is a holistically

oriented therapy
which integrates the
mental, emotional,
spiritual and physical
aspects.

I. Overview of
Psychopharmacology and other
Somatic Therapies
A. Key concepts
1. Mental illnesses (such as
schizophrenia, depression,
and anxiety disorder) known
to be associated with
chemical imbalances of
neurotransmitter in the
brain.

a. Neurotransmitters
Chemical messengers that carry
inhibiting or stimulating messages
from one neuron to another across
the space (synapse) between them.
b. Receptor sites
Are channels or specially tailored
protein molecules located or
presynaptic cell membranes, where
neurotransmitter are accepted.

2. Psychotropic (psychoactive) drugs

The mainstay of
psychopharmacology, exert their
effect in the brain.
They are used to relieve behavioral
and emotional symptoms of mental
illness.

3. Psychotropic Drugs

Work by altering the amount of neurotransmitters

available at the synapse in the following ways:
Preventing reuptake of the neurotransmitter at
the presynaptic neuron.
Binding to receptor sites at the postsynaptic
neuron (thus preventing the neurotransmitter
from entering the receptor)
Preventing enzymes present at the synapse from
metabolizing neurotransmitters
Affecting the ion channels of the nerve cell
membrane.

Psychotropic Drugs

4. Neurotransmitters Psychotropic Drugs

Dopamine
Primarily affected by antipsychotics
Serotonin
Primarily affected by antidepressants and antipsychotics.
Norepinephrine
Affected by mood-stabilizing agents, antidepressants,
antipsychotics, and psychostimulants.
Gamma- aminobutyric acid (GABA)
Primarily affected by anxiety agents.
Acetycholine
Affected by anticholinesterase agents, antipsychotics,
and antidepressants.

5. Medicinal herbs
1. Natural herbs
Use in treating emotional symptoms
Has grown over last 10 years with increased
popularity of complementary and alternative
medicine (CAM).
2. Herbs are currently not regulated in the
United States
Safety and effectiveness can be validated by
the U.S. Food and Drug Administration (
www.fda.gov) and the National Center for
Complementary and Alternative Medicine (
www.ncam.nih.gov)

Medicinal
herbs

3. Examples of herbal medicines

commonly used:
a. St. Johns Wort and SAMe (Sadenosylmethione)
Alleviate mild depression
b. Kava
Decrease anxiety symptoms
c. Gingko leaf extract
Improves memory
d. Melatonin
Improves sleep and counteracts jet lag.

C. Other biological treatments

1. Electroconvulsive therapy (ECT)

Is used primarily for treating
depression.
Has also used to treat mania,
catatonia, and schizophrenia that is
unresponsive to medications.
It requires a consent form and may
be administered 2 to 3 times per
week, for a total of 6 to 12
treatments.

Electroconvulsive therapy (ECT)

A. Procedure
Inducing unconsciousness, then
passing an electric current through
the brain.
Clients vital sign
Oxygenation
Cardiac functioning are carefully
monitored before, during and after
ECT.

Procedure
Short- acting anesthesia is used to
induce unconsciousness.
An electric current (70- 150 volts) is
applied through the brain for 0.5 to 2
seconds, producing a seizure that
lasts 30 to 60 seconds.
b. Following ECT, the client is
monitored according to routine
postoperative protocols.

Other biological
treatments
2. Light therapy (Phototherapy)
Involves exposing the client to an
artificial light source in the winter to
relieve depression in seasonal
affective disorder.

Other biological
treatments
3. Repetitive Transcranial Magnetic Stimulation
(TMS)
Is an experimental treatment for depression
It involves sending an electric current through a wire coil
on the clients head to generate a magnetic field, causing
neurochemical changes in targeted brain areas.
4. Eye Movement Desensitization Reprocessing
(EDMR)
Is a controversial treatment for posttraumatic stress
disorder.
It involves asking the client to recall traumatic memories
while making a series of rapid lateral eye movements.

Transcranial Magnetic
Stimulation (TMS)

II. ANTIPSYCHOTICS
(NEUROLEPTICS)
A. General Information
1. Antipsychotic Drugs
Otherwise known as ataractic,
neuroleptic, major tranquilizer,
psychic energizer.
Classified as either typical or
atypical.

a. General Considerations

1. Calms an exited patient without producing

impairment of motor function sleep.
2. Antipsychotics have a high therapeutic
index and can be given a high dose with
minimal risk.
3. They are not addicting, and the patients do
not develop tolerance to their
antipsychotics effects.
4.Use of an antipsychotics during pregnancy
and lactation is not recommended.

Antipsychotic Drugs
b. Indication
1. For treatment of following
illness
Acute psychotic symptoms of
schizophrenia, organic brain
syndrome with psychosis.
Manic phase of manic-depressiveillness.

Antipsychotic Drugs
2. For treatment of the following
symptoms
Agitation
Rage
Overeactivity to sensory stimuli
Hallucinations, delusions
Paranoia, combativeness
Vertigo

Chemical Classes of Antipsychotics

Chemical Classes of
Antipsychotics

B. Typical Antipsychotic Agents

It blocks the post synaptic dopamine
receptor in the limbic areas in the brain,
hypothalamus and cerebral cortex, an action
believed to reduce psychotic symptoms.
These antipyschotics also affect other
receptors, including those for histamine,
serotonin, norepinephrine, and
acetylcholine.
The effect on these receptors accounts to
many side effects.

Typical Antipsychotic
Agents
1. Pharmacokinetics
Peak plasma levels occur 2 to 4 hours after
administration, while serum half- life is 20 to
40 hours; the drug accumulates in fatty
tissue, which accounts for the persistence of
the drugs effect when it stopped.
The recommended dosage varies widely for
these drugs; dosage titration is important for
targeting specific changes in an individual
clients symptoms.
Tolerance does not develop with these drugs.

Typical Antipsychotic
Agents
Oral absorption is significantly affected by foods and
stomach acidity level
These drugs should be taken at least 2 hours after
eating and should not be used concurrently with
antacids or histamine (H) blocking agents
(cimetidine).
Asians require one-half to one-third the usual dose
because they are more sensitive to drug side effects.
Long-acting preparations are available for haloperidol
(Haldol) and fluphenazine (Prolixin)
They are administered I.M. via depot injection, and
effects last 2 to 4 weeks.

2. Administration

Daily dose is increased every 1- 4

days until symptoms improve.
Available in oral concentrates
suspension or intramuscular
injection.
If the patients symptoms are
unresponsive after the adequate
time (6 weeks), another class may be
tried.

3. Contraindications

a.In the patient with severe CNS depression due to excessive alcohol
or narcotic use, brain damage or trauma.
b.Patients with Parkinsons disease.
c. Patients with allergic response to one of the antipsychotic drugs.
d.Patients with blood dyscrasias.
e.Patients with acute narrow- angle glaucoma because it can cause
increase intracranial pressure.
f. Patients with prostatic hypertrophy because they are at risk for
urinary hesitancy or retention.
g.Benign prostatic hypertrophy.

4. Common Side Effects

a. Anticholinergic effects, including dry mouth, blurred vision, urinary
retention, and constipation.
b. Cardiovascular

effects,

including

postural

tachycardia.
c. Sedation, drowsiness, and lack of alertness.
d. Photosensitivity, including sunburn and rash.
e. Weight gain.
f. Endocrine changes, including:
. Amenorrhea
.Galactorrhea (in women)
.Gynecomastea (in men)
.False positive pregnancy test

hypotension

and

5. Some Serious but Uncommon

Side Effects
a.Agranulocytosis (WBC level < 2,000 l)
b.Acute dystonic reaction, characterized by severe, sudden muscle
spasms.
c. Tardive dyskinesia, characterized by involuntary mouth, tongue, and
facial movements.
d.Seizures
e.Hepatotoxicity, which may be characterized by jaundice, nausea, and
abdominal pain.
f. Neuroleptic malignant syndrome, which is severe reaction that can be
fatal.

C. Atypical Antipsychotic Agents

1. Atypical antipsychotics block dopamine receptors in the

limbic system and affect serotonin receptors in the
cortical areas of the brain.
2. The indications, contraindications, and interactions are
similar to those of typical antipsychotic agents.
. The following advantages over typical antipsychotics:
a. Reduce

positive

symptoms

of

schizophrenia

(hallucinations and delusions) as well as lessen the

negative symptoms (blunted affect, apathy, and social
withdrawal).

Atypical Antipsychotic
Agents

a. These agents cause decreased (or no) extrapyramidal

effects because they do not affect dopamine in striatal
areas.
b.

Rapid-dissolving

preparations

of

olanzapine

(Zyprexa) and risperidone (Risperdal) are available;

they begin to dissolve with saliva and can be
swallowed without water.

Atypical Antipsychotic
Agents

The Zyprexa
Molecule

3. Common Side Effects

a. Seizure
b. Agranulocytosis, which associated primarily with
clozapine (incidence of 1% to 2%)
The FDA currently mandates weekly testing of
WBC counts for the first 6 months while taking
these drugs.
Biweekly testing can be instituted if counts are
acceptable.

D. Dopamine System Stabilizer (DSS)

1. Currently, only one drug is available
Aripiprazole (Abilify)
2.Restores dopamine activity in cortical levels of
the brain and reduces dopamine in limbic areas,
thus decreasing psychotic symptoms.
3.This drug is not metabolized by P-450 enzymes;
therefore, few drug interactions occur.

4. Common Side Effects

Headache
Nausea
Vomiting
Constipation
Insomnia
Lightheadedness akathisia

III.

A. GENERAL INFORMATION

Used to treat depression, including symptoms of

depressed mood, loss of interest in activities or leasure,
altered sleep patterns, and somatic complaints.
Used o treat anxiety disorders (especially panic attacks),
phobic disorders, and obsessive-compulsive disorder;
additionally they are used to treat anxiety symptoms that
occur with depressive disorder.

Actions:

Block the reuptake of serotonin

and norepinephrine
(neurotransmitters) so that
more are available in the brain
to transmit messages.

Antidepressants
Indications:

Recurrent depressive disorders

Psychomotor retardation

Depression with no clear

precipitating event

Family history of depression

Chronic pain

Eneuresis

TYPES OF ANTIDEPRESSANTS
1. Tricyclic antidepressants
2. Monoamine oxidase inhibitors
3. Selective serotonin reuptake inhibitors
4. Atypical antidepressants
5. Serotonin-norepinephrine reuptake
inhibitors

Tricyclic Antidepressants
Affect norepinephrine, serotonin
acetylcholine and histamine receptors
Increase availability of norepinephrine,
serotonin
Inhibit transport back into the presynaptic
neuron

Mechanism of Action
Block reuptake of NE,Serotonin and Dopamine
at nerve terminal,thus increasing the NE,5HT or
DA at the extracellular and more of its action on
at receptor site.
Down regulation of Beta-adregernic receptors
in most TCA, other receptors (incl. those outside
the CNS) are also affected: blockade of H1receptor, -receptors, M-receptors

INDICATIONS
Clinical depression
Neuropathic pain-Diabetic
neuropathy/Analgesia
ADHD
Nocturnal Enuresis (Imipramine)
Panic disorder(Imipramine)
OCD(Clomipramine)
Others like eating disorder,narcolepsy

CONTRAINDICATIONS

Agranulocytosis
Severe liver damage
Glaucoma
Prostatic hyperplasia
Epilepsy
Lactation

Pharmacokinetics

Half life 36h up to 72 h in overdose

Blood level ranges in overdose
Most in tissue NOT blood (1-2%)
Dialysis does not work
Peaks 2-6 hours after ingestion
Most people die early if they have taken
fatal dose

TCAs Side Effects

Anticholinergic effects: Common and
troublesome in tricyclics: interfere with
patient
compliance.
dry mouth

sweating

constipation
urinary hesitancy/retention

drowsiness
blurred vision

Cardiovascular: Postural hypotension,

tachycardia, heart conduction defects.

TCAs Side Effects

Anticholinergic effects:
Closed angle glaucoma worsened
Toxic: confusion, psychosis
Other:
Weight gain, lowered seizure threshold,
EPS
Overdose: 1000 4000 mg is fatal

TCAs Side Effects

Managing Side Effects of Tricyclic Antidepressants
(Contd.)
If these dangerous side effects occur, advise the
patient either to call provider stop the medication, or
reduce the dosage.

Orthostatic hypotension

Marked, persistent sedation

Atropine-like psychosis

Cardiovascular conduction defect

Seizures

Severe anticholinergic effect: urinary

retention, etc.

Symptoms

Sedation
Ataxia
Agitation
Stupor
Coma
Convulsions and respiratory depression

Treatment
IV, O2, Monitor
Change in MS/respiratory distress
intubate!
Activated Charcoal for everyone
1g/kg, decreases absorption from
stomach

C. Mono-amine Oxidase Inhibitors

MAOIs
phenelzine.Nardil
isocarboxazide .Marplan
tranylcypromineParnate

D. Selective Serotonin reuptake

Inhibitors (SSRIs)

Block transport mechanism that returns

unbound serotonin left in synaptic cleft into
the presynaptic neuron
Terminates transmission of the message
carried by that receptor
When blocked, more serotonin is available to
the postsynaptic receptor

Selective Serotonin reuptake

Inhibitors (SSRIs)
Fluoxetine HCL (Prozac)

Non-tricyclic, less sedation, fewer side

effects

Sertraline HCI (Zoloft)

Lower risk of toxicity in overdose, fewer

side effects, shorter half-life than prozac

SSRI Antidepressants (contd.)

Paroxetine HCI (Paxil):
Effectiveness comparable to
Imipramine (Tofranil), shortest
half-life, safer for
elderly.
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram oxalate (Lexapro)

Common Side Effects of SSRIs

Insomnia
Instruct the client to take the dose early in the day.
Teach the client to eliminate caffeine.
Encourage the client to use relaxation techniques before
bed.
Headache
Instruct the client to use analgesics as prescribed and to
check with the doctor before taking any over-the-counter
drugs.

Common Side Effects of SSRIs

If the client has severe headaches, check with the doctor
about the discontinuing the drug.
Weight Loss
Encourage the client to consume adequate calories to
maintain weight. Note that extreme caution is needed
when the client has an eating disorder.
Sexual dysfunction
(Anorgasmia in women, ejaculatory dysfunction in men)
Advise the client that sexual dysfunction is possible with
these drugs, and instruct him to speak with the doctor
because another antidepressant may be prescribed.

D. Selective Seretonin Reuptake

Inhibitors (SSRIs)
SSRIs specially affect the neurotransmitter
seretonin by preventing its reuptake at the
synapse.
Because other neurotransmitters are not
affected, these drugs do not have the same side
effects as the other antipsychotic agents.

Pharmacokinetics:
a) The serum half-life is 20 to 168 hours;
therefore, SSRIs can be given once daily.
b) Tolerance does not develop, and these drugs
have a low potential for overdose.
c) Therapeutic effectiveness occurs in 2 to 4
weeks.

Contraindications:
a) Hypersensitivity reactions
b)Severe hepatic or renal
disease.
c) Seizures
d)Diabetes mellitus.

Interactions:
a) Additive CNS depressive effects may
occur when combining SSRIs with
alcohol, antihistamines and opiods.
b) Additive serotogenic effects are
possible when combining with other
antidepressants
c) SSRIs may increase the risk of toxicity
from other drugd (digoxin, phenytoin,
lithium, warfarin).

E. Atypical Antidepressants
These drugs do not have a wellexplained mechanism of action,
although they are thought to act
similarly to TCAs.
Their main advantage over TCAs is
fewer side effects, Particularly fewer
antichollinergic and cardiovascular
effects.

 Pharmacokinetics for each

drug in this category is unique to
the drug.

Contraindications and Interactions include:

a) Digoxin Preparations
b) Zyban, a smoking-cessation
medication that contains
bupropion (combined use may
cause seizures)

ommon Side effects are as follows:

a) Seizures, which are associated
with bupripion.
b) Priapism
- prolonged painful penile rection,
which is associated with
trazodone.

F. Serotonin-Norephinephrine
Reuptake Inhibitors (SNRIs)
A new generation of antidepressants,
SNRIs selectively inhibits the
reuptake of both serotonin and
norephinephrine.
SNRIs have the same general uses
and characteristics as other
antidepressants.

Serotonin & norepinephrine

reuptake inhibitor (SNRIs)
Effexor (Venlafaxine)
Inhibits serotonin & norepinephrine reuptake
Side effects include:
dizziness, migraine, weight gain

Pristiq (Desvenlafaxine)
Serzone (Nefazadone)
Trazodone HCL (Desyrel)

Common side effects

includes:
GI upset, dose-related hypertension,
insomnia, restlessness, headache,
and irritability.
Caution should be used with
nefazone because serious liver
failure has been reported; it has
been withdrawn from use in Europe.

IV. MOOD STABILIZERS

A. General Information
Mood stabilizers are the class of
drugs that include antimanics and
anticonvulsants.

Specific use includes:

a) Treatment of the manic cycle of
bipolar disorder.
b) Prevent or recurrent episodes of
mania and depression
characteristic in bipolar disorder.
c) Treatment of schizoaffective
disorder and episodes of acute
hyperactivity associated with
other mental disorders.

 These drugs are prescribed for

children and adults; however,
elderly clients are particularly
sensitive to toxicity because of
decreased renal function.
They are not recommended for use
during pregnancy and lactstion.

B. Antimanics (lithium carbonates)

Although its mechanism of action is poorly
understood, lithium is thought to normalize
reuptake of neurotransmitters, including
serotonin, norephinephrine, dopamine and
acetylcholine.
Unlike most of the psychotropic
medications, lithium exerts its action
intracellularly rather than the synapse.

Pharmacokinetics include the following:

a) The serum half-life is about 24

hours.
b) Upon initiation of lithium, blood is
drawn either daily or every 2 to 3
days until a therapeutic level is
identified for the individual client.

Contraindications include:
a) Hypersensitivity response (to
lithium)
b) Renal disease
c) Thyroid disease

Interactions are as follows:

a) Concurrent use with anesthetics,
angiotensin-converting enzyme
(ACE) inhibitors, non-steroidal
anti-flammatory drugs (NSAIDs),
tetracycline, or thiazide diuretics
increases the risk of lithium
toxicity.

Common side effects:

a) Gastrointestinal effects,
including nausea, anorexia and
diarrhea
b) Fatigue and lethargy
c) Weight gain
d) Polyuria (usually benign)

Treatment of lithium toxicity includes:

a) Withholding any further doses

(even if toxicity is only
suspected)
b) Obtaining an immediate serum
lithium level to confirm toxicity
level.
c) Monitor Vital signs and
electrolyte, blood urea nitrogen
and creatinine levels.

 Serious side effects:

a) Thyroid impairment

b)Renal impairment

C. Anticonvulsants
Mood-stabilizing anticonvulsants may
be prescribed for clients with bipolar
disorder.
Although the mechanism of action is
not well understood in treatment of
bipolar disorder, it is thought to inhibit
kindling activity in the brain;
it is also stimulates gamma-amino
acid (GABA), which is helps produce a
calming effect.

Pharmacokinetics as follows:
a) The serum half-life for carbamazepine
(tegretol) is 15 to 30 hours, whereas
valproic acid (Depakote) is about 8
hours, blood vessels should be
monitored for both these drugs.
b) Gabapentin (Neurotin) circulates
largely in a free state because of
minimal binding to plasma proteins,;
it is not appreciably metabolized and
is elimunated by the kidneys.

c. Lamotrigine ( Lamicetal) is
metabolized in the liver.
d. Oxcarbezipine (Trileptal) is
structurally related to
Carbamazepine.
e. Topiramate (Topamax) is not
extensively metabolized and is
eliminated unchanged by the
kidneys.

Contraindications include:
Cardiovascular disease, hepatic
impairment, hypersensitivity
reactions, and blood dyscrasias.
Interaction with Carbazepine include
the following:
a) Carbazepine levels may be
increased with use of erythromycin,
cimetidine, propoxyphene, isoniazid,
calcium channel blockers or SSRIs.

b. Decreased Carbamazepine levels

may occur with valproic acid,
phenytoin and phenobarbital.
c. Carbamazepine can decreased
the oral cotraceptives, warfarin,
theophylline
preparations,antipsychotics,
valproic acid, anticoagulants, and
doxycycline.

Interation with valproic acid

are as follows:
a) Increased Valproic acid levels
may occur with aspirin use.
b) Valproic acid potentates the
effect of alcohol, warfarin and
aspirin.
c) An increased seizure risk is
possible when valproic acid is
used with phenytoin or
clonazepam.

Common side effects:

a) CNS effect (drowsiness, fatigue,
sedation)
b) Gastrointestinal effects (including
nausea, vomiting, and indigestion,
especially with valproic acid)
c) Photosensitivity (sunburn, rash)
d) Visual disturbances (blurred
vission)

e. Skin rash,which can be serious

(may occur with lamotrigine)
f. Renal stones (may occur with
topiramate)
Serious side effects include hepatic
toxicity and agranulocytosis.

informatio
n

V. Antianxiety Agents (Anxiolytics)

And Sedative-Hypnotics
A. General information
Antianxiety agents include
benzodiazepines (anxiolytics and sedative
hypnotics), antihistamines, and the
nonbenzodiazepine anxiolytic buspirone.
They are generally prescribed to treat
anxiety and sleep disorders.

B. Benzodiadipines
BZAs are the drug of choice for
treatment of anxiety and sleep disorders;
they are also used in acute alcohol
withdrawal, preoperative sedation,
seizure disorders, short-term treatment f
acute mania, and as muscle relaxants;
Additionally, BZAs are used to treat
agitation and hyperactivity in cognitive
impairment disorders.

Pharmacokinetics as follows:
a) The serum half-life for drugs in
this group varies widely (5 to 30
hours for oxozepam, 30 to 100
hours for chlorazepate).
b) The onset of action also varies,
thus leading to the use of some of
these drugs as anxiolytics
whereas others are primarily used
as sedative-hypnotics.

Contraindications include:
a) Alcohol or substance abuse
problems.
b) Heaptic or renal impairment
c) Hypersensitivity reactions
d) CNS depressions.

Interactions are as follows:

a) Increased sedations and CNS depression may
occur when these agents are combined with
alcohol, barbiturates, opioids, antipsychotics,
antidepressants, antuhistamines, neuromascular
blocking agents, cimetidine or disulfiram.
b) Decreased effectiveness may oocur when these
agents are combined with nicotine or caffeine.

Common side effects:

a) CNS effects, including sedation,
fatigue, headache, and motor
incoordination
b) Gastrointestinal effects,
including nausea and dry
mouth.

Serious side effects:

a) Withdrawal syndrome, if abruptly
discontinued.
b) Respiratory depression with high
doses or deliberate ovdrdose.
c) Paradoxical behaviors of
restlessness, talkativeness, and
insomnia.

C. Antihistamines
These medications are used primarily to relieve
allergic symptoms; however, they are also used for:
a) Anxiety symptoms associated with a variety of
mental disorders.
b) Sleep induction.
) Antihistamines are prescribed for adults, children,
adolescents, and elderly clients; they are not
recommended for use during pregnancy and
lactation.

Using Benzodiazepines
safely
Clients receiving benzodiadipines
should be informed about the
following safety precautions:

 Do not drive or operate machinery

while taking the prescribed
medication.
Do not abruptly stop taking the
prescribed drug because this can
cause acute withdrawal symptoms.
Do not consume alcohol or any
other sedative drug while taking
the prescribed medication.

Benzodiadipine overdose
Benzodiadipines taken alone or in
therapeutic doses are relatively safe;
however, if combined with alcohol or
other CNS depressants, result can be
fatal.

SYMPTOMS:
Somnolence
Confusion
Diminished
reflexes
Hypotension
Coma

TREATMENT:

Induce vomiting or gastric lavage.

Monitor the clients vital signs and ECG readings.
Maintain a patent airway.
Administer the following medications as ordered:
Levarterenol (Levophed) for hypotension
Physostigmine (Antilirium) for acute diazepam
poisoning
- Fluamazenil (Mazicon), a benzodiazepine blocker,
to reverse CNS depression.

Pharmacokinetics:
a) The serum half-life of these drugs is
2.4 to 7 hours; therefore, they can
be used to induce sleep (sedativehypnotic use).
b) Unlike BZAs, these drugs are not
associated with tolerance and
dependence.

Contraindications include:
a) Hypersensitivity
response
b) Hepatic disease
c) Narrow-angle glaucoma
d) Prostatic hypertrophy

Interactions:
a) Additive CNS depression may occur
in the concurrent use of alcohol,
opioids or other sedative-hypnotics.
b) Additive antichollinergic effects may
occur with the use of TCAs,
guanidine, MAOLs, and other drug
causing antichollinergic response.

Commons side effects:

a) CNS effects (drowsiness, fatigue,
dizziness)
b) Antichollinergic effects ( dry mouth,
blurred vission, urinary retention,
constipation)
) Serious side effects include postural
hypotension.

D. Buspirone (BuSpar)
this nonbenzodiapine anxiolytic is
primarily prescribed for treating
generalized anxiety disorder.; it
may be used for children, and
elderly clients with disruptive or
aggressive behaviors.

Buspirone (BuSpar)

This drug cannot be used on a PRN

(as needed) basis because
effectiveness may not be reached for
up to 2 weeks.
Buspirone does not act on GABA, but
exerts its effects on serotonin
receptors, its specific action is not
well understood, but it effectively
reduces anxiety.

Pharmacokinetics:
a) The half-life is 2 to 7 hours.
b) A lag time exists before buspirone
exerts its antianxiety effect (it may
take 10 days to 2 weeks before
effectiveness occurs); clienys
should not be encouraged to
continue taking medication for this
time.

Pharmacokinetics include:
Hypersensitivity reactions and
hepatic disease; it should no be
taken during pregnancy or lactation.
Interaction include:
a) Hypertension
b) Increased sedation
c) Hepatic toxicity

Common side effects:

a) CNS effects including dizziness,
drowsiness, headache, fatigue, and
weakness
b) Gastrointestinal effects including
dry mouth, nausea, diarrhea or
constipation
c) Cardiovascular effects including
palpitations and hypertension
d) Endocrine effects, including
amenorrhea

VI. Other Medications

A. General Information
Various types of medication may be
used to treat mental problems.
Some commonly prescribed classes
of medications include the
treatment of attention deficit
hyperactivity disorder (ADHD) and
cognitive impaired associated with
Alzheimers disease.

B. Psychostimulants
- These drugs are commonly used to
treat children and adults with ADHD;
they also may be used to treat
narcolepsy in adults.
a) Psychostimulants are rarely
prescribed for elderly clients.
b) They should not be used during
pregnancy and lactation.

Drugs for treating Attention

Deficit Hyperactivity Disorder
PSYCHOSTIMULANTS
- Dextroamphetamine (Dexedrine)
- Methylpenidate (Ritalin, Concerta,
Adderal)
- Pemoline (Cylert)
NONPSYCHOSTIMULANTS
- Atomoxetine (strattera)

Pharmacokinetics:
a) Short-acting psychostimulating
medicaitions, such as
methylphenidate, have short halflives and therefore require several
(T.I.D.) doses throughout the day.

Contraindications:

a) Substance abuse
b) Seizure disorders
c) Hepatic disease
d) Cardiovascular disease
e) Tourette syndrome and other
abnormal movement disorders.

Interactions:

a) Use with MAOIs or vasopressors

may cause hypersensitive crisis.
b) An additive symphatomimetic effedt
occur if psychostimulants are used
with other drugs that stimlulates
the symphathetic nervous system.

Common side effects:

a) CNS effects, including headache,
insomnia, agitation and irritability.
b) Cardiovascular effects including
hypertension and palpitations
c) Gastrointestinal effects including
nausea, vomiting, anorexia and
diarrhea.
) Serious side effects include seizure
and hepatotoxicity.

C. Nonpsychostimulants
-Atoxetine (Strattera),a new nonstimulant
medication developed for treating ADHD, acts to
block postsynaptic norepinephrine transport in the
brain, thereby improving core ADHD symptoms.
- Because this is not a controlled substance, there
is a little risk of abuse.
-The drug should not be taken with MAOIs or
within 2 weeks of stopping an MAIO.

Common side effects:

a. GI upset
b. Increased appetite
c. Dizziness
d. Fatigue
e. Mood swings

D. Anticholinesterase drugs

-These agents are used to treat mid to moderate

cognitive impairments associated with Alzheimer's
disease and other cognitive impairment disorders.
a. Anticholineterase drugs are prescribed for
adults, especially elderly clients; they are generally
not used in children.
b. They should not be used during pregnancy or
lactation.

Pharmacokinetics:
a. The serum half-life of tacrine
(Cognex) is short (2 to 4 hours),
requiring multiple doses daily.
b. Theserum half-life of donepezil
(Aricept) is 70 hours, requiring only
one dose daily.
c. Tolerance does not develop with
these drugs.

Contraindications
Cardiovascular disease
Hepatic disease.

Interactions include the following:

a. Bleeding risk is increased when used
with NSAIDs.
b. Theophylline toxicity may occur
when used concurrently with
theophylline preparations.
c. Use with cholinergic stimulants
potentiates the action of
anticholinesterase drugs.

Common side effects:

a. CNS effects, including dizziness and
headache
b. Gastrointestinal effects, including
nausea, vomiting, diarrhea and
anorexia.
c. Cardiovascular effects, including
bradycardia.
Serious side effects include
hepatotoxicity and gastrointestinal
bleeding.

E. NMDA receptor antagonist

Memantine (Axura) is a new Nmethyl-D-aspartate (NMDA) receptor
antagonist developed for the
treatment of moderate severe
Alzheimer's disease.

 It is act as a neuroprotective agent

by preventing release of glutamate, a
neurotransmitter thought to
contribute to neuronal degeneration
in Alzheimer's disease.
Dosing is initiated, with 5mg P.O.
daily and increased weekly until a
dose of 20 mg daily is reached.

Common side effects:

Constipation
a)Cough
b)Dizziness
c)Headache
d)Hypertension

VII. CARE OF THE CLIENT

REQUIRING SOMATIC THERAPY

ASSESSMENT
Review all data collected on the client
receiving somatic therapy, including:
a. Medical history and physical examination
b. Laboratory and diagnostic studies, including
complete blood count, blood chemistry study,
thyroid profile and liver and renal function
studies
c. Baseline ECG reading
d. Baseline vital signs
e. Medication and allergy history
f. Target symptoms for the specific medication
prescribed.

ASSESSMENT
Assess the client's and family's
knowledge about the prescribed
medicatio, including:
a)Expected beneficial effect and when
it is most likely to occur.
b)Dose frequency and instructions
regarding food and fluids
c)Minor side effects and the measures
taken to counteract them.

d. Major side effects and appropriate

action
e. Foods, beverages and other
medications that the patient should
avoid.

 Assess the client's and family's knowledge

regarding ECT therapy, including:
A. Expected beneficial effect and when
it is most likely to oocur.
B. Necessity for signing informed
consent.
C. Pretreatment routine:
- Maintaining NPO status at least 4
hours before treatment

a- Baseline vital signs

- Removal of jewelry, glasses, contact
lenses, and dentures
- Pretreatment medications used to
decrease secretions (atropine sulfate),
to induce light coma (methohexital),
-and to prevent musculoskeletal
complications from seizure activity
(succinylcholine)

Post treatment routine, which

includes:
- Frequent monitoring of vital signs
- Safety precautions (keeping bedside rails up,
consuming no food or fluid until gag reflex
returns)
- Reassurance and appropriate reorientation
for initial confusion following ECT.

Nursing Diagnosis
1. Analyze all available client data,
indicating any possible risk factors
while the client is receiving
medication or ECT.
2. Establish appropriate nursing
diagnosis, as needed:
Anxiety
Deficient knowledge (specify)
Health- seeking behaviors (specify)

 ineffective family therapeutic regimen

management
Readiness for enhanced management of
therapeutic regimen
Risk for injury

Planning and outcome Identification

1. Work with the client and family in
establishing realistic goals.
2. Establish desired outcome criteria for
the client receiving psychotropic
medications or ECT therapy.
. The client and family will verbalize
expected benefits from treatment.
. The client and family will safely selfadminister medications.

Planning and outcome

Identification
The client and family will use
appropriate measures to counteract
minor side effects.
The client and family will contact the
health care provider if major side
effects occur.
The client and family will follow
prescribed laboratory and the other
testing to monitor medications and
any side effects.

Implementation
1. Provide the client and family with
accurate information regarding
medications or ECT therapy, and
reinforce their understanding of all
procedures and safety precautions.
2. Monitor the clients for any side
effects of medications.
3. Take appropriate measure to
counteract any side effects the
client experiences.

Implementation
4. Monitor the client for improvement
of symptoms.
5. Monitor the clients vital signs, level
of consciousness, and presence of
gag reflex following ECT therapy.
6. Reorient the client after ECT
therapy.

Outcome Evaluation
1. The client experiences beneficial effects
from medication or ECT therapy.
2. The client safely self- administers
prescribed medications.
3. The client uses appropriate measures to
counteract minor side effects.
4. The client and family contact the health
care provider when any major side effects
are experienced.
5. The client complies with prescribed
laboratory and other testing to ensure
safety.