Psychopharmacology: Neurotransmitters and Antipsychotics overview

Psychopharmacology

  • neurotransmitter

serotonin - controls mood

  • low depression

  • high serotonin syndrome

epinephrine fight and flight response

  • low fatigue

  • high panic disorder

norepinephrine alertness

  • low depression

  • high anxiety ( PTSD )

dopamine rewards and movement

  • low Parkinson's disease

  • High schizophrenia

  • fast absorbing carbidopa

  • effect sinamet

Histamine wakefulness

  • low sedation

  • high anxiety

endorphin pain relief

  • low depression

  • high euphoria

PSYCHIATRIC DRUGS

4 A's and MS

  1. Antipsychotic

  1. antidepressants

1 and 2 Major

  1. anti-anxiety

  1. anti cholinergic

3 abd 4 Minor

SIDE EFFECTS

sympathetic nervous system like

  • except BP

MOOD STABILZER

STIMULANTS

ANTIPSYCHOTIC

Aka: neuroleptics

Indication- to treat psychosis ( - symptoms )

+ symptoms

  • Delusion

  • Hallucinations

  • Auditory Hallucinations most dangerous and common

  • echolalia

PRIMARY CONDITION

  1. Schizophrenia

  1. Mania

  1. Schizoaffective disorder

SECONDARY CONDITION

  1. Tourete syndrome mngmt. antipsychotic

  1. Autism ( low dose )

  1. Aggressive disorder

  1. Insomnia d makatulog ( Hypersomnia sobra sa tulog )

MOA: Block receptor of dopamine, decrease dopamine, increase acetylcholine, increase muscle contraction,EPS( extrapyramidal symptoms)

TYPES OF ANTIPSYCHOTIC

TYPICAL

  • Conventional type

  • to treat + symptoms of schizophrenia

  • high level EPS

ex. Haloperidol

Chlorpromazine

Serentyl

Trilafon

ATYPICAL

  • Unconventional type

  • to treat - symptoms with schizophrenia

  • low level EPS

ex. Olanzapine

Quentapine

Serindole

Clozaril

Paliperidone ( sustenna )

Risperidone ( Risperdal )

Aripipirazole ( Maintena )

Decanuate Fluprenazine ( prolixin )

Decanuate Haloperidol ( Haldol )

Olanzapine paniote ( Zyprexa )

EPS ADVERSE EFFECT

Agranulocytosis

  • Sudden fever ,malaise

  • Ulcerative Sore Throat

  • Leukopenia ( decrease WBC ) normal 4,500 - 11,000 mm³

  • decrease WBC below 4,500

  • specific with: clozapine / olanzapine

NURSING CONSIDERATIONS

  • Blood sample weekly for WBC count

  • decrease WBC - discontinue medication if WBC drops to 50% or less than 3,000

  • 10,000 WBC take meds ,if 7,000 WBC continue meds, if 5,000 WBC stop meds

  • 5,500 WBC give meds, if 4,200 WBC give meds, if 2,900 WBC stop meds

PRIORITY

  • Risk for Infection

-Reverse Isolation or Neutropenic

EPS

  1. Acute Dystonia

-spasm or stiffness in muscle group

Torticollis : neck

Opistothonus : back

Oculogyric : crisis eye( rolling up of eye )

DRUG OF CHOICE

  • Congentine (Benzopyrines)

  • Benadryl ( Diphenhydramine )

  1. Akathisia

-intense need to move

-Restless or Anxious

-Unable to sit still

  1. Akinesia

-muscle rigidity slow movement

  1. PseudoParkinson's

-parkinsonian symptoms

signs and symptoms

  • maslike appearance

  • shuffling or festinating gait

  • cogwheel rigidity and decrease arm swing

  • tremors: pill rolling or resting

  • bradycardia and drooling

  1. Tardive Dyskinesia

-syndrome with permanent involuntary movement

-Due to long term use with Antipsychotic (conventional)

  • location: face , neck upper and lower extremities+ tronchial rigidity

  • lip smacking and tongue protrusion

  1. Neuroleptic Malignant syndrome

-rigidity + high fever

-Autonomic instability

  • unstable BP

  • Diaphoresis

  • Elevation of enzymes

most fatal EPS

Drug of choice - anticholinergic

SIDE EFFECT

  1. increase blood prolactin

  1. Diminished libido

  1. increases appetite ( increase weight - obesity)

  1. photophobia - apply sunscreen and wear long sleeve

ANTIDOTE: Anticholinergic

common medication CABA

Congentine

Artane

Benadryl

Akitone