choreiform movements of the limbs and feet
o Withdrawal: new symptoms resulting from discontinuation of drug or substance
Learning Objectives:
o Discuss the structures, processes, and functions of the brain.
Central Nervous System (CNS): brain, spinal cord, and associated nerves that control voluntary
acts
Brain consists of the cerebrum, cerebellum, brain stem, and limbic system
Cerebrum: 2 hemispheres; all lobes and structures are found in both halves except pineal body or
gland- located between hemispheres
Pineal Body: endocrine gland; influences pituitary gland activity, islet of Langerhans,
parathyroid, adrenals, and gonads
Corpus Callosum: pathway connecting two hemispheres and coordinating functions
o Left: controls right side of body; center for logical reasoning and analytic
functions reading, writing, and mathematical tasks
o Right: controls left side of body; center for creative thinking, intuition, and
artistic abilities
Cerebral Hemispheres: divided into four lobes frontal, parietal, temporal, and occipital
o Frontal: controls organization of thought, body movement, memories, emotions,
moral behavior
Integration: all info regulates arousal, focuses attention, enables problem
solving and decision making
Abnormalities: associated with schizophrenia, ADHA, dementia
o Parietal: interpret sensations of taste and touch, assist in spatial orientation
o Temporal: center for sense of smell and hearing, for memory and emotional
expression
o Occipital: assist in coordinating language generation and visual interpretation,
depth perception
Cerebellum: located below cerebrum, center for coordination of movements and postural
adjustments
Receives and integrates info from all body areas
Inhibited transmission of dopamine in this area is associated with lack of smooth
coordinated movements in disease such as dementia and Parkinsons
Brain Stem: includes midbrain, pons, medulla oblongata, nuclei for CN III-XII
Medulla: located top of spinal cord; contains vital centers for respiration and
cardiovascular functions
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Pons: above medulla, in front of cerebrum; bridges gap structurally and functionally
serving as primary motor pathway
Midbrain: connects pons and cerebellum with cerebrum; 0.8in long, includes most of
reticular activating system and extrapyramidal system
o Reticular Activating System: influences motor activity, sleep, consciousness, and
awareness
o Extrapyramidal System: relays info about movement and coordination from brain
to spinal nerves
Locus Coeruleus: small group of norepi-producing neurons, associated with stress,
anxiety and impulsive behavior
Limbic System: area of brain located above brain stem, includes thalamus, hypothalamus,
hippocampus, and amygdala
Thalamus: regulates activity, sensation, emotion
Hypothalamus: involved in temp regulation, appetite control, endocrine function, sexual
drive, impulsive behavior associated with anger, rage, or excitement
Hippocampus and Amygdala: involved in emotional arousal and memory
Disturbances: variety of mental illness such as memory loss that accompanies dementia
and the poorly controlled emotions and impulses seen with psychotic or manic behavior
o Describe the current neurobologic research and theories that are the basis for current
psychopharmacologic treatment of mental disorders.
Research and Theories:
Neurobiologic research is constantly expanding our knowledge in the field of psychiatry
and is significantly affecting clinical practice
Researchers continue to examine roles of genetics, heredity, and viruses in developmental
of mental illness
Researchers are finding that many of the changes in disorders such as schizophrenia are
at the molecular and chemical levels and cannot be detected with current aging
Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes but that the sources is not solely genetic; non-
genetic factors also play important roles
Research is continuing in an attempt to find genetic links to other disease such as
schizophrenia and mood disorders
Types of studies commonly conducted to investigate the genic basis of mental illness
o Twin Studies: compares rate of mental illness or traits in identical twins and
fraternal twins
o Adoption Studies: determine traits between biologic vs adoptive family
o Family Studies: compares if trait is more common among first degree family than
distance relative or general population
Most studies involving viral theories have focused on schizophrenia
Prenatal infections may impact the developing brain of the fetus, giving a proposed
theory that inflammation may contribute to the schizophrenia pathology
Neurotransmitters:
Electrochemical messages pass from the dendrites (projections from the cell body),
through the stoma or cell body, down the axon (long extended structures), and across the
synapses (gaps between cells) to the dendrites of the next neuron
Neurotransmitters fit into specific receptor cells embedded in the membrane of the
dendrite, just like a certain key shape fits into a lock
Major neurotransmitters have been found to play a role in psychiatric illness as well as in
the actions and side effects of psychotropic drugs
Dopamine: a neurotransmitter located primarily in the brain stem, involved in control of
complex movements, motivation, cognition, and regulation of emotional responses
o Generally excitatory, synthesized from tyrosine

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o Implicated in schizophrenia and other psychoses as well as in movement
disorders such as Parkinsons disease
Norepinephrine and Epinephrine: excess norepi has been implicated in several anxiety
disorders; deficits contribute to memory loss, social withdrawal, and depression
o Some antidepressants lock the reuptake of norepinephrine
Serotonin: derived from tryptophan; mostly inhibitory, involved in control of food intake,
sleep, wakefulness, temp reg, pain control, sexual behavior, and reg of emotion
o Plays important role in anxiety, mood disorders, schizophrenia
o Contribute to delusions, hallucinations, withdrawn behavior seen in
schizophrenic
Histamine: involved in peripheral allergic responses, control of gastric secretions, cardiac
stimulation, alertness
o Some psychotropic drugs block which results in weight gain, sedation,
hypotension
Acetylcholine: found in brain, spinal cord, PNS- particularly neuromuscular junction of
skeletal muscle
o Excitatory or inhibitory; synthesized from choline found in red meat, veggies,
found effective in sleep-wake cycle and signaling muscle of be active
o Alzheimers Disease: decrease acetylcholine-secreting neurons
o Myasthenia Gravis: reduced acetylcholine receptors
Glutamate: excitatory amino acid, high levels can have major neurotoxic effects
o Gamma-Aminobutyric Acid: amino acid, major inhibitory neurotransmitter, in
the brain, found to modulate other system rather than providing a direct stimulus
o Increase GABA function, benzos used to treat anxiety, induce sleep
Major Neurotransmitters Table 2.1 pg 19
o Discuss the nurses role in educating clients and families about current neurobiologic theories and
medication management.
Research in areas of neurobiology, genetics, and heredity, implications for clients and families are
unclear
Nurses must ensure clients and families are well informed about progress in these areas, they
must also help distinguish facts and hypotheses
Nurse must explain if or how new research may affect a treatment or prognosis
Nurses are good resources for proving info and answering questions
o Identify pertinent teaching for clients and families about brain imaging techniques.
Brain Imaging Technology Table 2.2 pg 20
CT: can visualize the brains soft tissues; so its used to dx primary tumors, mutases, effusions
and to determine size of ventricles
Schizophrenia: shown to have enlarged ventricles
Lie motionless on table for 20-40 min, and passes through a tunnel like ring
MRI: produces more tissue detail and contrast than CT and can show blood flow patterns and
tissues changes
Measure size and thickness of brain structures
Schizophrenia: have as much as a 7% reduction in cortical thickness
Small, closed chamber and remain motionless during the procedure, takes 45 min
Pacemakers, metal implants, heart valves, orthopedic devices, cant undergo
PET and SPECT: used primarily for research not dx and tx of those with mental disorders
PET: two photons simultaneously, 2-3 hours
o Chemical marker use FDDNP with PET to identify amyloid plaques and tangles
of Alzheimers in living clients, conditions that previously could be dx only
through autopsy; scans show those with this disease have decreased metabolism
in brain and decrease cerebral blood flow
SPECT: single photon, 1-2 hours
There could be a risk for allergic reaction with radioactive substances used during PET and
SPECT, some patients may find IV doses frightening and unacceptable
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o Discuss the categories of drugs used to treat mental illnesses and their mechanisms of action, side effects,
and special nursing considerations AND Identify client responses that indicate treatment effectiveness.
Principles that Guide Pharmacologic Treatment:
Medications effectiveness is evaluated largely by its ability to diminish or eliminate the
target symptoms
Must be given in adequate dosages for some time before their full effect is realized
Dosage of medication often is adjusted to the lowest effective dosage for the client
Older adults require lower dosages of medications then younger do to experience
therapeutic effect, may take longer for drug to achieve full therapeutic effect in older
adults
Meds often decreased gradually rather than abruptly
Follow ups are essential to ensure med regimen compliance, adjustments may be needed
in dosage and to manage side effects
Med compliance is enhanced when regimen is kept simple
Antipsychotic Drugs:
Off label uses: tx of anxiety and insomnia, aggressive behavior, delusions, hallucinations,
other disruptive behaviors that accompany Alzheimers disease
Primary medical tx for schizophrenia
Used in psychotic episodes of acute mania, psychotic depression, drug induced psychosis
First generation: elderly may respond to low dosages
Second generation: can increase mortality rate in elderly with dementia related psychosis
May me useful for short term use with those who have borderline personality disorder
Antipsychotic drugs Table 2.3 pg 24
Mechanism of Action:
o Major action to block receptors for neurotransmitter dopamine
o Dopamine receptors are classified into subcategories: D1, D2, D3, D4, D5
D2, D3, D4 associate with mental illness
First Generation: potent antagonist (blockers) of D2, D3, D4, blocking D2
receptors may produce extrapyramidal side effects
Second Generation: relatively weak blocker of D2, lower incidence of
extrapyramidal side effects; inhibit reuptake of serotonin
Paliperidone (Invega) similar to risperidone (Risperdal), but is
extended release
Asenapine (Saphris): sublingual, must avoid food or drink 10-15
min after med dissolves
Third Generation: dopamine system stabilizers; preserve or enhance
dopaminergic transmission when its too low and reduce when its too
high
Aripiprazole (Abilify): first of its type, most common side
effects H/A, anxiety, nausea; prescribed as adjunct med for
bipolar and depression
o 6 antipsychotics avail in depot injection
2 first gen use sesame oil as vehicle for injection so med can be absorbed
slowly over time
Prolixin (decanoate pluphenazine): duration 7-28 days
Haldol (decanoate haloperidol): duration 4 weeks
After being stabilized with oral doses injection is required every
2-4 weeks
Second gen encapsulated active med into polymer-based microspheres
that degrade slowly in body, gradually release drug at controlled rate
Riperdal Consta: 25mg every 2 weeks
Zyprexa Relprevv: 210mg every 2 weeks or 405 every 4;
potential to cause postinjection delirum/sedation syndrome; must
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be observed by HCP for 3 hours after injection; must be A&O
and symptom free before being released
Third gen is slowly absorbed into blood stream because of insolubility of
aripiprazole particles, after initiation of oral med may been given 400 mg
monthly
Atypical Antipsychotic Warning Box Pg 24
Side Effects:
o Extrapyramidal symptoms (EPSs)
o Geodon Warning Box Pg 25
o Dystonia
o Drugs Used to Treat Extrapyramidal Side Effects Table 2.4 pg 25
o Pseudoparkinsonism
o Akathisia
o Neuroleptic Malignant Syndrome (NMS)
o Tardive Dyskinesia (TD)
o Anticholinergic Side Effects
o Other Side Effects: increased blood prolactin levels, which may cause breast
enlargement and tenderness men and women; diminished libido, erectile and
orgasmic dysfunction, menstrual irregularities; increases risk for breast cancer;
may contribute to weight gain
Metabolic Syndrome: cluster of conditions that increase the risk for heart
disease, diabetes, and stroke
Droperidol, Thioridazine, Mesoridazine Warning Box pg 27
Clozapine Warning Box pg 27
Client Teaching:
o Nurse informs about types of side effects that may occur and encourages clients
to report problems to physician instead of discontinuing
o Teaches methods of managing and avoiding unpleasant side effects and
maintaining med regimen
o Drinking sugar free liquid and easting sugar free candy eases dry mouth
o Avoid beverages and candy high in calories
o Methods to prevent constipation
o Use of sunscreen due to photosensitivity
o Avoid driving and potentially dangerous activity until response times and
reflexes seem normal
Antidepressant Drugs:
Off label uses: tx of chronic pain, migraine headaches, peripheral and diabetic
neuropathies, sleep apnea, dermatologic disorders, panic disorders, eating disorders
Mechanism of action not completely understood, somehow interacts with 2
neurotransmitters norepi and serotonin
Divided into 4 groups:
o Tricyclic and the related cyclic antidepressants:
Became avail in 1950s
First drug of choice
Caused varying degrees of sedation, orthostatic hypotension,
anticholinergic effects
Potentially lethal if taken in overdose
o Selective serotonin reuptake inhibitors (SSRIs):
First avail 1987 with release of fluoxetine (Prozac)
Replaced cyclic drugs as first choice
Fewer troubling side effects
Effective in tx of OCD along with clomipramine
Prozac Weekly: first and only med given once a week for maintenance,
contains 90 mg enteric coating delaying release into bloodstream
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o MAO inhibitors (MAOIs):
Same period as tricyclics
Had positive effects on people, low incidence of sedation and
anticholinergic effects
Must be used with extreme caution:
Life threating side effects: HTN crisis if ingesting food
containing tyramine while taking med
Cannot be given in combination with other MAOIs, tricyclic
antidepressants, meperidine (Demerol), CNS depressants, many
antihypertensive, or general anesthetics
o Other antidepressents: desvenlafaxine (Pristiq), venlafaxine (Effexor), bupropion
(Wellbutrin), duloxentine (Cymbalta), trazodone (Desyrel) and nefazodone
(Serzone)
Antidepressant Drugs Table 2.5 pg 28
Preferred Drugs for Clients at High Risk for Suicide:
o SSRIs, venlafaxine, nefazodone, and bupropion better choice for those who are
potentially suicidal and high impulsive, carry no risk for lethal overdose
o Risk for suicide evaluation should continue after tx with meds is initiated
o Patients may feel more energized but still have suicidal thoughts increasing
likelihood of attempt
o Meds may take week for full effects, patient may feel discouraged resulting in
suicidal behavior
o FDA requires warning for SSRIs and increased suicidal risk in children and
adolescents
Mechanism of Action:
o Major interaction is monoamine neurotransmitter systems in brain, norepi and
serotonin
o Norepi, serotonin, dopamine are removed from synapses after release by reuptake
into presynaptic neurons, after reuptake the 3 are reloaded for subsequent release
or metabolized by enzyme MAO
o SSRIs block reuptake of serotonin
o Cyclics and venlafaxine block reuptake of norepi (primarily) and serotonin
(some degree)
o Cyclics may take 4-6 week to be effective, MAOIs 2-4 and SSRIs 2-3
Side Effects for SSRIs:
o Fewer in comparison to cyclic compounds
o Common Effects: anxiety, agitation, akathisia, nausea, insomnia, and sexual
dysfunction (diminished sexual drive, difficulty achieving erection or orgasm)
o Weight gain
o Less Common Effect: sedation, sweating, diarrhea, hand tremor, and headaches
Side Effects for Cyclic Antidepressants:
o Block cholinergic receptors, results in anticholinergic effects such as dry mouth,
constipation, urinary hesitancy or retention, dry nasal passages, and blurred
vision
o Severe Anticholinergic Effects: agitation, delirium, and ileus more in older adults
o Common Side Effects: orthostatic hypotension, sedation, weight gain,
tachycardia
o Frequent reports sexual dysfunction similar to SSRI
Side Effects for Monoamine Oxidase Inhibitors:
o Most Common: daytime sedation, insomnia, weight gain, dry mouth, orthostatic
hypotension, sexual dysfunction
o Potential for life-threatening hypertensive crisis if the client ingests food that
contains tyramine or takes sympathomimetic drug

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o Causes sever HTN, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and
cardiac dysrhythmias
o Foods (Containing Tyramine) To Avoid When Taking MAOIs Box 2.1 pg 30
Side Effects of Other Antidepressants:
o Nefazodone, trazodone, and mirtazapine: sedation
o Nefazodone and trazodone: headaches
o Nefazodone: dry mouth and nausea
o Bupropion, venlafaxine, and desvenlafaxine: loss of appetite, nausea, agitation,
and insomnia
o Venlafaxine: dizziness, sweating, sedation
o Trazadone: priapism, may result in impotence
o Nefazdone-Warning pg 30
o Bupriopion-Warning pg 30
Drug Interactions:
o Serotonin syndrome from taking MAOI and SSRI at same time
o Symptoms: agitation, sweating, fever, tachycardia, hypotension, fidgety,
hyperreflexia
o Extreme Reactions: coma, death
Client Teaching:
o SSRI: take first thing in morning, unless sedation is a problem; if dose is
forgotten take up to 8 hours after missed dose
o Cyclics: take at night in a single daily dose; if dose is forgotten take within 3
hours of missed dose or omit does for that day
o Should receive a written list of food to avoid while taking MAOIs
o Instruct not to take additional meds including OTC, while taking MAOIs without
consulting physician or pharmacist
Mood-Stabilizing Drugs:
Lithium: most established
Anticonvulsants: carbamazepine (Tegretol), valproic acid (Depakote, Depakene),
gabapentin (Neurontin), topiramate (Topamax), oxcarbazepine (Trileptal), lamotrigine
(Lamictal)
Clonazepam (Klonopin): tx acute mania
Lamotrigine-Warning pg 31
Mechanisms of Action:
o Lithium: normalizes reuptake of serotonin, norepi, acetylcholine, and dopamine
Reduces release of norepi through competition with Ca and produces
effects intracellularly rather than within synapses
Acts directly on G proteins and certain enzyme sub systems such as
cyclic adenosine monophosphates and phosphatidylinositol
First line agent in tx of bipolar disorder
o Valporic acid and topiramate: increase levels of GABA
o Valporic acid and carbamazepine: inhibit kindling process
Dosage:
o Lithium: tablet, capsule, liquid, sustained release forms; effective dosage
determined by monitoring serum levels and assessing response to drug; 900-
3600mg/day; serum level should be about 1 mEq/L, <0.5 and > 1.5 considered
toxic; levels should be monitored every 2-3 days till dose is determined then
weekly; if stable monitor once a month
o Lithium-Warning pg 31
o Carbamzepine: liquid, tablet, chewable; 800-1200mg/day, extreme dose 200-
2000mg/day
o Valproic acid: liquid, tablet, capsule form as sprinkles; 1000-1500mg/day,
extreme 750-3000mg/day; serum level drawn 12 hours after last dose
Side Effects:
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o Lithium Common Effects: mild nausea or diarrhea, anorexia, fine hand tremors,
polydipsia, polyuria, metallic taste in mouth, fatigue, lethargy; weight gain and
ache later in tx
o Lithium Toxic Effects: severe diarrhea, vomiting, drowsiness, muscle weakness,
lack of coordination; untreated can lead to renal failure, coma, death; levels >3
mEq/L may need dialysis
o Carbamazepine and valproic acid: drowsiness, sedation, dry mouth, blurred
vision
o Carbamazepine: rashes, orthostatic hypotension
o Valproic acid: weight gain, alopecia, hand tremor
o Topiramate: dizziness, sedation, weight loss, increased incidence of renal calculi
o Valproic Acid and Its Derivatives-Warning pg 32
o Carbamazepine-Warning pg 32
Client Teaching:
o Monitor blood levels periodically
o Take meds with meals to minimize nausea
o Dont attempt to drive till dizziness, lethargy, fatigue, blurred vision is gone
Antianxiety Drugs (Anxiolytics):
Most widely prescribed medication
Wide variety of drugs from different classes used in tx of anxiety and insomnia
Benzodiazepines: most effective in relieving anxiety and most frequently prescribed
drugs; may be prescribed for anticonvulsant and muscle relaxant effects as well
Buspirone: non-benzo, used to relieve anxiety
Propranolol, clonidine (Catapres), hydroxyzine (vistaril): relieve anxiety, less effective
Mechanism of Action:
o Benzodiazepines: mediate the actions of GABA; produces effects by binding to
specific site on GABA receptor
o Buspirone: exerts its anxiolytic effect by acting as a partial agonist at serotonin
receptors, decreasing serotonin turnover
o Antianxiety (Anxiolytic) Drugs Table 2.6 pg 33
o Drugs with longer half-life require less frequent doses and produce fewer
rebound effects between doses but they accumulate in body producing next day
sedation
Side Effects:
o Benzodiazepines have a tendency to cause physical dependence
o Psychological dependence on benzos is common d/t patients fearing that anxiety
symptoms will return and wont be able to handle them without drugs leading to
overuse or abuse
o Buspirone doesnt cause this type physical dependence
o Benzo Common Effects: CNS depression; drowsiness, sedation, poor
coordination, impaired memory, clouded sensorium
o Buspirone Common Effects: dizziness, sedation, nasueas, H/A; elderly may have
more difficulty managing CNS depression leading to being prone to more falls,
pronounced memory deficits, urinary incontinent (nocturia)
Client Teaching:
o Antianxiety agents are aimed at relieving symptoms of anxiety or insomnia not
treating underlying issues
o Benzos strongly potentiate alcohol effects, and it shouldnt be consumed while
taking meds
o Be aware of decreased response time, slower reflexes, and possible sedative
effects of the drugs
o Benzo withdrawal can be fatal
Stimulants:

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First used to treat psychiatric disorders in 1930s for pronounced effects on CNS
stimulation
Dextroamphetamine (Dexendrine): widely abused to produce high or remain awake for
long periods of time
Primary Use: ADHD in children and adolescents, residual ADD in adults, narcolepsy
ADHD Treatment: primary drugs include methylphenidate (Ritalin), amphetamine
(Adderall), dextroamphetamine (Dexedrine); Pemoline (Cylert) used infrequently d/t
potential liver problems
o Amoxetine (Strattera): 2003, SSRI, approved for tx of ADHD, first non-stimulant
med
Methylphenidate-Warning pg 34
Pemoline-Warning pg 34
Mechanism of Action:
o Often termed directly acting amine b/c they act by releasing norepi, dopamine,
serotonin from presynaptic nerve terminals as opposed to having direct agonist
effects on the postsynaptic receptors; block reuptake of neurotransmitters
o Methylphenidate milder CNS stimulation than amphetamines
o Pemoline primarily affects dopamine and has less effect on sympathetic nervous
system
o Atomoxetine helps block norepi into neurons, leaving more neurotransmitter in
synapse to help conduct electrical impulses in brain
Dosage:
o Narcolepsy Tx: dextroamphetamine, methylphenidate given in divided doses
totaling20-200mg/day
o Also avail in sustained release so once a day dosing is possible
o ADHD TX: in children varies depending on physician; age, weight and
behavior; family tolerance of childs behavior
o Drugs Used to Treat Attention Deficit Hyperactivity Disorder Table 2.7 pg 35
o Sustained release eliminates the need for the school nurse to provide additional
dosing while at school
Side Effects:
o Most Common: anorexia, weight loss, nausea, irritability; should avoid caffeine,
sugar, chocolate, which can worsen symptoms
o Less Common: dizziness, dry mouth, blurred vision, palpitations
o Most common long-term problem is growth and weight suppression
o Atomoextine: decrease appetite, nausea, vomiting, fatigue, upset stomach
Client Teaching:
o Potential for abuse exists
o Caffeine-free beverages are suggested
o Should avoid chocolate and excessive sugar
o Keep meds out of childs reach, as little as a 10-day supply can be fatal
Disulfiram (Antabuse):
A sensitizing agent that causes an adverse reaction when mixed with alcohol in the body
Only use is a deterrent to drinking alcohol in people receiving tx for alcoholism
5-10 min after taking a person who ingests alcohol symptoms will appear: facial and
body flushing from vasodilation, throbbing H/A, sweating, dry mouth, NVD, weakness;
Severe: chest pain, dyspnea, sever hypotension, confusion, death; symptoms can last
30min- 2 hours
Metabolized by liver, best if patients liver enzymes are close to or within normal range
Inhibits the enzyme aldehyde dehydronase (involved in metabolism of ethanol) these
levels increase 5-10X higher than normal resulting in a disulfiram-alcohol reaction; this
reaction is potentiated by decrease levels of epi and norepi in the sympathetic nervous
system d/t inhibition of dopamine beta-hydroxylase

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Disulfiram-Warning pg 35
Other Side Effects: fatigue, drowsiness, halitosis, tremor, impotence
Can interfere with metabolism of other drugs, phenytoin (Dilantin) isoniazid, warfarin
(Coumadin), barbiturates, long-acting benzos (diazepam, chlordiazepoxide)
Acamprosate (Campral): for persons in recovery for alcohol abuse or dependence; helps
reduce physical and emotional discomfort experienced within first weeks-months of
being sober; 2 tablets 333mg each t.i.d; side effects include diarrhea, nausea, flatulence,
pruritus
o

UNIT 1: Current Theories and Practice 11